Case Reports in Ophthalmological Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Surgical Excision of Orbital Progressive Granular Cell Tumour Mon, 18 May 2015 13:59:23 +0000 Granular cell tumour (GCT) is mostly benign lesion first described by Abrikossoff and named after him. Most cases are reported in the head and neck area, where the tongue is the most common site. Here we review previous cases in the literature for GCT in the orbit and present a new case. A 49-year-old male presented with apparent exophthalmos. Examination of the patient revealed the presence of a mass in the bottom side of the orbit. A substantial progress was noted after two months from the initial examination using computed tomography (CT) scan. An orbital mass was extracted and histological analysis showed signs typical for GCT. Immunohistochemistry was positive for S-100; the biopsy showed no mitotic or necrotic areas. Proptosis was resolved after surgery and a six-year follow-up CT scan was performed. We conclude that rapid progress of the tumour does not necessarily suggest malignancy. Demetrio Germanò, Hossein Mostafa Elbadawy, Diego Ponzin, Daniele Ferro, and Leonardo Priore Copyright © 2015 Demetrio Germanò et al. All rights reserved. Unilateral Congenital Lacrimal Fistula with Renal Agenesis and Pelvic Kidney: A Case Report and Review of the Literature Mon, 18 May 2015 12:48:27 +0000 A 12-year-old boy presented to the clinic of ophthalmology because of watering and discharge from his left lower eyelid. The inspection examination revealed an orifice that was associated with congenital lacrimal fistula (CLF). He underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings. Systemic evaluation revealed multiple renal anomalies: right renal agenesis and left ectopic pelvic kidney. This case is unique because this is the first reported case of CLF accompanied with ectopic pelvic kidney in the literature. A. Altun, S. A. Kurna, T. Sengor, G. Altun, A. Oflaz, and H. S. Sonmez Copyright © 2015 A. Altun et al. All rights reserved. Epidermoid Cyst of Orbit in a Newborn Wed, 13 May 2015 14:21:40 +0000 A 3-day-old male newborn presented with a severe proptosis of the left eye leading to exposure keratopathy. He underwent debulking of the cyst and biopsy of the tumour and received the pathological diagnosis of epidermoid cyst of orbit. Clinicopathological features of this rare disease are discussed. Handan Canan, Rana Altan-Yaycioglu, Nebil Bal, Birgin Törer, Bilin Çetinkaya-Çakmak, and Hande Gülcan Copyright © 2015 Handan Canan et al. All rights reserved. Corneal Collagen Cross-Linking in Pellucid Marginal Degeneration: 2 Patients, 4 Eyes Mon, 11 May 2015 13:44:11 +0000 Purpose. To report the long-term results of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A irradiation in 4 eyes of 2 patients affected by pellucid marginal degeneration (PMD). Methods. This study involved the retrospective analysis of 4 eyes of 2 patients with PMD that underwent CXL treatment. Of the eyes, three had only CXL treatment and one had CXL treatment after an intrastromal corneal ring segment implantation. We have pre- and postoperatively evaluated uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCDVA), corneal topography (Pentacam), specular microscopy, and pachymetry. Results. Patient 1 was a woman, aged 35, and Patient 2 was a man, aged 33. The right eye of Patient 1 showed an improvement in her BCDVA, from 16/40 to 18/20 in 15 months, and her left eye improved from 12/20 to 18/20 in 20 months. Patient 2’s right eye showed an improvement in his BCDVA, from 18/20 to 20/20 in 43 months, and his left eye improved from 16/20 to 18/20 in 22 months. No complications were recorded during or after the treatment. Conclusion. CXL is a safe tool for the management of PMD, and it can help to stop the progression of this disease. Serife Bayraktar, Zafer Cebeci, Merih Oray, and Nilufer Alparslan Copyright © 2015 Serife Bayraktar et al. All rights reserved. Cytomegalovirus Uveitis with Hypopyon Mimicking Bacterial Endophthalmitis Mon, 11 May 2015 13:18:03 +0000 We report an 83-year-old immune-competent female with unilateral endophthalmitis extraordinarily