Case Reports in Ophthalmological Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Optic Nerve Vascular Compression in a Patient with a Tuberculum Sellae Meningioma Sun, 01 Feb 2015 11:14:39 +0000 Background. Optic nerve vascular compression in patients with suprasellar tumor is a known entity but is rarely described in the literature. Case Description. We present a unique, well-documented case of optic nerve strangulation by the A1 segment of the anterior cerebral artery in a patient with a tuberculum sellae meningioma. The patient presented with pronounced progressive visual deterioration. Following surgery, there was immediate resolution of her visual deficit. Conclusion. Vascular strangulation of the optic nerve should be considered when facing progressive and/or severe visual field deterioration in patients with tumors proximal to the optic apparatus. Cezar José Mizrahi, Samuel Moscovici, Shlomo Dotan, and Sergey Spektor Copyright © 2015 Cezar José Mizrahi et al. All rights reserved. Unilateral Optic Neuropathy and Acute Angle-Closure Glaucoma following Snake Envenomation Thu, 29 Jan 2015 12:04:23 +0000 Purpose. We aimed to describe a unique case in which a patient developed unilateral optic neuritis and angle-closure glaucoma as a result of snake envenomation. Case Report. Approximately 18 hours after envenomation, a 67-year-old female patient described visual impairment and severe pain in her left eye (LE). The patient’s best corrected visual acuity was 10/10 in the RE and hand motion in the LE. Cranial magnetic resonance imaging showed signs of neuropathy in the left optic nerve. In the LE, corneal haziness, closure of the iridocorneal angle, and mild mydriasis were observed and pupillary light reflex was absent. Intraocular pressure was 25 mmHg and 57 mmHg in the RE and LE, respectively. The patient was diagnosed with acute angle-closure glaucoma in the LE. Optic neuropathy was treated with intravenous pulse methylprednisolone. Left intraocular pressure was within normal range starting on the fourth day. One month after the incident, there was no sign of optic neuropathy; relative afferent pupillary defect and optic nerve swelling disappeared. Conclusions. Patients with severe headache and visual loss after snake envenomation must be carefully examined for possible optic neuropathy and angle-closure glaucoma. Early diagnosis and treatment of these cases are necessary to prevent permanent damage to optic nerves. Osman Okan Olcaysu, Kenan Cadirci, Ahmet Altun, Afak Durur Karakaya, and Huseyin Bayramlar Copyright © 2015 Osman Okan Olcaysu et al. All rights reserved. Valsalva-Like Retinopathy Secondary to Pancytopenia following Induction of Etoposide and Ifosfamide Wed, 28 Jan 2015 09:24:50 +0000 Etoposide and ifosfamide are chemotherapeutic agents used frequently in the treatment of sarcomas and hematologic malignancies. Ocular side effects are rarely reported. We describe a case of a patient on etoposide and ifosfamide who presented with unilateral vision loss, anemia, and thrombocytopenia. The patient was found to have a large subinternal limiting membrane hemorrhage in the right eye that is thought to be related to his anemia and thrombocytopenia. The hemorrhage resolved spontaneously after 10 days. This case illustrates how bone marrow suppression by chemotherapeutic agents may indirectly contribute to retinal hemorrhages resulting in at least transient vision loss. Robert A. Prinzi, Steven Saraf, Ankit Desai, Oscar Kuruvilla, and Uday R. Desai Copyright © 2015 Robert A. Prinzi et al. All rights reserved. Idiopathic Bilateral Bloody Tearing Thu, 22 Jan 2015 11:52:05 +0000 Bloody tear is a rare and distinct clinic phenomenon. We report a case presenting with the complaint of recurrent episodes of bilateral bloody tearing. A 16-year-old girl presented to our clinic with complaint of bloody tearing in both eyes for 3 months. Bloody tearing was not associated with her menses. A blood-stained discharge from the punctum was not observed during the compression of both nasolacrimal ducts. Nasolacrimal passage was not obstructed. Imaging studies such as dacryocystography and gradient-echo magnetic resonance imaging (MRI) of nasolacrimal canal were normal. Intranasal endoscopic evaluation was normal. We collected samples from bloody tears two times and pathological examination was performed. Pathological