Case Reports in Ophthalmological Medicine The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. An OCT Study of Anterior Nodular Episcleritis and Scleritis Tue, 28 Feb 2017 08:18:48 +0000 Anterior scleritis and episcleritis are a well-known presentation in tuberculosis. The case of a female patient with presumed tuberculous anterior scleritis and episcleritis is discussed in this article. Anterior segment OCT was efficient in diagnosis and evaluation of the therapeutic outcome. Antituberculosis chemotherapy was sufficient to achieve clinical remission. Christos Christakopoulos Copyright © 2017 Christos Christakopoulos. All rights reserved. A Case of Conjunctival Amyloidosis with Repeated Subconjunctival Hemorrhage Thu, 23 Feb 2017 07:27:41 +0000 Conjunctival amyloidosis is a very rare disease, and its presence may be a sign of systemic amyloidosis. We present our ocular and systemic findings in a patient with conjunctival amyloidosis. A 43-year-old man had repeated subconjunctival hemorrhages (SCHs) for two years and was referred to the Chiba University Hospital. He had comprehensive ophthalmological and systemic examinations to determine the cause of the SCHs. His visual acuities were 1.2 OU, and the intraocular pressures were 13-14 mmHg OU. Magnetic resonance imaging was normal. Initially, the SCH was the only abnormality. After 3 months, the SCH had partially cleared, and a pink mass was detected in the superior area of the subconjunctiva. Partial biopsy and histopathological examinations showed a greenish birefringence and dichroism under polarized light illumination. The birefringence was located in amyloid fibers. Immunofixation electrophoresis detected λ-light chain abnormality in the ocular biopsy specimen but systemic examinations did not find any lesions. Multiple myeloma was ruled out, and the patient is being followed closely to detect any early signs of systemic amyloidosis. Because repeated SCHs might be initial signs of systemic amyloidosis, patients with conjunctival amyloidosis should be comprehensively examined for systemic amyloidosis because of its poor life prognosis. Takaaki Ando, Toshiyuki Oshitari, Mamiko Saito, Ayako Tawada, Takayuki Baba, Jiro Yotsukura, and Shuichi Yamamoto Copyright © 2017 Takaaki Ando et al. All rights reserved. Bilateral Birdshot Retinochoroiditis and Retinal Astrocytoma Tue, 21 Feb 2017 07:10:18 +0000 Background. This case highlights the importance of recognising multiple pathologies within the eye which may not necessarily be linked. Both birdshot retinochoroiditis and astrocytoma are rare conditions. The case underlines the need for early identification and treatment of birdshot retinochoroiditis with steroids and disease modifying drugs. Astrocytoma in the absence of tuberous sclerosis is also uncommon. Case Presentation. A 36-year-old male presented with 3-month history of bilateral progressive flashing lights and floaters. He was systemically well with no significant past medical history. Fundal examination revealed retinal vasculitis and active creamy lesions in the choroid radiating from the optic nerve. In the supranasal periphery of the right eye there was a raised white, jagged lesion protruding into the vitreous. Fluorescein angiogram and indocyanine green showed marked venous vasculitis, hypofluorescence, and disc leakage in keeping with birdshot retinochoroiditis. The supranasal lesion features were in keeping with astrocytoma and this was thought to be a coincidental finding. Conclusions. Retinal astrocytoma may be present as an isolated ocular finding; however, patients must still be investigated for tuberous sclerosis which is the most common association. Birdshot retinochoroiditis typically responds well to steroid therapy, and disease modifying drugs should be considered as soon as possible. Sunil Mamtora, Yun Wong, Dugald Bell, and Teresa Sandinha Copyright © 2017 Sunil Mamtora et al. All rights reserved. An Office-Based Fluid to Fluid Exchange Technique for the Treatment of Postvitrectomy Vitreous Cavity Hemorrhage and Secondary Glaucoma Tue, 21 Feb 2017 00:00:00 +0000 A case of postvitrectomy hemorrhage with secondary glaucoma successfully treated with an office-based fluid to fluid exchange is described. A 25 Ga trocar was placed 3 mm from the sclerocorneal limbus at the 2 o’clock position and connected to a 250 cc elevated bottle of balanced salt solution (BSS) through an intravenous (IV) line and an infusion cannula. Afterward, a 25 Ga needle was inserted 3 mm from the limbus at the 5 o’clock position approximately. The BSS fluid entered the eye through the 25 Ga trocar lavaging the vitreous cavity and the anterior chamber. About 