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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 351, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 238, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 6)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 41, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 50, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 61)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 353, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 325, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 39, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 54, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 10, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 8, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 39, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 8, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 235, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 57, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 22, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 57, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 11)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 161, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Ophthalmology Case Reports
  [5 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Online) 2451-9936
   Published by Elsevier Homepage  [3043 journals]
  • Recovery of outer retinal laminations on optical coherence tomography
           after treatment of cancer associated retinopathy

    • Authors: Francisco J. Irizarry; Laura J. Kopplin; Sherveen S. Salek; Grazyna Adamus; Mohamed Saleh; Kristin Biggee; Phoebe Lin; James T. Rosenbaum
      Pages: 11 - 13
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 8
      Author(s): Francisco J. Irizarry, Laura J. Kopplin, Sherveen S. Salek, Grazyna Adamus, Mohamed Saleh, Kristin Biggee, Phoebe Lin, James T. Rosenbaum
      Purpose To report novel optical coherence tomography findings in a case of anti-α-enolase cancer associated retinopathy. Observations An elderly female presented with bilateral decreased vision and a recent diagnosis of ovarian carcinoma. Optical coherence tomography demonstrated bilateral loss of outer retinal structures and macular edema. Serum testing found antibodies against α-enolase and 82–84 kDa proteins. Outer retinal structures showed recovery, macular edema resolved and repeat anti-retinal antibody testing became negative following cancer therapy and topical difluprednate treatment. Conclusions and importance Cancer associated retinopathy is a paraneoplastic disease that results in damage to retinal structures through an autoimmune response. The damage is generally considered to be irreversible; however, in rare cases, such as observed here, retinal structures may demonstrate recovery after treatment.

      PubDate: 2017-09-05T20:38:17Z
      DOI: 10.1016/j.ajoc.2017.08.001
      Issue No: Vol. 8 (2017)
       
  • Surgical treatment outcome of medically refractory huge giant papillary
           conjunctivitis

    • Authors: Yien Lai; Gangadhara Sundar; Manotosh Ray
      Pages: 22 - 24
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 8
      Author(s): Yien Lai, Gangadhara Sundar, Manotosh Ray
      Purpose To compare the surgical outcome of excision of giant papillae with and without amniotic membrane in a patient with bilateral medically refractory giant papillary conjunctivitis (GPC). Observations 27-year-old Chinese lady presented with bilateral itchy eyes, discomfort and fullness of upper lids for past two years. She was a long-term contact lens user but stopped completely 2 years ago. Not a known atopic, she had unusually large giant papillae involving both upper tarsal conjunctiva. She had used topical olopatadine(0.1%), intermittent dexamethasone(0.1%) and also underwent intralesional injection of Triamcinolone (40mg/ml) twice on each side without any improvement in past two years. We decided to excise the papillae with amniotic membrane transplantation (AMT) in left eye and only excision in the right eye. The results were compared after 2 years. Giant papillae were excised in both eyes under regional anesthesia on separate occasions. The left eye received AMT in addition to excision. A symblepharon ring was applied and left in place for two weeks in both eyes. She was treated with topical Prednisolone acetate (1%) and Levofloxacin 4 times a day for a month. Postoperative period was unremarkable and she recovered well. In 2 years follow-up, the upper tarsal conjunctiva was smooth in both eyes and there was no evidence of any recurrences. Conclusion and Importance Excision of giant papillae is a treatment option for cases with refractory GPC. Additional AMT after excision may not be necessary as there was no difference in surgical outcome.

      PubDate: 2017-09-24T10:35:24Z
      DOI: 10.1016/j.ajoc.2017.09.002
      Issue No: Vol. 8 (2017)
       
  • Tuberculous uveitis presenting as pigmented hypopyon – A case report

    • Authors: Sachin B. Shetty; Santhosh H. Devulapally; Sowmiya Murali; Jaydeep A. Walinjkar; Jyotirmay Biswas
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 7
      Author(s): Sachin B. Shetty, Santhosh H. Devulapally, Sowmiya Murali, Jaydeep A. Walinjkar, Jyotirmay Biswas
      Purpose Hypopyon in the eye is an alarming sign. A case of tuberculous uveitis which presented with pigmented hypopyon has been described. The aim of this paper is to report pigmented hypopyon, a rare presentation of tuberculous uveitis in a diabetic patient. Observations A 42-year-old patient with diabetes with a known history of miliary tuberculosis, on anti-tubercular therapy since two months presented with complaints of pain and redness followed by diminution of vision in the right eye since one month. Visual acuity was counting fingers close to face in right eye. Anterior chamber (AC) showed grade 4 cells and flare with a pigmented hypopyon measuring two mm. Fundus details were not made out. B scan revealed increased choroidal thickness with moderate vitritis. Routine blood counts revealed leucopenia and anemia suggestive of an immunosuppressed state. AC tap analysis was not helpful in diagnosis initially. Patient was lost to follow up and presented one month later with three - fourth of AC having hypopyon. AC wash was done and the AC sample evaluation revealed acid fast bacilli. Polymerase chain reaction results confirmed it to be Mycobacterium tuberculosis. Conclusions and importance Tuberculous anterior uveitis thus presenting as pigmented hypopyon is very rare and can cause diagnostic difficulties. High index of suspicion in tuberculosis endemic areas is a must for a prompt diagnosis. A possible association between immunosuppression and pigmented hypopyon may exist and needs to be studied further.

      PubDate: 2017-04-14T14:03:31Z
      DOI: 10.1016/j.ajoc.2017.04.002
      Issue No: Vol. 7 (2017)
       
  • Orbital ‘pseudo-abscess’ in a patient with spontaneous subluxation of
           globe: A case report

    • Authors: Hari Mylvaganam; Todd Goodglick
      Pages: 20 - 22
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 7
      Author(s): Hari Mylvaganam, Todd Goodglick
      Purpose We describe this case and review the literature, to allow this to be a cautionary tale in the interpretation of fluid collections in the setting of spontaneous globe subluxations (GS). Observations A 58 year old female, with a past medical history of globe subluxation, was diagnosed radiographically with an orbital abscess, and managed with an orbitotomy. However, no abscess was identified operatively and subsequent imaging showed only extravasation of serous fluid. Conclusions and importance We postulate that in the case here, the fluid collection posterior to the globe was in fact due to increase venous congestion and decrease venous return posteriorly from the globe to the cone, leading to an efflux of clear serous fluid. We postulate that in the case of GS without other clinical indications suggesting orbital abscess one can consider a posterior globe collection of fluid to be an extravasation of serous fluid, secondary to increased venous congestion.

      PubDate: 2017-05-05T12:30:40Z
      DOI: 10.1016/j.ajoc.2017.04.007
      Issue No: Vol. 7 (2017)
       
  • A stepping stone in treating dendritic keratitis

    • Authors: Hosam Sheha; Sean Tighe; Anny M.S. Cheng; Scheffer C.G. Tseng
      Pages: 55 - 58
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 7
      Author(s): Hosam Sheha, Sean Tighe, Anny M.S. Cheng, Scheffer C.G. Tseng
      Purpose To report the outcome of self-retained amniotic membrane after debridement in recurrent dendritic keratitis. Observations A 70-year-old female with a recurrent dendritic corneal ulcer received debridement followed by placement of self-retained amniotic membrane. Five days after treatment, the patient experienced a complete resolution of symptoms, marked reduction of inflammation, complete re-epithelialization of the cornea and improvement of visual acuity. The corneal surface remained stable for 18 months despite noncompliance in using antiviral therapy. Conclusions and importance Self-retained amniotic membrane after debridement appears effective in treating dendritic keratitis. While early debridement is crucial to remove the infected corneal epithelium, amniotic membrane was shown to enhance the healing without scarring or recurrence. Besides the known anti-inflammatory and anti-scarring effects of the amniotic membrane, it may have a potential topical antiviral effect that warrants further investigation.

      PubDate: 2017-06-09T12:12:45Z
      DOI: 10.1016/j.ajoc.2017.06.002
      Issue No: Vol. 7 (2017)
       
  • Utility of optical coherence tomography angiography in detecting
           glaucomatous damage in a uveitic patient with disc congestion: A case
           report

    • Authors: Jiun Lap Do; Beau Sylvester; Anoush Shahidzadeh; Ruikang K. Wang; Zhongdi Chu; Vivek Patel; Grace Marie Richter
      Abstract: Publication date: Available online 5 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Jiun Lap Do, Beau Sylvester, Anoush Shahidzadeh, Ruikang K. Wang, Zhongdi Chu, Vivek Patel, Grace Marie Richter
      Purpose To report a case of uveitic glaucoma with congested optic disc where optical coherence tomography angiography (OCT-A) provided diagnostic utility in assessing glaucomatous damage but optical coherence tomography (OCT) alone had limited utility. Observations We report a case of a 33-year-old Caucasian female referred to the USC Roski Eye Institute for uncontrolled intraocular pressure (IOP) in the left eye. She was managed by an outside provider for 6 months, where her IOP ranged from 28 to 42 mm Hg in the left eye on maximally tolerated medical therapy. Her clinical exam was consistent with Herpes family trabeculitis, optic nerve congestion, and possible glaucomatous damage. Initial evaluation of the optic nerve by standard modalities (fundus exam and OCT) was limited by optic nerve congestion; however, OCT-A showed peripapillary hypoperfusion, as commonly observed in glaucomatous eyes. She underwent aqueous shunt implantation for elevated IOPs poorly controlled by medications. Conclusions and importance OCT-A can be a useful tool in the evaluation of glaucoma in instances where disc congestion masks both nerve excavation and retinal nerve fiber thinning normally seen on exam and on standard OCT of the optic nerve.

