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  • 1
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    Online Resource
    Case Report: Nutritional and Toxic Optic Neuropathy: A Diagnostic Dilemma
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Optometry and Vision Science Vol. 97, No. 7 ( 2020-7), p. 477-481
    Details
    In: Optometry and Vision Science, Ovid Technologies (Wolters Kluwer Health), Vol. 97, No. 7 ( 2020-7), p. 477-481
    Abstract: Nutritional and toxic optic neuropathies are rare disorders characterized by visual impairment due to optic nerve damage by a toxin, usually with coexisting nutritional deficiencies. Its pathophysiology is still unclear, and multiple mechanisms implicated act synergistically to bring about this condition. The decline in its incidence and its confusing clinical appearance make diagnosing nutritional and toxic optic neuropathies challenging. PURPOSE This is an observational clinical case report of an atypical clinical case of a nutritional and toxic optic neuropathy with a subacute presentation and papilledema at the time of diagnosis. The patient provided written informed consent for medical information and images to be published. CASE REPORT A 47-year-old man presented with progressive, painless bilateral decrease in central vision over 15 days. The patient had a long-standing history of alcohol abuse and was a heavy smoker. The examination revealed dyschromatopsia, 20/400 visual acuity on both eyes, and no relative afferent pupillary defect. Funduscopy revealed bilateral papilledema. A visual field test showed generalized depression with centrocecal involvement in the left eye. Laboratory studies evidenced decreased vitamin B 12 /B 1 and red blood cell folate levels, increased acute phase reactants, hypertransaminasemia, and macrocytic anemia. Serologies and methanol in urine were negative. After the discontinuation of tobacco use and alcohol accompanied by vitamin supplementation, our patient's visual field, visual acuity, and papilledema improved remarkably. After 5 months, visual acuity and funduscopy were normal. CONCLUSIONS Although some hallmark signs were visible in this case, its subacute presentation and the presence of papilledema at diagnosis caused some diagnostic uncertainty. Nutritional and toxic optic neuropathy is a rare and challenging diagnosis because of a lack of biomarkers. Eye care clinicians should consider nutritional and toxic optic neuropathies to prevent severe and irreversible visual damage resulting from underdiagnosis and mismanagement.
    Type of Medium: Online Resource
    ISSN: 1538-9235 , 1040-5488
    URL: Article
    DOI: 10.1097/OPX.0000000000001531
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2083924-8
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  • 2
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    Case Report: Tapioca Iris Melanoma: An Uncommon Presentation of an Uncommon Tumor
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Optometry and Vision Science Vol. 97, No. 11 ( 2020-11), p. 1005-1009
    Details
    In: Optometry and Vision Science, Ovid Technologies (Wolters Kluwer Health), Vol. 97, No. 11 ( 2020-11), p. 1005-1009
    Abstract: Iris tumors are rare conditions, and there is a relative paucity of recent published data on its broad clinical spectrum. Tapioca iris melanoma is a rarer yet devastating form with wide and challenging differential diagnoses because of its amelanotic nodular appearance. PURPOSE This study aimed to report the challenging presentation of an uncommon iris melanoma, describing the clinical and histological findings and comparing them with the existing published data. CASE REPORT An uncommon clinicopathological report on the tumor unusual localization, patient age, absence of elevated IOP and heterochromia, and negative S-100 stain that caused diagnostic uncertainty is presented. The patient remains free of metastatic disease 7 years after a complete tumor full-thickness excision. CONCLUSIONS Tapioca iris melanomas are uncommon tumors with a presentation/surgical management that differs from other malignant tumors. Ophthalmologists should consider it among the vast differential diagnoses when observing amelanotic lesions, even without the hallmark signs being evident.
