Case Reports in Ophthalmological Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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. Embryonal Rhabdomyosarcoma of Upper Lid in 15-Year-Old Patient Sun, 09 Feb 2014 09:38:44 +0000 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 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 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 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 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 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 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 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 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 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. Diplopia due to Dacryops Wed, 04 Dec 2013 15:08:09 +0000 Dacryops is a lacrimal ductal cyst. It is known that it can cause globe displacement, motility restriction, and proptosis because of the mass effect. Diplopia due to dacryops has not been reported previously. Here, we present a 57-year-old man with binocular horizontal diplopia that occurred during left direction gaze due to dacryops. Rahmi Duman, Reşat Duman, and Mehmet Balcı Copyright © 2013 Rahmi Duman et al. All rights reserved. Primary Neuroendocrine Carcinoma of Ocular Adnexa Sun, 03 Nov 2013 15:40:42 +0000 We present our findings in a case of primary neuroendocrine carcinoma (NEC) of the lacrimal gland and a case of primary Merkel cell carcinoma (MCC) of the eyelid. An 86-year-old man noticed a swelling of the left upper eyelid three months earlier. We performed excision biopsy and histopathological examination indicated that he had a primary NEC of the left lacrimal gland. He underwent chemotherapy followed by excision including the clinically visible margins and 50 Gy radiotherapy of the surgical margins. He had neither recurrence nor metastasis for 6 months since the last radiotherapy. An 80-year-old man noticed a nodule in the right upper eyelid and was referred to our hospital because the size was increasing rapidly. A complete surgical excision of the margins of the tumor was performed with histopathological confirmation of negative margins. The final diagnosis was a primary MCC of the right upper eyelid. After surgery, he underwent 50 Gy radiotherapy on the neck to prevent metastasis. No recurrence or metastasis was found for two years. Although primary NEC of the ocular adnexa is extremely rare, the tumor has high malignancy and readily metastasizes. Thus, combined therapy including surgery, radiotherapy, and/or chemotherapy is needed for complete management of NEC. Daisuke Yamanouchi, Toshiyuki Oshitari, Yosuke Nakamura, Jiro Yotsukura, Kaoru Asanagi, Takayuki Baba, Tomohiro Nizawa, Takashi Kishimoto, Yoko Yonemori, Satoshi Ota, and Shuichi Yamamoto Copyright © 2013 Daisuke Yamanouchi et al. All rights reserved. Canthaxanthin Retinopathy with Visual Loss: A Case Report and Review Wed, 30 Oct 2013 10:55:50 +0000 Canthaxanthin is a naturally occurring chemical, which is most commonly utilized as a colorant for food and dyes or a skin bronzing agent. Its most prevalent impact on human health is canthaxanthin retinopathy, which appears as birefringent, yellow to red crystals surrounding the macula. This occurs with increasing, dose-dependent exposure. Generally, patients remain asymptomatic and findings may only be evident on funduscopic examination. Cessation of canthaxanthin ingestion appears to reverse the retinopathy, but the time until crystal disappearance is variable. Despite a usually favorable outcome, long-standing visual changes may occur. We report a case of an 84-year-old woman with significant visual loss secondary to canthaxanthin retinopathy that ultimately improved upon cessation of the drug. Robert A. Beaulieu, Ronald E. Warwar, and Bruce M. Buerk Copyright © 2013 Robert A. Beaulieu et al. All rights reserved. Long-Term Follow-Up of the Postoperative Macular Fold following the Vitreoretinal Surgery with Air Tamponade Wed, 25 Sep 2013 18:44:59 +0000 A 64-year-old male who had a macula-on superior bullous retinal detachment in OD underwent scleral buckling, 20-gauge-pars plana vitrectomy, internal drainage of subretinal fluid with perfluorocarbon fluid, 360° endolaser and perflourocarbon-fluid-air exchange surgery. Patient