搜索结果：American journal of ophthalmology case reports

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1·3 billion (95% uncertainty interval [UI] 1·2 to 1·4) individuals were estimated to be living with MASLD (ie, 16·1% of the global population), with an age-standardised prevalence rate of 14 429·3 (95% UI 13 268·3 to 15 990·6) per 100 000 population, representing a percentage increase of 142·7% (95% UI 139·2 to 146·7) in crude numbers from 1990 (0·5 billion [0·5 to 0·6]) and of 28·6% (27·8 to 29·5) in the rate (11 217·2 [10 276·8 to 12 467·0] per 100 000 in 1990). An estimated 3·6 million (2·8 to 4·5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39·6 (31·2 to 49·9) per 100 000 population. Despite a 116·3% (93·3 to 139·4) increase in crude DALYs (from 1·7 million [1·3 to 2·1] in 1990), its age-standardised estimate remained consistent (1·8% [-8·6 to 12·8]) from 1990 (38·9 [30·1 to 49·8] per 100 000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29 246·1 [26 848·3 to 32 048·7] per 100 000) and Andean Latin America showed the highest DALY rate (152·3 [114·1 to 194·7] per 100 000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653·5 [7923·7 to 9592·8] per 100 000) and east Asia had the lowest DALY rate (16·3 [13·5 to 19·9] per 100 000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15 616·4 [14 349·2 to 17 263·3] per 100 000 people in 2023) than in females (13 245·2 [12 132·0 to 14 692·6] per 100 000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2·2 [95% UI 1·6 to 3·1] per 100 000 people), followed by high BMI (1·4 [0·6 to 2·4] per 100 000 people) and smoking (1·0 [0·3 to 1·8] per 100 000 people). Our forecasting model estimates that 1·8 billion (95% UI 1·6 to 2·0) individuals are likely to have MASLD by 2050, representing a 42·0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15 774·9 (95% UI 14 613·9 to 17 336·2) per 100 000 people in 2050, representing an average annual percentage change of 0·3% (95% UI 0·3-0·3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16·1% and approximately 1·3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.

To compare the clinical findings and high-resolution optical coherence tomography (OCT) features of two cases of intraretinal silicone oil (SO) migration in the fovea following repair of fovea sparing rhegmatogenous retinal detachment. In case 1, a 53-year-old female with 20/20 visual acuity had a fovea sparing retinal detachment with grade C proliferative vitreoretinopathy repaired with vitrectomy, scleral buckle, and 1000 centistoke SO tamponade for 5 months. After SO removal, visual acuity was 20/400. In case 2, a 66-year-old-male with 20/25 visual acuity presented with a recurrent fovea sparing retinal detachment repaired with vitrectomy, scleral buckle, and 5000 cSt SO tamponade for 3 months. After SO removal, visual acuity remained 20/25. Intraretinal SO was detected in the fovea on OCT about 4 months after surgery for case 1, and 1 month after surgery for case 2. Intraretinal SO droplets were characterized by focal hyper-reflective light reflexes at the apex and base of SO droplet and increased hyperreflectivity projecting posteriorly. Prototype high resolution (HR) OCT parafoveal layer thickness maps demonstrated ganglion cell layer (GCL) thinning in both cases compared with the contralateral unaffected eye; however, the thinning was more severe in case 1 consistent with worse visual acuity. Over the course of one year HR OCT demonstrated no evidence of adverse reaction to SO and minimal change in SO size and location in both cases. Intraretinal migration of SO into the fovea, after repair of macula sparing retinal detachment, remained stable without evidence of adverse reaction after 1 year of follow-up. Using HR OCT, severe parafoveal GCL thinning, compared to fellow healthy eye, was associated with central vision loss while moderate parafoveal GCL thinning was associated with maintained central vision. Further study is needed to determine if parafoveal GCL thickness measurements can help guide timely SO removal.