caused by cytomegalovirus (CMV). Since she was suspected of suffering possible bacterial endophthalmitis, she was referred to our hospital. At the first visit, hypopyon in the anterior chamber and the opacity of vitreous body were observed in the left eye. The best-corrected visual acuity (BCVA) of the left eye was counting fingers and the intraocular pressure (IOP) was 20 mmHg. Bacterial and fungus culture of the aqueous humor revealed no infection. However, the density of corneal endothelial cell was less than the measurable range and CMV was detected by PCR of the aqueous humor. She was immune-competent and the data indicated neither systemic infections nor diseases. Systemic valganciclovir and corticosteroid were administered. After that, hypopyon in the anterior chamber and the opacity of vitreous body of the left eye were improved, and the BCVA of the left eye was 20/200 one year after the first visit. However, the inflammation of the anterior chamber recurred accompanied by elevated IOP after the discontinuance of administering valganciclovir. CMV-induced uveitis accompanied with hypopyon is quite rare. Therefore, it can be easily misdiagnosed as bacterial endophthalmitis. Atsushi Yoshida, Hiroto Obata, and Hidetoshi Kawashima Copyright © 2015 Atsushi Yoshida et al. All rights reserved. Infected Baerveldt Glaucoma Drainage Device by Aspergillus niger Thu, 07 May 2015 15:58:50 +0000 Fungal endophthalmitis is rare but may complicate glaucoma drainage device surgery. Management is challenging as the symptoms and signs may be subtle at initial presentation and the visual prognosis is usually poor due to its resistant nature to treatment. At present there is lesser experience with intravitreal injection of voriconazole as compared to Amphotericin B. We present a case of successfully treated Aspergillus endophthalmitis following Baerveldt glaucoma drainage device implantation with intravitreal and topical voriconazole. Nurul-Laila Salim, Yaakub Azhany, Zaidah Abdul Rahman, Roziawati Yusof, and Ahmad Tajudin Liza-Sharmini Copyright © 2015 Nurul-Laila Salim et al. All rights reserved. Ultrasound Biomicroscopy and Scheimpflug Imaging in Anterior Megalophthalmos: Changes Seen after Cataract Surgery Thu, 07 May 2015 14:07:49 +0000 Purpose. With this report we describe ultrasound biomicroscopic (UBM) findings in a patient with anterior megalophthalmos before and after undergoing phacoemulsification with posterior chamber intraocular lens implantation. Methods. Phacoemulsification was carried out for nuclear sclerosis in both eyes of a patient diagnosed with anterior megalophthalmos. The patient was subjected to detailed ophthalmic examination including ultrasound biomicroscopy and Scheimpflug imaging prior to and after surgery. Preoperative ultrasound biomicroscopy revealed a deep anterior chamber with posterior bowing of the midperipheral iris in both eyes. The ciliary processes were inserted on the posterior surface of the iris. UBM was repeated postoperatively as well. Results. Phacoemulsification and posterior chamber intraocular lens implantation (IOL) were carried out successfully in both eyes. The IOLs were well centered and captured within the anterior capsulorhexis. The anterior chambers were hyperdeep, 6.24 mm (OD) and 6.08 mm (OS), respectively. The posterior bowing of the midperipheral iris was absent, with the iris having a more flat profile. Conclusion. UBM findings in anterior megalophthalmos seemed to partially resolve after cataract surgery. The anterior chamber deepens appreciably as well. Nishant Nawani, Arun K. Jain, and Ramandeep Singh Copyright © 2015 Nishant Nawani et al. All rights reserved. Complete Disappearance of Choroidal Metastasis from Lung Adenocarcinoma Treated with Bevacizumab and Chemotherapy Thu, 07 May 2015 07:08:17 +0000 Choroidal metastasis from lung cancer is uncommon. We report a case of choroidal metastasis as an inaugural manifestation of lung adenocarcinoma, successfully treated by docetaxel, cisplatinum, and intravenous bevacizumab as an antiangiogenesis therapy. A complete remission was obtained after 4 cycles and maintained after six cycles. This case