PURPOSE: We report a case of cytomegalovirus (CMV) retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient diagnosed with non-infectious uveitis. CASE SUMMARY: A 60-year-old woman was referred to our hospital for recurrent anterior uveitis. Fundus examination and fluorescein angiography showed dense vitritis, but no definite retinal infiltration. After laboratory examinations, the patient was diagnosed with non-infectious panuveitis. Uveitis was much improved after the patient started taking oral steroid medication. However, the patient complained of systemic side effects from the oral steroids. Medication was stopped, and an intravitreal dexamethasone implant was fitted to address worsening inflammation. Two months later, perivascular retinal infiltration developed and vitritis recurred. Viral retinitis was suspected, and the patient underwent diagnostic vitrectomy adjunctive with intravitreal ganciclovir injection. Polymerase chain reaction of vitreous fluid confirmed the diagnosis of CMV retinitis. The patient has remained inflammation-free for more than 20 months after vitrectomy, single ganciclovir injection, and 2 months of oral valganciclovir medication. CONCLUSIONS: This is a case report of CMV retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient without any risk factors or previous history of immunosuppression. Potential risk factors for CMV retinitis should be evaluated and careful follow-up should be performed when intravitreal dexamethasone injections are unavoidable for the treatment of non-infectious uveitis.
Cytomegalovirus Retinitis ; Cytomegalovirus ; Dexamethasone ; Diagnosis ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Ganciclovir ; Humans ; Immunosuppression ; Inflammation ; Middle Aged ; Panuveitis ; Polymerase Chain Reaction ; Retinaldehyde ; Retinitis ; Risk Factors ; Steroids ; Uveitis ; Uveitis, Anterior ; Vitrectomy

PURPOSE: To report a case of recurrent endophthalmitis due to methicillin resistant Staphylococcus hemolyticus after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. CASE SUMMARY: A 76-year-old female visited our outpatient clinic with decreased vision 40 days after uncomplicated cataract surgery in her right eye. At the visit, anterior chamber inflammation and cloudy fluid between the posterior capsule and IOL were observed. Uveitis due to residual cortex of lens or capsular block syndrome was suspected, so YAG laser capsulotomy and subconjunctival injection of dexamethasone were performed. Two days later, hypopyon and vitreous opacity were seen. The patient underwent an emergency vitrectomy and intravitreal antibiotic injection with suspicion of bacterial endophthalmitis. The culture was negative. Twenty days after the vitrectomy, anterior chamber inflammation and vitreous opacity developed. The recurrence of endophthalmitis was suspected due to infection by bacteria in the surrounding tissue of the IOL, so the patient underwent an IOL and lens capsule removal with intravitreal antibiotic injection. At this time, the culture revealed methicillin resistant staphylococcus hemolyticus. Systemic and topical vancomycin was then administered, resulting in decreased inflammation. Twenty days after the IOL removal, decreased vision, anterior chamber inflammation, and vitreous opacity developed. Endophthalmitis was decreased by intravitreal antibiotic injection and topical antibiotic treatment. CONCLUSIONS: Methicillin resistant staphylococcus hemolyticus should be considered in the differential diagnosis of chronic recurrent endophthalmitis after cataract surgery.
Aged ; Ambulatory Care Facilities ; Anterior Chamber ; Bacteria ; Cataract ; Dexamethasone ; Diagnosis, Differential ; Emergencies ; Endophthalmitis ; Female ; Humans ; Inflammation ; Lasers, Solid-State ; Lenses, Intraocular ; Methicillin Resistance ; Methicillin ; Phacoemulsification ; Recurrence ; Staphylococcus ; Uveitis ; Vancomycin ; Vitrectomy

