Case Reports in Ophthalmological Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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. Acute Central Retinal Vein Occlusion Secondary to Reactive Thrombocytosis after Splenectomy Mon, 08 Sep 2014 12:54:51 +0000 The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. The patient was treated with steroids for papilledema and administered coumadin and aspirin. The symptoms resolved, and the findings returned to normal within three weeks. Current paper emphasizes that, besides other well-known thrombotic events, reactive thrombocytosis after splenectomy may cause central retinal vein occlusion, which may be the principal symptom of this risky complication. Thus, it can be concluded that followup for thrombocytosis and antithrombotic treatment, when necessary, are essential for these cases. Nursen Oncel Acir, Mehmet Borazan, and Zeynep Dadaci Copyright © 2014 Nursen Oncel Acir et al. All rights reserved. Transient Anisocoria after Corneal Collagen Cross-Linking Mon, 08 Sep 2014 00:00:00 +0000 Purpose. To report a case with transient anisocoria after corneal collagen cross-linking (CXL). Methods. Case report. Results. A 24-year-old male underwent corneal collagen cross-linking (CXL) in his right eye for keratoconus. At the end of the procedure, the pupil of the treated eye was irregular and dilated, while the pupil of the fellow eye was round, regular, and reactive (anisocoria). The following day, pupils were round, regular, and reactive in both eyes. Conclusion. Anisocoria may be a transient and innocuous complication after CXL. A possible cause for this complication might be the anesthetic drops used before and during the surgical procedure or/and the ultraviolet A irradiation during the treatment. George D. Kymionis, Michael A. Grentzelos, Nela Stojanovic, Theodore A. Paraskevopoulos, and Efstathios T. Detorakis Copyright © 2014 George D. Kymionis et al. All rights reserved. First Reported Case of Proliferative Retinopathy in Hemoglobin SE Disease Thu, 21 Aug 2014 13:13:39 +0000 We report the first case of proliferative sickle cell retinopathy in a patient with hemoglobin SE (Hb SE) disease. Only a few dozen cases of Hb SE disease have been reported previously, and none had evidence of proliferative retinopathy. A 56-year-old African American man presented to our clinic for routine examination and was found to have sea-fan peripheral neovascularization bilaterally without maculopathy. Hemoglobin analysis revealed Hb SE heterozygosity. Sector laser photocoagulation to areas of nonperfusion in both eyes resulted in regression of the peripheral neovascularization over a period of 6 months. Although Hb SE disease is rare, the incidence of Hb SE disease is postulated to rise in the future. Awareness of its potential ocular complications is needed to appropriately refer these patients for screening. Paul Baciu, Christopher Yang, Aldo Fantin, Deborah Darnley-Fisch, and Uday Desai Copyright © 2014 Paul Baciu et al. All rights reserved. Intrasurgical Imaging of Subinternal Limiting Membrane Blood Diffusion in Terson Syndrome Thu, 14 Aug 2014 12:52:28 +0000 We report a case of Terson syndrome, providing the first intrasurgical imaging of subinternal limiting membrane blood diffusion in Terson syndrome. We highlight some remarkable in vivo anatomical findings that may give a contribution to the debate about its pathogenesis. Here we hypothesize that the subretinal space might be unlikely to be a primary source of intraocular hemorrhage, and we support the two generally accepted theories about blood diffusion from the retinal vasculature or from the perivascular spaces. Lorenzo Iuliano, Giovanni Fogliato, and Marco Codenotti Copyright © 2014 Lorenzo Iuliano et al. All rights reserved. Definite Ocular Sarcoidosis Using Endobronchial Ultrasonography with Transbronchial Needle Aspiration Thu, 14 Aug 2014 11:44:22 +0000 Purpose. To introduce a minimally invasive procedure, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), to obtain a pathologic evidence of a definite ocular sarcoidosis in a patient who initially presented with presumed ocular sarcoidosis with pulmonary involvement. Methods. An EBUS-TBNA procedure was performed at perihilar lymph nodes, subcarina, and right paratrachea of the patient and specimen obtained was sent for histocytopathological studies. Result. Histocytopathological