report demonstrates the importance of the systemic bevacizumab and chemotherapy in the treatment of choroidal metastasis from adenocarcinoma of the lung. Hampig Raphael Kourie, Joelle Antoun, Alexandre Schakal, Elie Nasr, Marwan Sahyoun, and Joseph Kattan Copyright © 2015 Hampig Raphael Kourie et al. All rights reserved. Bilateral Sturge-Weber and Phakomatosis Pigmentovascularis with Glaucoma, an Overlap Syndrome Wed, 06 May 2015 09:11:52 +0000 Aim. To report a case of bilateral Sturge-Weber and Phakomatosis pigmentovascularis with secondary glaucoma in a child. Method. Case report. Results. A 4-year-old male child was referred to us for control of intraocular pressure (IOP). Sleeping IOP was 36 mm Hg in right eye and 28 mm Hg in the left eye. The sclera of both the eyes showed bluish black pigmentation—melanosis bulbi. Fundus examination of both eyes showed diffuse choroidal hemangiomas with glaucomatous cupping. Nevus flammeus was present on both sides of face along all the 3 divisions of trigeminal nerve with overlying hypertrophy of skin and on left forearm. Nevus fuscocaeruleus was present on upper trunk. All skin lesions were present since birth and were stationary in nature. CT scan of head revealed left-sided cerebral atrophy. Intraocular pressure was controlled after treatment with topical antiglaucoma medications. Pulsed Dye Laser has been advised by dermatologist for skin lesions. Patient has been advised for regular follow-up. Conclusion. The two overlapping dermatological disorders and their association with glaucoma are a rare entity. Management should be targeted both for dermatological and eye conditions. Bharat Patil, Gautam Sinha, Bhagabat Nayak, Reetika Sharma, Sadhana Kumari, and Tanuj Dada Copyright © 2015 Bharat Patil et al. All rights reserved. A Case of Goldenhar Syndrome Associated with a New Retinal Presentation: Exudative Vitelliform Maculopathy Sun, 03 May 2015 09:17:06 +0000 Goldenhar syndrome is a rare clinical disturbance with a wide range of clinical manifestations. We report on a 6-year-old male with peculiar retinal presentation of Goldenhar syndrome. The patient was referred to Ophthalmology for central scotoma in the left eye, where visual acuity was 20/100. Fundus examination was unremarkable, except for yellowish material in the central macula. SD-OCT revealed interruption of the external limiting membrane and inner and outer segment junctions, with disorganized material in the vitelliform space and subretinal fluid. Six months later, fundus and SD-OCT examinations were unchanged without treatment, but visual acuity in the left eye had improved to 20/50. Five years later, he had similar clinical manifestations in the right eye. He was started on systemic steroids. After 15 days, his visual acuity improved to 20/20 and subretinal fluid and yellowish material in the vitelliform space disappeared. Goldenhar syndrome has variable presentation, including vitelliform maculopathy. Claudia Bruè, Cesare Mariotti, Silvia Celani, Ilaria Rossiello, and Alfonso Giovannini Copyright © 2015 Claudia Bruè et al. All rights reserved. Late Stage of Corneal Decompensation Caused by Progressive Keratoconus: Can We Treat It and Save the Cornea? Thu, 30 Apr 2015 12:43:41 +0000 Aim. To report a case of 40-year-old male with progressive bilateral keratoconus who had undergone transepithelial phototherapeutic keratectomy (TE-PTK) and corneal collagen cross-linking (CXL) using hypoosmolar riboflavin solution in a same day procedure. Methods. Eye examination showed that UCDVA on both eyes was 0,01 according to Snellen charts, and slit lamp biomicroscopy showed paracentral diffuse intrastromal corneal haze. Anterior OCT marked stromal hyperreflective zones and localized paracentral thinning of the cornea. Scheimpflug tomography noted keratoconus stages III-IV on both eyes. After 40/35 microns TE-PTK, a CXL was performed for 30 minutes using hypoosmolar riboflavin solution. The left eye was treated first and the right eye 1 month after. Follow-up period was 10 months. Results. One month after the treatment both eyes showed improvement in corneal topography and the UCDVA was better. Eight months