Case Reports in Ophthalmological Medicine The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Pseudotumor Cerebri in a Child with Idiopathic Growth Hormone Insufficiency Two Months after Initiation of Recombinant Human Growth Hormone Treatment Thu, 04 Feb 2016 13:14:57 +0000 Purpose. To report a rare case of pseudotumor cerebri (PTC) in a child two months after receiving treatment with recombinant human growth hormone (rhGH) and to emphasize the need of close collaboration between ophthalmologists and pediatric endocrinologists in monitoring children receiving rhGH. Methods. A 12-year-old boy with congenital hypothyroidism started treatment with rhGH on a dose of 1,5 mg/daily IM (4.5 IU daily). Eight weeks later, he was complaining of severe headache without any other accompanying symptoms. The child was further investigated with computed tomography scan and lumbar puncture. Results. Computed tomography scan showed normal ventricular size and lumbar puncture revealed an elevated opening pressure of 360 mm H2O. RhGH was discontinued and acetazolamide 250 mg per os twice daily was initiated. Eight weeks later, the papilledema was resolved. Conclusions. There appears to be a causal relationship between the initiation of treatment with rhGH and the development of PTC. All children receiving rhGH should have a complete ophthalmological examination if they report headache or visual disturbances shortly after the treatment. Discontinuation of rhGH and initiation of treatment with acetazolamide may be needed and regular follow-up examinations by an ophthalmologist should be recommended. Eleni Loukianou, Anastasia Tasiopoulou, Constantinos Demosthenous, and Dimitrios Brouzas Copyright © 2016 Eleni Loukianou et al. All rights reserved. Free-Floating Iris Pigmented Epithelial Cyst in the Anterior Chamber Thu, 21 Jan 2016 13:46:18 +0000 An unusual case of a free-floating peripheral pigmented cyst in the anterior chamber is presented. A 30-year-old Caucasian male presented reporting a visual defect on his right eye in prone position over the past year. Slit-lamp examination revealed a small pigmented free-floating peripheral iris cyst at the 6 o’clock position in the anterior chamber. Ultrasound biomicroscopy revealed an unfixed epithelial pigmented cyst with an extremely thin wall and no internal reflectivity. Due to the lack of severity of visual disturbance of the patient, no surgical treatment was indicated. The patient is to be followed up annually and advised to return immediately in case of pain or any visual symptoms. Free-floating iris cysts in the anterior chamber are uncommon and remain stable in the majority of cases. Management includes only regular observation until any complications arise. Tryfon Rotsos, Georgios Bagikos, Spyridon Christou, Chrysanthos Symeonidis, Thekla Papadaki, Ioannis Papaeuthimiou, and Dimitrios Miltsakakis Copyright © 2016 Tryfon Rotsos et al. All rights reserved. Serous Macular Detachment Secondary to Optic Pit: Surgical Treatment and Long Time Results Mon, 04 Jan 2016 13:07:43 +0000 32-year-old Turkish male patient presented with an optic disk pit and serous macular detachment in the left eye. Spectral domain optical coherence tomography revealed serous macular detachment and retinoschisis. After vitrectomy the retina gradually flattened and vision was gradually improved. We aimed to report a case of serous macula detachment secondary to optic pit and long term result of surgical treatment. Selim Cevher, Nedime Sahinoglu-Keskek, Fikret Unal, Selahaddin Demirduzen, and Huseyin Oksuz Copyright © 2016 Selim Cevher et al. All rights reserved. Posttraumatic Sphingomonas paucimobilis Endophthalmitis Tue, 29 Dec 2015 12:39:42 +0000 A rare case of Sphingomonas paucimobilis endophthalmitis secondary to a penetrating globe injury with a retained intraocular foreign body is presented. A 30-year-old man presented with severe pain following a penetrating left eye injury. Visual acuity (VA) was 6/120. Slit-lamp examination revealed perforation of the temporal cornea and iris, hypopyon, and a fibrinous membrane covering the pupil. Ultrasonography showed dense vitreous infiltration and an orbital CT-scan confirmed the presence of a metallic foreign body in the vitreous cavity. Topical and systemic therapy were initiated. Pars-plana vitrectomy combined with phacoemulsification was performed in order to remove the foreign body; vitreous samples were acquired and Sphingomonas paucimobilis, sensitive to ceftazidime, was identified. To the best of our