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Publisher: Elsevier   (Total: 3031 journals)

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Showing 1 - 200 of 3031 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, 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: 302, 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  
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: 195, 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: 9, 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: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, 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: 3, 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)
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: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 119, 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: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, 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: 24, 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: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, 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: 26, 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: 24, 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: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, 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 Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
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: 39, 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: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
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: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
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: 33, 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: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
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: 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: 5, 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: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
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: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, 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: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
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: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, 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: 303, 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: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 389, 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: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, 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: 48, 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: 3, 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: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
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: 7, 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: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, 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: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, 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: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, 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: 173, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
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: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, 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: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
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: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 152, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, 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: 141, 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   (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
  [2 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Online) 2451-9936
   Published by Elsevier Homepage  [3031 journals]
  • 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)
       
  • Bilateral acute simultaneous onset anterior uveitis presumed secondary to
           erlotinib: A report of two cases

    • Authors: Kendra A. Klein; Christopher G. Azzoli; Lana M. Rifkin
      Pages: 21 - 23
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Kendra A. Klein, Christopher G. Azzoli, Lana M. Rifkin
      Purpose To report two new cases of presumed erlotinib-associated bilateral acute simultaneous-onset anterior uveitis effectively treated with topical steroids. Observations Two patients were referred to the uveitis clinic with bilateral acute simultaneous onset, anterior uveitis six weeks after starting the chemotherapeutic agent erlotinib. Frequent topical steroid were started and the inflammation responded swiftly and completely. Conclusions and Importance: Bilateral acute simultaneous onset anterior uveitis is a potential side effect associated with erlotinib use that has not been well described. Physicians should be aware of this potential association in patients with recent treatment with erlotinib who complain of blurred vision, photophobia, or redness of the eyes. In some cases, the inflammation responds well to topical therapy and medication can be continued.

      PubDate: 2017-02-19T13:36:34Z
      DOI: 10.1016/j.ajoc.2016.09.003
      Issue No: Vol. 6 (2017)
       
  • A case of complex macula-off retinal detachment following traumatic globe
           rupture

    • Authors: Daniel Arkfeld; William Rhoades; Andrew Baldwin; Diana V. Do
      Pages: 33 - 34
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Daniel Arkfeld, William Rhoades, Andrew Baldwin, Diana V. Do


      PubDate: 2017-02-26T15:03:42Z
      DOI: 10.1016/j.ajoc.2016.11.002
      Issue No: Vol. 6 (2017)
       
  • Spasm of the near reflex: A case report

    • Authors: Maedbh Rhatigan; Caroline Byrne; Patricia Logan
      Pages: 35 - 37
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Maedbh Rhatigan, Caroline Byrne, Patricia Logan
      Purpose Spasm of the near reflex (SNR) is a triad of miosis, excess accommodation and excess convergence. Primary SNR is most often functional in origin We aim to highlight the clinical features which distinguish primary convergence from other conditions with a similar presentation but more sinister underlying aetiology, for example bilateral abducens nerve palsy. Observations There is a paucity of published data on SNR, in particular diagnostic criteria and treatment. We report a case of SNR of functional origin in an otherwise healthy young female and discuss the clinical features that differentiate this condition from similar conditions with underlying neurological origin. Conclusion and importance SNR is predominantly a clinical diagnosis, and often leads to patients undergoing unnecessary investigations and sometimes treatment. Recognising the salient features that differentiate it could potentially avoid this.

      PubDate: 2017-02-26T15:03:42Z
      DOI: 10.1016/j.ajoc.2017.01.006
      Issue No: Vol. 6 (2017)
       
  • Identifying rhegmatogenous detachments in bullous retinoschisis with
           optical coherence tomography studies

    • Authors: Josh O Wallsh; Ron P. Gallemore
      Pages: 38 - 40
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Josh O Wallsh, Ron P. Gallemore
      Purpose To demonstrate a novel technique for capturing optical coherence tomography images of peripheral retina and its application in identifying rhegmatogenous retinal detachments within bullous retinoschisis. Observations We report two patients presenting with bullous retinoschisis noted on clinical examination. After performing optical coherence tomography studies utilizing our image acquisition technique these lesions were found to be associated with rhegmatogenous retinal detachments. Both patients were subsequently treated without further complications. Conclusions and importance The image acquisition technique described herein allows visualization of peripheral retina utilizing optical coherence tomography studies to identify areas of rhegmatogenous retinal detachment within bullous retinoschisis that are otherwise difficult to discern.

      PubDate: 2017-02-26T15:03:42Z
      DOI: 10.1016/j.ajoc.2016.09.002
      Issue No: Vol. 6 (2017)
       
  • The superficial and deep retinal capillary plexus in cases of fovea plana
           imaged by spectral-domain optical coherence tomography angiography

    • Authors: Georgia Kaidonis; Ruwan A. Silva; Steven R. Sanislo; Theodore Leng
      Pages: 41 - 44
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Georgia Kaidonis, Ruwan A. Silva, Steven R. Sanislo, Theodore Leng
      Purpose To describe the appearance of the superficial and deep retinal capillary plexi in three patients with fovea plana of differing severity using spectral-domain optical coherence tomography angiography (OCTA). Observations In the first case of grade 1 fovea plana (a patient with 20/25 vision), OCTA showed an orderly branching pattern of vessels from the superficial and deep retinal plexi extending to the center of the fovea. The second case of grade 3 fovea plana (20/30 vision) showed some disruption of the orderly vascular pattern with small caliber vessels from both superficial and deep layers densely covering the fovea center. Case 3 represented a patient with grade 4 fovea plana associated with PAX6 mutation and poor visual acuity. OCTA revealed a disorganized pattern of large and small caliber vessels from the superficial capillary network extending into the center of the fovea. Conclusions and importance: Previously available imaging modalities were unable to specifically target different layers of the retinal vasculature. Using OCTA we have been able to show progressive changes in the vascular pattern in the deep and superficial retinal layers of patients with different grades of fovea plana. This novel imaging technique may play a role in the classification and assessment of patients with fovea plana.

      PubDate: 2017-02-26T15:03:42Z
      DOI: 10.1016/j.ajoc.2016.09.007
      Issue No: Vol. 6 (2017)
       
  • Corneal edema and keratitis following selective laser trabeculoplasty

    • Authors: Erica Tan Liu; Loren S. Seery; Analisa Arosemena; Tania Lamba; Craig J. Chaya
      Pages: 48 - 51
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Erica Tan Liu, Loren S. Seery, Analisa Arosemena, Tania Lamba, Craig J. Chaya
      Purpose To describe three cases of keratitis following Selective Laser Trabeculoplasty (SLT). Observations Three females with a history of glaucoma presented with corneal edema, keratitis (endothelial, epithelial) and decreased visual acuity shortly after SLT. There was variable resolution of symptoms after starting treatment with oral antiherpetics and topical steroids. Conclusions and importance With the increase in usage of SLT as a treatment for glaucoma and subsequent reports of keratitis, it is imperative for ophthalmic surgeons to be aware of herpes simplex as a possible risk factor. Prompt treatment with antivirals and steroids can potentially prevent scarring and permanent damage to the cornea.

      PubDate: 2017-02-26T15:03:42Z
      DOI: 10.1016/j.ajoc.2016.11.007
      Issue No: Vol. 6 (2017)
       
  • Case report of the family transmission of Streptococcus pyogenes orbital
           cellulitis

    • Authors: Émilie Goodyear; Christelle Doyon
      Pages: 52 - 54
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Émilie Goodyear, Christelle Doyon
      Purpose This is a case report of an unusual case of the family transmission of Streptococcus pyogenes infection in three siblings. One brother contracted the infection which resulted in orbital cellulitis of two of his siblings, in the absence of anatomical or immunological predisposing factors. Observations A young boy contracted an uncomplicated S pyogenes upper respiratory tract infection. The twin brother closely followed by the older sister both developed a S pyogenes orbital cellulitis a couple of days later. Conclusions and importance To our knowledge, this is the first case ever reported of family transmission of orbital cellulitis. This highlights the importance of early diagnosis and treatment of S pyogenes, and the role of throat cultures as means of diagnosis even in the absence of symptoms or signs of pharyngitis.