after the treatment BSCVA improved to 0,6 in both eyes using Rose K2 contact lenses and remained stable. Conclusion. TE-PTK and CXL using hypotonic riboflavin solution as a same day procedure have been shown to be a safe and promising method in this case of progressive keratoconus. It was necessary to consider certain parameters that could influence the safety and the final outcome of this combined protocol. Igor Knezović, Mirna Belovari Višnjić, and Hrvoje Raguž Copyright © 2015 Igor Knezović et al. All rights reserved. Punctate Inner Choroidopathy Tue, 28 Apr 2015 09:38:59 +0000 Purpose. To report a case of bilateral punctate inner choroidopathy (PIC). Case Report. A 26-year-old Caucasian woman presented with bilateral blurred vision with one year of evolution. There was no relevant systemic disease or family history. Best-corrected visual acuity in the right eye was 20/30 and in the left eye was 20/20; there was no clinically significant refractive error. Fundoscopy evidenced multiple, small, round, yellow-white lesions limited to the posterior pole of both eyes, with greater macular involvement in the RE. There were no signs of inflammation in the anterior chamber or vitreous cavity. Fluorescein angiography revealed the presence of multiple hyperfluorescent lesions more evident in the later stages of the angiogram in both eyes. On indocyanine green angiography, these lesions appeared hypofluorescent in both early and late phases. Optical coherence tomography showed the presence of focal elevations of the retinal pigment epithelium with underlying hyporeflective space, bilaterally. Laboratory and imaging evaluation for evidence of autoimmune and infectious diseases were negative. Conclusion. The PIC is a relatively uncommon condition. In this report, an attempt has been made to describe a classic clinic presentation of this disease in a young and female patient. Mariana Sá-Cardoso, Arnaldo Dias-Santos, Natália Nogueira, Heloísa Nascimento, and Rubens Belfort-Mattos Copyright © 2015 Mariana Sá-Cardoso et al. All rights reserved. Nystagmus in Laurence-Moon-Biedl Syndrome Thu, 23 Apr 2015 07:41:12 +0000 Introduction. Laurence-Moon-Biedl (LMB) syndrome is a rare autosomal-recessive ciliopathy with manifold symptomatology. The cardinal clinical features include retinitis pigmentosa, obesity, intellectual delay, polydactyly/syndactyly, and hypogenitalism. In this paper, the authors report on three siblings with Laurence-Moon-Biedl syndrome associated with a probable pseudocycloid form of congenital nystagmus. Methods. This was a case study conducted at King Khaled Hospital. Results. The authors assert that the nystagmus in Laurence-Moon-Biedl syndrome is essentially similar to idiopathic motor-defect nystagmus and the nystagmus seen in optic nerve hypoplasia, ocular albinism, and bilateral opacities of the ocular media. Conclusion. The data support the previous hypothesis that there is a common brain stem motor abnormality in sensory-defect and motor-defect nystagmus. A. Bruce Janati, Naif Saad ALGhasab, Fazal Haq, Ahmad Abdullah, and Aboubaker Osman Copyright © 2015 A. Bruce Janati et al. All rights reserved. Clinical Findings and Genetic Expression Profiling of Three Pigmented Lesions of the Optic Nerve Thu, 23 Apr 2015 06:32:17 +0000 Background. Optic disk melanocytoma is a primary tumor of the optic disk that represents a clinical diagnostic challenge due to its similarities with melanoma. Purpose. The authors present three cases in which genetic expression profiling was used to identify tumor prognosis of optic disk melanocytoma. Case Series. In two cases fine-needle aspiration biopsy was performed to obtain tissue through a transvitreal route into the apex of the tumor while the patient underwent pars plana vitrectomy, laser ablation, phacoemulsification with posterior chamber intraocular lens implantation, and intravitreal triamcinolone acetonide. In the other case the tissue was obtained after definite enucleation. Conclusion. Genetic expression profiling is a useful diagnostic tool for classification and can provide vital information to the ocular oncologist regarding prognosis. Manuel A. de