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There is Something Strange and Unusual at the Back of the Eye
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Unless there is a significant amount of exudation from the lesion in question, or proximity to the macula is an issue, there is very likely to be virtually no symptoms associated with the more unusual posterior pole findings. Often the patient pitches up at the emergency clinic after being referred from their optometrist when they had simply popped in to update their spectacles. This lack of symptoms firstly means that it is difficult to determine a duration and also means that the patient has been potentially thrust into a terrifying situation for them where the optometrist is not happy with what they've seen but at the same time cannot give them a diagnosis beyond ‘I need someone to look at this very quickly’. Fortunately, the outcome is not often such that the services of the ocular oncology service need to be sought.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
The commonest cause in children is peripheral neovascularisation, seen in retinopathy of prematurity, sickle cell disease, familial exudative vitreoretinopathy and incontinentia pigmenti. Posterior pole neovascularisation may be seen in retinal vein occlusion, retinal vasculitis, retinal artery occlusion or radiation retinopathy.
Wide-angle viewing systems for vitreoretinal surgery
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Mark E Hammer, W Sanderson Grizzard
To achieve the initial focus with the system, the endoillumination probe should be placed in the vitreous cavity while the posterior pole is viewed. After the posterior pole is in focus, the periphery should be viewed by manipulating the eye and the X –Y movement of the microscope. The surgeon will quickly develop an intuitive understanding and ‘feel’ for the system.
Clinical Manifestations and Treatment of Vogt–Koyanagi–Harada Disease during Pregnancy and after Birth: A Case Report
Published in Ocular Immunology and Inflammation, 2023
José L. Sanchez-Vicente, Antonio Moruno-Rodríguez, Juan De las Morenas-Iglesias, Bosco Gonzalez-Jauregui, Carolina Franco-Ruedas, Beatriz Lechon-Caballero, Arturo Talego-Sancha, Trinidad Rueda-Rueda, Aurora Del Estad-Cabello, Fernando López-Herrero
In this case, even though initial presentation could suggest other inflammatory or non-inflammatory conditions, the follow-up and subsequent clinical and imaging exams supported the final diagnosis of incomplete Vogt-Koyanagi-Harada. After excluding infectious causes, the well-defined choroidal foci could remind the diagnosis of multifocal choroiditis with panuveitis or sarcoidosis. Multifocal choroiditis with panuveitis usually presents with mild to moderate anterior chamber inflammation and has multiple yellow-whitish medium size choroidal lesions in different stages. The most frequent complications in the posterior pole are cystic macular oedema and the appearance of epiretinal membranes, not the appearance of serous retinal detachments with the formation of subretinal septa. For ocular sarcoidosis diagnosis there should be at least some systemic findings not found in this patient besides further ocular clinical signs other than bilaterality and multiple chorioretinal lesions. Further cerebrospinal fluid analysis and fluorescein angiography in the early acute phase could add to Vogt-Koyanagi-Harada disease diagnosis.
Coats like response in healed choroiditis
Published in Ocular Immunology and Inflammation, 2022
Saurabh Verma, Indrish Bhatia, Mousumi Banerjee, Vinod Kumar
Abnormal telangiectatic retinal vessels accompanied with subretinal exudation with or without retinal detachment in association with other ocular or systemic disorder are included in Coats’-like response.1 The etiology of retinal telangiectasia, either congenital or secondary remains unclear till now. Tarkkanen et al.7 studied the histopathological specimen of retina in Coats’ disease and inferred functional or structural loss of the blood-retinal barrier with disorganization of mural architecture. Reese8 postulated that endothelial cell dysfunction causes localized microvascular atresia and occlusion, which leads to vascular ectasia and formation of collateral vessels. Thus, the possible etiology could be any vaso-occlusive event, autoimmune vasculopathy or chronic inflammation causing structural damage to retinal vasculature which may precede the development of retinal telangiectasias.6 The clinical significance of this entity arises from the fact that such an exudative response further deteriorates the visual acuity due to its involvement of the posterior pole. In our case, the damage to the retinal vasculature secondary to inflammatory response might have lead to the development of Coats’-like response. Early diagnosis of this response can halt the ongoing neovascular drive and stabilize the blood retinal barrier by treating with intravitreal anti-VEGFs/steroids and/or laser photocoagulation. It also reduces the need for vitrectomy in the future.
Quantitative Study of Human Scleral Melanocytes and Their Topographical Distribution
Published in Current Eye Research, 2020
Dan-Ning Hu, Shen Yao, Codrin E. Iacob, Jerome Giovinazzo, Richard B. Rosen, Hans E. Grossniklaus, Jodi Sassoon
The sclera is an opaque fibrous tissue that covers more than 4/5 of the surface of the eye. It is a densely fibrous, hypocellular tissue, and is arranged in compact collagenous bundles. The main resident cells of the sclera, the fibroblasts, are few in number and located between the fibrous bundles, with their long axis and nuclei parallel to the ocular surface and to collagen sheets.24−26 The inner surface of the sclera is covered by the lamina fusca: scleral bundles in this area are thinner and contain a large number of melanocytes which give the internal sclera a brown color.24,25 The sclera is interrupted by two large foramina, the anterior and the posterior scleral foramen. The latter is located 3 mm medial to the posterior pole and allows the exit of the optic nerve; it is funnel-shaped, has an inner diameter of 2 mm or less, and an external diameter of 3.5 mm.24−26 The sclera is also pierced by many canals which conduct the vessels and nerves entering the eye, for example the anterior ciliary vessels in the anterior part, the vortex veins posterior to the equator, and the posterior short and long arteries around the optic nerve.24−26