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Publisher: Elsevier   (Total: 3181 journals)

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Showing 1 - 200 of 3181 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 444, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 320, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 189, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 425, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 385, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 483, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 267, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 211, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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

  This is an Open Access Journal Open Access journal
ISSN (Online) 2451-9936
Published by Elsevier Homepage  [3181 journals]
  • Hyperacute spontaneous closure of a traumatic macular hole in a
           colobomatous eye

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Diva Kant Misra, Manabjyoti Barman, Nilutparna Deori, Awaneesh UpadhyayAbstractA 12 year old boy presented to us with complaints of diminution of vision following blunt injury to his left eye. Examination revealed a grade 5 retina-choroidal coloboma in left eye with haemorrhage at its inferior border. A macular hole was seen clinically which was confirmed on ocular coherence tomography (OCT). Repeat fundus examination & OCT after 10 days revealed spontaneous closure of the macular hole with improvement in the visual acuity.
       
  • The link between colon cancer and congenital hypertrophy of the retinal
           pigment epithelium (CHRPE)

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Brent Deibert, Letisha Ferris, Noel Sanchez, Paul WeishaarAbstractPurposeClarify the differences between Familial Adenomatous Polyposis (FAP)-associated Congenital Hypertrophy of the Retinal Epithelium (CHRPE) and benign variants with regards to lesion characteristics and associated risk.ObservationsAn eighteen-year-old man with no past medical history was found to have multiple lesions in both eyes that were consistent with FAP-associated CHRPE. Although family history was negative for colon cancer, a colonoscopy was performed, and hundreds of polyps were found extending from the rectum to the distal colon with pathological findings of tubular adenoma. Genetic testing was consistent with a possible de novo Adenomatous Polyposis Coli (APC) mutation.ConclusionsFAP is an autosomal dominant syndrome that causes colorectal cancer by age thirty-five in ninety-five percent of cases. There has been no established relationship between the benign variants of CHRPE and FAP, and patients with benign variants have no increased risk of colon cancer. While the lack of distinction in nomenclature and similar lesion appearance often leads to misdiagnosis and overtreatment, there are distinct ocular exam features that can provide the correct diagnosis. The exam findings that distinguish FAP-associated CHRPE lesions are (1) bilateralism, (2) occurrence in multiple quadrants, (3) pisiform shape, and (4) irregular borders. Knowing these features can be of great aid, especially in the setting of suspected de novo Familial Adenomatous Polyposis.
       
  • Time course of swept-source optical coherence tomography angiography
           findings after photodynamic therapy and aflibercept in eyes with
           age-related macular degeneration

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Kaori Sayanagi, Chikako Hara, Yoko Fukushima, Shigeru Sato, Hirokazu Sakaguchi, Kohji NishidaAbstractPurposeTo report swept-source optical coherence tomography angiography (SS-OCTA) findings after full-fluence photodynamic therapy (PDT) and aflibercept intravitreal injection (IVA) for age-related macular degeneration (AMD).MethodsFive eyes of five patients with AMD treated with PDT and IVA were include into the study. We retrospectively reviewed the data obtained from the five patients using SS-OCTA before and after treatment. Three eyes had type 1 choroidal neovascularization (CNV) and two eyes had polypoidal choroidal vasculopathy.ResultsBefore treatment, the CNV signals detected in all cases, decreased in three eyes and were not detected completely in two eyes at 1 months after treatment. The areas indicating CNV increased over time, but they did not increase to the baseline level. No CNV signal was detected in one eye during follow-up. In all cases, the exudation unchanged or resolved without additional IVA; the exudation recurred in two cases. In one eye, the CNV signal and the exudation occurred simultaneously; however, there was no association in another eye. A feeder vessel, from which the CNV signal seemed to originate, was seen in one of the five eyes.Conclusion and ImportanceSS-OCTA is useful to monitor the morphology of CNV after PDT and IVA, indicating that the remodeling of the choroidal vasculature occurs gradually after treatment. The presence or absence of the CNV signal might indicate CNV activity.
       
  • Peritomy-sparing scleral buckle

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Juan B. Yepez, Felipe A. Murati, Michele Petitto, Jazmin De Yepez, Marco Mura, Igor KozakAbstracPurposeTo introduce a modified technique for encircling circumferential scleral buckling without peritomy thorough a small conjunctival opening for the repair of uncomplicated rhegmatogenous retinal detachment (RD).MethodsThis technique was performed in 10 eyes of 10 patients with primary rhegmatogenous RD who underwent encircling circumferential scleral buckling without peritomy. Transconjunctival traction sutures were placed in four rectus muscles. After transconjunctival location of the retinal break, a 5- to 6-mm radial conjunctival incision was performed in 4 quadrants without cutting the limbal conjunctiva–Tenon's capsule. A 240-silicone band in scleral belt loops was used for an encircling circumferential buckle. After drainage and cryopexy, SF6 was used for tamponade. The incision was closed via layered closure only ocassionally.ResultsPrimary attachment success of 100% was achieved by single procedure. The intraoperative and postoperative complications observed included subconjunctival hemorrhage observed in 5 (50%) of eyes. These disappeared in the postoperative period.ConclusionsMinimal conjunctival incision in scleral buckle without peritomy can achieve excellent anatomical success in patients with rhegmatogenous RD without distorting ocular surface anatomy. This is the first description of technique preserving corneal limbus anatomy that could convert buckling surgery to more attractive option for retina surgeons.
       
  • Grafting of an autologous tissue-engineered human corneal epithelium to a
           patient with limbal stem cell deficiency (LSCD)

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Gaëtan Le-Bel, Louis-Philippe Guérin, Patrick Carrier, Frédéric Mouriaux, Lucie Germain, Sylvain L. Guérin, Richard BazinAbstractPurposeIn this study, we evaluated the feasibility of recovering the corneal surface integrity in a patient suffering from unilateral LSCD through the transplantation of cultured autologous corneal epithelial cells.MethodsHuman corneal epithelial cells (HCECs) were isolated from a limbal biopsy of the contralateral eye of a patient with unilateral LSCD and cultured in monolayer in the presence of an irradiated human fibroblasts feeder layer (iHFL). To produce a cultured autologous corneal epithelium (CACE), HCECs were seeded on a fibrin substrate and maintained in culture until confluence. The in vitro obtained CACE was then used to treat the affected eye of the patient. Two years later, a successful penetrating keratoplasty was performed.ResultsEfficient restoration of the corneal epithelium was achieved following transplantation of CACE indicating probable re-colonization of the cornea by stem cells. Corneal transparency was restored after removing the scarred stroma by performing a penetrating keratoplasty.ConclusionCACE produced in vitro was shown to restore a normal corneal surface capable of sustaining a viable and clear penetrating keratoplasty and reestablished a near normal vision in a unilateral LSCD patient.
       
  • Spontaneous closure of bilateral macular holes

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Avi Ohayon, Alexander RubowitzAbstractPurposeTo present a case of a right eye spontaneous closure of a full thickness macular hole (FTMH), followed several years later by a left eye spontaneous closure of a FTMH, in an otherwise healthy woman.ObservationsWe show the temporal changes and spontaneous resolution observed with Spectral-Domain Ocular Coherence Tomography (SD-OCT) of a FTMH in the right eye and a FTMH secondary to vitreomacular traction in the left eye of the same patient 5 years later, also with full spontaneous resolution. Following the resolution, SD-OCT demonstrated outer retinal layer disruption recovery and visual acuity improvement in both eyes.Conclusions and importanceSpontaneous closure of macular holes is an uncommon event, with most descriptions in the literature being of single cases or very small series, including several reports in patients who have undergone vitrectomy for other causes, or in highly myopic eyes. Bilateral spontaneous closure of macular holes in the same patient is an even more uncommon event, described only once in one patient previously in the literature to our knowledge.
       
  • Macular corneal dystrophy with isolated peripheral Descemet membrane
           deposits

    • Abstract: Publication date: Available online 13 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Wenlin Zhang, Austin Connor Kassels, Alice Barrington, Shaukat Khan, Shunji Tomatsu, Turad Alkadi, Anthony AldaveAbstractPurposeMacular Corneal Dystrophy (MCD, MIM #217800) is a category 1 corneal stromal dystrophy as per the current IC3D classification. While characterized by macular stromal deposits, we report a case of MCD type II with isolated bilateral peripheral posterior stromal opacities, describing the clinical features and results of screening the CHST6 gene and serum sulfated keratan sulfate levels.ObservationsA 68-year-old man with an unremarkable past medical and family history presented with bilateral progressive decrease in vision. Ocular exam revealed bilateral clear corneas with the exception of peripheral, round, gray-white discrete deposits at the level of Descemet membrane and decreased central corneal thickness in both eyes. The morphology of the corneal deposits, decreased corneal thickness and the absence of a family history were consistent with MCD, prompting screening of the CHST6 gene. Sanger sequencing followed by allele specific cloning revealed compound heterozygous CHST6 mutations in trans configuration: c.-26C > A, which created a new upstream open reading frame (uORF’), predicted to attenuate translation efficiency of the downstream main ORF; and c.803A > G (p.(Tyr268Cys)), previously associated with MCD. Serum keratan sulfate was reduced but detectable, consistent with the diagnosis of macular corneal dystrophy type II.Conclusionsand Importance: Although macular corneal dystrophy is classified as a corneal stromal dystrophy with endothelial involvement, we report a case of MCD with dystrophic deposits confined to the peripheral Descemet membrane, indicating that MCD may be associated with isolated endothelial involvement.
       
  • Bilateral central retinal/ophthalmic artery occlusion and near-complete
           ophthalmoplegia after bilateral lung transplant

    • Abstract: Publication date: Available online 11 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Nadine Rady, Ashwini Kini, Jonathan A. Go, Bayan Al Othman, Andrew G. LeeAbstractPurposeRecognize a rare yet existing risk of severe visual loss as a postoperative complication of bilateral lung transplant.ObservationsA 62-year-old male had undergone bilateral lung transplant for end-stage idiopathic pulmonary fibrosis and emphysema overlap syndrome. The operation was initially off-pump; however, during the left lung transplantation, cardiopulmonary bypass conversion was necessary to maintain intraoperative hemodynamic stability. On post-operative day 4, shortly after extubation and full recovery from sedation, the patient reported bilateral no light perception vision. There were no other associated neurologic symptoms. A computed tomographic (CT) of the head, cranial magnetic resonance (MR) scan of the head, MR angiogram of the circle of Willis and neck were negative. Neuro-ophthalmologic examination revealed no light perception vision in both eyes(OU). The pupils were non-reactive to light (amaurotic pupils). The intraocular pressure measured 18 mm Hg OU, and complete bilateral ophthalmoplegia was present. The fundus exam showed bilateral pallid optic disc edema, cherry red spots, with arteriolar attenuation, and mildly dilated and tortuous veins. Stroke work up was negative.Conclusions and importanceA case of post-operative visual loss and ophthalmoplegia carrying significant and permanent quality of life implications. It questions the role disruption of homeostasis during cardiopulmonary bypass contributes for this outcome.
       
  • Primary hepatic carcinoid tumor metastasizing to eyelid: A case report

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Pedro J. Davila, Jan C. Ortiz-Rosario, Meliza Matinez, Ana C. Toro, Jose J. Echegaray, Maria Correa-Rivas, Armando L. OliverAbstractPurposeWe report a rare case of a metastatic carcinoid tumor to the right lower lid masquerading as a chalazion.ObservationsA 78-year-old Hispanic woman who presented with a 3-month history of a non-resolving chalazion on the right lower lid despite aggressive medical treatment. The patient had a history of noninfectious anterior uveitis and primary hepatic carcinoid tumor that was incidentally diagnosed during the initial uveitis work-up. The right lower eyelid lesion was biopsied and histological and immunopathological analysis revealed a well differentiated neuroendocrine tumor consistent with a carcinoid tumor.Conclusionand ImportanceNeuroendocrine tumors should be considered as part of the differential diagnosis of focal, vascularized eyelid masses. To the authors best knowledge this is the first reported case of primary hepatic carcinoid tumor with metastasis to the eyelids. We also highlight the importance of pursuing a histopathologic diagnosis, in the setting of a non-resolving or recurrent chalazion.
       
  • Endogenous hypercortisolism inducing reversible ocular hypertension

    • Abstract: Publication date: Available online 9 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Shane Griffin, Timothy Boyce, Beth Edmunds, William Hills, Marjorie Grafe, Shandiz TehraniAbstractPurposeTo describe the clinical findings of two patients with reversible ocular hypertension secondary to endogenous hypercortisolism.DesignRetrospective, observational case series.SubjectsA 65-year-old man (patient 1) and a 21-year-old woman (patient 2) were both found to have Cushing's syndrome after presentation to our clinic with elevated intraocular pressures (IOP).MethodsClinical histories, ophthalmic examinations including IOP measurements, optical coherence tomography of the retinal nerve fiber layer, visual field testing, magnetic resonance imaging and computerized tomography of two patients were reviewed between 2007 and 2019.ObservationsPatient 1 demonstrated elevated IOP (maximum 26 mmHg OD and 22 mmHg OS) and bilateral disc edema. Following diagnosis of Cushing's syndrome, the patient underwent two pituitary resections and bilateral adrenalectomy, with subsequent resolution of his hypercortisolism and ocular hypertension (OHT). Patient 2 presented with blurred vision and found to have OHT (maximum 32 mmHg OU). Following diagnosis of Cushing's disease and two resections of her adrenocorticotropic hormone (ACTH) producing pituitary adenoma, her IOPs normalized. Both patients maintained normal IOPs after resolution of their endogenous hypercortisolism and discontinuation of topical IOP-lowering medication.Conclusionsand Importance: Ocular hypertension induced by endogenous hypercortisolism is, in some cases, fully reversible following normalization of cortisol levels. These findings suggest that the physiologic changes to the trabecular meshwork induced by endogenous hypercortisolism may be fully reversible.
       
  • An atypical case of acute posterior multifocal placoid pigment
           epitheliopathy with recurrent strokes

    • Abstract: Publication date: Available online 9 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Evan Berger, Ghassan Ghorayeb, Jeffery HoggAbstractPurposeTo report an atypical case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with central nervous system (CNS) vasculitis and recurrent strokes.ObservationsA 57 year-old female presented with APMPPE after a febrile illness and rash. She developed an acute infarct on magnetic resonance imaging. Computed tomography angiography of the cerebral vasculature was normal. Cerebrospinal fluid (CSF) analysis and an extensive serum lab workup were also unremarkable. She was treated with high-dose corticosteroids and eventually transitioned to methotrexate. A month after being on treatment she developed a second stroke. A cerebral angiogram was obtained and did not show evidence of CNS vasculitis. The methotrexate was eventually stopped and the prednisone was tapered. Approximately 3 months later she developed a third stroke and worsening APMPPE-associated maculopathy in both eyes. She was eventually started on oral cyclophosphamide.Conclusions & importanceAlthough rare, CNS vasculitis is a known complication of APMPPE. This case is atypical given the development of multiple recurrent strokes, lack of inflammatory evidence on CSF analysis, and normal imaging of the cerebral vasculature. This report highlights the need for a high level of clinical suspicion for CNS vasculitis with APMPPE despite noncontributory cerebral angiographic imaging and normal CSF analysis.
       
