Case Reports in Ophthalmological Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Central Retinal Vein Occlusion in a Patient with Retinal Vasculitis and Crohn’s Disease Mon, 24 Nov 2014 08:41:28 +0000 The authors report a rare case of a 47-year-old woman with Crohn’s disease (CD) who presented with retinal vasculitis and central retinal vein occlusion (CRVO) during remission. The patient complained of sudden painless visual loss in her left eye (OS). Ophthalmologic evaluation revealed a best corrected visual acuity (BCVA) of 20/20 in the right eye and hand movements in OS. Ophthalmoscopy and fluorescein angiography of OS showed signs of nonischemic CRVO and extensive vasculitis. She was treated with oral prednisolone, mercaptopurine, and intravitreal bevacizumab in OS. After 1 month of treatment, VA of OS improved to 5/10 and after 1 year it was 10/10 with complete resolution of retinal vasculitis and nonischemic CRVO. Lígia Figueiredo, Renata Rothwell, Arnaldo Brandão, and Sofia Fonseca Copyright © 2014 Lígia Figueiredo et al. All rights reserved. Rescue of Primary Incomplete Microkeratome Flap with Secondary Femtosecond Laser Flap in LASIK Sun, 23 Nov 2014 08:36:13 +0000 For laser-assisted in situ keratomileusis (LASIK) retreatments with a previous unsuccessful mechanical microkeratome-assisted surgery, some surgical protocols have been described as feasible, such as relifting of the flap or the creation of a new flap and even the change to a surface ablation procedure (photorefractive keratectomy (PRK)). This case shows the use of femtosecond technology for the creation of a secondary flap to perform LASIK in a cornea with a primary incomplete flap obtained with a mechanical microkeratome. As we were unable to characterize the interface of the first partial lamellar cut, a thick flap was planned and created using a femtosecond laser platform. As the primary cut was very thick in the nasal quadrant, a piece of loose corneal tissue appeared during flap lifting which was fitted in its position and not removed. Despite this condition and considering the regularity of the new femtosecond laser cut, the treatment was uneventful. This case report shows the relevance of a detailed corneal analysis with an advanced imaging technique before performing a secondary flap in a cornea with a primary incomplete flap. The femtosecond laser technology seems to be an excellent tool to manage such cases successfully. E. A. Razgulyaeva Copyright © 2014 E. A. Razgulyaeva. All rights reserved. Intravitreal Ranibizumab for Stage IV Proliferative Sickle Cell Retinopathy: A First Case Report Sun, 23 Nov 2014 08:14:09 +0000 Purpose. To present the case of a 27-year-old male patient with stage IV proliferative sickle cell retinopathy, treated with one intravitreal injection of ranibizumab, showing regression of the neovascularization and no recurrence at the 9-month follow-up. Methods. A 27-year-old male patient presented with blurred vision and floaters in the right eye since three days. His best corrected visual acuity was 6/18. Ophthalmological examination and fluorescein angiography revealed proliferative sickle cell retinopathy stage IV with vitreous hemorrhage and sea fan neovascularization, as well as ischemic areas at the temporal periphery. Results. The patient was treated with one intravitreal injection of ranibizumab, presenting improvement in the visual acuity from 6/18 to 6/6, resolution of vitreous hemorrhage, and regression of the neovascularization. Additionally, he underwent scatter laser photocoagulation at the ischemic areas. At the 9-month follow-up there was no recurrence, while no adverse effects were noticed. Conclusions. Intravitreal ranibizumab may be a useful adjunct to laser photocoagulation in the management of proliferative sickle cell retinopathy and may permit some patients to avoid pars plana vitrectomy for vitreous hemorrhage. Panagiotis G. Mitropoulos, Irini P. Chatziralli, Efstratios A. Parikakis, Vasileios G. Peponis, Georgios