      PubDate: 2017-10-14T08:07:11Z
      DOI: 10.1016/j.ajoc.2017.10.009
       
  • Purtscher-like retinopathy associated with cerebro- or cardiovascular
           surgery

    • Authors: Eiki Oshida; Shigeki Machida Tomoharu Nishimura Masaki Sakamoto
      Abstract: Publication date: Available online 7 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Eiki Oshida, Shigeki Machida, Tomoharu Nishimura, Masaki Sakamoto
      Purpose To report the findings in five patients of Purtscher-like retinopathy that developed after cerebro- or cardiovascular surgeries. Observations Three women and two men with a mean age of 56.6 years were studied. They had had cerebro- or cardiovascular disease that was treated by major vascular surgery. Postoperatively, all of the patients developed multiple patches of retinal whitening in the area corresponding to the radial peripapillary capillaries in the posterior pole of the eye uni- or bilaterally. In two patients, the optic nerve head was involved which affected their vision severely. Hematological examinations showed hypercoagulable state after the surgeries. The retinal pathologies abated with time. Conclusions and importance These results indicate that major cardio- or cerebrovascular surgeries can cause Purtscher-like retinopathy. The hypercoagulable state and specific structures of the radial peripapillary capillaries may play a role in pathogenesis of this disease.

      PubDate: 2017-10-07T22:55:13Z
       
  • Unusual Straatsma Syndrome - How dogmatic is a bad prognosis'

    • Authors: Ana Vide-Escada; Helena Prior Filipe
      Abstract: Publication date: Available online 7 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Ana Vide-Escada, Helena Prior Filipe
      Purpose To show that Straatsma Syndrome can have a good outcome and to highlight an unusual presentation of this disease. Observations A four-year-old boy presents with severe right eye amblyopia in association with high myopia, esotropia, heterochromia iridum and extensive myelinated retinal fibers involving both temporal arcades and the optic nerve head. Right eye initial visual acuity was less than 20/400 for distance and less than R6W10 for near. Left eye examination was unremarkable. Despite the indicators for bad prognosis, intensive occlusion therapy was prescribed. Parents were strongly involved in the treatment regimen. After four months, the patient presented an unexpected good visual recovery both for distance and near, that has persisted until present. Right eye visual acuity is 20/30 with -9.00 dioptres contact lens for distance and R2W1 for near. Esotropia also improved to 12 prism dioptres. Fundoscopic alterations and heterochromia iridum have remained stable. Spectral-domain optical coherence tomography images of the right eye showed thinner superior outer ring measurements. Conclusions and importance Straatsma Syndrome can present with heterochromia iridum. When strabismus is present, early surgery should be withheld. Intensive treatment of Straatsma Syndrome can yield an unexpected good result, despite initial high degree anisometropia and low vision acuity.

      PubDate: 2017-10-07T22:55:13Z
       
  • Parallel ocular and serologic course in a patient with early Sjogren's
           syndrome markers

    • Authors: Lam Phung; Ivonne Lollett Raquel Goldhardt Janet Davis Larry Young
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Lam Phung, Ivonne V. Lollett, Raquel Goldhardt, Janet L. Davis, Larry Young, Dana Ascherman, Anat Galor
      Purpose To report on a case of a young female with progressing dry eye symptoms and evolving autoimmune markers consistent with a presentation of early Sjogren's syndrome (SS). Observations A 32 year-old female presented with chronic dry eye symptoms refractory to artificial tears. Slit lamp examination revealed punctate epithelial erosions, decreased tear break-up time, and decreased tear lake bilaterally. Initial tests for ocular surface inflammation (InflammaDry, Quidel, San Diego) and systemic autoantibodies (antinuclear antibodies, anti-SSA/Ro and anti-SSB/La) were negative. After 4 months of persistent ocular symptoms and signs, ocular surface inflammation was detected via InflammaDry and blood results included a positive antinuclear antibody (1:160), rheumatoid factor (IgG 25.3 EU/ml), and carbonic anhydrase 6 (IgM 20.2 EU/ml), but persistently negative anti-SSA/Ro and anti-SSB/La antibodies. Conclusions and Importance: Taken together, these findings were suggestive of early Sjogren's syndrome with simultaneous appearance of both ocular and serum biomarkers. Novel autoantibodies testing in suspected patients can guide early intervention and potentially improve both the glandular and extra-glandular function in patients.

      PubDate: 2017-10-07T22:55:13Z
       
  • Photoreceptor disruption and vision loss associated with central serous
           retinopathy

    • Authors: Lynn Sun; Joseph Carroll Brandon Lujan
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Lynn W. Sun, Joseph Carroll, Brandon J. Lujan
      Purpose To present ophthalmic imaging findings in the case of a 40-year-old male with sustained visual loss after a single episode of acute central serous retinopathy (CSR). Observations A male subject presented with visual acuity decline to 20/50 OS and was diagnosed with acute CSR. The initial pigment epithelial detachment and subretinal fluid resolved within 6 weeks, but visual acuity remained impaired. Using directional optical coherence tomography (D-OCT) and confocal and split-detector adaptive optics scanning light ophthalmoscopy (AOSLO), we imaged pathologic alterations in the photoreceptor mosaic of the affected eye. A foveal region of intermittent missing cones, a temporal parafoveal region of confluent missing cones, and a nasal parafoveal region of misdirected cones were observed. Conclusions and Importance Pathologic alterations in photoreceptor microanatomy underlie residual visual acuity deficits in this case of acute CSR. Observations of missing cones correlated well across all imaging modalities in the fovea and the temporal parafoveal region of missing cones. However, in the nasal parafovea where cones were present but misdirected, D-OCT and AOSLO may be able to identify and image photoreceptors with greater fidelity as compared to non-directional SDOCT (spectral domain OCT). D-OCT may thus have a clinical role in rapidly assessing photoreceptor mosaic integrity in pathology.

      PubDate: 2017-10-07T22:55:13Z
       
  • Late extrusion of intrastromal corneal ring segments: A report of two
           cases

    • Authors: Julius Oatts; Louis Savar David Hwang
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Julius T. Oatts, Louis Savar, David G. Hwang
      Purpose To report two cases of patients with late extrusion following uneventful implantation of intrastromal corneal ring segments (ICRS) for myopia. Observations Two patients with previously implanted ICRS for low myopia presented with spontaneous onset of extrusion of their ICRS, one at 7 years post-operatively and the other at 17 and 20 years. Both cases underwent explantation and maintained excellent best-corrected visual acuity. These cases represent the longest reported intervals between implantation of the ICRS and subsequent extrusion. Conclusions and importance Late extrusion can occur many years following implantation of ICRS, even in eyes without pre-existing thinning or ectasia. The technique for explantation described herein can result in favorable clinical outcomes in such cases. These cases demonstrate the importance of long-term follow up of eyes that have undergone ICRS implantation.

      PubDate: 2017-10-07T22:55:13Z
       
  • One-year outcomes of ziv-aflibercept for macular edema in central retinal
           vein occlusion

    • Authors: Mohab Eldeeb; Errol Chan Chintan Dedhia Ahmad Mansour Jay Chhablani
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Mohab Eldeeb, Errol W. Chan, Chintan Dedhia, Ahmad Mansour, Jay Chhablani
      Purpose To report the 12-month efficacy and safety outcomes of intravitreal ziv-aflibercept in macular edema secondary to central retinal vein occlusion (CRVO). Methods Interventional case series documenting 12-month outcomes of intravitreal ziv-aflibercept (1.25 mg in 0.05 ml) in 6 patients with treatment-naive macular edema secondary to CRVO. All patients had comprehensive ophthalmic examination, spectral domain optical coherence tomography at baseline and all follow-up visits, and fluorescein. Retreatment decisions were based on recurrence or persistence of intraretinal or subretinal fluid, deterioration in visual acuity (VA), increase in central subfield thickness (CST) by ≥ 50 μm from the previous visit, or lowest recorded CST. Results Participants had (2 males, 4 females) an average age of 53.5 years. From baseline to 12 months, the mean logMAR VA improved from 0.86 (Snellen ≈ 20/145) to 0.33 (Snellen ≈ 20/40), central macular thickness decreased from 519 μm to 255 μm, and total macular volume decreased from 14.7 mm3 to 7.1 mm3. No eyes had uveitis, cataract progression, intraocular pressure (IOP) elevations, or systemic adverse events. Conclusions and Importance: Ziv-aflibercept achieves favorable intermediate-term functional and structural outcomes in macular edema secondary to CRVO. No safety concerns were raised. Low-cost ziv-aflibercept may thus be useful for CRVO in resource-poor countries. Further prospective studies in larger cohorts are needed further establish the efficacy and safety of this agent.