  • Bilateral serous retinal detachment associated with subretinal fibrin-like
           material in a case of pregnancy-induced hypertension

    • Abstract: Publication date: Available online 9 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Shimpei Komoto, Kazuichi Maruyama, Noriyasu Hashida, Shizuka Koh, Kohji NishidaAbstractPurposeTo describe a case of bilateral serous retinal detachment (SRD) associated with subretinal fibrin-like material (SRFM) in pregnancy-induced hypertension (PIH).ObservationsAngiography of a 31-year-old primigravida with PIH who developed acute bilateral SRD with SRFM after caesarean section showed choroidal hypoperfusion and dye leakage. Optical coherence tomography revealed irregularity of the ellipsoid zone and retinal pigment epithelium. The patient's visual acuity was hand motion in the both eyes at the initial examination. After 30 days, SRD and SRFM spontaneously disappeared. Moreover, the EZ returned and the visual acuity significantly improved to 20/25 in the right and 20/20 in the left eye.Conclusions and importanceAlthough there are reports on central serous chorioretinopathy or Vogt–Koyanagi–Harada disease, there have been no studies on SRFM complications in patients with PIH. In the current case, we speculated that SRFM was associated with acute intense choroidal ischemia and inflammation secondary to this ischemic condition. Distinguishing whether inflammation necessitating treatment is involved in SRFM may be difficult. Short observation intervals and frequent examinations are important to ensure that treatment timings are not missed.
       
  • Posterior microphthalmos with good visual acuity: A case report

    • Abstract: Publication date: Available online 7 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Miharu Mihara, Atsushi Hayashi, Toshihiko OiwakeAbstractPurposeWe report the case of an 11-year-old boy with posterior microphthalmos who exhibited normal and age appropriate development of visual acuity.ObservationsAt the initial diagnosis, when he was 3 years old, the best-corrected visual acuity (BCVA) was 20/125 in the right eye (OD) and 20/200 in the left eye (OS) with high hyperopia (cycloplegic refraction +15.75 D sphere OD and +16.25 D sphere OS). Eight years after he began wearing hyperopic glasses, BCVA was 20/16 OD and 20/20 OS. Optical coherence tomography did not reveal a foveal pit in either eye throughout the observation period. However, elongation of the outer segment and widening of the outer nuclear layers were observed.Conclusionand Importance: Many cases of posterior microphthalmos demonstrate subnormal BCVA due to an abnormal foveal structure (papillomacular retinal folds, absence of the foveal pit and avascular zone) and high hyperopia. However, if foveal maturity progresses, even if the foveal structure is abnormal, early aggressive amblyopia treatment can result in normal and age appropriate development of visual acuity.
       
  • Subretinal pseudocysts: A novel OCT finding in diabetic macular edema

    • Abstract: Publication date: Available online 7 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Riccardo Sacconi, Gerard A. Lutty, Robert F. Mullins, Enrico Borrelli, Francesco Bandello, Giuseppe QuerquesAbstractPurposeto report the presence of a new structural optical coherence tomography (OCT) finding, namely subretinal pseudocysts, in a patient affected by diabetic retinopathy (DR).ObservationsA 52-year-old man affected by type 2 diabetes from 10 years was referred to our department complaining of a visual decline in both eyes. Best corrected visual acuity was 20/100 and 20/80 in the right and left eye, respectively. Fundus examination, fluorescein angiography, and structural OCT revealed the presence of a proliferative DR with diabetic macular edema in both eyes. Interestingly, structural OCT showed subretinal pseudocystic spaces inside the subretinal fluid of the macular neuroretinal detachment.Conclusions and importanceSubretinal pseudocysts are a new structural OCT entity. We reported for the first time the evidence that pseudocysts may develop in the subretinal space in a case of diabetic macular edema.
       
  • Congenital Giant Orbital Eccrine Hidrocystoma

    • Abstract: Publication date: Available online 6 November 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Raghad Al Rasheed, Mazen AlSamnanAbstractPurposeTo describe the clinical presentation, management, and histopathological results of a congenital eccrine hidrocystoma.ObservationsA 4-year-old healthy boy presented with left upper eyelid ptosis and superonasal painless mass since birth. Computed tomography showed a hypodense cystic lesion located in the extraconal orbital compartment medially. Following complete excision, histopathology revealed an eccrine hidrocystoma.Conclusionsand Importance: Orbital eccrine hidrocystomas should be considered in the differential diagnosis of orbital cystic masses in the pediatric age group.
       
  • Sixth nerve palsy in sporadic Burkitt Lymphoma

    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Sowmya Yennam, Ashwini Kini, Bayan Al Othman, Andrew G. LeeAbstractPurposeTo describe a unique presentation of Central Nervous System Burkitt Lymphoma.ObservationsA 59-year-old male presented with new onset binocular horizontal diplopia five days after initial presentation with abdominal distension, weight loss, and night sweats. He was diagnosed with Burkitt Lymphoma with base of skull metastasis that was initially visible only on PET scan and subsequently resolved with chemotherapy.Conclusionsand Importance: Burkitt Lymphoma (BL) is an aggressive type of B-cell, non-Hodgkin, lymphoma that arises due to a translocation of the MYC proto-oncogene. Although central nervous system (CNS) involvement has been described previously with BL, isolated sixth nerve palsy as the initial sign of CNS metastasis is rare. Suspicion should remain high for metastatic disease in patients presenting with acute-onset neurologic complaints even when initial imaging is negative as timely treatment can prevent poor outcomes.
       
  • Bilateral abducens nerve palsy due to septic thrombophlebitis

    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Vincent N. Vu, Peter J. Savino, Shira L. RobbinsAbstractPurposeTo report a case of septic thrombophlebitis producing bilateral abducens nerve palsy.ObservationA 65 year-old woman with recent sinus surgery experienced the onset of horizontal diplopia during treatment for bacteremia. Computer tomography of head and a neck ultrasonography showed right internal jugular vein occlusion. Ophthalmology examination was consistent with bilateral abducens nerve palsy. She was treated with systemic antibiotics and antiplatelet therapy with resolution of the internal jugular vein occlusion. The diplopia improved over a six-months.Conclusion and importanceOur patient had Lemierre syndrome with an unusual presentation. The patient was treated for septic thrombophlebitis with a resolution of her ocular symptoms.
       
  • The development and spontaneous resolution of a full-thickness macular
           hole in bartonella henselae neuroretinitis in a 12-year-old boy

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Robert C. Gunzenhauser, Shaina M. Rubino, Vishak John, Margaret A. GrevenAbstractPurposeTo describe an unusual case of Bartonella henselae neuroretinitis complicated by macular hole (MH) development.ObservationsA full-thickness macular hole developed in a 12-year-old boy in association with serology-confirmed Bartonella henselae neuroretinitis. Following a period of observation, the MH closed without intervention.Conclusion and importanceMH may occur as a complication of neuroretinitis secondary to Cat-Scratch Disease.
       
  • Corneal endothelial dysfunction caused by Asclepias curassavica in a young
           farmer

    • Abstract: Publication date: Available online 16 October 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Yun Ji Lee, Sang Beom Han, Joon Young HyonAbstractPurposeTo introduce a case of corneal endothelial toxicity caused by Asclepias curassavica (Milkweed) in Korea.ObservationsA 37-year-old Asian man presented with decreased vision and redness in the right eye, which developed after contact with Asclepias curassavica. At presentation, best-corrected visual acuity (BCVA) was 20/60 in the right eye. Slit lamp examination demonstrated severe corneal stromal edema with Descemet's folds and conjunctival hyperemia. We prescribed topical prednisolone acetate 1% eye drops (8 times a day), cyclosporine 0.1% (once a day) and oral prednisolone (30 mg a day for 3 days). One day later, the BCVA improved to20/40 and marked improvement in corneal edema was observed. At 5 days, BCVA was 20/22 and anterior segment examination showed minimal corneal edema with resolution of Descemet's folds. At 2 weeks, BCVA was 20/20 in the right eye and corneal edema completely resolved.Conclusionsand importance: This case suggests that high index of suspicion for toxicity from Asclepias species is necessary when encountered with patients who present with corneal edema after exposure to these plants. Aggressive anti-inflammatory treatment might be helpful for early recovery, at least for young patients.
       
  • “Sclero-DALK”: New approach for treatment of superficial
           corneal leukoma

    • Abstract: Publication date: Available online 12 October 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Laura Escudero Bodenlle, Emeterio Orduña DomingoAbstractPurposePresent a new technique to perform a deep anterior lamellar keratoplasty (DALK) that could be an alternative to the “Big Bubble” or the Melles technique.ObservationsThe case concerns a 48 years old man who presents superficial corneal leukoma in the left eye secondary to ocular trauma 14 years ago. Sclero-DALK is performed under general anesthesia obtaining an excellent visual and refractive result.Conclusionsand Importance: Sclero-DALK is a novelty in surgical treatment of corneal surface opacities. It offers the same advantages than conventional DALK since it is also a non-penetrating extraocular technique. Better final visual acuities are expected with this technique in comparision with PK and the conventional DALK because less residual stroma can be remained since we acces directly to the predescemetic space.
       
  • A new mutation in the PAX2 gene in a Papillorenal Syndrome patient

    • Abstract: Publication date: Available online 11 October 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Rahul Rachwani, Carlos Rocha de Lossada, Carlos Hernando Ayala, Manuela España ContrerasAbstractPurposeTo present a new mutation in a patient with Papillorenal Syndrome (PAPRS).ObservationsPAPRS is an autosomal dominant disease that involves ocular and renal abnormalities. We present a patient with PAPRS with a genetically diagnosed PAX2 and new pathogenic mutation. A complete ophthalmological, neurological, nephrological and Ears-Nose-Throat (ENT) examination were undertaken. The patient suffered from Focal Segmental Glomerulosclerosis (FSGS) and some typical ophthalmological signs of PAPRS, including optic nerve coloboma and optic disc pit (ODP) maculopathy associated with an abnormal retinal vessel distribution and numerous cilioretinal arteries in the right eye. The left eye showed similar vessel abnormalities although the optic disc had a normal morphology.Conclusionsand Importance: a new mutation in the PAX2 gene was identified in a patient with ocular and renal abnormalities.
       
  • Acute myopic shift in a patient with systemic lupus erythematosus

    • Abstract: Publication date: Available online 10 October 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Jason Yosar, Eline WhistAbstractPurposeTo describe a rare case of acute, transient myopic shift occurring as a feature of a flare of systemic lupus erythematosus.ObservationsA 22-year-old Indigenous Australian woman with diagnosed systemic lupus erythematosus was admitted with blurry vision and periorbital oedema. She had a refractive error of −7.50 DS in the right eye and −3.50 DS in the left eye and cotton wool spots throughout the posterior poles of the retina of each eye. Treatment with intravenous and oral steroids resulted in rapid resolution of myopia and improvement in visual acuity.Conclusions and importanceSystemic lupus erythematosus disproportionately affects more indigenous than non-indigenous Australians with greater disease burden and severity. This case describes a rare manifestation of this disease.
       
  • Tick- borne infection revealing human immunodeficiency virus (HIV)
           positivity in a young adult

    • Abstract: Publication date: December 2019Source: American Journal of Ophthalmology Case Reports, Volume 16Author(s): Murat Hasanreisoglu, Sarakshi Mahajan, Pinar Cakar Ozdal, Kenan Hizel, Ahmet Yucel Ucgul, Merih Onol, Quan Dong NguyenAbstractPurposeTo describe a patient whose retinal findings suggestive of tick-borne disease but evaluations led to early diagnosis and treatment of human immunodeficiency virus (HIV) infection.ObservationA young patient presented with bilateral uveitis, branch retinal artery occlusion and retinal findings suggestive of infective/inflammatory etiology. Laboratory evaluations revealed that the patient was positive for co-infection with Rickettsia conorii and Bartonella henselae. On further investigation, the patient tested positive for HIV infection. The patient was treated with doxycycline as well as highly active anti-retroviral therapy (HAART) to control both opportunistic infections as well as HIV infection.Conclusion and ImportancePatients with HIV infection are at risk for multiple, simultaneous opportunistic co-infections, including those with tick-borne diseases.
       
  • Docetaxel-induced maculopathy possibly potentiated by concurrent
           hydroxychloroquine use

    • Abstract: Publication date: Available online 26 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Abdelrahman M. Elhusseiny, Nidhi Relhan, William E. SmiddyAbstractPurposeTo report a case of bilateral non-leaking cystoid macular degeneration induced by docetaxel, possibly potentiated by hydroxychloroquine.ObservationsA 63-year-old female patient with a long-term history of rheumatoid arthritis controlled on hydroxychloroquine for 33 years with no evidence of retinopathy developed bilateral loss of vision after having been on docetaxel chemotherapy for breast cancer. Optical coherence tomography showed bilateral cystic maculopathy with no angiographic evidence of leakage on fluorescein angiography. The patient was treated conservatively with no further interventions. Marked improvement of the macular degeneration occurred over the subsequent 9 months, but without visual improvement, although a cataract likely confounded final visual acuity measurement.Conclusionsand importance: Docetaxel-induced maculopathy has been previously reported, but with only four case reports in literature, and most often in conjunction with concurrent therapies or conditions also known to cause macular edema. This is the first case report of docetaxel-induced maculopathy in a setting of hydroxychloroquine therapy which may possibly has potentiated the effect of docetaxel to induce maculopathy. Impaired transcellular retinal pigment epithelial transport might be the cause of non-leaking cystic maculopathy.
       
