Metastatic choroidal abscess and choroidal neovascularization in a patient with Staphylococcus aureus renal abscess

Metastatic subretinal abscess in a patient with perinephric abscess

An 80-year-old lady with uncontrolled type 2 diabetes developed fever and abdominal pain followed by a sudden diminution of vision in her left eye. Right infra-renal abscess accounted for abdominal pain. A metastatic left subretinal abscess was diagnosed subsequently. Medical management for her systemic condition initiated. Vitreous biopsy was performed along-with intravitreal antibiotic administration. Because of no clinical recovery, patient underwent pars plana vitrectomy. Prompt systemic stabilization and a timely surgical intervention in the left eye resulted in a satisfactory visual gain. Metastatic subretinal abscess following a perinephric abscess is rare phenomenon and only a few cases are reported to date.

Inflammatory choroidal neovascularization

Purpose and Methods:

Choroidal neovascularization (CNV) can be a severe sight-threatening sequela, which can be secondary to both infectious and noninfectious uveitis. This review summarizes the different diseases associated with CNV, highlighting new treatment modalities and the possible strategies, which could be applied for the therapy of this occurrence.

Results:

Since CNV can often originate from posterior pole lesions and can be hard to identify, an accurate examination is mandatory in order to identify the correct diagnosis. In the majority of cases, fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) enable the determination of the clinical characteristics of the CNV. An infectious disease should be looked for to include a suitable therapy when available. The treatment strategy for CNV secondary to noninfectious uveal inflammations should be directed at controlling the inflammatory process. Systemic corticosteroids with or without immunosuppressive agents are indicated even when the CNV occurs with apparently inactive uveitis: Chronic subclinical inflammation can be the basis for the pathogenesis of CNV. Additional therapies aimed directly at the neovascular process, such as the intravitreal anti-Vascular Endothelial Growth Factor (VEGF) agents, are recommended particularly when the therapy shows an insufficient response.

Conclusion:

CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant information about the choroidal status. Several therapeutic options have been considered, but no guidelines are provided at the moment. Moreover, the current data are still only based on case reports or small series. For such reasons, further trials are mandatory to validate the preliminary available results.

Contralateral eyelid metastasis of uveal melanoma with further systemic dissemination

BACKGROUND

The usual way of dissemination of an uveal malignant melanoma comprises hematogenous metastases to various organs, liver in the first place. Uncommon development of the disease is always possible, while unusual ways of dissemination and secondary deposits in the unexpected sites have been observed. We presented an unusual case of a patient with uveal melanoma metastatic to the contralateral eyelid with very fast further dissemination in the manner typical for primary malignancies.

CASE REPORT

This observational case report included a 70-year-old male, enucleated for uveal melanoma in his left eye, appeared again 2.5 years later with a fast growing contralateral eyelid metastasis, followed by submandibular lymph node involvement on the same side and further systemic dissemination.

CONCLUSION

The first revealed solitary contralateral eyelid metastasis of uveal melanoma is extremely rare, such as an uncommon secondary deposit with a strange way of further dissemination.

Endogenous Candida albicans infection causing subretinal abscess

PURPOSE

We report a case of Candida albicans endophthalmitis with subretinal abscess formation in a patient who underwent liver transplantation.

METHODS

Case report.

RESULTS

A 51-year-old Japanese woman complained of deep pain and ciliary injection in her right eye. Three months prior, the patient had undergone liver transplantation for cirrhosis caused by hepatitis C. A slit-lamp examination revealed intense anterior chamber inflammation with hypopyon and fundoscopy showed a yellowish-white subretinal mass lesion in the inferior peripheral fundus. Systemic and topical antibiotics did not prevent further progression of the infection. The patient underwent pars plana vitrectomy treatment three times and a histopathological study of a vitreous specimen revealed C. albicans to be the causative organism.

CONCLUSION

A subretinal abscess, previously reported in Nocardia, Pseudomonas, Staphylococcus, and Aspergillus infection cases, can also occur in patients infected with Candida. Therefore, Candida infection should be considered as a potential cause of subretinal abscess in organ transplant recipients.