Case Reports in Ophthalmological Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Choroidal Coloboma in a Case of Tay-Sachs Disease Wed, 10 Sep 2014 05:33:42 +0000 Coloboma as an ocular finding has been documented in various syndromes. Here we have a case of infantile Tay-Sachs disease associated with unilateral choroidal coloboma. To the best of our knowledge, such an association has not been documented in the literature. Whether such an association is a matter of chance or signifies the involvement of ganglioside metabolism in ocular embryogenesis remains to be elucidated. Nasreen Raees Ahmed, Koushik Tripathy, Vivek Kumar, and Varun Gogia Copyright © 2014 Nasreen Raees Ahmed et al. All rights reserved. Acute Central Retinal Vein Occlusion Secondary to Reactive Thrombocytosis after Splenectomy Mon, 08 Sep 2014 12:54:51 +0000 The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. The patient was treated with steroids for papilledema and administered coumadin and aspirin. The symptoms resolved, and the findings returned to normal within three weeks. Current paper emphasizes that, besides other well-known thrombotic events, reactive thrombocytosis after splenectomy may cause central retinal vein occlusion, which may be the principal symptom of this risky complication. Thus, it can be concluded that followup for thrombocytosis and antithrombotic treatment, when necessary, are essential for these cases. Nursen Oncel Acir, Mehmet Borazan, and Zeynep Dadaci Copyright © 2014 Nursen Oncel Acir et al. All rights reserved. Transient Anisocoria after Corneal Collagen Cross-Linking Mon, 08 Sep 2014 00:00:00 +0000 Purpose. To report a case with transient anisocoria after corneal collagen cross-linking (CXL). Methods. Case report. Results. A 24-year-old male underwent corneal collagen cross-linking (CXL) in his right eye for keratoconus. At the end of the procedure, the pupil of the treated eye was irregular and dilated, while the pupil of the fellow eye was round, regular, and reactive (anisocoria). The following day, pupils were round, regular, and reactive in both eyes. Conclusion. Anisocoria may be a transient and innocuous complication after CXL. A possible cause for this complication might be the anesthetic drops used before and during the surgical procedure or/and the ultraviolet A irradiation during the treatment. George D. Kymionis, Michael A. Grentzelos, Nela Stojanovic, Theodore A. Paraskevopoulos, and Efstathios T. Detorakis Copyright © 2014 George D. Kymionis et al. All rights reserved. First Reported Case of Proliferative Retinopathy in Hemoglobin SE Disease Thu, 21 Aug 2014 13:13:39 +0000 We report the first case of proliferative sickle cell retinopathy in a patient with hemoglobin SE (Hb SE) disease. Only a few dozen cases of Hb SE disease have been reported previously, and none had evidence of proliferative retinopathy. A 56-year-old African American man presented to our clinic for routine examination and was found to have sea-fan peripheral neovascularization bilaterally without maculopathy. Hemoglobin analysis revealed Hb SE heterozygosity. Sector laser photocoagulation to areas of nonperfusion in both eyes resulted in regression of the peripheral neovascularization over a period of 6 months. Although Hb SE disease is rare, the incidence of Hb SE disease is postulated to rise in the future. Awareness of its potential ocular complications is needed to appropriately refer these patients for screening. Paul Baciu, Christopher Yang, Aldo Fantin, Deborah Darnley-Fisch, and Uday Desai Copyright © 2014 Paul Baciu et al. All rights reserved. Intrasurgical Imaging of Subinternal Limiting Membrane Blood Diffusion in Terson Syndrome Thu, 14 Aug 2014 12:52:28 +0000 We report a case of Terson syndrome, providing the first intrasurgical imaging of subinternal limiting membrane blood diffusion in Terson syndrome. We highlight some remarkable in vivo anatomical findings that may give a contribution to the debate about its pathogenesis. Here we hypothesize that the subretinal space might be unlikely to be a primary source of intraocular hemorrhage, and we support the two generally accepted theories about blood diffusion from the retinal vasculature or from the perivascular spaces. Lorenzo Iuliano, Giovanni Fogliato, and Marco Codenotti Copyright © 2014 Lorenzo Iuliano et al. All rights reserved. Definite