A. Amariotakis, and Marilita M. Moschos Copyright © 2014 Panagiotis G. Mitropoulos et al. All rights reserved. Two Cases of Suprachoroidal Hemorrhage after Implantation of an Ex-Press Miniature Glaucoma Device and an Intraocular Lens Tue, 18 Nov 2014 06:16:16 +0000 Suprachoroidal hemorrhage is a rare complication of ophthalmic surgery in general and of glaucoma filtration procedures in particular. We present herein two cases of suprachoroidal hemorrhage in aphakic patients after simultaneous implantation of an Ex-Press miniature glaucoma device and an intraocular lens. Although a rare complication, we have now seen two cases develop in previously aphakic patients when we have attempted to place an Ex-Press miniature glaucoma device in conjunction with placement of a secondary intraocular lens. These two cases suggest that greater caution is warranted when attempting to surgically implant an express mini shut in the aphakic patient. Evan B. Dreyer and Rebecca E. Dreyer Copyright © 2014 Evan B. Dreyer and Rebecca E. Dreyer. All rights reserved. Pneumatic Displacement with Perfluoropropane Gas and Intravitreal Tissue Plasminogen Activator for Subretinal Subfoveal Hemorrhage after Focal Laser Photocoagulation in Central Serous Chorioretinopathy Mon, 17 Nov 2014 12:12:19 +0000 Objective. To report the visual and anatomic outcomes of pneumatic displacement with perfluoropropane (C3F8) gas and intravitreal tissue plasminogen activator (IVTPA) for subretinal subfoveal hemorrhage after focal laser photocoagulation in central serous chorioretinopathy (CSCR). Method. Interventional, retrospective case report of one eye (one patient). Outcome measures included visual acuity (VA), central macular thickness (CMT), and size of the lesion at two weeks of followup. Fluorescein angiography (FA) and optical coherent tomography (OCT) were used to measure anatomic outcomes. Results. A 35-year-old man with history of chronic CSCR received focal laser photocoagulation in the right eye two days before presentation. At initial examination, VA was 20/200 (ETDRS chart), CMT was 398 μ, and a subretinal subfoveal hemorrhage was seen. Tissue plasminogen activator (tPA) at a dose of 25 µg/0.1 mL was injected intravitreally before intravitreal C3F8 injection, and prone positioning was indicated postoperatively. At 24 hours, the hemorrhage had been displaced inferiorly and VA improved to 20/100. Two weeks later, VA improved to 20/80, CMT decreased to 225 μ, and the hemorrhage decreased without foveal involvement. Conclusions. The technique seems safe and effective in treating visually significant subretinal subfoveal hemorrhage. Khalid Al Rubaie, Juan V. Espinoza, Andres F. Lasave, Dario Savino-Zari, Fernando A. Arevalo, and J. Fernando Arevalo Copyright © 2014 Khalid Al Rubaie et al. All rights reserved. FEVR-Like Presentation of Homocystinuria Thu, 13 Nov 2014 09:13:31 +0000 A male infant with a diagnosis of homocystinuria presented with avascularity of the peripheral retina with a ridge on ophthalmic exam, consistent with a FEVR-like manifestation homocystinuria. Upon follow-up and treatment for homocystinuria, the retinal vascularity improved without the need for prophylactic treatment to the peripheral avascular retina. Lorena A. Montalvo, Vincent D. Venincasa, Hassan A. Aziz, Ditte Hess, and Audina M. Berrocal Copyright © 2014 Lorena A. Montalvo et al. All rights reserved. Lacrimal Sac Cysticercosis: A Rare Site for Manifestation Thu, 13 Nov 2014 00:00:00 +0000 Cysticercosis, a parasitic tissue infestation caused by larval cysts (cysticercus cellulosae) of the pork tapeworm, Taenia solium, most commonly affects the central nervous system, subcutaneous tissue, skeletal muscle, heart muscle, and the eye. Ocular adnexal infestation in cysticercosis can involve various sites within the eye like vitreous humor, subretinal tissue, extraocular muscle, and lacrimal gland. In this case report, a lump slightly below and medial to inner corner of eye, surgically removed from