We report the case of a 38-year-old woman presenting with acute bilateral paracentral scotomas in the context of a COVID-19 infection. Multimodal imaging confirmed the diagnosis of acute macular neuroretinopathy (AMN). Flood-illumination adaptive optics (FlAO) imaging was used to monitor photoreceptor structural anatomy over an 11-month period, providing high-resolution longitudinal data. FIAO analysis revealed a marked reduction in cone reflectivity in the affected areas at baseline, followed by partial restoration of the cone mosaic at follow-up, likely reflecting outer segment recovery. To date, only few reports have described the use of adaptive optics in AMN with extended follow-up. This case highlights the utility of advanced imaging techniques in characterizing the evolution of pathologies such as AMN and monitoring their progression over time.

To report a case of spontaneous closure of full-thickness macular hole in highly myopic eye. A 68-year-old female with a known history of high myopia presented for routine annual ophthalmologic evaluation. Optical coherence tomography (OCT) was performed revealing an incidental finding of a full-thickness macular hole (FTMH) in the left eye. Given the patient's stable vision and absence of symptoms, a decision was made to observe without surgical intervention. At the 3-month follow-up, repeat OCT demonstrated spontaneous closure of the macular hole with structural and functional improvement of the photoreceptors. Routine imaging in myopic patients can reveal silent but potentially vision-threatening lesions such as macular holes. Although uncommon, spontaneous closure of FTMH in myopic eyes can occur and warrants consideration in patient counselling and management decisions with appropriate caution regarding long-term stability.

Ahmed glaucoma valve (AGV) migration is a rare postoperative complication after AGV implantation. We report a single case of AGV posterior migration in the early postoperative period. A 67-year-old male patient with a history of primary open angle glaucoma, diabetes, and pseudophakia of both eyes presented two days after AGV placement in the right eye. He reported right eye pain, fever, and chills. On examination, he had broken sutures at the valve placement site, purulent discharge from the upper fornix, and an elevated intraocular pressure of 34 mmHg in the right eye. The patient was sent to the hospital due to concerns for orbital cellulitis. Computerized tomography (CT) showed superotemporal post-septal migration of the AGV plate and tube. The patient was admitted to the hospital and started on broad-spectrum intravenous (IV) antibiotics. Cultures of the right eye drainage grew Group A beta-hemolytic streptococci. Six days after the original AGV placement, the patient underwent orbital exploration with removal of the displaced AGV from the posterior third of the globe by an oculoplastics surgeon. The entire AGV plate and tube were removed intact. The wound was irrigated with vancomycin and the conjunctiva was closed. Two days after the AGV removal, the patient showed significant clinical improvement. Upon further investigation, it was determined that the plate was not secured with fibrin glue or suture, only the patch graft was secured with suture. AGV posterior migration following AGV implantation is a rare but serious postoperative complication that must be recognized early and managed appropriately.

To present a proof-of-concept case series documenting the novel in-vivo progression of retinal microaneurysms (MAs) into retinal capillary macroaneurysms (RCMAs) in diabetic retinopathy (DR) using serial optical coherence tomography (OCT). We longitudinally followed four treatment-naïve DR eyes. Over 9 to 30 months, serial OCT clearly captured the enlargement of pre-existing MAs into distinct RCMAs, characterized by a marked increase in wall reflectivity and significant morphological remodelling. This conversion consistently coincided with a notable exacerbation of localized diabetic macular edema (DME) and increased hyperreflective intraretinal dots (HRIDs), indicative of increased inflammation and leakage. The MAs originated in both inner and middle retinal layers. Our series presents the first in vivo, multi-case demonstration of MAs dynamically enlarging into RCMAs, a clinically significant and aggressive form of diabetic microvascular disease. This transformation is consistently associated with worsening CME and increased HRIDs, marking RCMAs as a more exudative and potentially treatment-resistant subset of DME. Emerging evidence, supported by our observations, suggests that many RCMAs may arise at interconnecting vertical channels between the superficial and deep capillary plexuses, where mixed arterial-venous flow and focal pressure gradients predispose to outpouching. These findings challenge current uniform therapeutic approaches, underscoring the importance of serial-OCTs in detecting and characterizing this evolution. Early OCT-based identification could enable more tailored interventions, reducing the risk of severe vision loss. Future research should further clarify systemic and local drivers of this progression, refine OCT biomarkers, and assess whether aggressive or multimodal therapy targeting RCMAs improves patient outcomes.

