Publisher: Elsevier   (Total: 3206 journals)

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Showing 1 - 200 of 3206 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 27, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 8)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 449, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 338, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 3, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 14, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 194, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 20, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27, SJR: 1.562, CiteScore: 3)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 1)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Cosmetic Surgery     Full-text available via subscription   (Followers: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 14)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Family Practice Nursing     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 69, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 10, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Pathology     Hybrid Journal   (Followers: 1)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Ophthalmology and Optometry     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 433, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 36, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 398, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 485, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 56, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 59, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 17, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 35, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 51)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 1)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 276, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 29, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 26, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 223, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Ophthalmology Case Reports
Journal Prestige (SJR): 0.265
Number of Followers: 5  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2451-9936
Published by Elsevier Homepage  [3206 journals]
  • Late Progressive Corneal Flattening, Haze And Visual Loss After Eccentric
           Crosslinking For Pellucid Marginal Degeneration

    • Abstract: Publication date: Available online 22 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Gabriel Ferreira, Vinicius Ghanem, Ramon GhanemAbstractPurposePellucid marginal degeneration (PMD) is a rare disease that is often mistaken for keratoconus but can similarly be treated with corneal collagen crosslinking (CXL). We report a case followed though 6 years of progressive irregular corneal flattening and thinning in both eyes (OU) after eccentric CXL for PMD.ObservationA 46-year-old man with bilateral PMD and corrected distance visual acuity (CDVA) of 20/20 (-2.00x80) in the right eye (OD) and 20/30 (+3.50 -5.25x105) in the left eye (OS) underwent conventional 9 mm eccentric CXL in OU and intrastromal corneal ring implantation in the OS. An uneventful first year postoperative follow-up showed stabilization of the ectasia. In subsequent years, progressive inferior flattening was observed with decreased CDVA, corneal thinning and worsening of the haze. At the last follow-up, his CDVA was 20/40 (+5.00 -2.00x55) OD and 20/60 (+6.00 -1.50x80) OS.Conclusionand Importance: The current report highlights the notion that mid- and long-term evaluations of customized crosslinking techniques may reveal progressive flattening and corneal irregularity.
       
  • Anterior uveitis secondary to intraocular fiber from a hair enhancement
           product

    • Abstract: Publication date: Available online 22 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Michael B. Green, Milhim I. Aswad, Mary K. DalyAbstractPurposeTo report a case of anterior uveitis caused by migration of cosmetic “hair-building fibers” into the anterior chamber and discuss previous literature describing ocular disease caused by small foreign fibers.ObservationsA 73 year old male presented with his first episode of acute anterior uveitis. He was found to have a white fiber penetrating through the cornea into the anterior chamber. This foreign body was removed. The patient identified the material as a being from the cosmetic hair-building fiber product he had been using called Toppik. He was treated with topical steroids and antibiotic drops. The uveitis resolved without recurrence by six weeks after his initial presentation.Conclusionsand Importance: Small synthetic and non-synthetic fibers represent sources of both superficial and intraocular injury. Careful examination of the anterior chamber is critical in patients with new acute uveitis to identify possible foreign fibers that can migrate through the cornea. While medical therapy with topical steroids may suffice for treatment in many cases, intraocular persistence of these materials can result in recurrent inflammation, ocular hypertension, or further migration into the posterior chamber which may require surgical intervention.
       
  • Bilateral interstitial keratitis, erythema nodosum and atrial fibrillation
           as presenting signs of polyarteritis nodosa

    • Abstract: Publication date: Available online 21 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Filippos Vingopoulos, Theodoros Karagiotis, Sotiria PaliouraAbstractPurposeTo report a case of Polyarteritis Nodosa (PAN) presenting as bilateral episcleritis and interstitial keratitis along with erythema nodosum and atrial fibrillation and to review the ophthalmic literature on PAN with anterior segment findingsObservationsA 35-year old man presented with a two-month history of bilateral episcleritis, skin lesions consistent with erythema nodosum, joint effusions and episodes of prolonged diarrhea and atrial fibrillation. Ophthalmic examination was significant for bilateral diffuse episcleral injection and nummular corneal stromal infiltrates. The patient underwent an extensive infectious and inflammatory work-up that was negative except for a very elevated erythrocyte sedimentation rate (123 mm/h, normal 
       
  • Rhegmatogenous retinal detachment masquerading as exudative panuveitis
           with intense anterior chamber inflammatory reaction

    • Abstract: Publication date: Available online 15 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Ashlin S. Joye, Robert B. Bhisitkul, Daniel D.S. Pereira, John A. GonzalesAbstractPurposeThis is a retrospective case report illustrating the diagnostic and therapeutic challenges associated with a chronic rhegmatogenous retinal detachment masquerading as a severe panuveitis with intense anterior chamber inflammation. We have included clinical features, anterior segment and fundus photography, B-scan ultrasonography, fluorescein angiography, and intraoperative findings.ObservationsA 26-year-old male presented with features of unilateral panuveitis: hypotony, anterior segment inflammation (posterior synechiae and anterior chamber cell with fibrin clumping), diffuse choroidal thickening, and retinal detachment. Laboratory investigations for infectious or rheumatologic processes were negative, and empiric systemic corticosteroid therapy was unsuccessful. This prompted suspicion for an alternate primary etiology, and pars plana vitrectomy revealed small retinal breaks as the underlying cause of the retinal detachment and inflammation.Conclusionsand importance: Rhegmatogenous retinal detachments are a known cause of intraocular inflammation. Nevertheless, it remains a challenge to recognize retinal breaks in this setting, particularly with robust anterior segment inflammation and posterior findings resembling severe exudative uveitis. Being aware of this unique presentation may prevent delays in diagnosis and have important prognostic implications.
       
  • Novel insights into retinal neovascularization secondary to central serous
           chorioretinopathy using 3D optical coherence tomography angiography

    • Abstract: Publication date: Available online 11 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Markus Gruber, Julian Wolf, Andreas Stahl, Thomas Ness, Henrik Scholl, Hansjuergen Agostini, Peter Maloca, Clemens LangeAbstractPurposeTo describe the clinical presentation and novel anatomical features of a patient with chronic central serous chorioretinopathy (CSCR) complicated by retinal neovascularization (RNV).ObservationsA 48 year-old patient with a long-standing history of bilateral CSCR presented to our clinic complaining about a sudden onset of tiny floaters. Multimodal imaging including fundus autofluorescence (FAF), fundus fluorescein (FA) and ICG angiography (ICG) and spectral domain optical coherence tomography (SD-OCT) confirmed the diagnosis of CSCR and revealed a pre-retinal neovascularization and concurring vitreous hemorrhage. Swept source OCT angiography (OCTA) and 3D reconstruction virtual reality determined the retinal origin of the neovascularization. Follow-up examination revealed clearing of the vitreous hemorrhage and spontaneous obliteration of the RNV without any treatment three months following the initial presentation.Conclusionand importance: To the best of our knowledge, this is the first report of a RNV associated with CSCR which was determined by three-dimensional (3D) OCTA reconstruction
       
