Cases reported "Vision Disorders"

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11/50. Subfoveal choroidal neovascularization in a patient with pre-existing pseudomacular hole.

    PURPOSE: To report concomitant use of fluorescein angiography (FA) and optical coherence tomography (OCT) in a case of pre-existing pseudomacular hole (PMH) and macular choroidal neovascularization (CNV) treated with photodynamic therapy (PDT). methods: Case report. RESULTS: A 63-year-old man who received laser treatment for branch retinal vein occlusion in 1993 developed an asymptomatic macular epiretinal membrane 2 years later. In 2001, the patient complained of metamorphopsia. Biomicroscopy showed a PMH, confirmed by OCT. One year later, metamorphopsia suddenly increased and visual acuity dropped from 20/20 to 20/70. FA and OCT revealed subfoveal occult CNV PDT was successfully performed. FA and OCT were essential diagnostic tools during the follow-up. CONCLUSIONS: The case presented stresses the importance of different tools for accurate diagnosis and proper follow-up of macular diseases.
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ranking = 1
keywords = epiretinal membrane, epiretinal, membrane
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12/50. Visual loss associated with pseudoxanthoma elasticum.

    An 18-year-old woman with pseudoxanthoma elasticum had sudden profound bilateral visual loss, presumably as a result of optic nerve infarction caused by anemia and hypotension from massive gastrointestinal bleeding. Her central visual acuity largely recovered in her right eye, but her left eye had only hand motions acuity. During the subsequent 24 years, she underwent three separate surgical procedures for gastrointestinal bleeding. Abdominal arterial angiography showed numerous aneurysms of the gastric arteries. A subtotal gastrectomy was done, and histopathologic examination found advanced degenerative changes of the elastic lamina of the gastric arteries. At age 42 years, the patient lost residual vision in her right eye. This was caused by an extrafoveal subretinal choroidal neovascular membrane, which was obliterated with laser photocoagulation. Degeneration of elastic tissue, the primary defect in this syndrome, may cause cardiovascular complications and formation of breaks in the bruch membrane, which are visible as angioid streaks. Ingrowth of fibrovascular tissue through angioid streaks may cause disturbances of macular function. The optic nerve ischemia and infarction associated with the profound visual loss in this patient reminds the ophthalmologist of the systemic nature of this disorder and the possibility that systemic vascular complications with massive blood loss may occur.
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ranking = 0.003522328881283
keywords = membrane
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13/50. Corneal epithelial basement membrane dystrophy: an overlooked cause of painless visual disturbances.

    Although decreased vision from corneal epithelial basement membrane dystrophy (CEBMD) usually is associated with pain from corneal epithelial erosion, it may be an overlooked cause of painless, sometimes sudden, visual disturbance. We report a series of eight patients referred to our department with visual deficits for whom various diagnoses had been made. A total of 15 neurologic and ophthalmologic tests had been ordered before their referral. All patients had CEBMD as a cause for their visual deficit. Retroillumination through a dilated pupil and examination of the fluorescein tear film were the best methods to demonstrate the CEBMD. Six of the eight patients underwent epithelial debridement with complete resolution of their symptoms. We recommend that all patients with unexplained visual disturbances be examined closely for CEBMD.
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ranking = 0.0088058222032076
keywords = membrane
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14/50. Ruptured internal limiting membrane associated with blunt trauma revealed by indocyanine green staining.

    PURPOSE: Description of cases of traumatic macular hole that appeared concomitant with a ruptured internal limiting membrane (ILM) that was apparent during vitrectomy only after staining with indocyanine green (ICG). methods: vitrectomy with ILM peeling was performed on a 20-year-old man and a 13-year-old boy for treatment of traumatic macular holes. RESULTS: During vitrectomy, the ILM was found to be ruptured along the area of an identified macular hole only after ICG staining. After the vitrectomy, the macular holes were closed and visual acuity improved. However, visual field defect associated with apparent inner-layer retinal damage remained. CONCLUSION: Blunt trauma can cause severe inner-layer retinal damage with rupture of the ILM as well as frank macular hole formation and choroidal rupture.
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ranking = 0.0088058222032076
keywords = membrane
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15/50. Spontaneous separation of epiretinal membrane in young subjects: personal observations and review of the literature.