Intrastromal misplacement of a foldable intraocular lens (IOL) during cataract surgery is exceedingly rare. Immediate identification of the separation plane is critical to prevent additional corneal injury. A 76-year-old woman with bilateral glaucoma underwent routine phacoemulsification. During insertion of a one-piece acrylic IOL, the lens was inadvertently delivered into the corneal stroma. The IOL remained partially unfolded within a stromal pocket. Intraoperative anterior segment optical coherence tomography (AS-OCT; RESCAN 700) clearly demonstrated deep stromal migration of the IOL and a thick, taut, hyperreflective line consistent with a Type-1 separation of Dua's layer adherent to Descemet's membrane. This real-time confirmation enabled controlled removal of the misdirected IOL without Descemet's membrane rupture, followed by successful in-the-bag implantation of a new IOL and intracameral air tamponade. Postoperative AS-OCT showed gradual resolution of the separation without additional intervention. At 6 months, the cornea remained clear with improved visual acuity (0.6 to 0.7; logMAR 0.22 to 0.15) and an endothelial cell density of 1253 cells/mm2 (52.8% loss). At 17 months, visual acuity remained 0.7, and endothelial cell density was 1158 cells/mm2 (56.4% loss), and corneal clarity was maintained. Intraoperative AS-OCT provided decisive, real-time visualization of the stromal entry plane and Type-1 Dua's layer separation, allowing safe retrieval of the misdirected IOL and preservation of Descemet's membrane integrity. Recognition of this separation pattern is essential for guiding atraumatic management of this extremely rare complication.

Acetazolamide is the mainstay of treatment for idiopathic intracranial hypertension (IIH). Transient myopia is a rare ocular adverse effect, usually attributed to ciliary body edema and forward displacement of the lens-iris diaphragm. A 44-year-old woman developed IIH during pregnancy following hormonal therapy for in-vitro fertilization. She was started on acetazolamide 1 g/day and, after five doses, experienced sudden bilateral blurred vision that improved with myopic correction and resolved spontaneously within 24 hours after discontinuation of acetazolamide. Examination showed no signs of angle closure or choroidal effusion. Optical coherence tomography (OCT) confirmed preserved ganglion cell layer and no axonal loss. After counselling the patient about the potential for recurrent transient myopia and other acetazolamide-related adverse effects, acetazolamide was reintroduced at a lower dose (500 mg/day). No recurrence of myopia occurred, and papilledema improved markedly over six weeks. This case illustrates a rare idiosyncratic effect of acetazolamide in pregnancy-associated IIH and demonstrates that rechallenge at a lower dose may be tolerated without recurrence.

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

Cutaneous melanoma is the most common malignancy to present with vitreous metastasis. This report describes a case of vitreous metastasis from acral lentiginous melanoma masquerading as intermediate uveitis in a patient undergoing checkpoint inhibitor (CPI) therapy. This is an 86-year-old Caucasian female with Stage III Acral Lentiginous Melanoma of the left heel who was initiated on nivolumab and relatlimab along with intralesional talimogene laherparepvec (TVEC). Eight months later she developed blurry vision and floaters. She was diagnosed elsewhere with unilateral acute intermediate uveitis, leading to discontinuation of immunotherapy and initiation of topical difluprednate. Extensive infectious and autoimmune work-up including MRI of the brain and orbits was negative. Failing to improve, she presented to our hospital. Exam of the right eye showed best corrected visual acuity 20/50, intraocular pressure of 16 mmHg, keratic precipitates, 1+ anterior cells, and 2+ large amelanotic vitreous cells arranged in veils. The left eye was quiet. Vitreous biopsy revealed malignant melanoma cells, confirming metastatic melanoma. The patient underwent a therapeutic pars plana vitrectomy, intravitreal melphalan injection, and ocular radiotherapy, with resolution of vitreous metastasis. Several atypical, red flags in this patient may serve as clinical indicators; history of malignancy with locoregional progression, timing of immune CPI therapy to symptom onset, failure to treatment response, and large white, amelanotic vitreous cells arranged in veils. This case emphasizes the importance of maintaining a broad differential diagnosis in patients with atypical, or treatment resistant uveitis, especially in individuals with known underlying malignancy.