a 21-year-old male patient, was diagnosed as case of lacrimal sac cysticercosis on histopathological examination. To our knowledge, this is the one of rare sites for manifestation of cysticercus cellulosae. Amita Raoot Copyright © 2014 Amita Raoot. All rights reserved. Delayed Spontaneous Bleeding in the Blind Eye of a Type A Hemophilic Patient Sun, 09 Nov 2014 11:58:46 +0000 A 40-year-old man was complaining of severe left ocular pain and headache for the past 2 months. His left eye was traumatized and rendered blind about 20 years ago. He had no other medical problems and his preoperative laboratory tests were nonspecific. Evisceration of the left eye was performed for pain control and cosmetic improvement. However, postoperative progressive and prolonged eyelid swelling, bruising, and wound bleeding recurred. This patient was diagnosed with moderate factor VIII deficiency with a coagulation time within the normal range. Gi Sung Son, Sang Un Lee, and Sung Chul Kim Copyright © 2014 Gi Sung Son et al. All rights reserved. Scleritis Caused by In Vitro Linezolid-Resistant Nocardia asteroides Mon, 27 Oct 2014 06:03:31 +0000 Purpose. To describe a case of postoperative scleritis caused by a novel strain of Nocardia resistant to linezolid and trimethoprim-sulfamethoxazole (TMP-SMX). Methods. Case report of a patient with microbiologically proven scleritis due to Nocardia asteroides. Results. The patient presented with pain, redness, and nodules on the sclera three months following pterygium excision with mitomycin C and amniotic membrane placement. As no response was noted with empiric treatment for bacterial scleritis, debridement was performed. The cytopathology report showed gram positive filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made and therapy was initiated based on a literature review on treatments for Nocardia infections. Cultures returned growing Nocardia asteroides. Antibiotic sensitivity testing revealed resistance to linezolid and TMP-SMX which are the traditional drugs of choice for Nocardia. The patient was treated with amikacin and imipenem as well as extensive debridement with pedicle grafts. The patient’s scleritis resolved with a good visual outcome. Conclusions. Cultures should be obtained in all cases of necrotizing scleritis in patients with a recent history of conjunctival surgery to rule out unusual organisms such as Nocardia. Although literature states that resistance to linezolid and TMP-SMX is rare in Nocardia, sensitivity testing can be useful in unresponsive cases. Andres Gonzalez, Kaihan Fakhar, David Gubernick, and Sonal Tuli Copyright © 2014 Andres Gonzalez et al. All rights reserved. Pseudotumor of Ciliary Body Thu, 16 Oct 2014 09:48:02 +0000 Orbital pseudotumor is a benign disease involving the orbital structures. Pseudotumor of the ciliary body is rare. We present a case of a 27-year-old male who presented with gradual visual loss, pain, and redness in his left eye. On examination he was found to have a yellowish white mass at the periphery of anterior chamber in his left eye and ultrasound biomicroscopy (UBM) revealed a ciliary body mass in the same eye. He was treated with systemic steroids, which was tapered over a period of 8 weeks. His symptoms improved and the ciliary body mass disappeared with no recurrence over the next 6 months. UBM is an important diagnostic tool for diagnosing ciliary body mass. Early diagnosis and prompt treatment with systemic steroids may help resolve pseudotumor of the ciliary body. Mary Varghese, Raghavendra Ramappa, and Sripathi Kamath Copyright © 2014 Mary Varghese et al. All rights reserved. Elevated Intraocular Pressure due to Arteriovenous Fistula between External Carotid Artery and Facial Vein Thu, 02 Oct 2014 10:02:51 +0000 Aqueous outflow via the conventional outflow pathway is dependent on the pressure gradient between intraocular pressure (IOP) and episcleral venous pressure (EVP). Elevated IOP resulting from increased EVP is a well-known complication of