PURPOSE: We report an unusual case of presumptive diagnosis of herpes-induced anterior uveitis with acute hypopyon after trauma. CASE SUMMARY: A 82-year-old male was diagnosed with herpes keratitis due to dendritic keratitis in the left eye, and the lesion disappeared after antiviral treatment. However, 1 year later, the patient visited again with visual loss, pain, and tearing of the left eye after trauma. At the examination, best-corrected visual acuity was counting fingers and the intraocular pressure was 27 mmHg in the left eye. Slit-lamp examination revealed corneal epithelial erosion, moderate corneal edema, and prominent inflammation with 2 mm high hypopyon in the anterior chamber. We thought that bacterial endophthalmitis had rapidly progressed after trauma, so we performed bacterial cultures and an intravitreal antibiotics injection. Considering the clinical manifestations of lesions and herpes keratitis in the past, we could not exclude herpes virus infection. Cultures were negative and the symptoms improved, so the antiviral treatment was gradually reduced and stopped at 2 months. However, recurrence was observed on day 5 after stopping antiviral therapy. We therefore assumed that recurrent herpes virus caused anterior uveitis, and then, antiviral and steroid therapy was resumed. The patient subsequently showed improvement in his symptoms and recovered his visual acuity. CONCLUSIONS: When acute hypopyon is observed in the anterior chamber after trauma, not only bacterial iritis and endophthalmitis but also viral-induced anterior uveitis should be considered in the differential diagnosis.
Aged, 80 and over ; Anterior Chamber ; Anti-Bacterial Agents ; Corneal Edema ; Diagnosis ; Diagnosis, Differential ; Endophthalmitis ; Fingers ; Humans ; Inflammation ; Intraocular Pressure ; Iritis ; Keratitis ; Keratitis, Dendritic ; Male ; Recurrence ; Simplexvirus ; Tears ; Uveitis, Anterior ; Visual Acuity

PURPOSE: To report a case of candida endogenous endophthalmitis in healthy women who had received extraction of wisdom tooth. CASE SUMMARY: A 65-year-old medically healthy woman who had received extraction of wisdom tooth two weeks ago, presented with floater symptoms in her left eye. Best-corrected visual acuity was 20/40 and intraocular pressure was 17 mmHg in her left eye. Inflammatory cells were found in the anterior chamber and vitreous. Fluorescein angiography showed multiple hypofluorescence without vascular leakage. With provisional diagnosis of intermediate uveitis, she was prescribed oral steroid for two weeks. After that, inflammatory cells in anterior chamber was reduced but vitreous imflammatory cell was increased and fundus examination detected newly developed infiltrated lesion at superotemporal area. The patient was presumed to have fungal endophthalmitis and immediate intravitreal voriconazole injection was performed. Three days after intravitreal voriconazole injection, diagnostic vitrectomy and intravitreal voriconazole injection were performed. Vitreous cultures revealed the growth of Candida albicans. Despite the treatment, inflammatory response in anterior chamber and vitreous rapidly increased and visual acuity was decreased to hand movement. We changed anti-fungal agent, voriconazole to Amphotericin B. Additional three-time intravitreal injection was done and therapeutic vitrectomy with oil injection were performed. After treatment, the patient's fundus markedly improved and inflammatory response was decreased. CONCLUSIONS: This case report shows candida endophthalmitis in healthy woman who had received extraction of wisdom tooth. So to diagnose endophthalmitis, patient's medical history should carefully be checked including dental care history who presented with vitreous inflammation and inflammatory infiltrated lesion at fundus.
Aged ; Amphotericin B ; Anterior Chamber ; Candida ; Candida albicans ; Dental Care ; Diagnosis ; Endophthalmitis ; Female ; Fluorescein Angiography ; Hand ; Humans ; Inflammation ; Intraocular Pressure ; Intravitreal Injections ; Molar, Third ; Uveitis, Intermediate ; Visual Acuity ; Vitrectomy ; Voriconazole

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.
Adult ; Anterior Chamber ; Cytomegalovirus ; Diagnosis ; Diagnosis, Differential ; Fever ; Hematologic Tests ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Infectious Mononucleosis ; Leukocytosis ; Lymphocytes ; Lymphocytosis ; Male ; Myalgia ; Ophthalmic Solutions ; Panuveitis ; Pharyngitis ; Polymerase Chain Reaction ; Retinal Hemorrhage ; Uveitis ; Visual Acuity