  • Nodular posterior scleritis associated with presumed ocular tuberculosis:
           A multimodal imaging case report

    • Abstract: Publication date: Available online 26 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Carlos Moreira-Neto, Carlos Moreira, Diego Tolentino, Jay S. DukerAbstractPurposeTo describe a patient with nodular posterior scleritis associated with presumed ocular tuberculosis (TB).ObservationsA 25-year-old Caucasian man reported metamorphopsia in the right eye (OD). He had lost the vision in his left eye when he was 15 years old. The visual acuity (VA) levels were 20/20 and light perception in the right and left eyes, respectively. Wide-field color fundus photography, fluorescein and indocyanine green angiography, optical coherence tomography, and ultrasound suggested an inflammatory condition associated with an elevated lesion in the choroid/sclera. The purified protein derivative (PPD) skin test and all other screening tests were negative. A diagnosis of presumed nodular posterior scleritis was made and after oral corticosteroid therapy, the VA decreased to 20/100 OD associated with a red and painful eye. Subsequently a QuantiFERON-TB test was positive, tuberculosis (TB) treatment was started and the corticosteroid dose was increased. Three months after treatment, the pain resolved and the vision OD recovered to 20/20.Conclusionsand Importance: Nodular posterior scleritis can be associated with ocular TB that did not have a pulmonary manifestation. Rigorous testing is required in order to prevent visual loss in this disease that is not easily diagnosed.
       
  • Necrotic Uveal Melanoma Presenting as Orbital Cellulitis with Intraocular
           Hemorrhage: A Case Report

    • Abstract: Publication date: Available online 25 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Alexa L. Li, Julia Y. Kang, Duncan E. Berry, Krishna B. Patel, Andrew M. HendrickABSTRACTPurposeTo report a case of necrotic uveal melanoma presenting as orbital cellulitis with an intraocular hemorrhageObservationsA 61 year-old non-verbal male presented with a two-week history of right eyelid swelling and erythema unresponsive to antibiotics. In addition to these signs of orbital cellulitis, he presented with an opaque media precluding fundus visualization. He was later found to have a collar-button shaped mass consistent with uveal melanoma on B scan ultrasonography during an exam under anesthesia. The patient underwent enucleation with histopathology confirming a necrotic uveal melanoma.Conclusionand Importance: This case demonstrates how necrotic uveal melanoma can present as orbital cellulitis and the importance of keeping the diagnosis on the differential.
       
  • Complication associated with intravitreal injection of tissue plasminogen
           activator for treatment of submacular hemorrhage due to rupture of retinal
           arterial macroaneurysm

    • Abstract: Publication date: Available online 19 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Eiko Tsuiki, Mao Kusano, Takashi KitaokaAbstractPurposeTo report the possible complications of intravitreal injection of tissue plasminogen activator (t-PA) for the treatment of submacular hemorrhage associated with retinal arterial macroaneurysm (RAM).ObservationsA 75-year-old man complained of a sudden diminution of visual acuity in his left eye. Fundus examination of this eye revealed rupture of a RAM (0.5 disc diameters (DD) in size), submacular hemorrhage and hemorrhage under the internal limiting membrane (ILM). The patient had untreated hypertension and his systolic blood pressure was over 200 mmHg. Intravitreal injection of t-PA (42,000 units/0.07 ml) was given 1 day before undergoing vitrectomy. On the following day, the fundus was no longer visible because of a dense vitreous hemorrhage. After performing vitrectomy to remove the dense vitreous hemorrhage, we confirmed a marked increase in subretinal hemorrhage, and seemed to have markedly enlarged the macroaneurysm (6 DD). In addition, macular hole was found to have occurred. One week after surgery, the macular hole closed. Four months after surgery, best-corrected visual acuity improved from 20/400 to 20/40.Conclusionsand Importance: Untreated hypertension and the use of t-PA can cause re-ruptured RAM and deterioration of subretinal hemorrhage. In this case, a macular hole was also occurred. Since there are risks of various complications, it is necessary to be careful in the use of t-PA for RAM.
       
  • Oral miltefosine for refractory Acanthamoeba keratitis

    • Abstract: Publication date: Available online 19 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Kristin E. Hirabayashi, Charles C. Lin, Christopher N. TaAbstractPurposeTo report the first case of Acanthamoeba keratitis treated with oral miltefosine in the United States.ObservationsA 17-year-old female with a history of orthokeratology contact lens wear presented after five months of left eye pain, redness, and photophobia. She was previously treated with antivirals and topical corticosteroids for presumed herpetic disease. She was found to have a large central ring infiltrate and corneal cultures were positive for Acanthamoeba. The infection progressed despite hourly PHMB 0.02% and chlorhexidine 0.02%, and oral vorizonazole. The patient was started on oral miltefosine 50 mg 3 times per day. Following one week of treatment, repeat cultures were positive for Acanthamoeba and therefore, the concentration of chlorhexidine was increased from 0.02% to 0.06% and PHMB was changed to propamidine isetionate (Brolene 0.1%). There was definite clinical improvement after five weeks of treatment with oral miltefosine, topical chlorhexidine 0.06% and propamidine isetionate 0.1%.Conclusionsand importance: Acanthamoeba keratitis is a challenging entity to treat and often associated with a poor prognosis. Oral miltefosine may offer additional therapeutic benefit in cases of refractory Acanthamoeba keratitis.
       
  • RD repair using 360-degree scleral graft for extensive scleral ectasia in
           a patient with Ehlers Danlos syndrome

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

    • Abstract: Publication date: Available online 10 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Padmamalini Mahendradas, Shivani Sinha, Anand Vinekar, Maralusiddappa Pradeep, Bhujang K. ShettyAbstractPurposeTo report a case of bilateral acute necrotising retinitis due to cytomegalovirus infection (CMV) in an Asian Indian infant.ObservationsAn Asian Indian infant born with a birth weight of 1000 g at 26 week of gestation acquired cytomegalovirus infection from repeated blood transfusion for anemia. During the routine course of ROP screening, both eyes were detected with Type 1 ROP (stage 3 in zone 1 with plus disease) and treated withlaser photoablation at 39 + 2 weeks post menstrual age. The disease responded to the laser and showed signs of regression. Four weeks after laser therapy (PMA 43 + 3 weeks), both eyes presented with vitritis, inferior vitreous condensation and white lesions in the lower nasal retina and temporal retinaoverlying the lasered retinal bed associated with white fluffy hemorrhagic lesions resemblingnecrotising retinitis. As the infant was seropositive for CMV earlier, Necrotising retinitis due to CMV was suspected. The CMV DNA was repeated and was detected in serum. Infant was treated with anti-CMV medication (oral valgancyclovir) for six weeks. The retinal lesions resolved completely.Conclusionand Importance: Bilateral acute necrotising retinitis may present in an infant on post lasered retina as early as 16 weeks after birth. CMV may also present as acute necrotising retinitis in unusual cases therefore high index of suspicion and early management can result in a successful outcome.
       
  • Cytomegalovirus retinitis after treatment with topical difluprednate in an
           aphakic eye of an immunocompetent patient

    • Abstract: Publication date: Available online 10 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Richard I. Kaplan, Brian K. Do, Ronald C. Gentile, Sanjay R. KedharAbstractPurposeTo report a case of an immunocompetent 64-year-old man who developed cytomegalovirus (CMV) retinitis after using topical difluprednate.ObservationsA 64-year-old man with type 2 diabetes developed hemorrhagic retinitis while using topical difluprednate after penetrating keratoplasty. Polymerase chain reaction of the vitreous was positive for CMV DNA. Complete blood count was within normal limits and 4th generation human immunodeficiency virus assay was negative. The retinitis resolved with oral valgancyclovir and intravitreal foscarnet injections.Conclusionand Importance: CMV retinitis may occur after topical difluprednate in an immunocompetent patient.
       
  • Dupilumab-associated blepharoconjunctivitis

    • Abstract: Publication date: Available online 5 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Sefy A. Paulose, Suzanne W. Sherman, Lora R. Dagi Glass, Leejee H. SuhAbstractPurposeTo report a case of dupilumab-associated blepharoconjunctivitis.ObservationsA 48 year-old Caucasian male presented with bilateral blepharitis, multiple chalazia, dry eye disease and significant papillary conjunctivitis. The past medical history included fourteen years of severe atopic dermatitis. After failed attempts to treat atopic dermatitis with topical corticosteroids, the patient enrolled into a four-year clinical trial of biweekly dupilumab injections. Four to six weeks after initiation of dupilumab, the patient reported blurred vision, ocular irritation and redness. Slit lamp examination demonstrated bilateral meibomian gland dysfunction, edematous eyelids with multiple chalazia and significant papillary conjunctivitis. Meibography by Lipiscan revealed significant truncation, atrophy and bifurcation of meibomian glands bilaterally. The patient's multiple chalazia were excised and eyelid hygiene was closely followed. Cliradex wipes and Avenova were added to the patient's regime and one session of Lipiflow treatment was administered. The patient continued this eyelid hygiene regimen along with neomycin/polymyxin B/dexamethasone ophthalmic ointment after each dupilumab infusion.Conclusionsand Importance: Five weeks after Lipiflow treatment with concomitant use of Cliradex and Avenova, visual acuity and ocular discomfort improved. Current treatment includes Cliradex eyelid wipes along with neomycin/polymyxin B/dexamethasone ophthalmic ointment for a week after each dupilumab infusion. Topical steroids and antibiotics with eyelid hygiene are effective ways to treat atopic dermatitis patients exhibiting dupilumab's ocular side effects. Lipiflow therapy may also help in treatment.
       
  • Corneal perforation with uveal prolapse: An initial presentation of
           orbital metastatic breast cancer

    • Abstract: Publication date: Available online 5 September 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Dagmara J. Danek, Nathan W. Blessing, David T. TseAbstractPurposeMetastasis to the orbit is a rare and typically late manifestation of a systemic malignancy. Breast cancer is the most common orbital metastatic malignancy and as the prevalence of breast cancer rises, the incidence of orbital metastasis is expected to increase concomitantly. The purpose of this report is to illustrate a unique case of orbital metastatic breast cancer with grave ophthalmic sequelae and to review the salient findings and features of orbital metastatic disease.ObservationsHerein, we describe the case of a 61-year-old woman with no known history of malignancy who presented with a large compressive orbital mass that resulted in corneal perforation with uveal prolapse after initial treatment for orbital cellulitis followed by orbital pseudotumor. Anterior orbitotomy with biopsy of the mass ultimately revealed a diagnosis of metastatic breast carcinoma.ConclusionAs the incidence of breast cancer increases, ophthalmologists will play an increasingly important role in detecting both undiagnosed and recurrent breast cancer.
       
  • Branch retinal artery occlusion in the untreated contralateral eye
           following aflibercept injections during heparin treatment: Possible
           contribution of a heparin-induced thrombocytopenia-like condition

    • Abstract: Publication date: Available online 28 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Shintaro Nakao, Makoto Yoshimitsu, Yoshihiro Kaizu, Iori Wada, Muneo Yamaguchi, Koh-Hei SonodaAbstractPurposeIn this study, we report a case of branch retinal artery occlusion (BRAO) in the contralateral eye the day after aflibercept treatment during systemic heparin administration.ObservationsA 63-year-old woman with diabetic macular edema underwent repeated intravitreal injection of anti-VEGF drugs (0.5mg ranibizumab or 2mg aflibercept) for her left eye. The day after intravitreal injection of aflibercept, she presented with sudden painless blurred vision that was limited to the inferior visual field defect in the contralateral eye (right eye) during hemodialysis with the anti-coagulant heparin. Optical coherence tomography angiography (OCTA) showed decreased artery perfusion and the patient was diagnosed with contralateral BRAO.Conclusionsand importance: Previous in vitro and in vivo studies have reported that the Fc portion of anti-VEGF drugs activates platelets with heparin. Therefore, careful anti-VEGF drug selection may be necessary in cases with concomitant heparin treatment.
       
  • Presumed atypical peripapillary Vogt-Koyanagi-Harada disease

    • Abstract: Publication date: Available online 27 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Julio Zaki Abucham Neto, Andressa Passos Masson, Priscila Alves Nascimento, Aline Alves Barbosa Ferraz, Eduardo Cunha de SouzaAbstractPurposeTo describe a case of bilateral presumed atypical Harada disease with sequential, not simultaneous, involvement of the peripapillary retina (subretinal fluid) in a healthy patient with no systemic complaints.ObservationA 35-year-old healthy white man presented with sudden paracentral visual loss in the left eye. His medical history was unremarkable. However, he reported a similar episode 20 months earlier in the right eye that was associated with macular serous retinal detachment. The right eye showed evidence of reactive peripapillary atrophy and pigmentary alteration in the macula. Optical coherence tomography scans of the posterior left eye segment revealed a diffuse thickened choroid, papillomacular subretinal exudate and discontinuity of the ellipsoid layer with suggestion of vitreous cellularity. Autofluorescence imaging of the left eye showed peripapillary hyperautofluorescence. A fluorescein angiogram revealed progressive staining and pooling of the peripapillary retina with corresponding retinal vasculitis. Indocyanine green angiography revealed multiple hypocyanescent lesions with an area of hypercyanescence temporal to the disc. Rheumatologic evaluation and laboratory tests were all negative. Chest tomography was normal. Considering the apparent absence of infectious diseases, the patient was started on 60 mg/day prednisone. After 8 days, visual acuity improved to 20/250, improving to 20/20 vision six months after a slow steroid wean.ConclusionWe believe our case represented a variant of the Vogt-Koyanagi-Harada syndrome in an atypical situation, because the patient fulfilled the presumed criteria. Furthermore, the findings of clinical and complementary examinations led to this nosological entity to the exclusion of others.ImportanceThe point of this case is to alert ophthalmologists to the existence of this atypical presentation of the disease so that it should be included among the differential diagnoses of pathologies that present with these findings.
       
  • Sub-internal limiting membrane hemorrhage associated with Weil's disease

    • Abstract: Publication date: Available online 21 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Edwin Alvarez-Torres, Luis A. Acaba, Maria H. BerrocalAbstractPurposeLeptospirosis is a rare, typically tropical disease associated with water sources infected with rat urine. Symptoms can range from asymptomatic to a severe, deadly form known as Weil's disease, and ocular manifestations can arise. As global temperatures continue to rise, leptospirosis will become a larger problem worldwide. Here we describe the first case to our knowledge of foveal sub-internal limiting membrane (sub-ILM) hemorrhage due to Weil's disease.ObservationsA 56-year-old female presented with floaters and decreased vision to 20/200 in the right eye after being hospitalized for Weil's disease. Funduscopic examination and optical coherence tomography (OCT) demonstrated a foveal sub-ILM hemorrhage in the right eye. The patient was treated with pars-plana vitrectomy with internal limiting membrane removal and blood aspiration, and her best corrected visual acuity improved to 20/60.Conclusionsand Importance: Here we report the first case of sub-ILM hemorrhage following Weil's disease. Patients with leptospirosis and Weil's disease can develop retinal complications and therefore should be followed with fundoscopic eye examination after resolution of systemic symptoms. For those with retinal hemorrhages, OCT evaluation should be used to differentiate sub-hyaloid and sub-ILM hemorrhages.
       