4 to 6 cc of hemorrhagic fluid egressed the eye through the 25 Ga needle. Sergio E. Hernandez-Da Mota Copyright © 2017 Sergio E. Hernandez-Da Mota. All rights reserved. Internuclear Ophthalmoplegia Secondary to Cocaine Abuse Mon, 06 Feb 2017 00:00:00 +0000 Purpose. To report a case of internuclear ophthalmoplegia (INO) caused by cocaine. Method. We report a case of a 54-year-old female who presented with a left INO three days after snorting cocaine, and we review the literature. Results. MRI of the brain demonstrated several small abnormal foci in the pons on FLAIR and diffusion weighted imaging consistent with ischemic infarction. The patient’s symptoms remained stable throughout her hospitalization. She was sent to a rehabilitation facility and was lost to follow-up. Conclusion. In cases of extraocular movement abnormalities, it is important to inquire about recreational drug use. Richard L. Rabin, Azeem Wasay, Nicolas Biro, and Marcelle Morcos Copyright © 2017 Richard L. Rabin et al. All rights reserved. Unusual Presentation of Type 1 Idiopathic Macular Telangiectasia Thu, 19 Jan 2017 00:00:00 +0000 Purpose. To report unusual presentation of type 1A idiopathic macular telangiectasia (IMT). Methods. Two middle-aged women with bilateral IMT were examined. Results. Both patients presented with a gradual vision loss in both eyes. Fundus examination was unremarkable in one case and showed small macular telangiectasia in both eyes in the other case. Fluorescein angiography (FA) revealed early bilateral macular punctuated hyperfluorescence corresponding to the dilated capillaries in both cases. FA and fundus examination confirmed also the absence of vascular abnormalities in the middle or anterior fundus periphery in one case. Spectral-domain optical coherence tomography (SD-OCT) showed cystoid macular edema in both cases. No signs of retinal vein occlusions were detected in both cases and other differential diagnoses were excluded. Based on these findings, the patients were diagnosed with bilateral type 1A IMT according to Gass and Blodi classification and were treated with intravitreal antivascular endothelial growth factor (anti-VEGF) injections and focal laser photocoagulation. Twelve months later, SD-OCT revealed partial regression of the exudative signs and significant VA improvement. Conclusion. We described two patients with an unusual presentation of type 1A IMT with bilateral presentation, affecting two middle-aged women, with occult and without peripheral involvement in one case. The description of more cases of bilateral type 1 IMT should be helpful to more precisely define the pathophysiologic mechanism that could be different from a localized Coats’ disease of the macula area. Zaïnab Bentaleb Machkour, Philippe Denis, and Laurent Kodjikian Copyright © 2017 Zaïnab Bentaleb Machkour et al. All rights reserved. Retinitis Pigmentosa and Bilateral Idiopathic Demyelinating Optic Neuritis in a 6-Year-Old Boy with OFD1 Gene Mutation Mon, 16 Jan 2017 00:00:00 +0000 To identify the cause of a sudden binocular vision decrease in patients with retinitis pigmentosa and bilateral idiopathic demyelinating optic neuritis is difficult, but early diagnosis and treatment significantly improve the prognosis. Here, we report a 6-year-old boy with a progressive binocular vision decrease in 38 days. The patient had a history of night blindness, a mottled retina without pigmentation, extinguished electroretinographic response, tritanopia, and an absent ellipsoid zone outside the macula fovea by optical coherence tomography in both eyes. His condition was diagnosed as retinitis pigmentosa (RP) with idiopathic demyelinating optic neuritis (IDON). After corticosteroid therapy, visual acuity recovered to OD: 0.5 and OS: 0.4. Genetic analysis revealed a G985S variant in the oral-facial-digital syndrome 1 gene. Ophthalmologists should pay attention to the existence of other complications in patients with RP who suffer a sudden decrease in vision. A gene survey can help clarify this diagnosis. To our knowledge, this is the first report of a patient with RP and ON, as well as genetic testing results. Nevertheless, the pathogenicity of the variant needs further confirmation. Xun Wang, Cong Zheng, Wen Liu, and Hui Yang Copyright © 2017 Xun Wang et al. All rights reserved. Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses Sun, 15 Jan 2017 00:00:00 +0000 A 78-year-old woman complained of gradual, painless onset of horizontal binocular diplopia associated with progressive axial weakness. Physical examination revealed esotropia that was greater at distance than at near vision, bilateral levator dehiscence, and normal abducting saccadic speeds. Given the age of the patient and compatible clinical findings, the diagnosis of Sagging Eye Syndrome (SES) was made. However, further work-up with a muscle biopsy suggested Sporadic Late-Onset Nemaline Myopathy (SLONM) as the cause of her progressive muscle weakness. Although rare, external ophthalmoplegia has been described in the literature as a presenting symptom in SLONM. To elucidate the pathological mechanism for the patient’s diplopia, an MRI of the orbits was performed, which revealed findings consistent with SES. This case aims to highlight the importance of integrating clinical findings during the diagnostic process and serves as a reminder that diplopia can be a common symptom for an uncommon diagnosis. Stephanie S. L. Cheung, Larissa K. Ghadiali, Thomas H. Brannagan III, Gul Moonis, Phyllis L. Faust, and Jeffrey G. Odel Copyright © 2017 Stephanie S. L. Cheung et al. All rights reserved. IgG4-Related Disease Presenting as Isolated Scleritis Mon, 09 Jan 2017 00:00:00 +0000 A rare case of IgG4-related disease (IgG4-RD) manifesting as nodular scleritis is presented in a 20-year-old female. Patient complained of left eye pain and redness for one week. Ocular examination together with ancillary testing led to the diagnosis of nodular scleritis. Since the patient did not show apparent improvement after one week of systemic steroidal treatment, she underwent a biopsy of the affected area revealing histopathological characteristics of IgG4-RD. Long-term treatment with corticosteroids and a steroid-sparing agent (methotrexate) led to significant improvement in signs and symptoms. This case highlights the significance of IgG4-RD in the differential diagnosis of scleritis and raises the question as to whether various organs affected by IgG4-RD may have different underlying pathophysiological mechanisms in which pathogenic T cells play a role. Eran Berkowitz, Ella Arnon, Alona Yaakobi, Yuval Cohen, and Beatrice Tiosano Copyright © 2017 Eran Berkowitz et al. All rights reserved. Dengue Fever-Associated Maculopathy and Panuveitis in Australia Mon, 19 Dec 2016 13:07:00 +0000 Purpose. To describe a case of dengue fever-associated maculopathy and panuveitis to raise awareness of these ophthalmic complications of dengue in Australia in the light of recent increasing numbers of outbreaks from equatorial through to tropical Australia. Case Report. A 37-year-old Caucasian Australian male returning from Cambodia presented with a bilateral dengue fever-associated maculopathy with left panuveitis diagnosed clinically and haematologically. Automated perimetry revealed bilateral paracentral scotomas while optical coherence tomography demonstrated the maculopathies to be of the diffuse retinal thickening type in the right eye and acute macular neuroretinopathy (AMN) type in the left eye. He was treated conservatively with only topical steroids and cycloplegia and made a full clinical visual recovery. Conclusion. Our case study underscores the importance of the awareness of the ophthalmic complications of dengue fever as despite their rarity they can be potentially sight threatening. The incidence of these complications is likely to rise in Australia with increased global warming and the distribution of Aedes aegypti into subtropical Australia. K. G.-J. Ooi, H. Inglis, N. Paramanathan, J. A. Downie, and M. P. Hennessy Copyright © 2016 K. G.-J. Ooi et al. All rights reserved. Atypical Presentation of Idiopathic Bilateral Optic Perineuritis in a Young Patient Sun, 18 Dec 2016 11:20:40 +0000 A previously healthy 27-year-old Malay male presented with acute onset of painless, severe blurring of vision in his right eye. It was associated with headache and vomiting for the past week. Relative afferent pupillary defect was present in the right eye, with reduced optic nerve function. Patient also had bilateral generalised optic disc swelling, splinter haemorrhages, and tortuous vessels. Initial examination was suggestive of either optic neuritis or raised intracranial pressure. Typical features of bilateral optic perineuritis (OPN) such as tram track and doughnut sign were observed on magnetic resonance imaging. Connective tissue and infective screening were negative. He was diagnosed with bilateral optic perineuritis and treated with high dose intravenous corticosteroids followed by a three-month course of oral steroids. His vision and optic nerve function recovered to baseline levels. Jessica Mani Penny Tevaraj, Evelyn Tai Li Min, Raja-Azmi Mohd-Noor, Lakana Kumar Thavaratnam, Win Mar Salmah, and Wan Hazabbah Wan Hitam Copyright © 2016 Jessica Mani Penny Tevaraj et al. All rights reserved. Hemiretinal