    Type of Medium: Online Resource
    ISSN: 1538-9235 , 1040-5488
    URL: Article
    DOI: 10.1097/OPX.0000000000001596
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2083924-8
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  • 3
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    Online Resource
    Two-Year Results of a Treat and Extend Regimen with Aflibercept in Caucasian Patients with Pachychoroid Neovasculopathy
    Informa UK Limited ; 2023
    In:  Seminars in Ophthalmology Vol. 38, No. 4 ( 2023-05-19), p. 352-357
    Details
    In: Seminars in Ophthalmology, Informa UK Limited, Vol. 38, No. 4 ( 2023-05-19), p. 352-357
    Type of Medium: Online Resource
    ISSN: 0882-0538 , 1744-5205
    URL: Article
    DOI: 10.1080/08820538.2023.2194983
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2023
    detail.hit.zdb_id: 2083932-7
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  • 4
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    Online Resource
    An objective scatter index cutoff point as a powerful objective criterion for preoperative nuclear cataract decision-making based on ROC analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Cataract and Refractive Surgery Vol. 45, No. 10 ( 2019-10), p. 1452-1457
    Details
    In: Journal of Cataract and Refractive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 10 ( 2019-10), p. 1452-1457
    Type of Medium: Online Resource
    ISSN: 0886-3350
    URL: Article
    DOI: 10.1016/j.jcrs.2019.05.029
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 5
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    Rituximab in the treatment of Susac’s syndrome: Report of a case
    SAGE Publications ; 2021
    In:  European Journal of Ophthalmology Vol. 31, No. 5 ( 2021-09), p. NP48-NP52
    Details
    In: European Journal of Ophthalmology, SAGE Publications, Vol. 31, No. 5 ( 2021-09), p. NP48-NP52
    Abstract: Susac’s syndrome is a rare retinocochleocerebral immune-mediated endotheliopathy and clinically manifests as a pathognomonic triad of encephalopathy, hearing loss, and branch retinal artery occlusion. This triad is rarely present at symptom onset, thus, it is often initially misdiagnosed. To date, Susac’s syndrome has persisted as an elusive entity and there are numerous treatment regimens proposed with varying effectiveness mainly based on case series. Purpose To report our 12-month follow-up experience in the treatment of Susac’s syndrome with rituximab. Case report A 25-year-old female presenting with headache, paresthesias, tinnitus, peripheral vertigo, and a branch retinal artery occlusion. The patient had a personal history of anxiety-depressive disorder. After discarding other infectious/autoimmune conditions and magnetic resonance imaging suggestive findings of Susac’s syndrome, we observed a prompt response to the combination of intravenous immunoglobulin, corticosteroids, and rituximab. Conclusion A standard treatment paradigm is lacking in Susac’s syndrome as randomized controlled trials do not exist. There are no definitive scores to predict its outcome, and early diagnosis is important as the organs involved can easily become irreversibly damaged. Thus, patients with Susac’s syndrome must be treated promptly and aggressively. Our report highlights the possibility of positive long-term prognosis with an early use of rituximab. However, a systematic therapeutic approach on the basis of controlled trials is mandatory to develop a consensus.
    Type of Medium: Online Resource
    ISSN: 1120-6721 , 1724-6016
    URL: Article
    DOI: 10.1177/1120672120924545
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 1475018-1
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  • 6
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    Online Resource
    Multimodal imaging of two cases of retinal vein occlusion secondary to Waldenstrom macroglobulinemia
    SAGE Publications ; 2022
    In:  European Journal of Ophthalmology Vol. 32, No. 3 ( 2022-05), p. NP50-NP55
    Details
    In: European Journal of Ophthalmology, SAGE Publications, Vol. 32, No. 3 ( 2022-05), p. NP50-NP55
    Abstract: To report multimodal imaging characteristics of two cases of retinal vein occlusion (RVO) secondary to Waldenstrom macroglobulinemia (WM). Case report: Case 1: An 82-year-old woman presented with vision loss. She had a history of WM. Best-corrected visual acuity (BCVA) was 20/100 Snellen equivalent in the right eye (OD) and 20/63 in the left eye (OS). Fundoscopy showed bilateral hemorrhages in posterior pole and along superotemporal arcade. Fluorescein angiography illustrated no macular leakage. Optical coherence tomography (OCT) revealed macular edema (ME). Optical coherence tomography angiography (OCTA) demonstrated abnormalities in choriocapillaris. A diagnosis of bilateral branch RVO was made and ME was treated with intravitreal dexamethasone, achieving stability. Case 2: A 65-year-old man presented with venous dilation, tortuosity, and intraretinal hemorrhages. BCVA was 20/20 in both eyes (OU). OCT showed ME and hyperreflective dots in choroid. A diagnosis of bilateral central RVO was made. Laboratory evaluation and bone narrow biopsy confirmed a diagnosis of WM. After that, our patient consulted because of vision loss. BCVA was 20/400 in OU. Fundoscopy and OCT demonstrated a worsening of the intraretinal hemorrhages and the ME. OCTA showed damage of choriocapillaris. Thus, intravitreal dexamethasone and plasmapheresis was advised. Two months after, BCVA was 20/40 in the OD and 20/32 in the OS. Also, fundoscopy and OCT improved. Conclusion: Early treatment of WM is truly important, with the aim of achieving a decrease in IgM levels in order to avoid toxic effect over the RPE that results in refractory ME.