knowledge, this is the first report of Sphingomonas paucimobilis endophthalmitis following penetrating ocular injury. In this case, Sphingomonas paucimobilis was not resistant to antibiotics. This allowed for a good healing response following vitrectomy despite the fact that long-term retinal complications resulted in low VA. Konstantinos Droutsas, Georgios Kalantzis, Chrysanthos Symeonidis, and Ilias Georgalas Copyright © 2015 Konstantinos Droutsas et al. All rights reserved. Bilateral Macular Roth Spots as a Manifestation of Subacute Endocarditis Tue, 29 Dec 2015 08:46:55 +0000 A 42-year-old man presented with a 2-day history of impaired vision in the right eye (OD). The best corrected visual acuity (BCVA) (LogMAR) was 1.1 for the right eye and 0.0 for the left eye (OS). Fundus examination revealed white-centered hemorrhages resembling Roth spots in both macular regions. The spectral-domain optical coherence tomography (SD-OCT) showed intraretinal pseudocysts and hyperreflective deposits in the areas corresponding to the Roth spots. Conducted blood tests revealed elevated D-dimer concentration, increased total number of neutrophils, high C-reactive protein concentration, and elevated erythrocyte sedimentation rate. Procalcitonin concentration, platelet count, and body temperature were within normal ranges. A blood culture was ordered and yielded Streptococcus mitis and intravenous antibiotics were started immediately. The patient started complaining of chest and left calf pain. The systemic examination revealed infective endocarditis accompanied by bicuspid aortic valve and paravalvular abscess formation. The patient underwent cardiac surgery with mechanical aortic valve implantation. After recovery, the patient’s visual acuities improved fully. Control ophthalmic examination, including SD-OCT, showed no abnormalities. Karolina Ceglowska, Katarzyna Nowomiejska, Agnieszka Kiszka, Michael J. Koss, Ryszard Maciejewski, and Robert Rejdak Copyright © 2015 Karolina Ceglowska et al. All rights reserved. Primary Congenital Glaucoma with Delayed Suprachoroidal Hemorrhage following Combined Trabeculotomy Trabeculectomy and 5-Fluorouracil Thu, 24 Dec 2015 12:26:54 +0000 Background. Delayed postoperative suprachoroidal hemorrhage (DSCH) may occur following intraocular surgery for the treatment of glaucoma. It is considered to be a rare and debilitating event if not managed appropriately. Reported herewith is a case of Primary Congenital Glaucoma followed by DSCH with successful immediate surgical intervention and visual restoration. Patient and Method. An 8-month-old male child had bilateral Primary Congenital Glaucoma (PCG). Combined Trabeculotomy Trabeculectomy with 5-Fluorouracil (5FU) was performed. He developed delayed suprachoroidal hemorrhage (DSCH) within 24 hours after intraocular surgery which was drained. In addition, he developed exposure keratopathy and left amblyopia. Outcome. Resolution of the DSCH was seen with surgical drainage in addition to treatments for exposure keratopathy and amblyopia. These resulted in reduced intraocular pressure and improved visual acuities. Conclusion. There appears to be a difference in the overall management of PCG and DSCH between adults and children. A high index of suspicion as well as emergency surgical treatment for DSCH and associated conditions should be performed on pediatric patients that present with these challenges. Roseline Duke and Anthonia Ikpeme Copyright © 2015 Roseline Duke and Anthonia Ikpeme. All rights reserved. An Unusual Case of Nonhealing Granulomatous Keratitis Caused by Mycobacterium chelonae in a Healthy Middle Aged Adult Tue, 22 Dec 2015 11:28:32 +0000 Purpose. To report a rare presentation of culture positive Mycobacterium chelonae (M. chelonae) corneal ulcer and its management. Case Report. We report a rare case with history of chronic pain and blurriness of vision. Examination revealed chronic nonhealing paracentral corneal ulcer inferiorly at 5 to 7 o’clock meridian with anterior chamber cells 1+ unresponsive to routine antibiotic and antifungal medications with Mantoux test (MT) positivity in a middle aged nondiabetic patient with no prior obvious history of trauma, ocular surgery, and contact lens usage. Discussion. Ziehl Neelsen (ZN) staining in nonhealing ulcer revealed acid fast bacilli typical of M. chelonae with subsequent culture positivity in Lowenstein Jensen (LJ) medium. Subsequent treatment with topical fortified amikacin and tobramycin resulted in rapid healing of corneal