Ocular Sarcoidosis Using Endobronchial Ultrasonography with Transbronchial Needle Aspiration Thu, 14 Aug 2014 11:44:22 +0000 Purpose. To introduce a minimally invasive procedure, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), to obtain a pathologic evidence of a definite ocular sarcoidosis in a patient who initially presented with presumed ocular sarcoidosis with pulmonary involvement. Methods. An EBUS-TBNA procedure was performed at perihilar lymph nodes, subcarina, and right paratrachea of the patient and specimen obtained was sent for histocytopathological studies. Result. Histocytopathological findings revealed aggregates of epithelioid histiocytes forming a noncaseous granuloma, a hallmark of sarcoidosis. Conclusion. EBUS-TBNA should be considered an alternative procedure to provide cytohistopathology proven diagnosis of definite ocular sarcoidosis. Sukhuma Warrasak, Sawang Saenghirunvattana, Ataya Euswas, Santa Methasiri, Surapon Worapongpaiboon, and Supranee Nirapathpongporn Copyright © 2014 Sukhuma Warrasak et al. All rights reserved. Optical Coherence Tomography of Bilateral Nanophthalmos with Macular Folds and High Hyperopia Tue, 12 Aug 2014 09:17:27 +0000 Importance. There is a conflict about the content of the macular folds in nanophthalmic eyes in the literature. Our study clearly demonstrated that papillomacular folds seen in nanophthalmos or posterior microphthalmos were only composed of neurosensory retina without involvement of retinal pigment epithelium and choroid. Observations. This is a report of two consecutive nanophthalmic patients with macular folds at Maltepe University School of Medicine, Department of Ophthalmology, from January to June 2012. Anterior segment dimensions were near normal. The axial lengths of the eyes were short with markedly shortened posterior segment. A macular fold extending from the center of the fovea towards the optic nerve head was present in all eyes. Optic coherence tomography clearly demonstrated that folds were only composed of neurosensory retina. Binocular visual acuities and refractive errors of the cases were 0.3, 0.2 and +16.00, +15.75 diopters, respectively. Conclusions and Relevance. Our study proposes a surgical option to treat these folds like serous retinal detachments by showing the true content of the folds, although there is not any surgical operation accepted for this condition yet. Further studies dealing with the surgical interventions of these folds should be performed to support this option. Firat Helvacioglu, Ziya Kapran, Sadik Sencan, Murat Uyar, and Ozlem Cam Copyright © 2014 Firat Helvacioglu et al. All rights reserved. Effectiveness of Posaconazole in Recalcitrant Fungal Keratitis Resistant to Conventional Antifungal Drugs Mon, 11 Aug 2014 11:33:22 +0000 Purpose. To present the success of posaconazole in two cases with recalcitrant fugal keratitis that were resistant to conventional antifungal drugs. Method. We presented two cases that were treated with posaconazole after the failure of fluconazole or voriconazole, amphotericin B, and natamycin therapy. Case 1 was a 62-year-old man with a history of ocular trauma. He had been using topical fluorometholone and tobramycin. His best corrected visual acuity (BCVA) was hand motion. He had 5.0 × 4.5 mm area of deep corneal ulcer with stromal infiltration. Case 2 was a 14-year-old contact lens user. He had been using topical moxifloxacin, tobramycin, and cyclopentolate. His BCVA was 20/200. He had a 4.0 × 3.0 mm area of pericentral corneal ulcer with deep corneal stromal infiltration and 2 mm hypopyon. Results. Both patients initially received systemic and topical fluconazole or voriconazole and amphotericin B and topical natamycin that were all ineffective. But the response of posaconazole was significant. After posaconazole, progressive improvement was seen in clinical appearance. BCVA improved to 20/100 in case 1 and 20/40 in case 2. Conclusion. Posaconazole might be an effective treatment option for recalcitrant fusarium keratitis and/or endophthalmitis resistant to conventional antifungal drugs. A. Altun, S. A. Kurna, T. Sengor, G. Altun, O. O. Olcaysu, S. F. Aki, and M. H. Simsek Copyright © 2014 A. Altun et al. All rights reserved. Cervical Carcinoma Manifesting as Progressive Bilateral Visual Loss Wed, 06 Aug 2014 11:24:35 +0000 We report a patient