Alba, Victor M. Villegas, Aaron S. Gold, Andrea Wildner, Fiona J. Ehlies, Azeema Latiff, and Timothy G. Murray Copyright © 2015 Manuel A. de Alba et al. All rights reserved. Jugular Vein Insufficiency and Choroidal Neovascularization in Moderate Myopia: A New Unknown Factor of Additional Risk? Tue, 21 Apr 2015 09:00:05 +0000 To date, choroidal blood flow reduction in highly myopic eyes appears to be related to the development of choroidal neovascularization secondary to local reduction of arterial flow. Instead, no evidence of choroidal neovascularization was found in subjects with low or moderate myopia. The authors’ aim has been to encourage new studies regarding the potential role of chronic retinal venous congestion in the pathogenesis of choroidal neovascularization. In December 2011, a 54-year-old woman with moderate bilateral myopia had a sudden block upon swallowing while she was eating. Subsequently (January 2013) metamorphopsia in the left eye revealed macular degeneration with choroidal neovascularization. The related echo-color Doppler study of the neck veins, performed in November 2014, showed an atypical left jugular insufficiency associated with homolateral hypertension of the superior ophthalmic veins. This singular case highlights the necessity to further investigate the potential role of chronic alterations of intra- and extracranial venous drainage in the disruption of choroidal flow in myopic patients. Massimiliano Farina, Cristiano Ratti, and Eugenio Novelli Copyright © 2015 Massimiliano Farina et al. All rights reserved. Conservative Management in Congenital Bilateral Upper Eyelid Eversion Wed, 15 Apr 2015 12:27:09 +0000 Aim. To report the case of congenital bilateral upper eyelid eversion with severe chemosis that was successfully managed conservatively. Report. The patient was a six-hour-old male neonate with bilateral congenital upper eyelid eversion and severe chemosis, following uneventful delivery. Conservative management consisted of the application of antibiotic ointment and padding the exposed conjunctiva with 5% hypertonic saline-soaked gauze. The eyelids reverted spontaneously on day 3 and the condition was completely resolved by the third week. Conclusion. Congenital upper lid eversion is usually a benign condition which responds well to conservative treatment. Creating awareness amongst healthcare professionals is essential. Viola Andin Dohvoma, Alice Nchifor, Aronette Nana Ngwanou, Elisabeth Attha, Faustin Ngounou, Assumpta Lucienne Bella, and Côme Ebana Mvogo Copyright © 2015 Viola Andin Dohvoma et al. All rights reserved. Acute Corneal Hydrops Mimicking Infectious Keratitis as Initial Presentation of Keratoconus in a 10-Year-Old Child Tue, 31 Mar 2015 13:53:01 +0000 Purpose. To report a case of acute hydrops in a 10-year-old child with advanced keratoconus. Case Presentation. A ten-year-old boy diagnosed as having right eye (RE) infectious keratitis, not responding to antimicrobial therapy, was referred to our hospital. The diagnosis of infectious keratitis was established one month prior to his presentation following an episode of acute corneal whitening, pain, and drop in visual acuity. Topical fortified antibiotics followed by topical antiviral therapy were used with no improvement. Slit lamp examination showed significant corneal protrusion with edema surrounding a rupture in Descemet’s membrane in the RE. The diagnosis of acute corneal hydrops from advanced keratoconus was highly suspected and confirmed with corneal topography. Conclusion. Although a relatively rare disease at the age of 10 years, keratoconus can be rapidly progressive in the pediatric group. Keratoconus should always be considered in the differential diagnosis of progressive vision loss in this age group. Elise A. Slim, Elias F. Jarade, Bilal M. Charanek, Joelle S. Antoun, Adib I. Hemade, Sahar H. Awada, Henry W. Fakhoury, and Carole G. Cherfan Copyright © 2015 Elise A. Slim et al. All rights reserved. Long-Term Outcomes of Radial Keratotomy, Laser In Situ Keratomileusis, and Astigmatic Keratotomy Performed Consecutively over a Period of 21 Years Thu, 19 Mar 2015 07:19:17 +0000 Purpose. To