ulcer. Conclusion. M. chelonae presenting as a chronic nonhealing corneal ulcer spontaneously occurring in a healthy young adult with no predisposing factor draws the need to have a good index of suspicion by performing ZN stain and culture and its subsequent successful management with topical fortified amikacin and tobramycin. Vipul Bhandari, Sriganesh, and Kirti Relekar Copyright © 2015 Vipul Bhandari et al. All rights reserved. West African Crystalline Maculopathy in Sickle Cell Retinopathy Wed, 16 Dec 2015 14:08:36 +0000 Purpose. To describe the first reported case of West African crystalline maculopathy (WACM) from a member of the Benin tribe and explore the association with sickle cell retinopathy. Methods. Full ophthalmic examination and high-resolution ocular coherence tomographic imaging. Patients. 61-year-old patient from an academic retina practice. Results. The patient demonstrated bilateral yellow-green birefringent crystals localized to the inner retina on optical coherence tomography, as well as sickle cell-related neovascularization in the right eye. She reported no consumption of kola nuts. Conclusions. Associated retinal vascular disease may be important in the pathogenesis of crystalline maculopathy. Jennifer S. Kung and Theodore Leng Copyright © 2015 Jennifer S. Kung and Theodore Leng. All rights reserved. In Vivo Confocal Microscopy and Anterior Segment Optic Coherence Tomography Findings in Ocular Ochronosis Tue, 15 Dec 2015 11:39:34 +0000 Purpose. To report clinical and in vivo confocal microscopy (IVCM) findings of two patients with ocular ochronosis secondary due to alkaptonuria. Materials and Methods. Complete ophthalmologic examinations, including IVCM (HRT II/Rostock Cornea Module, Heidelberg, Germany), anterior segment optical coherence tomography (AS-OCT) (Topcon 3D spectral-domain OCT 2000, Topcon Medical Systems, Paramus, NJ, USA), corneal topography (Pentacam, OCULUS Optikgeräte GmbH, Wetzlar, Germany), and anterior segment photography, were performed. Results. Biomicroscopic examination showed bilateral darkly pigmented lesions of the nasal and temporal conjunctiva and episclera in both patients. In vivo confocal microscopy of the lesions revealed prominent degenerative changes, including vacuoles and fragmentation of collagen fibers in the affected conjunctival lamina propria and episclera. Hyperreflective pigment granules in different shapes were demonstrated in the substantia propria beneath the basement membrane. AS-OCT of Case 1 demonstrated hyporeflective areas. Fundus examination was within normal limits in both patients, except tilted optic discs with peripapillary atrophy in one of the patients. Corneal topography, thickness, and macular OCT were normal bilaterally in both cases. Conclusion. The degenerative and anatomic changes due to ochronotic pigment deposition in alkaptonuria can be demonstrated in detail with IVCM and AS-OCT. Confocal microscopic analysis in ocular ochronosis may serve as a useful adjunct in diagnosis and monitoring of the disease progression. Elif Demirkilinc Biler, Suzan Guven Yilmaz, Melis Palamar, Pedram Hamrah, and Afsun Sahin Copyright © 2015 Elif Demirkilinc Biler et al. All rights reserved. Visual Field Defect after Cardiac Surgery: The Striking Role of Interdisciplinary Collaboration Mon, 07 Dec 2015 13:35:59 +0000 Perioperative visual loss (POVL) is a potentially devastating complication that can occur following ocular or nonocular surgery. The leading causes of this disease are retinal vascular occlusions, ischemic optic neuropathies, and cortical blindness. POVL pathogenesis is strictly influenced by surgery, anesthesia, and patients’ comorbidities. We report of a 55-year-old caucasian man who presented with complaints of sudden painless loss of vision and unilateral campimetric deficit. We recorded a preserved visual acuity but at fundus examination a bilateral ischemic optic neuropathy (ION) was suspected. Our hypothesis was supported by uncommon and peculiar visual field defects and a history of cardiovascular surgery shortly before was a striking data. When we examined his medical records we found strong accordance with what is reported in literature to be risk factors for postoperative ION development. He presented intraoperative hypotension, anemia, and hypothermia, he was older than 50 years, and surgery lasted for more than five hours. We are currently monitoring his visual acuity and visual fields which remain unchanged. As there is no proved therapy for such severe adverse events, we