      PubDate: 2017-10-07T22:55:13Z
       
  • Projection-resolved optical coherence tomography angiography exhibiting
           

    • Authors: Kavita Bhavsar; Yali Jia Jie Wang Rachel Patel Andreas Lauer
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Kavita V. Bhavsar, Yali Jia, Jie Wang, Rachel C. Patel, Andreas K. Lauer, David Huang, Steven T. Bailey
      Purpose The purpose of this study is to analyze early retinal angiomatous proliferation (RAP) utilizing a novel imaging modality, Projection-Resolved Optical Coherence Tomography Angiography (PR-OCTA). Observations Five months prior to the diagnosis of a RAP lesion, cross-sectional PR-OCTA demonstrated flow in the outer retina contiguous with the deep retinal capillary plexus (DCP) and adjacent to a small pigment epithelial detachment. After development of a clinically visible RAP lesion, cross-sectional PR-OCTA demonstrated the RAP lesion connecting DCP and sub-retinal pigment epithelial neovascularization. Conclusions & Importance This is the first report of PR-OCTA demonstrating abnormal flow in the outer retina prior to the development of a clinically detectable RAP lesion. PR-OCTA may be useful for surveillance and to help further characterize and stage RAP lesions.

      PubDate: 2017-10-07T22:55:13Z
       
  • Changes in choroidal blood flow and choroidal thickness after treatment in
           two cases of pediatric anisohypermetropic amblyopia

    • Authors: Ryuya Hashimoto; Juri Kawamura Asato Hirota Mizuho Oyamada Asao Sakai
      Abstract: Publication date: Available online 5 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Ryuya Hashimoto, Juri Kawamura, Asato Hirota, Mizuho Oyamada, Asao Sakai, Takatoshi Maeno
      Purpose We aimed to examine the changes in choroidal blood flow (CBF) and central choroidal thickness (CCT) in children with anisohypermetropic amblyopia using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT). Observations The patients were both 6-year-old Japanese male children with complaints of worsening right visual acuity and were diagnosed with anisohypermetropic amblyopia. The decimal best-corrected visual acuities (BCVAs) in cases 1 and 2 were both 0.5. In both cases, LSFG results demonstrated CBF impairment in amblyopic eyes compared with fellow eyes. EDI-OCT results also showed that the CCTs of amblyopic eyes were greater than those of fellow eyes at the initial visit. Several months after the first visit, the decimal BCVAs in both cases had improved to 1.0 because of treatment. Further, the CBF gradually increased along with a decrease in the CCT of the amblyopic eye. The axial lengths and spherical powers of the amblyopic eyes in the two cases were not different during follow-up. Conclusions and importance We have determined the changes in CBF and CCT in two children with anisohypermetropic amblyopia for the first time. CBF impairments may be involved in the pathogenesis of anisohypermetropic amblyopia, and LSFG may be useful in examining CBF in pediatric anisohypermetropic amblyopia.

      PubDate: 2017-10-07T22:55:13Z
       
  • Bull's eye maculopathy and subfoveal deposition in two
           mucopolysaccharidosis type I patients on long-term enzyme replacement
           therapy

    • Authors: Heather G. Mack; R.C. Andrew Symons; Gerard de Jong
      Abstract: Publication date: Available online 4 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Heather G. Mack, R.C. Andrew Symons, Gerard de Jong
      Purpose To report retinal findings in two patients with mucopolysaccharidosis type I (MPS I) receiving human recombinant alpha-l-iduronidase (Laronidase) as enzyme replacement therapy. Observations Patient 1 had visual acuity 20/20 both eyes and unremarkable anterior segment and retinal examination. Optical coherence tomography (OCT) scanning demonstrated parafoveal thinning and subfoveal hyperreflectant material. Patient 2 had visual acuity 20/20 both eyes, with dense nuclear cataract both eyes. Retinal examination demonstrated bull's eye maculopathy both eyes. OCT scanning confirmed parafoveal atrophy and demonstrated similar appearing subfoveal hyperreflectant material, more prominent than in case 1. Conclusions and Importance These two patients with MPS I receiving Laronidase treatment have developed bull's eye maculopathy changes and subfoveal deposition of hyperreflectant material despite excellent compliance and good tolerance of the standard dose of enzyme therapy for this disorder. Further studies are required to determine the nature of the material, the incidence and the effect of enzyme replacement therapy on these findings in patients with MPS I.

      PubDate: 2017-10-07T22:55:13Z
      DOI: 10.1016/j.ajoc.2017.10.006
       
  • Swept-source optical coherence tomographic findings in eyes with
           metastatic choroidal tumor

    • Authors: Tomoka Ishida; Kei Morohoshi Yayoi Takeuchi Ryoko Soma Minami Uchida
      Abstract: Publication date: Available online 4 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Tomoka Ishida, Kei Morohoshi, Yayoi Takeuchi, Ryoko Soma, Minami Uchida, Kyoko Ohno-Matsui
      Purpose To report the swept-source optical coherence tomographic (OCT) findings in two eyes with choroidal metastases. Observations Two patients with choroidal metastasis were studied. The metastasis was from a breast cancer in Case 1 and from a lung cancer in Case 2. In Case 1, swept-source OCT showed a highly reflective solid tumor with low optical reflective tissues that had replaced the choroidal tissue. Swept-source OCT was able to image the choroidal mass where other fundus imaging methods such as fluorescein angiography did not show the mass. Ophthalmoscopy of Case 2 showed hemorrhages in the inner retina, on the tumor, and in the vitreous. Swept-source OCT showed a subretinal mass with a steeple-crowned cap and a ruptured Bruch's membrane on the tumor. Conclusion and importance Swept-source OCT imaging can detect the inner structure of a choroidal mass and retina around it in good detail.

      PubDate: 2017-10-07T22:55:13Z
       
  • Pathologic study of early manifestations of polypoidal choroidal
           vasculopathy and pathogenesis of choroidal neo-vascularization

    • Authors: Mark O.M.; Tso Maria Suarez Charles Eberhart
      Abstract: Publication date: Available online 4 October 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Mark O.M. Tso, Maria J. Suarez, Charles G. Eberhart
      Purpose To describe the histopathologic features of an early case of presumably bilateral polypoidal choroidal vasculopathy (PCV) in two eyes obtained at autopsy from a patient with no prior ocular therapy. Observations The choroid of both eyes at the macular and peripapillary regions was greatly thickened with dilated, thin walled choroidal venules intertwining with arteriosclerotic arterioles in the Sattler's layer of the choroidal vasculature. At the temporal and nasal equatorial regions of both eyes many of these congested venular channels abruptly disappeared and were replaced by loose connective tissue with loss of the normal choroidal stromal tissue and uveal melanocytes. A few remaining venules showed intraluminal sloughing of endothelial cells and deposition of fibrinous material networks suggesting occlusion of these choroidal venules. At this equatorial location, serous detachment of retinal pigment epithelium (RPE) appeared and a thin neovascular membrane with cords of endothelial cell invaded into the sub-RPE space. Anteriorly, the neovascular membrane expanded and bulged into the sub-retinal space with dilated neovascular capillaries in a “grape like” or polypoidal configuration. Conclusion and importance Polypoidal Choroidal Vasculopathy is a disease of the dilated and multi-layered choroidal venules. Occlusion of these choroidal vascular channels might give rise to choroidal stasis and ischemia leading to serous RPE detachment and a sub-RPE neovascular membrane. Gross dilatation of the choroidal venules and capillaries in the sub-RPE neovascular membrane leads to the characteristic “grape like” structures, a unique clinical feature in this disease entity. These pathologic features of PCV are different from the pathologic changes of neovascular age-related macular degeneration (nAMD). Consequently, PCV and nAMD are two distinct diseases. However, in the late stage of both entities, choroidal ischemia in both diseases, lead to sub-RPE neovascularization and subsequent sub-RPE and/or sub-retinal hemorrhage. These results in both entities showed comparable clinical and pathologic features that are frequently mistaken PCV as a sub-type of Neovascular AMD.

