Case Reports in Ophthalmological Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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 http://www.hindawi.com/journals/criopm/2014/581273/ 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 http://www.hindawi.com/journals/criopm/2014/279491/ 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 http://www.hindawi.com/journals/criopm/2014/410289/ 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 http://www.hindawi.com/journals/criopm/2014/285942/ 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 http://www.hindawi.com/journals/criopm/2014/829469/ 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 http://www.hindawi.com/journals/criopm/2014/851971/ 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 http://www.hindawi.com/journals/criopm/2014/823953/ 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 http://www.hindawi.com/journals/criopm/2014/204762/ 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 http://www.hindawi.com/journals/criopm/2014/351534/ 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 http://www.hindawi.com/journals/criopm/2014/231913/ 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 http://www.hindawi.com/journals/criopm/2014/312030/ 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 http://www.hindawi.com/journals/criopm/2014/453789/ 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 http://www.hindawi.com/journals/criopm/2014/285485/ 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 http://www.hindawi.com/journals/criopm/2014/964892/ 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 http://www.hindawi.com/journals/criopm/2014/135252/ 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 http://www.hindawi.com/journals/criopm/2014/686973/ 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 http://www.hindawi.com/journals/criopm/2014/795837/ 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 http://www.hindawi.com/journals/criopm/2014/182892/ 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 http://www.hindawi.com/journals/criopm/2014/756840/ 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 http://www.hindawi.com/journals/criopm/2014/839359/ 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. Embryonal Rhabdomyosarcoma of Upper Lid in 15-Year-Old Patient Sun, 09 Feb 2014 09:38:44 +0000 http://www.hindawi.com/journals/criopm/2014/157053/ Rhabdomyosarcoma is the most common childhood primary malignant tumor of orbit. Most of patients present between the ages of 7 and 8 years. Pure eyelid rhabdomyosarcoma is a very rare tumor with only a few reported cases in the literature. We introduce a pure embryonal rhabdomyosarcoma of upper lid in 15-year-old patient and demonstrate successful management of it. Mohammad Sharifi Copyright © 2014 Mohammad Sharifi. All rights reserved. Isolated Multiple Pigment Epithelial Detachments with Unknown Cause Tue, 04 Feb 2014 11:38:00 +0000 http://www.hindawi.com/journals/criopm/2014/289107/ There are many etiological factors that have led to the development of retinal pigment epithelial detachment (PED). In this paper, we have reported a patient with isolated multiple PEDs. Based on this fact, this paper aimed to give an overview of the causes of PEDs. Arzu Seyhan Karatepe Hashas, Altan Göktas, and Mustafa Atas Copyright © 2014 Arzu Seyhan Karatepe Hashas et al. All rights reserved. Tolerance to Systemic Isotretinoin Therapy in Two Patients Using Highly Wettable Contact Lenses Tue, 28 Jan 2014 09:01:28 +0000 http://www.hindawi.com/journals/criopm/2014/452462/ Purpose. Numerous ocular side effects have been reported with the use of systemic isotretinoin therapy. Herein, we presented two contact lens user patients who did not have contact lens intolerance during systemic isotretinoin therapy. Methods. 