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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 332, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 129, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 345, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 309, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 158, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Ophthalmology Case Reports
  [3 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Online) 2451-9936
   Published by Elsevier Homepage  [3043 journals]
  • Tuberculous uveitis presenting as pigmented hypopyon – A case report

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

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

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

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

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

      PubDate: 2017-06-09T12:12:45Z
      DOI: 10.1016/j.ajoc.2017.06.002
      Issue No: Vol. 7 (2017)
       
  • A novel clinical sign in intraocular tuberculosis: Active chorioretinitis
           within chorioretinal atrophy

    • Authors: Avinash Pathengay; Bhavik Panchal; Himadri Choudhury; Soumyava Basu; Nidhi Relhan; Harry W. Flynn
      Pages: 59 - 61
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 7
      Author(s): Avinash Pathengay, Bhavik Panchal, Himadri Choudhury, Soumyava Basu, Nidhi Relhan, Harry W. Flynn
      Purpose To report a novel clinical sign in patients with intraocular tuberculosis. The current study is an observational consecutive case series of patients diagnosed with intraocular tuberculosis managed at a tertiary eye care centre from June 1, 2012 to December 31, 2015. Observations The diagnosis of intraocular tuberculosis was made in 6 patients based on ocular features suggestive of tuberculosis along with a positive tuberculin skin testing and chest X-ray consistent with tuberculosis. All patients presented with decreased visual acuity ranging from 20/25 to 20/400, anterior chamber reaction, vitritis, multifocal choroiditis and vasculitis. All patients had an area of active chorioretinitis within the zone of pre-existing chorioretinal atrophy, apart from various other signs suggestive of intraocular inflammation. All patients were started on anti-tubercular therapy for a period of 9 months alone or in combination with oral corticosteroids tapered over 3–4 months. A prompt response to the treatment with resolution of chorioretinitis within the chorioretinal atrophy occurred in all patients. In addition, there was resolution of vitritis and improvement in the visual acuity ranging from 20/20 to 20/40 at last follow-up. Conclusions and Importance: Active chorioretinitis within an area of chorioretinal atrophy is a novel clinical sign that may indicate intraocular tuberculosis.

      PubDate: 2017-07-31T08:18:55Z
      DOI: 10.1016/j.ajoc.2017.06.001
      Issue No: Vol. 7 (2017)
       
  • Poor prognosis of elderly individuals >80 years of age with acute
           retinal necrosis

    • Authors: Ryoji Yanai; Daisuke Harada; Sho-Hei Uchi; Chiemi Yamashiro; Tomoko Orita; Koh-Hei Sonoda; Kazuhiro Kimura
      Pages: 107 - 112
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 7
      Author(s): Ryoji Yanai, Daisuke Harada, Sho-Hei Uchi, Chiemi Yamashiro, Tomoko Orita, Koh-Hei Sonoda, Kazuhiro Kimura
      Purpose To report the clinical features and prognosis of acute retinal necrosis (ARN) in elderly (>80 years of age) individuals. Methods Six consecutive patients with unilateral ARN who attended the Department of Ophthalmology at Yamaguchi University Hospital between 2014 and 2015 were retrospectively reviewed. Clinical characteristics, causative virus, time from symptom onset to physician visit, visual acuity at presentation and final visit, and treatment were evaluated and compared between the three elderly and three middle-aged (<80 years) patients. Results Varicella zoster virus (VZV) DNA was detected in aqueous humor by the polymerase chain reaction in all six cases. The mean ± SD time between symptom onset and medical attention was 18.0 ± 8.7 and 8.3 ± 1.5 days in the elderly and middle-aged groups, respectively. All patients were treated with intravenous aciclovir, oral prednisolone, and a nonsteroidal anti-inflammatory drug, and five of the six patients also received oral valaciclovir and underwent vitrectomy. The final best corrected visual acuity of the affected eye was worse for the elderly patients (20/400, hand motion, and light perception negative) than for the middle-aged patients (20/15, 20/50, and 20/25). Conclusions and importance ARN in the elderly individuals of the present study was caused by VZV infection and associated with a poorer visual prognosis compared with that of middle-aged patients. A delay in the onset of antiviral treatment might contribute to the poor prognosis of elderly patients with ARN.