recommend intraoperative check of blood pressure, blood loss, and body temperature, associated with repeated eye checks and patients’ interview. Raffaele Nuzzi and Carlo Lavia Copyright © 2015 Raffaele Nuzzi and Carlo Lavia. All rights reserved. Arginine-Restricted Therapy Resistant Bilateral Macular Edema Associated with Gyrate Atrophy Sun, 06 Dec 2015 06:32:29 +0000 Introduction. Gyrate atrophy is a rare genetical metabolic disorder affecting vision. Here, we report a 9-year-old boy with gyrate atrophy associated with bilateral macular edema at the time of diagnosis and the effect of long term metabolic control on macular edema. Case Presentation. A 9-year-old boy presented with a complaint of low visual acuity (best corrected visual acuity: 20/80 in both eyes, refractive error: −12.00 D). Dilated fundus examination revealed multiple bilateral, sharply defined, and scalloped chorioretinal atrophy areas in the midperipheral and peripheral zone. Spectral-domain optical coherence tomography revealed bilateral cystoid macular edema in both eyes. Serum ornithine level was high (622 μmol/L). An arginine-restricted diet reduced serum ornithine level (55 μmol/L). However, visual findings including macular edema remained unchanged in 2 years of follow-up. Conclusion. Arginine-restricted diet did not improve macular edema in our patient with gyrate atrophy. A more comprehensive understanding of the underlying factors for macular edema will lead to the development of effective therapies. Sibel Doguizi, Mehmet Ali Sekeroglu, Mustafa Alpaslan Anayol, and Pelin Yilmazbas Copyright © 2015 Sibel Doguizi et al. All rights reserved. Bilateral Multifocal Choroidal Osteoma with Choroidal Neovascularization Sun, 06 Dec 2015 06:31:50 +0000 Choroidal osteoma has been reported to be unilateral in approximately 80% of cases diagnosed with this condition. Herein we report the clinical characteristics and multimodal imaging findings in a rare case of bilateral multifocal choroidal osteoma. A 32-year-old female presented with decreased visual acuity (VA) in the right eye (20/100), though she had normal VA (20/20) in the left eye. Ophthalmoscopy and multimodal imaging investigation revealed bilateral multifocal choroidal osteoma complicated by choroidal neovascularization (CNV) in the right eye. Following three injections of intravitreal bevacizumab (IVB) for CNV in the right eye, VA improved to 20/40. Mousavi MirNaghi, Shoeibi Nasser, Hosseini SeyedehMaryam, and Saadat Targhi Ali Copyright © 2015 Mousavi MirNaghi et al. All rights reserved. Unilateral Crystalline Vitreoretinopathy: A Rare Entity Associated with Intraocular Inflammation Tue, 24 Nov 2015 12:44:32 +0000 A 31-year-old Indian male presented with floaters and diminution of vision in the right eye. Ocular examination showed features of old anterior uveitis with posterior subcapsular cataract and fine, refractile crystals in the vitreous cavity and on the retinal surface. A thorough workup for all known causes of crystalline retinopathy was inconclusive. Unilateral crystalline retinopathy has been sparingly reported. This is the first report of unilateral, crystalline vitreoretinopathy in the absence of any demonstrable and known cause for intraocular crystals. Kaustubh B. Harshey, Karthik Srinivasan, Ramakrishnan Rengappa, and Kim Ramasamy Copyright © 2015 Kaustubh B. Harshey et al. All rights reserved. Ischemic Retinal Vasculitis Associated with Cataract Surgery and Intracameral Vancomycin Thu, 05 Nov 2015 14:16:41 +0000 Recently, there have been reports suggesting that intracameral vancomycin has been associated with retinal vasculitis; some have described this phenomenon as postoperative hemorrhagic occlusive retinal vasculitis. We present a case of a 65-year-old woman who underwent uncomplicated phacoemulsification and posterior chamber intraocular lens implantation followed by intracameral antibiotic prophylaxis. Unlike prior reports, this report demonstrates a case of mild visual reduction and minimal inflammation with subtle but complete unilateral peripheral retinal ischemia associated with cataract surgery and intracameral vancomycin, suggesting a spectrum of toxicity that may be underrecognized. Lucas T. Lenci, Eric K. Chin, Christi Carter, Stephen R. Russell, and David R. P. Almeida Copyright © 2015 Lucas T. Lenci et al. All rights reserved. Ocular Inflammatory Myofibroblastic Tumor in the Left Eye with Phthisis Right Eye: A Rare Occurrence in a Child Sun, 18 Oct 2015 16:04:25 +0000 Inflammatory myofibroblastic