analysis showed lots of squamous cells and no endometrial cells; dysplastic cells were found. Further evaluations for underlying causes were unremarkable. No abnormalities were found in ophthalmologic, radiologic, and pathologic investigations. This condition is likely a rare abnormality and the least recognized aetiology for the idiopathic phenomenon. Emrullah Beyazyıldız, Yasemin Özdamar, Özlem Beyazyıldız, and Hasan Yerli Copyright © 2015 Emrullah Beyazyıldız et al. All rights reserved. Single Intravitreal Aflibercept Injection for Unilateral Acute Nonarteritic Ischemic Optic Neuropathy Thu, 08 Jan 2015 07:38:10 +0000 Acute nonarteritic ischemic optic neuropathy (ANAION) is the most common optic neuropathy in the elderly population without a well-established treatment. A 67-year-old man with a sudden painless visual loss in his left eye of one-day duration was diagnosed to have left ANAION. Next day, 2 mg aflibercept injection was injected intravitreally in OS. Visual acuity improved to 7/10 from 1/10 a week after the injection. Mean retinal nerve fiber layer thickness (RNFLT) was reduced to 159,7 μm from 182,4 μm at the first week. Visual fields improved dramatically during the follow-up of three months. The aim of this study is to present a case having ANAION treated with a single intravitreal aflibercept injection and discuss the place of intravitreal anti-VEGF injections in the treatment of armamentarium of ANAION. Ziya Ayhan, Gamze Kocaoğlu, Aylin Yaman, Meltem Söylev Bajin, and A. Osman Saatci Copyright © 2015 Ziya Ayhan et al. All rights reserved. A Frontal Lobe Meningioma in a Child Leading to Visual Loss Tue, 06 Jan 2015 13:46:02 +0000 Objective. Meningiomas are benign primary meningeal tumors and are seen rare in children and adolescents. Clinical Presentation and Intervention. A 15-year-old Turkish boy reported a 1-month history of headache and blurred vision in both eyes. His visual acuity was 0.3 in both eyes with papilledema. Magnetic resonance imaging showed a  mm intracranial-extra-axial frontal lesion which compresses the chiasm. He was diagnosed with intracranial meningioma and referred to neurosurgery clinic. Conclusion. Ophthalmologists should be aware of the fact that papilledema and low vision can be caused by an intracranial tumor which compresses optic chiasm. Nedime Sahinoglu-Keşkek, Gokhan Soker, Şakir Özgür Keşkek, Sehire Sahinoglu, Figen Unal, Fikret Unal, and Selim Cevher Copyright © 2015 Nedime Sahinoglu-Keşkek et al. All rights reserved. Purtscher-Like Retinopathy Tue, 06 Jan 2015 08:10:19 +0000 Purtscher-like retinopathy is associated with retinal hemorrhages and ischaemia probably due to the complement-mediated leukoembolization. It is a rare and severe angiopathy found in conditions such as acute pancreatitis. Case. We present a case of a 53-year-old man who presented with a Purtscher-like retinopathy associated with the development of acute pancreatitis in the context of a Klatskin tumour (a hilar cholangiocarcinoma). The ophthalmologic evaluation revealed the best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and of 20/40 in the left eye (LE); biomicroscopy of anterior segment showed scleral icterus and fundoscopy revealed peripapillary cotton-wool spots, optic disc edema, and RPE hypo- and hyperpigmentation in the middle peripheral retina in both eyes with an intraretinal hemorrhage in the LE. 15 months after the initial presentation, without ophthalmological treatment, there was an improvement of BCVA to 20/20 in both eyes and optical coherence tomography (OCT) revealed areas of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots. Conclusion. Purtscher-like retinopathy should not be neglected in complex clinical contexts. Its unclear pathophysiology determines an uncertain treatment strategy, but a meticulous follow-up is compulsory in order to avoid its severe complications. Rita Massa, Carolina Vale, Mafalda Macedo, Maria João Furtado, Miguel Gomes, Miguel Lume, and Angelina Meireles Copyright © 2015 Rita Massa et al. All rights reserved. Chorioretinal Atrophy after Spontaneous Resolution of Myopic Foveoschisis Wed, 24 Dec 2014 11:57:40 +0000 Myopic foveoschisis is one of the major complications of pathologic myopia, and it was most recently identified by new imaging modalities. During the natural evolution of this complication, anatomical and visual improvement