To report a rare case of a full-thickness macular hole (FTMH) that underwent spontaneous closure on two separate occasions following vitrectomy and intraocular lens (IOL) scleral fixation. A 58-year-old man, who had undergone IOL scleral fixation and vitrectomy for a dislocated IOL, developed an FTMH (minimum diameter: 21 μm) in the left eye approximately one year post-surgery. While awaiting surgical intervention, the macular hole closed spontaneously two months after its discovery. Two years and nine months later, the FTMH recurred (minimum diameter: 180 μm) and closed spontaneously again within four weeks. Optical coherence tomography (OCT) confirmed the presence of epiretinal proliferation (EP) at the macular surface during both occurrences. Small-diameter FTMHs that form after vitrectomy, particularly those with associated EP, may have the potential for spontaneous closure. This case indicates that short-term observation may be a reasonable management option for select cases of small post-vitrectomy macular holes before proceeding with further surgery.

Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.

Individuals with hereditary retinoblastoma (RB) carry a heightened risk of developing subsequent malignant neoplasms that is amplified by prior radiation treatment. Here, we present a novel case of intraocular extraskeletal osteosarcoma (ESOS) arising in the phthisical eye of an irradiated, heritable RB survivor. A 23-year-old man with a history of bilateral RB presented with a year of left orbital and eye pain. On examination, the left eye had mucopurulent discharge and exposed orbital tissue. On imaging, the left globe, periocular structures, optic nerve, and optic nerve sheath were surrounded by abnormal contrast enhancement. As a result, the left eye was enucleated. On histopathology, an ESOS filled most of the globe with extraocular extension. The tumor was associated with focal, benign-appearing intraocular bone of the type commonly seen in phthisical eyes. The patient was found to have pulmonary metastases, consistent with metastatic stage IV osteosarcoma. He was started on systemic chemotherapy and underwent an exenteration of the left orbit. This case highlights a rare manifestation of osteosarcoma in an irradiated, heritable RB survivor. It underscores the need for longitudinal ophthalmic examination that potentially includes periodic echography when eyes are phthisical, and oncologic surveillance in RB survivors to facilitate early diagnosis and intervention for life-threatening secondary malignancies. The findings also suggest that osteosarcoma can arise from metaplastic bone within phthisical globes.

We report a unique case of iris metastasis from epidermal growth factor receptor (EGFR)-positive lung adenocarcinoma, diagnosed solely by cytologic analysis of aqueous humor without tissue biopsy. A 56-year-old man with a known history of lung adenocarcinoma presented with unilateral iris masses, anterior chamber inflammation, and secondary glaucoma. Intraocular pressure was initially controlled with cataract surgery combined with microhook trabeculotomy. However, the pressure re-elevated despite maximal topical antiglaucoma therapy (including a prostaglandin analog, beta-blocker, carbonic anhydrase inhibitor, alpha-2 agonist, and Rho-kinase inhibitor) and oral acetazolamide. Three sessions of transscleral cyclophotocoagulation were performed. In addition, two intravitreal injections of aflibercept (2.0 mg each) were administered for rubeosis iridis. Aqueous humor obtained via anterior chamber paracentesis immediately before intravitreal injection demonstrated Class V adenocarcinoma cells on cytology, allowing the diagnosis of iris metastasis without iris biopsy.The lesions subsequently enlarged, and similar iris lesions appeared in the fellow eye during the final 1 month before the patient's death. Systemic disease progression became evident during the final 1 month before death, and the patient ultimately succumbed 9 months after the initial visit. Conclusions and Importance: This is among the few reported cases of iris metastasis confirmed solely by aqueous cytology. This case underscores the diagnostic utility of anterior chamber paracentesis as a less invasive yet reliable alternative to iris biopsy in carefully selected patients. It also highlights the clinical course and therapeutic challenges in managing anterior segment metastasis from epithelial tumors such as lung cancer.