Artery Occlusion in an 11-Year-Old Child with Dextrocardia Tue, 06 Dec 2016 14:21:14 +0000 Purpose. To report a case of hemiretinal artery occlusion in a child with dextrocardia, visceral heterotaxia, and secondary polycythemia. Methods. Complete clinical examination, fundus photography, and retinal fluorescein angiography were performed. Laboratory testing included complete blood cell count, homocysteine, protein c, protein s, activated protein s, methyltetrahydrofolate and homocysteine activator genes, factor leiden V gene, antithrombin III, and activated protein c resistance. In addition, transthoracic and transesophageal echocardiogram and cardiac catheterism were performed. Results. We report an 11-year-old boy with a sudden, painless visual loss in his right eye. His past medical history is remarkable for a congenital cardiac disease. He presented with vision of light perception in the right eye and a relative afferent pupillary defect. Fundus findings included a macular cherry-red spot and inferior hemiretinal whitening consistent with hemiretinal artery occlusion. Laboratory testing showed increased red blood cell (RBC) count, hemoglobin, and hematocrit. The patient was treated with four phlebotomies with improvement of RBC count and after one month reperfusion of the retina and a visual acuity of 20/200 were observed. Thrombophilia and cardiac screening were negative, except for secondary polycythemia. Conclusion. Hemiretinal artery occlusion is extremely rare in children and is often associated with congenital cardiac disease and hypercoagulative states. Diana E. Arévalo Simental, Enrique A. Roig Melo-Granados, Saúl Cortés Quezada, Manuel A. Páez Escamilla, Carmen L. Soria Orozco, and Jorge E. Jacinto Buenrostro Copyright © 2016 Diana E. Arévalo Simental et al. All rights reserved. Frosted Branch Angiitis Secondary to Familial Mediterranean Fever Resembling Central Retinal Vein Occlusion Sun, 04 Dec 2016 09:43:42 +0000 Purpose. To report a case of unilateral frosted branch angiitis (FBA) resembling central retinal vein occlusion associated with Familial Mediterranean Fever (FMF). Case Report. A 32-year-old woman presented with progressive, painless vision loss in her left eye lasting for 2 days. She was clinically diagnosed with FMF 2 months ago. The best-corrected visual acuity (BCVA) was 20/20 in her right eye and there was light perception in the left. Ophthalmologic examination revealed severe retinal vasculitis showing clinical features of FBA in the left eye. 64 mg/day oral methylprednisolone was started. A significant improvement in retinal vasculitis was observed in two weeks. However, BCVA did not increase significantly due to subhyaloid premacular hemorrhage. Argon laser posterior hyaloidotomy was performed. One week after hyaloidotomy, visual acuity improved to 20/20 and intravitreal hemorrhage disappeared. Four months after the first attack, FBA recurred. Oral methylprednisolone dosage was increased to 64 mg/day and combined with azathioprine 150 mg. At the end of 12-month follow-up, the BCVA was 20/25 and development of epiretinal membrane was observed in the left eye. Conclusions. Frosted branch angiitis may occur with gene abnormalities as an underlying condition. Our case showed that FMF might be a causative disease. Serdar Ozates, Pınar Çakar Ozdal, and Mehmet Yasin Teke Copyright © 2016 Serdar Ozates et al. All rights reserved. Necrotizing Retinitis Secondary to Congenital Cytomegalovirus Infection Associated with Severe Combined Immunodeficiency Wed, 23 Nov 2016 13:29:54 +0000 A 20-day-old male infant who was born at 39 weeks of gestation was admitted to neonatal intensive care unit due to severe respiratory insufficiency. In retinal examination, peripheric retinal white-black color areas that correspond to necrotizing retinitis, moderate vitritis, macular and optic nerve head involvement, vascular leakage, and sheathing indicating perivasculitis were revealed. Despite the fact that CMV specific IgM was undetectable, CMV DNA with high viral load was found in his blood sample by means of real-time polymerase chain reaction assay. Serologic examination (IgM) for rubella, toxoplasma, herpes simplex type 2, and human immunodeficiency virus (anti-HIV) was negative. During the further evaluation for systemic immune dysfunction, decreased immunoglobulin and lymphocyte levels that confirm the diagnosis of severe combined immunodeficiency have been reached. Although given systemic intravenous ganciclovir and antibiotics treatment, the patient died at the 4th month of life due to respiratory insufficiency. Pehmen Yasin Ozcan, Hasan Tolga Celik, Kenan Sonmez, and Melda Celik Copyright © 2016 Pehmen Yasin Ozcan et al. All rights reserved. Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome Wed, 23 Nov 2016 12:37:33 +0000 Purpose. To report a modified surgical strategy in the management of intraoperative floppy iris syndrome-associated iris prolapse. Methods. Prolapsed iris is left as is and a new corneal incision near the original wound but at a different site is created. Depending on the location of the original incision and the surgeon’s preference, this additional incision can be used as a new port for phacoemulsification tip or can be the new site for the iris to securely prolapse, allowing for the surgery to proceed safely. Results. We present 2 cases of iris prolapse and inadequate pupil dilation in patients with IFIS. Along with our modified technique, additional iris retractors were placed to increase the workspace for the phacoemulsification tip. The cataract surgery was performed successfully without further complications in both cases. Conclusion. This surgical technique could be an adjunct to allow the surgeons to expand the armamentarium for the management of IFIS-associated iris prolapse. Pornchai Simaroj, Kaevalin Lekhanont, and Puwat Charukamnoetkanok Copyright © 2016 Pornchai Simaroj et al. All rights reserved. Location of a Dexamethasone Implant at the Macula after Intravitreal Injection in a Silicone Oil-Filled Eye Wed, 23 Nov 2016 05:58:33 +0000 Here, we report a case with cystoid macular edema (CME) due to central retinal vein occlusion (CRVO) presented with a dexamethasone implant (Ozurdex) trapped at the macula in her silicone oil- (SO-) filled eye after injection. No additional complications such as intraocular pressure (IOP) rise or retinal damage were observed. The CME was resolved during the follow-up period. At the last visit, 3 months following the injection, Ozurdex implant was found to be mostly dissolved without any additional ocular complications. Cenap Mahmut Esenulku and Murat Gunay Copyright © 2016 Cenap Mahmut Esenulku and Murat Gunay. All rights reserved. Bacillus Panophthalmitis with Posterior Extension to the Prechiasmatic Optic Nerve Tue, 22 Nov 2016 14:14:40 +0000 A rare case of Bacillus panophthlamitis with extension to the prechiasmatic optic nerve secondary to hematogenous spreading after intravenous drug use is presented. A 27-year-old man with a recent history of trauma to the left eye presented with severe left eye pain following a binge of intravenous drug use. Visual acuity (VA) was LP. On examination he had chemosis, proptosis, elevated intraocular pressure, and a complete hyphema. CT-scan identified preseptal swelling, but no evidence of any posterior extension of the anterior process or orbital fractures. Topical and systemic therapy were initiated. On follow-up clinical examination less than 12 hours after presentation he had signs of a keratitis with worsening ophthalmoplegia and repeat imaging demonstrated posterior extension to the prechiasmatic optic nerve. Shortly after the cornea ruptured with cultures growing Bacillus. The patient underwent enucleation and has had no further progression of infection. To the best of our knowledge, this is the first report of Bacillus panophthalmitis presenting with signs of trauma with posterior extension to the prechiasmatic optic nerve. James E. Kasenchak, Benjamin P. Hale, Thomas W. Wilson, and Gregory M. Notz Copyright © 2016 James E. Kasenchak et al. All rights reserved. Endogenous Fusarium Endophthalmitis in Diabetes Mellitus Mon, 21 Nov 2016 11:26:52 +0000 Endogenous endophthalmitis accounts for 2% to 8% of cases of endophthalmitis. Immunocompromised state and intravenous drug use are the 2 most common causes of endogenous endophthalmitis due to molds fungi. Aspergillus, Fusarium, and Scedosporium are the common organisms in mold endophthalmitis. We report a case of Fusarium endophthalmitis in a patient with uncontrolled diabetes. While diabetes mellitus is a well-known risk factor for endogenous endophthalmitis, we did not find any reported case of Fusarium endophthalmitis in a case of diabetes mellitus. The patient presented with granulomatous uveitis masquerading as noninfectious uveitis with a very good response to steroids. The characteristic clinical features were established late in the clinical course associated with poor outcome. This case highlights the significance of uncontrolled diabetes as a risk factor for Fusarium endophthalmitis and also the presentation of endophthalmitis as a masquerade syndrome. The clinician should have high index of suspicion as these cases have poor outcomes. S. Balamurugan and Ashish Khodifad Copyright © 2016 S. Balamurugan and Ashish