25-year-old male and 20-year-old female patients with severe acne vulgaris who were using highly wettable silicone hydrogel contact lenses which increase tear film stability were examined. Tear film function tests including Schirmer tests and tear break up time (TBUT) test and ocular surface staining with fluorescein were done. Subjective ocular complaints were scored with ocular surface disease index (OSDI) questionnaire. Patients were followed up monthly and examinations were repeated at each visit. Results. Both patients completed the therapy after a cumulative dose of 140 mg/kg isotretinoin in 6 months. The OSDI score and tear film function tests before and after treatment were all within normal limits. Discussion. Highly wettable contact lenses that provide increase in the tear film stability may be used during systemic retinoid therapy under close followups. Although isotretinoin affects ocular glands, the differences between tolerances to this retinoid therapy need to be investigated in larger patient groups using contact lenses. Ayşegül Arman, D. Deniz Demirseren, and Gulsen Akoglu Copyright © 2014 Ayşegül Arman et al. All rights reserved. Sclerokeratoplasty as the Therapy for Corneal Perforation due to Exposure and Neurotrophic Keratopathy Thu, 16 Jan 2014 12:11:00 +0000 http://www.hindawi.com/journals/criopm/2014/467249/ A case report of exposure and neurotrophic keratopathy after acoustic neuroma surgery resulting in perforation if not managed appropriately and timely is presented. Sclerokeratoplasty on 360 degrees may be an effective treatment method of corneal perforation in complete anaesthetic cornea when the standard penetrating keratoplasty failed. At a 12-month follow-up, the patient is doing well. UCVA is 0.5, the IOP is normal, and the graft remains clear. Systemic immunosuppression is the main disadvantage of this method. Further investigation is needed to assess the effectiveness and safety of this method. Radoslaw Rozycki, Izabela Nowak-Gospodarowicz, Dominika Bialas, Rafal Pawlik, and Marek Rekas Copyright © 2014 Radoslaw Rozycki et al. All rights reserved. Intravitreal and Subtenon Depot Triamcinolone as Treatment of Retinitis Pigmentosa Associated Cystoid Macular Edema Mon, 23 Dec 2013 14:20:53 +0000 http://www.hindawi.com/journals/criopm/2013/591681/ We present a case of retinitis pigmentosa (RP) related cystoid macular edema (CME) refractory to oral acetazolamide and topical ketorolac that was treated with intravitreal and subtenon depot triamcinolone. A 32-year-old male with RP presented with complaints of bilateral decrease in visual acuity. His best-corrected visual acuity (BCVA) was 20/50 in the right eye and 20/100 in the left eye. After being informed of the available treatment options, the patient received bilateral intravitreal injection triamcinolone. The patient’s BCVA improved to 20/40 in the right eye and 20/50 in the left eye and the CME was resorbed. However, 5 months after the injection in the left eye and two months in the right eye, visual acuity decreased due to recurrence of CME. We performed a second intravitreal injection in the left eye with improvement of visual and anatomic results, but we observed a recurrence of CME. Afterwards, we treated the patient with subtenon depot triamcinolone in both eyes, with the result that there was no recurrence after 4 months in OD or after 3 months in OS. We conclude that intravitreal and subtenon depot triamcinolone appear to provide at least temporary benefit in refractory CME as regards the improvement of visual acuity. Sidnei Barge, Renata Rothwell, Paula Sepúlveda, and Luís Agrelos Copyright © 2013 Sidnei Barge et al. All rights reserved. A Case of Medication-Resistant Acanthamoeba Keratitis Treated by Corneal Crosslinking in Turkey Sun, 22 Dec 2013 18:40:37 +0000 http://www.hindawi.com/journals/criopm/2013/608253/ Purpose. To report a case of medication-resistant acanthamoeba keratitis (AK) treated successfully by corneal crosslinking (CXL). Methods. A 26-year-old male with medication-resistant AK underwent a standard CXL procedure with local anesthesia, followed by central corneal epithelial debridement, application of riboflavin 0.1%, and UV-A irradiation. Results. The patient experienced a dramatic symptomatic improvement within 24 hours. At two months, keratitis was healed with a semitransparent paracentral scar that did not affect visual acuity. Conclusions. Our experience, considered in the context of recent studies, suggests that CXL may be an option for selected patients with medication-resistant AK and corneal melting. CXL allows patients to avoid emergency keratoplasty and experience rapid symptomatic relief. Goktug Demirci and Akif Ozdamar Copyright © 2013 Goktug Demirci and Akif Ozdamar. All rights reserved. External Ophthalmomyiasis Caused by a Rare Infesting Larva, Sarcophaga argyrostoma Sun, 22 Dec 2013 09:37:24 +0000 http://www.hindawi.com/journals/criopm/2013/850865/ Purpose. External ophthalmomyiasis (EO) is caused by infesting larvae belonging to various species of flies. Most documented