    BACKGROUND: Idiopathic epiretinal membranes (ERM) grow on the surface of the internal limiting membrane (ILM) and are a very uncommon condition in young subjects. methods: We report six young subjects with ERM and describe the spontaneous separation of the membranes. The functional and anatomical recovery was assessed by Snellen visual acuity, Amsler grid and funduscopy. Selected cases were additionally assessed by optical coherence tomography (OCT). RESULTS: All subjects initially claimed a sudden, unilateral, reduction in visual acuity (VA) with severe distortion at the age of 15-30 years. No ocular trauma or disease was ascertained in any case. Initial fundus examination demonstrated a gray-whitish ERM with translucent stress lines over the macula. Visual recovery occurred in all cases after resolution of the ERM. Sequential OCT demonstrated the successive peeling of an ERM accompanied by normalization of foveal thickness. CONCLUSIONS: Young subjects should be counseled about the favorable prognosis for maintaining good vision and possible spontaneous membrane separation. Conservative observation is advocated if the visual disturbance is located temporally, as functional recovery and spontaneous membrane separation may occur. When the contracting forces of the immature ERM are stronger than its adhesions to the retina, the membrane may separate spontaneously.
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ranking = 5.0088058222032
keywords = epiretinal membrane, epiretinal, membrane
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16/50. Congenital pupillary-iris-lens membrane with goniodysgenesis.

    BACKGROUND: A unilateral congenital pupil-iris-lens membrane with goniodysgenesis syndrome, not benign tunica vasculosa lentis, was first described by Cibis et al. One of three cases developed angle closure. Robb described catastrophic vision loss from angle closure in one of his seven cases. methods: We did a retrospective review of previously unreported cases of pupil-iris-lens membrane with goniodysgenesis seen in our practices. RESULTS: We report the clinical spectrum of a further nine cases, three of which needed surgery for angle closure, two of which needed surgery for clearing the visual axis. CONCLUSION: Congenital pupil-iris-lens membrane with goniodysgenesis is a unilateral membrane clearly differentiated from benign persistent tunica vasculosa lentis tissue. The membrane represents ectopic iris on the lens with abnormal iris stroma and chamber angle from aberrant induction, migration, or regression of neural crest cells. The membrane can be progressive. Catastrophic vision loss from angle closure can occur and may be controlled with surgery. Surgery may be needed to open the visual axis even when glaucoma is not present and may prevent angle closure.
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ranking = 0.017611644406415
keywords = membrane
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17/50. Tomographic and multifocal electroretinographic features of idiopathic epimacular membranes.

    OBJECTIVE: To determine the relationship between the tomographic and electrophysiologic characteristics of the retina with an idiopathic epimacular membrane. methods: Sixty patients with unilateral idiopathic epimacular membranes underwent optical coherence tomography and multifocal electroretinography (mfERG). The mfERGs were elicited by a pseudorandom m-sequence stimulus with 37 hexagonal elements, and the mfERGs in area 1 (central 4.1 degrees ), area 2 (ring from 4.10 degrees -7.15 degrees ), and area 3 (ring from 7.15 degrees -13.75 degrees ) were compared with the tomographic features of the corresponding area. The data from the normal fellow eyes served as control. MAIN OUTCOME MEASURES: The retinal thickness, amplitudes, and implicit time of the mfERG. RESULTS: On optical coherence tomographs, the retina was thickest in area 1, followed by area 2 with low tissue reflectivity of the outer retina, and area 3 was of normal thickness. electroretinography showed the amplitude ratio (affected vs fellow eyes) of mfERGs from areas 1, 2, and 3 was significantly lower than that of the controls (P<.01), and the implicit times were significantly delayed (P<.01). The amplitude ratio was reduced the most in area 1, and the implicit time was delayed the most in area 3. The foveal thickness was negatively correlated with visual acuity (rho = -0.46; P<.001). The mfERG amplitude in area 1 was not significantly correlated with the visual acuity. CONCLUSIONS: It is likely that retinal thickness is correlated with neural dysfunction, but mfERGs demonstrated various physiological changes in the retina.
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ranking = 0.010566986643849
keywords = membrane
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18/50. optic atrophy and macular degeneration as initial presentations of subacute sclerosing panencephalitis.