      PubDate: 2017-03-04T23:28:23Z
      DOI: 10.1016/j.ajoc.2017.02.002
      Issue No: Vol. 6 (2017)
       
  • A case of non-arteritic anterior ischemic optic neuropathy after
           completion of Harvoni therapy

    • Authors: Niranjan Manoharan; Prem Sagar Subramanian
      Pages: 55 - 57
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Niranjan Manoharan, Prem Sagar Subramanian
      Purpose To report the first reported case of non-arteritic anterior ischemic optic neuropathy (NAION) associated with the use of Harvoni (Gilead Sciences, Foster City, CA, USA), a newly approved treatment for Hepatitis C. Observations We report a case of NAION in a hepatitis C patient who completed Harvoni therapy just prior to presentation. Harvoni was suspected to be the causative agent given a lack of NAION risk factors in an otherwise healthy young patient. Conclusions NAION is an acute, painless vision loss that typically affects adults over 50. The mechanism of NAION remains uncertain although numerous associations have been identified including certain medications. Harvoni, a combination drug of ledipasvir/sofosbuvir, is a recently FDA-approved treatment for Hepatitis C. To date, however, no ophthalmological side effects have been reported with its use. Continued surveillance of patients treated with Harvoni will be needed to determine if additional events are observed in the future.

      PubDate: 2017-03-18T19:34:41Z
      DOI: 10.1016/j.ajoc.2017.03.002
      Issue No: Vol. 6 (2017)
       
  • Hypertensive crisis with massive retinal and choroidal infarction

    • Authors: Cyrus Golshani; Ronni M. Lieberman; Robert M. Fischer; Scott E. Brodie
      Pages: 58 - 60
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Cyrus Golshani, Ronni M. Lieberman, Robert M. Fischer, Scott E. Brodie


      PubDate: 2017-03-18T19:34:41Z
      DOI: 10.1016/j.ajoc.2017.02.005
      Issue No: Vol. 6 (2017)
       
  • Ciliary body metastasis from renal cell carcinoma successfully treated
           with intravitreal bevacizumab

    • Authors: Margaret Wong; W. Barry Lee; Robert L. Halpern; James H. Frank
      Pages: 61 - 63
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Margaret Wong, W. Barry Lee, Robert L. Halpern, James H. Frank
      Purpose To report an innovative new treatment option for ciliary body tumor metastasis from renal cell carcinoma treated with intravitreal bevacizumab. Observations A 70-year-old Caucasian man presented with a ciliary body tumor as a result from metastasis from renal cell carcinoma. It was preferable to treat the ciliary body tumor in the least invasive manner possible based on the patient's health, systemic metastasis, and the invasiveness of local resection. The tumor was treated with intravitreal bevacizumab for attempted tumor regression. Complete tumor resolution occurred following three injections. Conclusions and importance There is no consensus on treatment for ciliary body metastases from renal cell carcinoma. Based on the successful result of our patient, intravitreal bevacizumab could be an acceptable treatment option for this type of intraocular tumor. It affords a relatively non-invasive method of tumor regression without undergoing major intraocular surgery.

      PubDate: 2017-03-18T19:34:41Z
      DOI: 10.1016/j.ajoc.2017.01.009
      Issue No: Vol. 6 (2017)
       
  • Femtosecond laser-assisted cataract surgery in anterior lenticonus due to
           Alport syndrome

    • Authors: Alexander C. Barnes; Allen S. Roth
      Pages: 64 - 66
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Alexander C. Barnes, Allen S. Roth
      Purpose We describe a case of bilateral anterior lenticonus in a patient with Alport syndrome treated with femtosecond laser-assisted cataract surgery (FLACS). Observations FLACS was performed without complication, and a desirable postoperative visual acuity was achieved. Conclusions and Importance Femtosecond laser-assisted cataract surgery is an effective approach for managing patients with anterior lenticonus secondary to Alport syndrome.

      PubDate: 2017-03-18T19:34:41Z
      DOI: 10.1016/j.ajoc.2017.03.004
      Issue No: Vol. 6 (2017)
       
  • Cavernous sinus syndrome associated with metastatic colorectal cancer and
           perineural spread along the trigeminal nerve

    • Authors: Georges Nassrallah; Vincent Sun; Marie-Christine Guiot; Mikel Mikhail; Bryan Arthurs
      Pages: 67 - 70
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Georges Nassrallah, Vincent Sun, Marie-Christine Guiot, Mikel Mikhail, Bryan Arthurs
      Purpose We report the case of a patient with cavernous sinus syndrome associated with biopsy-confirmed metastasis from colorectal cancer. Observations A patient known for laryngeal carcinoma and metastatic colorectal carcinoma presented with symptoms of left trigeminal neuralgia and progressive, near-complete ophthalmoplegia. Magnetic resonance imaging (MRI) revealed a mass in the left cavernous sinus, extending into Meckel's cave with perineural spread along the mandibular branch of the left trigeminal nerve. A transsphenoidal biopsy was performed and demonstrated metastatic colon adenocarcinoma. We review the existing literature on colorectal cancer associated cavernous sinus syndrome. Conclusions and importance Cavernous sinus metastasis from colorectal cancer is exceedingly rare. We report the second case of this entity with histopathologic confirmation, and the first case with concurrent perineural spread involving the trigeminal nerve. Cavernous sinus metastasis may represent a poor prognostic factor in colorectal cancer.

      PubDate: 2017-03-18T19:34:41Z
      DOI: 10.1016/j.ajoc.2016.11.011
      Issue No: Vol. 6 (2017)
       
  • Results with the Boston Type I keratoprosthesis after Acanthamoeba
           keratitis

    • Authors: Albert Santos; Luzia Diegues Silva; Luciene Barbosa de Sousa; Denise de Freitas; Lauro Augusto de Oliveira
      Pages: 71 - 73
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Albert Santos, Luzia Diegues Silva, Luciene Barbosa de Sousa, Denise de Freitas, Lauro Augusto de Oliveira
      Purpose To report the outcomes of implantation of the Boston Type I keratoprosthesis in three patients with Acanthamoeba keratitis (AK), a severe infection that can lead to significant visual loss. Observations Case series reporting three patients with difficult cases of AK that needed multiple corneal transplantations and glaucoma surgeries. All patients were implanted with the Boston Type I keratoprosthesis device. The main outcomes measure were the visual function and anatomical retention after implantation of the Boston Type I keratoprosthesis. All patients retained the device over the long-term and had good visual function. In one patient a retroprosthetic membrane developed and in another patient an epithelial lip developed over the anterior surface of the keratoprosthesis. The visual acuities range from 20/25 to 20/80 in the implanted eyes. Conclusions and importance The Boston Type I keratoprosthesis resulted in good anatomic and functional results after multiple graft failures after AK.

