Case Reports in Ophthalmological Medicine https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Valsalva-Related Subretinal Hemorrhage as a Presenting Symptom of Polypoidal Choroidal Vasculopathy Tue, 12 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/criopm/2017/9650287/ Purpose. To describe a case of Valsalva-related subretinal hemorrhage as a presenting symptom of polypoidal choroidal vasculopathy (PCV). The patient refrained from treatment against our best advice, and thus this is also a rare case of the natural course of an untreated PCV. Methods. Case report. Results. A 66-year-old female with a respiratory infection coughed intensely until exhaustion, after which she developed visual symptoms on the right eye. Primary care ophthalmologist examined the patient on the same day of the onset of symptoms and referred her to our tertiary medical retinal service for detailed retinal diagnosis including fluorescein and indocyanine green angiography. The right eye had a large subretinal hemorrhage and pigment epithelium detachment in the lower temporal arcade with foveal involvement. Against our best advice, the patient refused treatment. In the following 9 months, the BCVA decreased from 68 to 55 ETDRS letters, the subretinal hemorrhage almost regressed, pigment epithelium detachments persisted, and macular edema, intraretinal cysts, and subretinal fibrosis developed. Conclusions. Although classic Valsalva retinopathy with preretinal hemorrhage in most cases can be managed by careful observation and no treatment, this case demonstrates that Valsalva-related subretinal hemorrhage needs different attention and approach. Yousif Subhi and Torben L. Sørensen Copyright © 2017 Yousif Subhi and Torben L. Sørensen. All rights reserved. Giant Conjunctival Nevus in a 12-Year-Old Child Wed, 23 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criopm/2017/8414352/ We describe a case of a giant conjunctival nevus presented in a 12-year-old girl with suspicious clinicomorphological appearance. The lesion was noticed by the parents at the age of 3 years as a “fleshy spot” on the bulbar conjunctiva. The lesion remained unchanged until approx. 6 months before recent admission. On slit-lamp examination, a large conjunctival lesion with variegate pigmentation and indistinct margins was detected on the superonasal part of the bulbar conjunctiva of the left eye. Intralesional cysts and vessels were detected with AS-OCT examination. Wide excision and cryotherapy to the scleral bed were performed and amniotic membrane graft was used to restore the ocular surface. Histopathological examination revealed compound type conjunctival nevus and disclosed any sign of malignancy. Although giant conjunctival nevus is a rare entity, precise diagnosis and adequate management are very important as it can be confused with malignant melanoma. Edit Tóth-Molnár, Eszter Vizvári, Ákos Skribek, and András Vörös Copyright © 2017 Edit Tóth-Molnár et al. All rights reserved. Concomitant Intravitreal Ganciclovir and Dexamethasone Therapy in the Management of Acute Retinal Necrosis in a Patient Previously Treated with Oral Famciclovir Tue, 08 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criopm/2017/4613624/ Several treatments have been reported for acute retinal necrosis (ARN). We report a case of treatment with intravitreal injection of ganciclovir and dexamethasone in addition to oral valacyclovir in a patient who was previously treated with oral famciclovir for ipsilateral herpes zoster ophthalmicus (HZO). Chirag V. Patel and Kamal Kishore Copyright © 2017 Chirag V. Patel and Kamal Kishore. All rights reserved. Eyelid Edema: A Rare Cause of a Common Sign Mon, 07 Aug 2017 08:27:19 +0000 http://www.hindawi.com/journals/criopm/2017/9193706/ We report a 48-year-old female patient who presented to the emergency room with right eyelid edema, with 3 days of evolution. She had suffered minor trauma to this eye one week before. She reported episodes of right eyelid swelling of spontaneous resolution since the occurrence of a traumatic brain injury 5 years ago. Ophthalmological examination showed a soft and painless eyelid edema of the right eye. Brain