      PubDate: 2017-07-31T08:18:55Z
      DOI: 10.1016/j.ajoc.2017.06.014
      Issue No: Vol. 7 (2017)
       
  • Reversal of cilioretinal artery occlusion with intra-arterial tissue
           plasminogen activator

    • Authors: Andrew J. McClellan; Harry W. Flynn; Eric C. Peterson; Norman J. Schatz
      Pages: 138 - 139
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 7
      Author(s): Andrew J. McClellan, Harry W. Flynn, Eric C. Peterson, Norman J. Schatz
      Purpose To present the reversal of a cilioretinal artery occlusion with the use of intra-arterial tissue plasminogen activator. Observations A monocular 74 year old male presented with a cilioretinal artery occlusion. Treatment with intra-arterial tissue plasminogen activator 7 hours after the onset of symptoms led to a complete restoration of vision. Conclusions and importance Early intervention with tissue plasminogen activator reversed acute onset loss of vision from cilioretinal artery occlusion.

      PubDate: 2017-07-13T14:41:38Z
      DOI: 10.1016/j.ajoc.2017.07.002
      Issue No: Vol. 7 (2017)
       
  • A unique case of valsalva retinopathy in a conch blower

    • Authors: Rajya L. Gurung
      Pages: 140 - 142
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology Case Reports, Volume 7
      Author(s): Rajya L. Gurung
      Purpose Valsalva hemorrhagic retinopathy is a form of preretinal hemorrhage that develops after a valsalva maneuver, leading to rupture of the superficial retinal capillaries. Here, we report a case of valsalva retinopathy secondary to blowing a conch, the first case report of its kind. The patient blew conch, which was part of his daily ritual to pray to God as he was a Hindu priest. Observations A 58-year-man developed an acute decrease in vision to 5/60 in his right eye after blowing the conch while performing “Puja,” which is the act of praying to God in Hindu culture. Ophthalmoscopy showed a fresh preretinal hemorrhage over the macula in his right eye. YAG laser membranotomy was performed, and his vision returned to 6/6. Conclusion and Importance Conch “Shankha” is a religious instrument used routinely in Hindu culture. Its mechanism is very much similar to that of a wind instrument. This is the first case report of valsalva retinopathy caused by conch blowing.

      PubDate: 2017-07-13T14:41:38Z
      DOI: 10.1016/j.ajoc.2017.07.003
      Issue No: Vol. 7 (2017)
       
  • Antiphosphospholipid syndrome presenting with amaurosis fugax and cotton
           wool spots

    • Authors: Kimberly D. Tran; Sarah P. Read; Nimesh A. Patel; Harry W. Flynn; Norman J. Schatz
      Pages: 143 - 145
      Abstract: Publication date: Available online 8 July 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Kimberly D. Tran, Sarah P. Read, Nimesh A. Patel, Harry W. Flynn, Norman J. Schatz
      Purpose To describe the importance of considering vaso-occlusive disease on the differential diagnosis of a patient presenting with amaurosis fugax (AF) and unilateral cotton wool spots (CWS). Observations A 69-year-old female with history of obesity, hyperlipidemia and recent orthopaedic surgery, presented with 3 days of worsening monocular AF and CWS in the right eye. She was diagnosed with antiphosphospholipid syndrome based on positive serologic testing for antiphosphatidylserine IgM, anticardiolipin IgM. The patient was treated with lipid lowering medication, long-term aspirin, and has followed a weightloss and physical therapy program under medical supervision. The CWS resolved and AF symptoms have not recurred. Conclusions and importance Antiphospholipid syndrome can be considered in the differential diagnosis of patients presenting with AF, assymetric CWS, and/or rapid progression of symptoms.