The Smaller-Incision New-Generation Implantable Miniature Telescope (SING IMT) is an IOL designed to enhance central vision in patients with bilateral late-stage AMD. This report describes a case of successful surgical repositioning of a tilted SING IMT following haptic displacement out of the capsular bag. A 77-year-old man with bilateral geographic atrophy and baseline CDVA (Corrected Distance Visual Acuity) of logMAR 0.96 (Snellen 20/200) underwent uncomplicated implantation of a SING IMT in the right eye. Six weeks postoperatively, CDVA showed no improvement, and the patient reported monocular diplopia with off-axis visual perception. Retinal morphology remained stable. Slit-lamp and anterior segment OCT revealed pronounced optic tilt caused by inferior haptic dislocation out of the capsular bag. The haptic was successfully repositioned by performing superior traction with a push-pull hook, resulting in restoration of straight, diplopia-free vision and an improvement in CDVA to logMAR 0.52 (Snellen 20/63). Prompt surgical correction of haptic displacement may fully restore the optical and functional benefits of the SING IMT without compromising corneal health.

Neuro-ophthalmic manifestations are common in patients with advanced human immunodeficiency virus (HIV) infection and may result from opportunistic intracranial infections. However, partial pupil-sparing third cranial nerve palsy is an uncommon presentation in this population and may be misleading, as it is often presumed to be ischemic. We report an atypical presentation of cerebral toxoplasmosis manifesting as partial pupil-sparing third nerve palsy. We report the case of a 37-year-old HIV-positive male with advanced human immunodeficiency virus infection who presented with headache, seizures, and binocular diplopia and was found to have a partial pupil-sparing third nerve palsy. Neuroimaging revealed multiple intracranial enhancing lesions with surrounding vasogenic edema. Cerebrospinal fluid analysis demonstrated varicella zoster virus positivity, and stereotactic brain biopsy ultimately confirmed cerebral toxoplasmosis. The patient was managed with antimicrobial therapy and showed clinical improvement. In patients with human immunodeficiency virus infection, pupil-sparing third nerve palsy should not be presumed to be exclusively ischemic, as infectious and other opportunistic etiologies may underlie its presentation. Careful clinical assessment, detailed examination, and appropriate neuroimaging are essential for accurate diagnosis and timely management.

Belzutifan, a hypoxia-inducible factor-2α (HIF-2α) inhibitor approved for von Hippel-Lindau (VHL) disease-related tumors, induces radiological responses in hemangioblastomas, but the timing and extent of early changes are not well defined. A 9-year-old girl was admitted with nausea, vomiting, and ataxia. Brain MRI showed a cystic cerebellar mass, which was fully resected; histology and genetic testing confirmed VHL. Follow-up revealed a small stable cerebellar residual. Two years later, she developed multiple retinal hemangioblastomas (RH) with major visual decline and new cerebellar nodules. Argon laser photocoagulation provided no lasting benefit, prompting initiation of belzutifan. The drug was well tolerated over the first six months, with only grade 1 anemia. Psychological assessments documented excellent adaptation, preserved quality of life, stable daily routines, and regular school attendance. MRI demonstrated a marked reduction in two of the three cerebellar nodules as early as day 15 of cycle 1, followed by progressive shrinkage and stabilization by cycle 4. No new RH emerged, and visual acuity improved within eight weeks of treatment and then remained stable. This case highlights an unusually rapid radiological response of VHL-associated cerebellar and retinal hemangioblastomas shortly after belzutifan initiation, suggesting that imaging performed soon after treatment onset may detect changes earlier than commonly reported. A slight but measurable improvement in visual acuity was also observed, despite the overall structural stability of the RH. These findings support the potential value of early radiological and functional assessment in selected patients receiving HIF-2α inhibitors.