findings revealed aggregates of epithelioid histiocytes forming a noncaseous granuloma, a hallmark of sarcoidosis. Conclusion. EBUS-TBNA should be considered an alternative procedure to provide cytohistopathology proven diagnosis of definite ocular sarcoidosis. Sukhuma Warrasak, Sawang Saenghirunvattana, Ataya Euswas, Santa Methasiri, Surapon Worapongpaiboon, and Supranee Nirapathpongporn Copyright © 2014 Sukhuma Warrasak et al. All rights reserved. Optical Coherence Tomography of Bilateral Nanophthalmos with Macular Folds and High Hyperopia Tue, 12 Aug 2014 09:17:27 +0000 Importance. There is a conflict about the content of the macular folds in nanophthalmic eyes in the literature. Our study clearly demonstrated that papillomacular folds seen in nanophthalmos or posterior microphthalmos were only composed of neurosensory retina without involvement of retinal pigment epithelium and choroid. Observations. This is a report of two consecutive nanophthalmic patients with macular folds at Maltepe University School of Medicine, Department of Ophthalmology, from January to June 2012. Anterior segment dimensions were near normal. The axial lengths of the eyes were short with markedly shortened posterior segment. A macular fold extending from the center of the fovea towards the optic nerve head was present in all eyes. Optic coherence tomography clearly demonstrated that folds were only composed of neurosensory retina. Binocular visual acuities and refractive errors of the cases were 0.3, 0.2 and +16.00, +15.75 diopters, respectively. Conclusions and Relevance. Our study proposes a surgical option to treat these folds like serous retinal detachments by showing the true content of the folds, although there is not any surgical operation accepted for this condition yet. Further studies dealing with the surgical interventions of these folds should be performed to support this option. Firat Helvacioglu, Ziya Kapran, Sadik Sencan, Murat Uyar, and Ozlem Cam Copyright © 2014 Firat Helvacioglu et al. All rights reserved. Effectiveness of Posaconazole in Recalcitrant Fungal Keratitis Resistant to Conventional Antifungal Drugs Mon, 11 Aug 2014 11:33:22 +0000 Purpose. To present the success of posaconazole in two cases with recalcitrant fugal keratitis that were resistant to conventional antifungal drugs. Method. We presented two cases that were treated with posaconazole after the failure of fluconazole or voriconazole, amphotericin B, and natamycin therapy. Case 1 was a 62-year-old man with a history of ocular trauma. He had been using topical fluorometholone and tobramycin. His best corrected visual acuity (BCVA) was hand motion. He had 5.0 × 4.5 mm area of deep corneal ulcer with stromal infiltration. Case 2 was a 14-year-old contact lens user. He had been using topical moxifloxacin, tobramycin, and cyclopentolate. His BCVA was 20/200. He had a 4.0 × 3.0 mm area of pericentral corneal ulcer with deep corneal stromal infiltration and 2 mm hypopyon. Results. Both patients initially received systemic and topical fluconazole or voriconazole and amphotericin B and topical natamycin that were all ineffective. But the response of posaconazole was significant. After posaconazole, progressive improvement was seen in clinical appearance. BCVA improved to 20/100 in case 1 and 20/40 in case 2. Conclusion. Posaconazole might be an effective treatment option for recalcitrant fusarium keratitis and/or endophthalmitis resistant to conventional antifungal drugs. A. Altun, S. A. Kurna, T. Sengor, G. Altun, O. O. Olcaysu, S. F. Aki, and M. H. Simsek Copyright © 2014 A. Altun et al. All rights reserved. Cervical Carcinoma Manifesting as Progressive Bilateral Visual Loss Wed, 06 Aug 2014 11:24:35 +0000 We report a patient with bilateral choroidal metastasis from disseminated cervical squamous cell carcinoma. A 52-year-old woman presented with progressive bilateral visual loss due to choroidal masses in both eyes. The fundus examination revealed posterior serous retinal detachment in both eyes associated with creamy choroidal lesions. A thorough systemic work-up revealed choroidal metastasis from a squamous cell carcinoma of the cervix. This case highlights the importance of a thorough systemic evaluation in patients with choroidal tumours. O’Sam Shibeeb, Paul Athanasiov, Sumu Simon, and Jagjit Gilhotra Copyright © 2014 O’Sam Shibeeb et al. All rights reserved.