with bilateral choroidal metastasis from disseminated cervical squamous cell carcinoma. A 52-year-old woman presented with progressive bilateral visual loss due to choroidal masses in both eyes. The fundus examination revealed posterior serous retinal detachment in both eyes associated with creamy choroidal lesions. A thorough systemic work-up revealed choroidal metastasis from a squamous cell carcinoma of the cervix. This case highlights the importance of a thorough systemic evaluation in patients with choroidal tumours. O’Sam Shibeeb, Paul Athanasiov, Sumu Simon, and Jagjit Gilhotra Copyright © 2014 O’Sam Shibeeb et al. All rights reserved. Cytomegalovirus Retinitis in an ALL Child during Maintenance Therapy Treated Successfully with Intravenous Ganciclovir Sun, 03 Aug 2014 06:43:44 +0000 Purpose. In here we described cytomegalovirus retinitis (CMVR) in 12-year-old male patient with acute lymphoblastic leukemia (ALL) who was on maintenance phase therapy. Methods. He was referred to our clinic for seeing of spots with the right eye for 3 days. At presentation, his best corrected visual acuity was 20/20 in the right eye and 20/20 in the left eye. Slit-lamp biomicroscopic examination of the anterior chamber of the left eye was within normal limits, whereas we observed 3+ anterior chamber cellular reaction in the right eye. On retinal examination, we found active retinitis lesions (cream-colored lesions associated with hemorrhages) and perivascular cuffing in the retinal periphery in the right eye. Left eye was normal. Results. On the basis of clinical picture, we made the diagnosis of CMVR in the right eye. Vitreous aspiration was performed and 23096 copies/mL of CMV DNA was detected by polymerase chain reaction (PCR) technique. The patient was successfully treated with intravenous ganciclovir for two weeks and discharged with oral valganciclovir prophylaxis. Conclusion. CMVR should be in mind in children with ALL on maintenance phase therapy even in those without hematopoietic stem cell transplantation. These patients can be treated successfully by intravenous ganciclovir alone. Hande Celiker, Ayse Karaaslan, Eda Kepenekli Kadayifci, Serkan Atici, Ahmet Soysal, Haluk Kazokoglu, and Ahmet Koc Copyright © 2014 Hande Celiker et al. All rights reserved. Bilateral Persistent Pupillary Membrane with Tetralogy of Fallot: A Case Report and Review of the Literature Thu, 24 Jul 2014 08:09:47 +0000 Case Report. A 15-year-old boy presented to the Fatih Sultan Mehmet Education and Research Hospital with the complain of bilateral vision blurring associated with severe glare and photophobia. On ophthalmological examination, uncorrected visual acuity was 20/200 in the right eye and 20/100 in the left eye, and there was no improvement with pinhole testing. The slit-lamp examination showed persistent pupillary membranes (PPM) in both eyes. According to the history obtained from his parents, he had received cardiac surgery for tetralogy of Fallot (TOF) 8 years ago. Conclusion. This patient is unique because this is the first reported case of bilateral PPM with congenital heart anomaly in the literature. Bilaterality of the eye anomaly strengthens the possibility of an uncommon association between PPM and TOF, rather than local failure in embryonic development. A. Altun, S. A. Kurna, E. Bozkurt, G. Erdogan, G. Altun, O. O. Olcaysu, and S. F. Aki Copyright © 2014 A. Altun et al. All rights reserved. Partial and Total Descemet’s Detachments in a Patient with Severe Terrien’s Marginal Degeneration and Juvenile Idiopathic Arthritis Sun, 20 Jul 2014 12:11:02 +0000 A 16-year-old female with juvenile idiopathic arthritis presented with a one-month history of decreasing vision and increasing corneal edema in her left eye. Slit-lamp examination, keratometric measurements, and OCT evaluation led to a diagnosis of Terrien’s marginal degeneration in both eyes along with a complete detachment of Descemet’s membrane in the left eye and partial detachment in the right eye. She was treated with an intracameral injection of air and then topical betamethasone and chloramphenicol which lead to the resolution of symptoms. We further examine the pathophysiology of this disease based on current literature. Amir Hossein Vejdani, Hamid Khakshoor, Michael V. McCaughey, and Majid Moshirfar Copyright © 2014 Amir Hossein Vejdani et