  • Combined Microinvasive Glaucoma surgery in Osteogenesis imperfecta patient
           with Refractory Open Angle Glaucoma

    • Abstract: Publication date: Available online 5 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Daniel Laroche, Gideon NkrumahABSTRACT:PurposeTo report a case of refractory open angle glaucoma (POAG) in an osteogenesis imperfecta patient who was successfully treated with combination microinvasive glaucoma surgery: combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion.ObservationA 57-year-old woman with a history of osteoporosis, breast cancer, osteogenesis imperfecta, with uncontrolled POAG in right more than left. Anterior segment examination revealed thin blue sclera, the optic nerve examination revealed glaucomatous cupping with cup to disc ration of 0.9 in right and 0.7 in left. Her IOP on six (6) medications was 26mmHg in the right eye. After discussion of the risks and benefits, she agreed to undergo combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion surgery to lower her intraocular pressure. Her IOP at 6 months follow up was 13 in the right eye and a decrease number of medications from six (6) to three.Conclusionand Importance: Patients with OI have homogenously thinner sclera and conjunctiva which pose a challenge to traditional subconjunctival surgical methods. Combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion surgery are bleb sparing operations that enhances aqueous outflow to the aqueous veins and supraciliary space to lower intraocular pressure.
       
  • Presumed mast cell choroidal infiltrate in aggressive systemic
           mastocytosis

    • Abstract: Publication date: Available online 4 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Tu M. Tran, Mehdi Najafi, Tadeu Ambros, Jose S. Pulido, Celalettin Ustun, Dara KoozekananiAbstractPurposeTo report a rare case of a unilateral choroidal mast cell infiltration in a patient with aggressive systemic mastocytosis (ASM).ObservationsThe patient is a man in his fifties with a diagnosis of ASM. He developed visual complaints in the right eye associated with an area of subretinal fluid on fundus exam. Visual acuity at presentation was 20/150 in the right eye and 20/25 in the left eye. After ophthalmic and radiologic imaging workup, the patient was diagnosed with presumed choroidal mast cell infiltrate. The index of suspicion was high due to the prior ASM diagnosis. External beam radiation and intravitreal injection treatments were offered but the patient declined. The patient was switched from interferon to a new targeted systemic therapy for ASM, midostaurin. Despite some mixed, temporary response in systemic symptoms/signs of ASM at four months, the choroidal lesion and subretinal fluid were stable with visual acuity at 20/125.Conclusion and importanceMast cell choroidal infiltration in ASM should be considered as part of the differential with acute/subacute vision changes. Diagnosis requires exclusion of other possibilities with ocular imaging and in this case, monitoring for development of other malignancies in which there were none. Midostaurin’s ocular response was not on par with systemic response. Additional localized ocular therapies may be required.
       
  • Placoid choroidopathy after bilateral uncomplicated descemet's membrane
           endothelial keratoplasty

    • Abstract: Publication date: Available online 1 February 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Thomas H. Dohlman, Neepa Shah, Colin Prensky, Mrinali P. Gupta, Donald J. D'Amico, Szilard Kiss, Christopher S. SalesAbstractPurposeTo describe a case of bilateral, sequential placoid choroidopathy following uncomplicated Descemet's membrane endothelial keratoplasty (DMEK).ObservationsA 49-year old woman presented with flashing lights and central visual field scotomas after undergoing uncomplicated DMEK combined with cataract surgery for Fuch's endothelial dystrophy in the right eye. She was found to have placoid choroidopathy responsive to systemic steroids and for which a comprehensive work-up was unrevealing. Three and a half months later, she underwent DMEK surgery in the fellow eye and again developed placoid choroidopathy in the operated eye. Work-up was again unrevealing and the lesion followed a similar course to the first eye on systemic steroids. Over the course of seven (right eye) and three and a half months (left eye) of follow-up, the uncorrected visual acuity was 20/20 bilaterally and the retinal lesions had modestly improved.Conclusionsand Importance: We report a case of placoid choroidopathy following uncomplicated DMEK combined with cataract surgery in both eyes of a single patient. This case expands upon the reported complications following DMEK surgery and suggests a need to remain aware of posterior segment complications following endothelial keratoplasty.
       
  • Alternaria keratitis after corneal crosslinking

    • Abstract: Publication date: Available online 31 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Samantha McGirr, Dallin Andersen, John HalgrenAbstractPurposeTo report a case of fungal keratitis after corneal collagen crosslinking (CXL) surgery.ObservationsWe report a case of fungal keratitis after CXL for post-refractive surgery ectasia. The patient presented 12 days after surgery with a corneal ulcer that was culture positive for Alternaria species of fungus. She subsequently developed a bacterial superinfection. The keratitis resolved with medical therapy, although the patient required a penetrating keratoplasty (PKP) due to central corneal scarring.Conclusionsand Importance: To our knowledge, this is the first case of fungal keratitis as a complication after CXL in the United States and the first case of Alternaria infection after CXL using the Dresden protocol. Infectious keratitis is a rare but serious complication of CXL, and we suggest continued innovation of operative techniques that may reduce the risk of infectious keratitis.
       
  • Diagnostic challenges in a case of an isolated third nerve palsy

    • Abstract: Publication date: Available online 30 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Priya Sivakumar, Savithri Palanive, Debasis GochaitAbstractPurposeNeuro-ophthalmic manifestations may be the first and sole presenting feature of a nasopharyngeal carcinoma. Peri-neural spread is an emerging phenomenon that explains the distant spread of tumour cells well beyond the local extent of invasion. This under recognized route of tumour spread often results in delayed diagnosis and reduced life expectancy. The authors report a case of an isolated third nerve palsy as the only initial manifestation of nasopharyngeal carcinoma and emphasize the need for a high index of suspicion.ObservationThe patient presented with left painful pupil involving complete third nerve palsy. Contrast enhanced imaging was initially deferred due to renal impairment. Plain MRI with MRA brain was normal. Hematology was suggestive of giant cell arteritis which is a rare but well documented cause of painful nerve palsies in the elderly. Unresponsiveness to steroids prompted contrast imaging with a reduced gadolinium dosing and hemodialysis backup which finally revealed a nasopharyngeal carcinoma.Conclusionand importance: This report is the journey of a third nerve palsy from a clinical diagnosis of an aneurysm (pupil involving palsy) to a probable diagnosis of giant cell arteritis (based on hematology) and to a final diagnosis of nasopharyngeal carcinoma (based on contrast imaging and immunohistochemistry)Nasopharyngeal carcinoma can be successfully cured if detected early. This report highlights the various manifestations of nasopharyngeal carcinoma and challenges faced in diagnosing this elusive tumor.
       