      PubDate: 2017-10-07T22:55:13Z
       
  • Juvenile xanthogranuloma involving concurrent iris and skin: Clinical,
           pathological and molecular pathological evaluations

    • Authors: Peter Meyer; Elisabeth Graeff; Corina Kohler; Francis Munier; Elisabeth Bruder
      Abstract: Publication date: Available online 23 September 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Peter Meyer, Elisabeth Graeff, Corina Kohler, Francis Munier, Elisabeth Bruder
      Purpose To report a case of juvenile xanthogranuloma involving the iris and skin that clincally was diagnosed with an obvious cutaneous lesion. Observations A four month-old girl with hyphema and increased intraocular pressure of the left eye persisting for 2 weeks. A suspicious yellow-brown mass with nodular surface and traversed by irregular vascularization was noted on the inferior iris surface. Ultrasound biomicroscopy (UBM; 35 MHz) of the mass revealed multiple nodular irregular hyperreflective lesions in the peripheral iris. Using a biopsy of an obvious cutaneous abdominal skin lesion a diagnosis was made based on histopathological analyses. The biopsy showed dense dermal infiltrate consisting of foamy histiocytes. Additional stains revealed CD68 positivity and CD1a and S100 negativity. This mass revealed histopathologic features identical to juvenile xanthogranuloma and was concurrent with the iris lesion. Next-generation sequencing using Ion AmpliSeqTM Cancer Hotspot Panel revealed a missense mutation of FGFR3 (p.F386L). Conclusion and importance The diagnosis of a xanthogranuloma of the iris with hyphema can be made easier in patients with obvious cutaneous lesions as described in our case. The significance of FGFR3 mutation in association with JXG is unknown and should be further investigated.

      PubDate: 2017-09-24T10:35:24Z
      DOI: 10.1016/j.ajoc.2017.09.004
       
  • Ocular sporotrichosis: A frequently misdiagnosed cause of granulomatous
           conjunctivitis in epidemic areas

    • Authors: João Paulo M. Yamagata; Fabiana B. Rudolph; Maria Clara L. Nobre; Leninha V. Nascimento; Felipe Maurício S. Sampaio; Andrea Arinelli; Dayvison F. Freitas
      Abstract: Publication date: Available online 23 September 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): João Paulo M. Yamagata, Fabiana B. Rudolph, Maria Clara L. Nobre, Leninha V. Nascimento, Felipe Maurício S. Sampaio, Andrea Arinelli, Dayvison F. Freitas
      Purpose Sporotrichosis is a subcutaneous mycosis caused by Sporothrix sp., a dimorphic fungus. Although the cutaneous form is the most frequent form, the ocular presentation has been increasingly diagnosed in epidemic areas. We describe three cases of ocular sporotrichosis with the involvement of the ocular adnexa due to autoinoculation without trauma with successful antifungal treatment. Observations Patient 1: A 68-year-old woman presented with granulomatous conjunctivitis of the right eye with an ulcerated nodule on the right temporal region for 5 months. Patient 2: A 46-year-old woman with conjunctival hyperemia of the left eye with associated periorbital edema and erythema for the past 4 months was referred to the Dermatology Department due to an ulcerated nodule on the left malar region. Patient 3: A 14-year-old boy presented to the emergency department with inferior palpebral edema with a 5-day evolution. Specimens were obtained from the lesions of the three patients, and the cultures were positive for Sporothrix sp. The three cases were diagnosed as ocular sporotrichosis and were successfully treated with itraconazole (200–400 mg/d). Two of the three patients developed sequelae such as conjunctival fibrosis and symblepharon. Conclusions and importance We emphasize the importance of the ophthalmologist being familiar with the diagnosis and management of this rare and frequently misdiagnosed form of sporotrichosis.

      PubDate: 2017-09-24T10:35:24Z
      DOI: 10.1016/j.ajoc.2017.09.005
       
  • Persistent pseudomyopia following a whiplash injury in a previously
           emmetropic woman

    • Authors: Fintan E. Hughes; Maxwell P. Treacy; Emma S. Duignan; Paul B. Mullaney
      Abstract: Publication date: Available online 22 September 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Fintan E. Hughes, Maxwell P. Treacy, Emma S. Duignan, Paul B. Mullaney
      Purpose Accommodative spasm, which manifests as ciliary muscle spasm, convergent strabismus or miosis, is a recognised consequence of head trauma. In whiplash cases, cervical spine hyperextension poses a risk of contra-coup injury and brainstem trauma, and is known to affect the visual system. However, to date, no cases of accommodative spasm due to whiplash injury have been reported. Observations We present the case of a 34-year-old female who developed sudden onset blurred distance vision after a rear impact car crash, having previously been emmetropic. Her unaided distance visual acuity was 20/70 in the right eye and 20/20 in the left. Best-corrected visual acuity in the right eye was 20/20 with a correction that progressed from -1.75 to -3.50 DS over the 12 months following the accident. This patient's sudden unilateral myopia, with unilaterally increased amplitude of accommodation suggests pseudomyopia due to accommodative spasm. Magnetic resonance imaging showed no evidence of injury to her brain stem, frontal lobes or oculomotor nerve. The patient is now well adjusted with a -3.50DS corrective lens for the right eye. Conclusions and importance The accommodation reflex is susceptible to injury at the occipital lobe, frontal eye fields, Edinger-Westphal nuclei and oculomotor nerves. As such it should be examined in patients who present with visual disturbances following whiplash injury. It is important that such cases are identified at presentation, as early intervention can improve outcomes in accommodative spasm and reduce the long term psychological effects often associated with whiplash injuries.

      PubDate: 2017-09-24T10:35:24Z
      DOI: 10.1016/j.ajoc.2017.09.006
       
  • Successful long-term treatment of paraneoplastic optic neuropathy with
           mycophenolate mofetil, prednisone, and plasmapheresis

    • Authors: Alia Durrani; Rohan J. Shah; Stephen J. Kim
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Alia Durrani, Rohan J. Shah, Stephen J. Kim
      Purpose To report long-term follow-up of a case of paraneoplastic optic neuropathy (PON) successfully treated with combination therapy. Observations We present a confirmed case of PON from cutaneous melanoma with nearly six years of meticulous follow-up in which vision was preserved and disease remission was successfully induced with combination mycophenolate mofetil, prednisone, and plasmapheresis therapy. Conclusions and importance Treatment of PON and long-term follow-up are not well described in the literature. In our case of PON, vision was preserved and disease remission was achieved with mycophenolate mofetil, prednisone, and plasmapheresis. Such information may be useful for future cases of PON.

      PubDate: 2017-09-18T02:22:10Z
      DOI: 10.1016/j.ajoc.2017.09.003
       
  • A case of congenital retinal macrovessel in an otherwise normal eye

    • Authors: Margaret R. Strampe; William J. Wirostko; Joseph Carroll
      Abstract: Publication date: Available online 9 September 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Margaret R. Strampe, William J. Wirostko, Joseph Carroll
      Purpose To present the case of a 37-year-old female with a foveal macrovessel. Observations The patient had an incidental finding of congenital retinal macrovessel (CRM) in the left eye on optical coherence tomography (OCT). Visual acuity was normal, and slit lamp and dilated fundus examinations were otherwise unremarkable. OCT angiography (OCTA) imaging allowed for visualization of the depth profile of the vessel as well as the foveal avascular zone (FAZ). The FAZ and foveal pit were both smaller in the affected eye compared to the fellow eye. Conclusions and Importance We describe findings of OCTA imaging in a patient with CRM. Previous reports have relied on examination using fluorescein angiography, which does not provide sufficient axial resolution to discern the different vascular plexuses. This report further characterizes how this rare condition can affect foveal morphology and retinal vasculature.

      PubDate: 2017-09-12T00:03:15Z
      DOI: 10.1016/j.ajoc.2017.09.001
       
  • Corneal graft failure due to migration of Ozurdex™ implant into the
           anterior chamber

    • Authors: Haifa A. Madi; Stephen J. Morgan; Saurabh Ghosh
      Abstract: Publication date: Available online 1 September 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Haifa A. Madi, Stephen J. Morgan, Saurabh Ghosh
      Purpose We report a case of corneal endothelial graft failure secondary to dexamethasone intravitreal implant (Ozurdex™) migration into the anterior chamber (AC). Observations A 53-year-old man with a history of bilateral idiopathic chronic uveitis, had a right anterior vitrectomy and AC intraocular lens (ACIOL) with a peripheral iridotomy. He received an intravitreal Ozurdex™ implant for right cystoid macular oedema (CMO). Three months later he developed pseudophakic bullous keratopathy and underwent a Descemet stripping automated endothelial keratoplasty (DSAEK), combined with IOL exchange (ACIOL explantation followed by scleral fixated posterior chamber IOL). He developed recurrent CMO post-operatively, for which he had a second Ozurdex™ implant. Six weeks following the implant he presented with reduced vision and corneal graft failure with migration of the Ozurdex™ implant into the AC. Despite prompt surgical removal of the implant, the graft did not recover and he underwent a repeat DSAEK. Conclusions and importance Ophthalmologists should be aware of this adverse event and the importance of early implant removal to reduce the risk of permanent corneal oedema.

