Purpose: To report an unusual case of retinitis caused by influenza virus. Case: A 30-year-old male claimed partial color blindness after recovery from influenza encephalitis. Visual acuity was 0.3 in the right eye and 0.03 in the left. An ophthalmoscopic fundus examination looked normal, but fluorescein angiography revealed granular hyperfluorescence with multiple dark circular lesions at the posterior pole of both eyes. Serological testing revealed an influenza A virus infection. With corticosteroid pulse therapy (3 days) followed by oral methyl prednisolone for 1 month, visual acuity gradually recovered. Over the following 2-year period, visual acuity has recovered to 1.2 in both eyes, but color sensation still remains impaired. Conclusions: Influenza encephalitis can cause visual loss due to retinitis at the posterior pole.
A 56-year-old male patient complaining of productive cough, hoarseness, and fatigue was found to have extensive disease of small cell lung cancer (ED-SCLC), with staging of cT4N3M1(PUL). He was treated with chemotherapy. While undergoing treatment with chemotherapy, he complained of a right visual disturbance, and choroidal metastasis was diagnosed. Because the primary site responded well to chemotherapy alone and the visual disturbance did not worsen, the patient refused radiotherapy to the choroidal metastasis. Two months after the first diagnosis of the choroidal metastasis, while he was receiving the first treatment regimen for SCLC, the visual disturbance suddenly worsened; emergent radiotherapy was started, with a total dose of 40 Gy, given as 2.0 Gy/fraction per day. The visual disturbance never improved, and the patient lost 80% of his right visual field. Within 6 months of diagnosis, the patient became blind in his right eye. The patient died of septic shock related to treatment received during his third chemotherapy regimen. Choroidal metastasis is very rare with extraocular malignant tumors, though it is common with intraocular malignant tumors. Choroidal metastasis secondary to SCLC has a poor prognosis, but in order to maintain quality of life during the patients' remaining lifespan, aggressive treatment would appear appropriate for these patients, because SCLC is a chemo-sensitive cancer.
We describe the intraocular lens (IOL) roll-up technique, which uses lens forceps to insert 3 types of foldable polyacrylic IOLs with optic diameters of 6.0 mm through small sclerocorneal incisions comparable to those used by injector systems.
Since the development of the 25-gauge transconjunctival sutureless vitrectomy system in 2002 by Fujii et al, 1 several authors have described the usefulness of this system and examined the possibility of using this system to treat vitreoretinal diseases. Because of this and the various advantages of this system, the number of operations performed using this system has significantly increased worldwide. 2-4 This system also has been reported to decrease surgical time, reduce conjunctival and scleral damage, and minimize postoperative inflammation. 2-4 The 25-gauge sutureless system does have some disadvantages. Instability of the infusion cannulas is a major intraoperative problem. 5 Unlike the infusion cannulas of the conventional 20-gauge suture system, those of the 25-gauge sutureless system are simply inserted into microcannulas. These microcannulas are not stable enough to prevent movements of the infusion cannulas because the former are held by a relatively small collar located extraocularly. Consequently, the infusion cannulas incline with even minor disturbances like an unintentional touch with a finger, scleral distortion, movement of the eye, and pressure of the eyelid. Uncontrolled inclinations of the infusion cannulas increase the possibility of damage to the retina and lens and may even lead to choroidal detachment or collapse of the eyeballs as a result of falling off. These drawbacks are significant especially in the case of operations of the peripheral vitreous (e.g., treatment of rhegmatogenous retinal detachment) that involve conventional prism contact lenses because these operations require frequent tilting and compression of the eyeballs without wide-angle viewing systems. Therefore, surgeons are required to constantly monitor the positions of the infusion cannulas and this may decrease the efficiency of the surgery.To overcome these problems, we devised a small silicone ring and transected it, as shown in Figure 1. The ring measured 1.78 mm in height with an inner/ outer diameter of 1.78/5.34 mm. We placed the ring around the microcannula in which an infusion cannula was inserted during 25-gauge transconjunctival sutureless vitrectomy. Installation and removal of the ring were very easy because the ring was transected (Figure 2).After the ring was in place, movements of the infusion cannula were remarkably reduced because the ring acted as a collar that prevented unintentional inclinations ( Figure 3). Furthermore, infusion cannulas and microcannulas did not fall off as often as was evident from the results of our case series. Interfering powers (caused by touch with a finger, scleral distortion, etc.) were usually horizontal to the eyeball, not vertical. Therefore, they did not make them fall off unless the microcannulas were inclined. Consequently, All authors have directly participated in the development of the device mentioned in the article and have approved the final version of the submitted manuscript.None of the authors have a financial interest in any product mentioned.
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