arteriovenous fistulas, which are usually between the carotid artery and the cavernous sinus. Arteriovenous malformations usually occur spontaneously, after a trauma or from iatrogenic causes, and they manifest with findings of chemosis, dilatation of the conjunctival vessels, exophthalmos, and extraocular motility limitation. In this study, we present a case of elevated IOP due to facial arteriovenous malformations following a functional neck dissection surgery that caused intraocular pressure elevation. Halil Huseyin Cagatay, Metin Ekinci, Selam Yekta Sendul, Ceylan Uslu, Mehmet Demir, Sıtkı Mert Ulusay, Ender Uysal, and Selma Şeker Copyright © 2014 Halil Huseyin Cagatay et al. All rights reserved. Macular Oedema in Idiopathic Macular Telangiectasia Type 1 Responsive to Aflibercept but Not Bevacizumab Wed, 01 Oct 2014 00:00:00 +0000 We report a patient with macular oedema due to type 1 macular telangiectasia responding to intravitreal aflibercept injection. A 51-year-old man was diagnosed with type 1 idiopathic macular telangiectasia (IMT) in the right eye. The macular oedema was refractory to initial treatment with intravitreal bevacizumab and argon laser photocoagulation. The patient was then treated with intravitreal aflibercept injections, following which the macular oedema was completely resolved and his vision was significantly improved. Intravitreal aflibercept injection appears to improve vision and reduce persistent macular oedema secondary to type 1 IMT and demonstrated promising anatomical and visual outcomes. O’Sam Shibeeb, Anagha Vaze, Mark Gillies, and Timothy Gray Copyright © 2014 O’Sam Shibeeb et al. All rights reserved. Prepapillary Vascular Loops Complicated by Suspected Macroaneurysm Rupture Tue, 23 Sep 2014 00:00:00 +0000 We present a case of prepapillary vascular loops complicated by a suspected macroaneurysm rupture which was treated with intravitreal bevacizumab (IVB). A 62-year-old woman presented with decreased vision and myodesopsia in her left eye. Her best-corrected visual acuity (BCVA) was 0.6 in the left eye. Fundus examination disclosed an elevated, round, and reddish lesion, retinal hemorrhage at the superior aspect of the optic disc, retinal opacification along the superior branch retinal artery, and a small vitreous hemorrhage. Optical coherence tomography showed a serous retinal detachment, and indocyanine green angiography demonstrated prepapillary vascular loops and a hypofluorescent area with hyperfluorescent margins. These findings suggested the presence of a macroaneurysm. No filling of the dye in the aneurysm-like dilatation suggested a blockage of the lumen with a thrombus which might be associated with a branch retinal artery occlusion (BRAO). A diagnosis of prepapillary vascular loops complicated by a suspected macroaneurysm rupture and BRAO was made. Because of a persistent serous retinal detachment, IVB was performed. One month later, the BCVA improved to 1.0. Fundus examination disclosed an organized yellowish-white macroaneurysm and resolution of the serous retinal detachment. We recommend careful monitoring of patients with prepapillary vascular loops because of complications such as macroaneurysm rupture and BRAO. Kei Akaiwa, Yoshinori Mitamura, Takashi Katome, Kentaro Semba, Mariko Egawa, and Takeshi Naito Copyright © 2014 Kei Akaiwa et al. All rights reserved. Unsuccessful Self-Enucleation in a Schizophrenic Patient Sun, 21 Sep 2014 11:43:32 +0000 Self-enucleation is a very unusual form of self-mutilation directly linked to mental illness. In this case we present a 26-year-old schizophrenic patient who attempted to enucleate his eye with a rollerball pen. Antipsychotic therapy and emergency surgery saved the patient eye and emphasize the importance of quick response and good collaboration between psychiatric and ophthalmic teams. Noam Bar-Yaakov, Romi Noy Achiron, Michael Paul, and Asaf Achiron Copyright © 2014 Noam Bar-Yaakov et al. 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.