Renal tumors correspond to a small part of the total number of neoplasms. However, they can cause metastasis, mainly in the lungs, bones, and liver. In the eye, the uvea is the structure with the highest affinity due to its high vascularity, and its presence is considered a poor prognostic factor for patient survival. A case report of a patient diagnosed with a renal cell tumor with metastasis in multiple body parts, including the choroid, is presented. A review of the literature in this regard is also carried out.

A case of bilateral ocular decompression retinopathy (ODR) is presented on a patient with steroid-induced glaucoma, after immediate postoperative period trabeculectomy with mitomycin C; we observed a sudden decrease of vision due to the presence of multiple superficial retinal hemorrhages that resolved completely 2 weeks after the postoperative period. ODR is a rare complication after glaucoma surgery. Although it has been described in the literature, this case shows an unusual presentation, bilateral and consecutive in a patient with steroid-induced glaucoma.

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare inflammatory disorder affecting renal and ocular systems. Certain associations have been made with systemic conditions such as autoimmune diseases, infections, and even medications. We present the case of a 16-year-old male patient who presented to our service with bilateral uveitis and urinary symptoms, associated with proteinuria, glycosuria, increase in serum creatinine and beta-2 microglobulin in urine considering TINU as the main differential diagnosis. Antibiotics were considered a possible trigger in this patient. He presented an adequate response to systemic and topical steroids and systemic immunomodulators. Renal biopsy results reported interstitial tubulonephritis. TINU syndrome is a rare autoimmune condition, mainly seen in younger patients. Multiple triggers have been associated. Renal compromise usually resolves spontaneously with a relatively rare risk of incomplete recovery as well as uveal compromise. However, early diagnosis and multidisciplinary management is fundamental in these patients.

This article aims to report the case of a female child with Coats disease stage 5 who underwent posterior vitrectomy plus perfluorocarbon liquid injection, internal drainage, endolaser, and cryotherapy. Follow-up of the patient showed that although visual recovery was not able to achieve due to its severity, and anatomical preservation of the eye with an appropriate surgical approach was guaranteed.

The lacrimal sac compression by an anterior ethmoidal mucocele is unusual. The ethmoidal mucocele may masquerade as lacrimal sac mucocele and may lead to disastrous consequences if treated along the lines of lacrimal mucocele. We present a case of an 18-year-old female presenting with a mass lesion over the medial canthal area causing a dilemma in diagnosis.

Kjer's optic neuropathy, also known as optic atrophy type 1 (OPA-1), is a genetic condition that usually presents with the bilateral pallor of the optic disc (OD) associated with decreased visual acuity (VA), in addition to defects in the visual field (VF) and color vision. This article aims to report a case of OPA-1 diagnosed through genetic testing. A 22-year-old male patient searched for neuro-ophthalmological care, complaining of low VA, difficulty adapting to both light and dark, and photophobia in both eyes (BE) since 6 years old. He denies VF loss, nyctalopia, or hearing deficit and has maternal relatives with similar conditions. The patient presented VA of 20/63 in the right eye (RE) and 20/50 in the left eye (LE) with dyschromatopsia and bilateral OD pallor, in addition to reduced foveal brightness. Humphrey's visual perimetry showed centrocecal scotoma in the LE only and a nonspecific loss in the RE. He brought a pattern electroretinography (PERG) examination showing the reduced function of ganglion cells in the macular area and optic nerve in BE and multifocal electroretinogram with cone system function slightly reduced in BE. A genetic panel was performed to search for mutations in the OPA-1 gene, which showed a variant associated with this disease in the patient described and in his mother. Thus, this report exemplifies a case of OPA-1 hereditary OPA, emphasizing the importance of combining clinical evaluation, electrophysiological, and genetic tests for a precise and accurate diagnosis.