  • l-Arginine&rft.title=American+Journal+of+Ophthalmology+Case+Reports&rft.issn=2451-9936&rft.date=&rft.volume=">Recurrent herpes zoster ophthalmicus in a young, healthy individual taking
           high doses of l-Arginine

    • Abstract: Publication date: Available online 20 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Stephen A. LoBue, Prashant Tailor, Stacy M. Carlson, Fukutaro Mano, Richard A. Giovane, Erin Schaefer, Thomas D. LoBueAbstractPurposeTo report a case of a healthy, young male with recurrent herpes zoster ophthalmicus (HZO) and high-dose l-arginine supplementation.ObservationsA 39-year-old man presented to another institution with a HZO involving the right eye. He was treated with oral acyclovir with complete resolution. Four months later the patient had a recurrent HZO episode and was started again on oral acyclovir. After resolution of the episode, the patient was continued on 1 g of oral acyclovir daily as a prophylactic measure. He then presented to our institution for a second opinion. The patient was otherwise healthy, with no past medical history involving systemic immunosuppressant agents. However, the patient was an active weight lifter taking high doses of amino acids. A diet recall was performed prior to both HZO episodes, which calculated an average intake of 46.5 g of l-arginine a day. Examination revealed 20/40 best-corrected acuity, anterior stromal haze in the visual axis, and inferior superficial punctate keratitis in the right eye. The patient was treated for dry eye disease with punctual plugs and artificial tears. The patient was instructed to decrease all supplemental arginine consumption while continuing with oral acyclovir prophylaxis for one year.Conclusions and importancel-arginine is associated with the replication and virulence of a variety of viruses in vitro, including herpes simplex and varicella zoster. Although arginine consumption increased prior to the initial and recurrent HZO infection, further investigation needs to be performed to deem if a true association exists.
       
  • Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma,
           masquerading as an infectious retinitis

    • Abstract: Publication date: Available online 15 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Varun Reddy, Richard Winslow, Jennifer H. Cao, Zachary M. Robertson, Bo Chen, Rafael L. Ufret-VincentyAbstractPurposeTo report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis.ObservationsA 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics.ConclusionIt is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis.
       
  • Glass intraocular foreign body removal with a nitinol stone basket

    • Abstract: Publication date: Available online 10 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Andrew W. Francis, Frances Wu, Ivy Zhu, Daniel de Souza Pereira, Robert B. BhisitkulAbstractPurposeGlass intraocular foreign bodies (IOFBs) complicate up to 14% of all IOFB cases and require specialized instruments for removal. We present a case of ocular trauma with two large glass IOFBs removed using a nitinol stone basket (NSB) designed for kidney stone extraction in the ureter and calyces.ObservationsAn adult male suffered a restrained motor vehicle accident. Radiographic computed tomography identified a 9-mm polygonal IOFB within the posterior segment of the right eye. A staged procedure was performed with repair of the ruptured globe followed by 23-gauge pars plana vitrectomy, pars plana lensectomy, and removal of the IOFBs using a NSB.ConclusionAt post-operative month one, visual acuity was correctable to 20/60. The retina remained attached and the patient was recovering without complication.ImportanceLarge glass IOFBs are poorly gripped by standard ophthalmic forceps due to their smooth surface, large size, and irregular shape. The NSB is an effective instrument for controlled removal of glass IOFBs. Further customized design may adapt this device for additional intraocular procedures.
       
  • Choroidal mass as the first presentation of Erdheim-Chester disease

    • Abstract: Publication date: Available online 9 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Francesco PichiAbstractPurposeTo describe a choroidal mass that proved to be histiocytic choroidal infiltration in Erdheim-Chester disease.ObservationsA 54-years-old Caucasian male presented to our Retina Clinic with a suspect of choroidal melanoma in the left eye. Dilated fundus exam of the left eye showed a yellow-grey lesion along the inferior arcade, with sub-retinal fluid clinically visible. Enhanced depth imaging-OCT (EDI-OCT) showed a dome-shaped choroidal lesion with hyperreflective exudation present between the inner retina and the retinal pigment epithelium (RPE). On fundus autofluorescence the lesion appeared to have a diffuse speckled hyper-autofluorescent pattern secondary to the exudative subretinal material. On ultrasound, the lesion appeared hyper-echoic and dome-shaped, with a baseline thickness of 6.13 mm. Indocyanine green angiography (ICGA) was performed and showed hypocyanescence of the lesion from the early phases that persisted through the whole exam. Chest CT with contrast showed an abnormal, non-calcific, eccentric thickening of segments of the aorta (“coated aorta”) and PET an abnormally strong labeling of the distal ends of the long bones. An additional proximal tibial biopsy was performed to confirm the diagnosis on histology of Erdheim-Chester disease and the patient was started on oral prednisone. The choroidal mass progressively shrunk and the subretinal exudative material on top partially reabsorbed.Conclusions and importanceIntraocular involvement in Erdheim-Chester disease is extremely rare but as a result of recent better awareness the number of new diagnosis is increasing. Erdheim-Chester disease should be considered in the differential of every choroidal mass.
       
  • Resolution of subretinal abscess from presumed Nocardia chorioretinitis
           with serial intravitreal amikacin

    • Abstract: Publication date: Available online 8 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Kurt Scavelli, Yafeng Li, Robert Carroll, Benjamin J. KimAbstractNocardia subretinal abscess is a rare complication of nocardiosis with typically poor visual outcomes. We present a case of a large submacular abscess that responded favorably to early, frequent intravitreal amikacin along with systemic antibiotic therapy.
       
  • Descemet's membrane detachment following an intracameral injection of
           viscoelastic

    • Abstract: Publication date: Available online 20 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Eileen Choudhury Bowden, Kateki Vinod, Paul A. Sidoti, Joseph F. Panarelli
       
  • Orbital metastasis from a gastrointestinal stromal tumor: A case report

    • Abstract: Publication date: Available online 3 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Yan Yu, Xiaoqian Ji, Wei Li, Changfan WuAbstractBackgroundGastrointestinal stromal tumor (GIST) is the most common primary mesenchymal tumor. The most common metastasis sites are the liver and the surface of the peritoneum. In this study, we present a case of orbital GIST metastasis.Case presentationA 43-year-old woman who had a history of small intestinal stromal tumor 4 years ago suffered GIST metastasis to the left orbit. MRI confirmed the presence of a lacrimal gland lesion with isointense on T1 and hyperintense on T2 weighted images. Histopathology analysis of the tumor showed predominantly spindle or oval cells with nuclear pleomorphism and increased mitoses. The tumor also stained positive for c-KIT (CD117) upon immunochemistry, confirming the diagnosis.ConclusionsGISTs typically occur as sporadic solitary tumors, and their common metastasis sites are the liver and the surface of the peritoneum. Orbital involvement is extremely rare. The orbital GIST metastatic tumor has special imaging properties, as evidenced by histopathology, immunochemistry, and magnetic resonance imaging (MRI).
       
  • Accelerated Visual Recovery from Protracted Hypoxic Cortical Blindness in
           a Child

    • Abstract: Publication date: Available online 2 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Sasha Mansukhani, Mai Lan Ho, Elizabeth Bradley, Michael C. BrodskyAbstractPurposeThis report describes accelerated visual recovery in a child following protracted hypoxic cortical visual loss, and reviews mechanisms responsible for visual recovery.ObservationsA 12-year-old boy developed cortical blindness after a severe snowboarding crash. Magnetic resonance imaging showed severe multifocal hypoxic brain injury, with multifocal restricted diffusion and extensive T2/FLAIR hyperintensities throughout the visual cortex, basal ganglia and midbrain. The mismatch of affected areas on FLAIR and DWI sequences indicated a combination of cytotoxic and vasogenic edema, which suggested partial reversibility with potential for recovery. Two weeks after his injury, he began to experience an accelerated improvement in vision with recovery of 20/20 visual acuity and 40 sec/arc stereoacuity over the following week. Three months later, visual field examination showed a steep-margined horizontal band of spared visual field, which showed further expansion on repeat testing 1 year later.Conclusionsand Importance: Protracted hypoxic cortical visual loss can be followed by dramatic visual recovery in children. Magnetic resonance imaging can provide useful prognostic information.
       
  • Chronic chiasmal compression and persistent visual field defect without
           detectable changes in optical coherence tomography of the macular ganglion
           cell complex

    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Mark K. Lukewich, Jonathan A. MicieliAbstractPurposeOptical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) are important in the ophthalmological evaluation of patients with sellar masses. Changes in OCT of the RNFL and macular GCC often precede visual field changes in patients with chronic chiasmal compression. OCT of the macular GCC has been shown to have better correlation with visual function and allow for even earlier detection of compression of the anterior visual pathways. We present a case of a chronic visual field defect from a pituitary adenoma with largely normal OCT parameters and only subtle changes in OCT of the RNFL and no perceptible changes in OCT of the macular GCC.ObservationsA 32-year-old man presented with a four-month history of decreased vision in his left eye and was found to have a monocular temporal visual field defect from a pituitary adenoma. OCT of the RNFL showed only a subtle change in that the nasal quadrant was mildly reduced and the optic nerve did not follow the ISNT rule. There was no asymmetry, deviation from normal parameters or differences in the nasal and temporal sextants on OCT of the macular GCC. This remained stable after testing two months later and a worsening visual field defect. He was found to have an elevated prolactinoma and after initiation of cabergoline, his visual field defect rapidly resolved within a few days.Conclusionsand Importance: OCT RNFL and macular GCC may have parameters in the normal range in patients with chronic chiasmal compression, emphasizing the importance of both anatomical and psychophysical testing. OCT of the RNFL may show these changes earlier than OCT macular GCC and both should be performed for the pre-treatment evaluation of patients with sellar masses. Preserved RNFL and macular GCC thickness confer a good prognosis as demonstrated in this case with rapid resolution of visual changes after medical treatment.
       
  • Endogenous Serratia marcescens panophthalmitis: A case series

    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Mark P. Breazzano, Gowtham Jonna, Niraj R. Nathan, Hilary H. Nickols, Anita AgarwalAbstractPurpose– Two rare and unusual cases of endogenous panophthalmitis from Serratia marcescens are presented with mechanisms for infection explored.Observations – The first patient had history of intravenous drug use (IVDU) without any medical implants. The second patient, in addition to IVDU, had a history of end-stage renal disease with upper extremity arteriovenous fistula graft infection from Serratia marcescens confirmed by wound culture. One patient had a history of licking the needles prior to IV drug injection. Clinical exam in both cases revealed light perception vision, relative afferent pupillary defect, periorbital edema with limited extraocular motility, and hypopyon in the affected eyes. Cultures from the anterior chamber aspirate were positive for Serratia marcescens in the first case and demonstrated Gram-negative rods in the second. Attempted vitreous aspiration was unsuccessful at obtaining specimens. Computed tomography demonstrated orbital fat stranding without abscess, and histopathology showed intense neutrophilic infiltration in all layers of enucleated specimen in case one.Conclusionsand Importance – Needle licking may be an underappreciated mechanism for endogenous endophthalmitis in intravenous drug users. This report includes the first case in the literature, to authors’ knowledge, of non-nosocomial endogenous Serratia marcescens panophthalmitis with orbital cellulitis. The second case illustrates a rare consequence of the rise in arteriovenous fistula placement and dialysis across the United States, which may predispose to future cases of endogenous Serratia marcescens endophthalmitis. This series supports previous observations of Serratia marcescens endogenous endophthalmitis exhibiting a generally poor visual prognosis.
       
  • Transient extremely shallow anterior chamber caused by ciliochoroidal
           detachment in a patient with Mycobacterium chelonae keratitis

    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Issei Nishiyama, Yoshinori Oie, Kenji Matsushita, Shizuka Koh, Andrew Winegarner, Kohji NishidaAbstractPurposeTo report a case of Mycobacterium chelonae keratitis that resulted in a transient reduction of anterior chamber depth.ObservationsA 46-year-old man with keratoconus and reduced visual acuity (20/286) in his left eye presented with ciliary injection 16 months after femtosecond laser-assisted penetrating keratoplasty (PK). A slit-lamp examination showed a corneal ulcer with infiltrates and edema in both the host and graft between the 3 o'clock and 6 o'clock positions. Microbiologic tests confirmed the presence of M. chelonae. Topical arbekacin and moxifloxacin, erythromycin/colistin ointment, and oral clarithromycin were prescribed. We monitored anterior chamber depth by anterior segment optical coherence tomography (AS-OCT) throughout the recovery period. The anterior chamber depth was normal before treatment, with an intraocular pressure (IOP) of 7 mmHg. Although ciliary injection and infiltrates were gradually resolved, slit-lamp examination and AS-OCT revealed an extreme reduction of anterior chamber depth without corneal perforation, 1 month after beginning treatment. The IOP was 5 mmHg, and ciliochoroidal detachment (CCD) was present. The anterior chamber increased with the resolution of CCD and keratitis. Although hypotony continued despite the resolution of CCD and keratitis, the IOP eventually recovered to ≥10 mmHg at 1 month after remission. Onset and resolution of transient reduction of anterior chamber depth presumably occurred by anterior rotation and recovery of the ciliary body, respectively. Subsequent PK triple surgery enabled visual recovery to 20/100.Conclusions and importancesevere anterior segment inflammation due to infectious keratitis may cause CCD and subsequent reduction of anterior chamber depth due to anterior rotation. AS-OCT is a non-invasive and efficient tool for the evaluation of iridociliary structure and the anterior chamber in patients with infectious keratitis.
       
  • Primary adenocarcinoma of the orbit initially diagnosed as idiopathic
           sclerosing orbital inflammation

    • Abstract: Publication date: Available online 31 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Donovan Reed, Aditya Mehta, Bartlett Hayes, Matthew Caldwell, Frank Scribbick, Brett DaviesAbstractPurposeDifferentiating idiopathic sclerosing orbital inflammation from orbital inflammation secondary to neoplasia may be challenging, as both processes can present similarly. Neoplasms in the orbit may induce inflammation with accompanying fibrosis. Limited sections of histopathological specimens may demonstrate nonspecific inflammation and lead to an inaccurate diagnosis.ObservationsThe authors present a case of infiltrating adenocarcinoma of the orbit with mucinous features which was misdiagnosed as idiopathic sclerosing orbital inflammation due to three separate benign biopsy specimens.Conclusionsand Importance: The ophthalmologist must remain suspicious of malignancy in cases of suspected idiopathic orbital inflammation with an atypical clinical course, regardless of apparently benign biopsy results.
       
