干扰素相关性眼病

干扰素具有抑制病毒复制、免疫调节及抗肿瘤等多种效应,目前各种类型的干扰素在临床上广泛用于多种疾病的治疗。干扰素相关性眼病是干扰素治疗过程中出现相对少见的一种副作用,临床表现形式多样,包括干扰素相关性视网膜病变、干扰素相关性视神经病变和非典型眼部病变。其中干扰素相关性视网膜病变最常见,眼底表现为视乳头旁或后极部视网膜散在点状白色棉絮斑和/或点片状出血,大部分患者无症状,可不予特殊处理,病变即可消失自愈。但少数干扰素相关性眼病较重的患者,如出现前部缺血性视神经病变、视网膜血管阻塞、黄斑水肿、Vogt-小柳-原田综合征等,患者可出现不可逆性视功能损害,此时应终止干扰素治疗,并积极给予相应的治疗措施,如全身糖皮质激素治疗、抗血管内皮成长因子药物玻璃体内注射以及眼底激光等。详细询问病史,及时发现高危因素如患有高血压病、糖尿病、糖尿病视网膜病变或有Vogt-小柳-原田综合征史等,定期眼底检查,有助于本病的早期诊治。     

Clonazepam associated retinopathy

PURPOSE: To report a case of retinopathy associated with the longterm intake of the antiepileptic drug clonazepam. METHODS: Case report. RESULTS: A 36-year-old woman, with a history of long-term use of the antiepileptic drug clonazepam developed subtle visual disturbances. Funduscopy revealed areas of mild depigmentation of the retinal pigment epithelium throughout the posterior pole bilaterally corresponding to transmission hyperfluorescence on fluorescein angiography. There was no history of any inherited retinal degenerative disease and no other known agent responsible for retinal toxicity had been used. CONCLUSIONS: The longstanding intake of the antiepileptic drug clonazepam may be associated with the development of toxic retinopathy.     

Interferon alpha-associated retinopathy in patients with chronic hepatitis C

BACKGROUND: Interferons are a complex group of glycoproteins with antiviral, antiproliferative and immunomodulatory activity. They are used to treat different types of human neoplasms and chronic hepatitis C. Several case reports have described interferon-induced ocular side effects since the first case in 1990. PATIENT AND METHODS: We report about a 61-year-old female undergoing interferon 2alpha treatment who developed bilateral retinopathy during systemic therapy and provide a summary about ocular side effects and their consequences. CONCLUSIONS: Patients should be monitored by ophthalmologists before, during and after interferon therapy in order to avoid side effects like retinal neovascularisation and to prevent potential serious side effects.     

Interferon beta-1b retinopathy during a treatment for multiple sclerosis

Ocular adverse effects of interferon are described during the treatment of malignant diseases and chronic viral hepatitis with interferon alpha. At this time, there is no report of these effects during multiple sclerosis treatment with interferon beta-1b. The authors report a bilateral retinopathy during this treatment. The production of neutralizing antibodies during interferon beta-1b treatment leads to a decrease in diminution of therapeutic efficacy. When treatment failure occurs, neutralizing antibodies are to be tested.     

Cryoglobulinemia associated with Purtscher-like retinopathy

PURPOSE: To report a case of Purtscher-like retinopathy in a young man with chronic hepatitis C--associated cryoglobulinemia. METHODS: Case report. RESULTS: A 44-year-old Caucasian man with chronic hepatitis C developed sudden loss of vision in the left eye and abdominal pain. Ocular fundus examination revealed peripapillary cotton-wool spots and superficial retinal whitening in the macula. Systemic evaluation revealed markedly elevated rheumatoid factor, hypertension, and acute renal insufficiency. A renal biopsy demonstrated intravascular deposition of immunoglobulins IgG and IgM and complement consistent with type II mixed cryoglobulinemia. CONCLUSION: Clinicians should consider cryoglobulinemia in the differential diagnosis of a patient with Purtscher-like retinopathy and history of infection with hepatitis C.     