tumor (IMT) is a benign pseudoneoplastic inflammatory condition with the potential for persistent local growth and recurrence that rarely affects the orbit. We report a very rare case of anterior orbital IMT in a child who presented with gradually progressive mass in left eye for 16 months. Ocular examination showed a cauliflower like exophytic mass at 360 degrees of the perilimbal area covering the entire cornea and obscuring the visualization of anterior and posterior segments. The right eye was phthisical. CT scan showed a lobulated exophytic soft tissue mass in the preseptal region and along the anterior portion of the left globe extending from medial canthus to the lateral canthus. Enucleation of the left eye was performed and the histopathological examination confirmed the diagnosis of IMT. This report aims to raise awareness about this rare ocular entity and emphasizes its early treatment as delay can result in loss of the eye. Sangeeta Shah, Badri Prasad Badhu, Poonam Lavaju, and Anju Pradhan Copyright © 2015 Sangeeta Shah et al. All rights reserved. Multifocal ERG Guiding Therapy in a Case of Hydroxychloroquine Premaculopathy Sun, 18 Oct 2015 06:55:01 +0000 We report the case of a 28-year-old female treated for systemic lupus erythematosus with hydroxychloroquine (200 mg/day) for 11 years. She was visually asymptomatic, with normal fundus appearance, normal colour vision testing findings, 20/20 visual acuity in both eyes, and only mild central bilateral defects on 10-2 perimetry. Multifocal electroretinography (mfERG) showed low density values for ring 1 in both eyes. Because the patient had not previously responded to alternative treatments and in consultation with her physician, the hydroxychloroquine dose was reduced to 200 mg four days/week. Four serial mfERGs performed at 4, 18, 25, and 34 months after dose reduction showed a progressive improvement in the definition and density of the responses until they were normalized at the third mfERG (25 months after hydroxychloroquine dose reduction). The fourth and final mfERG at 34 months confirmed the recovery in both eyes. Perimetry defects were mostly normalized. These results demonstrate the importance of mfERG for the safe management of patients under long-term hydroxychloroquine treatment. José Antonio Sáez-Moreno, Concepción Domínguez-Hidalgo, and José Manuel Rodríguez-Ferrer Copyright © 2015 José Antonio Sáez-Moreno et al. All rights reserved. Unilateral Acute Anterior Ischemic Optic Neuropathy in a Patient with an Already Established Diagnosis of Bilateral Optic Disc Drusen Thu, 15 Oct 2015 09:32:19 +0000 Optic disc drusen (ODD) are calcific deposits that form in the optic nerve head secondary to abnormalities in axonal metabolism and degeneration. Anterior ischemic optic neuropathy, central retinal artery, and vein occlusion are among the rare vascular complications of disc drusen. We reported the clinical course of a 51-year-old patient with a unilateral acute nonarteritic anterior ischemic optic neuropathy (NAION) who received the diagnosis of bilateral optic disc drusen five years earlier and thereby reiterated the association of ODD and acute NAION. Ziya Ayhan, Aylin Yaman, Meltem Söylev Bajin, and A. Osman Saatci Copyright © 2015 Ziya Ayhan et al. All rights reserved. Medical and Surgical Treatment in Pediatric Orbital Myositis Associated with Coxsackie Virus Thu, 15 Oct 2015 09:08:39 +0000 Purpose. To report a case of orbital myositis associated with Coxsackie virus and its medical and surgical approach. Methods. Complete ophthalmological examination and imaging and analytical investigation were performed. Results. A 6-year-old male presented with subacute painless binocular horizontal diplopia. Examination revealed bilateral best-corrected visual acuity (BCVA) of 20/20 and right eye 45-prism-dioptre (PD) esotropia in near and distance fixations, with no motility restrictions. Serologic screening was positive for Coxsackie virus acute infection and computerized tomography (CT) suggested right eye medial rectus orbital myositis. An oral corticosteroid 1.0 mg/kg/day regimen was started. A new CT after two months showed symmetrical lesions in both medial rectus muscles. Corticosteroids were increased to 1.5 mg/kg/day. After imagiological resolution on the 4th month, alternating 45 PD esotropia persisted. Bilateral 7 mm medial rectus recession was performed after 1 year without spontaneous recovery. At 1-year follow-up, the patient is orthophoric with 200′′ stereopsis and bilateral 20/20 