  • Acupuncture resulting in eye penetration and proliferative
           vitreoretinopathy – surgical and medical management with intraocular
           methotrexate

    • Abstract: Publication date: Available online 30 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): James Denstedt, David C. Schulz, Vlad Diaconita, Tom G. SheidowAbstractPurposeTo highlight the surgical and medical management used in an extensive globe penetrating injury caused by an acupuncture needle.ObservationsWe report on a case of acupuncture treatment error resulting in needle penetration of the eye, retinal detachment, and progressive post-traumatic proliferative vitreoretinopathy (PVR). This patient required aggressive surgical management with multiple vitrectomies along with adjunctive intravitreal methotrexate to control ongoing PVR. At last follow-up, 15 months after presentation, the patient’s BCVA was 20/40 and the periphery was flat with fibrosis stable.Conclusionsand Importance: Open globe injuries are a subtype of ocular trauma which can cause irreparable vision loss. This case highlights the extensive potential complications which can occur following traumatic injury to the retina and choroid, as well as the role of both surgical and medical management of retinal detachment and PVR. In addition, this is the first report of the use of off-label adjunctive intravitreal methotrexate to control post-traumatic PVR. Further research into this treatment approach could reveal a role of adjunctive methotrexate in the management of such injuries.
       
  • Optical coherence tomographic angiography and ultra-widefield indocyanine
           green angiography of a choroidal macrovessel

    • Abstract: Publication date: Available online 30 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Hidetsugu Mori, Haruhiko Yamada, Yuki Sato, Kanji TakahashiAbstractPurposeWe evaluated a choroidal macrovessel using optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA).ObservationsA 79-year-old female presented with blurred vision in both eyes and metamorphopsia of the left eye. Mild cataract was noted in both eyes. Color fundus photography of the left eye revealed a red-orange tortuous vessel originating from the fovea and running in an inferior-temporal direction. Enhanced-depth imaging OCT revealed a large caliber choroidal vascular shadow and ambiguous line of the photoreceptor and retinal pigment epithelium layers. OCTA demonstrated a serpentine-shaped choroidal vessel. This anomalous vessel was seen by early phase ICGA as a rapidly perfused vessel connected to a vortex vein. We diagnosed this anomalous vessel as a choroidal macrovessel. We identified that cataract induced blurred vision in both eyes and choroidal macrovessel induced metamorphopsia in left eye. She was received cataract surgery for both eyes. The degree of metamorphopsia and the choroidal macrovessel of the left eye remains unchanged after a year of follow-up.Conclusionsand importance: OCTA and ICGA are useful techniques to diagnose choroidal macrovessels.
       
  • LASIK flap stability after severe ocular injury

    • Abstract: Publication date: Available online 30 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Timothy Todd, Todd Mondzelewski, John Cason, Elizabeth Hofmeister, Stephen O'Connell, Christopher RichmondAbstractPurposeTo report two cases of LASIK flap stability after severe ocular trauma.Observations: Two patients suffered open globe injuries several years after undergoing uneventful LASIK with femtosecond laser corneal flap. Both underwent primary ruptured globe repair, during which no LASIK flap dislocation was identified. Histopathologic examination of one of the cornea specimens confirmed an intact LASIK flap.Conclusionand Importance: In these cases, the femtosecond LASIK flap remained in place despite significant injury to the cornea. The presence of a femtosecond LASIK flap did not complicate surgical management of the injury, and did not contribute to the patient's loss of BCVA.
       
  • Sclero-conjunctival ischaemia secondary to intra-arterial chemotherapy for
           retinoblastoma

    • Abstract: Publication date: Available online 30 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Lisa McAnena, Zishan Naeem, Catriona Duncan, Fergus Robertson, Mandeep S. Sagooa, M. Ashwin ReddyAbstractPurposeIntra-arterial chemotherapy (IAC), delivered directly to the globe via the internal carotid artery is now an established treatment for retinoblastoma. We report a case of anterior segment ischaemia following treatment with multiple intra-arterial chemotherapy (IAC) infusions.ObservationsA 5 month old female presented with bilateral retinoblastoma and was treated with 12 infusions of IAC. Her right eye was enucleated at diagnosis. After her seventh IAC treatment, she developed ipsilateral sixth and third cranial nerve palsies. After the twelfth IAC, she developed an area of conjunctival and scleral ischaemia between 12 and 3 o'clock meridians in her left eye. However, she maintained visual acuity of LogMAR 0.34.Conclusionsand Importance: The median number of IAC treatments in large studies is three. It is possible that repeated doses of IAC have an accumulative negative effect on the ocular blood supply, risking anterior segment and neurologic sequelae. This case highlights the significant challenge of balancing the salvage of eyes and vision with the potentially significant morbidity associated with IAC.
       
  • Optic neuropathy due to chronic lymphocytic leukemia: the first
           manifestation of the disease

    • Abstract: Publication date: Available online 28 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Diogo Maleita, Rita Serras Pereira, Diogo Hipólito Fernandes, Nuno Moura Coelho, João Paulo Cunha, Joana Tavares FerreiraAbstractPurposeChronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the western world. The involvement of the central nervous system (CNS) or the optic nerve in CLL, however, is rare. We report a case of a previously untreated patient with CLL whose first manifestation of the disease was a progressive visual loss caused by optic neuropathy.ObservationsClinical manifestations, optical coherence tomography (OCT), and automated visual fields pointed to the diagnosis of neuropathy. Leukemic involvement of the CNS was confirmed after cells suggestive of CLL were found by cerebrospinal fluid analysis. Optic nerve infiltration is thought to be the cause of this optic neuropathy, and the clinical course and treatment are described herein.Conclusionsand Importance: When readily diagnosed, optic nerve infiltration is a rare, yet manageable complication of CLL.
       
  • Medical monitoring of patient with cavernous hemangioma of the retina and
           intracranial involvement

    • Abstract: Publication date: Available online 27 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Laís Yumi Sakano, Carlos Roberto Neufeld, Teruo AiharaAbstractPurposeTo describe a case report of Cavernous Hemangioma of the Retina and highlight the importance of investigating intracranial system when retinal vascular alterations are present.ObservationsPatient of 26 years old, with right eye fundus alteration since 7 years old, no visual complaint. In the exam, there were sacular lesions with hematic content in the macula, configurating liquid level, associated with whitish lesion suggestive of fibrosis, compatible with cavernous hemangioma; best visual accuity of 20/20 both eyes. Comparing the current retinography with the previous one, there was no significant lesion progression of the exam. By neuroimaging investigation, the Magnetic Ressonance Imaging showed multiple cavernomas. As his sister had been diagnosed with cerebral cavernous malformation 3 years before, due to termic hiposensitivity on left leg investigation, familial multiple cavernous malformation syndrome was defined.Conclusionand importance: Imaging investigation of the Central Nervous System should be considered when CHR is observed. Clinical monitoring is necessary, interventional treatment is selected only for particular cases.
       