describe a case of 3 refractive procedures performed in one eye over 2 decades. Methods. Case report. Results. A 41-year-old patient presented for refractive surgery evaluation. His ocular history includes bilateral radial keratotomy performed 21 years ago for moderate myopia: spherical equivalence of −4.25 D bilaterally. Postoperative uncorrected visual acuity (UCVA) was 20/30; however, over time he developed a hyperopic shift and UCVA decreased to 20/40 in the right eye. Thus, laser-assisted in situ keratomileusis (LASIK) was performed at an outside institution 6.5 years later, and the patient had initial improvement of UCVA to 20/25. Due to a change in refractive error, the patient underwent uneventful astigmatic keratotomy 13 years after LASIK in the right eye, and 1.5 years after surgery best-corrected visual acuity was 20/25 with manifest refraction of −°.  Conclusion. We report the outcomes and natural refractive progression in a patient who underwent three corneal refractive procedures over two decades. This case underlines the difficulties of long-term management of post-RK hyperopia and astigmatism. Priyanka Chhadva, Florence Cabot, Anat Galor, and Sonia H. Yoo Copyright © 2015 Priyanka Chhadva et al. All rights reserved. An Office-Based Procedure for Hyphema Treatment Wed, 18 Mar 2015 09:59:27 +0000 Three cases of hyphema in three different eyes were treated in the office using an anterior chamber fluid-gas exchange technique. Hyphemas were associated with complications of underlying systemic and retinal disease and in the postoperative period of vitrectomy procedures. Patients were successfully treated without requiring return to operating room. Mikelson MomPremier, Divya Sadhwani, and Saad Shaikh Copyright © 2015 Mikelson MomPremier et al. All rights reserved. Methicillin-Resistant Staphylococcus aureus Ocular Infection after Corneal Cross-Linking for Keratoconus: Potential Association with Atopic Dermatitis Wed, 18 Mar 2015 09:37:26 +0000 Purpose. To report the risk of methicillin-resistant Staphylococcus aureus (MRSA) ocular infection after UVA-riboflavin corneal collagen cross-linking in a patient with atopic dermatitis. Methods. A 22-year-old man, with bilateral evolutive keratoconus and atopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and cyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum antimicrobic therapy. Results. The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic therapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures was unavoidable. Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in halting keratoconus’ progression. However, this procedure is not devoid of infectious complications, due to known risk factors and/or poor patients’ hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with keratoconus and Staphylococcus aureus colonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity with atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days after surgery and the imposition of strict personal hygiene rules are strongly recommended. Romina Fasciani, Antonio Agresta, Alice Caristia, Luigi Mosca, Andrea Scupola, and Aldo Caporossi Copyright © 2015 Romina Fasciani et al. All rights reserved. Idiopathic Organ Transplant Chorioretinopathy after Liver Transplantation Mon, 16 Mar 2015 05:52:57 +0000 Idiopathic organ transplant chorioretinopathy is a rare disease associated with kidney and heart transplantation. We present a case secondary to liver transplantation including its multimodal imaging, differential diagnosis, and physiopathology discussion. Maria Fernanda Abalem, Pedro Carlos Carricondo, Sergio Luis Gianotti Pimentel, and Walter Yukihiko Takahashi Copyright © 2015 Maria Fernanda Abalem et al. All rights reserved. A Second New Choroidal Osteoma in the Same Eye: Differences between Them with New Imaging Techniques Thu, 12 Mar 2015 08:11:48 +0000 The authors introduce a 42-year-old woman with a choroidal osteoma. After 10 years the patient presented a second choroidal osteoma in the same eye; this osteoma has been growing in the last years. New tests that were unavailable during the first diagnosis were performed such as Fundus Autofluorescence