computed tomography showed an area of bone discontinuity of the orbital roof with brain herniation and a CSF leak into the eyelid (blepharocele). Magnetic resonance confirmed the result of TC and revealed an area of frontal encephalomalacia. Ibuprofen (800 mg/day) was prescribed, with complete resolution within 20 days. She was evaluated by Neurosurgery with no indication of surgery due to the resolution of the edema and absence of symptoms. Blepharocele is a rare entity that should be considered in the differential diagnosis of unilateral eyelid edema. It can be secondary to an orbital fracture or congenital lesion. Andreia Soares, Cristina Almeida, Cristina Freitas, Marco Sales-Sanz, and Sara Ribeiro Copyright © 2017 Andreia Soares et al. All rights reserved. Management of Traumatic Cataract with Posterior Capsular Rupture: A Case Report and In Vitro Model Study Tue, 18 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/criopm/2017/4230657/ Purpose. To investigate the optimal strategy for surgical management of traumatic cataract with posterior capsular rupture. Methods. We describe four cases of traumatic cataract with posterior capsular rupture and an in vitro model built to evaluate the optimal infusion pressure during surgery. Results. All patients underwent cataract surgery. By using an anterior chamber maintainer to elevate infusion pressure, we safely performed cataract extraction without phacoemulsification. At 3 days after surgery, visual acuity was greater than 20/25 in all patients, without any complications. Phacoemulsification would also be feasible under anterior chamber maintainer infusion in a similar case of traumatic cataract with posterior capsular rupture during intravitreal injection. In addition, an in vitro model that we established using pig’s eyes revealed that the anterior chamber remained stable when the height of infusion bottle was 50–90 mmHg, whereas shallowing of the anterior chamber occurred when the height of infusion bottle was reduced to 40 mmHg, and corneal edema occurred when the height of infusion bottle was raised to 100 mmHg. Conclusions. During management of traumatic cataract with posterior capsular rupture, using an anterior chamber maintainer to maintain optimal infusion pressure may reduce the risk of anterior hyaloid membrane breakup and vitreous loss. Wenjuan Wan, Ke Hu, Yan Ji, and Can Li Copyright © 2017 Wenjuan Wan et al. All rights reserved. Peripheral Ulcerative Keratitis Associated with HCV-Related Cryoglobulinemia Wed, 12 Jul 2017 08:32:03 +0000 http://www.hindawi.com/journals/criopm/2017/9461937/ Purpose. To describe a case of peripheral ulcerative keratitis associated with type II cryoglobulinemia in the context of Hepatitis C infection. Methods. Case report and literature review. Results. A 36-year-old male patient presented to our emergency department with unilateral moderate pain in his right eye, associated with redness and photophobia. Medical background elicited a history of Hepatitis C and IV illicit drug abuse. Ocular examination revealed a BCVA of 20/30 of the affected eye and slight discomfort with eye movement. Biomicroscopy revealed a ring shaped peripheral corneal ulcer, with a dense white stromal infiltrate sparing the limbus, plus an adjacent area of mild anterior diffuse nonnecrotizing scleritis. No intraocular inflammation was present. Posterior segment was normal. The patient was placed under oral prednisolone (1 mg/Kg/day) with gradual tapering. A dramatic clinical response occurred, with complete resolution of the clinical condition. Systemic analytic workup aiming at autoimmune and infectious diseases was negative, except for high HCV-viral load and the presence of type 2 cryoglobulins. Conclusion. Albeit rare, cryoglobulinemia, even in the absence of systemic vasculitis, should be considered in the differential diagnosis of PUK, when systemic workout for autoimmune diseases is negative. Pedro Coelho, Carlos Menezes, Rita Gonçalves, Pedro Rodrigues, and Elena Seara Copyright © 2017 Pedro Coelho et al. All rights reserved. Idiopathic Bilateral Suprachoroidal Haemorrhage: A Rare Case Presentation Wed, 28 Jun 2017 09:24:51 +0000 