sat upright immediately after the surgery for the night. At the first postoperative morning although the retina was attached, there was a macular fold extending toward the temporal retinal periphery. Patient denied further surgery. During the follow-up, retinal fold gradually became less visible and it could be noticeable only by fundus autoflorescence imaging at the sixth postoperative year with a subtle epiretinal membrane formation on the optical coherence tomographic section. Ali Osman Saatci, Ozlem Barut Selver, and Melih Parlak Copyright © 2013 Ali Osman Saatci et al. All rights reserved. Fungal Keratitis Caused by Drechslera spp. Treated with Voriconazole: A Case Report Wed, 18 Sep 2013 18:24:44 +0000 Objective. To present a case of Drechslera spp. keratitis treated with topical Voriconazole. Method. A case report. Results. A 52-year-old diabetic male presented with a one-week history of foreign body sensation of the left eye, self-medicated with Neomycin, Polymyxin B, and Dexamethasone eye drops, and was diagnosed to have bacterial conjunctivitis, which was treated with Levofloxacin drops. The patient developed a corneal opacity after 2 days and was initially seen with a visual acuity of counting fingers on the left eye, with a 3 mm central corneal ulcer with feathery borders. No hypopyon was noted. The right eye had a visual acuity of 20/20 and had unremarkable findings. Corneal scraping of the ulcer showed no organisms on Gram and Giemsa stain. Cultures were positive for Drechslera spp. and patient was started on Natamycin drops every 15 minutes, Atropine drops 3× a day, and Levofloxacin was continued every 4 hours. The ulcer increased to 4 mm, the infiltrates became deeper involving the midstroma, and there was appearance of a 2 mm hypopyon. Natamycin was shifted to Voriconazole eye drops every 15 minutes. There was note of a decrease in the size of the ulcer and clearing of the infiltrates with the new treatment regimen. Final visual acuity after 29 days of treatment was 20/40 with note of a slight corneal haze in the area of the previous ulcer. Conclusion. Voriconazole may be safe and effective in the treatment of Drechslera keratitis. There was no perforation and there was immediate decrease in the size of the ulcer. This is the first known case of Drechslera keratitis treated with Voriconazole eye drops in the Philippines. Margarita I. Echavez, Archimedes Lee D. Agahan, and Noel S. Carino Copyright © 2013 Margarita I. Echavez et al. All rights reserved. Choroidal Metastasis of Non-Small Cell Lung Cancer That Responded to Gefitinib Thu, 12 Sep 2013 08:52:33 +0000 A 52-year-old Japanese woman presented with optical symptoms, including left-sided myodesopsia, blurred vision, narrowed visual field, and diminished visual acuity. Ocular evaluation revealed a metastatic tumor in the choroid. Further examinations identified pulmonary adenocarcinoma as the primary tumor. Because an epidermal growth factor receptor gene (EGFR) mutation was detected in a biopsy specimen, gefitinib treatment was initiated. Dramatic responses were obtained in the primary tumor and metastatic foci. Optical symptoms improved and remained stable for 5 months during the treatment, until relapse. This report demonstrates that gefitinib is effective for choroidal metastasis of pulmonary adenocarcinoma harboring an EGFR mutation. Iwao Shimomura, Yuji Tada, Gen Miura, Toshio Suzuki, Takuma Matsumura, Kenji Tsushima, Jiro Terada, Ryota Kurimoto, Emiko Sakaida, Ikuo Sekine, Yuichi Takiguchi, Shuichi Yamamoto, and Koichiro Tatsumi Copyright © 2013 Iwao Shimomura et al. All rights reserved. Retinal Detachment due to CrossFit Training Injury Wed, 11 Sep 2013 08:00:12 +0000 The purpose of this paper is to describe a traumatic retinal detachment occurring as a result of CrossFit training using an elastic exercise band. The patient sustained an ocular injury from an elastic band during CrossFit training, resulting in a giant retinal dialysis and retinal detachment, which were successfully repaired. Trainers and athletes need to be aware of the potential for ocular injury from elastic exercise bands and take appropriate precautions. Stephanie A. Joondeph and Brian C. Joondeph Copyright © 2013 Stephanie A. Joondeph and Brian C. Joondeph. All rights reserved. Severe Macular Edema in