    PURPOSE: To report a case of subacute sclerosing panencephalitis in which the initial clinical presentations were optic atrophy and macular degeneration. DESIGN: Observational case report. methods: A 9-year-old boy with visual loss attributable to optic atrophy and macular degeneration had a diagnostic examination. RESULTS: The visual acuity levels of both eyes were light perception at presentation. Fundus examination revealed bilateral optic atrophy and macular degenerative changes including retinal pigment epithelial atrophy, macular scarring, and epiretinal membrane formation. The antimeasles IgG titers were high both in serum and cerebrospinal fluid samples. Neurologic symptoms of myoclonus, ataxia, motor, and mental disabilities occurred 4 months after the onset of first visual disturbances and 2 weeks after the patient applied to our clinic. CONCLUSION: Children with optic atrophy and macular degenerative lesions should be examined for sclerosing panencephalitis, even if the classical neurologic symptoms of this disease are not present.
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ranking = 1
keywords = epiretinal membrane, epiretinal, membrane
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19/50. Cultivated corneal epithelial transplantation for severe ocular surface disease in vernal keratoconjunctivitis.

    PURPOSE: To report cultivated epithelial transplantation in 2 patients with vernal keratoconjunctivitis (VKC) with severe ocular surface disease. methods: Two patients initially diagnosed with burnt-out VKC presented with bilateral photophobia, decreased vision, and corneal neovascularization. The first patient underwent living-related conjunctival-limbal allograft in the left eye and cultivated limbal epithelial cell allotransplant in the right. The second patient underwent unsuccessful amniotic membrane transplantation (AMT) followed by autologous cultivated limbal epithelial cell transplantation in the worse eye. RESULTS: Both patients had onset of VKC in the first decade. Surgical intervention in both led to marked amelioration in symptoms and improvement in vision. In patient 1, vision improved from 20/800 (both eyes) to 20/30 in the right and 20/100 in the left eye at a follow-up of 34 months. In patient 2, it improved from 20/400 to 20/50 after the second procedure, 25 months postoperatively. Histopathology of the excised pannus revealed fibrosis and mononuclear cell infiltrates in all 3 eyes. CONCLUSIONS: Severe ocular surface disease may occur in persistent VKC, leading to marked visual loss. AMT alone may be insufficient to restore the ocular surface, and limbal epithelial cell transplantation is warranted.
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ranking = 0.0017611644406415
keywords = membrane
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20/50. Retinal contraction and metamorphopsia scores in eyes with idiopathic epiretinal membrane.

    PURPOSE: Using M-charts (Inami Co., tokyo, japan), which were developed by the authors to measure metamorphopsia, and image-analysis software, which was developed to quantify retinal contraction, the authors investigated the relationship between the degree of retinal contraction and the degree of metamorphopsia in eyes with idiopathic epiretinal membrane (ERM). methods: This study was conducted in 29 eyes with ERM (29 patients, 20 women; mean age, 62.1 /- 8.6 years) observed for at least 3 years (mean, 3.55 /- 0.6 years) after diagnosis. Horizontal (MH) and vertical (MV) metamorphopsia scores were obtained with the M-charts. Horizontal and vertical retinal contraction due to ERM was measured by using image-analysis software developed by the authors to calculate horizontal and vertical components of changes in the locations of retinal vessels on sequential fundus images. RESULTS: There was a significant (P < 0.01) positive correlation between the degree of retinal contraction and metamorphopsia score. In addition, there were significant positive correlations between horizontal contraction of the retina and the MV score (P < 0.01) and between vertical contraction of the retina and the MH score (P < 0.05). No significant correlations were found between change in the metamorphopsia score and change in visual acuity or mean defect. CONCLUSIONS: Metamorphopsia scores correlate well with measurements of retinal contraction due to idiopathic ERM. Using M-charts is a simple and useful method for quantitatively monitoring metamorphopsia in patients with ERM.
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ranking = 1.6752444994687
keywords = epiretinal membrane, epiretinal, membrane
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