  • Cobalt Toxic Optic Neuropathy and Retinopathy: Case Report and Review of
           the Literature

    • Abstract: Publication date: Available online 25 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Maria D. Garcia, Minjun Hur, John J. Chen, M. Tariq BhattiAbstractPurposeWe detail a case of cobalt toxicity with visual and systemic complications, review the pathogenic process for the optic neuropathy and retinopathy, and discuss the controversy of metallic hip prosthesis.ObservationsA 59-year-old female with a history of multiple left hip arthroplasties presented to our clinic with bilateral visual loss. The year prior, she had failure of the hip implant necessitating revision surgery with placement of a chrome-cobalt head. A few months after surgery, she began experiencing blurred and “white, spotty” vision in both eyes in addition to hypothyroidism, cardiomyopathy and neuropathy. The possibility of the patient’s symptoms being due to cobalt toxicity from her hip prosthesis was proposed and she was found to have a serum cobalt level>1000 μg/L (normal 0-0.9 ng/mL). Visual acuity was 20/600 in the right and 20/800 in the left eye. There was bilateral temporal optic disc pallor. Goldmann visual field testing demonstrated bilateral central scotomas, optical coherence tomography (OCT) showed severe ganglion cell layer-inner plexiform layer (GCLIPL) thinning and multifocal electroretinography (mfERG) demonstrated decreased amplitudes in both eyes. She underwent a total hip revision arthroplasty with extensive debridement of “black sludge” found within a pseudocapsule. Four days after surgery, cobalt serum levels had significantly decreased to 378 ng/mL. One month after surgery, she had significant improvement in visual acuity (20/150 right eye, 20/250 left eye), Goldmann visual field testing, and mfERG. OCT showed retinal nerve fiber thinning and persistent GCLIPL thinning in both eyes.Conclusionsand Importance: Excessive cobalt levels can result in systemic toxicity leading to visual changes, peripheral neuropathy, hearing loss, cognitive deficits, cardiomyopathy and hypothyroidism. In recent years it has become apparent that cobalt toxicity can be associated with metal-on-metal total hip arthroplasty, or the grinding effects of retained ceramic particles from a fractured ceramic head on a cobalt-chromium femoral head prosthesis.
       
  • A Case of Pentosan Polysulfate Maculopathy Originally Diagnosed as
           Stargardt Disease

    • Abstract: Publication date: Available online 25 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Robin A. Vora, Amar P. Patel, Sam S. Yang, Ronald MellesAbstractPurposeTo describe a patient with a past diagnosis of Stargardt disease that was later determined to be pentosan polysulfate (PPS) maculopathy.ObservationsThe patient had clinical and imaging findings uncharacteristic of Stargardt disease. Rather, her fundus resembled the recently described maculopathy ascribed to PPS. After genetic testing was found to be negative for pathologic variants, the patient was asked to cease usage of PPS.Conclusionsand Importance: This case emphasizes the importance of reviewing patient medication profiles prior to rendering a diagnosis of a retinal dystrophy. It is essential that ophthalmologists catch drug toxicities as early as possible, to minimize risk of further irreversible vision loss due to continued medication exposure.
       
  • Intraoperative Suprachoroidal Hemorrhage During Xen Gel Stent Implantation

    • Abstract: Publication date: Available online 25 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): James C. Liu, Wesley Green, Arsham Sheybani, John T. LindAbstractPurposeTo report for the first time a case of intraoperative suprachoroidal hemorrhage during Xen gel stent implantation with accompanying surgical video and subsequent 6-month follow-up.ObservationsOur patient required incisional glaucoma surgery after inadequate pressure reduction with four classes of topical medication, methazolamide, and selective laser trabeculoplasty. The patient underwent Xen gel stent implantation and developed an intraoperative suprachoroidal hemorrhage, which was managed in the operating room. The patient recovered his baseline visual acuity with a functioning bleb out to 6 months postoperatively.Conclusionsand Importance: Micro-invasive glaucoma surgeries offer a new repertoire of surgical options, purportedly with safer and less invasive techniques. Xen gel stent implantation may be a promising alternative to traditional trabeculectomies and tube shunt implants, providing similar IOP lowering results with potentially lower risk for complications. However, rare and severe complications such as suprachoroidal hemorrhage may still occur. Recognizing a suprachoroidal bleed, particularly intraoperatively, will still be necessary to help minimize the potential vision threatening sequelae often associated with this severe complication.
       
  • Scleral lens for severe dry eye status post lacrimal gland resection for
           adenoid cystic carcinoma

    • Abstract: Publication date: Available online 24 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Daniel J. Oh, Raman Michael, Pete Setabutr, Ellen ShorterAbstractPurposeScleral contact lenses (SCLs) are devices that allow a fluid reservoir between the contact lens and the cornea, providing both improved lubrication and refraction. Consequently, SCLs have been used for significant refractive error in addition to a wide range of ocular surface diseases. We present the first case of a woman who complained of severe dryness and pain following resection of an adenoid cystic carcinoma of her lacrimal gland with complete resolution of her symptoms with a SCL.ObservationsA woman who complained of severe dryness and pain following resection of an adenoid cystic carcinoma of her lacrimal gland presented to the ophthalmology clinic. She had no subsequent lacrimal function without relief from conventional dry eye treatments. However, early treatment with a SCL successfully preserved her ocular surface, improved her corneal staining pattern, and improved her vision.Conclusionsand Importance: While other options exist, including permanent tarsorrhaphy, lid taping, or moisture goggles, the SCL allowed the combination of cosmesis, visual function, and ocular surface rehabilitation.
       
  • Aqueous penetration of topical tacrolimus

    • Abstract: Publication date: Available online 17 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Samir S. Shoughy, Faisal Aljassar, Khalid F. TabbaraAbstractPurposeTo evaluate the penetration of topical tacrolimus 0.05% into the aqueous humor.ObservationsA total of four patients scheduled for routine cataract surgery were included prospectively. We excluded patients with corneal pathology or ocular surface diseases. Topical tacrolimus 0.05% was compounded at our facility. It was dosed every 1 min for 5 min an hour before the aqueous was sampled. Aqueous samples were collected at the time of cataract surgery and were subjected to detection of presence and level of tacrolimus. There were 2 male and 2 female patients. The age range was 58–73 years with a mean age of 66 years. Tacrolimus was detected in the aqueous humor in all patients. The concentration of tacrolimus in the aqueous ranged from 2.6 to 5.6 ng/ml (mean 4.15 ± 1.18 ng/ml). In all patients, the aqueous tacrolimus concentration was greater than the minimal therapeutic level. The study was registered at clinicaltrials.gov (registration number is NCT02794610).Conclusions and ImportanceTacrolimus was detected in the aqueous humor following topical application. Topical tacrolimus may be a promising steroid-sparing modality for the treatment of anterior uveitis.
       