cases result from sheep (Oestrus ovis) and Russian (Rhinoestrus purpureus) botfly larvae, but we recently discovered a rare case of EO caused by flesh fly (Sarcophaga argyrostoma) larvae. Here, we report the case of a patient with EO who had been hospitalized and sedated for 1 week because of unrelated pneumonia. Methods. Case report. Results. A total of 32 larvae were removed from the adnexae of both eyes. Larvae identification was confirmed through DNA analysis. Treatment with topical tobramycin resulted in complete resolution of EO. Conclusion. EO can be caused by S. argyrostoma, and the elderly and debilitated may require extra ocular protection against flies during sedation. Shmuel Graffi, Avi Peretz, Amos Wilamowski, Heather Schnur, Fouad Akad, and Modi Naftali Copyright © 2013 Shmuel Graffi et al. All rights reserved. Retinal Emboli in Cholesterol Crystal Embolism Wed, 11 Dec 2013 08:44:59 +0000 http://www.hindawi.com/journals/criopm/2013/421352/ Cholesterol crystal embolism (CCE) is a rare and severe multisystemic disorder. It results from a massive release of cholesterol crystals from widespread atherosclerotic disease. The main difference with atherosclerosis is the severity and the quantity of the embolic events that occur during the course of the disease, eventually leading to multivisceral failure and death. The symptoms are multiple and make it a diagnostic challenge. Fundoscopic examination can be of great help, showing retinal emboli in up to 25% of the cases, and has been rarely described in the ophthalmologic literature. We report the case of a 77-year-old man with acute renal failure after coronarography. Retinal emboli seen in the fundus confirmed the diagnosis of cholesterol crystal embolism and thus prevented any further invasive investigations. In this case, anticoagulants must be stopped and any further endovascular procedure proscribed. Although impossible for this patient, peritoneal dialysis should be preferred to hemodialysis because it does not need any anticoagulation. Systemic corticosteroid can be used in the acute phase. Fundoscopic examination should be performed each time cholesterol crystal embolism is suspected. When typical emboli are seen in the retina, it permits avoiding invasive investigations and saving precious time for the management of this potentially lethal disease. Antoine Rousseau, Ivan de Monchy, Emmanuel Barreau, Yasmina Yahiaoui, Mohamed M'garrech, Godefroy Kaswin, and Marc Labetoulle Copyright © 2013 Antoine Rousseau et al. All rights reserved. Suspected Endothelial Pencil Graphite Deposition Tue, 10 Dec 2013 18:04:28 +0000 http://www.hindawi.com/journals/criopm/2013/369374/ A 14-year-old male patient had an ocular trauma with a pencil. Biomicroscopic examination revealed a broken part of pencil into the cornea. Foreign body removal and corneal wound closure were performed in the same day. After corneal repair, there was a grade 4+ anterior chamber reaction just like in preoperative examination. Dilated examination showed a very small piece broken tip of pencil on the upper nasal quadrant of the lens. A small and linear deposition was also seen on endothelial surface. Endothelial deposition and foreign body disappeared with intensive topical steroid treatment. Adem Gül, Ertuğrul Can, Özlem Eşki Yücel, Leyla Niyaz, Halil İbrahim Akgün, and Nurşen Arıtürk Copyright © 2013 Adem Gül et al. All rights reserved. Bilateral Intravitreal Ranibizumab Injection and Panretinal Photocoagulation in a 16-Year-Old Girl with Severe Vaso-Occlusive Lupus Retinopathy Mon, 09 Dec 2013 15:07:35 +0000 http://www.hindawi.com/journals/criopm/2013/817186/ A 16-year-old girl with fever of unknown origin and bilateral vaso-occlusive retinopathy with retinal neovascularization, preretinal hemorrhage, and serous macular detachment was treated with single bilateral 0.5 mg intravitreal ranibizumab injection prior to aggressive PRP with success. No systemic steroids or immunosuppressive therapy was employed at that time. She received the diagnosis of “systemic lupus erythematosus” five years after this episode with further systemic symptoms. In certain cases with vaso-occlusive type of lupus retinopathy, anti-VEGF agents may be administered in addition to panretinal photocoagulation to achieve better visual and anatomic outcome. Hasan Can Doruk, Pinar Cetin, Fatos Onen, and A. Osman Saatci Copyright © 2013 Hasan Can Doruk et al. All rights reserved.