Patients with Juvenile Idiopathic Arthritis-Related Uveitis Mon, 19 Aug 2013 10:34:49 +0000 Purpose. To report the onset of severe macular edema in adolescent female patients affected by juvenile idiopathic arthritis (JIA). Methods. Four female patients affected by JIA-related chronic anterior uveitis (CAU), complicated by severe macular edema, were retrospectively analyzed. Macular area was evaluated by fluorescein angiography and optical coherence tomography (OCT). Results. CAU was bilateral in three patients. Mean age of uveitis and arthritis onset was, respectively, years and years. All patients underwent cataract extraction surgery. Despite ocular inflammation being controlled by topical/systemic therapy, during adolescence (mean age of appearance/diagnosis: years) patients developed severe unilateral macular edema. OCT revealed massive macular thickening (range from 550 μm to 1214 μm). Conclusions. Macular edema appeared in female adolescent patients in eyes with long-dating CAU submitted to cataract surgery. In such patients, in presence of age-related microvascular changes due to the enhancer effect of sex hormones, cataract extraction should be a factor triggering the retinal complication. Maria Pia Paroli, Claudia Fabiani, Giovanni Spinucci, Irene Abicca, Alfredo Sapia, and Leopoldo Spadea Copyright © 2013 Maria Pia Paroli et al. All rights reserved. Splitting of a Dexamethasone Implant (Ozurdex) following the Injection Tue, 30 Jul 2013 10:51:14 +0000 In this brief report, we share our observations on a splitted Dexamethasone implant (Ozurdex) which we discovered a week after the injection. It is likely that implant splitting neither changes the efficacy of the implant nor creates a mishap for the patient. Oya Donmez, Melih Parlak, Aylin Yaman, and Ali Osman Saatci Copyright © 2013 Oya Donmez et al. All rights reserved. Confocal Microscopy in Biopsy Proven Argyrosis Thu, 18 Jul 2013 14:08:06 +0000 Purpose. To evaluate the confocal microscopy findings of a 46-year-old male with bilateral biopsy proven argyrosis. Materials and Methods. Besides routine ophthalmologic examination, anterior segment photography and confocal microscopy with cornea Rostoch module attached to HRT II (Heidelberg Engineering GmbH, Heidelberg, Germany) were performed. Findings. Squamous metaplastic changes on conjunctival epithelium and intense highly reflective extracellular punctiform deposits in conjunctival substantia propria were detected. Corneal epithelium was normal. Highly reflective punctiform deposits starting from anterior to mid-stroma and increasing through Descemet’s membrane were evident. Corneal endothelium could not be evaluated due to intense stromal deposits. Conclusion. Confocal microscopy not only supports diagnosis in ocular argyrosis, but also demonstrates the intensity of the deposition in these patients. Melis Palamar, Suzan Guven Yilmaz, Taner Akalin, Sait Egrilmez, and Ayse Yagci Copyright © 2013 Melis Palamar et al. All rights reserved. A Minor Modification of Direct Browplasty Technique in a Patient with Brow Ptosis Secondary to Facial Paralysis: Copy-Paste-Excise and Stitch Mon, 15 Jul 2013 15:10:09 +0000 Purpose. This report aimed to describe a minor modification of the traditional direct browplasty technique that aids in surgical planning for patients with brow ptosis secondary to facial paralysis without changing the shape of the brow. Case Report. A 74-year-old male patient with left facial paralysis secondary to chronic otitis media was referred with a complaint of low vision due to brow ptosis. We performed direct browplasty with a minor modification in order to aid a treatment customized to the patient. In this technique, a transparent film paper is used to copy the brow shape. A brow-shaped excision is facilitated just superior to the ptotic brow. Conclusion. The authors found that the copy-paste-excise and stitch technique was effective and successful for deciding the shape and the amount of excision that should be performed in patients with brow ptosis without resulting in asymmetrical, arched, and feminized brows. Arzu Taskiran Comez, Baran Gencer, Selcuk Kara, and Hasan Ali Tufan Copyright © 2013 Arzu Taskiran Comez et al. All rights reserved. Biopsy with the New Essen Biopsy Forceps Wed, 10 Jul 2013 14:01:12 +0000 Purpose. To present initial