SIGNIFICANCE Although rare, vitamin A retinopathy should be considered by the clinicians in their differentials for conditions that can lead to nyctalopia, especially in those patients who have undergone bariatric surgery. Patients must be educated on this potential delayed adverse effect of the surgery and possible lifelong vitamin A supplementation. PURPOSE The purpose of this study was to report a rare case of delayed vitamin A retinopathy that occurred because of vitamin A malabsorption secondary to bariatric surgery. CASE REPORT A 55-year-old woman presented with nyctalopia and dark adaptation problems. The patient had a history of gastric bypass surgery 22 years earlier. Fundus examination revealed a large number of small white dots in the midperiphery of both eyes. Electrophysiology testing revealed flat-lined scotopic responses. Vitamin A levels were found to be severely reduced. Subsequent vitamin A supplementation resulted in the reversal of all signs and symptoms. CONCLUSIONS This case report demonstrates the importance of considering vitamin A deficiency in patients who present with symptoms of nyctalopia with a history of bariatric surgery. Clinicians should be aware of a possible delayed onset and refer for appropriate testing and treatment, as vitamin A retinopathy has been shown to be reversible. Because other conditions can present with nyctalopia and retinal white spots, clinicians also need to consider the appropriate differential diagnoses. Lifelong monitoring is indicated because reoccurrences have been reported.
Necrotising retinopathies can be visually devastating. Most often associated with the viral family Herpesviridae and seen in both immune-competent and immunocompromised hosts, possible complications of necrotising retinopathies include progressive retinal necrosis with or without macular involvement, optic neuropathy and ultimately, secondary retinal detachment. Examples include progressive outer retinal necrosis, acute retinal necrosis and cytomegaloviral retinitis. If diagnosed early and treated aggressively, visual complications can be prevented; however, there is no current consensus on the most appropriate antiviral regimen for each of the different varieties of necrotising herpetic retinopathy. This paper reviews aspects of varieties of necrotising herpetic retinopathy, including pathophysiology, treatment and diagnostic testing.
Purpose: Laser pointer retinopathy is a condition increasing in prevalence due to poor education of proper laser use at the childhood/teenage level and poor awareness of risks and complications of laser pointers among the adult population. Eye care physicians can serve as an important bridge among these populations to help increase awareness and promote and educate patients on the potentially damaging retinal effects associated with laser pointer viewing/exposure. Pathophysiology, signs and symptoms, multimodal imaging interpretation, and treatment management options of laser pointer retinopathy are reviewed through a case study. Background: A 19-year-old male presented to the eye clinic without any ocular or visual complaints for a routine eye examination. Fundus examination revealed yellow subfoveal scarring in the left eye and corresponding damage to the foveal ellipsoid zone on optical coherence tomography imaging. Amsler grid findings further confirmed metamorphopsia that was present only in the left eye. Further questioning determined the foveal damage to be laser pointer retinopathy secondary to extended laser pointer viewing. Conclusions: Laser pointer retinopathy is an increasingly prevalent retinal finding in younger populations. In most cases vision loss slowly improves with time, but the retinal damage has often been reported to be irreversible. Considering this information, it is imperative for optometrists to educate school staff, parents and children of the permanent ocular damage that can occur with laser pointer viewing and promote safe practices. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/laser-pointer-retinopathy-a-case-report-and-review)
The etiology and pathogenesis of MEWDS remain unknown; fortunately, the natural course of the disease is favorable because almost all patients retain a good outcome without the need for treatment. This case highlights the importance of considering MEWDS and other white dot syndromes in the differential diagnosis of patients who present with a history of photopsia. Because many clinical findings are absent or very subtle when patients present, the clinician should consider supplemental testing such as spectral domain optical coherence tomography and fundus autofluorescence in aiding in the diagnosis.
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