      PubDate: 2017-03-23T15:39:58Z
      DOI: 10.1016/j.ajoc.2017.01.007
      Issue No: Vol. 6 (2017)
       
  • Bilateral uveitis following intravenous immunoglobulin administration

    • Authors: Enis D. Kocak; Bob Z. Wang; Anthony J. Hall
      Pages: 74 - 76
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Enis D. Kocak, Bob Z. Wang, Anthony J. Hall
      Purpose To report a case of bilateral acute anterior uveitis in an adult female occurring following the administration of intravenous immunoglobulin (IVIG). Observations A 44-year-old female patient was commenced on IVIG following presentation to hospital with upper limb neuropathic pain. Within two days, she developed bilateral red, painful photophobic eyes. Examination revealed bilateral acute anterior uveitis and IVIG was ceased. Investigations for autoimmune or infective causes for the uveitis were unremarkable. Complete resolution of the uveitis was achieved with topical corticosteroids and cessation of IVIG. Conclusions and importance Clinicians should be aware of the possibility of uveitis as an adverse effect of IVIG. Early identification of the offending medication and its cessation in this case were associated with a good visual prognosis.

      PubDate: 2017-03-30T13:02:52Z
      DOI: 10.1016/j.ajoc.2017.03.005
      Issue No: Vol. 6 (2017)
       
  • Purtscher's retinopathy as the presenting manifestation of immune
           thrombocytopenic purpura

    • Authors: Caroline C. Awh; Bobeck S. Modjtahedi; Dean Eliott
      Pages: 77 - 80
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Caroline C. Awh, Bobeck S. Modjtahedi, Dean Eliott
      Purpose To report the case of a 52-year-old man with Purtscher's retinopathy as the presenting manifestation of immune thrombocytopenic purpura (ITP). Observations Treatment with corticosteroids led to the resolution of hematologic findings within 1 week, and normal visual acuity was achieved after 2 months with no additional treatment. Conclusions and Importance: This is the first reported association between Purtscher's retinopathy and ITP. Complement activation has been implicated in the pathogenesis of both ITP and Purtscher's retinopathy, and we suggest that the patient's systemic process accounted for the retinal findings.

      PubDate: 2017-03-30T13:02:52Z
      DOI: 10.1016/j.ajoc.2017.03.001
      Issue No: Vol. 6 (2017)
       
  • Acute up-beating nystagmus in a pregnant woman with hyperemesis gravidarum

    • Authors: Kenzo Hokazono; Francisco Geminiani; Debora Bertholdo
      Pages: 81 - 83
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Kenzo Hokazono, Francisco Geminiani, Debora Bertholdo
      Purpose to describe a case of sudden onset of nystagmus in a pregnant patient with hyperemesis gravidarum. Observations sixteen days after onset of persistent nausea and uncontrollable vomiting, a 12 week pregnant woman presented up-beating nystagmus, mild memory impairment and reduced sensitivity in the lower limbs. Laboratory tests presented thiamine deficiency and magnetic resonance imaging showed bilateral medial thalami and midbrain lesions. Because of suspected Wernicke's encephalopathy, the patient was treated with thiamine replacement and significant improvement of symptoms took place. Conclusions and Importance: uncontrollable vomiting can lead to malabsorption of vitamin B1 causing acute onset of nystagmus.

      PubDate: 2017-03-30T13:02:52Z
      DOI: 10.1016/j.ajoc.2017.01.008
      Issue No: Vol. 6 (2017)
       
  • Severe bilateral optic nerve and retinal hypoperfusion in a patient with
           acute respiratory distress syndrome and septic shock

    • Authors: Wei Gui; Erika Tanaka Friesen; Laura Bonelli; Ye Elaine Wang; Anthony C. Arnold
      Pages: 84 - 87
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 6
      Author(s): Wei Gui, Erika Tanaka Friesen, Laura Bonelli, Ye Elaine Wang, Anthony C. Arnold
      Purpose To report a case of bilateral central retinal artery occlusion with both anterior and posterior ischemic optic neuropathy. Observations A 65-year-old Caucasian woman presented with acute respiratory distress syndrome and septic shock. After treatment with vasopressors and prolonged prone positioning, she was noted to be bilaterally completely blind on hospitalization day 12. Evaluation revealed evidence of bilateral central retinal artery occlusion and bilateral ischemic optic neuropathy. Magnetic resonance imaging of the orbits demonstrated severe restricted diffusion of both optic nerves consistent with ischemia. Both central retinal artery occlusion and ischemic optic neuropathy have been reported in cases of severe hypotension, blood loss, and prone positioning, most often postoperatively after spinal surgery. Conclusions and importance To our knowledge, this is the first reported case of bilateral central retinal artery occlusion with both anterior and posterior ischemic optic neuropathy, presumed due to the combination of severe systemic hypotension, hypoxemia due to the respiratory distress syndrome, and prolonged prone positioning.

      PubDate: 2017-03-30T13:02:52Z
      DOI: 10.1016/j.ajoc.2017.03.006
      Issue No: Vol. 6 (2017)
       
  • 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
       
  • Dysflective cones: Visual function and cone reflectivity in long-term
           follow-up of acute bilateral foveolitis

    • Authors: Joanna H. Tu; Katharina G. Foote; Brandon J. Lujan; Kavitha Ratnam; Jia Qin; Michael B. Gorin; Emmett T. Cunningham; William S. Tuten; Jacque L. Duncan; Austin Roorda
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Joanna H. Tu, Katharina G. Foote, Brandon J. Lujan, Kavitha Ratnam, Jia Qin, Michael B. Gorin, Emmett T. Cunningham, William S. Tuten, Jacque L. Duncan, Austin Roorda
      Purpose Confocal adaptive optics scanning laser ophthalmoscope (AOSLO) images provide a sensitive measure of cone structure. However, the relationship between structural findings of diminished cone reflectivity and visual function is unclear. We used fundus-referenced testing to evaluate visual function in regions of apparent cone loss identified using confocal AOSLO images. Methods A patient diagnosed with acute bilateral foveolitis had spectral-domain optical coherence tomography (SD-OCT) (Spectralis HRA + OCT system [Heidelberg Engineering, Vista, CA, USA]) images indicating focal loss of the inner segment-outer segment junction band with an intact, but hyper-reflective, external limiting membrane. Five years after symptom onset, visual acuity had improved from 20/80 to 20/25, but the retinal appearance remained unchanged compared to 3 months after symptoms began. We performed structural assessments using SD-OCT, directional OCT (non-standard use of a prototype on loan from Carl Zeiss Meditec) and AOSLO (custom-built system). We also administered fundus-referenced functional tests in the region of apparent cone loss, including analysis of preferred retinal locus (PRL), AOSLO acuity, and microperimetry with tracking SLO (TSLO) (prototype system). To determine AOSLO-corrected visual acuity, the scanning laser was modulated with a tumbling E consistent with 20/30 visual acuity. Visual sensitivity was assessed in and around the lesion using TSLO microperimetry. Complete eye examination, including standard measures of best-corrected visual acuity, visual field tests, color fundus photos, and fundus auto-fluorescence were also performed. Results Despite a lack of visible cone profiles in the foveal lesion, fundus-referenced vision testing demonstrated visual function within the lesion consistent with cone function. The PRL was within the lesion of apparent cone loss at the fovea. AOSLO visual acuity tests were abnormal, but measurable: for trials in which the stimulus remained completely within the lesion, the subject got 48% correct, compared to 78% correct when the stimulus was outside the lesion. TSLO microperimetry revealed reduced, but detectible, sensitivity thresholds within the lesion. Conclusions and Importance: Fundus-referenced visual testing proved useful to identify functional cones despite apparent photoreceptor loss identified using AOSLO and SD-OCT. While AOSLO and SD-OCT appear to be sensitive for the detection of abnormal or absent photoreceptors, changes in photoreceptors that are identified with these imaging tools do not correlate completely with visual function in every patient. Fundus-referenced vision testing is a useful tool to indicate the presence of cones that may be amenable to recovery or response to experimental therapies despite not being visible on confocal AOSLO or SD-OCT images.