or Enhanced Depth Imaging-Optical Coherence Tomography (EDI-OCT). These tests show characteristics of the tumors and allow us to realize a visual prognosis for the patient. Javier Sambricio, Marifé Fernández-Reyes, Beatriz De-Lucas-Viejo, Álvaro Bengoa-González, and Enrique Mencía-Gutiérrez Copyright © 2015 Javier Sambricio et al. All rights reserved. Intravitreal Aflibercept Injection and Photodynamic Treatment of a Patient with Unilateral Subretinal Neovascular Membrane Associated with Fundus Flavimaculatus Mon, 02 Mar 2015 16:09:00 +0000 We report the good outcome of combined intravitreal aflibercept injection and photodynamic treatment in a case with fundus flavimaculatus (FFM) and unilateral subretinal neovascular membrane (SRNM). A 57-year-old man with FFM and unilateral SRNM who was treated with two consecutive ranibizumab injections with no improvement at another institution was referred to us. He was treated successfully with three aflibercept injections three months apart and a single photodynamic treatment performed a week after the initial aflibercept injection. Six weeks after the last aflibercept injection visual acuity was improved and submacular exudation exhibited dramatic resolution with a moderate degree of residual scarring. SRNM formation is rarely observed in eyes with FFM and a satisfactory outcome can be achieved with a proper treatment. Ali Osman Saatci, Ziya Ayhan, Bora Yüksel, Göktuğ Seymenoğlu, and Seenu M. Hariprasad Copyright © 2015 Ali Osman Saatci et al. All rights reserved. Descemet Membrane Endothelial Keratoplasty: Intraoperative and Postoperative Imaging Spectral-Domain Optical Coherence Tomography Thu, 26 Feb 2015 07:28:24 +0000 We describe a case report of using the same handheld spectral-domain anterior segment optical coherence tomography (ASOCT) for rapid intraoperative and postoperative imaging in a case of Descemet membrane endothelial keratoplasty (DMEK). A 67-year-old woman, with Fuchs dystrophy and corneal decompensation, underwent DMEK with intraoperative ASOCT imaging using the handheld Envisu spectral domain ASOCT system (Bioptigen, Inc., Morrisville, NC, USA). We found that this easy-to-use portable system with handheld probe allowed for rapid imaging of the anterior segment during donor manipulation to visualize the orientation of the DMEK donor, as well as to confirm the initial adhesion of the DMEK donor. Moreover, the same system may be used for postoperative monitoring of graft adhesion, corneal thickness, and stromal remodeling in the clinic with very high-definition images. Marcus Ang, Adam M. Dubis, and Mark R. Wilkins Copyright © 2015 Marcus Ang et al. All rights reserved. Cicatricial Ectropion Secondary to Psoriatic Arthritis Tue, 24 Feb 2015 09:19:06 +0000 Ectropion is characterized by the eversion of the eyelid margin and the consequent exposure of the conjunctiva and cornea. The shortening of the anterior lamella of the lid causes cicatricial ectropion. We described a case of skin pathology causing cicatricial ectropion. The case is about a 68-year-old woman with a 2-year history of psoriatic arthritis. She complained of eyelid tearing and redness for two years. Due to the psoriasis, she presented a very dry skin, also in the periocular region, resulting in cicatricial ectropion. A skin graft was indicated to correct the eyelid malposition. Careful investigation should be performed in patients who have a skin disease that can lead to cicatricial ectropion. Carolina P. B. Gracitelli, Tammy Hentona Osaki, Natalia Yumi Valdrighi, Giovanni André Pires Viana, and Midori Hentona Osaki Copyright © 2015 Carolina P. B. Gracitelli et al. All rights reserved. Lower Lid Ectropion in Hypohidrotic Ectodermal Dysplasia Mon, 23 Feb 2015 12:03:21 +0000 We report a case of a lower lid ectropion with ectodermal dysplasia and ectropion blepharoplasty surgery experience. A 14-year-old Han nationality male patient with typical characteristics of hypohidrotic ectodermal dysplasia presented to our clinic for his right lower lid eversion. The patient was diagnosed as having hypohidrotic ectodermal dysplasia and underwent an uneventful blepharoplasty surgery. The