BACKGROUND: The present study describes our 10-year experience with uveoretinal adverse events that manifest because of chemotherapy. METHODS: A retrospective chart review was performed for all patients who presented to the ophthalmologic department while undergoing systemic chemotherapy between July 2005 and June 2015. RESULTS: A total of 55 patients (mean age, 51.2 years, 38 women [69.1%]) suspected of having uveoretinal disease owing to the use of chemotherapeutic agents alone were enrolled. Breast cancer was the predominant disease (36.4%); noninfectious anterior uveitis (21.8%) was the most common condition. Bilateral involvement was observed in 16 patients (29.1%). Although cisplatin (21.8%) was the most commonly used drug, daunorubicin, cytarabine, tamoxifen, toremifene, and imatinib were also frequently used. The median duration until ophthalmologic diagnosis was 208.5 days (range, 19–5,945 days). The proportion of patients with final visual acuity (VA) < 20/40 Snellen VA (0.5 decimal VA) was 32.7%. However, no relationship was observed between final VA < 20/40 and age, sex, therapeutic agents, and metastasis. CONCLUSION: Uveoretinal complications were mostly mild to moderate and exhibited a favorable response to conservative therapy. A considerable number of patients exhibited significant irreversible loss of vision after cessation of the causative chemotherapeutic agent. Ophthalmological monitoring is required during chemotherapy.
Antineoplastic Agents ; Breast Neoplasms ; Cisplatin ; Cytarabine ; Daunorubicin ; Diagnosis ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Imatinib Mesylate ; Molecular Targeted Therapy ; Neoplasm Metastasis ; Retrospective Studies ; Tamoxifen ; Toremifene ; Uveitis ; Uveitis, Anterior ; Visual Acuity

PURPOSE: To investigate the clinical features and treatment outcomes of ocular toxocariasis in Jeju Island using ultra-wide-field fundus photography. METHODS: We retrospectively reviewed the medical records of 40 eyes of 37 patients who were diagnosed with ocular toxocariasis based on clinical aspects and serologic tests. The quality of history-taking was assessed and peripheral blood samples were analyzed. Ocular characteristics were evaluated using ultra-wide-field fundus photography and optical coherence tomography. Changes in visual acuity and funduscopic findings after treatment were also analyzed. RESULTS: The average age of the patients was 57.9 years and the mean Toxocara canis IgG titer was 1.979 ± 0.486. The most common fundus findings were vitreous opacity (63.6%) and granuloma (60%). Granulomas that were not initially observed within the field of view of conventional fundus photography were found using ultra-wide-field imaging in 15 eyes (62.5%). Ultra-wide-field fluorescein angiography showed peripheral vascular leakage in 16 eyes (69.6%). Treatment with oral prednisolone and albendazole resulted in average vision improvements of 0.19 ± 0.07 logMAR (p = 0.031) as well as significant improvements in anterior chamber inflammation and vitreous opacity. Combination therapy led to a significantly lower recurrence rate than prednisolone monotherapy (p = 0.049). CONCLUSIONS: In Jeju Island, the mean Toxocara canis IgG titer of ocular toxocariasis was high. The incidences of vitreous opacity and granulomas were also high. Ultra-wide-field fundus imaging was useful for finding peripheral retinal lesions and peripheral vascular leakage that were not observed within the field of view of conventional fundus photography. Ultra-wide-field fundus imaging was valuable not only during clinical diagnosis, but also on follow-up evaluations of ocular toxocariasis. Treatment with oral prednisolone and albendazole effectively improved ocular inflammation and visual acuity and helped reduce the recurrence rate.
Albendazole ; Anterior Chamber ; Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; Granuloma ; Humans ; Immunoglobulin G ; Incidence ; Inflammation ; Medical Records ; Photography* ; Prednisolone ; Recurrence ; Retinaldehyde ; Retrospective Studies ; Serologic Tests ; Tomography, Optical Coherence ; Toxocara canis ; Toxocariasis* ; Uveitis ; Visual Acuity