      PubDate: 2017-04-14T14:03:31Z
      DOI: 10.1016/j.ajoc.2017.04.001
       
  • 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
       
  • Optical coherence tomography angiography of iris microhemangiomatosis

    • Authors: Amarjot S. Kang; R. Joel Welch; Kareem Sioufi; Emil Anthony T. Say; Jerry A. Shields; Carol L. Shields
      Abstract: Publication date: Available online 13 February 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Amarjot S. Kang, R. Joel Welch, Kareem Sioufi, Emil Anthony T. Say, Jerry A. Shields, Carol L. Shields
      Purpose To report optical coherence tomography angiography (OCTA) of iris microhemangiomatosis. Observations A 75-year-old asymptomatic Caucasian man was found to have bilateral pupillary vascular lesions during cataract evaluation. Visual acuity was counting fingers in the right eye (OD) and 20/40 in the left eye (OS) with normal intraocular pressures in both eyes (OU). In each eye there were multifocal, round, dark red, pinpoint vascular tufts at the pupillary margin, randomly distributed and numbering 1 in OD and 7 in OS, each measuring 0.2–0.3 mm in diameter and without active bleeding or hyphema. Fundus examination OU was normal. By fluorescein angiography, the multifocal pupillary vascular tufts demonstrated mild staining without leakage. By OCTA, the tufts were clearly delineated and were fed by normal appearing radial iris vessels. OCT b-scan documented the optically dense vascular tufts at 0.1 mm in thickness and angio-overlay confirmed blood flow emanating from the deep iris stroma. Observation was recommended with the option of cataract surgery to improve vision. Conclusions and Importance Non-invasive imaging of iris microhemangiomatosis with OCTA delineates the vascular lesion with flow arising from the posterior iris stroma.

      PubDate: 2017-02-13T13:19:55Z
      DOI: 10.1016/j.ajoc.2017.02.003
       
  • Severe corneal ulcer with progression to endophthalmitis and high-grade
           bacteremia

    • Authors: Tomasz P. Stryjewski; James Chodosh; Ivana K. Kim; Miriam Baron Barshak; John B. Miller
      Abstract: Publication date: Available online 7 February 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Tomasz P. Stryjewski, James Chodosh, Ivana K. Kim, Miriam Baron Barshak, John B. Miller
      Purpose Bacterial sepsis is a common consequence of many infectious processes. Here, we describe a case of a woman with a corneal ulcer who went on to develop group B streptococcal (GBS) endophthalmitis, bacteremia, and eventual loss of the eye. Observations A previously healthy, immunocompetent, middle aged, contact lens wearing female who, after freshwater boating in her contact lenses, developed a red, painful eye. She was initially prescribed an hourly topical steroid by an outside optometrist but worsening of her condition prompted her to present to our Emergency Department. Despite aggressive initial management, the patient went on to develop GBS endophthalmitis, sepsis with high-grade bacteremia, and eventual loss of the eye. Conclusions and importance Eye care providers should exercise caution when prescribing frequent, potent corticosteroids when an infectious etiology is in the differential diagnosis.

      PubDate: 2017-02-07T20:36:30Z
      DOI: 10.1016/j.ajoc.2017.02.001
       
  • A case of ophthalmomyiasis interna in the Pacific Northwest

    • Authors: Homer H. Chiang; Rasanamar K. Sandhu; Justin Baynham; David J. Wilson; Andreas K. Lauer
      Abstract: Publication date: Available online 3 February 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Homer H. Chiang, Rasanamar K. Sandhu, Justin Baynham, David J. Wilson, Andreas K. Lauer
      Purpose We report a case of ophthalmomyiasis interna successfully removed in toto with pars plana vitrectomy. Observations An 84-year-old woman with recent close contact with lambs presented with a new floater. Examination revealed subretinal tracks pathognomonic for ophthalmomyiasis and a larva suspended in the vitreous. The larva was successfully removed in toto with pars plana vitrectomy by aspiration through the vitreous cutter. Conclusions and importance Aspiration with pars plana vitrectomy can be considered a primary therapeutic modality for botfly larvae suspended in the vitreous. In our case, in toto removal of the larvae reduced the risk of inflammatory reaction.

      PubDate: 2017-02-07T20:36:30Z
      DOI: 10.1016/j.ajoc.2017.01.002
       
  • Oculocardiac reflex elicited by orbital floor fracture and inferior globe
           displacement

    • Authors: Chau M. Pham; Steven Couch
      Abstract: Publication date: Available online 3 February 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Chau M. Pham, Steven Couch
      Purpose To review the physiology, presentation and management of the oculocardiac reflex (OCR) by describing a case of the OCR associated with an orbital foreign body and complete ocular prolapse through a large orbital floor fracture in a 40-year-old male following a motor vehicle accident. Observations The patient demonstrated marked bradycardia and hypotension necessitating intubation and medical therapy for autonomic shock. A computed tomography (CT) showed a total blow out floor fracture and complete dislocation of a radiographically intact globe with uninterrupted rectus muscle attachments into the left maxillary sinus. He was taken to the operating room for urgent repair resulting in subsequent termination of severe OCR. Conclusions and importance The oculocardiac reflex can precipitate marked bradycardia and hypotension in the setting of trauma with significant orbital and maxillofacial injury. Prompt identification and management with vagolytic agents or definitive surgical intervention may prevent morbidity or mortality.

      PubDate: 2017-02-07T20:36:30Z
      DOI: 10.1016/j.ajoc.2017.01.004
       
  • Isolated presumed optic nerve gumma, a rare presentation of neurosyphilis

    • Authors: Nailyn Rasool; James A. Stefater; Dean Eliott; Dean M. Cestari
      Abstract: Publication date: Available online 3 February 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Nailyn Rasool, James A. Stefater, Dean Eliott, Dean M. Cestari
      Purpose The incidence of syphilitic infections continues to rise and represents a major public health concern, particularly in patients co-infected with human immunodeficiency virus (HIV). The infection has a multitude of clinical presentations and is often referred to as the ‘great imitator.’ We present a rare case of an isolated presumed syphilitic optic nerve gumma and characterize it using newer imaging modalities. Observations A 36-year-old HIV-positive man, compliant with treatment, presented with a five day history of decreased vision in the left eye. On examination his visual acuity was 20/30 with mild dyschromatopsia and an inferior altitudinal field defect in the left eye. Funduscopy demonstrated small cup to disc ratios bilaterally and a swollen and hyperemic left optic disc. Following five months of stable vision, the patient's vision in the left eye declined to 20/60, associated with diffuse visual field loss and continued swelling of the left optic disc. Subsequent magnetic resonance imaging with contrast demonstrated enhancement of the left optic nerve, and his serologies were positive for syphilis. Fluorescein angiography and optical coherence tomography were used to better characterize the lesion being most consistent with a syphilitic optic nerve gumma. Conclusions and importance Gummas of the central nervous system are a rare presentation of neurosyphilis and the last reported gumma of the optic nerve was in 1990. Such lesions have not been characterized using newer imaging modalities including optical coherence tomography and fluorescein angiography, both of which may assist in the diagnosis of this rare entity. With the increased prevalence of syphilis and remarkable response to therapy, syphilitic gummas should be considered in at-risk patients presenting with an optic neuropathy.