  • Bilateral giant retinal pigment epithelial tears in hypertensive
           choroidopathy

    • Abstract: Publication date: Available online 24 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Natsuki Matsubara, Aki Kato, Aoi Kominami, Miho Nozaki, Tsutomu Yasukawa, Munenori Yoshida, Yuichiro OguraAbstractPurposeTo report a case of hypertensive choroidopathy with bilateral bullous serous retinal detachments (SRDs), retinal pigment epithelial detachments (PEDs), and giant retinal pigment epithelial (RPE) tears.ObservationsA 68-year-old man with a history of hypertension and diabetes mellitus presented with bilateral visual loss of about 10 day's duration. He discontinued his oral medications for 2 months without the advice of a physician. At his first visit, the best-corrected visual acuities (BCVAs) were 0.02 in the right eye and 0.3 in the left eye (decimal notation), and the respective intraocular pressures were 15 and 13 mmHg. Bullous SRDs, large PEDs, and giant RPE tears were present bilaterally. Blot retinal hemorrhages and hard exudates were seen in the left eye. The systemic blood pressure was 231/77 mmHg, and bilateral lower leg edema was observed. Biochemical blood tests showed deteriorated renal function, hypoalbuminemia, and hyperglycemia. Ultra-wide-field fundus fluorescein angiography showed leakage at the areas of the SRDs and hyperfluorescent areas corresponding to the RPE tears bilaterally. Indocyanine green angiography showed hypofluorescent areas corresponding to the PEDs. Systemic computed tomography and magnetic resonance imaging were performed, and no malignancy was found. Based on these findings, hypertensive choroidopathy was diagnosed. A week after antihypertensive treatment, the SRDs and PEDs resolved bilaterally, and the BCVAs improved to 0.4 and 0.5 in the right and left eyes, respectively. The RPE tears remained in both eyes, although the SRDs and PEDs did not recur.Conclusionsand importance: Hypertensive choroidopathy must be considered in the differential diagnosis of SRDs and/or PEDs.
       
  • A case with acquired lacrimal fistula due to Sjögren's syndrome

    • Abstract: Publication date: Available online 23 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Sho Ishikawa, Takuhei Shoji, Yuri Nishiyama, Kei ShinodaAbstractPurposeTo report a case with lacrimal fistula presumably associated with Sjögren's syndrome.ObservationsA patient with Sjögren's syndrome was referred to our hospital for fistula from the inferior lacrimal canaliculus to the palpebral conjunctiva of her left lower eyelid. She also revealed severe dry eye in both eyes. She had no history of trauma or congenital lacrimal fistula. She was administering 0.3% purified sodium hyaluronate and 3% diquafosol sodium solution 6 times a day for dry eye. The Schirmer-1 test indicated that tear secretion was 0 mm for 5 min for both eyes. She was diagnosed with Sjögren's syndrome based on increased levels of blood Sjögren's-syndrome-related antigen A and Sjögren's-syndrome-related antigen B antibodies, decreased saliva volume, and lip biopsy. We performed silicone tube intubation and patched the fistula with conjunctiva. We observed the lacrimal sac and nasolacrimal duct under lacrimal micro-endoscopy; there was no bacterial concretion, obstruction, and inflammation of lacrimal mucosa. After the operation, her symptoms improved and lacrimal perforation healed after the removal of the silicone tube.Conclusions and importanceSjögren's syndrome can cause not only corneal perforation but also mucosal perforation, which may lead to a lacrimal fistula. Sjögren's syndrome patients with severe dry eye should be managed carefully.
       
  • Serous macular detachment in nanophthalmos: A manifestation of
           pachychoroid spectrum

    • Abstract: Publication date: Available online 17 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Vinod Kumar, Shorya V. Azad, Rajpal Vohra, Pradeep VenkateshAbstractPurposeThe purpose of this article is to report serous macular detachment (SMD) similar to that seen in central serous chorioretinopathy (CSCR) in patients with nanophthalmos.ObservationIt is a retrospective case series from a tertiary eye care center in India. Multi modal imaging features of eyes with serous macular detachment in patients with nanophthalmos including colour fundus photographs, short wave autofluorescence, fundus fluorescein angiography and optical coherence tomography were studied. In addition axial length, anterior chamber depth, lens thickness and subfoveal choroidal thickness were measured. The eyes were treated with laser photocoagulation to the focal leak seen on fluorescein angiography. The patients were followed up for 12–18 months.ResultsThree eyes of three patients having serous macular detachment in nanophthalmos were identified. All three eyes had axial length 450 microns and a focal leak on fluorescein angiography. Two eyes had serous pigment epithelial detachments underneath the SMD as well. Two eyes had peripheral pigmentary changes due to resolved subretinal fluid. The SMD resolved completely in two eyes and partially in one eye following focal laser photocoagulation.Conclusionand importance: Serous macular detachments bearing features similar to that of CSCR can occur in the setting of nanophthalmos. These may represent manifestation of thick choroid or may represent forme fruste choroidal effusion.
       
  • Hydrogel sealant to prevent recurrent epithelial ingrowth in the setting
           of a LASIK flap buttonhole

    • Abstract: Publication date: Available online 17 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Kristin E. Hirabayashi, Edward E. MancheAbstractPurposeTo report the first case of hydrogel sealant to prevent the recurrence of epithelial ingrowth in a LASIK flap buttonhole.ObservationsA 67-year-old female presented ten years after undergoing bilateral LASIK with diffuse lamellar keratitis and flap dislodgement after blunt trauma to the right eye. She was found to have epithelial ingrowth with diffuse debris and striae, so her flap was lifted and the epithelial ingrowth was removed. However, a central buttonhole was noted intraoperatively. Once all the epithelium was removed, the flap was repositioned and hydrogel sealant (ReSure, Ocular Therapeutix, Bedford, MA) was used to fill the buttonhole as well as seal down the edges of the flap. Sixteen months postoperatively, the patient's uncorrected visual acuity was 20/50-2 and there was no recurrence of the epithelial ingrowth at the edges of the buttonhole.Conclusionsand importance: Preventing the recurrence of epithelial ingrowth is a challenging situation, especially in the setting of a LASIK flap buttonhole. The use of hydrogel sealant in the buttonhole and around the edges of the flap may offer an elegant and effective solution.
       
  • Congenital toxoplasmosis as one phenocopy of North Carolina Macular
           Dystrophy (NCMD/MCDR1)

    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Kent W. Small, Andrea L. Vincent, Chelsea L. Knapper, Fadi S. ShayaAbstractPurposeTo highlight the striking similarities between the lesions of congenital toxoplasmosis (CT) and North Carolina Macular Dystrophy (NCMD) using multimodal imaging including spectral domain optical coherence tomography (SD-OCT).ObservationsWe are comparing a case report of CT compared to that of NCMD. The case of a 64-year-old man with a lifelong history of decreased vision OD from toxoplasmosis and new onset of central retinal vein occlusion OS. Color fundus photography, spectral domain optical coherence tomography (SD-OCT), and intravenous fluorescein angiography (IVFA) were used as diagnostic imaging tools to demonstrate the similarities and differences between CT and NCMD. In this case, unilateral CT demonstrated a large, excavated, coloboma-like chorioretinal lesion identical to NCMD grade 3. Serology studies were positive for toxoplasmosis. The similarities of CT and NCMD grade 3 using SD-OCT are especially striking.Conclusionand Importance: Lesions of CT and NCMD grade 3 can appear identical on clinical exam and are indistinguishable from one another on SD-OCT. Because CT is a phenocopy of NCMD, many cases of the original NCMD family members had been misdiagnosed as CT. North Carolina Macular Dystrophy may be more common than previously realized and bilateral CT cases should be reexamined along with family members and genetic testing performed. Cases of bilateral CT actually may be NCMD cases. Now that the genetic and molecular mechanisms of NCMD are known, these may provide clues into the pathogenesis of CT.
       
  • Keratoconus progression associated with hormone replacement therapy

    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Giulia Coco, Ahmad Kheirkhah, William Foulsham, Reza Dana, Joseph B. CiolinoAbstractPurposeTo report a postmenopausal patient with keratoconus who experienced significant progression after using hormone replacement therapy.ObservationsA 51-year-old woman with previously stable keratoconus presented with acute disease progression following hormone replacement therapy in the context of prophylactic hysterectomy and bilateral ovariosalpingectomy. Over a 14-month period after starting hormone therapy, the steepest K increased from 63.7D to 71.5D in the right eye and from 65.8D to 78.1D in the left eye.Conclusionsand Importance: Hormone replacement therapy may amplify progression of keratoconus.
       
  • Small lymphaticovenous malformation of the orbital apex clinicopathologic
           correlation

    • Abstract: Publication date: Available online 13 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Mark Hankins, Ryan Murtagh, Curtis E. Margo, Jasmina Bajric, Siviero Agazzi, Patrick J. Malafronte, Mitch DruckerAbstractPurposeTo familiarize clinicians with the clinical and magnetic resonance imaging (MRI) features of a small orbital apex lymphaticovenous malformation that resulted in blindness and evaded timely clinical diagnosis.ObservationsA 68-year-old man presented with severe vision loss due to a 9 mm mass at the apex of the orbit above the optic nerve. When surgically removed 4 years later, the lesion was characterized by vascular spaces of varying size. Larger ones were filled with fibrin and organized thrombi. Stromal septa of endothelial-lined cavernous spaces were partially necrotic and there was evidence of remote hemorrhage. Some endothelial cells expressed D2-40, a marker of lymphatic channels.Conclusionsand importance: Unless a high index of suspicion is maintained for a lymphaticovenous malformation the clinical diagnosis of a small but vision-threatening lesion can be overlooked.
       
  • Vitrectomy for a secondary epiretinal membrane following treatment of
           adult-onset Coats’ disease

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Ayman G. Elnahry, Essam M. Sallam, Kirollos J. Guirguis, Joseph H. Talbet, Ahmed A. Abdel-KaderAbstractPurposeTo report a case of adult-onset Coats’ disease that had worsening of macular edema and progressive macular traction following cryotherapy and repeated intravitreal bevacizumab injections due to formation of a secondary epiretinal membrane which only improved following pars plana vitrectomy and membrane peeling.ObservationsA 35-year-old male presented with diminution of vision in his left eye and was found to have localized telangiectatic retinal vessels and aneurysmal dilatations with massive exudation and cystoid macular edema. He was diagnosed as adult-onset Coats’ disease and treated with cryotherapy and a concomitant intravitreal injection of 2.5 mg bevacizumab followed by 3 monthly intravitreal injections of 2.5 mg bevacizumab and a single injection of 4 mg triamcinolone acetonide. Partial obliteration of the telangiectatic vessels and aneurysmal dilatations with improvement in surrounding lipid and fluid exudate was achieved, however, this was associated with progressive worsening of macular edema and macular traction due to formation of an epiretinal membrane which only improved following vitrectomy and membrane peeling. Effect of therapy at each stage was evaluated using visual acuity testing, fundus examination, fundus fluorescein angiography, and optical coherence tomography.Conclusion and ImportanceA secondary epiretinal membrane can develop following treatment of adult-onset Coats’ disease and cause traction especially when combining cryotherapy with bevacizumab injections. Vitrectomy in such cases with membrane peeling may result in improvement of anatomical and functional outcomes.
       
  • Bilateral consecutive Xen gel stent surgery during pregnancy for
           uncontrolled early-onset primary open angle glaucoma

    • Abstract: Publication date: Available online 11 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Tzukit Zehavi-Dorin, Evan Heinecke, Shivram Nadkarni, Catherine Green, Christine Chen, Yu Xiang George KongAbstractPurposeTo report here a case of uncontrolled glaucoma during third-trimester of pregnancy that was treated successfully with bilateral Xen gel stent insertion.ObservationsA 35-year-old woman presented during the third trimester of pregnancy with bilateral uncontrolled primary open angle glaucoma. Her disc examination and visual fields were consistent with advanced glaucoma. After failed Selective Laser Trabeculoplasty and maximal medical treatment, including Acetazolamide, she was treated with bilateral consecutive Xen stent surgery with successful control of her intraocular pressure.Conclusionsand Importance: The use of Xen implant may have advantages over traditional trabeculectomy, especially during pregnancy, as the procedure is shorter, with less dependence on on-table antimetabolite and being minimally invasive with sparing of the conjunctiva.
       
  • Severe bilateral descemetoceles in Alpha-1 antitrypsin deficiency

    • Abstract: Publication date: Available online 10 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Jeffrey Ma, Jeanine BaqaiAbstractPurposeTo report a case of severe bilateral descemetoceles in a patient with alpha-1 antitrypsin (A1AT) deficiency during intensive care unit hospitalization.Observations A 42-year-old male presented with sub-acute bilateral vision loss during an intensive care unit hospitalization following liver and kidney transplantations. On exam, this patient's best-corrected visual acuity was 20/80 in both eyes. There were bilateral descemetoceles inferotemporally in both eyes with overlying epithelial defects and dense surrounding punctate epithelial staining. The patient was initially treated with gatifloxacin drops and frequent lubricating ointment. Given the concern for impending perforation, cyanoacrylate glue with bandage contact lens was applied to both eyes. His best corrected visual acuity remained unchanged in the right eye and improved to 20/30 in the left eye. Upon medical stabilization, anterior lamellar graft was performed in the right eye, with plans for the same treatment in the left eye in the future.ConclusionsAs A1AT is found in the tear film and is believed to play a role in regulating protease activity in the cornea, we hypothesize that this patient's A1AT deficiency exacerbated the progression of corneal ulceration leading to severe descemetocele formation.
       
  • Ocular coherence tomography for the diagnosis of Descemet's detachment
           after deep sclerectomy and resolution after intracameral air injection

    • Abstract: Publication date: Available online 8 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Abdulrahman AlZaid, Abdulrahman AlDarrab, Rizwan Malik, Ohoud OwaidhahAbstractPurposeto report the use of optical coherence tomography (OCT) in a case of Descemet's membrane detachment (DMD) secondary to a nonpenetrating deep sclerectomy (NPDS) and the efficacy of intracameral air injection for management.ObservationsDMD was identified by anterior segment OCT (AS-OCT) in a 61-year-old male patient who was blind in the right eye and had advanced open angle glaucoma. This patient underwent NPDS in the left eye and developed localized corneal edema postoperatively. Air was injected into the anterior chamber resulting in reattachment of Descemet's membrane and resolution of corneal edema.Conclusionsand Importance: This case highlights the need for a high suspicion of DMD in cases of localized corneal edema after non-penetrating surgery. Following confirmation with AS-OCT, DMD can be successfully managed with air injection. DMD is a rare complication of NPDS with all the reported cases associated with implant. To the best of our knowledge, this is the first case report of NPDS without any type of implant.
       