http://www.hindawi.com/journals/criopm/2017/4234238/ 55-year-old male presented with sudden onset painful diminution of vision in both eyes. On local examination, his visual acuity was FC at 2 metres in right eye and FC at 1 m in left eye. The IOP in right eye was 46 mm Hg and 44 mm Hg in left eye. The patient was admitted and started on injection mannitol, oral syrup glycerol, and oral acetazolamide. Locally, timolol maleate and brimonidine were also started. The next day, his IOP was 17 mm Hg bilaterally but his visual acuity deteriorated to FC 1 m in right eye and hand movement in left eye with inaccurate projection of rays in both eyes. USG B-scan was performed which revealed bilateral choroidal detachment. The echotexture of fluid was suggestive of haemorrhage. As the IOP was controlled, systemic hyperosmotic/antiglaucoma agents were withdrawn in stepwise fashion over next two days. The patient was started on oral prednisolone. At 2 weeks, the visual acuity in both eyes was only perception of light, with inaccurate PR. IOP was 10 mm Hg in both eyes. USG B-scan revealed resorption of the hemorrhage, with partial resolution of the choroidal detachment. The final BCVA was 6/18 and 6/12 in right and left eye. Komal Saluja, Mayuresh Naik, Rajshekhar Vemparala, and Anuj Mehta Copyright © 2017 Komal Saluja et al. All rights reserved. Traumatic Submacular Hemorrhage with Macular Hole Repaired by Pneumatic Displacement and Intravitreal t-PA Injection Sun, 11 Jun 2017 09:18:16 +0000 http://www.hindawi.com/journals/criopm/2017/9821416/ This paper presents a case demonstrating repair of traumatic macular hole and submacular hemorrhage with intravitreal gas tamponade and t-PA in an office setting. Amy A. Mehta, Jay Berdia, Lilly H. Wagner, Irene Choi, and Brandon B. Johnson Copyright © 2017 Amy A. Mehta et al. All rights reserved. Kingella kingae Keratitis in a Child with Underlying Vernal Keratoconjunctivitis Thu, 04 May 2017 07:39:21 +0000 http://www.hindawi.com/journals/criopm/2017/1087821/ Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC). Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. We report a case of bacterial ulcer with isolation of Kingella kingae from the corneal scraping in a young child with underlying VKC. Salim Nurul-Laila, Khai-Siang Chai, Ahmad Tajudin Liza-Sharmini, and Ismail Shatriah Copyright © 2017 Salim Nurul-Laila et al. All rights reserved. Retinal Artery Occlusion Secondary to Buerger’s Disease (Thromboangiitis Obliterans) Sun, 16 Apr 2017 09:40:00 +0000 http://www.hindawi.com/journals/criopm/2017/3637207/ Purpose. To report a case report of one patient suffering from retinal artery occlusion secondary to Buerger’s disease, in order to raise awareness to this etiology in the differential diagnosis of retinal artery occlusion. Methods. A retrospective case report of a patient with retinal artery occlusion secondary to Buerger’s disease. Data retrieved from the medical records included exposure, complaints, visual acuity, clinical findings and imaging, laboratory assessment, treatment, disease course, and visual outcome. Results. Diagnosis of retinal artery occlusion secondary to Buerger’s disease was established based on ruling out other causes of retinal artery occlusion. Inflammatory retinal vascular disease, permanent vision loss, and macular atrophy were shown in this case. Conclusion. The very first case of central retinal artery occlusion (CRAO) in a 64-year-old male patient with Buerger’s disease. Although diagnosing CRAO based on both fundoscopic and fluorescein angiographic findings is not difficult, revealing underlying condition of CRAO occasionally could be challenging. Erdem Eris, Mehmet Emin Sucu, Irfan Perente, Zeynep Alkın, Abdullah Ozkaya, and Hatice Nur Tarakcioglu Copyright © 2017 Erdem Eris et al. All rights reserved. Echographic Evaluation of a Subconjunctival Cystic Lesion Wed, 12 Apr 2017 09:22:29 +0000 http://www.hindawi.com/journals/criopm/2017/5401850/ Migration of intraocular silicone oil, used in the treatment of complicated retinal detachment, has been rarely described, but when it happens it can arise with a differential diagnosis with scleral buckling extrusion, tumor, dermoid, ocular