Surgical removal of subretinal cysticercosis in conjunction with administration of intravenous methylprednisolone: A case report

Supplementary data are available online at: https://www.sciencedirect.com/science/article/pii/S2451993625000337?via%3Dihub#appsec1 (Multimedia component 1.video (3 MB)).Purpose: Intraocular cysticercosis in the sub-macular location is a rare but potentially blinding disease. The management requires immediate surgical management and anti-parasitic medications. We present a case of subretinal cysticercosis that was managed with a novel method of intravenous methylprednisolone administration before and after it was surgically removed. Observations: A 17-year-old Indian female patient presented to our clinic with a history of vision deterioration through the last 27 days in her left eye (OS). Best-corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and hand motion OS. Fundus examination showed a healthy-appearing OD and a whitish glow in the macular region OS. She was diagnosed with subretinal cysticercosis and underwent pars plana vitrectomy with in toto removal of the cyst along with pre/post-surgical intravenous methylprednisolone and anti-parasitic medications. A significant visual recovery of 20/60 was achieved three weeks following the surgery in OS. Conclusion and importance: The index case shows a favorable visual recovery in a patient with a subfoveal cyst of relatively long duration. We hypothesize that intravenous methylprednisolone in conjunction with routine treatment may have led to favorable visual outcomes.No funding was received from any individual, institute, or organization to conduct the study. The Byers Eye Institute is a recipient of funding from the National Eye Institute (P30-026,877), and Research to Prevent Blindness, Inc

Effect of Pupil Size on Fixed-Luminance Flicker Full-Field Electroretinogram Magnitude

Purpose: Diopsys® NOVA fixed-luminance flicker full-field electroretinogram (ffERG) device is a potential adjunct to conventional flicker ffERG testing for assessing cone cell function. Magnitude of measured electrical response is known to vary with pupil size in conventional ffERG testing. The index study characterizes the relationship between magnitude of measured electrical activity and pupil size, both pupil diameter and pupil area, for this device. Methods: Seventeen patients (34 eyes) with no known ocular diseases were enrolled in the study. Electrophysiologic function of cone cells was evaluated using fixed-luminance flicker ffERG before and after dilation. Linear regression models, with inter-eye correlations controlled as fixed-effects, were used to characterize the effect of pupil dilation on the magnitude of the measured responses. Results: Mean age of study patients was 33.5 (standard deviation 7.4 years), and 35.3% of the subjects were female. Mean value of electrical response magnitude was 10.07±2.79µV before dilation and 15.30±4.08µV after dilation. The correlations of ERG magnitude with pupil diameter and with pupil area were not significant for either dilated or undilated eyes considered separately but were highly significant (p<0.001) for dilated and undilated eyes considered in aggregate. ERG magnitude tended to increase by 1.08 µV for every 1 mm increase in pupillary diameter. Conclusion: An increase in pupil size, both pupil diameter and pupil area, is significantly associated with an increase in flicker ffERG magnitude recorded by the Diopsys device, suggesting that pupil size should be measured and considered when making clinical judgments based on the flicker ffERGs recorded by the device, and that pupil size-specific reference ranges could improve the clinical utility of the device. © 2022 Mobasserian et al.2773318The Diopsys ERG device at the Byers Eye Institute is on loan from Diopsys, Inc. for clinical and research usage. The abstract of this paper was presented at the Association for Research in Vision and Ophthalmology (ARVO) 2021 Conference as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” in the Investigative Ophthalmology & Visual Science (IOVS) journal. URL: https://iovs.arvojournals.org/article.aspx?arti cleid=2773318. Azadeh Mobasserian and Moosa Zaidi are co-first authors in this work

Neurosarcoidosis, Coccidioidomycosis, or Both!

Amir Akhavanrezayat,1 Wataru Matsumiya,1,2 Prapatsorn Ongpalakorn,1 Hashem H Ghoraba,1 Chris Or,1 Hassan Khojasteh Jafari,1 Gunay Uludag Kirimli,1 Cigdem Yasar,1 Ngoc Trong Tuong Than,1 Irmak Karaca,1 Moosa Zaidi,1 Azadeh Mobasserian,1 Negin Yavari,1 Vahid Bazojoo,1 Yong Un Shin,1 Albert John Bromeo,1 Quan Dong Nguyen1 1Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA; 2Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, JapanCorrespondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute at Stanford University, 2452 Watson Court, Suite 200, Palo Alto, CA, 94303, USA, Tel +1 650 723 9386, Email [email protected]: To report a case of neurosarcoidosis (NS) who was initially diagnosed as Coccidioidomycosis immitis (CI) infection.Observations: A 57-year-old diabetic man presented with sudden painless diminution of vision, metamorphopsia, and color vision deficits in the left eye (OS) for one month. His vision was 20/20 in the right eye (OD) and 20/40 OS. Ophthalmic examination revealed left relative afferent pupillary defect, blurred optic nerve margin, creamy chorioretinal infiltration around the optic disc, and mild macular edema. OD examination was non-revealing. Chest CT scan with contrast showed calcified mediastinal lymph nodes, but biopsy of the lymph nodes was normal. Brain and orbit MRI demonstrated soft tissue abnormality with enhancement in left orbital apex with involvement of the extraocular muscles. CSF culture was negative, but complement fixation had positive titer of 1:2 for CI. The patient was diagnosed with CI meningitis, and antifungal therapy was initiated. Slight visual and symptomatic improvement was observed, which was not completely satisfactory. Biopsy of extraocular orbital muscle five months later revealed non-caseating granulomatous inflammation, leading to initiation of prednisone trial therapy. Nine months later, the patient was referred to a tertiary center owing to persistence of optic disc edema OS. PET CT was consistent with a diagnosis of sarcoidosis. Antifungal treatment was discontinued, and oral prednisone with methotrexate was initiated. Subsequently, methotrexate was replaced by infliximab to further manage ocular inflammation and neurologic symptoms which was effective. Vision was 20/20 OD and 20/30 OS at the most recent visit.Conclusion and Importance: Signs and symptoms of neurosarcoidosis and coccidioidomycosis can be similar and deceiving. The index case underscores importance of considering appropriate differential diagnoses in patients with similar symptoms and signs who may respond to preliminary designated treatment but not to the optimal extent. Considering such possibility could assist clinicians in managing the patients timely and efficiently.Keywords: neurosarcoidosis, coccidioidomycosis, sarcoidosis, ocular involvemen