      PubDate: 2017-02-07T20:36:30Z
      DOI: 10.1016/j.ajoc.2017.01.003
       
  • Conjunctival squamous papilloma refractory to interferon α-2b in a
           patient on systemic immunosuppression (tacrolimus)

    • Authors: Preethi S. Ganapathy; Thomas Plesec; Arun D. Singh
      Abstract: Publication date: Available online 3 February 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Preethi S. Ganapathy, Thomas Plesec, Arun D. Singh
      Purpose To describe a case of diffuse conjunctival papilloma in an immunocompromised individual on tacrolimus that was refractory to treatment with interferon α-2b, but responded to topical mitomycin-c. Observations A 79-year-old Caucasian female with a history of a liver transplant twenty years ago, who was immunosuppressed with tacrolimus (2 mg daily) presented with a diffuse conjunctival and corneal squamous papilloma. Following treatment with four weekly subconjunctival interferon-α2b injections (3 million units/0.5 mL) and 3 months of topical interferon-α2b therapy (1 million units/mL), four times daily, slow progression was documented. The patient was switched to topical mitomycin-c drops (0.04%) administered four times daily (one week on and one week off) with dramatic regression of the tumor. Conclusion and Importance. In cases of conjunctival squamous papilloma that do not respond readily to topical interferon, topical mitomycin-c is an alternate therapeutic option. We hypothesize that use of tacrolimus may have contributed to the lack of response to topical interferon-α2b.

      PubDate: 2017-02-07T20:36:30Z
      DOI: 10.1016/j.ajoc.2017.01.005
       
  • Familial exudative vitreoretinopathy presentation as persistent fetal
           vasculature

    • Authors: Jeffrey Z. Kartchner; M. Elizabeth Hartnett
      Abstract: Publication date: Available online 2 February 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Jeffrey Z. Kartchner, M. Elizabeth Hartnett
      Purpose To illustrate a presentation of familial exudative vitreoretinopathy (FEVR) that can be mistaken for unilateral persistent fetal vasculature (PFV) and the importance of wide angle fluorescein angiography in making this distinction. A patient was referred with a unilateral retrolental membrane and retinal detachment from PFV but was found to have FEVR. Observations A 4 month-old full-term infant was referred with the diagnosis of PFV based on findings of a dense retrolental membrane and microphthalmia in the left eye. The patient had a near-complete retinal detachment with some exudation. Wide-field fluorescein angiography of the right eye revealed avascular retina and leakage at the vascular/avascular junction. Genetic testing confirmed a mutation in FZD4, supporting the clinical diagnosis of FEVR. Prompt laser therapy to the avascular area in the right eye was performed and lensectomy/vitrectomy with membrane dissection was performed in the left eye. Conclusions and importance FEVR can present with great variability between eyes. In patients presenting with findings suggestive of PFV, careful bilateral examination with wide-field fluorescein angiography is helpful. Early diagnosis and treatment are important to preserve visual acuity, especially in the less affected eye.

      PubDate: 2017-02-07T20:36:30Z
      DOI: 10.1016/j.ajoc.2017.01.001
       
  • Primary hepatoid adenocarcinoma of the orbit

    • Authors: Joseph B. Alsberge; F. Lawson Grumbine; Michele M. Bloomer; M. Reza Vagefi; Robert C. Kersten
      Pages: 38 - 40
      Abstract: Publication date: April 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 5
      Author(s): Joseph B. Alsberge, F. Lawson Grumbine, Michele M. Bloomer, M. Reza Vagefi, Robert C. Kersten
      Purpose To report a case of primary hepatoid adenocarcinoma of the orbit. Observations An adult patient was referred for evaluation of an orbital mass. Histopathology of the orbital biopsy indicated a carcinoma with hepatoid features. Laboratory studies revealed normal liver function tests, elevated serum alpha-fetoprotein, and whole-body positron emission tomography/computed tomography scan showed no evidence of liver involvement or an alternative primary origin. Conclusions and importance To the authors' knowledge, this is the first reported case of primary hepatoid adenocarcinoma of the orbit.

      PubDate: 2016-12-31T17:16:03Z
      DOI: 10.1016/j.ajoc.2016.10.006
      Issue No: Vol. 5 (2016)
       
  • Giant retinal pigment epithelial tear associated with fluid overload due
           to end-stage diabetic kidney disease

    • Authors: Yusuke Kameda; Akira Hirose; Tomohiro Iida; Yasuko Uchigata; Shigehiko Kitano
      Pages: 44 - 47
      Abstract: Publication date: April 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 5
      Author(s): Yusuke Kameda, Akira Hirose, Tomohiro Iida, Yasuko Uchigata, Shigehiko Kitano
      Purpose To report a case of a giant retinal pigment epithelial (RPE) tear associated with fluid overload in a patient with diabetic macular edema (DME) and kidney disease. Observations A 60-year-old man with type 2 diabetes mellitus and end-stage diabetic kidney disease who had gained weight because of fluid overload complained of a visual disturbance in the left eye that had started a few days earlier. The left fundus showed a RPE defect in two temporal quadrants under an extensive serous retinal detachment (SRD) with exacerbation of the original DME. Seven days later, he was admitted for severe edema and pleural effusion. No overt signs of congestive heart failure were noted. On admission, the RPE defect had markedly widened to involve the macula. Spectral-domain optical coherence tomography images showed substantial intraretinal fluid and an extensive SRD with rolled edges of the retinal pigment epithelium, which led to the diagnosis of a RPE tear. The fluid under the SRD was absorbed on the fourth hospital day and the substantial intraretinal fluid resolved on the eleventh day after systemic management of fluid overload only without ophthalmic treatment. The change in the appearance of the RPE area was minimal and the visual field defect remained even after 6 months. Conclusion and importance A RPE tear may develop in association with fluid overload in patients with diabetes.

      PubDate: 2016-12-31T17:16:03Z
      DOI: 10.1016/j.ajoc.2016.11.004
      Issue No: Vol. 5 (2016)
       
  • Isolated endogenous Fusarium endophthalmitis in an immunocompetent adult
           after a thorn prick to the hand

    • Authors: Alice L. Milligan; Anna M. Gruener; Iain D. Milligan; Geraldine A. O'Hara; Miles R. Stanford
      Abstract: Publication date: Available online 30 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Alice L. Milligan, Anna M. Gruener, Iain D. Milligan, Geraldine A. O'Hara, Miles R. Stanford
      Purpose To report the case of an immunocompetent adult presenting with endogenous Fusarium endophthalmitis. Observations A woman in her thirties presented with symptoms and signs of a unilateral anterior uveitis. After initial improvement with topical corticosteroids, she continued to develop a panuveitis with an associated drop in vision to counting fingers. A vitreous biopsy confirmed Fusarium solani by 18S rRNA fungal gene detection and PCR sequencing. Despite treatment with pars plana vitrectomy, intravitreal amphotericin B and systemic voriconazole her visual outcome was poor. Detailed review of her antecedent history revealed the route of acquisition to be a thorn prick to the hand two weeks prior to presentation. Conclusions and importance This patient's endophthalmitis most likely resulted from cutaneous inoculation of Fusarium solani with subsequent hematogenous spread. Endogenous Fusarium endophthalmitis is well recognized in the immunocompromised but is very rarely seen in the immunocompetent. This case highlights the importance of thorough history-taking and consideration of fungal endophthalmitis in the differential diagnosis of a treatment-refractory uveitis.

      PubDate: 2016-12-31T17:16:03Z
      DOI: 10.1016/j.ajoc.2016.12.017
       
  • Incontinentia pigmenti with secondary Raynaud's phenomenon: A case report
           and review of the literature

    • Authors: Margaret A. Greven; Darius M. Moshfeghi
      Abstract: Publication date: Available online 26 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Margaret A. Greven, Darius M. Moshfeghi
      Purpose To describe a patient with incontinentia pigmenti (IP) and Raynaud's phenomenon (RP). Observations A 5 year-old girl with history of IP was noted to have RP. Visual acuity was unaffected in both eyes, and fundus examination demonstrated regressed peripheral neovascularization. Photos of the patient's hands demonstrated pale discoloration associated with exposure to cold. Conclusions and Importance: IP, known to affect small cerebral and retinal blood vessels, can also affect the small blood vessels in the extremities, resulting in secondary RP.