  • Transient crystalline lens deposits following the insertion of a phakic
           sulcus-fixated collamer intraocular lens in a hyperopic eye

    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Lama El Khatib, Ahmad K. Hatoum, Hassan M. Moukhadder, Nasrine Anais El Salloukh, Shady T. AwwadAbstractPurposeThe purpose of this study was to report crystalline lens deposit formation following ICL implantation for the correction of hyperopia.ObservationsA 23-year-old male presented at the American University of Beirut Medical Center in 2008 seeking refractive surgery for hyperopia. His cycloplegic refraction was +7–1.25 × 115° and +7–1.00 × 115° in the right and left eyes, respectively, yielding a vision of 20/20 bilaterally. The patient underwent right eye insertion of a non-toric phakic sulcus-fixated collamer lens 2 weeks after undergoing peripheral iridotomies. The early postoperative course was complicated by anterior chamber inflammation and the appearance of diffuse whitish precipitates on the anterior surface of the crystalline lens, hypotony, and a mid-dilated mildly reactive pupil. With the prompt administration of topical and systemic steroids, the anterior chamber reaction subsided, and the anterior capsular deposits gradually resolved peripherally with some remaining centrally over the course of several weeks. The patient's visual acuity at 6 months was 20/20.Conclusionsand importance: Adequate viscoelastic removal and minimal iris stimulation seem to be essential to avoid this condition in hyperopic implants that lack a central port. Additionally, prompt treatment can minimize visual impairment and hasten visual recovery.
       
  • Polymicrobial infection confined to Ahmed glaucoma shunt

    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Jessica C. Lee, Bret M. Evers, Dominick Cavuoti, R. Nick Hogan, Karanjit S. KoonerAbstractPurposeTo present a case of a unique complication of an Ahmed glaucoma shunt. The pathological and immunohistochemical findings will also be discussed.ObservationsA 58-year-old woman with glaucoma secondary to Marfan syndrome and cataract surgery developed exposure of an Ahmed glaucoma tube, intraluminal white inflammatory material, and low-grade endophthalmitis five years after insertion. The patient was treated with topical and oral antibiotics and successfully underwent removal and replacement of the shunt. Pathologic analysis of the intraluminal contents revealed a bacterial infiltrate of mixed morphology.Conclusionsand Importance:Concurrent tube exposure, intraluminal exudates, and endophthalmitis is a rare but potentially serious complication of glaucoma drainage device surgery. When this complication is encountered, prompt medical and surgical intervention is necessary to prevent significant vision loss. Ultimately, the glaucoma shunt may be revised, replaced, or removed altogether from the eye.
       
  • Oral acetazolamide as a medical adjuvant to retinal surgery in optic disc
           pit maculopathy in a pediatric patient

    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Carla J. Osigian, Daniel Gologorsky, Kara M. Cavuoto, Audina Berrocal, Victor VillegasAbstractPurposeTo describe a novel combination of surgical and medical management for the treatment of optic disc pit maculopathy.ObservationsA 12-year-old obese girl with bilateral optic disc pits presented with decreased vision in the left eye (20/400). On dilated fundus examination, she was found to have a macula-involving serous retinal detachment. Pars plana vitrectomy, posterior hyaloid peel, internal limiting membrane peel, fluid-air exchange, temporal juxtapapillary endolaser, and C3F8 tamponade were performed. Postoperatively, there was persistence of subretinal fluid, so oral acetazolamide and a weight loss regimen were started. After 3 months of medical treatment, the subretinal fluid decreased significantly and visual acuity improved to 20/60.Conclusionand Importance: Currently, the mechanisms leading to optic disc pit maculopathy remain a topic of debate. As optic disc pits may provide a conduit between the subarachnoid and subretinal spaces, the reduction of intracranial pressure with the use of systemic carbonic anhydrase inhibitors may play a role in decreasing the subretinal fluid associated with select cases of optic disc pit maculopathy.
       
  • Lymphoplasmacytic lymphoma infiltrating both lacrimal glands in a patient
           with Waldenström's macroglobulinemia

    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Andreas Vangsted, Lauge Hjorth Mikkelsen, Jesper Skovlund Jørgensen, Steffen HeegaardAbstractPurposeTo describe a case of Waldenström's macroglobulinemia/lymphoplasmacytic lymphoma with infiltration of both lacrimal glands.ObservationsA 63-year-old male with Waldenström's macroglobulinemia was referred to the ophthalmological clinic due to intermittent bilateral painless swollen eyelids. The patient had slight bilateral chemosis along with swelling of both eyelids. A mechanical ptosis was present on both sides. Funduscopic examination and tonometry were normal. Computed tomography and positron emission tomography showed an enlargement of both lacrimal glands with positive PET signal, and hence a biopsy was performed for histological and cytogenetic examination. Histopathological examination revealed an infiltrate of lymphoplasmacytic cells and small lymphocytes within the lacrimal gland. The tumor cells stained positive for IgM and CD20, CD79, BCL-2, and kappa light chain. A cytogenetic examination revealed a mutation in MYD88 confirming Morbus Waldenström/lymphoplasmacytic lymphoma.Conclusionsand Importance: Intermittent swollen lacrimal glands are a rather common symptom, and Morbus Waldenström/lymphoplasmacytic lymphoma should be considered as a differential diagnosis. This symptom should be carefully evaluated in Waldenström patients, as it can be a sign of disease progression in case of lacrimal gland involvement.
       
  • Rapid and progressive decline despite early intervention in a case of
           bilateral hemorrhagic occlusive retinal vasculitis

    • Abstract: Publication date: Available online 14 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Mahsaw N. Motlagh, Cameron G. JavidAbstractPurposeTo present a case of severe bilateral hemorrhagic occlusive retinal vasculitis (HORV) after uncomplicated cataract surgery with intracameral vancomycin. We present a report of a single patient with bilateral presentation of HORV that demonstrated classic features of the disease and progressed to profound vision loss despite early and aggressive intervention.ObservationsOn initial presentation, the patient had good Snellen visual acuity of 20/25 PH 20/20 OD and 20/60 PH 20/30 OS with retinal hemorrhages in both eyes and sub-hyaloid hemorrhage in the left eye. Early therapeutic intervention with intravitreal corticosteroids, anti-vascular endothelial growth factor (anti-VEGF) agents and oral steroids was pursued. Even with treatment, the clinical picture rapidly deteriorated with progression of occlusive and hemorrhagic complications in both eyes resulting in bilateral ischemic retinopathy and breakthrough vitreous hemorrhage. After a prolonged course of treatment including the aforementioned along with panretinal photocoagulation (PRP) in both eyes and vitreoretinal surgery in the left eye, the final visual acuity was light perception (LP) OD and 20/100 OS.Conclusionsand importance: Hemorrhagic occlusive retinal vasculitis remains a feared complication of uncomplicated cataract surgery utilizing intracameral vancomycin. Despite early recognition and appropriate intervention, our patient still had a poor visual outcome with significant ischemic damage.
       
  • Concurrent ophthalmomyiasis externa and aural myiasis: A case report in an
           urban hospital in the United States

    • Abstract: Publication date: Available online 8 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Ying Jiang, Anil Rengan, Joseph Matz, Mark KrakauerAbstractPurposeTo describe a case of concurrent ophthalmomyiasis externa and aural myiasis in a patient presenting with headache, right eye pain and blurred vision in an urban hospital in Philadelphia, PA.ObservationsMyiasis is the parasitic infestation of a live mammal with fly larvae or maggots that feed and grow on host tissue. Predominantly described in the Middle East, Africa and Asia, it is rarely reported in the United States. We describe a case of concurrent ophthalmomyiasis externa and aural myiasis in a 44-year-old man who presented with headache, right eye pain and blurred vision in an urban hospital in Philadelphia, PA. After complete extraction and examination at bedside and in the operating room, the patient improved without complications after being treated with topical antibiotics and steroids.Conclusionsand Importance: Although rare in the urban settings in the United States, in certain demographic populations, it is important to consider myiasis in the setting of eye and ear pain and to perform a complete ocular and auditory examination.
       