      PubDate: 2017-09-05T20:38:17Z
      DOI: 10.1016/j.ajoc.2017.08.002
       
  • Unilateral pigmented paravenous retinochoroidal atrophy with retinitis
           pigmentosa in the contralateral eye: A case report

    • Authors: Shuichiro Aoki; Tatsuya Inoue; Mari Kusakabe; Masaya Fukushima; Kohdai Kitamoto; Asako Ogawa; Motoshi Yamamoto; Ryo Obata
      Abstract: Publication date: Available online 1 September 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Shuichiro Aoki, Tatsuya Inoue, Mari Kusakabe, Masaya Fukushima, Kohdai Kitamoto, Asako Ogawa, Motoshi Yamamoto, Ryo Obata
      Purpose We describe a sporadic case of unilateral pigmented paravenous retinochoroidal atrophy (PPRCA) with retinitis pigmentosa (RP) in the contralateral eye. Observations a 24-year-old female aware of the narrowing of visual field was examined at our hospital. Funduscopic examination revealed left eye showing retinochroidal atrophy along the retinal veins with pigment accumulation while right eye showing peripheral diffuse retinal pigmented epithelium atrophy with bone spicule pigmentation. Fundus autofluorescence, electroretinogram, visual field test and optic coherent tomography were also performed and obtained results were compatible with funduscopic observation. Conclusions and importance Simultaneous manifestation of PPRCA and RP observed in this case is rare and supports a shared genetic basis between the two diseases. Further genetic investigations are needed to elucidate the etiology and to properly manage PPRCA.

      PubDate: 2017-09-05T20:38:17Z
      DOI: 10.1016/j.ajoc.2017.08.003
       
  • Acute bacterial endophthalmitis after scleral buckling surgery with
           chandelier endoillumination

    • Authors: Takato Sakono; Hiroki Otsuka; Hideki Shiihara; Naoya Yoshihara; Taiji Sakamoto
      Abstract: Publication date: Available online 21 July 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Takato Sakono, Hiroki Otsuka, Hideki Shiihara, Naoya Yoshihara, Taiji Sakamoto
      Purpose The non-contact wide-angle viewing system (WAVS) with chandelier endoillumination is being used more commonly during scleral buckling surgery for rhegmatogenous retinal detachments although its safety has not been established. We report our findings in a case of bacterial endophthalmitis that developed after scleral buckling surgery with WAVS and chandelier endoillumination. Observations A 42-year-old man underwent scleral buckling surgery for a rhegmatogenous retinal detachment in his right eye using a WAVS with chandelier endoillumination. Three days after the surgery, the patient noticed a marked decrease in his vision with ocular pain. Slit-lamp examination showed dense infiltration in the anterior chamber and vitreous body. Pars plana vitrectomy with antibiotic irrigation was done immediately, and Staphylococcus epidermidis was detected in the vitreous fluid. After vancomycin 6/day for 4 weeks, the inflammation gradually subsided, and the visual acuity recovered to 20/20 in 3 months. Conclusions and importance Acute bacterial endophthalmitis can develop after scleral buckling surgery performed with WAVS and chandelier endoillumination.

      PubDate: 2017-07-24T09:44:12Z
      DOI: 10.1016/j.ajoc.2017.07.007
       
  • Treatment of cystic cavities in X-linked juvenile retinoschisis: The first
           sequential cross-over treatment regimen with dorzolamide

    • Authors: Razek Georges Coussa; Michael Alton Kapusta
      Abstract: Publication date: Available online 21 July 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Razek Georges Coussa, Michael Alton Kapusta
      Purpose To report the first sequential cross-over treatment with the longest ophthalmic follow-up in a case of X-linked juvenile retinoschisis (XLRS) successfully treated with topical dorzolamide. Observations A healthy 34 year-old man presented with one month history of decreased visual acuity in his left eye. Funduscopy was significant for a blunted and cystoid-like foveal reflex in both eyes. The macular OCT showed cystic foveal changes OU. The patient was diagnosed with XLRS and was observed. On two subsequent follow-ups, a significant decrease in the patient's visual acuity warranted the use of topical dorzolamide for treating the cystic foveal changes, which completely resolved two months post-treatment initiation. Conclusion and importance Previous reports showed the benefit of dorzolamide in treating foveal cystic cavities in XLRS. To our knowledge, this is the first case of XLRS demonstrating the benefits of topical dorzolamide based on a sequential cross-over treatment regimen. It may also represent a case with the longest ophthalmic follow-up providing, in consequence, long-term understanding of the natural history and complications of this rare disease After ruling out major causes of cystoid macular edema, XLRS patients presenting with worsening of their visual acuities due to larger cystic macular changes may benefit from an alternating ON/OFF regimen of topical dorzolamide, which offers a significant treatment advantage outweighing its well-known side effects. Our study consolidates the importance of “medication vacation” by showing its efficacy in providing anatomical and visual functional improvements in patients with chronic cystic macular changes.

      PubDate: 2017-07-24T09:44:12Z
      DOI: 10.1016/j.ajoc.2017.07.008
       
  • Invasive Streptococcus viridans sphenoethmoiditis leading to an orbital
           apex syndrome

    • Authors: Lance Bodily; Jenny Yu; Dante Sorrentino; Barton Branstetter
      Abstract: Publication date: Available online 21 July 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Lance Bodily, Jenny Yu, Dante Sorrentino, Barton Branstetter
      Purpose Orbital apex syndrome due to spread of infectious sinusitis is a serious disease, often with an insidious presentation with few ophthalmic signs and symptoms. Failure to recognize and treat infectious orbital apex syndrome early portends a grave prognosis, including profound, permanent visual loss and potentially death. Herein we describe a representative case and discuss the relevant aspects of prompts diagnosis and treatment. Observations An unusual case of infectious orbital apex syndrome due to contiguous spread of Streptococcus viridans sphenoethmoiditis in a hospitalized, immunosuppressed patient with acute myelogenous leukemia is presented. Given the few clinic signs and subtle imaging findings, a delay in diagnosis occurred resulting in vision loss to light perception and internal carotid artery occlusion within the cavernous sinus. A brief literature review of orbital apex syndromes is presented. Conclusion and Importance: A high clinical suspicion for orbital apex syndrome must be maintained in the appropriate circumstance given the subtle clinical signs and imaging, as well as the potential devastating morbidity of the disease process. Prompt diagnosis and treatment is crucial to patient survival and preservation of vision.

      PubDate: 2017-07-24T09:44:12Z
      DOI: 10.1016/j.ajoc.2017.07.006
       
  • Hypertensive retinopathy as the initial presentation of neuroblastoma

    • Authors: Anna Djougarian; Sylvia Kodsi
      Abstract: Publication date: Available online 23 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Anna Djougarian, Sylvia Kodsi
      Purpose To describe a case of a patient who presented with hypertensive retinopathy and was found to have neuroblastoma. Observations Neuroblastoma has three main ocular presentations. As a primary disease, it can present with a paraneoplastic syndrome in the form of opsoclonus, or it can present as a Horner's syndrome from its effect on the cervical sympathetic ganglia. Metastatic disease can present as a triad of periorbital edema, ecchymosis and proptosis from orbital bone involvement. Hypertension is a rare systemic presentation of neuroblastoma. We report the case of a two-year-old girl whose initial presentation of neuroblastoma was hypertensive retinopathy. Conclusions and importance To our knowledge, this is the first reported case of neuroblastoma presenting as hypertensive retinopathy. Our case highlights the importance of a multidisciplinary approach and thorough systemic work up of ocular findings in order to arrive at an appropriate diagnosis.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.008
       
  • Cardinal features of superior oblique myokymia: An infrared oculography
           study

    • Authors: Sumeer Thinda; Yi-Ren Chen; Yaping Joyce Liao
      Abstract: Publication date: Available online 23 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Sumeer Thinda, Yi-Ren Chen, Yaping Joyce Liao
      Purpose Superior oblique myokymia (SOM) is a rare eye movement disorder characterized by unilateral oscillopsia and binocular diplopia. Our study aimed to better understand SOM using infrared oculography. Methods We examined and recorded five patients with SOM. Results Binocular infrared oculography showed that in primary gaze, all patients exhibited torsional oscillations, which worsened in infraduction and abduction and improved in supraduction and adduction. Saccades showed increased downward saccade amplitudes but normal peak velocities. During fixation in primary gaze, removal of target led to extorsion and supraduction, unmasking underlying superior oblique weakness. Conclusions and importance Our data suggest both weakness and activity-dependent hyperactivity of the trochlear motor unit, supporting a model of injury followed by aberrant regeneration.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.018
       