BCVA. Conclusions. To our knowledge, this is the first reported case of orbital myositis associated with Coxsackie virus. This is also the first reported case of isolated strabismus surgery after orbital myositis in pediatric age, highlighting the favourable aesthetic and functional outcomes even in cases of late ocular motility disorders. Pedro Gil, João Gil, Catarina Paiva, Guilherme Castela, and Rui Castela Copyright © 2015 Pedro Gil et al. All rights reserved. Peripapillary Intrachoroidal Cavitation in Myopia Evaluated with Multimodal Imaging Comprising “En-Face” Technique Mon, 12 Oct 2015 11:28:47 +0000 Objectives. To demonstrate the usefulness of “en-face” Spectral Domain Optical Coherence Tomography (SD-OCT) combined with Fluorescein Angiography (FA) in the investigation of peripapillary intrachoroidal cavitation. Materials and Methods. A 72-year-old man followed for primary open-angle glaucoma (POAG) for 4 years was referred for an asymptomatic “peripapillary lesion.” A full ophthalmological examination and conventional imaging of the retina were done. FA, Indocyanine Green Angiography (ICG-A), and SD-OCT using the “en-face” technique were also performed. Results. Best-corrected visual acuity (BCVA) was 20/25 both eyes. Slit-lamp examination revealed no abnormalities of anterior segment. Intraocular pressure (IOP) was normal. Fundus examination showed a triangular yellow-orange thickening at the inferior border of both optic nerves. FA showed early hypofluorescence of the lesion and progressive staining without any dye pooling. SD-OCT with “en-face” technique showed an intrachoroidal hyporeflective space resembling a cavitation below the retinal pigment epithelium (RPE). Conclusions. “En-face” SD-OCT and FA are valuable techniques for the diagnosis of peripapillary intrachoroidal cavitation associated with myopia. Pathophysiological insights regarding SD-OCT findings and angiography behavior are offered. Georges Azar, Romain Leze, Aude Affortit-Demoge, and Céline Faure Copyright © 2015 Georges Azar et al. All rights reserved. Fellow Eye Macular Edema Improvement after Intravitreal Bevacizumab for Radiation Retinopathy Thu, 08 Oct 2015 13:19:03 +0000 Radiation retinopathy (RR) is a progressive, chronic condition directly related to the amount of radiation administered to the retina. We report a 37-year-old patient with medulloblastoma that was treated with external beam radiation and presented to us with bilateral cystoid macular edema. He was treated with monthly bevacizumab injections only in his worst seeing eye. There was a significant improvement in his fellow eye, with marked retinal thickness reduction. Therefore, we present clinical evidence of systemic absorption and fellow eye activity of the drug (bevacizumab). One must be aware of distant side effects after intravitreal injections. Isis A. S. Brito, Leandro C. Zacharias, and Sérgio Luis G. Pimentel Copyright © 2015 Isis A. S. Brito et al. All rights reserved. Craniofacial Microsomia: Goldenhar Syndrome in Association with Bilateral Congenital Cataract Thu, 08 Oct 2015 12:16:12 +0000 Craniofacial microsomia (CFM) includes a spectrum of malformations primarily involving structures derived from the first and second branchial arches. Patients with hemifacial microsomia and epibulbar dermoids are said to have Goldenhar syndrome (GHS). Four-month-old boy with whitish pupillary reflex presented with the features of GHS in pediatric ophthalmology clinic. The child had ocular and auricular manifestations. There were no vertebral anomalies, but he had bilateral congenital cataract. The peculiarity of this case is the presence of the bilateral total congenital cataract, in association with CFM. There is absence of epibulbar dermoid or lipodermoid in the eyes, although the child had features of GHS. In addition to it, anesthetic intubation was smooth in this case. Any case diagnosed with CFM and/or GHS needs treatment through multidisciplinary approach, consultation in ophthalmology department is one of them. U. D. Shrestha and S. Adhikari Copyright © 2015 U. D. Shrestha and S. Adhikari. All rights reserved. Anterior Segment Findings in Vitamin A Deficiency: A Case Series Mon, 05 Oct 2015 13:55:31 +0000 Vitamin A deficiency is a rare but vision threatening disorder in the developed world, which can lead to blindness for severe keratomalacia with cornea scarring and perforation or night blindness due to impaired dark adaptation. Conversely, the disease is quite common in developing countries, as a consequence of