without surgical intervention is an unusual course, and most of these eyes remain stable or progressively worsen. The authors report a case of a highly myopic eye that developed patchy chorioretinal atrophy after spontaneous resolution of myopic foveoschisis, which to the best of our knowledge has not been reported previously in the medical literature. Antonio García-Ben, José Manuel García-Campos, María José Morillo Sanchez, and Laura Cristina Figueroa-Ortiz Copyright © 2014 Antonio García-Ben et al. All rights reserved. Corneal Bee Sting Controlled with Early Surgical Intervention and Systemic High-Dose Steroid Therapy Tue, 16 Dec 2014 09:25:22 +0000 A 34-year-old Asian woman presented with painful corneal bee sting. Examinations revealed severe corneal swelling with stinger stuck in deep stroma and endothelial cell loss. She was treated with early surgery including stinger removal and anterior chamber irrigation combined with systemic high-dose steroid therapy. Vision and corneal clarity was recovered in 5 days and no additional corneal endothelial damage was observed. This report suggests that early surgical intervention and high-dose steroid therapy appear to be a useful option in the treatment of corneal bee sting. Jung-Hoon Kim, Moosang Kim, Seung-Jun Lee, Sang Beom Han, and Joon Young Hyon Copyright © 2014 Jung-Hoon Kim et al. All rights reserved. Branch Retinal Artery Occlusion following Dental Extraction Tue, 16 Dec 2014 00:10:14 +0000 Aim. To describe a case of branch retinal artery occlusion following dental extraction and to point out the ophthalmic complications of dental procedures to ophthalmologists and dentists. Case. A 51-year-old woman was referred to our clinic with painless sudden visual loss in her left eye after tooth extraction two days ago. In her left eye the best corrected visual acuity was 6/30 and fundus examination revealed peripapillary flame-shaped hemorrhages and pale retina in the upper temporal arcuate. The right eye examination was unremarkable. Conclusion. Dental procedures can lead to miscellaneous ophthalmic complications possibly due to the close proximity of the anatomic structures. Retinal arterial occlusion is a rare but serious cause of permanent visual loss among these dental procedures where the exact pathologic mechanism is still obscure. Tevfik Oğurel, Zafer Onaran, Reyhan Oğurel, Nurgül Örnek, Nesrin Büyüktortop Gökçınar, and Kemal Örnek Copyright © 2014 Tevfik Oğurel et al. All rights reserved. Epibulbar Osseous Choristoma Mon, 15 Dec 2014 00:10:19 +0000 The topic of this case report is a rare subconjuctival osseous choristoma that corresponded to the left lateral sunconjunctiva and canthus. A 20-year-old man was asymptomatic when he arrived for the examination. His full ophthalmic examination was normal. Orbital computerized tomography was concordant with osseous lesion. Osseous choristomas are the rarest forms of ocular choristomas, they are usually being defined as sporadic, and they are found at the superior temporal region of the episclera. In our case, choristoma was in the lateral canthus of the left eye. We had administered surgical excision by reason of the patient’s cosmetic requirement. We had noted that the lesion was adherent to conjunctiva but not to the sclera and the muscles. After surgical treatment, we saw mature heterotrophic osseous tissue in subconjunctival area and Haversian canals in compact bone tissue. Tolga Bicer and Hasan Soylemez Copyright © 2014 Tolga Bicer and Hasan Soylemez. All rights reserved. Macular Hole Progression following Ocriplasmin Intravitreal Injection Sun, 14 Dec 2014 09:00:32 +0000 Ocriplasmin is a protease which has been approved for the treatment of symptomatic vitreomacular adhesion (VMA). A 63-year-old presented with blurred vision in the left eye and a best corrected visual acuity of 6/18. Optical coherence tomography revealed VMA with an underlying macular hole and she subsequently underwent a left intravitreal ocriplasmin injection. One week after the injection, VMA had been released but with enlargement of the macular hole and a drop in her BCVA to 6/60. This persisted at 1 month after the injection. It is important to warn patients that ocriplasmin may lead to an enlargement of their macular hole with resultant loss in visual acuity. Edward Casswell, Guillermo Fernandez-Sanz, Danny Mitry, Sheila Luk, and