Objective To analyze the problems in the diagnosis of Coats disease and its main causes of misdiagnosis. Methods The clinical data of a group of patients with Coats diseases who had undergone indirect ophthalmoscopy, ocular fundus photography, fundus fluorescein angiography (FFA) and follow-up examination were retrospectively analyzed. The main causes of misdiagnosis were analyzed via reviewing the images of FFA and revising or confirming the initial diagnosis of Coats diseases according to the main features of abnormal dilation of retinal capillary vessels. Result In 68 patients (75 eyes), there were 45 cases whose initial diagnosis was Coats disease while the final diagnosis was not, in whom the final diagnosis was old retinal vein occlusion in 21, retinal vasculitis in 9, diabetic retinopathy in 3, old posterior uveitis in 3, congenital retinoschisis in 3, and proliferative vitreoretinopathy, familial exudative vitreoretinopathy, racemose hemangioma, old rhegmatogenous retinal detachment, macular epiretinal membrane, and idiopathic juxtafoveal telangiectasis in 1, respectively. There were 23 patients who was diagnosed as Coats disease in the final diagnosis but not the initial one. The initial diagnosis was old posterior uveitis in 6 patients, retinal vasculitis in 5, exudative age-related macular degeneration in 4, retinal main arterial tumor in 2, retinal angioma in 3, intraocular tumor in 2, and central serous chorioretinopathy in 1. Conclusions There are many problems in the clinical diagnosis of Coats disease. The main reason of misdiagnosis is that the clinicians can not comprehensively master the core of the definition of Coats disease and its clinical characters.

0.05);group C is the lowest-cost treatment options and the most economical one.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis. However, there is increasing evidence in the literature for secondary SUNCT being attributable to certain known lesions. We explored the possible neurobiological mechanism underlying SUNCT based on all reported cases of secondary SUNCT for which detailed information is available. Here we report a case of neuromyelitis optica spectrum disorders that had typical symptoms of SUNCT that might have been attributable to involvement of the spinal nucleus of the trigeminal nerve. We also review cases of secondary SUNCT reported in the English-language literature and analyze them for demographic characteristics, clinical features, response to treatment, and imaging findings. The literature review shows that secondary SUNCT can derive from a neoplasm, vascular disease, trauma, infection, inflammation, or congenital malformation. The pons with involvement of the trigeminal root entry zone was the most commonly affected region for inducing secondary SUNCT. In conclusion, the neurobiology of secondary SUNCT includes structures such as the nucleus and the trigeminal nerve with its branches, suggesting that some cases of primary SUNCT have underlying mechanisms that are related to existing focal damage that cannot be visualized.
Headache Disorders ; Headache* ; Inflammation ; Neurobiology ; Neuromyelitis Optica ; Pons ; Tears* ; Trigeminal Nerve ; Vascular Neoplasms

Objective:To investigate the efficiency, safety and complication of 0.7 mg dexamethasone sustained release agent (Ozurdex ?) vitreous cavity implantation for macular edema secondary to vitrectomy. Methods:A total of 15 patients (16 eyes) were included in this retrospective case series study. There were 7 males (8 eyes) and 8 females (8 eyes). Age ranged from 47 to 72 years old with an average age of (60.2±8.6)years. Among them, 8 cases were diabetic retinopathy (6 cases combined cataract surgery). 4 cases were silicone oil removal after retinal detachment surgery (all combined cataract surgery). 2 cases were epi-macular membrane (all combined with cataract surgery) and 1 case was vitreous hemorrhage (combined with cataract surgery). Ozurdex ? was implanted for macular edema after vitrectomy. The number of implantation was from 1 to 3 times (mean 1.67 times). The follow-up time was from 3 to 12 months, with an average of (7.33±3.50)months. Results:The best corrected visual acuity (BCVA) was improved in 10 cases (11 eyes), unchanged in 4 cases and decreased in 1 case within 3 months after Ozurdex ? implantation in the 15 cases (16 eyes). The macular edema was significantly improved in all cases. The central macular thickness (CMT) measured by optical coherence tomography (OCT) was from 350 to 1 370 γm before surgery with average thickness (621.60±235.48)γm, and the CMT postoperative was 118 to 556 γm with average thickness (269.87±118.14)γm, with statistically significant difference ( P<0.001). Cataract was not progressive after Ozurdex ? implantation. Macular edema was recurrent in 7 cases after first implantation and stable for additional 1-2 injections. Intraocular pressure elevation occurred in 3 cases 1 to 2 months after implantation with the highest intraocular pressure of 36 mmHg, which were controlled by local anti-glaucoma eye drops. Drugs entered into the anterior chamber in 2 cases and was taken out in 1 case. Conclusions:The efficiency of Ozurdex ? vitreous cavity implantation is definite and the complications are controllable, so it is a safe and effective method to treat macular edema after vitrectomy.

Objective To observe the clinical features ofuveal effusion syndrome (UES) and the efficacy of sclerectomy in the treatment of UES.Methods A retrospective case series.Twenty patients (36 eyes) of UES with sclerectomy were enrolled in this study from June 2012 to December 2016 in Beijing Tongren Hospital.Among them,there were 12 males (22 eyes) and 8 females (14 eyes),with an average age of 37.8 years.All patients suffered from bilateral diseases,including 4 patients in single eye group and 16 patients in double eye group.Visual acuity,intraocular pressure,indirect ophthalmoscope,UBM,FFA combined with ICGA,A/B ultrasonography,axial length (AL) and scleral thickness were measured.All patients underwent lamellar sclerectomy,and those with exudative retinal detachment underwent four quadrant lamellar sclerectomy,followed by four quadrant full-thickness sclerectomy with the size of 1 mm × 2 mm in the center of the scleral bed.The follow-up time after operation was more than 6 months.Visual acuity,intraocular pressure and fundus examination were performed 1,3 and 6 months after operation with the same equipment and methods before operation.Results There was no obvious inflammation in the anterior chamber of all eyes,and intraocular pressure was 24-28 mmHg (1 mmHg =0.133 kPa) in 4 eyes (11.1％).Axial length of 8 eyes (22.2％) were 16-18 mm (true microphthalmia).12 eyes (33.3％) had scleral thickness ＞ 1.0-1.8 mm.Visual acuity ranged from hand movement to 0.05 in 20 eyes,0.1 to 0.3 in l0 eyes and＞0.3 in 6 eyes.Fundus examination showed peripheral choroidal and ciliary detachment;UBM examination showed annular peripheral ciliary and choroidal detachment.32 eyes (88.9％) were complicated with exudative retinal detachment.FFA examination showed that 14 eyes (38.9％) had leopard spot changes.Compared with preoperative vision,the visual acuity improved in 28 eyes (77.8％) and remained unchanged in 8 eyes (22.2％) after surgery.Thirty-two eyes with different degrees of retinal detachment were found before surgery.After surgery,ciliary body detachment,choroidal detachment and retinal detachment were restored.Six eyes (16.7％) recurred and underwent sclerectomy again.Conclusions The mild symptoms and recurrent attack are the characteristics of UES.Sclerectomy is an effective method to treat UES.