      PubDate: 2017-07-13T14:41:38Z
      DOI: 10.1016/j.ajoc.2017.07.005
      Issue No: Vol. 7 (2017)
       
  • Bilateral acute simultaneous onset anterior uveitis presumed secondary to
           erlotinib: A report of two cases

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

      PubDate: 2017-02-19T13:36:34Z
      DOI: 10.1016/j.ajoc.2016.09.003
      Issue No: Vol. 6 (2017)
       
  • Silicone oil droplets following intravitreal bevacizumab injections

    • Authors: Jea H. Yu; R.A. Esmeralda Gallemore; Jisoo K. Kim; Rocky Patel; Jorge Calderon; Ron P. Gallemore
      Abstract: Publication date: Available online 21 July 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Jea H. Yu, R.A. Esmeralda Gallemore, Jisoo K. Kim, Rocky Patel, Jorge Calderon, Ron P. Gallemore
      Purpose To report the transient resurgence of symptomatic silicone oil droplets following intravitreal bevacizumab injections. Observations We report seven patients presenting with silicone oil droplets following intravitreal bevacizumab injections. These were the first cases noted in 10 years using the same supplier of preloaded syringes in an estimated 90,413 injections performed by 7 physicians. They occurred during a 4 month period (06–10/2016), suggesting they may have been related to a batch or batches of syringes. Symptomatic floaters attributed to the droplets were noted on an average of 6.7 ± 1.5 days following the injection and followed an average of 10.4 ± 3.75 injections over a period of 3.4 ± 1.9 years and resolved in 5 of our 7 patients within 9 months. Conclusions and importance Symptomatic intravitreal silicone oil droplets are a rare complication of intravitreal injections. Symptoms are generally transient and not clinically significant and hence the benefits of treating potentially blinding eye diseases in this fashion appear to outweigh the limited risk of the rare, temporary floaters. The current series may be related to a batch or batches of syringes.

      PubDate: 2017-07-31T08:18:55Z
      DOI: 10.1016/j.ajoc.2017.07.009
       
  • Acute bacterial endophthalmitis after scleral buckling surgery with
           chandelier endoillumination

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

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

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

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

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

      PubDate: 2017-07-24T09:44:12Z
      DOI: 10.1016/j.ajoc.2017.07.006
       
  • Tocilizumab as a steroid sparing agent for the treatment of graves'
           orbitopathy

    • Authors: David J. Russell; Lilly H. Wagner; Stuart R. Seiff
      Abstract: Publication date: Available online 8 July 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): David J. Russell, Lilly H. Wagner, Stuart R. Seiff
      Purpose To describe the effect of tocilizumab in two patients with thyroid associated orbitopathy (TAO). Observations We present two patients with TAO who could not tolerate corticosteroids and had a reduction in clinical and laboratory markers of inflammatory activity with subsequent tocilizumab therapy. Conclusions and importance The IL-6 receptor antibody tocilizumab is a promising candidate for the treatment of TAO because it selectively targets a key inflammatory mediator and has a favorable side effect profile. Our report demonstrates that tocilizumab can achieve further reduction in inflammatory activity after treatment with corticosteroids. Importantly, we and others have observed a decrease in the level of thyroid stimulating immunoglobulin (TSI) with tocilizumab treatment. This suggests an upstream effect in the inflammatory cascade. Although the impact of tocilizumab on long-term outcome is unknown at this time, we believe that early disruption of the inflammatory process may prevent late complications and decrease the need for rehabilitative surgery.