White dot syndromes are a group of inflammatory chorioretinopathies that share pathologic features involving lesions in the external retinal layers and choroid. This report describes a case of acute visual loss due to a white dot syndrome superimposed on severe diabetic retinopathy (DR), leading to a challenging diagnosis. A 53-year-old man with severe DR was referred with acute unilateral vision loss, with the presumptive diagnosis of diabetic macular edema. The clinical examination and complementary diagnostic tests revealed the absence of diabetic macular edema but showed disruption of the outer retinal layers and choroidal thickening. Laboratory and imaging testing excluded other etiological factors, so an inflammatory chorioretinopathy superimposed on severe DR was considered. Following the initial presentation, without any therapeutic intervention, rapid anatomical and functional improvement was objectified. This case demonstrated that in rare cases, an inflammatory chorioretinopathy may go unnoticed in the presence of preexisting retinopathy, and the true cause of vision loss may initially be misdiagnosed.

Giant cell arteritis (GCA) is the most common primary vasculitis in adults. In general, the diagnosis is straightforward when characteristic symptoms such as headaches, scalp tenderness, jaw claudication, vision problems, or other ischemic complications are present. Atypical presentations of GCA have become increasingly recognized but we report for the first time a case of GCA presenting as partial tongue necrosis and paracentral acute middle maculopathy. This case adds to the literature and emphasizes the importance of rapid recognition of these atypical changes and optical coherence tomography in the evaluation of GCA patients.

The main purpose of this study is to describe the visual outcomes in children with bilateral cataracts undergoing small incision cataract surgery and is mainly focused on children with bilateral cataracts from poorer backgrounds who tend not to receive adequate and timely medical attention. This could lead to issues such as amblyopia. However, it is important to provide surgical care even at a later date to afford some visual redemption. When affordability is the weakest link in the treatment, a manual small incision cataract surgery (MSICS) can be an ideal manner to treat bilateral cataracts. In this study, we highlight the good visual outcome post-MSICS with polymethylmethacrylate lens implantation, primary posterior capsulotomy, and anterior vitrectomy in children with bilateral cataracts who have presented at ages beyond 5 years.

A scleral buckle is a surgical procedure used for rhegmatogenous retinal detachment repair. Different materials have been used for this technique over the years. During the 1980s, MIRAgel (MIRA Inc., Waltham, Mass) introduced hydrogel bands. This material allowed easy handling for the surgeon and self-expansion over time. A decade after their introduction, late complication reports began to appear, associated with uncontrolled expansion and the need for surgical removal. We present two complete cases and a literature review of patients presenting with ophthalmoplegia, pain, and proptosis, 25 years after hydrogel scleral buckle surgeries.

A young adult Asian Indian male presented to us with a 1-month history of trauma to the right eye (RE) with a tennis ball. He had intraocular pressure (IOP) of 32 mmHg while on three topical antiglaucoma drugs and oral acetazolamide, with uncontrolled inflammation in the anterior chamber (AC) and arteriolar occlusions in the periphery. His best corrected visual acuity was 20/20 in RE. Fluorescein angiography of the RE showed the presence of neovascularization of disc (NVD). Magnetic resonance angiography of the head and neck, and blood investigations ruled out the embolic origin of arteriolar occlusion and systemic causes for inflammation. Intra ocular pressure (IOP) and inflammation were controlled with appropriate treatment. NVD resolved with photocoagulation treatment (PRP) for capillary non-perfusion areas in 4 weeks. This case documents the occurrence of arteriolar occlusion, with neovascularization after arteriolar occlusion post blunt trauma, and successful adjunct use of topical cyclosporine in the management of AC inflammation and high IOP.

To report a rare case of orbital teratoma diagnosed in utero by ultrasound examination at 24 + 4 weeks of gestation. The fetus was delivered by cesarean section, by terminative medical indication, at 39 weeks of pregnancy, due to the possibility of dystocia caused by the size of the tumoral mass, or the risk of tumor rupture during vaginal delivery, with risk to fetal survival. The neonate, a 3 day-old female patient was examined in our Department with a large tumoral mass in the right orbit, severe proptosis, producing severe disfigurement. The diagnosis of orbital teratoma was confirmed by clinical, image, and histopathological exams. To the authors best knowledge this is the first case of orbital teratoma in Brazilian literature reporting a case where the diagnosis was made in utero, at 24 + 4 weeks of gestation.