lower lid maintained normal position during the 10-month follow-up period. Patients with ectodermal dysplasia could firstly visit ophthalmologist for their ectropion and blepharoplasty surgery could be useful for the disease. Xiaoyun Zhang, Li Xu, Xiaofang Li, Chunyan Li, and Haitao Zhang Copyright © 2015 Xiaoyun Zhang et al. All rights reserved. Periorbital Edema Secondary to Positive Airway Pressure Therapy Thu, 12 Feb 2015 13:41:23 +0000 Two patients developed bilateral, periorbital edema after initiating positive airway pressure (PAP) therapy with a full face mask. The periorbital edema was more pronounced in the morning and would dissipate throughout the day. This phenomenon seemed to be correlated with the direct pressure of the full face mask, which may have impaired lymphatic and venous drainage. To test this hypothesis, each patient was changed to a nasal pillow interface with subsequent improvement in the periorbital edema. F. Dandekar, M. Camacho, J. Valerio, and C. Ruoff Copyright © 2015 F. Dandekar et al. All rights reserved. Hyperbaric Oxygen Therapy in Branch Retinal Artery Occlusion in a 15-Year-Old Boy with Methylenetetrahydrofolate Reductase Mutation Thu, 05 Feb 2015 06:23:34 +0000 Purpose. To report the efficacy of hyperbaric oxygen (HBO) therapy in a case of branch retinal artery occlusion (BRAO) in a 15-year-old boy. Methods. We report a 15-year-old boy with sudden loss of vision due to BRAO. Examination included laboratory evaluation for systemic risk factors. Follow-up exams included visual acuity, fundus examination, fundus fluorescein angiography, and visual field testing. HBO therapy was employed for treatment. Results. Medical history was positive for isolated glucocorticoid deficiency. Laboratory evaluation disclosed hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) mutation. The visual acuity 0.05 at presentation improved to 0.8 after 20 days of HBO therapy. There was no change on visual fields. Conclusion. In this pediatric case, HBO therapy was useful in the treatment of BRAO. Ali Riza Cenk Celebi, Sibel Kadayifcilar, and Bora Eldem Copyright © 2015 Ali Riza Cenk Celebi et al. All rights reserved. Intravitreal Bevacizumab and Triamcinolone for Treatment of Cystoid Macular Oedema Associated with Chronic Myeloid Leukaemia and Imatinib Therapy Wed, 04 Feb 2015 06:19:20 +0000 Purpose. To evaluate the efficacy of intravitreal bevacizumab and triamcinolone in the treatment of cystoid macular oedema in a case with chronic myeloid leukaemia on imatinib treatment. Methods. We treated a 78-year-old man with bilateral cystoid macular oedema with intravitreal triamcinolone and subsequent bevacizumab in one eye and intravitreal bevacizumab, alone, in the fellow eye. Results. Serial intravitreal bevacizumab with and without triamcinolone treated cystoid macular oedema in both eyes and improved the vision. Conclusion. Intravitreal bevacizumab and triamcinolone could be viable options to treat cystoid macular oedema due to chronic myeloid leukaemia and imatinib therapy. Eric K. Newcott, Abdallah A. Ellabban, Shokufeh Tavassoli, and Ahmed Sallam Copyright © 2015 Eric K. Newcott et al. All rights reserved. Catastrophic Antiphospholipid Syndrome Presenting as Bilateral Central Retinal Artery Occlusions Mon, 02 Feb 2015 14:34:19 +0000 A previously healthy 22-year-old African American woman presented with bilateral vision loss associated with headache. Her ocular examination was significant for bilateral retinal arterial “boxcarring,” retinal whitening, retinal hemorrhages, and cherry red spots. She was diagnosed with bilateral central retinal artery occlusions and was hospitalized due to concomitant diagnosis of stroke and hypercoagulable state. She was also found to be in heart failure and kidney failure. Rheumatology was consulted and she was diagnosed with catastrophic antiphospholipid syndrome in association with systemic lupus erythematosus. Approximately 7 months after presentation, the patient’s vision improved and remained stable at 20/200 and 20/80. Steven S. Saraf, Yogin P. Patel, Ankit Desai, and Uday R. Desai Copyright © 2015 Steven S. Saraf et al. All rights reserved.