Vaso-occlusive retinopathy associated with antiphospholipid antibodies (lupus anticoagulant retinopathy)

The authors observed three cases (6 eyes) of vaso-occlusive retinopathy associated with the lupus anticoagulant and the related antiphospholipid antibody anticardiolipin. The disease occurred in patients who had no definable autoimmune disease such as systemic lupus erythematosus (SLE) and was characterized by severe bilateral retinal vascular occlusion. There was profound visual loss from intraretinal ischemia as well as vitreous hemorrhage from preretinal neovascularization. Results of laboratory testing showed a prolonged partial thromboplastin time (PTT) in two patients, and the presence of the lupus anticoagulant in all. Treatment with panretinal photocoagulation appeared to stabilize the neovascularization. The role of systemic anticoagulation and immunosuppressive therapy is uncertain.     

Choroidal neovascularization associated with cancer‐associated retinopathy

Purpose: To report an unusual association between cancer‐associated retinopathy (CAR) associated with invasive thymoma and choriodal neovascularization (CNV), treated by photodynamic theraphy (PDT). Methods: A 39‐year‐old man affected with thymoma and paraneoplastic syndrome (myasthenia gravis and diarrhoea) was observed between October 1997 and September 2007. The patient developed progressive visual dysfunction including bilateral visual acuity loss and concentric constriction of visual fields. Ophthalmological, immunological and systemic examinations were performed. Immunological evaluations included an assessment of antibody activity by indirect immunohistochemistry on sectioned rhesus monkey eye, and Western blot reactions upon an extract of pig retina. Results: Fundus ophthalmoscopy and fluorescein angiography revealed retinal vessel attenuation and retinal pigment epithelium degeneration. Electroretinogram suggested both rod and cone dysfunction. Indirect immunohistochemistry identified antibody activity within the photoreceptor outer segments. Western blots on the retina revealed that most of the patient’s antibody activity was focused upon a retinal protein antigen approximating 145 kD. These findings share the commonalities of size and retinal distribution of the interphotoreceptor retinoid‐binding protein (IRBP), a recognized autoantigen. The surgically resected mediastinal tumour was diagnosed as invasive thymoma. No other malignancy has since been found throughout nearly 10 years of follow‐up. In March 2006, the patient developed a subfoveal CNV in his left eye, which was treated by PDT. Conclusion: We describe the third case of paraneoplastic retinopathy associated with invasive thymoma. This is the first example of CAR involving autoantibodies reactive with a retinal protein having the characteristics of the IRBP, and is also the first complicated by CNV treated by PDT.     

Neovascular maculopathy associated with rubella retinopathy

BACKGROUND: We report three eyes of two patients with rubella retinopathy which were associated with choroidal neovascularization in the macula. CASES: A 7-year-old girl (case 1) and a 12-year-old girl (case 2) whose mothers had suffered rubella during their pregnancy revealed typical rubella retinopathy in both eyes and neovascular maculopathy in one eye at their initial visit to our clinic. Neovascular maculopathy developed in another eye of case 1 after a follow-up of 10 months. RESULTS: The clinical characteristics indicated that 1. sudden visual loss occurs in children, 2. there is no external trigger such as eye injury, and 3. the visual prognosis appears relatively good. CONCLUSION: Although neovascular maculopathy is rare in pediatric disease, the rubella retinopathy may have the potential to cause neovascular maculopathy.     

Cancer-associated retinopathy associated with invasive thymoma

PURPOSE: To report a case of cancer-associated retinopathy associated with invasive thymoma. DESIGN: Interventional case report. METHOD: A 41-year-old Japanese woman was observed between February 1998 and May 2001. Ophthalmologic examinations and systemic examinations were performed. The patient received treatment including corticosteroid pulse therapy, plasmapheresis, and thymectomy. RESULTS: The patient developed progressive visual dysfunction including bilateral visual acuity loss, concentric contraction of visual fields, and color vision loss. In both eyes, retinal vessel attenuation and retinal pigment epithelium degeneration were observed with fundus ophthalmoscopy and fluorescein angiography. Response in electroretinogram was reduced, suggesting both rod and cone dysfunction. Autoantibody against 23-kD cancer-associated retinopathy (CAR) antigen (antirecoverin antibody) was detected in the patient's serum. A mediastinal tumor that was histopathologically diagnosed as invasive thymoma was detected and was surgically resected. During more than 3 years of follow-up, no other malignancy was detected despite extensive systemic evaluation. The patient also suffered from subclinical myasthenia gravis. Although temporary improvement of visual function was observed after treatment with steroid pulse therapy and plasmapheresis' light perception of each eye was lost in the end. CONCLUSIONS: The patient was diagnosed as having CAR. Invasive thymoma was considered to be the causative tumor because there had been no evidence that suggested other systemic malignancy during more than 3 years of follow-up.     