  • Diagnostic dilemma: Unilateral panuveitis mimicking endophthalmitis in
           very severe HLA B27-Associated uveitis

    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): TOH Zhi Hong, Rupesh AgrawalAbstractPurposeTo report a case of a 28-years-old male who presented with a worsening unilateral panuveitis after intensive topical steroid therapy which resulted in a diagnostic and treatment dilemma as to whether the patient should be treated as for infective endophthalmitis despite no immediate known infective risk factors.ObservationsA patient presented initially with unilateral non-granulomatous acute anterior uveitis which worsened after being started on intensive steroid therapy, developing fibrinous panuveitis. The rapid worsening of inflammation and vision deterioration despite being on intensive steroid therapy resulted in the patient subsequently being treated as for infective endophthalmitis. Anterior chamber and vitreous tap were done and intravitreal antibiotics were administered, along with topical antibiotics therapy. Vitrectomy was withheld due to the lack of conclusive evidence of infective etiology and risk factors. Full uveitis and infective workup were done. Investigations were largely unremarkable, and fluid and vitreous cultures were negative. HLA B27 was positive. The patient was subsequently started on systemic oral corticosteroids and improved in terms of his visual acuity, signs and symptoms.Conclusionsand Importance: HLA B27-associated uveitis can present in a range of clinical spectrum with the extreme being of unusual severity in the form of fibrinous panuveitis that can mimic infective endophthalmitis. This can lead to a dilemma in management and subject patients to unnecessary risks from diagnostic and therapeutic interventions. Patients under this subgroup may require long term systemic immunosuppression therapy for disease remission and will require long term follow up.
       
  • Multimodal ophthalmic imaging of staphylococcus aureus bacteremia
           associated with chorioretinitis, endocarditis, and multifocal brain
           abscesses

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): Chiara Veronese, Marco Pellegrini, Chiara Maiolo, Mariachiara Morara, Grayson W. Armstrong, Antonio P. CiardellaAbstractPurposeStaphylococcus aureus bacteriemia (SAB) as critical condition for the life and occasionally involves the eyes. The aim of this report is to describe the ocular involvement with multimodal imaging.ObservationsA patient admitted for evaluation of acute onset of confusion, disorientation, and generalized malaise and found to have methicillin-resistant staphylococcus aureus (MRSA)-associated endocarditis and multifocal brain abscesses was evaluated by the ophthalmology service. The patient's visual acuity was 20/20 OU without relative afferent pupillary defect and normal intraocular pressures. Bedside anterior segment examination was normal. Posterior segment examination revealed intraretinal hemorrhages and Roth spots in the posterior pole of the right eye, and two deep well-defined focal white chorioretinal infiltrates and a hemorrhagic pigment epithelium detachment in the temporal quadrant of the left eye. Multimodal imaging was utilized to document these findings and ensure adequate antibiotic therapy.ConclusionSAB has the potential for poor visual outcomes as well as significant morbidity and mortality. Multimodal imaging of SAB-related chorioretinitis allows for accurate diagnosis as well as assessment of response to antimicrobial therapy.
       
  • A case of giant cell arteritis presenting with nodular posterior scleritis
           mimicking a choroidal mass

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): Caroline Awh, David A. Reichstein, Akshay S. ThomasAbstractPurposeHerein we present a case of giant cell arteritis presenting with nodular posterior scleritis and exudative retinal detachment mimicking a choroidal mass.ObservationsA 67-year-old man presented with sudden onset left-sided periorbital pain, blurry vision, and a choroidal lesion in the posterior pole. Despite treatment with high-dose oral prednisone for suspected nodular posterior scleritis mimicking a choroidal mass, the vision in his left eye did not recover, and he developed optic nerve pallor on exam. Further evaluation revealed an ESR of>140 mm/hr (Upper limit of normal = 20 mm/hr), a CRP of 113 mg/L (Upper limit of normal = 9 mg/L), and a temporal artery biopsy consistent with GCA. The patient was started on methotrexate and the oral steroids were slowly tapered.ConclusionsGiven the potential for GCA to present with scleritis and the potential for nodular posterior scleritis to mimic a choroidal mass, presence of a painful choroidal lesion with optic nerve swelling should prompt an evaluation for GCA to prevent permanent and bilateral vision loss.
       
  • Bilateral rhegmatogenous retinal detachments from giant retinal tears in
           an infant with abusive head trauma and Stickler syndrome

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): Jared J. Ebert, Virginia M. Utz, Robert A. SiskAbstractPurposeTo present a rare presentation of abusive head trauma (AHT) in an infant with a hereditary vitreoretinopathy.ObservationsA two-month-old infant female victim of AHT presented with bilateral rhegmatogenous retinal detachments from giant retinal tears. She had rib fractures, a subdural hematoma, and hyphemas bilaterally. Retinal hemorrhages were not observed. The left eye was repaired by vitrectomy with intermediate-term perfluorocarbon liquid tamponade. Genetic testing demonstrated a pathogenic COL2A1 mutation confirming Stickler syndrome.Conclusions and ImportanceOphthalmic complications of AHT classically manifest as retinal hemorrhages in multiple layers. Instead, bilateral RRDs from GRTs were observed in this infant with Stickler syndrome.
       
  • Bilateral nevus comedonicus of the eyelids: An unusual cause of ptosis and
           ectropion

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): T. Adam, R. Hage, C. Ahomadegbe, V. Molinié, E. Baubion, H. MerleAbstractPurposeNevus comedonicus is a rare developmental abnormality of the infundibulum of the hair follicle.ObservationWe report here an unusual case of bilateral extensive nevus comedonicus of the eyelids complicated by bilateral ptosis and ectropion of the lower eyelids. Blepharoplasty was performed on both upper eyelids. Histopathological findings on skin biopsy typically show large, grouped, dilated follicular ostia filled with keratin.Conclusions and importanceThis case is unusual as regards the late-onset (lesions first appeared at age 35) and location of the nevus comedonicus on both eyelids.
       