chronic malnutrition. The correct diagnosis and therapy with prompt vitamin A supplementation avoid blindness. We report a series of 3 local cases with different age and causes for vitamin A deficiency. The diagnostic workup, therapy, and prognosis are discussed. Pierangela Rubino, Paolo Mora, Nicola Ungaro, Stefano A. Gandolfi, and Jelka G. Orsoni Copyright © 2015 Pierangela Rubino et al. All rights reserved. Pseudotumoral and Multiple Retinal Pigment Epithelium Proliferation in Vogt-Koyanagi-Harada Disease Mon, 05 Oct 2015 11:49:24 +0000 We report a case of pseudotumoral retinal pigment epithelium (RPE) proliferation in Vogt-Koyanagi-Harada (VKH) disease, in a 50-year-old female who presented with a juxtapapillary and peripheral subretinal hyperpigmented lesions in the left eye and “sunset glow fundus,” hyperpigmented striae, and multiple atrophic chorioretinal spots in the periphery. The darkly pigmented exuberant larger subretinal mass extended to the periphery with associated subretinal fibrosis. This patient demonstrated the entire clinical presentation of VKH disease, which tends to course with a chronic, bilateral, granulomatous panuveitis and exudative retinal detachment associated with poliosis, vitiligo, alopecia, and central nervous system and auditory signs. Our case is unique for the presence of exuberant, pseudotumoral RPE proliferation at the juxtapapillary region and peripheral area. Although this complication has rarely been reported, a high index of suspicion is warranted for early diagnosis and avoids unnecessary treatments of a pseudotumor. Juan B. Yepez, Felipe Murati, Michele Petitto, and J. Fernando Arevalo Copyright © 2015 Juan B. Yepez et al. All rights reserved. Escherichia coli Eyelid Abscess in a Patient with Alcoholic Cirrhosis Tue, 15 Sep 2015 10:15:57 +0000 Escherichia coli (E. coli) is a rare cause of ocular infections and has not yet been reported as a cause of an ocular abscess. We describe the case of a 47-year-old woman with a history of alcoholic cirrhosis who presented with painful left lower eyelid swelling that did not improve with oral antibiotics. The abscess was drained and cultures were positive for E. coli. Patients with cirrhosis are at increased risk for developing E. coli bacterial infections, but to our knowledge this is the first case of an E. coli eyelid abscess reported in the literature. Matthew Stratton, Cara Capitena, Logan Christensen, and Miguel Paciuc-Beja Copyright © 2015 Matthew Stratton et al. All rights reserved. Benign Lymphoid Hyperplasia Presenting as Bilateral Scleral Nodules Tue, 01 Sep 2015 08:34:07 +0000 Purpose. To report a case of transient lymphoid hyperplasia presenting as bilateral nodular scleral mass in a young male patient. Design. Observational case report. Methods. Chart review. Causes of scleritis were considered and excluded based on detailed history, physical examination, and laboratory investigations. Results. Excisional biopsy of scleral lesions indicated lymphoid tissue. Immunohistochemical studies revealed a polyclonal population of T and B cells consistent with a benign reactive process. Conclusions. Chronic exposure of the ocular adnexa to many allergens and irritants may lead to activation of the inflammatory cascade. In severely allergic patients activation may be exponential and elicit an immune-mediated response resulting in a transient lymphoid reactive process. Ricardo J. Cumba and Rene Vazquez-Botet Copyright © 2015 Ricardo J. Cumba and Rene Vazquez-Botet. All rights reserved. Posterior Cortical Atrophy Presenting with Superior Arcuate Field Defect Mon, 31 Aug 2015 13:08:20 +0000 An 80-year-old female with reading difficulty presented with progressive arcuate field defect despite low intraocular pressure. Over a 5-year period, the field defect evolved into an incongruous homonymous hemianopia and the repeated neuroimaging revealed progressive posterior cortical atrophy. Further neuropsychiatric assessment demonstrated symptoms and signs consistent with Benson’s syndrome. Sue Ling Wan, Danuta M. Bukowska, Stephen Ford, and Fred K. Chen Copyright © 2015 Sue Ling Wan et al. All rights reserved. Bilateral Coats’ Disease Combined with Retinopathy of Prematurity Sun, 30 Aug 2015 09:32:17 +0000 Purpose. To report a case of bilateral Coats’ disease combined with retinopathy of prematurity (ROP). Case. Retinal vascularization was complete in the right eye, whereas zone III, stage 3 ROP and preplus disease were observed in the left eye at 43 weeks of postmenstrual age (PMA) in