  • Office-based intravitreal injection of expansile gas for management of
           macular hole in previously vitrectomized eyes

    • Abstract: Publication date: Available online 5 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Michael A. Apolinario, Shaun I.R. Lampen, Tien P. Wong, Christopher R. Henry, Charles C. WykoffAbstractPurposeTo report the successful closure of full-thickness macular hole (MH), using an office-based intravitreal gas injection, in two eyes having undergone prior pars plana vitrectomy (PPV).ObservationsPatient 1 presented with acute loss of visual acuity to 20/300 in the left eye 5 months following PPV for fovea-off rhegmatogenous retinal detachment; MH was confirmed by examination and optical coherence tomography (OCT). 0.6 cc of 100% C3F8 gas was injected, with subsequent MH closure following one week of face-down positioning. Patient 2 presented with right eye visual acuity of 20/60 one month following PPV for optic nerve pit-associated maculopathy; MH was confirmed by examination and OCT. 0.85 cc of 100% C3F8 gas was injected in the office, with subsequent MH closure following one week of face-down positioning.Conclusions and importanceMH management in previously vitrectomized eyes has traditionally been repeat PPV with internal limiting membrane peeling, fluid-air exchange, and expansile gas exchange. Intravitreal gas injection, in an office-based setting, is a viable clinical approach to close MH in some previously vitrectomized eyes.
       
  • Epithelial downgrowth after femtosecond laser-assisted cataract surgery

    • Abstract: Publication date: Available online 2 July 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Han Kim, Michele C. Lim, J. Mark, Esther S. KimAbstractPurposeTo present the case of a 72-year-old female with epithelial downgrowth after femtosecond laser-assisted cataract surgery.ObservationsThe patient previously underwent YAG vitreolysis after uncomplicated femtosecond laser-assisted cataract surgery and presented 1 year later with epithelial downgrowth causing complete pupillary block and severe angle closure glaucoma. Subsequent management with nd:YAG peripheral iridotomies failed rapidly leading to a confusing presentation with a flat anterior chamber and high intraocular pressure ultimately requiring surgical management.Conclusionsand Importance: We describe the occurrence of epithelial downgrowth after femtosecond laser-assisted cataract surgery and illustrate the utility of ultrasound biomicroscopy to differentiate between severe pupillary block and malignant glaucoma.
       
  • In vivo confocal microscopy of verticillata-like paraproteinemic
           keratopathy in a patient with monoclonal gammopathy of uncertain
           significance evolving into smoldering multiple myeloma

    • Abstract: Publication date: Available online 29 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Chiara Chierego, Tommaso Merz, Adriano Fasolo, Neil Lagali, Emilio PedrottiAbstractPurposeTo highlight the utility of in vivo confocal microscopy (IVCM) in the microstructural characterization of corneal deposits resembling vortex keratopathy in a case of secondary deposition keratopathy due to an evolving monoclonal gammopathy.ObservationsA 56-year-old Caucasian woman previously diagnosed with monoclonal gammopathy of undetermined significance (MGUS), exhibited bilateral diffuse sub-epithelial and anterior stromal opacities distributed in a whorl-shaped pattern. IVCM examination permitted analysis of the microstructural features and distribution of the opacities in different corneal layers. Deposits resembling those reported in multiple myeloma rather than MGUS were detected, and the patient's hematologist was subsequently advised to re-evaluate the earlier diagnosis. Two months later, a bone marrow biopsy led to a diagnosis of plasma cell myeloma.Conclusions and importanceIt is suggested that cornea verticillata-like paraproteinemic keratopathy (PPK) in MGUS might be predictive of disease evolution to plasma cell myeloma. Characteristic deposits and morphological features revealed by IVCM may be helpful for non-invasive assessment or screening in patients with hematological disorders.
       
  • Scleral rupture during intraoperative silicone oil injection in pars plana
           vitrectomy

    • Abstract: Publication date: Available online 29 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Ana Laura Domínguez Yates, Jimena Rojas, Mario Joaquín SaraviaAbstractPurposeTo report a single case history of scleral rupture (SR) during silicone oil injection in a pars plana vitrectomy.ObservationsA 60-year-old woman with a history of pathological myopia presented with acute vision loss in her right eye. A retinal detachment, with multiple tears, was diagnosed, and she underwent vitreoretinal surgery. During silicone oil injection, a SR, with extra ocular oil leakage, was advised. Due to the small extent of the lacerated area, the SR was left to spontaneously resolve and, after three surgeries, the retina remained attached, with no internal tamponade, and the patient had not presented symptoms or signs of intracranial migration or toxicity.Conclusionsand importance: During silicone oil injection, it is most important to maintain a controlled eyeball pressure, especially in patients with scleral weakness, and to carefully check the drainage of air, due to the risk of SR. When oil leakage is detected in the orbital cavity, an accurate assessment may be required due to the likelihood of progression inside the intracranial structures.
       
  • Descemet membrane endothelial keratoplasty for endothelial decompensation
           after previous radial keratotomy

    • Abstract: Publication date: Available online 28 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Sruti S. Akella, Roy S. Chuck, Jimmy K. LeeAbstractPurposeTo report Descemet membrane endothelial keratoplasty (DMEK) for endothelial decompensation in an eye with previous radial keratotomy.ObservationsA history of radial keratotomy may hasten endothelial dysfunction. Previously reported surgical treatments include penetrating kerotoplasty and Descemet stripping automated endothelial keratoplasty.Conclusions and ImportanceDMEK may be successfully used in post-RK eyes with good recovery of visual acuity and patient satisfaction.
       
  • Adrenocorticotropic hormone gel for patients with non-infectious uveitis

    • Abstract: Publication date: Available online 22 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Yael Sharon, David S. ChuAbstractPurposeTo describe the potential role of adrenocorticotropic hormone (ACTH) gel treatment in patients with chronic non-infectious uveitis.ObservationsWe report the clinical course of three patients with bilateral, non-infectious anterior and intermediate uveitis, treated with ACTH gel for ≥12 months. All three patients had chronic and steroid-dependent ocular inflammation with subsequent development of ocular complications. Twice-weekly treatment with subcutaneous 80 unit/day ACTH gel was administered, and clinical outcome measures were observed. After a mean period of 14 months, all patients demonstrated significant improvement in disease activity, stable visual acuity, and an absence of side effects. Systemic steroids dosage was successfully reduced from a mean dose of 16 mg/day upon the initiation of ACTH gel treatment to 2 mg/day at last follow up.Conclusions and ImportanceSubcutaneous ACTH gel has shown to be a safe and effective therapy in the management of non-infectious uveitis. Specifically, ACTH gel plays a role in refractory and steroid-dependent cases and in those who do not respond to or are unable to tolerate other immunomodulatory therapies.
       
  • Successful medical management of Pythium insidiosum keratitis using a
           combination of minocycline, linezolid, and chloramphenicol

    • Abstract: Publication date: September 2019Source: American Journal of Ophthalmology Case Reports, Volume 15Author(s): Sayo Maeno, Yoshinori Oie, Atsuko Sunada, Honami Tanibuchi, Shigehiro Hagiwara, Koichi Makimura, Kohji NishidaAbstractPurposeTo report successful medical management of Pythium insidiosum keratitis using an antibiotic combination of minocycline, linezolid, and chloramphenicol.ObservationsA 20-year-old Japanese man was referred for visual disturbance, hyperemia, and discharge from his right eye. Slit-lamp examination revealed a paracentral corneal hyphate ulcer. His visual acuity was 20/28. Smear examination of corneal scrapings revealed a filamentous fungus. Pimaricin ointment four times a day and voriconazole eye drops hourly were initially prescribed. Although intravenous liposomal amphotericin B 100 mg was added, the corneal infiltrates and ulcer worsened. The possibility of P. insidiosum keratitis was considered, and in vitro antifungal susceptibility testing were performed based on the disc diffusion method. The inhibition zones around each antibiotic disc revealed that the pathogen was susceptible to minocycline, linezolid, and chloramphenicol. Therefore, minocycline ointment four times a day, chloramphenicol eye drops hourly, and linezolid 1200 mg orally per day were also administered. Eventually, sequencing of ribosomal DNA confirmed the pathogen to be P. insidiosum. The triple regimen dramatically improved the patient's keratitis. Therapeutic penetrating keratoplasty for corneal perforation was successfully performed, and his visual acuity recovered from 20/2000 to 20/25.Conclusions and importanceWe have encountered a case of P. insidiosum keratitis that responded to a combination of minocycline, linezolid, and chloramphenicol. This triple combination should be considered in patients with P. insidiosum keratitis.
       
  • High fluence PACK-CXL as adjuvant treatment for advanced Acanthamoeba
           keratitis

    • Abstract: Publication date: Available online 20 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Mehrdad Nateghi Pettersson, Neil Lagali, Jes Mortensen, Victor Jofré, Per FagerholmAbstractPurposeTo describe the outcome of adjuvant high fluence photoactivated chromophore for infectious keratitis cross-linking (PACK-CXL) used to treat an advanced form of refractory Acanthamoeba keratitis (AK) diagnosed several months after initial presentation.ObservationsAn otherwise healthy 24-year old female presented with a severe unilateral keratitis. The diagnosis eluded clinicians for several months and when finally confirmed as AK, anti-amoebic therapy was instated and only appeared to be effective after addition of PACK-CXL.Conclusionand importance: In this case of advanced AK, high fluence PACK-CXL treatment given adjuvant to pharmacologic anti-amoebic therapy resulted in lasting pain relief, re-epithelization and eradication of the Acanthamoeba parasite. Given adjuvant to anti-amoebic pharmacotherapy, PACK-CXL might be a useful method for treating typically refractory advanced AK.
       
  • Atypical herpes simplex virus type 2 acute retinal necrosis presentation
           with large subretinal lesion

    • Abstract: Publication date: Available online 20 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Daniel Wang, Justin D. Bloomberg, Lucia Sobrin, Debra Goldstein, Dimitra SkondraAbstractPurposeTo report the unique clinical findings of a case of Herpes Simplex Virus Type 2 herpetic retinitis manifesting as a large elevated subretinal lesion.ObservationsA 26-year-old Hispanic male with no significant past medical history presented with a one-week history of right eye pain and endorsement of worsening vision. Ophthalmic examination of the right eye identified a markedly elevated white subretinal lesion with associated findings of vitritis and hypotony. Ultrasound biomicroscopy demonstrated a diffusely thickened choroid and confirmed the observed subretinal mass. Examination of the fellow left eye was largely unremarkable with the exception of lesions suggestive of inactive chorioretinal scars. Diagnostic vitrectomy and vitreous PCR (polymerase chain reaction) was positive only for HSV-2 (herpes simplex virus type 2) and verified by two independent laboratories. The observed subretinal lesion of right eye improved on intravenous acyclovir and intravitreal foscarnet treatment.Conclusionsand Importance: Presented here is an unusual, novel clinical presentation of HSV-2 acute retinal necrosis manifesting as an elevated subretinal lesion along with findings of panuveitis. This case suggests that consideration should be given to the diagnosis of HSV ARN (acute retinal necrosis) when a subretinal elevation is concomitantly appreciated in the setting of vitritis and chorioretinal lesions.
       
  • Exercise band-induced lens dislocations: A case series

    • Abstract: Publication date: Available online 13 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Luca M. Rosignoli, Kathleen A. Regan, Matthew J. Gray, Collin R. Ohning, Siva S.R. IyerAbstractPurposeWe report three cases of lens dislocation due to ocular trauma from a recoiling exercise band.ObservationsThree patients had closed globe injury resulting in lens dislocation. All had previously undergone intraocular surgeries; two patients were within three weeks of pars plana vitrectomy for retinal detachment repair. Findings included vision loss, hyphema, and increased intraocular pressure refractory to medical management. The retina remained attached post-traumatically in all cases. Lens removal or repositioning resulted in improved vision.Conclusionsand Importance: A recoiling exercise band can cause lens dislocation, hyphema, and ocular hypertension that may require surgical intervention. Our report emphasizes the importance of patient counseling in the perioperative period for the prevention of traumatic complications.
       
  • Atypical posterior pole retinitis

    • Abstract: Publication date: Available online 13 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Parthopratim Dutta Majumder, Saurabh Mistry, Saurabh Luthra, Shrutanjoy M Das, Varsha Sekar, Ekta Rishi, Jyotirmay BiswasAbstractPurposeNecrotizing retinopathy is an uncommon, devastating, potentially blinding condition, which can be seen in both immunocompetent and immunocompromised patients. The purpose of this case is to report a new subset of necrotizing viral retinopathy.ObservationA 34-year old lady presented to our outpatient department with sudden diminution of vision in both eyes following a brief history of viral fever with vesicular rashes. Fundus examination showed areas of necrotizing retinitis in posterior pole involving macula with scattered superficial retinal hemorrhages, cotton-wool spots in both the eyes. She was treated with intravenous acyclovir and oral valacyclovir.Conclusion and importanceOur case may represent a new subset of necrotizing viral retinopathy, which may intermediate the clinical pictures of acute retinal necrosis and progressive outer retinal necrosis.
       
  • Intraocular lens power calculation after radial keratotomy and LASIK - A
           case report

    • Abstract: Publication date: Available online 13 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Chun-Fu Liu, Chi-Chin Sun, Yun-Hsuan Lin, Shu-Yen Peng, Ling YeungAbstractPurposeTo report a challenging intraocular lens (IOL) power calculation case who received both radial keratotomy (RK) and laser-assisted in situ keratomileusis (LASIK).ObservationsA 51-year-old man had received refractive surgery with RK and later enhanced by LASIK more than 20 years ago. He developed severe cataract in left eye with best-corrected visual acuity of 20/100. The IOL power calculation was made using several methods available at the American Society of Cataract and Refractive Surgery (ASCRS) online calculator, including IOL calculation formulas for post-LASIK condition (Shammas, Haigis-L, Barrett True K no history, and Potvin-Hill Pentacam) and formulas for post-RK condition (Double K-modified Holladay 1 based on Oculus Pentacam and IOL Master, and Barrett True K). Haigis-L, Shammas and Barrett true K no history were found to be most accurate in predicting IOL power.Conclusionsand Importance: Haigis-L, Shammas and Barrett true K no history are reliable formulas for IOL power calculation in patients who received both RK and LASIK.
       
  • A modified surgical technique for Descemet's stripping automated
           endothelial keratoplasty (DSAEK) in altered or abnormal anatomy

    • Abstract: Publication date: Available online 13 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Ellen H. KooAbstractPurposeThis paper describes a modified technique for the Descemet's Stripping Automated Endothelial Keratopasty (DSAEK) surgery in eyes with abnormal or altered anatomy. Certain anatomic abnormalities increase the level of surgical complexity, and lead to increased risk of donor lenticule detachment. These challenges include aniridia, abnormal iris, aphakia and hypotony from previous vitrectomy.ObservationsThe Sheets glide was trimmed to 4mm in width and inserted into the clear-corneal wound. The “needle-push"/Fichman glide technique was used to insert the DSAEK donor graft. The modification of the technique involves maintaining the Sheets glide in the eye for the duration of the intraoperative air bubble. After confirming desired orientation of the graft, air was injected into the anterior chamber, creating a large air bubble between the graft and the Sheets glide. After 10 minutes, the Sheets glide was removed, and the main wound was closed.Conclusionsand Importance: This technique overcomes the challenges of posterior air bubble migration and posterior dislocation of the donor lenticule in eyes with altered anatomy.
       
