Bilateral giant retinal pigment epithelial tears in hypertensive choroidopathy

Potential Ophthalmological Side Effects Induced by Anti-Neoplastic Regimens for the Treatment of Genitourinary Cancers: A Review

The outcomes of patients with genitourinary (GU) cancers have been steadily improving in recent years. Novel therapies have entered our armamentarium, while several other regimens are currently being studied in clinical trials. This recent explosion of new agents has improved patient survival and the quality of life for patients, but has also significantly increased the frequency of several side effects. The current review will focus on the potential ocular adverse reactions of GU neoplastic treatments. The broad spectrum of manifestations of ocular toxicity underscores the uniqueness and complexity of the anatomic, physiologic, and metabolic features of the human eye. Most side effects are mild in severity and transient, but some can be severe, disabling, and irreversible. Clinicians should be aware of complications that might be vision threatening and impact the patient's quality of life. In this review, we focused on the ocular toxicity of the antineoplastic regimens that are currently used for the treatment of GU, including prostate cancer, bladder cancer, renal cell carcinoma, testicular cancer, pheochromocytoma, adrenocortical carcinoma, and penile cancer.

Serpentine retinal pigment epithelial tear

We report a case of retinal pigment epithelial tear in a patient with peripheral exudative hemorrhagic chorioretinopathy (PEHCR). A 60-year-old diabetic female presented with left eye metamorphopsia. Fundus examination showed bilateral peripheral retinal pigment epithelium (RPE) degeneration, and a large serpentine-shaped RPE degeneration tract extending from the superotemporal arcade to the inferior periphery with associated subretinal hemorrhages in her left eye. This tract curved around the fovea, just sparing it. Fundus fluorescein and indocyanine green angiographies showed bilateral polyps in the superotemporal periphery. Optical coherence tomography through the tract showed scrolled up RPE at its edges with bare underlying Bruch's membrane and choroid in the region of the rip. There was no sign of an underlying pigment epithelial detachment. The patients with PEHCR should be prognosticated about such a rare vision-threatening macular complication.

Retinal detachment with retinal pigment epithelial tear under hypotony after trabeculectomy: A case report

Purpose

To report a case of retinal detachment with retinal pigment epithelium (RPE) tear, under hypotony after trabeculectomy, which immediately resolved upon elevation of intraocular pressure.

Observations

A 67-year-old man who had undergone trabeculectomy presented for treatment of a visual field defect in his left eye. His glaucoma surgery was uneventful. At his first visit to our clinic, the patient's visual acuity was 15/20 in the right eye and 20/40 in the left; intraocular pressure was 18 mmHg in the right and 5 mmHg in the left. Fundus examination of the left eye revealed a retinal detachment, overlying a choroidal detachment, and an RPE tear. The retinal detachment did not resolve with systemic steroid pulse therapy or vitrectomy. The patient was then diagnosed with an exudative retinal detachment with RPE tear under hypotony, and transconjunctival sutures were applied to tighten the scleral flap, to elevate intraocular pressure. After the transconjunctival sutures were applied, intraocular pressure increased to 10 mmHg and the exudative retinal detachment immediately resolved. There was no recurrence of retinal detachment after the intervention.

Conclusions and importance

Because there have been few case reports of retinal detachment with an RPE tear after glaucoma filtering surgery, no therapeutic strategy has yet been proposed. The findings in this case indicate that intraocular pressure elevation is effective for treating exudative retinal detachment with RPE tear in cases of hypotony after glaucoma filtering surgery.

Hypertensive choroidopathy in atypical hemolytic-uremic syndrome

PURPOSE

We present the case of a 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome with a hypertensive crisis, who presented a bilateral serous retinal detachment.

CASE DESCRIPTION

A 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome, was referred for blurred vision in both eyes, evolving over 7 days. Treatment including hemodialysis, plasma exchange, systemic steroids, antihypertensive medications and eculizumab was started 1 month prior to referral. At presentation, best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye. Retinal examination revealed bilateral serous retinal detachment in the posterior pole and some small, flat, variably pigmented lesions. Optical coherence tomography confirmed marked serous retinal detachment in both eyes. Fluorescein and indocyanine green angiography was performed. Treatment for systemic hypertension was changed. Seven days later, dilated fundus examination and optical coherence tomography demonstrated a significant regression of the serous retinal detachment. Her visual acuity improves in both eyes at the last control, showing at fundus examination a complete resolution of the exudative detachment but a persistence of variable flat pigmented lesion.

CONCLUSION

Although multiple organ systems are commonly affected in hemolytic uremic syndrome, ocular involvement has only been described in very few cases. Ocular manifestations in atypical hemolytic uremic syndrome include retinal, choroidal and vitreal hemorrhages, retina and/or ischemic signs. Bilateral serous retinal detachment may also be a sign of atypical hemolytic uremic syndrome or even the first manifestation of a hypertensive event.