      PubDate: 2016-12-31T17:16:03Z
      DOI: 10.1016/j.ajoc.2016.12.012
       
  • Progression of transsynaptic retinal degeneration with spectral-domain
           optical coherence tomography

    • Authors: Stephen G. Schwartz; Armando Monroig; Harry W. Flynn
      Abstract: Publication date: Available online 14 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Stephen G. Schwartz, Armando Monroig, Harry W. Flynn
      Purpose To illustrate the progression of retrograde transsynaptic retinal degeneration using spectral-domain optical coherence tomography (SD-OCT). Observations A 60 year-old man with a stroke was followed over a 17-month period using SD-OCT of the macula, ganglion cell layer (GCC), and retinal nerve fiber layer. Transsynaptic retinal degeneration progressed over this time. Conclusions and Importance Retrograde transsynaptic retinal degeneration may occur in patients with homonymous visual field loss caused by post-geniculate neurologic disease. This is best detected as homonymous thinning of the retina, corresponding to the pattern of visual field loss, using SD-OCT of the GCC and macula. The retinal changes occur at a variable time following the onset of neurologic disease.

      PubDate: 2016-12-16T17:15:12Z
      DOI: 10.1016/j.ajoc.2016.12.010
       
  • Outcomes in bullous retinal detachment

    • Authors: Sarah P. Read; Ryan C. Young; Harry W. Flynn
      Abstract: Publication date: Available online 12 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Sarah P. Read, Ryan C. Young, Harry W. Flynn
      Purpose To report two patients with giant retinal tear (GRT) associated retinal detachment in the setting of baseball trauma. Observations Two patients presented with retinal detachment associated with GRT following blunt trauma with a baseball. The first was a superotemporal GRT detachment treated with scleral buckling, pars plana vitrectomy, endolaser, and silicone oil injection. He subsequently underwent cataract surgery with silicone oil removal and at two year follow up the retina with attached with best-corrected visual acuity of 20/20. The second case was an inferotemporal GRT detachment treated initially with laser demarcation, however the tear progressed to a retinal detachment that was then treated with pars plana vitrectomy and lensectomy, endolaser, perfluoro-octane (PFO), and silicone oil injection. At the one year follow up, the retina was attached and the best-corrected visual acuity was 20/30. Conclusions and importance GRTs are an uncommon cause of retinal detachment. While pars plana vitrectomy with tamponade is standard in GRT management, there is variability in the use of scleral buckling and PFO in these cases. This is in contrast to retinal dialysis where scleral buckle alone can yield favorable results. Though a baseball ocular trauma is common, retinal involvement is rare compared to other sports injuries such as those occurring with tennis, soccer and golf. Sports trauma remains an important cause of retinal injury and patients should be counseled on the need for eye protection.

      PubDate: 2016-12-16T17:15:12Z
      DOI: 10.1016/j.ajoc.2016.12.008
       
  • Surgical interventions for late ocular complications of relapsing
           polychondritis

    • Authors: Yuan He; Huifeng Liu; Zhi Ji; Binliang Zhu
      Abstract: Publication date: Available online 10 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Yuan He, Huifeng Liu, Zhi Ji, Binliang Zhu
      Purpose To report a case of surgical interventions for a patient with relapsing polychondritis who presented with late ocular complications. Observations A 44-year-old male was diagnosed to have relapsing polychondritis on the basis of recurrent acute auricular chondritis, deformity of the ear, saddle nose deformity and painful nasal chondritis, acute ocular inflammation with conjunctivitis, episcleritis and keratouveitis, laryngotracheal chondritis, erythema nodosum in the skin, a history of polyarthritis, and abnormal blood examination findings. The acute ocular and auricular inflammation was resolved with oral corticosteroid treatment. Intraocular pressure (IOP) of the left eye was 60 mmHg as measured by Goldmann applanation tonometer. Gonioscopic observation revealed the presence of peripheral anterior synechiae and plateau iris configuration. Express drainage screw implantation was applied to the left eye, because topical and systemic medicines failed to decrease the IOP. After 12 months, complicated cataract aggravated in the right eye, and phacoemulsification operation was performed with corticosteroids administered during the perioperative period. His corrected visual acuity was 20/20 for the right eye, and the IOP remained below 21 mmHg for the left eye. The patient has been healthy, without any recurrence, for 36 months. Conclusion and importance The present case of relapsing polychondritis is the first to be reported wherein late ocular complications were alleviated by surgical interventions. Routine use of corticosteroids is necessary for successful anti-glaucoma and phacoemulsification operations.

      PubDate: 2016-12-16T17:15:12Z
      DOI: 10.1016/j.ajoc.2016.12.007
       
  • Cystic mucosa-associated lymphoid tissue lymphoma of lacrimal gland
           associated with vision loss: A case report

    • Authors: Jacqueline Mupas-Uy; Yoshiyuki Kitaguchi; Yasuhiro Takahashi; Emiko Takahashi; Hirohiko Kakizaki
      Abstract: Publication date: Available online 7 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Jacqueline Mupas-Uy, Yoshiyuki Kitaguchi, Yasuhiro Takahashi, Emiko Takahashi, Hirohiko Kakizaki
      Purpose To report an atypical case of cystic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of lacrimal gland associated with vision loss. Observations An 89-year-old woman was presented with a rapidly progressing proptosis, lagophthalmos, and vision loss. Endophthalmitis was also present. Computed tomography scan images showed a hyperdense mass with hypodense cystic areas occupying the superolateral orbit, which displaced the globe antero-inferiorly with optic nerve compression and stretching. An erosion to the adjacent superior and lateral orbital walls was also demonstrated. Complete tumor excision was performed via upper transconjunctival orbitotomy concurrently with enucleation. The immunohistopathological diagnosis was MALT lymphoma. Conclusions and importance This case emphasizes the importance of considering lymphoma in the differential diagnosis of a cystic superolateral orbital mass.

      PubDate: 2016-12-09T17:16:37Z
      DOI: 10.1016/j.ajoc.2016.12.006
       
  • Nonarteritic anterior ischemic optic neuropathy associated with interferon
           and ribavirin in a patient with hepatitis C

    • Authors: Walid Sharif; Khayam Sheikh Ian Silva Samer Elsherbiny
      Abstract: Publication date: Available online 5 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Walid Sharif, Khayam Sheikh, Ian De Silva, Samer Elsherbiny
      Purpose To report a case of a temporal artery biopsy negative anterior ischemic optic neuropathy associated with a recently completed course of pegylated interferon 2 α with ribavirin for chronic hepatitis C. Observations Despite the early presentation with symptoms and prompt treatment with systemic intravenous steroids the patient experienced deterioration of their optic neuropathy over the following few days. Although nonarteritic anterior ischemic optic neuropathy is a common disorder with known risk factors, the timing of onset of symptoms in our patient was suggestive of a possible etiology related to treatment with ribavirin and interferon 2 α, as found in the previously reported cases. Conclusions and importance There have been a few reported cases of the association between the use of interferon/ribavirin for treatment of chronic hepatitis with nonarteritic anterior ischemic optic neuropathy. In these cases stopping the drug caused some improvement of symptoms or halting the progression of optic neuropathy. Having reviewed the literature on previous cases, we postulate that there may be a dose related reaction to explain the delay and deterioration of vision in some cases despite stopping the drugs. We also advise that any person who is started on this treatment for chronic hepatitis are appropriately counselled as to the potential optic nerve side effect of the drug, based on the evidence reported in the literature.