  • Early vitrectomy to reverse macular dragging in a one-month-old boy with
           familial exudative vitreoretinopathy

    • Abstract: Publication date: Available online 11 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Akiko Iwata, Shunji Kusaka, Mayumi Ishimaru, Hiroyuki Kondo, Kazuki KuniyoshiAbstractPurposeVitrectomy is usually only indicated for familial exudative vitreoretinopathy (FEVR) cases with progressive retinal folds or macular dragging. In this report, we present our experience reversing the progression of macular dragging by performing early eye vitrectomies in a 1-month-old male baby with FEVR.ObservationsA 7-day-old, full-term male baby was examined by a pediatric ophthalmologist. His sister had a laser ablation treatment after being diagnosed with FEVR. The ophthalmologist found the baby had avascular retinas, fibrovascular membranes, and vitreous hemorrhages in both eyes, and performed retinal photocoagulations the next day. Although the retinal folds had not yet formed, the arcade vessels began to linearize after the procedure, strongly suggesting disease progression. Therefore, we performed lens-sparing vitrectomies in both eyes on the twenty-ninth day of life. After surgery, the macular dragging reversed, as evidenced by vascular arcade angle measurements. Three years after the surgery, the boy's visual acuity was 0.4 in both eyes.Conclusionsand Importance: In this case, we believe the good postoperative outcomes were due to early vitrectomies before the vitreoretinal traction became severe. In addition, the retinal photocoagulation performed on the eighth day of life may have reduced disease activity, at least partially. This case highlights the importance of prompt diagnosis and appropriate treatment of FEVR.
       
  • Contralateral amaurosis after a retrobulbar block

    • Abstract: Publication date: Available online 7 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Blake Williams, Sidney A. Schechet, Ishani Hariprasad, Hassan Shah, Liliya Golas, Seenu M. HariprasadAbstractPurposeTo describe and discuss the workup and management of a rare complication of retrobulbar anesthesia, as well as CT and MRI findings of this complication.ObservationsThe patient underwent uncomplicated pars plana vitrectomy with membrane peel for epiretinal membrane removal. Shortly after completion of the surgery, the patient noted that he could not see out of his non-operated eye. Visual acuity was bare hand motion, and physical exam revealed a dilated, non-reactive pupil with normal, well-perfused retina. Imaging revealed an air bubble in the optic nerve of the operated eye, suggesting penetration of the optic nerve sheath during retrobulbar block with posterior spread of anesthetic to the contralateral optic nerve.Conclusions and importanceAfter imaging ruled out acute intracranial pathology and confirmed the correct diagnosis, the patient was monitored until vision in the non-operated eye returned to baseline. Excellent visual acuity was attained in the operated eye. Central spread of anesthetic after retrobulbar anesthesia is a rare but potentially life-threatening complication that must be promptly addressed and diagnosed.
       
  • Spectral optical coherence tomography findings in an adult patient with
           syphilitic bilateral posterior uveitis and unilateral punctate inner
           retinitis

    • Abstract: Publication date: Available online 7 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Ariel Schlaen, María Paula Aquino, María Soledad Ormaechea, Cristóbal Couto, Mario SaraviaAbstractPurposeTo describe the spectral domain optical coherence tomography (SD-OCT) features of a punctate inner retinitis, a rare ocular manifestation of syphilis, in an HIV positive adult patient.ObservationsIn the right eye, SD-OCT images during the active period showed hyperreflectivity of the full thickness of the inner retina, precluding the individualization of the layers. In addition, multifocal areas with higher hyperreflectivity were identified within the affected retina. Once the lesion became inactive, SD-OCT images revealed inner retina layers atrophy, disruption of the ellipsoid layer, and multifocal damage to the retinal pigment epithelium layer.Conclusionand importance: Punctate inner retinitis affects the full thickness retina, leading to severe retinal damage, along with multifocal damage of the retinal pigment epithelium. The multifocal white retinal lesions observed within the affected retinal area correlated with the presence of intense hyperreflective dots within the retina showed by SD-OCT. These lesions are deeper than was described in other reports.
       
  • “Pacman” invasion of the retina: Two cases of ophthalmomyiasis
           interna posterior

    • Abstract: Publication date: Available online 6 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Omar S. Punjabi, David J. Browning, Loraine Clark, Andrew N. AntoszykAbstractPurposeTo discuss two striking cases of ophthalmomyiasis interna posterior, in which the larval stage of a botfly is found in the posterior segment.ObservationsIn the first case, the subretinal maggot is alive and found to be migrating under the retina. The maggot was lasered in the office and killed. In the second case, a dead maggot was discovered in the subretinal space in a child, after it had caused significant subretinal scarring and permanent vision loss.Conclusionsand Importance: Ophthalmomyiasis is a rare condition that can often be unrecognized and result in permanent vision loss. Early diagnosis and photocoagulation of the larva (if alive) can halt progression of vision loss in these cases.
       
  • Femtosecond laser-assisted cataract surgery in patients with zonular
           weakness

    • Abstract: Publication date: Available online 6 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Olivia Dryjski, Abdelhalim Awidi, Yassine J. DaoudAbstractPurposeTo present the clinical value of femtosecond laser assisted cataract surgery (FLACS) in eyes with compromised zonules.ObservationsWe present two cases of femtosecond laser assisted cataract surgery (FLACS) in eyes with compromised zonules. Three eyes from two patients with zonular weakness and cataract underwent FLACS (Alcon LenSx Lasers Inc., Aliso Viejo, CA). One patient underwent bilateral FLACS in the setting of spherophakia with zonular weakness. The other patient had Marfan's syndrome with associated ectopia lentis. Laser assisted capsulotomy was achieved in all eyes. One eye had vitreous prolapse during surgery and required an iris-sutured lens. All eyes had a postoperative corrected distance visual acuity of 20/25 or better.Conclusionsand Importance: FLACS is a safe and effective alternative to conventional phacoemulsification cataract surgery in patients with zonular weakness.
       
  • Achiasma and Kapur-Toriello syndrome: Two rare entities

    • Abstract: Publication date: Available online 5 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Grant A. Justin, Keith E. Earley, Justin G. Peacock, Aaron D. GrantAbstractPurposeDescribe a unique case of achiasma in a patient with Kapur-Toriello syndrome.ObservationsWe provide a brief review of achiasma with common findings on examination and imaging studies, and a published classification system. In addition, consistent with the rare Kapur-Toriello syndrome, he had a right unilateral cleft lip and palate, neurologic abnormality in his achiasma, anal atresia, vesicoureteral reflux, hypospadias, and growth deficiency.Conclusionsand Importance: Achiasma is an incredibly rare neurological deficit and we present the first case of achiasma in Kapur-Toriello syndrome.
       
  • A unique case of vision loss in a patient with hypotrichosis and juvenile
           macular dystrophy and primary ciliary dyskinesia

    • Abstract: Publication date: Available online 5 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Kenneth C. Fan, Nimesh A. Patel, Nicolas A. Yannuzzi, Supalert Prakhunhungsit, Catherin I. Negron, Elisa Basora, Andrew A. Colin, Mustafa Tekin, Audina M. BerrocalAbstractPurposeWe describe a unique case of CDH3-related hypotrichosis with juvenile macular dystrophy (HJMD) and DNAH5-related primary ciliary dyskinesia (PCD) with progressive vision loss in a young Indian female without positive family history. Both mutations in this patient have not been previously described in the literature.ObservationsAn 11-year-old girl of Indian descent from a consanguineous family presented to our clinic with poor central visual acuity, recurrent sinopulmonary infections, hypotrichosis, and gradual hearing loss. Fundus examination was significant for atrophic retinal pigmented epithelial (RPE) changes involving both the macula and periphery of both eyes with central foveal hypoautofluorescence. Optical coherence tomography (OCT) demonstrated RPE loss and significant disruption of the ellipsoid layer in both eyes. Full-field electrophysiology tests on initial presentation demonstrated low cone amplitude reduced to  C; p. Thr554Pro and DNAH5 c.6688-1G>T.Conclusionand Importance: We report two novel variants in the CDH3 and DNAH5 genes that are important for future mutational analysis of both HJMD and PCD respectively. A relationship between the cadherin protein dysfunction in CDH3 mutations and the ciliopathy of DNAH5 mutations has not been established. HJMD is known to cause a longitudinal deterioration of cone and rod mediated function, therefore recognizing the symptoms, visual impairment, physical examination, and photographic and electrophysiological findings is crucial in counseling the patient, the family, and fellow clinicians.
       
  • Ciliochoroidal effusion syndrome with central serous-like
           chorioretinopathy and secondary angle closure following exogenous
           testosterone use

    • Abstract: Publication date: Available online 5 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Daniel Brill, Desiree Albert, Taylor Fields, Shravani Mikkilineni, David Crandall, Hua GaoAbstractPurposeTo report a unique presentation of ciliochoroidal effusion syndrome with central serous-like chorioretinopathy and secondary angle closure following exogenous testosterone use.ObservationsA 37 year-old man presented with a two week history of blurred vision, elevated intraocular pressure, and myopic shift in his right eye. Gonioscopy showed angle closure. After YAG iridotomy, ultrasound biomicroscopy (UBM) showed ciliochoroidal effusion and anterior rotation of the ciliary processes. Subsequent color fundus photography, enhanced depth imaging optical coherence tomography (EDI-OCT) and near-infrared reduced-illuminance autofluorescence imaging (NIR-RAFI) showed macular striae, choroidal folds, and increased choroidal thickness without presence of subretinal fluid (SRF) or pigment epithelial detachment (PED). Further questioning revealed the patient was using dermal testosterone gel for six months for treatment of hypogonadism. The patient was advised to stop testosterone, and his visual acuity and intraocular pressure significantly improved six weeks later. Follow-up UBM showed significant improvement of the ciliochoroidal effusion, and repeat multimodal images demonstrated resolution of the macular striae and choroidal folds, and slightly improved choroidal thickness.Conclusions and importanceOur patient demonstrates a rare case of ciliochoroidal effusion, central serous-like chorioretinopathy, and secondary angle closure that dramatically improved with cessation of testosterone. We believe that this unique clinical constellation is the first to be reported associated with exogenous testosterone use.
       
  • Systemic anti-CD20 (rituximab) as primary treatment for symptomatic
           primary uveal lymphoma

    • Abstract: Publication date: Available online 5 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Honeylen Maryl Tiu Teo, Süleyman Çiftçi, Victor Maurice Elner, Hakan DemirciAbstractPurposeUveal lymphomas are indolent, frequently choroid-involving neoplasms that are mainly CD20-positive B-cell extranodal marginal zone lymphoma. Irreversible visual loss may occur from retinal detachment and/or glaucoma among untreated symptomatic patients, or from radiation-induced changes secondary to external beam radiotherapy. To avoid radiation-induced complications, we used systemic rituximab monotherapy as primary treatment, and present two cases to show its long-term effectiveness for symptomatic primary uveal lymphoma.ObservationsTwo elderly men who presented with painless blurred vision were clinically diagnosed with symptomatic primary uveal lymphoma, which were biopsy-confirmed to be marginal zone lymphoma. Both patients with symptomatic, primary marginal zone uveal lymphoma that appeared as multiple yellow, nummular choroidal infiltrates, had complete ocular remission after three and one cycles of systemic rituximab monotherapy (375mg/m2 infused intravenously once weekly for four consecutive weeks), with disappearance of the lesions and improvement of visual acuity. Both patients tolerated systemic monotherapy well without any adverse systemic or ocular effects. There was no local ocular recurrence at 29 and 39 months after the last treatment.Conclusionsand Importance: Systemic rituximab monotherapy induced complete ocular remission and improved visual acuity, without adverse effects, and without local ocular recurrence of uveal lymphoma 29–39 months following the last treatment. To our knowledge, this is the first manuscript to show long-term effectiveness of systemic rituximab monotherapy as the primary treatment for symptomatic primary uveal lymphoma. Long-term follow-up of this indolent neoplasm is still imperative to monitor its ocular and systemic course.
       
  • Long-term outcomes of riboflavin photodynamic antimicrobial therapy as a
           treatment for infectious keratitis

    • Abstract: Publication date: Available online 1 June 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Jaime D. Martinez, Alejandro Arboleda, Andrea Naranjo, Mariela C. Aguilar, Heather Durkee, Pedro Monsalve, Sander R. Dubovy, Kendall E. Donaldson, Darlene Miller, Guillermo Amescua, Jean-Marie ParelAbstractPurposeTo report the long-term outcomes of three patients with infectious keratitis treated with riboflavin photodynamic antimicrobial therapy (PDAT).ObservationsCase series reporting three patients with infectious keratitis unresponsive to standard medical treatment who underwent riboflavin photodynamic antimicrobial therapy (PDAT) as an adjunct therapy. One male and two female patients were treated, the median age of presentation was 58 years (range, 29–79 years). The organisms isolated and treated were Pseudomonas aeruginosa, Mycobacterium chenolae, and Curvularia spp. Different risk factors to develop corneal infection ulcers were identified, including corneal abrasion in a contact lens user, history of penetrating keratoplasty with chronic use of topical corticosteroids, and organic trauma. The median follow-up was 47 months (range 37–54 months), and there were no complications secondary to riboflavin PDAT treatment. Two cases underwent optical penetrating keratoplasty after infection was resolved and ocular surface was quiet for at least 3 years.Conclusionsand importance: Riboflavin PDAT can be used as an adjunct treatment in infectious keratitis to strengthen the corneal collagen fibers, delay keratolysis, and allow more time for antimicrobials to work and this way prevent a corneal perforation.
       