  • Retinal findings in membranoproliferative glomerulonephritis

    • Authors: Ahmad M. Mansour; Luiz H. Lima; J. Fernando Arevalo; Miguel Hage Amaro; Virginia Lozano; Alaa Bou Ghannam; Errol W. Chan
      Abstract: Publication date: Available online 22 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Ahmad M. Mansour, Luiz H. Lima, J. Fernando Arevalo, Miguel Hage Amaro, Virginia Lozano, Alaa Bou Ghannam, Errol W. Chan
      Purpose To assess the evolution of retinal findings in patients with membranoproliferative glomerulonephritis (MPGN) by funduscopy, intravenous fluorescein angiography and optical coherence tomography. Observations Three women and one man were followed for a period of 1.5–37 years. Four patients (8 eyes) had drusen detected at first fundus exam at age 24, 29, 50 and 55. Three patients (6 eyes) had diffuse thickening of Bruch's membrane, and two patients (3 eyes) had detachment of the retinal pigment epithelium with serous retinal detachment. Drusen tended to widen over a period of 10-year follow-up in one case. Conclusion and importance Drusen remain the ocular stigmata for MPGN occuring at an early age. The retinal disease is progressive with gradual thickening of Bruch's membrane and occurrence of retinal pigment epithelium detachment.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.011
       
  • Metallic intraocular foreign body as detected by magnetic resonance
           imaging without complications– A case report

    • Authors: Alex S. Platt; Benjamin G. Wajda; April D. Ingram; Xing-Chang Wei; Anna L. Ells
      Abstract: Publication date: Available online 22 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Alex S. Platt, Benjamin G. Wajda, April D. Ingram, Xing-Chang Wei, Anna L. Ells
      Purpose To describe a case and present unique images of a metallic intraocular foreign body that was identified in a 12-year-old male patient who underwent routine magnetic resonance imaging (MRI) to assess neurodevelopmental delay. Observations We present MRI and diagnostic imaging of a metallic intraocular foreign body in a young patient with no known history of trauma or reason for the existence of metal in the eye area. Computed tomography scan was performed to confirm the presence of the intraocular foreign body, followed by optical coherence tomography and electroretinogram to assess visual status. It was determined that no surgical intervention was currently required as no visual impairment or ocular toxicity was identified. The patient continues to be monitored. Conclusions and importance This case presentation highlights the novel imaging features of a metallic intraocular foreign body, unexpectedly detected with MRI.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.010
       
  • An unusual case of acute angle-closure glaucoma following deep anterior
           lamellar keratoplasty using the “big bubble” technique

    • Authors: Samir Jabbour; Adam Myzuchuk; Younes Agoumi; Mona Harissi-Dagher
      Abstract: Publication date: Available online 22 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Samir Jabbour, Adam Myzuchuk, Younes Agoumi, Mona Harissi-Dagher
      Purpose To report the first case of acute angle closure due to a high-pressure Descemet membrane detachment following deep anterior lamellar keratoplasty (DALK) using the “big bubble” technique. Observations A 25-year-old man underwent DALK surgery for keratoconus using the “big bubble” technique in which an air bubble is injected in deep stroma to promote dissection of underlying Descemet membrane from stroma. Surgery was uneventful and the patient was discharged home in good conditions. On post-operative day 1, the patient came back with severe periocular pain. Intra-ocular pressure was found to be 38 mmHg. Anterior-segment OCT revealed a “double anterior chamber” created by a high-pressure Descemet detachment that was occluding the pupil and causing secondary acute angle closure glaucoma. The patient was brought back promptly to the operating room where the high-pressure chamber was properly evacuated, allowing Descemet membrane to properly reattach to stroma. Conclusions Inability to recognize stroma from Descemet membrane during the dissection of the “big bubble technique” can result in failure to evacuate the high-pressure Descemet membrane detachment, putting the patient at risk for acute angle closure glaucoma from occlusion of the pupil. Proper dissection of stroma from underlying DM is a challenging and crucial step in the “big bubble” technique. Several methods, such as the injection of small bubbles in the anterior chamber or the use of intra-operative anterior segment OCT could be employed to prevent such a complication.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.013
       
  • Cicatricial ectropion in a patient treated with dupilumab

    • Authors: Alexander C. Barnes; Alexander D. Blandford; Julian D. Perry
      Abstract: Publication date: Available online 22 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Alexander C. Barnes, Alexander D. Blandford, Julian D. Perry
      Purpose To describe a case of bilateral conjunctivitis and cicatricial ectropion associated with dupilumab therapy for atopic dermatitis. Observations Severe hyperemia of the conjunctiva and eyelid margins, as well as cicatricial ectropion, began two months after starting weekly dupilumab injections for atopic dermatitis. The findings worsened over the next several months and improved after discontinuing dupilumab. Conclusions and importance Dupilumab is a promising intervention in the management of atopic dermatitis and asthma, however, little is known about its potential ocular adverse effects. We report the first case of dupilumab-associated ocular inflammation leading to cicatricial ectropion.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.017
       
  • Neovascularization of the iris in retinoschisis

    • Authors: Geraldine R. Slean; Arthur D. Fu; Judy Chen; Ananda Kalevar
      Abstract: Publication date: Available online 22 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Geraldine R. Slean, Arthur D. Fu, Judy Chen, Ananda Kalevar
      Purpose To report the association of rubeosis iridis with chronic bullous degenerative peripheral retinoschisis. Observations A 63 year-old female presented with acute hyphema and neovascularization of the iris in association with elevated intraocular pressure. Posterior segment examination including imaging revealed no vascular occlusion as a potential cause. However, large, peripheral bullous retinoschisis was noted in the right eye. No non-perfusion aside from that seen within the schism detachment, or neovascularization of the retina on wide-field fundus photography or fluorescein angiography was noted. Bullous retinoschisis was also found in the left eye. The patient was treated conservatively with prednisolone acetate and timolol eye drops. Conclusions and importance Chronic bullous retinoschisis can be associated with anterior segment neovascularization such as rubeosis iridis, presumably due to non-perfusion within the retinoschisis cavity.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.019
       
  • Optical coherence tomography angiography of diffuse unilateral subacute
           neuroretinitis

    • Authors: Ananda Kalevar; J. Michael Jumper
      Abstract: Publication date: Available online 22 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Ananda Kalevar, J. Michael Jumper
      Purpose Diffuse unilateral subacute neuroretinitis (DUSN) is often a challenging diagnosis to make. We present a DUSN case with its multimodal imaging to aid in the diagnosis, emphasizing the observations on optical coherence tomography angiography (OCTA). Observations The evolution of a DUSN case is presented. Fundus photography and OCTA aided in the identification of the nematode. Conclusion and importance DUSN is a difficult diagnosis to establish. We report the first case to our knowledge in which OCTA aided in the diagnosis of DUSN.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.015
       
  • Acute hypotony maculopathy following the initiation of a topical aqueous
           suppressant in a patient with a history of panuveitis without prior
           filtering surgery

    • Authors: Dagny Zhu; Hossein Ameri; Alena Reznik; Narsing R. Rao
      Abstract: Publication date: Available online 22 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Dagny Zhu, Hossein Ameri, Alena Reznik, Narsing R. Rao
      Purpose To report a case of profound hypotony maculopathy as a complication of single-agent glaucoma therapy in a patient with a history of panuveitis without previous filtering surgery. Observations A 70-year old Hispanic male with a history of resolved bilateral panuveitis, chronic angle closure glaucoma, and pars plana vitrectomy was started on topical timolol 0.5% daily in the left eye for mildly elevated intraocular pressure (15 mmHg). The patient returned 1.5 weeks later with new onset hypotony (1 mmHg), chorioretinal folds, and cystoid macular edema in the same eye without associated signs of inflammation. The drop was discontinued. The patient returned 1 month later with normalized eye pressure and improved vision with near-resolution of chorioretinal changes on optical coherence tomography (OCT). Conclusions and importance Hypotony maculopathy is most commonly seen following glaucoma filtering surgery and ocular trauma. The development of hypotony maculopathy following the administration of topical glaucoma medication alone is rare. Our case is the first to our knowledge to describe the rapid onset of visually significant hypotony maculopathy characterized by profound OCT changes upon the administration of a single topical glaucoma agent in a patient without prior filtering surgery. Treatment with glaucoma medications in patients with complex ocular histories including uveitis and vitreoretinal surgery requires caution and close follow-up.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.016
       
  • Migration of segmental arteriolar fluorescein staining peripherally in eye
           with idiopathic recurrent branch retinal arterial occlusion