  • Solar retinal phototoxicity masquerading as self-inflicted handheld
           laser-induced lesions

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): Sylvia Nghiem-Buffet, Alain Gaudric, Salomon Y. CohenAbstractPurposeTo report multimodal imaging of lesions due to the unprotected observation of the sun with an astronomical telescope, mimicking self-inflicted handheld laser-induced macular lesions.ObservationA 44-year old man was diagnosed with chronic central serous chorioretinopathy leaving a relative scotoma in his left eye, with visual acuity limited to 20/40. He complained of a sudden visual loss to 20/400. Fundus examination showed a yellowish discoloration of the fovea. Fundus autofluorescence pictures showed hyper-autofluorescent spots that were hyperfluorescent both on fluorescein and indocyanine-green angiography. Spectral-domain optical coherence tomography (SD-OCT) showed hyper-reflective foveal outer layers, and OCT-angiography showed dark areas at the choriocapillaris. Multimodal imaging was highly suggestive of self-inflicted handheld laser-induced lesions that were ruled out by the patient. He remembered having observed the sun during an astronomical session, looking for solar winds. The main astronomical telescope was protected by a specific filter, but the aiming side-telescope was incidentally not protected by any filter.Conclusion and importanceThe unprotected observation of the sun with an astronomical telescope may result in visual loss due to macular burns that may mimic self-inflicted handheld laser-induced lesions. This hypothesis should be searched before concluding denied self-injuries.
       
  • Trifocal toric intra-ocular lens implantation in pediatric traumatic
           cataract

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): Lucas M.M. Vianna, Christina R. Prescott, Lívio O. FerrazAbstractPurposeTo present the case of a 6-year-old child who presented with a traumatic cataract and was treated with trifocal toric intra-ocular lens implantation.ObservationsThe child's uncorrected distance visual acuity improved from +0.7 logMAR preoperatively to 0.00 logMAR after cataract surgery, with spectacle independence and no reported side effectsConclusions and importanceIn carefully selected pediatric patients with traumatic cataracts, trifocal toric intra-ocular lenses may offer some benefit over standard monofocal lenses
       
  • Surgical simulator training reduces operative times in resident surgeons
           learning phacoemulsification cataract surgery

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): Cristina Lopez-Beauchamp, Gemini A. Singh, Soo Y. Shin, M. Teresa MagoneAbstractPurposeTo compare the surgical duration for routine phacoemulsification surgeries in residents with and without virtual simulator training.MethodsRetrospective cohort study of operative times of routine phacoemulsification cataract surgeries performed by 29 different third-year residents rotating at one academic institution. One group underwent mandatory virtual cataract surgery simulator training (SIM) in their second year of residency before starting surgeries while the other group did not undergo any simulator training (NOSIM). Outcomes measured were comparative surgical times and vitreous loss rates between groups in their third year of residency.Results722 surgeries were included. Surgeries in the SIM group were on average 6.7 min (min) shorter compared to the NOSIM group (P = 0.0001). Although both groups required less time for surgery over the course of the academic year, regression analysis showed that NOSIM group residents overall required 17% longer time for an uncomplicated clear corneal phacoemulsification surgery (incidence rate ratio 1.17; p = 0.0001). In the final month of their residency residents in the SIM group (32.2 ± 3 min) were 9 min faster than NOSIM peers (41.2 ± 3 min mean ± SE; p = 0.02). Vitreous loss rates were 1.4% in the SIM group and 3.6% in the NOSIM group (p = 0.06).Conclusion and ImportanceEarly and continuous implementation of mandatory virtual simulator surgical training before starting intraocular surgeries significantly decreases operative times in third year residents learning phacoemulsification compared to non-simulator trained peers.
       
  • An unusual vertical hypopyon

    • Abstract: Publication date: March 2020Source: American Journal of Ophthalmology Case Reports, Volume 17Author(s): Yan Yu Julia Chan, Kwok Lai Hunter Yuen
       
  • Recurrent fungal endophthalmitis after intravitreal injections of
           bevacizumab

    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Alaa Din Abdin, Shady Suffo, Dina Alnaggar, Loay Daas, Berthold SeitzAbstractPurposeWe intend to describe an uncommon case of recurrent post-cataract fungal endophthalmitis after intravitreal injections of Bevacizumab.ObservationsA 73-year-old male, who underwent an uncomplicated cataract surgery 8 months ago, presented to our department with postoperative endophthalmitis 5 days after his fifth intravitreal injection (IVI) of bevacizumab for treatment of cystoid macula edema caused by central retinal venous occlusion 6 months ago. The visual acuity (VA) was 0.1 (20/200). The patient underwent an emergency pars plana vitrectomy. Culture of vitreous tap was negative. Eight weeks later, the patient presented again with recurrent endophthalmitis 2 days after his sixth IVI of bevacizumab. VA was hand motion. The patient was treated with an emergency anterior and posterior segment washout with intracapsular posterior intraocular lens (pIOL) extraction. Culture of pIOL revealed Saccharomyces cervisiae fungi in the capsular bag. Six months later, clinical findings were stable with no signs of intraocular inflammation, VA was 0.3 (20/60).Conclusionsand Importance: we assume that this is a rare case of chronic late-onset post-cataract fungal endophthalmitis, which was activated by repeated intravitreal injections of Bevacizumab.
       
  • Cavernous sinus thrombosis caused by Streptococcus constellatus-associated
           Lemierre syndrome presenting as an isolated abducens nerve palsy

    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Landon J. Rohowetz, Sean M. Gratton, Daniel Dansdill, Cory J. Miller, Sarah DubinAbstractPurposeTo describe a patient with Streptococcus constellatus-associated Lemierre syndrome complicated by eventual cavernous sinus thrombosis (CST) that manifested as an isolated abducens nerve palsy.ObservationsA patient with a history of heavy alcohol use presented with Lemierre syndrome caused by an odontogenic infection due to Streptococcus constellatus. Despite initiation of intravenous antibiotics and eventual eradication of her bacteremia, she developed an isolated abducens nerve palsy on hospital day 7 due to associated CST.Conclusionsand Importance: CST is a rare complication of odontogenic infection and Lemierre syndrome. This case demonstrates the potential for primary odontogenic infections to progress to life- and sight-threatening diseases. This case also illustrates the importance of considering uncommon pathogens as the etiology of CST based on the suspected source of primary infection.
       
  • Anterior ischemic optic neuropathy in a patient with papilledema from
           idiopathic intracranial hypertension

    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Jingyi Ma, Jonathan A. MicieliAbstractPatients may lose vision in idiopathic intracranial hypertension from worsening papilledema and optic nerve dysfunction. Acute vision loss may also occur in this context from anterior ischemic optic neuropathy. We report a case of a 29-year-old woman with bilateral moderate papilledema from idiopathic intracranial hypertension who experienced sudden loss of vision in the superior part of the visual field of her right eye. She was found to have a new relative afferent pupillary defect and a stable superior altitudinal defect with optic disc pallor. Papilledema often creates crowding of the optic nerve head and places patients at risk for anterior ischemic optic neuropathy.
       
