Tryfon Rotsos

The purpose of this report is to document the occurrence of transient central retinal artery occlusion (CRAO) as a rare and serious ocular complication in a patient with granulomatosis with polyangiitis (GPA), emphasizing the potential vision-threatening nature of this condition. A 49-year-old male with a known diagnosis of GPA presented with transient CRAO. The case was analyzed to understand the ocular manifestations associated with GPA and the challenges in its management. The patient exhibited a transient CRAO, highlighting the potential for severe ocular complications in the context of GPA. Transient CRAO is a rare but serious vision-threatening complication of GPA. This case underscores the importance of early diagnosis and timely management in patients with ocular manifestations of GPA. Financial disclosure: No financial support was received for this case report. None of the authors has any proprietary interests or conflicts of interest related to this submission. It is not simultaneously being considered for publication at any other journal.

Monoclonal gammopathies can produce a spectrum of ocular manifestations, most commonly paraproteinemic keratopathy, but retinal involvement, though rare, may be vision‐threatening. We report a case of paraproteinemic maculopathy in a 49‐year‐old female with a history of hypertension and albuminuria, who presented with blurred vision and renal impairment. Examination revealed subretinal yellow infiltrates in the posterior pole with hyperautofluorescence on fundus autofluorescence and subretinal fluid with hyperreflective deposits above the retinal pigment epithelium on optical coherence tomography. Laboratory workup identified an excess of free kappa light chains in serum. A diagnosis of light chain deposition disease (LCDD) was made on the basis of a renal biopsy, and systemic therapy was initiated. At 5 months posttreatment, best‐corrected visual acuity improved to 20/20 OU, with resolution of subretinal fluid, although sub‐RPE deposits persisted. This case illustrates that monoclonal free light chains can induce maculopathy through RPE and choroidal depositions, mimicking other macular diseases. Early recognition and systemic treatment targeting the underlying plasma cell disorder are essential for visual recovery. Ophthalmologists should maintain a high index of suspicion for paraproteinemic maculopathy in patients with atypical serous macular detachments, particularly when the findings are bilateral or associated with subtle systemic signs, emphasizing the need for a multidisciplinary approach.

A case of a patient with the Alstrm syndrome (AS) that was misdiagnosed as Lebers hereditary optic neuropathy or retinitis pigmentosa for 13 years is presented. AS is a rare genetic disorder caused by mutations in the ALMS1 gene. AS may lead to abnormal ciliary formation and function. AS affects metabolism, and symptomatology includes type 2 diabetes mellitus (T2DM), obesity, hypogonadism and gynecomastia in males, progressive bilateral sensorineural hearing loss, cardiomyopathy, nonalcoholic fatty liver disease (NAFLD), cirrhosis, and chronic progressive kidney disease. The onset of the above symptoms may vary significantly. The ophthalmic manifestation is early onset cone-rod dystrophy that starts as progressive vision loss, photophobia, and nystagmus in the first months of life. An accurate diagnosis may enable specialists to facilitate a significantly positive effect in the everyday life of a patient. Genetic counseling may also be recommended for these patients. Diagnosis was confirmed by DNA testing, thus highlighting its necessity in everyday practice.

BACKGROUND Central serous chorioretinopathy (CSCR) involves a localized serous macular detachment, secondary to retinal pigment epithelial and choroidal vascular changes, which can be an adverse effect of corticosteroid use. Most CSCR cases resolve spontaneously, and normal vision returns, while some chronic cases can result in blindness. This report is of a 30-year-old man with a recent history of Corona virus disease (COVID)-19 requiring corticosteroid treatment who developed bilateral CSCR with unilateral fibrin and a 7-month follow-up. CASE REPORT A 30-year-old male patient presented with malaise and high fever. The patient tested positive for COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus and was admitted. During hospitalization, he received intravenous (IV) corticosteroids for 1 week (6 mg dexamethasone IV once daily). Following hospitalization, the patient received per os methylprednisolone 16 mg (16 mg once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days). One month later, the patient presented with bilateral visual acuity (VA) deterioration and acute CSCR. The diagnosis and follow-up were performed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). The patient was followed-up for a period of 7 months, during which, although the VA improved and remained stable, the OCT findings were changing. CONCLUSIONS This report highlights the importance of timely ophthalmological examination in patients with sudden vision loss and identification of the association between corticosteroid use and CSCR, as well as the importance of a longer follow-up period.

Two cases with peripapillary pachychoroid syndrome (PPS) along with the challenges concerning correct diagnosis and treatment are presented. In the first case, the patient presented with painless unilateral gradual visual loss. Fundoscopy and optical coherence tomography (OCT) revealed cystoid macular edema (CME) in the left eye (LE), extending from the temporal optic disc margin towards the fovea, with no additional findings. Enhanced-depth imaging- (EDI-) OCT provided additional information and increased choroidal thickness nasally to the macula and pachyvessels in the outer choroidal layer, findings supportive of PPS. Photodynamic therapy (PDT) was applied at the leakage sites. Two months later, CME and subretinal fluid (SRF) had resolved, and VA had significantly improved. In the second case, a patient presented with reduced vision and metamorphopsia bilaterally over the previous 5 days. Fundoscopy revealed CME in both eyes. OCT confirmed the presence of CME in the papillomacular area in the right eye; similarly, CME was recorded in the macula of the LE with SRF located subfoveally. EDI-OCT showed increased choroidal thickness in both eyes. Treatment was administered, originally with dorzolamide eye drops along with eplerenone tablets, and then dexamethasone eye drops that eventually led to significant anatomic and functional improvement. It is important for ophthalmologists to be able to recognize the unique clinical entity of PPS, as its resemblance to disorders with similar features may lead to misdiagnoses and unnecessary, or even incorrect, interventions.

An unusual case of nitroglycerin-induced Paracentral Acute Middle Maculopathy (PAMM) is presented. A 50-year-old patient with sudden vision loss and scotoma was followed up with swept-source optical coherence tomography (SS-OCT), optical coherence tomography-angiography (OCT-A), and fluorescein angiography (FA). An anal fissure treated with glyceryl trinitrate (GTN) 0.2 ointment with headache and dizziness after application was reported. Fundoscopy OS revealed mild retinal venous dilatation and tortuosity with scattered blot hemorrhages and subtle, parafoveal, whitish lesions in the outer retina. SS-OCT revealed diffuse, hyperreflective lesions in the inner plexiform (IPL), inner nuclear (INL), and outer plexiform layers (OPL). OCT-A revealed focal dropout in the deep capillary plexus. FA showed masking due to blot hemorrhages and early punctuate leakage in the inner retina. This entity was identified as nitroglycerin-induced PAMM. Over the following 8 months, after discontinuation of the ointment application, the patient was symptom-free with stable visual acuity. OCT revealed INL/OPL thinning and confirmed complete lesion resolution. This first report of retinal vascular abnormalities due to nitrite ointment provides an insight into an unknown side effect of nitroglycerin ointment use. A dose-dependent correlation between GTN application and retinal vascular abnormalities remains to be confirmed.