      PubDate: 2016-12-09T17:16:37Z
       
  • Juvenile X-linked retinoschisis responsive to intravitreal corticosteroids

    • Authors: Waseem H. Ansari; Andrew W. Browne; Rishi P. Singh
      Abstract: Publication date: Available online 3 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Waseem H. Ansari, Andrew W. Browne, Rishi P. Singh
      Purpose To report the case of an adult male with X-linked retinoschisis (XLRS) who presented with cystoid macular edema (CME) that responded consistently to treatment with intravitreal steroids. Observations A 39 year old male with unilateral presentation of CME after repair of a retinal detachment secondary to XLRS responded initially to an injection of intravitreal triamcinolone acetonide (IVTA). Central subfield thickness on OCT was reduced. Three months later, the CME recurred and he was unresponsive to topical treatment so repeat IVTA was given, and the CME once again was reduced dramatically. After the next recurrence, intravitreal dexamethasone implant treatment was initiated and successful at treating recurrences in 3 month intervals for 5 additional injections. Finally, an intravitreal fluocinolone acetonide implant was surgically placed with control of CME. Conclusion and importance Corticosteroids have never been reported to be effective in CME related to XLRS. Here, we document a case of a man who successfully had decrease of intraretinal fluid and schisis with treatment of intravitreal corticosteroids as demonstrated by spectral domain optical coherence tomography.

      PubDate: 2016-12-09T17:16:37Z
      DOI: 10.1016/j.ajoc.2016.12.002
       
  • Posterior pole retinal detachment due to a macular hole in a patient with
           a Boston Keratoprosthesis

    • Authors: Daniel Gologorsky; Basil K. Williams; Harry W. Flynn
      Abstract: Publication date: Available online 2 December 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Daniel Gologorsky, Basil K. Williams, Harry W. Flynn
      Purpose To describe the clinical course of a patient with a Boston Keratoprosthesis type I who developed a localized posterior pole retinal detachment secondary to a macular hole. Observations A 73-year-old patient with a Boston Keratoprosthesis developed a localized posterior pole retinal detachment secondary to a macular hole. The retinal detachment was repaired with a 23-gauge pars plana vitrectomy, membrane peel, fluid-air exchange and 18% C3F8. Retinal reattachment was achieved but the macular hole remained open. Conclusions and importance A posterior pole retinal detachment secondary to a macular hole can be repaired using standard techniques despite the limited view through a Boston Keratoprosthesis.

      PubDate: 2016-12-09T17:16:37Z
      DOI: 10.1016/j.ajoc.2016.12.001
       
  • Atypical Tolosa Hunt syndrome with bilateral sclerokeratitis and optic
           atrophy in Takayasu's arteritis

    • Authors: Kalpana Babu; Deepika C. Parameswarappa
      Abstract: Publication date: Available online 15 November 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Kalpana Babu, Deepika C. Parameswarappa
      Purpose We report an interesting case of atypical Tolosa Hunt syndrome with bilateral Sclerokeratitis and optic atrophy in a patient with Takayasu's arteritis. Observations A 31-year- old lady presented with severe retroorbital pain in the right eye and right sided headache of 2 weeks duration. She had a history of 6th and 7th nerve palsies which improved with oral corticosteroids. Her BCVA was no perception of light in OD and 6/6 in OS. Slitlamp examination showed bilateral old sclerokeratitis and fundus examination showed bilateral optic atrophy. Systemic examination revealed BP of 240/100 mm of hg in the right upper limb with absent pulsations in the left radial, bilateral femoral and dorsalis pedis arteries noted. CT aortic angiography confirmed the diagnosis of Takayasu's arteritis. Symptoms improved with oral corticosteroids and azathioprine, which was followed by a renal stenting procedure. At 1 year followup, she is doing well with no recurrences. Conclusions and Importance: This case report presents a unique manifestation of atypical Tolosa Hunt syndrome in Takayasu's arteritis. To our knowledge, atypical Tolosa Hunt syndrome in Takayasu'arteritis has not been described in literature.

      PubDate: 2016-11-18T21:07:23Z
      DOI: 10.1016/j.ajoc.2016.11.006
       
  • Case series: Two cases of eyeball tattoos with short-term complications

    • Authors: Gonzalo Duarte; Diana Pachón; Carolina Ramírez; Lourdes Arellanes
      Abstract: Publication date: Available online 14 November 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Gonzalo Duarte, Diana Pachón, Carolina Ramírez, Lourdes Arellanes
      Purpose To report two cases of eyeball tattoos with short-term post procedural complications. Observations Case 1 is a 26-year-old Mexican man that developed orbital cellulitis and posterior scleritis two hours after an eyeball tattoo. Patient responded satisfactorily to systemic antibiotic and corticosteroid treatment. Case 2 is a 17-year-old Mexican man that developed two sub-episcleral nodules in the ink injection sites immediately after the procedure. Conclusions and Importance: Eyeball tattoos are performed by non-ophthalmic trained personnel. There are a substantial number of short-term risks associated with this procedure. Long-term effects on the eyes and vision are still unknown, but in a worst case scenario could include loss of vision or permanent damage to the eyes.

      PubDate: 2016-11-18T21:07:23Z
      DOI: 10.1016/j.ajoc.2016.11.005
       
  • Drainage and analysis of suprachoroidal fluid in a patient with acute
           systemic lupus erythematous

    • Authors: James A. Stefater; Dean Eliott; Leo A. Kim
      Abstract: Publication date: Available online 14 November 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): James A. Stefater, Dean Eliott, Leo A. Kim
      Purpose To describe a case of a patient with acute systemic lupus erythematous (SLE) causing choroidal effusions and to report a novel technique for evaluation of the choroidal fluid which sheds light on effusion pathogenesis. Observations A 37 year-old woman was referred for decreased vision, eye pain and shortness of breath. The patient had bilateral angle closure glaucoma from choroidal effusions and bilateral pleural effusions. Work-up revealed new onset acute SLE. A technique for obtaining suprachoroidal fluid is described, and the fluid was analyzed using Light's criteria and found to be exudative in nature. Conclusions and importance There has been speculation as to pathogenesis of choroidal effusions in a variety of conditions, and many authors believe the most likely process to be transudative. The exudative nature of the fluid in our patient suggests that choroidal effusions in acute SLE are likely caused by inflammation, and not secondary to hypoalbuminemia or another transudative process. Similar analyses of suprachoroidal fluid in other disease processes may help elucidate the underlying pathogenesis and may possibly guide treatment.

      PubDate: 2016-11-18T21:07:23Z
      DOI: 10.1016/j.ajoc.2016.11.001
       
  • Androgen receptor-positive ductal adenocarcinoma of the nasolacrimal duct:
           A case report

    • Authors: In Ah Park; Ho-Seok Sa; Yoo-Sam Chung; Kyung-Ja Cho
      Abstract: Publication date: Available online 14 November 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): In Ah Park, Ho-Seok Sa, Yoo-Sam Chung, Kyung-Ja Cho
      Purpose Primary ductal adenocarcinoma arising in the structures of the lacrimal apparatus is extremely rare, and the entity is considered a lacrimal counterpart of salivary duct carcinoma, of which the majority are known to express androgen receptor (AR). Less than 10 cases of AR-positive carcinomas of lacrimal gland or lacrimal sac have been described. Observations We present a primary ductal adenocarcinoma with AR expression involving the nasolacrimal duct of a middle-aged patient who had suffered from right eyelid swelling, diplopia and epiphora for 4 months. Although the tumor histologically resembled oncocytic carcinoma, electron microscopic examination did not show cytoplasmic accumulation of mitochondria, which excluded the diagnosis of oncocytic carcinoma with AR positivity. Conclusions and importance We concluded that this is the first case of AR-positive ductal adenocarcinoma arising from nasolacrimal duct. It is possible that some of the previously documented oncocytic carcinomas of the lacrimal drainage system may include ductal adenocarcinomas with oncocytic features.

