Successful management of retinal metastasis from renal cancer with everolimus in a monophthalmic patient: a case report

Background

The retina is an uncommon site for metastases, in particular from solid tumors. Some authors have reported a recent increase in the incidence of metastases in infrequent sites, such as brain or bone, probably due to the expanded treatment options and the resulting improved survival. Choroidal metastasis is the most common type of intraocular malignancy. The most common primary sites associated with choroidal metastasis are breast cancer in women and lung cancer in men. Treatment options are limited, but they must be discussed and adapted to the patient profile.

Cases presentation

We report a case of a 62-year-old Moroccan man with a history of monophthalmitis secondary to a war injury of 30 years’ duration. He has been followed for 28 months for metastatic clear-cell renal carcinoma. The first-line treatment was effective for 24 months, before disease progression as retinal metastasis and accentuation of lung metastases. A second-line treatment with everolimus resulted in marked improvement of symptoms, complete recovery of visual function, and partial response in retinal localization.

Conclusions

Choroidal metastasis of renal cancer is a rare situation that must be actively sought in order to arrive at a suitable therapeutic approach.

[Ocular Behçet]

Our study aimed to determine the clinical, therapeutic and prognostic features of ocular involvement in patients with Behçet's disease treated in our Department of ophthalmology. We conducted a retrospective data collection from medical records of 20 patients treated at the military hospital in Laayoune. All patients underwent complete ophthalmological examination and fluorescein angiography if necessary. OCT exam was performed in two patients. Ten patients had anterior uveitis, complicated in one case by ocular hypertonia; two patients had intermediate uveitis; eight patients had posterior segment involvement complicated in one case by intravitreal hemorrhage. Behcet's Disease (BD) is an systemic idiopathic inflammatory disease currently classified within primary non-necrotizing vasculitis. Ocular involvement is common and severe in Behçet's disease, with the potential to compromise the visual prognosis. Behcet's disease is common in Morocco. It can compromise patient's visual prognosis making the collaboration between ophthalmologists and internists particularly important.

Latent tuberculosis-related scleritis: a case report

BACKGROUND

Scleritis is a painful inflammatory process centered in the sclera that may involve the cornea and the underlying uvea. The etiology is commonly idiopathic or autoimmune but some cases are associated with systemic infection such as tuberculosis.

CASE PRESENTATION

In this report, we describe an unusual case of a female Moroccan patient who had a long history of bilateral recurrent scleritis associated with peripheral keratopathy and anterior uveitis. The patient was diagnosed with latent tuberculosis and responded to antitubercular therapy administrated after exclusion of other aetiologies. This patient was finally diagnosed with latent tuberculosis- related scleritis.

CONCLUSIONS

Although systemic tuberculosis is reported as a possible cause of scleritis and other ocular inflammatory manifestations, assessment of the diagnosis of tuberculosis-related ocular inflammation is challenging especially in latent forms. The treatment is largely presumptive. However, a favorable response to antitubercular therapy without relapse is taken as evidence of the disease.

[Vogt-Koyanagi Harada syndrome in its purely ocular form: about a case]

Le syndrome de Vogt-Koyanagi-Harada (VKH) est une affection systémique rare, sévère mettant en jeu le pronostic visuel malgré les traitements agressifs, caractérisée par l'association de plusieurs symptômes: oculaires, méningés, auditifs et cutanés secondaire à une auto-immunisation où le mélanocyte serait la cellule cible. Nous rapportons un nouveau cas rare où l'atteinte oculaire est isolée. La sévérité de l'uvéite réside dans la fréquence des récidives, dans la cortico-résistance et dans la forte incidence des complications qui conditionnent le pronostic et expliquent les acuités visuelles finales médiocres. La prise en charge doit être précoce afin d'essayer d'améliorer le pronostic visuel.

[Palpebral pilomatricoma simulating a chalazion in a young adult]

The pilomatricoma or epithelioma of Malherbe is a mummified benign and rare skin tumor. We report a rare case of palpebral pilomatricoma simulating a chalazion in a 26-year-old patient. This skin tumor is exceptional in adults. Its diagnosis is often missed preoperatively because of its great clinical polymorphism and is histopathologically based on the detection of mummified cells. Its surgical treatment will aim at a complete excision of the tumour in order to minimize the risks of recurrence.

[A new clinical entity: ascending solar iris degeneration. Report of 284 cases]

The observation in a certain number of subjects of an atypical iris depigmentation led us to study this phenomenon. Therefore, the authors engaged in a prospective study of 398 subjects (100 cases in the city of Marrakesh, and 298 in the city of Dakhla). The geography, clinical signs and environmental factors were studied. Depigmentation was observed in 55% of the population of Marrakesh and 77% of the population of Dakhla. It is bilateral, symmetric, very progressive, always begins in the inferior one-third of the iris, and always spares the superior iris covered by the eyelid. By the time the depigmentation reaches the middle one-third, the inferior one-third also begins to demonstrate stromal atrophy: (26 cases). Of the 45 subjects with normal iris pigmentation, 31 cases spend more than 8 hours per day in the shade, and 26 cases constantly use some means of solar protection (sunglasses, caps, "Taraza", "Feroual"). Thus, this acquired iris depigmentation of an ascending nature, accompanied by an advanced stage involving primarily inferior iris atrophy, appears to be closely associated with exposure to the sun. Ascending solar iris degeneration, if we may refer to it as such, is a clinical entity never before reported in the literature. Now that we are faced with this new condition, numerous questions arise, to which future research must respond. Are there other factors in addition to sun exposure, which may lead to the depigmentation? Does this condition lead to further ocular pathology (due to the depigmentation and stromal atrophy)? Must solar protection be prescribed systematically for anyone at risk?