Purtscher-like retinopathy associated with pancreatic adenocarcinoma

PURPOSE: To investigate a case of Purtscher-like retinopathy that occurred in association with pancreatic adenocarcinoma. METHOD: Case report. RESULTS: A 63-year-old woman presented with multiple gray patches in the central vision of both eyes. Visual acuity was 20/20 in both eyes. Funduscopy showed large peripapillary yellow-white patches within the superficial retina and small superficial retinal hemorrhages in both eyes. The patient subsequently had abdominal pain. Computed tomography of the abdomen demonstrated a large pancreatic mass with extension into the liver. Histologic examination of a percutaneous needle biopsy specimen showed mucinous pancreatic adenocarcinoma. CONCLUSION: Pancreatic adenocarcinoma should be added to the list of systemic diseases that can be associated with Purtscher-like retinopathy.     

Proliferative retinopathy associated with incontinentia pigmenti

An 8-year-old white female presented with retinal vascular changes of fibrovascular proliferation and avascularity of the peripheral retina that suggested a diagnosis of incontinentia pigmenti. These findings prompted a systemic evaluation, and the features of this disease were confirmed, including a history of recurring vesicles on the lower extremities of her sister in infancy. Associated systemic findings in the patient included alopecia, apigmented skin lesions, conical teeth, and a confirmatory biopsy. This case illustrates that a clinical recognition of eye findings can be of assistance in correctly diagnosing such forme fruste cases.     

Melanoma-associated retinopathy associated with intranasal melanoma

Purpose  

To present a case of melanoma-associated retinopathy (MAR) associated with an intranasal melanoma.     

Macular fibrosis associated with talc retinopathy

PURPOSE: To investigate a patient with talc retinopathy who developed macular fibrosis with resultant visual loss. METHODS: A 64-year-old intravenous drug abuser was evaluated for bilateral peripheral retinal neovascularization. He admitted to abusing oral methylphenidate intravenously. Funduscopy showed numerous intravascular talc particles in the macular area of both eyes. Over a period of next 4 years, visually significant macular fibrosis gradually developed in both eyes, the left eye more than the right eye. RESULTS: Fluorescein angiography confirmed the presence of bilateral peripheral retinal neovascularization with adjacent areas of ischemic retina. The patient was treated with peripheral laser treatment to the ischemic retina with resultant regression of peripheral retinal neovascularization. Bilateral macular fibrosis accounted for the reduced vision in our patient. CONCLUSION: Talc retinopathy can be associated with macular fibrosis with resultant visual loss.     

Myopia associated with retinopathy of prematurity

A complete analysis of the components of refractive error was performed on ten eyes of five patients with myopia and retinopathy of prematurity (ROP). In comparison to an age-matched control group, these eyes exhibited both lenticular and axial myopia. Only the high crystalline lens powers, which ranged from 22.20 to 44.13 diopters (D) (mean value, 31.27 D), were found to be statistically significant. In two patients, only one eye had high myopia. The lens power in these eyes was approximately 11 D more powerful than the lens of the fellow eye. Further investigation into the ocular changes induced by prematurity and abnormal oxygen metabolism is needed to determine the reason for the high degree of lenticular myopia.     

Valsalva retinopathy associated with fiberoptic gastroenteroscopy

CASE REPORT: A 45-year-old woman presented with a sudden loss of vision in her left eye, which occurred while she was having a routine upper fiberoptic gastroenteroscopy. According to the gastrointestinal specialist, the patient had performed multiple sustained Valsalva maneuvers during the procedure. Funduscopy showed a preretinal hemorrhage with a half disc diameter in the fovea of the left eye. COMMENTS: A diagnosis of Valsalva retinopathy was made on the basis of history and fundus finding. The hemorrhage resolved within 2 months without any sequelae. To our knowledge, this is the first report of the occurrence of Valsalva retinopathy following a routine upper fiberoptic gastroenteroscopy.