Retinal pigment epithelium (RPE) adenoma represents an extremely rare posterior segment tumor with frequent diagnostic challenges, commonly mimicking vasoproliferative tumors or amelanotic choroidal melanoma. This report details a novel case of peripheral nonpigmented RPE adenoma coexisting with retinitis pigmentosa (RP), highlighting diagnostic complexities in dual pathology presentation. A 77-year-old male presented to the Department of Ophthalmology at Shanghai General Hospital with a two-month history of progressive vision loss in his right eye. Best-corrected visual acuity (BCVA) was finger-counting (FC) in the right eye and 20/30 in the left. Bilateral fundus examination revealed mid-peripheral bone-spicule-like pigmentary deposits. In the right eye, a yellowish-white retinal mass was observed at the supratemporal vascular arcade, accompanied by retinal detachment extending into the macula. The patient underwent combined cataract surgery and vitrectomy in the right eye. Based on clinical and multimodal imaging findings, the patient was diagnosed with peripheral nonpigmented RPE adenoma and RP. Over three months of follow-up, his visual acuity remained stable (FC), with normal intraocular pressure and maintained retinal attachment. Subsequent silicone oil removal was performed without complications. This case highlights a rare occurrence of nonpigmented RPE adenoma in association with RP. Given its phenotypic resemblance to choroidal melanoma, three critical insights emerge: 1) RPE adenoma should be considered in the differential diagnosis when RP patients develop atypical retinal masses, 2) Diagnostic confirmation requires histopathological verification through immunohistochemical (IHC) markers and 3) Multidisciplinary evaluation integrating clinical, imaging, and histopathological data is essential to prevent misdiagnosis. This dual pathology presentation expands our understanding of retinal tumor manifestations in hereditary retinal degenerations.

To present a case of advanced glaucoma and central retinal vein occlusion (CRVO) linked to elevated episcleral venous pressure (ESVP) in the setting of double-chambered right ventricle (DCRV), a rare congenital cardiac anomaly. A 40-year-old man presented with advanced bilateral glaucoma and longstanding light perception vision in the right eye due to CRVO and neovascular glaucoma. Examination revealed elevated intraocular pressures (IOP) and bilateral corkscrew episcleral vessels, consistent with elevated ESVP. Systemic workup uncovered erythrocytosis and an undiagnosed DCRV with severe right ventricular outflow tract obstruction. Despite medical therapy, progressive glaucoma in the left eye required surgical intervention with Xen gel stent implantation. Initial IOP control was achieved but later increased due to iris incarceration and bleb fibrosis, requiring surgical revision and implantation of a new Xen stent. The patient also underwent cardiac surgery to correct the congenital defect. After cardiac surgery and new Xen implantation, IOP stabilized at 10-12 mmHg without topical medications. Congenital cardiac anomalies such as DCRV can result in secondary glaucoma and CRVO. However, reports of ocular complications in patients with congenital heart disease remain limited, warranting heightened clinical awareness. This case illustrates the importance of evaluating systemic and cardiac causes in patients presenting with glaucoma secondary to elevated ESVP. Appropriate investigation can reveal life-altering diagnoses as seen in our patient where a cardiac anomaly was identified and necessitated surgical correction. Glaucoma management in this context is particularly challenging and this case illustrates the unique limitations and important considerations involved in both medical and surgical treatments.