Purpose: The purpose was to highlight the potential dangers of the air gun loaded with carbide commonly used by the farmers, causing injury to the eye. Scare airguns are used to prevent the birds from destroying the crops in their fields. Method: This was an observational study. Results: A 44-year-old Indian male presented to us with redness, diminution of vision, and mucopurulent discharge in his right eye (RE). On evaluation, it showed lid edema, excoriations, conjunctival congestion, corneal epithelial defect, anterior chamber inflammation, and hyphema in his RE. On his last follow-up a month later, hyphema and anterior chamber inflammation had resolved in his RE with an improved visual acuity. He was also educated about the dangers of using illegal air guns. Conclusion: Eye protection should be used when using devices that are inflammable. Ocular air gun injuries can range from some causing minor corneal abrasions to potentially serious ones. Due to the timely evaluation and treatment of our patient, the patient did not suffer significant visual morbidity.

The m.3243A>G variant in the MTL1 gene is a DNA point mutation which has been shown to cause a variety of diseases including retinal abnormalities. We report on the ophthalmologic phenotype and systemic findings in a new patient with this mutation, presenting with sensorineural hearing loss, diabetes and macular dystrophy. We characterized the retinal phenotype with a multimodal approach and throughout the follow-up period we observed sustained centripetal progression of the areas of chorioretinal atrophy.

The simultaneous occurrence of an infectious and an autoimmune systemic disorder associated with bilateral panuveitis is always feasible but improbable. While Vogt-Koyanagi-Harada requires prompt systemic corticosteroids and immunosuppressives, ocular tuberculosis (TB) requires multiple antibiotic therapies, and to a certain extent, corticosteroids to avoid inflammatory damage to crucial intraocular structures. We report a patient with granulomatous bilateral panuveitis, in which VKH and ocular TB were diagnosed simultaneously. This case emphasizes the importance of ruling out TB in the presence of a granulomatous panuveitis, despite the lack of pulmonary manifestations, especially in an endemic country. The hindmost because both diseases require different treatments.

Epibulbar choristomas are benign congenital ocular tumors characterized by abnormal growth in the epibulbar tissue, eyelids, and choroids. Two cases of epibulbar choristomas are described; the first one is a 39-year-old woman who presented a temporally conjunctival mass that had progressed in size accompanied by foreign body sensation and epiphora. Optical coherence tomography (OCT) and surgical resection were performed with a histopathological diagnosis of dermolipoma. The second case is a 7-year-old boy with a congenital corneal lesion in the nasal sector, elevated, vascularized, and with decreased visual acuity. In both cases, OCT showed a thinned epithelium with hyporeflective subepithelial fusiform lesions. OCT is an auxiliary method for the diagnosis of conjunctival lesions, such as epibulbar choristomas.

Intracranial tumors are known to have a broad clinical spectrum. Meningiomas are the second-most common benign tumors, usually affecting women in their sixth or seventh decade of life. The World Health Organization (WHO) classified them into three grades, and Grade 1 meningiomas are considered benign neoplasias. Despite being benign, they are usually located in noble areas of the brain, most frequently in the parasagittal area, followed by the falx, the sinus cavernosus, tuberculum sellae (5%–10%), lamina cribrosa, foramen magnum, and torcular zones, and are important causes of sequelae to the patient. We herein present the case of a young patient who experienced overnight visual loss. Literature shows that several factors are related to visual recovery, which is divided into phases and occurs in approximately 23%–80% of the cases. For the WHO grade 1 tumors, the standard treatment is complete excision of the mass, and it is possible to supplement treatment with stereotactic radiotherapy in atypical, malignant, or recurrent meningioma.

Objective: The objective of this study is to report a case of superior orbital fissure syndrome (SOFS), secondary to ocular herpes zoster, with a favorable evolution. Materials and Methods: Herpes zoster ophthalmicus (HZO) usually presents with ocular manifestations, being infrequent with the ophthalmoplegia. SOFS secondary to HZO is rare. We present the case of a 72-year-old man with dermatome involvement of the first left trigeminal branch, secondary to herpes zoster infection, who also developed herpetic keratitis in the left eye. After 8 days of antiviral treatment, he developed total left eye ophthalmoplegia that required steroid treatment. The evolution of the ophthalmoplegia was favorable with resolution at 3 months of follow-up. Conclusions: It is essential to make known one of the complications of HZO infection, although not as frequent, just as important, is to recognize this pathology when it occurs for prompt management and recovery.