al. All rights reserved. Ischemic Retinopathy and Neovascular Proliferation Secondary to Severe Head Injury Sun, 20 Jul 2014 12:09:48 +0000 We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma. Muge Coban-Karatas and Rana Altan-Yaycioglu Copyright © 2014 Muge Coban-Karatas and Rana Altan-Yaycioglu. All rights reserved. Ocular Trauma from the “Knockout Game” Sun, 13 Jul 2014 11:53:34 +0000 The “knockout game” is a new form of urban violence receiving much attention in local and national media. Apart from the obvious head trauma, eye injuries may be subtle and overlooked. This report brings awareness of potential eye damage with this type of assault. This report is of a young woman, victim of the knockout game, who sustained a submacular hemorrhage. Beyond a neurologic evaluation for anyone knocked unconscious following the knockout game, patients should be counseled regarding potential ocular injury and encouraged to seek eye care promptly should symptoms develop. Brian C. Joondeph Copyright © 2014 Brian C. Joondeph. All rights reserved. Ocular Toxicity Secondary to Asclepias physocarpa: The Balloon Plant Wed, 02 Jul 2014 06:25:41 +0000 We report a case of a 65-year-old woman with symptoms of blurred vision and ocular irritation a few hours after accidental contact of the right eye with Asclepias physocarpa milky latex. Observation showed a diffuse conjunctival hyperemia and stromal corneal edema with Descemet’s membrane folds. Recovery was fast and apparently complete in less than one month. However, specular microscopy at 6-months follow-up showed an abnormal endothelial morphology as sequelae, suggesting this condition is not as innocuous as it has been suggested. Susana Pina, Catarina Pedrosa, Cristina Santos, Bernardo Feijóo, Peter Pego, Cristina Vendrell, Maria João Santos, and Isabel Prieto Copyright © 2014 Susana Pina et al. All rights reserved. Corneal Decompensation after Selective Laser Trabeculoplasty Tue, 01 Jul 2014 00:00:00 +0000 A 64-year-old Caucasian man referred for decreased vision after selective laser trabeculoplasty (SLT). Slit lamp examination revealed diffuse corneal edema. Despite intensive topical treatment including steroids, corneal edema did not resolve; on the contrary, it advanced to bullous keratopathy. Corneal edema after SLT is an exceptionally rare complication and in all of the previous reports edema resolved with medical treatment. To the best of our knowledge, this is the first report presenting persistent corneal edema after SLT. Ahmet Ozkok, Nevbahar Tamcelik, Didar Ucar Comlekoglu, and Guzin Iskeleli Copyright © 2014 Ahmet Ozkok et al. All rights reserved. Spontaneous Resolution of Subretinal Hemorrhage Secondary to Choroidal Osteoma Unassociated with Choroidal Neovascularization Thu, 26 Jun 2014 08:09:05 +0000 Choroidal osteoma is a rare benign intraocular tumor composed of calcification throughout the choroid. Various treatment modalities are available according to location of the tumor and the cause of the visual distortion. We report herein a 30-year-old male who was referred to our hospital with acute blurred vision as a result of the subretinal hemorrhage from choroidal osteoma. We ruled out the presence of CNV and observation was preferred and we prevented unnecessary treatment attempts as spontaneous recovery is the easiest and safest way. Mehmet Talay Koylu, Gokcen Gokce, Yusuf Uysal, and Ali Hakan Durukan Copyright © 2014 Mehmet Talay Koylu et al. All rights reserved. Optic Neuritis Caused by Rathke’s Cleft Cyst in Young Adult Thu, 19 Jun 2014 10:57:37 +0000 We report a case of right optic neuritis caused by Rathke's cleft cyst (RCC) in a young adult. A 15-year-old boy presented with reduced visual acuity in the right eye. He was diagnosed with optic neuritis in the right eye 4 years earlier at other clinics before he was referred to our department. During our one-year examinations, the cause of the reduced vision in his right eye could not be determined conclusively. At the age of 17 years, a RCC was detected by a neurosurgeon who specialized in hypophyseal diseases. He underwent microscopic transsphenoidal resection of the cyst, and his vision recovered to 1.2 and he has had no recurrence for at least 9 months. We suggest that repeated rupturing of the RCC was the cause of the optic neuritis, and a RCC can be successfully treated by