  • Glioblastoma multiforme mimicking optic neuritis

    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Meera S. Ramakrishnan, Robin A. Vora, Aubrey L. GilbertAbstractPurposeTo present a case of glioblastoma multiforme which initially presented with only ophthalmic manifestations.ObservationsA 48-year-old man presented with decreased vision and pain with eye movements of the right eye. MRI of the brain showed increased T2/FLAIR signal involving the right optic nerve with no other identified abnormalities. He was treated with intravenous steroids for presumed optic neuritis. His visual acuity then rapidly worsened to no light perception, with new orbital apex symptoms including central retinal artery and vein occlusions and inferior division third and fourth nerve palsies. Repeat MRI with contrast showed perineural enhancement surrounding the right optic nerve and markedly reduced diffusion along its entire course. After an unrevealing initial workup and then a 7 month period during which the patient refused follow up, he re-presented with left sided weakness, headache, and confusion. Repeat brain MRI revealed a large mass involving the right optic nerve, optic chiasm, basal ganglia, corpus callosum and brainstem. Biopsy led to a diagnosis of WHO grade IV glioblastoma multiforme. The disease was poorly responsive to temozolomide, bevacizumab and external beam radiation, and the patient passed away 5 months later.Conclusions and importanceMalignant optic glioma of adulthood is a challenging diagnosis with a poor prognosis. This rare case highlights the importance of maintaining neoplasm in the differential for optic neuritis masqueraders.
       
  • An unusual case of nine cilia embedded in the retina after a perforating
           ocular injury

    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Gabriel Z. Ramos, Thiago B. Goncalves, Arnaldo F. BordonAbstractPurposeTo report an extremely rare case involving a 41-year-old man with nine intraocular cilia embedded in the retina after a perforating ocular injury caused by a metal wire. This case is particularly rare because of the number and location of the cilia.ObservationsThe patient underwent an uneventful corneal suturing and extracapsular extraction of the damaged lens of his right eye. Intraocular foreign bodies were discovered following surgery and were removed at a later date. Following lens extraction and ocular repair, the patient's best-corrected visual acuity (BCVA) was counting fingers. Fundus examination during follow-up revealed several eyelashes embedded in the retina. Thirty-two days after the injury, the patient showed signs of ocular inflammation. Therefore, the patient underwent vitrectomy and intraocular foreign body removal. Nine cilia were embedded in the retina at the posterior perforation site. At the final follow-up visit, his BCVA was 20/25.Conclusion and importanceThis report describes an unusual case where intraocular cilia were embedded in the retina after a perforating ocular injury. The eyelashes caused an intraocular inflammatory reaction that subsided after their removal.
       
  • Case of bilateral Mooren's ulcers following filtering surgery using
           EX-PRESS glaucoma filtering devices

    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Noriko Toyokawa, Kaoru Araki-sasaki, Hideya Kimura, Shinichiro KurodaAbstractPurposeTo report our findings in a case of bilateral Mooren's ulcer that developed after filtering surgeries using the EX-PRESS glaucoma filtering device (EX-PRESS surgery).Patients and methodsA 71-year-old Japanese man with primary open angle glaucoma underwent EX-PRESS surgery first in his left eye and 1 month later in his right eye. He developed Mooren's ulcer in his right eye at 7 months and in his left eye at 10 months after the initial EX-PRESS surgery. Systemic examinations showed no collagen vascular disease, and he did not have a history of bacterial or viral infections. He was not allergic to metallic materials. Before the EX-PRESS surgery, he had underdone cataract surgery combined with trabeculotomy in both eyes, and a reoperation of trabeculotomy in his left eye. He had not developed Mooren's ulcer after these surgeries. The Mooren's ulcer after the EX-PRESS surgery was treated with oral prednisolone (30 mg tapering) in combination with topical 0.1% betamethasone sodium. The ulcers were responsive and healed well in three months.ConclusionsThe EX-PRESS devices was most likely the cause of the Mooren's ulcers considering that they were located close to the site of EX-PRESS insertion and no peripheral corneal ulcer developed after prior intraocular surgeries.
       
  • Bilateral retinitis after influenza virus infection in a case report

    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Shin-ichiro Ito, Seiji Takagi, Masayo Takahashi, Sunao Sugita, Yasuhiko Hirami, Masashi Fujihara, Towa Uzu, Atsushi Azumi, Yasuo KurimotoABSTRACTPurposeTo report 2 years’ longitudinal retinal changes using spectral domain optical coherence tomography (SD-OCT) images in a case of retinitis after influenza virus infection.ObservationsA 48-year-old female complained of scotoma in the central visual field after influenza virus infection. Her best visual acuity was 20/16, her fundus examination was normal, and fluorescein angiography demonstrated no evident leakage in either the retina or the optic disc. However, SD-OCT images showed a disrupted, blurred inner-segment ellipsoid zone in the macula of both eyes. Two steroid pulse therapy sessions in the first 3 months showed temporary improvement of the central scotoma. However, atrophy of the photoreceptor layer at the juxta fovea gradually progressed in OCT images during the follow-up period. In contrast, the fovea itself was mostly intact and visual acuity was maintained in the 2-year period.Conclusions and importanceWe experienced a unique case of retinitis after influenza infection, in whom progressive atrophy of the photoreceptor layer was observed in SD-OCT images.
       
  • Schwartz-Matsuo Syndrome: An Important Cause of Secondary Glaucoma

    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of Ophthalmology Case ReportsAuthor(s): Tyler Etheridge, Jennifer C. Larson, T. Michael Nork, Anna C. MomontAbstractPurposeWe report a case of Schwartz-Matsuo syndrome that highlights the pathophysiology, diagnostic challenges, and management considerations of this rare disease.Observations31-year-old man with a history of left eye cataract presented with left eye photophobia and elevated intraocular pressure (IOP) of 64 mm Hg. Visual acuity 20/40. Open angles with an increased pigment of trabecular meshwork by gonioscopy, 2+ anterior chamber (AC) cell, superior retinal detachment, and 0.6 cup-to-disc ratio. Electron microscopy of AC fluid demonstrated outer segments of photoreceptors. IOP was lowered with oral and topical ophthalmic antihypertensives. Retinal detachment was treated with pars plana vitrectomy with endolaser, gas tamponade, and AC paracentesis. Follow-up VA 20/20 with normal IOP.Conclusionsand Importance: Schwartz-Matsuo syndrome is characterized by elevated IOP with marked fluctuations, open angles, aqueous cells, and retinal detachment. Diagnosis is supported by electron microscopy of AC fluid with outer segments of photoreceptors. Treatment includes retinal detachment repair and antihypertensive therapy.
       
  • RD repair using 360-degree scleral graft for extensive scleral ectasia in
           a patient with Ehlers Danlos syndrome

    • Abstract: Publication date: Available online 13 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Shane Whitlow, Zubair IdreesAbstractPurposeTo report a case of a woman who had Ehlers Danlos syndrome who developed a bullous retinal detachment.ObservationsA 33-year-old Caucasian woman presented with 1-day history of floaters and photopsia. Patient had extensive scleral ectasia. Scleral buckle could not be performed due the severity of the ectasia. Patient had a vitrectomy and subsequently had multiple re-detachments with sclera ruptures during the retinal detachment repairs. Patient required a 360-degree scleral patch graft to prevent scleral ruptures during the vitrectomy. Patient has a stable flat report 7 months post-op with vision of 1/60.Conclusionsand importance: This is the first case report of a patient requiring a 360-degree scleral patch graft. This option should be considered to assist in preventing scleral ruptures, intraoperatively and post operatively in patient who have an increased risk of scleral rupture, such as patients with connective tissue disorders.
       
 
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