      PubDate: 2017-07-13T14:41:38Z
      DOI: 10.1016/j.ajoc.2017.07.001
       
  • Crystalline lens dislocation secondary to bacterial endogenous
           endophthalmitis

    • Authors: Amit Sangave; Rahul Komati; Allison Weinmann; Linoj Samuel; Uday Desai
      Abstract: Publication date: Available online 8 July 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Amit Sangave, Rahul Komati, Allison Weinmann, Linoj Samuel, Uday Desai
      Purpose To present an unusual case of endogenous endophthalmitis secondary to Group A streptococcus (GAS) that resulted in dislocation of the crystalline lens. Observations An immunocompetent 51-year-old man presented to the emergency room (ER) with upper respiratory infection (URI) symptoms and painful right eye. He was diagnosed with URI and viral conjunctivitis and discharged on oral azithromycin and polytrim eyedrops. He returned to the ER 30 h later with sepsis and findings consistent with endophthalmitis, including light perception only vision. Ophthalmology was consulted at this time and an emergent vitreous tap and injection was performed. Both blood and vitreous cultures grew an atypical non-hemolytic variant of GAS (Streptococcus pyogenes). The primary source of infection was presumed to be secondary to pharyngitis or cutaneous dissemination. Final vision in the affected eye was no light perception, likely from a combination of anterior segment scarring, posterior segment damage, and hypotony. Interestingly, head computed tomography (CT) at the initial ER presentation showed normal lens position, but repeat CT at re-presentation revealed posterior dislocation of the lens. Conclusions and importance Endophthalmitis secondary to GAS has been sparsely reported in the literature, and this case highlights a unique clinical presentation. We suspect that this atypical non-hemolytic strain may have evaded detection on initial pharyngeal cultures. Additionally, we hypothesize that GAS-mediated protease release resulted in breakdown of the zonular fibers and subsequent lens dislocation. Ophthalmologists should be aware of GAS and its devastating intraocular manifestations.

      PubDate: 2017-07-13T14:41:38Z
      DOI: 10.1016/j.ajoc.2017.07.004
       
  • CDH3 gene related hypotrichosis and juvenile macular dystrophy – A
           case with a novel mutation

    • Authors: Omer Karti; Saygin Abali; Ziya Ayhan; Eylem Gokmeydan; Serhad Nalcaci; Aylin Yaman; Ali Osman Saatci
      Abstract: Publication date: Available online 26 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Omer Karti, Saygin Abali, Ziya Ayhan, Eylem Gokmeydan, Serhad Nalcaci, Aylin Yaman, Ali Osman Saatci
      Purpose CDH3-related hypotrichosis with juvenile macular dystrophy (HJMD) is an autosomal-recessive entity characterized by congenital sparse scalp hair and macular dystrophy, leading to severe central visual loss. We report a family with HJMD caused by a novel CDH3 gene mutation and review the mutation spectrum in HJMD. A detailed phenotypic assessment for patients whose molecular results were reported previously is also summarized. Observations We present a 13-year-old Turkish girl who experienced gradual bilateral visual deterioration with marked hair loss. Hair-pull test results and scalp skin texture were normal. The eyebrows and eyelashes were normal, and no abnormality in the teeth, nails, or limbs was detected. Fundus examination revealed bilateral ring-shaped atrophy of the retinal pigment epithelium with patchy intraretinal pigment clumping at the posterior pole. DNA sequencing analysis detected a novel homozygous deletion (c.447_467del (p.149_156del)) in exon 5 of the CDH3 gene of the patient. Both healthy parents and an older brother were heterozygous for the mutation. Conclusions and importance This case of HJMD was related to a novel homozygous mutation, termed c.447_467del (p.149_156del). These findings have significance for the future mutational analysis and genetic counseling of families with HJMD, particularly in our region. The presence of sparse hair in childhood, with or without limb anomalies, should alert clinicians to request an eye consultation. Pediatricians, dermatologists, and ophthalmologists should be aware of the rarely seen entity of juvenile macular dystrophy with hypotrichosis.