surgery even after 3 years of optic neuritis. Namie Kobayashi, Toshiyuki Oshitari, Kentaro Kobayashi, Takatsugu Onoda, Hidetoshi Ikeda, and Emiko Adachi-Usami Copyright © 2014 Namie Kobayashi et al. All rights reserved. Simplified Technique for Sealing Corneal Perforations Using a Fibrin Glue-Assisted Amniotic Membrane Transplant-Plug Wed, 18 Jun 2014 06:59:42 +0000 Purpose. To describe a surgical technique using amniotic membrane transplant (AMT) with fibrin glue (FG) for treating smaller corneal perforations more practically and appropriately filling the defect. Method. A patient with noninfectious central corneal perforation, in 1 mm in diameter, was treated with FG-assisted AMT-plug. An AMT was folded in on itself twice by using FG then a small piece of this FG-AMT mixture was cut to maintain an appropriate plug for the site of the corneal perforation. The FG-assisted AMT-plug was placed in the perforation area by using FG. An amniotic membrane patch was placed over the plug, which was then secured by a bandage contact lens. Result. Surgery to restore corneal stromal thickness without recurrence of perforation. Conclusion. The FG-assisted AMT-plug allowed a successful repair of 1 mm in diameter corneal perforation. This technique was easily performed, thus seeming to be a good alternative to treat corneal perforations with restoring corneal thickness. Selcuk Kara, Sedat Arikan, Ismail Ersan, and Arzu Taskiran Comez Copyright © 2014 Selcuk Kara et al. All rights reserved. Macular Oedema Related to Idiopathic Macular Telangiectasia Type 1 Treated with Dexamethasone Intravitreal Implant (Ozurdex) Tue, 17 Jun 2014 11:59:25 +0000 A 65-year-old female presented with visual disturbance in her right eye lasting for over 2 months. Following investigations, she was diagnosed with MacTel type 1 in the right eye. Visual symptoms were refractory to initial treatment with intravitreal bevacizumab and thereafter intravtireal triamicinolone. The patient was then treated with Ozurdex, following which central macular thickness (CMT) decreased (from 397 m to 286 m) and visual acuity deteriorated (from logMAR 0.48 to 0.59). At 14 weeks posttreatment with Ozurdex, a recurrence of cystoid macular oedema (CMO) was observed. Following a second Ozurdex, visual acuity improved (from logMAR 0.7 to 0.64) and CMT decreased (from 349 m to 279 m). An additional recurrence of CMO was observed at eighteen weeks following the second Ozurdex. Following a third Ozurdex injection visual acuity deteriorated (from logMAR 0.74 to 0.78) and CMT decreased (from 332 m to 279 m). Conclusion. Treatment of macular oedema secondary to MacTel with Ozurdex demonstrated promising anatomical outcomes. However, visual outcomes continued to gradually deteriorate. Mohamed Loutfi, Thomas Papathomas, and Ahmed Kamal Copyright © 2014 Mohamed Loutfi et al. All rights reserved. Unilateral Cataract and Vitreoretinopathy in a Case with Klippel-Trenaunay Syndrome Mon, 16 Jun 2014 08:30:50 +0000 Purpose. We present a case with Klippel-Trenaunay (KT) syndrome that had unilateral mature cataract and vitreoretinopathy. Case Report. A 17-year-old boy with KT syndrome presented to the clinic of ophthalmology for low vision in the right eye. His best corrected visual acuity (BCVA) was hand motion in the right eye and 20/20 in the left eye. Anterior segment examination revealed mature cataract in the right. During the physical examination, port-wine stains were noted over right side of his face, ankle, and toes. He had asymmetric face and his head was larger on the right side. Leg lengths were symmetrical, although he had skin hypertrophy. Cranial magnetic resonance imaging studies showed cortical atrophy discordant to his age, asymmetric vascular dilatations in the right hemisphere, hypertrophy in the right periorbital soft tissue, and choroidal plexus. The patient received an uncomplicated cataract surgery. His BCVA in the right eye improved to 20/200 after the surgery. After removing cataractous lens, we were able to examine the fundus that revealed severe vitreoretinopathy and choroidal hemangioma. Conclusion. This case emphasizes the importance of prompt ophthalmic examination in patients with KT syndrome. Osman Okan Olcaysu, Ahmet Altun, Elif Olcaysu, Ebru Marzıoğlu Ozdemır, and Berrin Demır Copyright © 2014 Osman Okan Olcaysu et al. All rights