Open ocular trauma at the posterior segment can present with nonobvious scleral injuries, which represents a diagnostic challenge. The purpose of this article is to describe an atypical case of occult posterior scleral lesion. We present a clinical case of a 22-year-old man who consulted for a blunt trauma in his left eye. Physical examination revealed decreased visual acuity and vitreous hemorrhage without visualization of the posterior segment. Axial head computed tomography scan showed continuity solution of the posterior ocular wall, so the patient was taken to surgery with intraoperative atypical findings of loss of temporal retinal tissue with macular involvement, with good postoperative clinical course. In conclusion, high-energy trauma with both sharp and blunt mechanisms can generate posterior segment injuries such as occult posterior scleral rupture and even avulsion of retinal tissue in the macular area. Timely diagnosis and treatment of this type of injury is imperative for the patient's visual prognosis.

Radial keratotomy (RK) was a popular refractive procedure in the 90s. However, more reproducible laser-assisted surgeries are currently preferred. Furthermore, RK patients who undergo cataract surgery experience variable refractive and keratometric changes during the early postoperatory period. Unfortunately, those post-RK patients currently require cataract surgery. A 58-year-old male with a history of RK in both eyes (OU) presented with a 2-year history of night glare and progressive vision loss due to a subcapsular cataract in OU. Using the double-K Holladay formula, bilateral phacoemulsification was performed. At 1 week, refraction was + 2.25/-1.00/27° (power [Pwr]: 39.25D) in oculus dextrus (OD) and + 3.00/−0.75/171° in oculus sinister (OS) (Pwr: 37.41D), achieving a best-corrected visual acuity (BCVA) of 20/30 OU. At 6 weeks, refraction was + 0.75/−0.75/18° (Pwr: 39.71D) in OD and + 1.00/−0.25/180° (Pwr: 38.33) in OS. BCVA remained 20/30 OU. The resulting transitory hyperopic shift after surgery demands a careful and comprehensive intraocular lens calculation preferably aiming toward myopic overcorrection.

Lyme disease is a multisystemic infection caused by the spirochete bacterium Borrelia burgdorferi, transmitted by the tick of the genus Ixodes sp. and has three stages: primary, secondary, and tertiary. Ocular involvement is possible in any of these stages. Neuroretinitis is a rare manifestation. It is recommended that the diagnosis be performed by serology using an immunoenzymatic test, and confirmed by the Western Blot test. The recommended therapy is doxycycline 100 mg 12/12 h or 200 mg once a day for 14 days to 21 days or amoxicillin 500 mg three times a day for 14–21 days. We herein present a patient who had neuroretinitis related to a previous diagnosis of Lyme disease. The presence of neuroretinitis in a setting of Lyme disease represents a very uncommon manifestation of this particular infection.

This is a case report of a 61-year-old woman who was referred to the PUC Campinas Hospital due to a femoral fracture. Ophthalmological evaluation was requested due to complaints of enophthalmos and low visual acuity, which showed signs suggestive of an orbital tumor. Physical and complementary examinations were important for the confirmation of metastatic orbital carcinoma. Knowing that breast cancer is the most common primary tumor site involved in orbital metastasis in women, this study aimed to highlight the importance of prompt recognition and appropriate diagnostic and therapeutic management in these cases.

The German pathologist Friedrich Wegener described granulomatosis with polyangiitis (GPA), formerly known as Wegener's Granulomatosis, in 1936. Lesions are inflammatory, and typically include vasculitis, necrosis, and granulomatous changes. Ocular symptoms may be the first manifestation of this disease in 16%–58% of cases. The ocular manifestations of GPA occur in the most diverse ways. Delayed diagnosis can have serious consequences for patients' vision, as can the preservation of the globe, in addition to other systemic involvement, which can be rapidly progressive in some cases, leading to long-term disability or mortality.