cysticercosis, and abscess. The presence of silicone oil in the eye gives very ugly echographic pictures, but these kinds of pictures can be very useful in making a differential diagnosis in the above-mentioned cases. A 39-year-old white female complained of the presence of conjunctival hyperemia and tearing in the right eye (RE); her visual acuity was hand motion, and the intraocular pressure was 14 mmHg. In the upper nasal quadrant a dome shaped lesion was detected. Due to the lens opacities, the patient underwent an echographic examination, which revealed the presence of silicon oil both in the vitreous chamber and in a large subconjunctival space, corresponding to the lesion. This article in addition provides a possible explanation of such cystic formation and discusses the risk factors and the role of the echographic examination in such cases. Maddalena De Bernardo, Gennarfrancesco Iaccarino, Valeria Russo, and Nicola Rosa Copyright © 2017 Maddalena De Bernardo et al. All rights reserved. Orbital T-Cell Lymphoma with Discrete Enlargements of All Extraocular Muscles Bilaterally in Patient with Moon Face Countenance Sun, 09 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/criopm/2017/8902162/ Purpose. To report our findings in a case of orbital T-cell lymphoma in which all of the extraocular muscles (EOMs) were bilaterally and discretely enlarged and the patient had a moon face countenance. Case. A 59-year-old woman presented with visual disturbances in her left eye, hyperemia in both eyes, and a moon face countenance. Examinations showed limited upward gaze in the right eye, blepharoptosis, hypertropia, and limited downward and rightward gaze in the left eye. Slit-lamp examination showed only chemosis and hyperemia of both eyes. Magnetic resonance imaging with contrast revealed discrete enlargements of the muscle bellies in all EOMs without abnormalities of the orbital fat in both eyes. Blood examinations excluded thyroid- and IgG4-related ophthalmopathy, and EOM biopsy revealed peripheral T-cell lymphoma. After beginning aggressive chemotherapy, the enlarged EOMs, limited eye motility, and moon face countenance improved. Unfortunately, the patient died of sepsis during the chemotherapy. Conclusions. A lymphoma should be included in the differential diagnosis of eyes with enlarged EOMs. Because lymphomas can lead to death, it is important for clinicians to consider lymphomas in eyes with enlarged EOMs. Hideaki Kawakami, Kiyofumi Mochizuki, Hideko Goto, Naoki Watanabe, and Takuji Tanaka Copyright © 2017 Hideaki Kawakami et al. All rights reserved. The Histopathological Finding of the Surgically Extracted Atypical Dome-Shaped Choroidal Osteoma Wed, 15 Mar 2017 06:52:39 +0000 http://www.hindawi.com/journals/criopm/2017/2874823/ Purpose. To report a case of atypical dome-shaped choroidal osteoma, which was diagnosed by histopathological finding of surgically extracted tumor. Case Report. A 35-year-old woman presented with visual field abnormality in the left eye (OS). Her best-corrected visual acuity with Landolt ring chart was 1.0 OS. The funduscopic examination revealed a yellowish dome-shaped choroidal tumor located in the temporal side of the macula with exudative retinal detachment. 25-gauge pars plana vitrectomy and the extraction of the tumor were performed for the definitive diagnosis. Results. As a result of histopathological finding from the extracted tumor, she was diagnosed with choroidal osteoma. 10 months after the last surgery, the BCVA is 0.7 OS. The tumor is not relapsed. Conclusions. We must keep in mind that choroidal osteoma can be one of the differential diagnoses for the dome-shaped choroidal tumor. Hirona Bessho, Hisanori Imai, and Atsushi Azumi Copyright © 2017 Hirona Bessho et al. All rights reserved. Intramuscular Cavernous Hemangioma of Medial Rectus Muscle in Paediatric Age Group Mon, 13 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/criopm/2017/1076404/ An 11-year-old male child presented with a mass on the nasal aspect of the right eye that has been there for the last 2 years. Extraocular movements were decreased in the right eye on levoversion, levoelevation, and