5 research outputs found
Unusual Presentation of Unilateral Choroidal Melanoma with Bilateral Vasculitis in Young Individual: A Case Report and Review of Literature
No full textOcular melanoma stands as the predominant primary intraocular malignancy, albeit infrequently exhibiting ipsilateral inflammatory manifestations. In this article, we present an exceptional case involving a middle-aged male who presented with unilateral ocular choroidal melanoma alongside bilateral retinal vasculitis. The patient initially received temporary steroid treatment, followed by brachytherapy, which contributed to the resolution of vasculitis symptoms. The study aims to document the atypical occurrence of bilateral retinal vasculitis, which could potentially masquerade as melanoma, emphasizing the need for heightened vigilance and further investigations when encountering choroidal masses in its presence. Future research endeavors are warranted to better understand the incidence of such occurrences in this context
The Role of Adding Intravitreal Dexamethasone Implant to the Standard Management of Serpiginous Choroiditis for Achieving Rapid Remission: A Case Report
No full textAlmoayad M Makrami,1 Yazeed J Alhaqbani,1 Dhoha M Alhamad,1 Talaat J Hamdi,2 Abdulaziz S Khoshaim1 1Dhahran Eye Specialist Hospital, Eastern Health Cluster, Dhahran, Saudi Arabia; 2Ophthalmology Division, Jeddah University, Jeddah, Saudi ArabiaCorrespondence: Abdulaziz S Khoshaim, Email [email protected]: This case highlights the potential of combining intravitreal dexamethasone implants as first line of management with reduced dose of systemic steroid therapy to achieve rapid remission in acute serpiginous choroiditis. To prevent systemic adverse effects and obtain rapid control of serpiginous lesions, as necessary in the case presented, local therapy using a dexamethasone intravitreal implant may be considered as a complement to systemic treatment.Case Presentation: A 42 year old woman with steadily declining vision in her right eye for the previous four months presented to the emergency department. On the Snellen chart, the best-corrected visual acuity was 20/28 in the left eye and 20/100 in the right eye. The intraocular pressure (IOP) of the right and left eyes was 15 and 16 mmHg, respectively. Anterior segment examination was unremarkable. Fundus examination of the right eye revealed a gray finger-like lesion with an active border. The left eye showed a small yellowish-finger-like lesion involving the nasal macula. Disruption in the ellipsoid zone in the right eye and the parafoveal region in the left eye was demonstrated using optical coherence tomography (OCT). Fundus fluorescein angiography revealed bilateral, finger-like branching lesions were seen on fundus fluorescein angiography (FFA). Fundus Autofluorescence (FAF) showed hypoautofluorescence lesions with hyper-autofluorescence edges. Both eyes were diagnosed with active serpiginous choroiditis, after excluding any active infections through blood work-up. The patient was started oral prednisolone 0.5 mg/kg tapering; however, because the patient would be traveling for three weeks, the systemic oral steroid with an intravitreal dexamethasone implant in each eye. After nine days, there was noticeable improvement in the visual acuity of the right eye with normal intraocular pressure. OCT showed minimal restoration of the ellipsoid zone in the right eye, with resolved inflammatory material in both eyes (Figure 1). After starting Azathioprine, disease activity was suppressed for six months without relapsing.Conclusion: This case raises a question about the benefit of combined therapy for quick vision restoration, inhibiting further destruction of outer retinal layers during the management of acute attack and reduction of overall systemic steroids dose together with its complications versus the risk of local steroids administration and cost-effectiveness. Additional research is required to validate this finding.Keywords: serpiginous choroiditis, dexamethasone intravitreal implant, uveitis, remissio
Unusual Presentation of Unilateral Choroidal Melanoma with Bilateral Vasculitis in Young Individual: A Case Report and Review of Literature