    Type of Medium: Online Resource
    ISSN: 1120-6721 , 1724-6016
    URL: Article
    DOI: 10.1177/1120672121991389
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 1475018-1
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  • 7
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    Optical coherence tomography angiography analysis of aneurismal type 1 neovascularization in a cohort of white patients
    SAGE Publications ; 2022
    In:  European Journal of Ophthalmology Vol. 32, No. 4 ( 2022-07), p. 2338-2346
    Details
    In: European Journal of Ophthalmology, SAGE Publications, Vol. 32, No. 4 ( 2022-07), p. 2338-2346
    Abstract: To evaluate the detection rate of aneurysmal type 1 neovascularization (AT1) in Caucasian patients using optical coherence tomography angiography (OCTA) and to describe OCTA characteristics of AT1 in a cohort of white patients. Methods: We conducted an observational retrospective study in 44 eyes of 43 patients with AT1. All patients underwent a complete ophthalmologic examination, including fundus imaging, indocyanine green angiography, optical coherence tomography, and OCTA. Branching vascular network (BVN) and polyp detection rates by OCTA were evaluated. Furthermore, we described BVN and polyp morphologies on en face OCTA and flow of polyps on B-scan OCTA. Results: En face OCTA revealed BVN in 84.09% of cases and polypoidal lesions in 86.36% of cases. B-scan OCTA showed BVN and polyps in 95.45% and 93.18% of the patients, respectively. “Trunk” BVNs (51.35%) and “ring” polyps (47.37%) were the most frequent morphologies observed in our cohort, and “patchy hyperflow” (80.49%) signal was the most common visualized in our patients. Regarding OCT parameters, CT under polyps was higher in patients with positive detection of polyps on B-scan OCTA. Conclusion: OCTA is a possible diagnosis tool in Caucasian patients with AT1. To the best of our knowledge, this is the largest study performed in Caucasian patients regarding OCTA diagnostic abilities and features.
    Type of Medium: Online Resource
    ISSN: 1120-6721 , 1724-6016
    URL: Article
    DOI: 10.1177/11206721211048801
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 1475018-1
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  • 8
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    Optical coherence tomography angiography quantitative analysis of retinal and choroidal microvasculature in patients with dyslipidemia
    SAGE Publications ; 2023
    In:  European Journal of Ophthalmology Vol. 33, No. 4 ( 2023-07), p. 1666-1671
    Details
    In: European Journal of Ophthalmology, SAGE Publications, Vol. 33, No. 4 ( 2023-07), p. 1666-1671
    Abstract: The purpose of this investigation was to report swept source-optical coherence tomography angiography (SS-OCTA) quantitative information of retinal and choroidal microvascularization in patients with dyslipidemia (DL). Methods We performed a retrospective study. The study enrolled 37 eyes of 20 patients with DL and 40 eyes of 23 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP) and choriocapillaris (CC)) in 6 mm × 6 mm and 4,5 mm × 4,5 mm cubes were recorded. Results No differences in VD in SCP, MCP and DCP were demonstrated between DL group and control group ( p  〉  0,05). Conversely, VD in the central region at CC was diminished in patients with DL in both cubes ( p  〈  0,05). Moreover, total VD in CC was decreased in the DL group in 6 mm × 6 mm cube ( p  〈  0,05). Regarding FAZ area, we demonstrated and enlargement of FAZ in each retinal capillary plexus, but it did not reach statistical significance ( p  〉  0,05). Conclusion We objectified a diminution of VD in the CC, suggesting that DL mainly affects the choroidal microvasculature. Nonetheless, further studies with a larger population are needed.