reserved. Blinding Orbital Apex Syndrome due to Onodi Cell Mucocele Thu, 15 May 2014 16:15:49 +0000 The onodi cell is a posterior ethmoidal cell that is pneumatized laterally or superiorly to the sphenoid sinus with close proximity to the optic nerve. A mucocele, a benign, expansile, cyst-like lesion of the paranasal sinuses, may uncommonly involve the onodi cell causing compression of the optic nerve and nearby structures. In this paper, we report a rare case of onodi cell mucocele causing orbital apex syndrome, with prompt recovery after endoscopic removal. However, optic neuropathy did not improve and the patient remained blind. Efrat Fleissig, Oriel Spierer, Ilan Koren, and Igal Leibovitch Copyright © 2014 Efrat Fleissig et al. All rights reserved. Papillary-Cystic Variant of Acinic Cell Carcinoma in the Lacrimal Gland Thu, 15 May 2014 00:00:00 +0000 Papillary-cystic variant of acinic cell carcinoma is a rare tumour confined to salivary gland tissue. Here, we report the first case ever to manifest in a tumour affecting the lacrimal gland, a completely different tissue type, and review the current published literature on this type of tumour. Miles Bannister and Greig Lawson Copyright © 2014 Miles Bannister and Greig Lawson. All rights reserved. Cystoid Macular Edema in Bietti's Crystalline Retinopathy Sun, 11 May 2014 12:34:29 +0000 A 27-year-old man with progressive bilateral visual decline was diagnosed to have Bietti's crystalline dystrophy (BCD). Fluorescein angiography revealed bilateral petaloid type late hyperfluorescence implicating concurrent cystoid macular edema (CME). Optical coherence tomography exhibited cystoid foveal lacunas OU. During the follow-up of six years, intraretinal crystals reduced in amount but CME persisted angiographically and tomographically. CME is among the rare macular features of BCD including subfoveal sensorial detachment, subretinal neovascular membrane, and macular hole. Ali Osman Saatci, Hasan Can Doruk, and Aylin Yaman Copyright © 2014 Ali Osman Saatci et al. All rights reserved. Huge Cavernous Hemangiomas Enveloping the Optic Nerve Successfully Removed by a Vertical Lid Split Orbitotomy Tue, 29 Apr 2014 09:39:59 +0000 A 63-year-old woman presented with a 15-year history of gradually increasing proptosis of right eye. Ocular examination revealed proptosis of 9 mm with decreased visual acuity in her right eye. CT scan showed a well-circumscribed and enhancing orbital mass filling almost the entire right orbit. The tumor occupied the superolateral, superomedial, and inferomedial intraconal space, enveloping the optic nerve. Complete excision of two large intraconal tumors was performed successfully via a vertical lid split orbitotomy. Histopathologic examination confirmed the diagnosis of cavernous hemangioma. There were no intraoperative or postoperative complications. The patient achieved a satisfactory cosmetic outcome 1 year after surgery. Jung-Hoon Yum, Yoon-Duck Kim, Jung Hye Lee, and Kyung In Woo Copyright © 2014 Jung-Hoon Yum et al. All rights reserved. Subconjunctival and Orbital Silicone Oil Granuloma (Siliconoma) Complicating Intravitreal Silicone Oil Tamponade Thu, 24 Apr 2014 06:08:18 +0000 A 30-year-old male, who underwent previous pars plana vitrectomy and silicone oil tamponade due to endogenous endophthalmitis originated from Klebsiella liver abscess, was referred for evisceration. At 2 months after vitrectomy with silicon oil tamponade, conjunctival chemosis and ocular pain were aggravated. Diffuse eyelid swelling and large subconjunctival mass with lipid droplets were noted. On MRI examination, subconjunctival mass and intra- and extraconal orbital mass around superior rectus muscle were observed. Excision of subconjunctival and orbital mass was performed. Histopathologic examination showed multiple silicone oil vacuoles surrounded by foreign body giant cells and fibrosis, which confirmed silicone oil granuloma. In a patient with suspicious melting sclera in diseases such as endophthalmitis, large silicone oil granuloma may be complicated in a rapid fashion after intravitreal silicone oil tamponade due to silicone oil leakage. Jung Hye Lee, Yoon-Duck Kim, Kyung In Woo, and Mingui Kong Copyright © 2014 Jung Hye Lee et al. All rights reserved. Recurrent Bilateral Occipital Infarct with Cortical Blindness and Anton Syndrome Thu, 13 Mar 2014 