No full textOcular melanoma stands as the predominant primary intraocular malignancy, albeit infrequently exhibiting ipsilateral inflammatory manifestations. In this article, we present an exceptional case involving a middle-aged male who presented with unilateral ocular choroidal melanoma alongside bilateral retinal vasculitis. The patient initially received temporary steroid treatment, followed by brachytherapy, which contributed to the resolution of vasculitis symptoms. The study aims to document the atypical occurrence of bilateral retinal vasculitis, which could potentially masquerade as melanoma, emphasizing the need for heightened vigilance and further investigations when encountering choroidal masses in its presence. Future research endeavors are warranted to better understand the incidence of such occurrences in this context
The VKORC1 ER-luminal loop mutation (Leu76Pro) leads to a significant resistance to warfarin in black rats (Rattus rattus)
No full textWell-known 4-hydroxycoumarin derivatives, such as warfarin, act as inhibitors of the vitamin K epoxide reductase (VKOR) and are used as anticoagulants. Mutations of the VKOR enzyme can lead to resistance to those compounds. This has been a problem in using them as medicine or rodenticide. Most of these mutations lie in the vicinity of potential warfarin-binding sites within the ER-luminal loop structure (Lys30, Phe55) and the transmembrane helix (Tyr138). However, a VKOR mutation found in Tokyo in warfarin-resistant rats does not follow that pattern (Leu76Pro), and its effect on VKOR function and structure remains unclear. We conducted both in vitro kinetic analyses and in silico docking studies to characterize the VKOR mutant. On the one hand, resistant rats (R-rats) showed a 37.5-fold increased IC50 value to warfarin when compared to susceptible rats (S-rats); on the other hand, R-rats showed a 16.5-fold lower basal VKOR activity (Vmax/Km). Docking calculations exhibited that the mutated VKOR of R-rats has a decreased affinity for warfarin. Molecular dynamics simulations further revealed that VKOR-associated warfarin was more exposed to solvents in R-rats and key interactions between Lys30, Phe55, and warfarin were less favored. This study concludes that a single mutation of VKOR at position 76 leads to a significant resistance to warfarin by modifying the types and numbers of intermolecular interactions between the two
The Clinical Spectrum and Outcomes of Ocular Syphilis in Saudi Arabia: The Emergence of a Uveitic Masquerader
No full textAbstract This retrospective multicenter cohort study aimed to describe the clinical features and report the outcomes of the management of ocular syphilis in Saudi Arabia. Thirty-three eyes of 19 patients with ocular syphilis were reviewed, including data on visual acuity, signs of anterior and posterior uveitis, systemic work-up, and treatment outcomes. A total of 38 eyes from 19 patients were examined, with 33 eyes showing manifestations of ocular syphilis. The majority of patients (89.5%; n = 17) were males, with an average age of 40.6 ± 12 years. About one half of the patients (52.6%; n = 10) reported previous unprotected sexual encounters, and 26.3% had positive human immunodeficiency virus (HIV) testing. Systemic manifestations of syphilis were observed in 68.4% of the patients. Fourteen patients (73.7%) had bilateral disease. At presentation, the average Log MAR visual acuity was 0.81 ± 0.80 (Snellen equivalent = 20/120). Anterior chamber inflammation was seen in 72.7% of eyes (n = 28 eyes), while posterior segment examination revealed vitritis in 48.5% (n = 18 eyes), hyperemic optic discs in 62.5% (n = 24 eyes), and vascular sheathing in 46.9% (n = 17 eyes). Placoid lesions were observed in 51.5% of eyes (n = 20 eyes). The most common ocular syphilitic phenotypes were acute syphilitic posterior placoid chorioretinitis (ASPPC) in 54.5% of eyes (n = 21 eyes) and necrotizing retinochoroiditis in 15.2% (n = 6 eyes). Treatment included intravenous penicillin G for 14 days in 12 patients, intramuscular penicillin G in 2 patients, and systemic ceftriaxone in 2 patients. All treated patients showed clinical improvement, with a mean follow-up duration of 6.5 ± 4.5 weeks and a significant improvement in mean Log MAR visual acuity to 0.23 ± 0.46 (Snellen equivalent = 20/30; P < 0.001). These findings highlight the emergence of ocular syphilis in Saudi Arabia and the need for ophthalmologists to recognize its diverse clinical and multimodal retinal imaging features to ensure timely diagnosis and treatment