      PubDate: 2017-07-04T16:18:28Z
      DOI: 10.1016/j.ajoc.2017.06.007
       
  • Management of incision failure during small incision lenticule extraction
           because of conjunctivochalasis

    • Authors: Bu Ki Kim; Su Joung Mun; Dae Gyu Lee; Hyun Tae Choi; Young Taek Chung
      Abstract: Publication date: Available online 24 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Bu Ki Kim, Su Joung Mun, Dae Gyu Lee, Hyun Tae Choi, Young Taek Chung
      Purpose We report a case of incision failure during small incision lenticule extraction (SMILE) and its management. Observations The incision could not be made using the femtosecond laser because of a redundant conjunctiva, so it was instead done manually using a diamond knife. The lenticule was successfully separated and extracted. Three months after the procedure, the uncorrected distance visual acuity was 20/20 and no complication was observed. Conclusions and importance This case demonstrates that the conjunctiva should be carefully examined before SMILE. If a complication occurs because of conjunctivochalasis, it can be resolved with proper management without compromising the patient's visual acuity.

      PubDate: 2017-07-04T16:18:28Z
      DOI: 10.1016/j.ajoc.2017.06.020
       
  • Hypertensive retinopathy as the initial presentation of neuroblastoma

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.016
       
  • Bilateral cavernous sinus thrombosis with septic lung lesions resulting
           from a nasal abscess

    • Authors: Matthew J. Schear; Alexander Weiss; Rand Rodgers
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Matthew J. Schear, Alexander Weiss, Rand Rodgers


      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.005
       
  • Lithium-induced downbeat nystagmus

    • Authors: Flora Schein; Pierre Manoli; Pascal Cathébras
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Flora Schein, Pierre Manoli, Pascal Cathébras
      We report the case of a 76-year old lady under lithium carbonate for a bipolar disorder who presented with a suspected optic neuritis. A typical lithium-induced downbeat nystagmus was observed. Discontinuation of lithium therapy resulted in frank improvement in visual acuity and disappearance of the nystagmus.

      PubDate: 2017-06-23T22:55:20Z
      DOI: 10.1016/j.ajoc.2017.06.012
       
  • Migration of segmental arteriolar fluorescein staining peripherally in eye
           with idiopathic recurrent branch retinal arterial occlusion

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

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

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

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

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

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

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

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

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

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

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

      PubDate: 2017-05-20T00:55:39Z
      DOI: 10.1016/j.ajoc.2017.05.005
       
  • Melanosis oculi

    • Authors: Osama M. Mustafa; Yassine J. Daoud
      Abstract: Publication date: Available online 19 May 2017
      Source:American Journal of Ophthalmology Case Reports
      Author(s): Osama M. Mustafa, Yassine J. Daoud


      PubDate: 2017-05-20T00:55:39Z
      DOI: 10.1016/j.ajoc.2017.05.004
       
  • Bilateral orbital marginal zone B-cell lymphoma of the mucosa-associated
           lymphoid tissue in a patient with hepatitis B virus infection

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

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

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

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

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

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

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

      PubDate: 2017-04-14T14:03:31Z
      DOI: 10.1016/j.ajoc.2017.04.006
       
  • Dysflective cones: Visual function and cone reflectivity in long-term
           follow-up of acute bilateral foveolitis

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

      PubDate: 2017-04-14T14:03:31Z
      DOI: 10.1016/j.ajoc.2017.04.001
       
  • Transient anisocoria in a patient treated with nebulized ipratropium
           bromide

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

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

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

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

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

      PubDate: 2017-04-14T14:03:31Z
       
  • Optical coherence tomography angiography of iris microhemangiomatosis

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

      PubDate: 2017-02-13T13:19:55Z
      DOI: 10.1016/j.ajoc.2017.02.003
       
  • A case of ophthalmomyiasis interna in the Pacific Northwest

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

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

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

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

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

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

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

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

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

      PubDate: 2017-02-07T20:36:30Z
      DOI: 10.1016/j.ajoc.2017.01.001
       
 
 
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