Iridociliary Body Metastasis of Atypical Carcinoid: Case Management with Intravitreal Anti-Vascular Endothelial Growth Factor Injections

We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had metastases to the iris and ciliary body, resulting in progressive vision loss in her left eye. Treatment was successful by intravitreal injections of anti-vascular endothelial growth factor.

Spectral Domain Optical Coherence Tomography of Vogt-Koyanagi-Harada Disease: Novel Findings and New Insights into the Pathogenesis

Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

Altered amplitude of low-frequency fluctuations and default mode network connectivity in high myopia:a resting-state fMRI study

AIM:To analyze changes in amplitude of low-frequency fluctuations(ALFFs)and default mode network(DMN)connectivity in the brain,using resting-state functional magnetic resonance imaging(rs-fMRI),in high myopia(HM)patients.METHODS:Eleven patients with HM(HM group)and 15 age-and sex-matched non-HM controls(non-HM group)were recruited.ALFFs were calculated and compared between HM group and non-HM group.Independent component analysis(ICA)was conducted to identify DMN,and comparisons between DMNs of two groups were performed.Region-of-interest(ROI)-based analysis was performed to explore functional connectivity(FC)between DMN regions.RESULTS:Significantly increased ALFFs in left inferior temporal gyrus(ITG),bilateral rectus gyrus(REC),bilateral middle temporal gyrus(MTG),left superior temporal gyrus(STG),and left angular gyrus(ANG)were detected in HM group compared with non-HM group(all P<0.01).HM group showed increased FC in the posterior cingulate gyrus(PCC)/precuneus(preCUN)and decreased FC in the left medial prefrontal cortex(mPFG)within DMN compared with nonHM group(all P<0.01).Compared with non-HM group,HM group showed higher FC between mPFG and bilateral middle frontal gyrus(MFG),ANG,and MTG(all P<0.01).In addition,HM patients showed higher FC between PCC/(preCUN)and the right cerebellum,superior frontal gyrus(SFG),left pre CUN,superior frontal gyrus(SFG),and medial orbital of the superior frontal gyrus(ORB supmed;all P<0.01).CONCLUSION:HM patients show different ALFFs and DMNs compared with non-HM subjects,which may imply the cognitive alterations related to HM.

Apnea caused by retrobulbar anesthesia: A case report

BACKGROUND Apnea caused by retrobulbar anesthesia is a very rare but severe complication during ophthalmic surgery.CASE SUMMARY We report a rare case of apnea caused by retrobulbar anesthesia,and emergency resuscitation was used.A 74-year-old female patient was diagnosed with rhegmatogenous retinal detachment in the right eye and planned to undergo vitrectomy under retrobulbar anesthesia.After the retrobulbar anesthesia in her right eye,she became unconscious and apneic.It was suggested that she had developed brainstem anesthesia.Assisted ventilation was initiated.Atropine 0.5 mg,epinephrine 1 mg,ephedrine 30 mg,and lipid emulsion were given.Five minutes later,her consciousness and breathing gradually returned,but with uncertain light perception in her right eye.Alprostadil 20μg was given,and after 2 h her visual acuity resumed to the preoperative level.CONCLUSION Brainstem anesthesia is a serious complication secondary to retrobulbar anesthesia.Medical staff should pay attention to the identification of brainstem anesthesia and be familiar with the emergency treatment for this complication.

Bilateral Macular Lesions Following Electrical Injury

HIGH-VOLTAGE electrical injuries can result in a variety of ocular complications.Cataract and macular edema are the most common injuries.1Other injuries include punctate keratopathy,uveitis,macular hole,subretinal macular haemorrhage,and choroidal atrophy.1-4 We report a case that optical coherence tomography(OCT)and multifocal electroretinogram(mf ERG)clearly demonstrated the

Systemic Lupus Erythematosus and Antiphospholipid Syndrome Related Retinal Vasculitis Mimicking Ocular Cysticercosis: a Case Report

MAKING accurate and timely diagnosis is often challenging when patients with a systemic disease first present with ocular manifestations.The possibility that vasculitis associated with systemic lupus erythematosus(SLE)and antiphospholipid syndrome(APS)can be misdiagnosed as cysticercosis has not been discussed in the literatures.