[Sneddon Syndrome and antiphospholipid antibodyies: an etiology of later al homonymous hemianopia]

Sneddon's syndrome is a particular and rare entity that mostly affects young women and whose diagnosis is based on the coexistence of a cuteaneous livedo and a cerebrovascular ischemic attack. It had be considered as being an expression of an occlusive vasculitis or of antiphospholipid antibody syndrome. We report the case of a 20-year-old female, who had developed a left homonymous hemianopia after ischemic encephalopathy. Visual field examination confirmed the presence of a complete left homonymous hemianopia. Cerebral Magnetic Resonance Imaging revealed right occipital cerebrovascular ischemic lesions. Sneddon's syndrome diagnosis was considered on the presence of cutaneous livedo reticularis and associated cerebral ischemic events. With medical treatment, a small functional improvement could be noticed but without net improvement in the visual field defect.

[Macular tuberculoma and optic neuritis: rare association with tuberculosis meningoencephalitis]

INTRODUCTION

Tuberculosis is an endemic disease responsible for death and morbidity in developing countries.

OBSERVATION

A 50-year-old man with no medical history was admitted to the emergency department for meningism associated with fever and confusion. The ophthalmic exam showed a decline in left visual acuity, reduced to light perception, VIth nerve left oculomotor paralysis, ocular fundus demonstrating a yellow tumor located on the posterior segment, measuring 1.5-2mm, papillomatous and prominent in the vitreous cavity. Fluorescein angiography showed a peritumoral choroiditis area, miliary tubercles of the choroid, and sectorial papillomatous edema. Color retinography unmasked inflamed posterior vitreous areas. Echography demonstrated a 4- to 5-mm oval hyperechogeneous and calcified tumor along with hyperechogeneous vitreous areas. Lumbar puncture showed lymphocytic meningitis associated with hyponatremia. The CT scan and MRI demonstrated optic neuritis. The antibiotic therapy was initiated and the outcome was favorable.

CONCLUSION

This case report shows the importance of systematic ocular fundus in the presence of systemic tuberculosis and outlines the assessment of color retinography to unmask vitreous lesions. It shows the importance of radiological imaging in the semiological study of orbital and cerebral lesions.

[Orbital location of Kaposi's sarcoma]

Kaposi's sarcoma is a proliferative disease, probably induced by human herpes virus type 8 (HHV8). Its expression is cutaneous and visceral, with four clinical forms. An orbital location of Kaposi's sarcoma remains exceptional. In order to evaluate the epidemiological, clinical, and therapeutic objectives of this tumor location, we report a case of a 58-year-old patient hospitalized in the ophthalmology department for a surgically treated right orbital tumor.

[Peribulbar anesthesia: comparing 1% ropivacaine and a mixture of 0.5% bupivacaine--2% lidocaine]

PURPOSE

To compare the efficacy of 1% ropivacaine with a mixture of 0.5% bupivacaine and 2% lidocaine in peribulbar anesthesia for elective cataract surgery.

MATERIAL AND METHODS

Prospective double-blinded study, enrolling 100 patients randomly assigned to two different groups. Group 1 received 9 ml of 1% ropivacaine and group 2 received 4.5 ml of 0.5% bupivacaine and 4.5 ml of 2% lidocaine. Both groups received 1 ml of hyaluronidase to reach a total volume of 10 ml.

RESULTS AND CONCLUSION

No difference between the groups was noted during the study regarding not only onset time, but also the duration of anesthesia and perioperative analgesia. A greater incidence of pain on injection was significantly reported in group 2 (p<0.001). Patients in group 1 had less need for top-up injection and showed better ocular akinesia (p<0.01).

[An unusual case of major restriction of eye motility: severe myopia]

Severe restrictive disorders of ocular motility are rarely described in high myopia. Their cause is still unknown. Several theories have been suggested: structural changes in the ocular muscles, sixth-nerve palsy or an elongation of the ocular globe. We report the case of a 44 years old man with high myopia of the left eye and disturbed ocular motility. Medical imaging techniques (echography, CT, MRI) allowed us to objectify the cause of ocular motility problem.

[Olfactory esthesioneuroblastoma with an ophtalmological presentation: a case report]

Esthesioneuroblastoma (ENB) is a rare malignant tumor, which develops from the olfactory neuroepithelium and is one of the rarest tumors of the nasal cavity. Revelation by ocular signs is unusual. We report the original observation of a case of ENB of the olfactive placodes in a 28-year-old adult discovered during exophthalmia. The authors studied the clinical, radiological, pathological, and therapeutic aspects. ENB should not be forgotten in case of unilateral tumorous exophthalmia associating rhinological signs.