PURPOSE: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) that developed after human papilloma virus (HPV) vaccination. CASE SUMMARY: A 31-year-old woman experienced sudden bilateral blurred vision and paracentral scotomas four days before visiting the hospital. The symptoms occurred two weeks after the second vaccination with quadrivalent HPV vaccine (Gardasil®, MSD Korea, Seoul, Korea), and she had no pain or cold symptoms. At initial visit, the anterior chamber cells were observed, and the anterior vitreous was found to be clear. On fundus examination, multiple placoid yellow-whitish lesions were observed at the posterior pole, and fluorescein angiography showed early hypofluorescence and late hyperfluorescence with staining. Under a diagnosis of bilateral APMPPE, oral corticosteroid was used as treatment for two weeks, after which symptoms were resolved, anterior chamber cells disappeared, and lesions at the posterior pole markedly decreased. After five weeks, multiple hyperreflective areas on the outer retinal layers as well as missing photoreceptor and retinal pigment epithelial layers were almost recovered upon optical coherence tomography. CONCLUSIONS: Non-infectious uveitis such as APMPPE can rarely present after HPV vaccination. Further studies are necessary to understand whether HPV vaccine is a direct cause of uveitis.
Adult ; Anterior Chamber ; Diagnosis ; Female ; Fluorescein Angiography ; Humans* ; Korea ; Papillomaviridae* ; Retinaldehyde ; Scotoma ; Seoul ; Tomography, Optical Coherence ; Uveitis ; Vaccination*

PURPOSE: To report a case of phacoanaphylactic uveitis presenting as endophthalmitis. CASE SUMMARY: A 77-year-old woman presented with sudden visual disturbance and painful red right eye. She did not have a history of trauma or surgery in her right eye. Her best corrected visual acuity was hand movement in the right eye and log MAR 0.22 in the left eye; intraocular pressure was 27 mm Hg in the right eye and 15 mm Hg in the left eye. Slit-lamp examination revealed corneal edema and prominent inflammation with hypopyon in the anterior chamber. B-scan showed vitreous opacity behind the lens. Based on the diagnosis of endophthalmitis, anterior chamber paracentesis and irrigation were performed. After irrigation, a hypermature cataract with intact anterior capsule was observed. Therefore, we performed extracapsular cataract extraction and intravitreal antibiotics injection. Gram staining of the aqueous humor revealed numerous macrophages filled with lens protein but no organisms. She was treated with hourly topical corticosteroid and an antibiotic agent. One month later, the anterior chamber is clear, and the cultures remained negative. CONCLUSIONS: We report a case of spontaneous phacoanaphylactic uveitis presenting as endophthalmitis in a patient with no history of eye trauma or surgery.
Aged ; Anterior Chamber ; Anti-Bacterial Agents ; Aqueous Humor ; Cataract ; Cataract Extraction ; Corneal Edema ; Diagnosis ; Endophthalmitis* ; Female ; Hand ; Humans ; Inflammation ; Intraocular Pressure ; Macrophages ; Paracentesis ; Uveitis* ; Visual Acuity

PURPOSE: To identify ophthalmologic features of Kawasaki disease (KD), and to evaluate anterior uveitis incidence in typical KD and atypical KD. METHODS: We conducted a retrospective chart review of 60 patients who clinically suspected KD at The Catholic University of Korea Uijeongbu St. Mary's Hospital between October 2013 and January 2015. RESULTS: Among a total of 60 patients, 46 were diagnosed with KD; 32 (69.57%) were typical KD and, 14 (30.43%) atypical KD. Anterior uveitis was reported in 69.57% of children with KD. Slit-lamp examination showed anterior chamber cells (average Standardization of Uveitis Nomenclature [SUN] grade 1.3) and the anterior uveitis fully resolved within 9.4 days after the onset of the disease. There was no significant difference in typical KD and atypical KD in terms of age, gender, or uveitis incidence. CONCLUSIONS: KD may progress with severe cardiac complications, eventually resulting in permanent sequale. Therefore, early diagnosis and therapeutic intervention is important in KD patients. Anterior uveitis as diagnostic criteria for KD has yielded 100% positive predictive value, 69.6% sensitivity and 100% specificity. Ophthalmologic examination may be useful for suspected KD patients, and a high index of suspicion is necessary in patients with anterior uveitis.
Anterior Chamber ; Child ; Early Diagnosis ; Humans ; Incidence ; Korea ; Mucocutaneous Lymph Node Syndrome ; Retrospective Studies ; Sensitivity and Specificity ; Uveitis ; Uveitis, Anterior* ; Vasculitis