    • Authors: Kenichi Kawano; Yasuki Ito; Fuminori Haga; Taichi Tsunekawa; Hiroko Terasaki
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Kenichi Kawano, Yasuki Ito, Fuminori Haga, Taichi Tsunekawa, Hiroko Terasaki
      Purpose To report a novel finding in a case of idiopathic recurrent branch retinal arterial occlusions. Observations We report our findings in a 31-year-old woman with an idiopathic recurrent branch retinal arterial occlusions (BRAOs) who was followed in our clinic for 16 years. Repeated fluorescein angiographies were performed to evaluate the idiopathic recurrent BRAOs. The findings showed multiple segmental arteriolar staining in the fundus. These staining were found at locations with and without branch retinal arterial occlusions. Repeated fluorescein angiography showed that these staining migrated toward the periphery. The speed of the migration of the staining was about 0.64 ± 0.22 mm/day with a range of 0.43–0.85 mm/day in the posterior pole of the eye. In each of the BRAO, the staining did not cause branch retinal arterial occlusions in the peripheral retina again. Conclusion and Importance: Segmental arteriolar staining that migrates towards the periphery may be a clue to the etiology of this disease process.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.009
       
  • A recurrent, non-penetrant sequence variant, p.Arg266Cys in
           Growth/Differentiation Factor 3 (GDF3) in a female with unilateral
           anophthalmia and skeletal anomalies

    • Authors: Tanya Bardakjian; Max Krall; Di Wu; Richard Lao; Paul Ling-Fung Tang; Eunice Wan; Sarina Kopinsky; Adele Schneider; Pui-yan Kwok; Anne Slavotinek
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Tanya Bardakjian, Max Krall, Di Wu, Richard Lao, Paul Ling-Fung Tang, Eunice Wan, Sarina Kopinsky, Adele Schneider, Pui-yan Kwok, Anne Slavotinek
      Purpose The genetic causes of anophthalmia, microphthalmia and coloboma remain poorly understood. Missense mutations in Growth/Differentiation Factor 3 (GDF3) gene have previously been reported in patients with microphthalmia, iridial and retinal colobomas, Klippel-Feil anomaly with vertebral fusion, scoliosis, rudimentary 12th ribs and an anomalous right temporal bone. We used whole exome sequencing with a trio approach to study a female with unilateral anophthalmia, kyphoscoliosis and additional skeletal anomalies. Observations Exome sequencing revealed that the proposita was heterozygous for c.796C > T, predicting p.Arg266Cys, in GDF3. Sanger sequencing confirmed the mutation and showed that the unaffected mother was heterozygous for the same missense substitution. Conclusions and importance Although transfection studies with the p.Arg266Cys mutation have shown that this amino acid substitution is likely to impair function, non-penetrance for the ocular defects was apparent in this family and has been observed in other families with sequence variants in GDF3. We conclude p.Arg266Cys and other GDF3 mutations can be non-penetrant, making pathogenicity more difficult to establish when sequence variants in this gene are present in patients with structural eye defects.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.006
       
  • Resection and anterior transposition of the inferior oblique muscle for
           treatment of inferior rectus muscle hypoplasia with esotropia

    • Authors: Noriko Nishikawa; Haruna Ito; Yuriya Kawaguchi; Miho Sato; Akitoshi Yoshida
      Abstract: Publication date: Available online 13 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Noriko Nishikawa, Haruna Ito, Yuriya Kawaguchi, Miho Sato, Akitoshi Yoshida
      Purpose To report a case of inferior rectus muscle hypoplasia with esotropia, which was treated successfully by resection and anterior transposition of the inferior oblique muscle. Observations A 1-year-old boy presented with esotropia. He had esotropia of 15–30° and intermittent left hypertropia. At the age of 3 years, the alternate prism cover test showed esotropia of 35Δ and left hypertropia of 25Δ. Magnetic resonance imaging of the orbit revealed left inferior rectus muscle dysgenesis. Strabismus surgery was performed and a hypoplastic left inferior rectus muscle was identified. We performed bilateral medial rectus muscle recession, and resection and anterior transposition of the left inferior oblique muscle. Nine months after the surgery, the patient had esotropia of 8Δ and left hypertropia of 6Δ. Conclusion and importance Resection and anterior transposition of the inferior oblique muscle is useful for hypoplasia of the inferior rectus muscle accompanied by horizontal strabismus.

      PubDate: 2017-06-14T07:06:37Z
      DOI: 10.1016/j.ajoc.2017.06.004
       
  • Moraxella atlantae keratitis presenting with an infectious ring ulcer

    • Authors: Alexander Barash; Timothy Y. Chou
      Abstract: Publication date: Available online 12 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Alexander Barash, Timothy Y. Chou
      Purpose Moraxella atlantae is a rare pathogen. Keratitis from this organism has never been specifically reported or described. In this report we provide the first clinical description and photograph of Moraxella atlantae infectious keratitis. Observations A 41 year-old man presented with a three day history of left eye pain. He was found to have a corneal ring ulcer and infiltrate from which Moraxella atlantae was cultured. The patient was successfully treated with intensive topical gatifloxacin (0.5%) and fortified tobramycin (1.5%); oral doxycycline was added to reduce corneal thinning. The patient's infection resolved with a residual scar and final best corrected visual acuity of 20/200 OS. Conclusions and Importance Moraxella atlantae can present as a ring-shaped infectious corneal infiltrate and ulcer. Ring infiltrates have been observed with other microorganisms, including several other gram negative bacteria and classically, acanthamoeba. Frequently presumed to be purely immunologic, corneal ring infiltrates can have a number of other etiologies, including infectious and toxic. There are different types of immunologic rings as well, making differentiation of corneal rings sometimes difficult for the ophthalmologic generalist and subspecialist alike. In this paper we discuss characteristics of various corneal ring infiltrates, along with their immune pathophysiology. Infectious rings are distinguished from immunologic Wessely rings.

      PubDate: 2017-06-14T07:06:37Z
      DOI: 10.1016/j.ajoc.2017.06.003
       
  • Femtosecond laser-assisted cataract surgery and implantable miniature
           telescope

    • Authors: Randal Pham; Burton Worrell; Phuc Nguyen; Keshav Narain
      Abstract: Publication date: Available online 26 May 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Randal Pham, Burton Worrell, Phuc Nguyen, Keshav Narain
      Purpose This paper is a case report of the use of femtosecond laser for cataract surgery to implant an implantable miniature telescope for a patient with large central areas of geographic atrophy. Observations On postoperative day 1 the patient's uncorrected visual acuity at near was 20/50. The cornea was clear and the patient reported no problem with navigation without occupational therapy training. Conclusion and importance To our knowledge and confirmed by the manufacturer of the implantable miniature telescope this is the first case ever reported of a patient who has undergone femtosecond laser cataract surgery with corneal astigmatism correction and implantation of the implantable miniature telescope. This is also the first case report of the preoperative use of microperimetry and visual electrophysiology to evaluate patient's postoperative potential visual acuity. The success of the procedure illustrated the importance of meticulous preoperative planning, the combined use of state-of-the-art technologies and the seamless teamwork in order to achieve the best clinical outcome for patients who undergo implantation of the implantable miniature telescope.

      PubDate: 2017-05-30T09:33:02Z
      DOI: 10.1016/j.ajoc.2017.05.006
       
  • Topiramate-induced macular neurosensory retinal detachment

    • Authors: Kevin Rosenberg; Joseph Maguire; Joseph Benevento
      Abstract: Publication date: Available online 19 May 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Kevin Rosenberg, Joseph Maguire, Joseph Benevento
      Purpose To present a previously unreported retinal side-effect from topiramate use in two cases. Observations Macular neurosensory retinal detachments were seen in two patients shortly after beginning oral topiramate. The macular detachments resolved shortly after discontinuing this medication. Conclusions and Importance: As these two cases represent the first reports of topiramate-induced macular neurosensory retinal detachment, clinicians should be aware of this potential ocular side effect when administering this medication.

      PubDate: 2017-05-20T00:55:39Z
      DOI: 10.1016/j.ajoc.2017.05.005
       
  • Bilateral orbital marginal zone B-cell lymphoma of the mucosa-associated
           lymphoid tissue in a patient with hepatitis B virus infection

    • Authors: Pei-Hsuan Lin; Yoshiyuki Kitaguchi; Jacqueline Mupas-Uy; Yasuhiro Takahashi; Hirohiko Kakizaki
      Abstract: Publication date: Available online 18 May 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Pei-Hsuan Lin, Yoshiyuki Kitaguchi, Jacqueline Mupas-Uy, Yasuhiro Takahashi, Hirohiko Kakizaki
      Purpose To report a case of marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) in the bilateral orbit with chronic hepatitis B virus (HBV) infection. Observations A 72-year-old man with chronic HBV infection presented with a bilateral proptosis with slight restriction of ocular motility for 9 months. Computed tomographic images showed well-defined, isodense masses in the bilateral superolateral orbit. Magnetic resonance images showed isointense on T1-and hyperintense on T2-weighted images, with bilateral involvements of the lateral rectus muscles reaching the superior orbital fissures. These masses molded along the globe contour. Incisional biopsies via upper eyelid crease were performed on both lesions. The immunohistopathological diagnosis was MALT lymphoma. Conclusions and importance This case showed a possible association between orbital MALT lymphoma and HBV.