This is a retrospective case report of a male patient referred to the PUC Campinas Hospital as a victim of blunt car trauma. On ophthalmological examination, the patient had bilateral retinal changes in the foveal region, causing low visual acuity in both eyes. Knowing that ocular trauma is the main cause of legal blindness in working-age people, this study aimed to highlight the importance of ophthalmological evaluation to provide the necessary treatment and follow-up to minimize the ocular sequelae resulting from trauma.

Retrobulbar hemorrhage (RBH) is an ophthalmological complication with the potential risk of irreversible blindness due to the compressive effect on the optic nerve. Cases of patients with a history of antiaggregation and/or anticoagulation therapy and RBH have been reported in the literature; ophthalmologists should keep this antecedent in mind and consider the risk–benefit of surgery while working in conjunction with the area of anesthesia to establish the times when medication is suspended or initiated. Similarly, early and timely identification of signs and symptoms related to this complication improves patients' visual prognosis. The following describes the case of a patient who had RBH associated with the use of antiplatelet therapy.

The utility of retropupillary (RP) iris-fixated lenses, even when the iris support is deemed inadequate is portrayed in this case series. The case series emphasizes iris-claw lens as an effective alternative in cases where there is a disfigurement of the iris with meticulous surgical skills. A 58-year-old with diminution of vision in the right eye for 6 months had a vision of 6/60, iris coloboma inferiorly with zonule loss and cataractous lens. Manual small-incision cataract surgery (M-SICS) was performed with placement of iris-claw lens despite the presence of iris disfiguration. A 62-year-old male with diminution of vision in the left eye had a vision of counting fingers at 1 m. On slit-lamp examination, iris atrophy, an oval-shaped pupil with a maximum of 5 mm eccentric dilation, cataractous lens inferiorly subluxated and partially absorbed, a breach in the anterior capsule, and vitreous strands were noted in the anterior chamber. M-SICS with iris-claw lens was then performed. A 3-year-old female child with a history of trauma to the left eye had a vision of perception of light only. On anterior segment evaluation, she had radial, full-thickness corneoscleral tear with iris plugging the wound, iris trauma, and traumatic immature cataract. Left eye corneal tear repair with cataract extraction and iris-claw insertion was performed. Postoperative vision on follow-up after a month was 6/12p in all three cases. Iris claw lens being readily available, and surgical technique of insertion being easy and quick, serves as one of the effective alternatives for the intraocular lens in difficult situations.

We report a rare case of ocular cryptococcosis that presents as chorioretinitis in a patient with acquired immunodeficiency syndrome.

Ocular surface complications secondary to continuous positive airway pressure (CPAP) machines have been previously reported such as ocular irritation, dry eye disease, lid laxity, and floppy eyelid syndrome. No severe ocular complications have been specified in the literature. We report a serious ocular complication in a patient under helmet CPAP (hCPAP). A 68-year-old male with COVID-19 pneumonia required ventilatory support with hCPAP. Following 5 days, the patient started complaining of ocular discomfort, purulent discharge in his left eye, and ocular dryness upon awakening. Ophthalmological examination showed no light perception in the left eye and slit-lamp biomicroscopy revealed atalamia, loss of corneal transparency with superior infiltrates, and a total epithelial defect with iris herniation and a central perforation. Considering the patient's progressive worsening clinical condition, with a painful blind eye, left evisceration was performed. It is important to be aware of possible ophthalmological complications related to ventilation since prompt diagnosis and treatment can avoid poor visual outcomes. In this clinical case, we faced a serious ocular complication following hCPAP ventilation.

Coronavirus disease (COVID)-19 is associated with ophthalmic manifestations during and after recovery from the disease and may be sight-threatening. A 54-year-old Asian Indian female patient presented to us with redness, pain, and blurred vision in her right eye (RE) of 2-day duration. In RE, the best-corrected visual acuity was 20/25, and she was diagnosed with anterior sclero-uveitis. Three days later, she had mild breathlessness and loss of taste. Nasopharyngeal swab for reverse transcription–polymerase chain reaction-COVID-19 was positive, and investigations for uveitis were negative. The systemic evaluation was also within normal limits. A month later, she had no evidence of ocular inflammation. There was no other attributable cause to her ocular inflammation. Her COVID-19 immunoglobulin G antibody was positive, confirming the previous COVID-19 infection. The case emphasizes the importance for eye care professionals to remain vigilant and considers SARS-CoV-2 as the causative agent in patients presenting with anterior segment inflammation.