experience with a novel biopsy method, the Essen biopsy forceps. Therefore, two patients with diagnostic suspicion of uveal melanoma underwent biopsy for histopathological confirmation. Case Presentation. Two patients presented with painless unilateral vision reduction. Ultrasound revealed the diagnostic suspicion of uveal melanoma. Therefore, biopsy with the Essen biopsy forceps using a sutureless 23-gauge three-port vitrectomy system was performed. The specimens were then submitted to a pathologist and processed. Histopathology of the obtained specimen confirmed the diagnostic suspicion of choroid melanoma in both patients. Conclusion. Essen biopsy forceps is a very practicable alternative method to the FNAB, allowing a combined histopathological and immunohistochemical examination for achieving high diagnostic accuracy at minimal risk. Peter G. Traine, Katharina J. E. Schedler, Mariuccia G. S. Brusa, and Eduardo B. Rodrigues Copyright © 2013 Peter G. Traine et al. All rights reserved. Enterococcus faecalis Endogenous Endophthalmitis from Valvular Endocarditis Mon, 01 Jul 2013 10:53:08 +0000 We report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP) in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP) has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis. Sidnei Barge, Renata Rothwell, Rosário Varandas, and Luís Agrelos Copyright © 2013 Sidnei Barge et al. All rights reserved. Isolated Bulbar Conjunctival Kaposi’s Sarcoma as a Primary Presentation of AIDS: A Case Report Thu, 27 Jun 2013 18:06:48 +0000 Kaposi’s sarcoma (KS) is a malignant vascular tumor, caused by the human herpesvirus 8. It is one of the commonest tumors in human immunodeficiency virus (HIV) patients and not uncommonly the first manifestation of acquired immunodeficiency syndrome (AIDS). Case. We present a case of an isolated bulbar conjunctival KS on a 43-year-old HIV positive male, with no other lesions. Excision and cryotherapy were performed, and the patient remains free of lesions to date. Conclusion. Isolated bulbar conjunctival KP is an unusual site for its initial presentation and must be kept in mind in HIV positive patients. Sofia Maia, Miguel Gomes, Luís Oliveira, and Paulo Torres Copyright © 2013 Sofia Maia et al. All rights reserved. Macular Hole after Laser In Situ Keratomileusis in a 26-Year-Old Patient Wed, 12 Jun 2013 09:28:55 +0000 The purpose of this study is to describe the 26-year-old patient with developed macular hole after bilateral laser in situ keratomileusis (LASIK). A macular hole with sharp margins and irregular surface of surrounding retina appeared in the left eye of the female 26-year-old patient two months after LASIK for correction of myopia (followup of 6 months). Although the best corrected visual acuity (BCVA) after LASIK was 1.0, after the macular hole has developed BCVA became 0.5. After surgery, the final visual acuity recovered to 0.7. Macular hole may develop after LASIK for myopia correction due to unknown changes of vitreoretinal interface. Complete informed consent must be obtained from patients with high myopic eyes before LASIK. Guzel Bikbova, Toshiyuki Oshitari, Madoka Sakurai, Takayuki Baba, and Shuichi Yamamoto Copyright © 2013 Guzel Bikbova et al. All rights reserved. Steroid Induced Central Serous Chorioretinopathy in Giant Cell Arteritis Tue, 11 Jun 2013 11:26:43 +0000 Giant cell arteritis (GCA) is an ophthalmic emergency which requires early diagnosis and treatment with high dose systemic corticosteroids in order to prevent permanent visual loss. However, systemic corticosteroids have significant ocular side effects including cataract formation, raised intraocular pressure, and less commonly, central serous chorioretinopathy (CSCR). We report a case of visual loss secondary to CSCR complicating corticosteroid therapy in GCA. When assessing patients with systemic conditions such as GCA or other vasculitic process, who complain of visual loss which is getting worse on corticosteroid treatment, clinicians should consider other causes such as CSCR as part of the differential diagnosis. Extra caution should be exercised in such cases as increasing the dose of corticosteroids might aggravate CSCR resulting in further visual loss. Andre Grixti and Vineeth Kumar Copyright © 2013 Andre Grixti and Vineeth Kumar. All rights reserved.