Congenital toxoplasmosis is a rare, non-curable parasite infection, that affects approximately 242 children in Europe each year. Poland has one of the highest rates of congenital toxoplasmosis in Europe. Transmission of Toxoplasma gondii to the fetus results in numerous medical conditions, such as developmental delay, intellectual disabilities, seizures, hearing loss, and blindness. Chorioretinitis is a serious manifestation of congenital toxoplasmosis that can recur even after 25 years from the primary infection, which poses a significant therapeutic challenge. A 41-year-old female reported to the Ophthalmology Emergency Room due to blurred vision and pain in the right eye, accompanied by a constant headache. The patient suffered from congenital toxoplasmosis with two relapses in the past. On examination, the best-corrected visual acuity was 1,0 in both eyes, and the intraocular pressure was significantly increased. Slit-lamp examination showed vitritis and an active retinochoroidal lesion in the right eye. In the left eye, there was a retinochoroidal scar. A relapse of toxoplasmosis was suspected. Serology for Toxoplasma gondii was positive. Pyrimethamine with sulfadiazine, clindamycin, topical corticosteroids, and intraocular pressure-lowering drugs were implemented. During the treatment, the patient developed corticonuclear cataract in both eyes and reported psychotic symptoms. Clinical condition improved after the treatment with corticosteroids at a lower dose. Treatment of ocular manifestations of congenital toxoplasmosis is challenging. The clinical benefit of treatment should be weighed against side effects for each patient. Running title: Congenital toxoplasmosis treatment
This paper aims to report clinical features, differential diagnosis and successful surgical outcome of a patient with myopic strabismus fixus, also known as Heavy Eye syndrome (HES). We present a case of a 47-year-old man who presented to the Ophthalmology Department with diplopia and poor vision. In the past, he had been diagnosed with Graves’ disease, high myopia, and secondary open-angle glaucoma. He had undergone orbital decompression and cataract surgery of both eyes. On examination, the patient had esotropia and hypotropia with limited abduction and elevation. The patient was ultimately diagnosed with HES. Yokoyama’s surgery combined with a medial rectus muscle recession in the right eye, were performed. The procedure reduced esotropia, hypotropia and improved ductions.
The iridocorneal endothelial syndrome manifests in three clinical types: Chandler syndrome, progressive iris atrophy, and Cogan-Reese syndrome. It is caused by the presence of abnormal corneal endothelium on the iris stroma and anterior chamber angle leading to usually unilateral, progressive iris atrophy, glaucoma, and/or corneal edema. The etiology is yet unclear. It affects mostly young adults, mostly females. Management of iridocorneal endothelial syndrome is complex: conservative and surgical, depending on the stage of the disease and intensity of present symptoms. A 30-year-old female with a medical history of the iridocorneal endothelial syndrome was reported to the Ophthalmology Department for consultation. Slit-lamp examination revealed iris atrophy and superior-nasal corectopia in the left eye. On gonioscopy, the angle was wide open in the right eye, but there were iridocorneal adhesions and incomplete angle-closure in the left eye. The patient was provided with maximum local therapy consisting of three anti-glaucoma medications. On later check-ups, the patient presented corneal edema and increased intraocular pressure. She was qualified to ExPress mini shunt trabeculectomy with mitomycin C. Two years later, a patient came to the clinic because of increased values of intraocular pressure (up to 59 mmHg), slit-lamp examination showed that the ExPress implant was congested with fragments of the corneal endothelial cells. Thanks to YAG iridotomy the implant was recanalized.
This article aims to present up-to-date information on ocular symptoms of pediatric multi-system inflammatory syndrome. The reviewers obtained the results based on a search of an electronic database. The pediatric multi-system inflammatory syndrome appears a few weeks after COVID-19 in children. The exact etiology remains unclear. It is diagnosed based on clinical and laboratory criteria. The most prevalent manifestation of the syndrome is non-purulent conjunctivitis (observed in around 50% of cases). The other ocular findings in the pediatric multi-system inflammatory syndrome can be; eyelid swelling, bilateral uveitis or vitreous hyperreflective dots in the posterior vitreous. The treatment of the ophthalmic symptoms is systemic and topical, targeting the enhanced inflammatory response of the organism and the presence of the given ocular findings.
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