Khodifad. All rights reserved. Ectropion and Conjunctival Mass in a Patient with Primary Bilateral Conjunctival Amyloidosis Tue, 15 Nov 2016 07:43:29 +0000 Background. Amyloidosis is a group of disorders characterized by deposition of an extracellular protein, known as amyloid, in an abnormal fibrillar form with highly characteristic histopathologic staining properties. The clinical presentation can vary from a focal, localized lesion where amyloidosis has minor clinical consequences to extensive systemic disease that can involve any organ system of the body. Ocular amyloidosis can occur as a localized lesion or as a part of a systemic disorder. Conjunctival amyloidosis is an uncommon condition that is rarely associated with systemic disease. It may be a manifestation of an immunologic disorder. Case Report. We report the case of a patient with bilateral conjunctival amyloidosis who was referred to us with the suspicion of a malignant conjunctival lesion. Examination of both eyes showed a yellow-pink mass with prominent intrinsic vessels, subconjunctival hemorrhage, and ectropion of the left lower eyelid. Diagnosis of primary localized conjunctival amyloidosis was made based on histopathologic evaluation of incisional biopsy and negative systemic work-up. Conclusion. Ocular amyloidosis is a rare disease that is slowly progressive and has a wide variety of clinical presentations. Consequently, the clinical diagnosis is often overlooked or delayed. Definitive diagnosis is achieved through histopathologic evaluation of biopsy specimen. Alessandro Meduri, Miguel Rechichi, Cosimo Mazzotta, Sergio Zaccharia Scalinci, and Mahmoud O. Jaroudi Copyright © 2016 Alessandro Meduri et al. All rights reserved. Bimatoprost Induced Serous Macular Detachment after Cataract Surgery Sun, 13 Nov 2016 12:50:21 +0000 We report a case of bimatoprost induced serous macular detachment and choroidal folds following uneventful cataract surgery. A 66-year-old male using topical bimatoprost in both eyes for open angle glaucoma underwent uneventful cataract surgery in the right eye. Postoperatively, he was restarted on topical bimatoprost and antibiotic-steroids combination drops. One week after surgery, he presented with conjunctival hyperemia, serous macular detachment, and choroidal folds at the posterior pole. Fundus fluorescein angiography showed perifoveal leaks in early stage with pooling of dye in late stage. Discontinuation of bimatoprost led to resolution of serous detachment and choroidal folds within 3 weeks with significant improvement in visual acuity. Occurrence of serous macular detachment and choroidal folds in this case could be probably related to the proinflammatory property of bimatoprost. Hence, it should be used with caution in the immediate postoperative period after cataract surgery. Swapnil Parchand, Subashini Kaliaperumal, Amit Kumar Deb, K. Ramesh Babu, and Renuka Srinivasan Copyright © 2016 Swapnil Parchand et al. All rights reserved. Severe Corticosteroid-Induced Ocular Hypertension Requiring Bilateral Trabeculectomies in a Patient with Takayasu’s Arteritis Thu, 10 Nov 2016 11:29:21 +0000 We present a rare case of severe corticosteroid-induced ocular hypertension (OHT) after prolonged systemic corticosteroid use in a young woman with Takayasu’s arteritis. As she did not sufficiently respond to ocular antihypertensive therapies, bilateral enhanced trabeculectomies were required to normalize her intraocular pressures. The systemic side effects of corticosteroids are well known, yet steroid-induced OHT and glaucoma remain silent causes of ocular morbidity. This case highlights the importance of IOP-monitoring in visually asymptomatic patients on systemic corticosteroids. It further emphasizes the need to raise awareness of the potential ocular side effects of steroids amongst physicians, in particular those looking after patients with autoimmune and inflammatory diseases. Anna Maria Gruener, Pranev Sharma, Sally Ameen, and Faisal Ahmed Copyright © 2016 Anna Maria Gruener et al. All rights reserved. Pediatric Balint’s Syndrome Variant: A Possible Diagnosis in Children Tue, 08 Nov 2016 13:06:37 +0000 Balint’s syndrome is well described in adults, but not in children. It is caused by bilateral posterior parietal lobe damage and comprises a triad of simultanagnosia (inability to simultaneously see more than a small number of items), optic ataxia (impaired visual guidance of movement of the limbs and body), and apraxia of gaze (inability to volitionally direct gaze despite the requisite motor substrate) often associated with homonymous lower visual field loss. We, here, describe five children (four males, one