      PubDate: 2017-05-20T00:55:39Z
      DOI: 10.1016/j.ajoc.2017.05.002
       
  • Reversal of carotid dissection-induced ocular and cerebral ischemia by
           stenting

    • Authors: Daniel L. Albertus; Baldassare Pipitone; Ashok Srinivasan; Jonathan D. Trobe
      Abstract: Publication date: Available online 18 May 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Daniel L. Albertus, Baldassare Pipitone, Ashok Srinivasan, Jonathan D. Trobe
      Purpose To present an example of how close clinical monitoring of a patient with acute Horner syndrome from carotid artery dissection may be critical in reversing neurologic dysfunction. Observations A patient whose initial neuro-ophthalmic manifestation was Horner syndrome, but who evolved over 14 days to display transient monocular vision loss, ipsilateral ocular ischemic syndrome, and episodic contralateral hemiparesis. Digital subtraction angiography demonstrated progressive ipsilateral carotid occlusion with lack of collateral flow. The patient underwent stenting with rapid reversal of transient monocular visual loss and hemiparesis. Follow-up examination several months later confirmed complete resolution of all clinical abnormalities. Conclusions and importance This case displayed protracted evolution of ischemic manifestations following carotid artery dissection and their prompt reversal with stenting. This case emphasizes the value of close clinical attention to a patient with acute Horner syndrome because manifestations may appear more than 10 days after event onset that impel intervention for the dissection.

      PubDate: 2017-05-20T00:55:39Z
      DOI: 10.1016/j.ajoc.2017.05.003
       
  • Endothelial keratoplasty for posterior polymorphous corneal dystrophy in a
           4-month-old infant

    • Authors: M. Hermina Strungaru; Asim Ali; David Rootman; Kamiar Mireskandari
      Abstract: Publication date: Available online 4 May 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): M. Hermina Strungaru, Asim Ali, David Rootman, Kamiar Mireskandari
      Purpose To report a case of endothelial keratoplasties (EKs) performed in a 4 month old with a posterior polymorphous corneal dystrophy. Observations A 4 month old infant underwent Descemet membrane endothelial keratoplasty (DMEK) for posterior polymorphous corneal dystrophy. The graft was found to be dislocated on day 5 post-operatively and an attempt to unfold the DMEK scroll and re-bubble was not successful. The patient was then treated successfully with bilateral Descemet stripping automated endothelial keratoplasty (DSAEK). At 3 years of follow-up, her visual acuity was 20/70 in the right and 20/60 in the left eye with good endothelial cell counts. Conclusions and Importance: This study reports the youngest case of EKs performed at the age of 4 months in an infant. This is also the first reported case of attempted DMEK highlighting its challenges in infants. DSAEK remains a good treatment option for endothelial dysfunction secondary to posterior polymorphous corneal dystrophy in infants even after failed DMEK.

      PubDate: 2017-05-05T12:30:40Z
      DOI: 10.1016/j.ajoc.2017.05.001
       
  • Bilateral cataract formation via acute spontaneous fracture of the lens
           following treatment of hyperglycemic hyperosmolar syndrome

    • Authors: Yevgeniy V. Sychev; Emily M. Zepeda; Deborah L. Lam
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Yevgeniy V. Sychev, Emily M. Zepeda, Deborah L. Lam
      Purpose Acute development of cataracts that may be transient is known to occur during correction of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Nettleship in 1885 was the first to describe the presence of a transient cataract in three diabetic patients that grew worse and eventually cleared with treatment.1 We present a case of irreversible cataracts formed by nuclear fracture of the crystalline lens after hyperglycemia correction, an entity that has not yet been described. Observations A 67 year-old Caucasian man presented with sudden bilateral vision loss one week after a week-long hospitalization in the intensive care unit for correction of hyperglycemia in the setting of hyperglycemic hyperosmolar syndrome requiring an insulin drip. This was caused by spontaneous fractures of the lens nuclei causing bilateral irreversible cataracts. The patient underwent uncomplicated bilateral cataract extraction resulting in restoration of normal vision. Conclusions and Importance Acute transient cataracts that develop during correction of hyperglycemic hyperosmolar syndrome are thought to result from osmotic lens swelling. In this case report, internal fracture of the lens was produced by mechanical forces generated in the process of lens swelling occurring as a consequence of initial hyperglycemia and its subsequent correction. This case represents a rare ocular complication of hyperglycemia correction, and provides new evidence that mechanical forces can be part of diabetic cataractogenesis.

      PubDate: 2017-04-14T14:03:31Z
      DOI: 10.1016/j.ajoc.2017.04.006
       
  • Transient anisocoria in a patient treated with nebulized ipratropium
           bromide

    • Authors: Renato Pejic; Branka Klaric
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Renato Pejic, Branka Klaric
      Purpose We present a case report of a 44-year old female patient with complicated pneumonia who developed anisocoria after treatment with inhaled ipratropium bromide. Discontinuation of ipratropium bromide treatment led to complete resolution of anisocoria. Observation A 44-year old female patient was admitted to the Department of Pulmonology due to high body temperature (40.0 °C), coughing and general weakness. After a general examination and tests the patient was diagnosed with right-sided pneumonia. Since spirometry test showed signs of bronchial obstruction, pulmonologist indicated inhalation therapy with ipratropium bromide. Soon after ipratropium bromide therapy was initiated, the patient noticed enlarged left pupil and stated that some aerosol reached her left eye during the inhalation therapy. After consulting neurology and monitoring neurological signs, ipratropium bromide treatment was discontinued. Twenty-four hours after discontinuing the ipratropium bromide treatment anisocoria was completely resolved. Conclusions and Importance Presence of anisocoria may be a concerning neurological sign. If there are no other neurological or ophthalmological signs and symptoms and a recent ipratropium bromide inhalation treatment exists in the patient's history, we should consider iatrogenic side-effect of drugs as a possible reason of anisocoria and possibly spare the patient extensive and invasive diagnostic procedures that can also raise costs of treatment significantly. Observing neurological status and testing with 1% pilocarpine solution may be necessary to determine the etiology of this condition.

      PubDate: 2017-04-14T14:03:31Z
      DOI: 10.1016/j.ajoc.2017.04.005
       
  • Ocular dirofilariasis: Ophthalmic implication of climate change on
           vector-borne parasites

    • Authors: Joseph D. Boss; Gabriel Sosne; Asheesh Tewari
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Joseph D. Boss, Gabriel Sosne, Asheesh Tewari
      Purpose To describe a geographically rare case of ophthalmic dirofilariasis. Observations An 81-year-old male of good socioeconomic status living in the state of Michigan in the United States, presented to the eye clinic with a painful red left eye. He had not traveled outside of the state of Michigan in over three years. He was found to have a 7 cm long subconjunctival roundworm, which was ultimately extracted. Conclusions and Importance With increasing global temperatures, ocular dirofilariasis is being introduced in more northern climates and should be included in the differential diagnosis in areas previously isolated from these vector-borne parasites.

      PubDate: 2017-04-14T14:03:31Z
      DOI: 10.1016/j.ajoc.2017.04.004
       
  • Atypical intravitreal growth of retinoblastoma with a multi-branching
           configuration

    • Authors: Sachiko Nishina; Satoshi Katagiri Atsuko Nakazawa Chikako Kiyotani Tadashi Yokoi
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Sachiko Nishina, Satoshi Katagiri, Atsuko Nakazawa, Chikako Kiyotani, Tadashi Yokoi, Noriyuki Azuma
      Purpose To report the clinical and histopathological findings of atypical intravitreal growth of a retinoblastoma with a multi-branching configuration. Observations A 7-month-old boy was referred to our hospital due to leukocoria in the right eye. Ophthalmic examinations identified multi-branching vessels surrounded by diaphanous tissue behind the lens in the right eye. Imaging modalities showed microphthalmos, band-shaped calcification, and cystic lesions in that eye. Because it was difficult to rule out congenital anomalies such as persistent fetal vasculature due to the atypical clinical features of retinoblastoma, we performed a biopsy using a limbal approach. An intraoperative rapid pathological examination led to the definitive diagnosis of retinoblastoma. The right eye was enucleated and postoperative adjuvant chemotherapy was administered. Immunohistochemical staining of the enucleated eyeball showed that the tumoral cells and diaphanous tumoral tissue around the vessels were positive for neuron-specific enolase and Ki-67 and partially positive for glial fibrillary acidic protein (GFAP). The vessels of the diaphanous tissues near the tumoral mass were stained by GFAP and those behind the lens were stained faintly. Conclusion and Importance We described an atypical retinoblastoma of pseudo-persistent fetal vasculature with a multi-branching configuration, which expanded the clinical spectrum of retinoblastoma. Such a specific growth pattern of the embryonic tumor might occur with a combination of retinal development, retinal vasculature, and hyaloid vascular system.

      PubDate: 2017-04-14T14:03:31Z
       
 
 
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