      PubDate: 2016-11-18T21:07:23Z
      DOI: 10.1016/j.ajoc.2016.11.003
       
  • Anterior infectious necrotizing scleritis secondary to Pseudomonas
           aeruginosa infection following intravitreal ranibizumab injection

    • Authors: Razek Georges Coussa; Susan M. Wakil; Hady Saheb; David E. Lederer; Karin M. Oliver; Devinder P. Cheema
      Abstract: Publication date: Available online 29 October 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Razek Georges Coussa, Susan M. Wakil, Hady Saheb, David E. Lederer, Karin M. Oliver, Devinder P. Cheema
      Purpose To report the occurrence and management of severe infectious scleritis in a 75 year-old woman following intravitreal ranibizumab injection. Observations A 75 year-old monocular woman receiving monthly intravitreal ranibizumab injection for wet age related macular degeneration in the left eye presented with severe dull pain, decreased vision, and scleral melt with discharge 2 weeks after her last injection. The dilated fundus exam was devoid of vitritis. The patient was admitted to our hospital for both diagnostic and therapeutic purposes. She was initially started on aggressive oral and topical antibiotics, but showed no significant improvement. The scleral cultures were positive for Pseudomonas aeruginosa. In view of the aggressive nature of her infection, intravenous antibiotics were added to the treatment regimen. The patient recovered her baseline visual function after two weeks of intravenous, oral and, topical antibiotics. Conclusion and importance To our knowledge, this is the first case of anterior infectious necrotizing scleritis secondary to Pseudomonas aeruginosa infection following intravitreal ranibizumab injection. Clinicians performing intravitreal injections should have a high index of suspicion for iatrogenic infections including scleritis and endophthalmitis, as these infections require aggressive topical and systemic antibiotics as well as possible hospitalization.

      PubDate: 2016-11-04T17:15:16Z
      DOI: 10.1016/j.ajoc.2016.10.009
       
  • Malignant solitary fibrous tumor of the orbit: Spectrum of histologic
           features

    • Authors: Lilangi S. Ediriwickrema; Michael Burnstine; Maria S. Saber; Narsing Rao
      Abstract: Publication date: Available online 28 October 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Lilangi S. Ediriwickrema, Michael Burnstine, Maria S. Saber, Narsing Rao
      Purpose Primary malignant solitary fibrous tumor (SFT) of the orbit is a rare spindle cell neoplasm that requires excisional biopsy for histopathological diagnosis. We present a clinical case using contemporary immunohistochemical stains, report on the latest World Health Organization classification, and provide a review of the literature. Observations Report of a single case of a 65 year old male who presented with right-sided proptosis, limited adduction, ptosis, lateral globe displacement, and cheek festooning. Neuroimaging revealed a 2.2 cm, extraconal heterogeneous mass that diffusely enhanced. En-bloc tumor resection confirmed SFT malignancy based upon nuclear atypia, hypercellularity, and increased mitotic activity (13 mitotic figures/10 high powered fields). Ki-67 showed 2% nuclear staining in the benign tumor and 10–15% staining in the malignant counterpart. Immunohistochemical analysis revealed diffuse Stat6 positivity, CD 34 positivity with partial lack of staining within the malignant portion, S-100 positivity in the malignant portion, and overall negativity for CAM 5.2, desmin, actin, CD 31, and CD 117. Conclusions and Importance: Immunoprofiling is helpful to making the diagnosis of malignant solitary fibrous tumor of the orbit. Complete tumor resection continues to be the preferred treatment. The behavior of extrathoracic SFT is unpredictable, and patients with SFT in all locations require careful, long-term follow-up.

      PubDate: 2016-11-04T17:15:16Z
      DOI: 10.1016/j.ajoc.2016.10.007
       
  • Lacrimal gland enlargement as an early clinical or radiological sign in
           thyroid orbitopathy

    • Authors: James Khu; Kenn A. Freedman
      Abstract: Publication date: Available online 15 October 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): James Khu, Kenn A. Freedman
      Purpose Characteristic ophthalmic signs of Thyroid Orbitopathy (TO) include exophthalmos, eyelid retraction, eyelid edema, restrictive extraocular myopathy, and optic neuropathy. In addition lacrimal gland (LG) enlargement can be observed in these patients. However TO has not usually been considered in the differential diagnosis of cases of isolated LG enlargement. Observations A female patient at our institution (Texas Tech) was seen over a period from 2006 to 2012. This patient presented initially with LG enlargement as the primary clinical or radiologic sign of what later was diagnosed as TO. Computerized tomography and/or magnetic resonance imaging of the orbits were obtained and demonstrated isolated LG enlargement. Conclusions and importance This case represents, to our knowledge, the first report of LG enlargement as an initial presenting sign of TO. Further clinical and radiological studies looking at the natural history of TO would be useful to better understand the timing of LG involvement. In patients presenting with lacrimal gland enlargement, thyroid orbitopathy should be strongly considered in the differential diagnosis together with other causes of dacryoadenitis and LG tumors. This may save unnecessary and extensive diagnostic testing or even LG biopsies.

      PubDate: 2016-10-20T16:15:40Z
      DOI: 10.1016/j.ajoc.2016.10.005
       
  • Simultaneous central retinal artery occlusion and optic nerve vasculitis
           in Crohn disease

    • Authors: Razek Georges Coussa; Andre Ali-Ridha; Natalia Vila; Rayan Alshareef; John Chen
      Abstract: Publication date: Available online 15 October 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Razek Georges Coussa, Andre Ali-Ridha, Natalia Vila, Rayan Alshareef, John Chen
      Purpose To describe a case of Crohn disease presenting as occlusive vasculitis resulting in a central retinal artery occlusion (CRAO) in one eye and transient ischemic optic neuropathy in the fellow eye. Observations An 18-year-old patient recently diagnosed with biopsy-proven Crohn disease presented with CRAO OD after a previous episode of transient visual loss OS. Extensive workup was negative for other autoimmune or infectious etiologies. The patient was started on intravenous methylprednisolone for 72 h followed by maintenance dose of azathioprine and oral prednisone. Signs of inflammation resolved gradually with some improvement of visual acuity despite developing optic atrophy. Conclusion and importance: To our knowledge, this is the first case of unilateral CRAO and bilateral optic nerve occlusive vasculitis in Crohn disease, which should be considered as an etiology of retinal vascular occlusive disorders especially in young patients. It is important for ophthalmologists to be aware of the ophthalmic risks associated with Crohn disease as aggressive treatment with systemic steroids and immunosuppressive agents is often needed.

      PubDate: 2016-10-20T16:15:40Z
      DOI: 10.1016/j.ajoc.2016.10.004
       
  • Epibulbar osseous choristoma: A case report

    • Authors: Keegan A. Harkins; Deborah Perry; Donny W. Suh
      Abstract: Publication date: Available online 13 October 2016
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Keegan A. Harkins, Deborah Perry, Donny W. Suh
      Purpose To present the case of a 12-year-old female with an epibulbar osseous choristoma. Observations The patient presented with right-sided conjunctival mass, which caused her discomfort. Slit lamp examination revealed a 5×5-mm, firm nodule in the superotemporal quadrant of the bulbar conjunctiva. The nodule had feeder vessels, adhered firmly to the sclera, and lacked signs of malignancy. The patient underwent excisional biopsy under general anesthesia. During this procedure, great care was taken to avoid perforation of the globe. The pathologic sections were significant for well-circumscribed osseous tissue without atypia. Conclusions and importance: We describe diagnosis and successful surgical management of osseous choristoma the rarest subtype of ocular choristoma. With only 65 cases reported since mid-19th century, the condition remains poorly described. This report provides additional information on diagnosis and treatment of this rare condition.

      PubDate: 2016-10-20T16:15:40Z
      DOI: 10.1016/j.ajoc.2016.10.002
       
 
 
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