Rahila Zakir Copyright © 2014 Edward Casswell et al. All rights reserved. Spontaneous Absorption of Extensive Subinternal Limiting Membrane Hemorrhage in Shaken Baby Syndrome Sun, 07 Dec 2014 00:10:29 +0000 The Shaken Baby Syndrome (SBS) is characterized by subdural hematomas (SH), retinal hemorrhages (RH), and multiple fractures of long bones without external evidence of head trauma. Subinternal limiting membrane (ILM) hemorrhage, also known as macular schisis, is a characteristic finding of this entity. There is no guideline on the right time to indicate surgical treatment. This report describes an abused child with massive sub-ILM hemorrhage, which showed spontaneous absorption after less than two months of follow-up. Due to the possible spontaneous resolution, we suggest an initial conservative treatment in cases of sub-ILM hemorrhage related to SBS. Tatiana Tarules Azzi, Leandro Cabral Zacharias, and Sérgio Luis Gianotti Pimentel Copyright © 2014 Tatiana Tarules Azzi et al. All rights reserved. Inner Segment Ellipsoid Band and Cone Outer Segment Tips Changes Preceding Macular Hole Development in a Young Patient Thu, 04 Dec 2014 12:28:48 +0000 Purpose. Pathophysiology of macular hole (MH) is not yet well defined but the advances of spectral domain optical coherence tomography (SD-OCT) give us access to further detailed imaging. We report a case with macular inner segment ellipsoid (ISe) band loss and cone outer segment tips (COST) line changes seen in SD-OCT preceding MH appearance in a young patient. Methods. 21-year-old woman presented with a partial central scotoma, metamorphopsia, and a 20/25 vision in her right eye. Past medical history was positive for laser assisted in situ keratomileusis (LASIK) surgery 7 months ago with no complications. Macular SD-OCT showed ISe band loss and COST line elevation. She was followed a month later with visual acuity deteriorating to 20/200 and a full thickness MH. Results. The patient underwent a pars plana vitrectomy with internal limiting membrane peeling. Her visual acuity 2 months later was 20/20. Conclusion. SD-OCT can identify preliminary changes, yet to be described, preceding MH formation. Our patient demonstrated ISe band loss and COST abnormalities on SD-OCT a month prior to MH development. SD-OCT should be considered in young patients with subtle visual symptoms and mild changes in visual acuity that are not readily explained by ophthalmological exam. Mariana Harasawa, Hugo Quiroz-Mercado, Guillermo Salcedo-Villanueva, Gerardo Garcia-Aguirre, and Shulamit Schwartz Copyright © 2014 Mariana Harasawa et al. All rights reserved. Case Report of Optic Disc Drusen with Simultaneous Peripapillary Subretinal Hemorrhage and Central Retinal Vein Occlusion Tue, 02 Dec 2014 08:13:31 +0000 A 52-year-old Chinese gentleman presented with right eye floaters and photopsia over one week. His visual acuities were 20/20 bilaterally. Posterior segment examination showed a right eye swollen optic disc and central retinal vein occlusion (CRVO) associated with an area of subretinal hemorrhage adjacent to the optic disc. Fundus fluorescein (FA) and indocyanine green angiographies (ICGA) of the right eye did not demonstrate choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), or retinal ischemia. Ultrasound B-scan revealed optic disc drusen (ODD). In view of good vision and absence of CNV, he was managed conservatively with spontaneous resolution after two months. Commonly, ODD may directly compress and mechanically rupture subretinal vessels at the optic disc, resulting in peripapillary subretinal hemorrhage, as was likely the case in our patient. Mechanical impairment of peripapillary circulation also results in retinal ischemia and may trigger the development of choroidal neovascularization (CNV) and/or polypoidal choroidal vasculopathy (PCV), leading to subretinal haemorrhage. Compromise in central venous outflow with increased retinal central venous pressure from the direct mechanical effects of enlarging ODD results in central retinal vein occlusion (CRVO). Patients with subretinal hemorrhage and CRVO from ODD should be monitored closely for the development of potentially sight-threatening complications. David Zhiwei Law, Francine Pei Lin Yang, and Stephen Charn Beng Teoh Copyright © 2014 David Zhiwei Law et al. 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.