  • Pars plana vitrectomy with intraoperative optical coherence tomography for
           sub-internal limiting membrane fibrosis excision in a child with Terson
           syndrome: Surgical and pathological correlation

    • Abstract: Publication date: Available online 31 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Rehan M. Hussain, Sander R. Dubovy, Xiao Yi Zhou, Stephen G. Schwartz, Victor M. VillegasAbstractPurposeTo report the intraoperative optical coherence tomography (OCT)-guided surgery of a consolidated sub-internal limiting membrane (ILM) hemorrhage that developed into a sub-ILM fibrotic membrane in a child with a history of Terson syndrome.ObservationsA one year-old boy with a history of Terson syndrome due to a motor vehicle accident presented three months after trauma with a white feather-shaped membrane in the left macula. Preoperative OCT showed a preretinal hyperreflective tissue at the foveal center. The patient underwent pars plana vitrectomy. After separation of the posterior hyaloid, intraoperative OCT did not show any change in structural components. After peeling the ILM, the fibrotic membrane persisted. A bent 30-gauged needle was used to create a plane of dissection in the adherent sub-ILM membrane, which was then peeled with ILM forceps without complication. Post-operative OCT confirmed complete excision without evidence of macular edema. Pathology results indicated presence of fibrocellular tissue that contained hemosiderin, consistent with old organized hemorrhage as a component of the membrane.Conclusionand importance: Sub-ILM hemorrhage may persist as a tautly adherent fibrotic membrane that can mimic the appearance of an epiretinal membrane or a chronic subhyaloidal hemorrhage during examination, especially in young children. Intraoperative OCT may aid in select complex macular surgery cases to better delineate the planes of dissection during sub-ILM fibrosis excision.
       
  • Familial exudative retinopathy TSPAN12 positive presenting as bilateral
           retinal stalks: Late structural and functional findings

    • Abstract: Publication date: Available online 31 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Giulia M. Amorelli, Marco H. Ji, Lorenzo Orazi, Fernando Molle, Domenico Lepore
       
  • Pseudozyma aphidis endophthalmitis post-cataract operation: Case
           discussion and management

    • Abstract: Publication date: Available online 31 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Shong Min Voon, Arlo Upton, Deepak GuptaAbstractPurposeTo present a case of fungal endophthalmitis with a novel organism and our management.ObservationsA 46 year old male presented with delayed-onset acute endophthalmitis 6 weeks after routine phacoemulsification and intraocular lens implantation. Initial treatment with intravitreal antibiotics did not improve his condition. With repeated vitreal taps, the causative organism was eventually identified as a fungus, Pseudozyma aphidis. Treatment with oral and intravitreal voriconazole, as well as pars plana vitrectomy, led to resolution of the endophthalmitis and recovery of vision to 20/25.Conclusionsand Importance: Fungal endophthalmitis is a rare, potentially blinding complication of cataract surgery. We report our approach to this previously unreported organism, that led to an excellent visual outcome. There are no specific guidelines for fungal endophthalmitis. The management approach has to be tailored to the clinical response and emerging laboratory data from the microbiologist. Identification of the organism will require specialist laboratory references that may not be available in all hospitals. Ophthalmologists must work closely with microbiologists in order to ensure an optimal outcome.
       
  • Bilateral pulmonary emboli following macular hole surgery with
           postoperative prone positioning

    • Abstract: Publication date: Available online 30 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Daniel A. Brill, Taylor S. Fields, Anjali U. Badami, Alexander J. Kuley, Nitin Kumar, Uday R. DesaiAbstractPurposeTo report a rare case of bilateral pulmonary emboli following pars plana vitrectomy with postoperative prone positioning.ObservationsA 60 year-old female presented with a four-month history of unilateral distorted vision. Ocular coherence tomography revealed a full thickness macular hole. Two weeks later, the patient underwent a 23-gauge pars plana vitrectomy with internal limiting membrane peeling and 12% perfluoropropane gas tamponade. Postoperatively, she completed two weeks of prone positioning. Five days later, she presented with a two day history of abdominal pain and shortness of breath. Computed tomography pulmonary angiography revealed bilateral pulmonary emboli. The patient received six months of anticoagulation to prevent further thromboembolic events.Conclusionsand Importance: Life threatening blood clots can form due to prolonged immobilization from prone positioning. Patients should be educated to perform light exercise postoperatively to prevent complications of blood stasis.
       
  • Case of isolated Rhizobium radiobacter contact lens-related infectious
           keratitis: A plant microbe now emerging as a human pathogen

    • Abstract: Publication date: Available online 30 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Beau J. Fenner, Ashish Kumar, Nicholas Y.Q. Tan, Marcus AngAbstractPurposeTo report a case of contact lens-related infectious keratitis caused by the Gram-negative plant pathogen Rhizobium radiobacter.ObservationsA 26-year old lady with history of contact lens use presented with three weeks history of right eye redness and pain, with the left eye also being involved in the past week. Slit lamp examination of the right eye demonstrated multiple faint subepithelial and stromal infiltrates with no overlying epithelial defect, and no anterior chamber activity. Anterior segment optical coherence tomography demonstrated multiple hyper-reflective foci scattered at various depths of the corneal stroma. Corneal scrapings grew Rhizobium radiobacter, and culture-directed antibiotic therapy with topical gentamicin and levofloxacin resulted in slow clinical improvement of the R. radiobacter keratitis without visual sequelae.Conclusions and importanceWe have described the clinical features, microbial susceptibilities, and response to treatment in a case of R. radiobacter infectious keratitis.R. radiobacter has recently emerged as a source for several ocular and systemic infections and was identified in a series of polymicrobial keratitis cases. Our case report of monomicrobial R. radiobacter keratitis adds to the sparse literature on this uncommon but potentially sight-threatening infection.
       
  • Keratoglobus with ARCL1B (EFEMP2 gene) cutis laxa

    • Abstract: Publication date: Available online 30 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Thomas F. Mauger, Chantelle L. Mundy, Tyler D. Oostra, Pratik J. PatelAbstractPurposeTo report a case of keratoglobus in a patient with autosomal recessive (AR) cutis laxa.ObservationsA 38 year old male presented with decreased vision in both eyes uncorrectable with spectacles and a history of corneal rupture in the left eye from incidental trauma a decade prior. His ocular exam was consistent with Keratoglobus. His medical and family history indicated AR cutis laxa.Conclusionsand Importance: We believe that this is the first reported case of Keratoglobus associated with cutis laxa.
       
  • Bilateral methamphetamine-induced ischemic retinopathy

    • Abstract: Publication date: Available online 22 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Jingli Guo, Wenyi Tang, Wei Liu, Yongjin Zhang, Ling Wang, Wenji WangAbstractPurposeTo describe the multimodal imaging and treatment of a 37-year-old male presenting with bilateral ischemic retinopathy induced by methamphetamine abuse.ObservationsA 37-year-old male presented with progressively deteriorating vision and was found to have branch retinal artery occlusion and central retinal vein occlusion in both eyes along with secondary vitreous hemorrhage in the left eye following seven years of intermittent intranasal methamphetamine abuse. Fundus fluorescein angiography and optical coherence tomography angiography revealed large areas of non-perfusion in the peripheral retina along with peripapillary neovascularization. Systemic evaluation revealed ischemic foci scattered in the deep brain on magnetic resonance angiography scanning. Based on the retinal findings, the patient was diagnosed with methamphetamine-induced ischemic retinopathy. He received panretinal photocoagulation, which improved the vision in the right eye and vitreous hemorrhage in the left eye. The vision in the left eye remained stable.Conclusions and importanceThis case highlights that intranasal methamphetamine abuse is associated with bilateral simultaneous central retinal vein occlusion and branch retinal artery occlusion. To our knowledge, extensive bilateral ischemic retinopathy has not been documented previously with newer modalities. In addition, PRP may be considered for the treatment of ischemic retinopathy induced by methamphetamine abuse.
       
  • Orbital cholesterol granuloma: A report and discussion of orbital findings

    • Abstract: Publication date: Available online 21 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Andrew J. Rong, Benjamin P. Erickson, Nathan W. Blessing, Sander R. Dubovy, Bradford W. LeeAbstractPurposeTo report a case of orbital cholesterol granuloma and discuss the orbital findings seen in this entity.ObservationA 38-year-old male presented with an 8-month history of progressive left upper lid ptosis and hypoglobus. Clinical examination was significant for 3 mm of hypoglobus and restricted supraduction in the left eye. Contrasted computed tomography imaging revealed a well-circumscribed lesion in the superotemporal orbit causing extensive bone erosion that appeared to arise from the lacrimal gland. An incisional biopsy was performed, and histopathological evaluation demonstrated fibrovascular tissue surrounding a mixture of histiocytes and cholesterol clefts, consistent with a cholesterol granuloma.Conclusions and importanceOrbital cholesterol granulomas are rare lesions that are predominantly found in the superotemporal orbit. These lesions can be associated with marked bony changes in the superotemporal fossa that can be mistaken for a lacrimal gland neoplasm; however, bony erosion is a hallmark of this lesion and should be considered on the differential diagnosis of any lacrimal gland mass with extensive bony erosion.
       
  • Monoclonal gammopathy of “ocular” significance

    • Abstract: Publication date: Available online 20 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Sezen Karakus, John D. Gottsch, Patrizio Caturegli, Allen O. EghrariAbstractPurposeDiagnostic criteria for monoclonal gammopathy of undetermined significance (MGUS) do not currently include ocular phenotypic changes. Here, we offer a new diagnostic approach that is useful in patients with posteriorly located corneal depositions and present evidence to support the theory that the aqueous humor is a source for monoclonal proteins accumulated in the cornea.ObservationsA 77-year-old woman presented to the clinic with a gradual decrease in visual acuity over 6 months. Slit lamp examination revealed bilateral central guttae consistent with Fuchs corneal dystrophy, peripheral circular band-like corneal opacities in the deep stroma, and bilateral nuclear sclerotic and cortical cataracts. Anterior segment optical coherence tomography confirmed corneal opacities in the posterior stroma and Descemet membrane. Immunological studies revealed increased serum IgG levels of 3220 mg/dL and serum electrophoresis showed an abnormal monoclonal band of 2.4 g/dL identified as IgG lambda by immunofixation electrophoresis. The patient was referred to the hematology clinic where she underwent further systemic workup and was diagnosed with MGUS. Immunofixation electrophoresis of aqueous sampling, which was performed at the time of cataract surgery, confirmed the presence of the IgG lambda gammopathy in the anterior chamber.Conclusionsand Importance: Monoclonal gammopathy, although rare, should be included in the differential diagnosis of corneal opacities, as the ocular finding can be the initial manifestation of a systemic disease that can potentially be life-threatening. When corneal biopsy is not feasible due to the location of corneal pathology, aqueous sampling may be an alternative approach towards a clinical diagnosis. We propose a new terminology, “monoclonal gammopathy of ocular significance,” for patients diagnosed with MGUS, however, their only significant clinical finding is ocular manifestation.
       
  • Real-time polymerase chain reaction in recurrent cytomegalovirus anterior
           uveitis

    • Abstract: Publication date: Available online 20 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Vinita Girish Rao, M.K. Janani, Jyotirmoy BiswasAbstractPurposeCytomegalovirus (CMV) has been reported to cause anterior uveitis in the immunocompetent people. Recurrence of this viral uveitis poses a mangement dilemma. With real-time polymerase chain reaction(PCR), it is possible to confirm the clinical diagnosis. We report a case of recurrent CMV anterior uveitis documented by real-time PCR.ObservationsA 42 year old man developed PCR proven CMV anterior uveitis. It resolved with oral and topical antivirals but recurred after ten months. The recurrence was controlled by restarting the oral antivirals. Real-time PCR was used to sequentially document the inital infection, the subsequent resolution and the recurrence of the infection.Conclusionsand Importance: Real-time PCR is a useful tool in the management of CMV anterior uveitis.
       
  • Classification and treatment follow-up of a juxtapapillary retinal
           hemangioblastoma with optical coherence tomography angiography

    • Abstract: Publication date: Available online 20 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Lisette M. Smid, Koen A. van Overdam, Valentina Davidoiu, Jan H. de Jong, Johannes F. de Boer, Koenraad A. Vermeer, Mirjam E.J. van VelthovenAbstractPurposeOnly an endophytic growth pattern in juxtapapillary retinal hemangioblastoma (JRH) is an indication for surgical treatment, but classification of growth types is difficult using conventional imaging techniques. This case report describes the use of optical coherence tomography angiography (OCT-A) features for classification and treatment follow-up in a case with JRH.ObservationsThe JRH of this patient was easily detected with two different OCT-A methods in both en-face and cross-sectional B-scan images, and was classified as a sessile growth type. This growth type excluded the treatment option of vitreoretinal surgery with excision of the lesion or ligation of the feeder vessels. The patient was treated multiple times with intravitreal bevacizumab. Treatment follow-up with OCT-A initially revealed a stable extent of the JRH, with some slight flow deviations in en-face visualization, followed by a period of progressive growth of the lesion.Conclusionsand Importance: OCT-A revealed the depth localization of the JRH and seems to be a valuable tool for JRH classification. Detailed classification may be useful when surgery is considered as a treatment strategy. Furthermore, treatment follow-up is possible with OCT-A, although imaging artifacts should be taken into account.
       
  • Neurotrophic keratitis after micropulse transscleral diode laser
           cyclophotocoagulation

    • Abstract: Publication date: Available online 20 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Claudio I. Perez, Ying Han, Jennifer Rose-Nussbaumer, Yvonne Ou, Yen C. HsiaAbstractPurposeTo report two cases of neurotrophic keratitis (NK) after micropulse transscleral cyclophotocoagulation (MP-TCP).ObservationsTwo patients with predisposing factors for decreased corneal sensation developed NK 1 month after MP-TCP. Both patients did not heal with initial treatment with topical antibiotic and preservative free artificial tears. One patient required use of a bandage contact lens and the other patient required tarsorrhaphy. Both eyes experienced recurrence of NK.Conclusionsand importance: NK can be triggered after MP-TCP in patients with underlying predisposing factors for decreased corneal sensation. This uncommon but vision-threatening complication should be discussed preoperatively with high-risk patients as a possible adverse event after MP-TCP and followed closely postoperatively.
       
  • Utility of en-face imaging in diagnosis of occult macular dystrophy with
           RP1L1 mutation: A case series

    • Abstract: Publication date: Available online 9 May 2019Source: American Journal of Ophthalmology Case ReportsAuthor(s): Merry ZC. Ruan, S. Amal Hussnain, Amanda Thomas, Mahesh Mansukhani, Stephen Tsang, Lawrence YannuzziAbstractPurposeTo report en-face imaging findings at the level of ellipsoid zone (EZ) in two cases of occult macular dystrophy (OMD) with retinitis pigmentosa 1-like 1 (RP1L1) p.Arg45Trp mutation.ObservationsIn both patients who presented with decreased vision, pupillary examination, intraocular pressure, and anterior examination were normal. Ophthalmoscopic examination showed prominent choroidal marking whereas fundus autofluorescence was unremarkable. Spectral domain optical coherence tomography (SD-OCT) showed subtle gaps between EZ and retinal pigment epithelium (RPE). The photoreceptor disruption became more evident with en-face imaging at the EZ plane.Conclusionsand Importance: This is a report of two patients with EZ en-face imaging that aided in the diagnosis of OMD where other structural imaging was largely unremarkable. The en-face imaging modality can also be used to monitor OMD progression.
       
 
 
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