female; mean age 7.4 years, [range 4−11 years]; birth weight ≤ 2.5 kg; four were born ≤ 36 weeks of gestational age and one at 40 weeks) who presented to the Cerebral Visual Impairment Clinic at a tertiary care center in South India with clinical features remarkably consistent with the above description. In all children neuroimaging showed bilateral parietooccipital gliosis with regional white matter volume loss and focal callosal thinning, consistent with perinatal hypoxic ischemic encephalopathy and possible neonatal hypoglycemia. Swetha Sara Philip, Sunithi Elizabeth Mani, and Gordon N. Dutton Copyright © 2016 Swetha Sara Philip et al. All rights reserved. Orbital Infarction due to Sickle Cell Disease without Orbital Pain Mon, 07 Nov 2016 06:12:15 +0000 Sickle cell disease is a hemoglobinopathy that results in paroxysmal arteriolar occlusion and tissue infarction that can manifest in a plurality of tissues. Rarely, these infarcted crises manifest in the bony orbit. Orbital infarction usually presents with acute onset of periorbital tenderness, swelling, erythema, and pain. Soft tissue swelling can result in proptosis and attenuation of extraocular movements. Expedient diagnosis of sickle cell orbital infarction is crucial because this is a potentially sight-threatening entity. Diagnosis can be delayed since the presentation has physical and radiographic findings mimicking various infectious and traumatic processes. We describe a patient who presented with sickle cell orbital crisis without pain. This case highlights the importance of maintaining a high index of suspicion in patients with known sickle cell disease or of African descent born outside the United States in a region where screening for hemoglobinopathy is not routine, even when the presentation is not classic. Cameron L. McBride, Kim-Binh T. Mai, and Kartik S. Kumar Copyright © 2016 Cameron L. McBride et al. All rights reserved. A Rare Case of Lateral Canthal Gouty Tophus Presenting as an Eyelid Mass Sun, 06 Nov 2016 10:58:01 +0000 A 41-year-old man with a history of gout presented with an enlarging eyelid growth. Clinical examination revealed a mildly indurated nodule at the lateral canthus. Following resection, histopathological examination revealed needle-shaped, crystalline material surrounded by multinucleated giant cells, findings consistent with gouty tophus. This represents just the sixth case of gouty tophus of the eyelid reported in the literature. Austin S. Nakatsuka, Timothy F. McDevitt, and Pamela S. Tauchi-Nishi Copyright © 2016 Austin S. Nakatsuka et al. All rights reserved. Optic Disk Pit with Sudden Central Visual Field Scotoma Mon, 31 Oct 2016 09:29:43 +0000 Purpose. To describe a case of optic disk pit (ODP) with sudden central visual field scotoma. Methods. A 49-year-old woman presented, reporting sudden painless central visual field loss 3 months prior to presentation. Neuroophthalmologic, systematic, and laboratory evaluation and full imaging processes were performed. Results. Fundoscopy and color photography demonstrated an optic disk pit inferotemporally. Perimetry identified central visual field horizontal scotoma. OCT revealed absence of serous retinal detachment, but disclosed inner retina thinning corresponding to the area of the visual field loss. Fluorescein angiography demonstrated delay in the cilioretinal arteries and also disclosed a relative delay in the perfusion of an arterial branch off the inferior retinal arcade. Clinical and laboratory evaluations were negative for any related pathology. Conclusion. Sudden central visual field scotoma in patients with ODP may be associated with delayed vascular filling of CRA and retinal arterioles within the optic disc anomaly region. Nikol Panou and Demetrios G. Vavvas Copyright © 2016 Nikol Panou and Demetrios G. Vavvas. All rights reserved. A Case of Secondary Epiretinal Membrane Spontaneous Release Mon, 31 Oct 2016 08:57:45 +0000 Purpose. To report a rare case of secondary epiretinal membrane (ERM) spontaneous separation with subsequent visual restoration. Case Summary. We are reporting a case with the history of branch retinal vein occlusion, peripheral retinal neovascularization, and retinal photocoagulation. Our examination revealed secondary ERM associated with relatively high visual acuity (0.6), and a watchful waiting strategy was chosen. During the follow-up, slight visual deterioration, progressive deformation of the retinal profile, and an increase in diffuse retinal edema were observed. No surgical or laser treatment was performed. On the next visit, the spontaneous ERM separation with residual parapapillary fixation, the increase in visual acuity (0.9), and the decrease in retinal thickness were revealed. Conclusion. Such cases present additional evidence to a deferral surgical strategy for the management of patients with ERM and relatively high visual acuity. Andrey N. Andreev, Alexey V. Bushuev, and Sergey N. Svetozarskiy Copyright © 2016 Andrey N. Andreev et al. All rights reserved. Ultra-Wide-Field Fluorescein Angiography in Microscopic Polyangiitis Sun, 30 Oct 2016 13:52:14 +0000 A 25-year-old Hispanic female presented with 5 months of dry eyes and 2 months of bilateral photophobia and decreased vision. On examination, she had bilateral anterior uveitis and mild disc edema of the left eye. A complete infectious and inflammatory work-up was positive for elevated antinuclear antibodies and p-ANCA, leading to a diagnosis of microscopic polyangiitis. One year after initial treatment and steroid taper, an ultra-wide-field fluorescein angiography revealed peripheral vasculitis, outside of the standard traditional field of view, leading to an increase in immunomodulatory therapy and illustrating the utility of wide-field angiography for managing patients with uveitis. Philip P. Storey, Shannon A. Philander, Anna Ter-Zakarian, Narsing A. Rao, and Damien C. Rodger Copyright © 2016 Philip P. Storey et al. All rights reserved. Central Retinal Artery Occlusion in Takayasu’s Arteritis as the First Presentation of the Disease Thu, 27 Oct 2016 09:18:00 +0000 Takayasu’s arteritis (TA) is a chronic inflammatory granulomatous vasculitis which affects large and medium arterial vessels. The disease involves especially subclavian arteries and aortic branches but it can consist of any arteries. The major pathology is granulomatous panarteritis with intima proliferation and defects of the elastic lamina of the vessels. We present a case of central retinal artery occlusion in TA as the first presentation of the disease. To the best of our knowledge, the present case is the first case that demonstrates central retinal artery occlusion as an initial manifestation in TA. A 48-year-old woman was admitted to our clinic with the complaint of sudden and painless vision loss in her right eye for one day. Although retinal artery involvement is a very rare presentation in TA, it is important to recall TA particularly in young patients with retinal artery occlusion. Hande Guclu, Vuslat Pelitli Gurlu, Sadık Altan Ozal, and Orkut Guclu Copyright © 2016 Hande Guclu et al. All rights reserved. Spontaneous Regression of Choroidal Neovascularization in a Patient with Pattern Dystrophy Wed, 26 Oct 2016 11:56:42 +0000 Purpose. To present a case of a patient with pattern dystrophy (PD) associated choroidal neovascularization (CNV) that resolved spontaneously without treatment. Methods. A 69-year-old male patient was referred to our unit, for evaluation of a recent visual loss (metamorphopsias) in his left eye. Fundus examination, fundus autofluorescence imaging, and fluorescein angiography showed a choroidal neovascular membrane in his left eye. Since visual acuity was satisfactory the patient elected observation. Clinical examination and OCT testing were repeated at 6 and 12 months after presentation. Results. Visual acuity remained stable at the level of 0.9 (baseline BCVA) during the follow-up period (12 months). Repeat OCT testing showed complete spontaneous regression of the choroidal neovascular membrane without evidence of intra- or subretinal fluid in both follow-up visits. Conclusions. Spontaneous regression of choroidal neovascularization can occur in patients with retinal dystrophies and associated choroidal neovascular membranes. The decision to treat or observe these patients relies strongly on the presenting visual acuity, since, in isolated instances, spontaneous resolution of choroidal neovascularization may occur. Anastasios Anastasakis, Flamur Goleni, Gerasimos Livir-Rallatos, Charalampos Livir-Rallatos, Panagiotis Zafirakis, and Gerald Allen Fishman Copyright © 2016 Anastasios Anastasakis et al. All rights reserved. Long-Term Retention of an Intraorbital Metallic Foreign Body Adjacent to the Optic Nerve Wed, 12 Oct 2016 08:07:46 +0000 We report the case of an asymptomatic 47 year-old male patient who suffered a penetrating wound from a metallic foreign body that became embedded adjacent to the optic nerve for over thirty years, as well as the associated examination, imaging, and fundus photography. Intraorbital metallic foreign bodies can be well tolerated and may not require surgical intervention despite proximity to important structures. Andrew N. Siedlecki, Edmund Tsui, Jie Deng, and Donald M. Miller Copyright © 2016 Andrew N. Siedlecki et al. All rights reserved.