13:14:01 +0000 Bilateral cortical blindness and Anton syndrome, are most commonly caused by ischaemic stroke. In this condition, patients have loss of vision but deny their blindness despite objective evidence of visual loss. We report a case of a patient with multiple cardiovascular risk factors who developed recurrent bilateral occipital lobe infarct with Anton syndrome. A suspicion of this condition should be raised when the patient has denial of blindness in the presence of clinical and radiological evidence of occipital lobe injury. Management of this condition should focus on the underlying cause, in which our patient requires secondary stroke prevention and rehabilitation. Kiu Kwong Yew, Sanihah Abdul halim, Ahmad Tajudin Liza-Sharmini, and John Tharakan Copyright © 2014 Kiu Kwong Yew et al. All rights reserved. Spontaneous Closure of a Fully Developed Macular Hole in a Severely Myopic Eye Wed, 05 Mar 2014 06:36:14 +0000 Purpose. Myopic macular holes can be difficult to close with surgery and are frequently associated with retinal detachment. We report on a case of a macular hole in a severely myopic eye that underwent spontaneous closure. Methods. An observational case study. Results. A 55-year-old female was referred to Ophthalmology for a central scotoma and metamorphopsia in the right eye. Visual acuity was 1/20 in both eyes. Fundus examination showed loss of the foveal depression, with a small yellow ring in the center of the fovea in the right eye, and a tilted optic disc and peripapillary staphyloma bilaterally. Spectral domain optical coherence tomography (SD-OCT) revealed a fully developed macular hole with a rim of thickened and slightly elevated retina in the right eye. The patient refused surgery. After 4 years of follow-up, her visual acuity improved to 20/40 in the right eye, and SD-OCT revealed spontaneous sealing of the macular hole without bare retinal pigment epithelium. Conclusions. Myopic macular holes represent a challenge regarding their management, and the prognosis is often poor. C. Bruè, I. Rossiello, J. M. Guidotti, and C. Mariotti Copyright © 2014 C. Bruè et al. All rights reserved. Photodynamic Therapy for Juxtapapillary Retinal Capillary Hemangioma Mon, 03 Mar 2014 12:51:53 +0000 Various treatment modalities have been described for retinal capillary hemangioma. Our purpose is to present a case of juxtapapillary retinal capillary hemangioma treated with photodynamic therapy. A 69-year-old woman with no previous ocular history presented with blurred vision and photopsias in the right eye three months ago. At presentation, her best corrected visual acuity was 6/9 in the right eye and 6/6 in the left eye. The anterior segment was totally normal and IOP was normal in both eyes as well. Dilated fundoscopy revealed a yellowish, well-circumscribed, elevated area with blood vessels, on the inferior margin of the right optic disc, as optic disc edema. Fluorescein angiography and angiogram with indocyanine green confirmed the diagnosis of juxtapapillary retinal capillary hemangioma. The patient was treated with photodynamic therapy with verteporfin and three months later her visual acuity was 6/7.5 in the right eye, while the lesion was slightly smaller. These findings remained stable at the one-year follow-up. In conclusion, photodynamic therapy offers promising anatomical and functional results for juxtapapillary retinal capillary hemangioma, providing visual acuity improvement or even stabilization and restriction of enlargement of the lesion. Panagiotis G. Mitropoulos, Irini P. Chatziralli, Vasileios G. Peponis, Vasileia A. Tsiotra, and Efstratios A. Parikakis Copyright © 2014 Panagiotis G. Mitropoulos et al. All rights reserved. Random Implantation of Asymmetric Intracorneal Rings Sun, 23 Feb 2014 12:56:59 +0000 Intracorneal ring employment for treating ectasia is widespread. Although the mechanism of action of intracorneal rings in the regularization of the corneal surface after its implantation is well known in most cases, there are still many doubts. We present a case of implanted intracorneal rings, where, despite the peculiar position of the rings, the patient gains lines of visual acuity and keratoconus remains stable. Cristina Peris-Martínez and Irene Gregori Gisbert Copyright © 2014 Cristina Peris-Martínez and Irene Gregori Gisbert. All rights reserved.