levodepression. Local examination revealed a bluish mass with irregular surface and ill-defined margins located in the medial rectus muscle. The mass was 10 × 20 mm in size, firm, nodular, nontender, nonpulsatile, noncompressible, and nonreducible. MRI of the orbit revealed a well-defined mass of approximately 23 × 13 mm along the medial rectus (MR) muscle. It was hyperintense on T2W images with very minimal contrast enhancement. A provisional diagnosis of hemangioma or lymphangioma with intralesional haemorrhage was made. During surgical excision, the mass was found to be encapsulated by MR fibres. The MR fibres were separated, and the mass measuring 20 × 8 × 6.5 mm was removed and sent for histopathology. The histopathological examination revealed an intramuscular cavernous hemangioma. Anuj Mehta, Shalini Butola, Mayuresh Naik, Sangeeta Abrol, and Anju Kumari Copyright © 2017 Anuj Mehta et al. All rights reserved. Bilateral Severe Sterile Inflammation with Hypopyon after Simultaneous Intravitreal Triamcinolone Acetonide and Aflibercept Injection in a Patient with Bilateral Marked Rubeosis Associated with Ocular Ischemic Syndrome Mon, 13 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/criopm/2017/5123963/ We report the clinical course of a diabetic patient with bilateral cataract and rubeosis in association with ocular ischemic syndrome and initially treated him with simultaneous intravitreal 2 mg aflibercept and 2 mg triamcinolone acetonide injection at the same setting prior to planned cataract surgery and further photocoagulation. However, sterile anterior segment inflammation characterized by hypopyon occurred four days apart in OU. Right eye developed the sterile inflammation at the third postinjection day and the left eye developed the sterile inflammation at the seventh postinjection day (two days after the uneventful cataract surgery with intraocular lens implantation) without any pain or significant redness. Vitreous biopsy taken during the right phacovitrectomy was negative for any microbial contamination. Both eyes were treated successfully with intensive topical prednisolone acetate with a relatively good visual outcome. It is likely that underlying ocular ischemic syndrome might have facilitated the formation of sterile inflammation as blood-aqueous barrier disruption and flare have already been present. Ceren Durmaz Engin, Ziya Ayhan, Süleyman Men, Aylin Yaman, and A. Osman Saatci Copyright © 2017 Ceren Durmaz Engin et al. All rights reserved. An OCT Study of Anterior Nodular Episcleritis and Scleritis Tue, 28 Feb 2017 08:18:48 +0000 http://www.hindawi.com/journals/criopm/2017/5742673/ 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 http://www.hindawi.com/journals/criopm/2017/5423027/ 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 http://www.hindawi.com/journals/criopm/2017/6586157/ 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 http://www.hindawi.com/journals/criopm/2017/8190823/ 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 http://www.hindawi.com/journals/criopm/2017/2379697/ 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 http://www.hindawi.com/journals/criopm/2017/5395069/ 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 http://www.hindawi.com/journals/criopm/2017/5310924/ 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 http://www.hindawi.com/journals/criopm/2017/1708734/ 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 http://www.hindawi.com/journals/criopm/2017/4876587/ 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 http://www.hindawi.com/journals/criopm/2016/5704695/ 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 http://www.hindawi.com/journals/criopm/2016/6741925/ 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 http://www.hindawi.com/journals/criopm/2016/5104789/ 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 http://www.hindawi.com/journals/criopm/2016/2916027/ 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 http://www.hindawi.com/journals/criopm/2016/1495639/ 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 http://www.hindawi.com/journals/criopm/2016/1289834/ 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.