    Type of Medium: Online Resource
    ISSN: 1120-6721 , 1724-6016
    URL: Article
    DOI: 10.1177/11206721221146680
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 1475018-1
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  • 9
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    Online Resource
    Analysis of anatomical biomarkers in subtypes of diabetic macular edema refractory to anti-vascular endothelial growth factor treated with dexamethasone implant
    SAGE Publications ; 2020
    In:  European Journal of Ophthalmology Vol. 30, No. 4 ( 2020-07), p. 764-769
    Details
    In: European Journal of Ophthalmology, SAGE Publications, Vol. 30, No. 4 ( 2020-07), p. 764-769
    Abstract: To analyze functional and anatomical outcomes in subtypes of diabetic macular edema treated with a single dexamethasone implant and to assess the usefulness of a pro-re-nata treatment among subtypes. Methods: Retrospective study in morphologic patterns of diabetic macular edema (diffuse retinal thickening n = 15; cystoid macular edema n = 38, and serous retinal detachment n = 17) recalcitrant to anti-vascular endothelial growth factor, treated with dexamethasone implant. Examinations included timing to recidive of diabetic macular edema, best-corrected visual acuity, and central subfield macular thickness at 2, 4, and 6 months. Results: In previously treated patients with a mean of 6.64 ± 3.69 anti-vascular endothelial growth factor injections, the best-corrected visual acuity improved from 61.64 ± 13.71 to 65.71 ± 14.65 as per the Early Treatment Diabetic Retinopathy Study protocol (p = 0.009) and central subfield macular thickness change from 447.46 ± 110.82 to 354.39 ± 80.46 µm (p  〈  0.005). The best-corrected visual acuity improvement was better in the diffuse retinal thickening group (68.67 ± 13.81 vs 65.26 ± 14.04 in cystoid macular edema and vs 64.12 ± 17.06 in serous retinal detachment), whereas higher central subfield macular thickness thinning was observed in serous retinal detachment group (368.47 ± 29.96 to 310.27 ± 67.47 in diffuse retinal thickening, vs 445.92 ± 105.06 to 364.39 ± 80.28 and 520.59 ± 122.96 to 370.94 ± 81.73 in cystoid macular edema and serous retinal detachment, respectively). Cystoid macular edema group was the group with more recurrences after 6 months (86.8% vs 66.7% in diffuse retinal thickening and 70.6% in serous retinal detachment). Conclusion: Dexamethasone implant is effective for all persistent diabetic macular edema subtypes with sustained functional and morphologic gains in the first 6 months.
    Type of Medium: Online Resource
    ISSN: 1120-6721 , 1724-6016
    URL: Article
    DOI: 10.1177/1120672119834182
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 1475018-1
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  • 10
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    Online Resource
    Vitamin A retinopathy secondary to Billroth II anastomosis triggered after the beginning of dialysis
    SAGE Publications ; 2022
    In:  European Journal of Ophthalmology Vol. 32, No. 6 ( 2022-11), p. NP50-NP54
    Details
    In: European Journal of Ophthalmology, SAGE Publications, Vol. 32, No. 6 ( 2022-11), p. NP50-NP54
    Abstract: To report a case of vitamin A retinopathy secondary to Billroth II anastomosis triggered after the beginning of dialysis in a patient with a chronic renal failure. Case report: A 73-year-old male complained of nyctalopia that had started 9 months ago, coinciding with the beginning of dialysis. His medical history is remarkable for hepatic cirrhosis and Billroth II anastomosis 20 years ago. Best-corrected visual acuity (BCVA) was 60 letters in both eyes. Dilated fundus examination showed faint white-yellowish dots. Optical coherence tomography (OCT) illustrated hyperreflective dots and small hyporreflective cavities between the retinal pigment epithelium (RPE) and the ellipsoid zone (EZ). En face OCT showed multiple hyperreflective dots that coincide with white-yellowish dots of the fundus, and multiple hyporreflective defects which correspond to hyporreflective cavities seen in the OCT. Visual field examination showed concentric narrowing of the visual field. A diagnosis of vitamin A deficiency was confirmed and oral vitamin A supplementation was initiated. One month after treatment, the patient reported a subjective improvement of nyctalopia, and BCVA ameliorated up to 80 and 85 letters. Fundus examination, OCT, and en face OCT showed a diminution of the observed lesions. Moreover, visual field improved. Conclusion: Early diagnosis of vitamin A deficiency can prevent irreversible visual sequelae. This highlights the crucial role of ophthalmologists in the prompt detection of this condition. A lifelong monitoring should be needed in patients undergoing biliopancreatic diversion surgery. Furthermore, OCT and en face OCT becomes a main tool in the diagnosis and monitor response to treatment.
    Type of Medium: Online Resource
    ISSN: 1120-6721 , 1724-6016
    URL: Article
    DOI: 10.1177/11206721211027416
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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