a 31-week premature, 1200-g neonate. Intraretinal exudates developed and retinal hemorrhages increased in the left eye at 51 weeks of PMA. Diode laser photocoagulation (LP) was applied to the left eye. Exudates involved the macula, and telangiectatic changes developed one month following LP. Additional LP was applied to the left eye combined with intravitreal bevacizumab (IVB) injection at 55 weeks of PMA. Disease regressed one month after the additional therapy. At the 14-month examination of the baby, telangiectatic changes and intraretinal exudates were observed in the right eye. Diode LP was applied to the right eye combined with IVB injection. Exudates did not resolve completely, and cryotherapy was applied one month following LP. Retinal findings regressed three months following the cryotherapy. Conclusion. This is the first report of presumed bilateral Coats’ disease combined with ROP. If Coats’ disease could be diagnosed at early stages, it would be a disease associated with better prognosis. Huseyin Gursoy, Nazmiye Erol, Mustafa Deger Bilgec, Hikmet Basmak, Ozden Kutlay, and Huseyin Aslan Copyright © 2015 Huseyin Gursoy et al. All rights reserved. Adie’s Tonic Pupil in Systemic Sclerosis: A Rare Association Thu, 27 Aug 2015 12:54:50 +0000 We report a rare association of Adie’s tonic pupil in a patient with systemic sclerosis who was otherwise systemically stable. This paper is an effort to unravel whether the tonic pupil and systemic sclerosis are an association by chance (which may be the case) or systemic sclerosis is the source of the tonic pupil. Anusha Venkataraman, Bijnya Birajita Panda, and Chandrasekhar Sirka Copyright © 2015 Anusha Venkataraman et al. All rights reserved. Sub-Tenon Injections of Triamcinolone Acetonide Had Limited Effect on Cystoid Macular Edema Secondary to Nanoparticle Albumin-Bound-Paclitaxel (Abraxane) Sun, 23 Aug 2015 12:01:13 +0000 Purpose. To report the first case of cystoid macular edema (CME) induced by nanoparticle albumin-bound- (nab-) paclitaxel treated with sub-Tenon injections of triamcinolone acetonide (STTA) with detailed long-term follow-up. Case. A 39-year-old Japanese woman with breast cancer presents with decreased vision in both eyes while receiving nab-paclitaxel. Two STTA treatments were administered for persistent CME in her right eye. Central retinal thickness (CRT) of the treated eye decreased after the first STTA, but there was no change after the second STTA. CRT of the other eye and bilateral visual acuity (VA) showed no change after each treatment. However, this patient experienced gradual recovery of visual function after nab-paclitaxel treatment was completed, 3 months after the second STTA. Improvements in VA and CRT did not overlap in time. Moreover, there was a big improvement time lag in VA between the eyes. Conclusion. Cessation of nab-paclitaxel could lead to resolution of CME more than STTA, although STTA had some effect. Since nab-paclitaxel has been recently approved for treating more types of malignancies, the number of the patients with this CME is expected to increase in the near future. Patients and physicians should understand this side effect and prepare for other treatment options. Naoki Matsuoka, Hiruma Hasebe, Tetsuji Mayama, and Takeo Fukuchi Copyright © 2015 Naoki Matsuoka et al. All rights reserved. Congenital Upper Eyelid Coloboma: Clinical and Surgical Management Sun, 23 Aug 2015 08:57:16 +0000 Purpose. The goal was to describe our experience in the surgical management and treatment of four patients with congenital upper eyelid colobomas. Methods. A descriptive, observational, retrospective study was performed including patients with congenital eyelid colobomas referred to Asociación para Evitar la Ceguera en México I.A.P. “Dr. Luis Sánchez Bulnes” between 2004 and 2014 and assessed by the Oculoplastics and Orbit Service. Results. The four cases required surgical treatment of the eyelid defects before one year of age and their evolution was monitored from the time of referral to the present day. One of the patients needed a second surgical procedure to repair the eyelid defect and correct the strabismus. Conclusions. Eyelid colobomas are a potential threat to vision at an early age, which requires close monitoring of the visual development of patients. José María Ortega Molina, Eduardo Ramón Mora Horna, Andrés David Salgado Miranda, Rosa Rubio, Ana Solans Pérez de Larraya, and Guillermo Salcedo Casillas Copyright © 2015 José María Ortega Molina et al. All rights reserved.