Spherophakia is usually associated with systemic disorders but may also present as an isolated entity. Spherophakia patients often present in adolescence or before 50 years of age. Here, we describe a case of isolated spherophakia in a 61-year-old woman with bilateral angle closure and cataract managed by lens extraction and retropupillary iris-claw lens implantation.

Iridociliary melanoma represents a rare and aggressive variant of intraocular melanoma. We report the case of a 30-year-old male with iridociliary melanoma that started as a uveitis masquerade syndrome. Noninvasive, stereotactic radiosurgery with CyberKnife^® at a dose of 27 Gy to the 90% isodose line was promptly performed. Six months after treatment, no postoperative complications were observed. The patient achieved local tumor control, maintained a 20/20 visual acuity, and no signs of systemic metastasis were observed. The versatility and outpatient nature of CyberKnife^® make it an option to consider for the multidisciplinary management of these patients.

Paraneoplastic optic neuropathy (PON) is a rare phenomenon that is associated with lung carcinoma. In addition, retinal metastasis is extremely rare, accounting for <1% of intraocular metastasis. We hereby report a rare case of synchronous metastases from lung carcinoma to the choroid of the right eye and the retina of the left eye complicated with presumed PON. The presence of intraocular mass and optic disc swelling should prompt investigations for systemic malignancies.

Dermoid cysts are epidermis-like cysts with dermal adnexal structures such as sebaceous glands, hair follicles, or sweat glands in the cyst wall. They contain mature or immature germ cells of pluripotent origin. The usual sites of occurrence in the periorbital region include the lateral angle of the orbit, medial angle, limbal, and deep orbital region. Here, we present a case of 16-year-old female who came to the hospital with complaints of swelling in the upper eyelid and intermittent pain. After an excisional biopsy of the mass was done, the diagnosis of tarsal dermoid cyst was confirmed. Due to the paucity of cases in literature, reporting this case may help shed light on the importance of including dermoid cyst in the differential diagnosis of a tarsus-based eyelid mass.

Cytomegalovirus (CMV) is a double-stranded DNA virus. It is an opportunistic infection that usually affects individuals with AIDS or with profound immunosuppression. CMV retinitis is the most frequent ocular manifestation. Infrequently, this pathology has been observed in patients undergoing immunosuppressive treatment due to autoimmune diseases. This article presents a case of Crohn's disease with systemic and ocular involvement by CMV after starting treatment with infliximab (anti-tumor necrosis factor-alpha antibody).

Nanophthalmos, a congenital rare condition, is defined as a small eye characterized by hypermetropia, narrow anterior chamber, and thickened choroid and sclera. These features create an environment with high risk of developing angle-closure glaucoma (AGC) and higher risk of intraoperative and postoperative complications. This is a case of young female patient with nanophthalmos, chronic angle closure, elevated intraocular pressure (IOP) refractory to medical therapy, iridotomy, and iridoplasty, yet without glaucomatous changes. In a case of nanophthalmos refractive to medical treatment, it is challenging to decide whether lowering IOP and preventing ACG are worth the risk of vision reduction by intraocular lens miscalculation or surgical complications.

We describe the case of a 71-year-old woman with periocular tuberculosis manifesting as eyelid edema. The diagnosis of tuberculosis infection was particularly difficult given the atypical presentation, the negative result of interferon-gamma release assay, and the absence of active or past pulmonary disease. Skin biopsy and its analysis with polymerase chain reaction (PCR) enabled the definitive diagnosis of Mycobacterium tuberculosis infection. This represents an exceptionally rare form of eyelid tuberculosis and highlights the importance of a thorough investigation in the diagnostic workup of unspecified and refractory cases of eyelid edema that should include histopathological tissue analysis.

Optic perineuritis (OPN) is a rare inflammatory disease involving the optic nerve sheath. Most cases are idiopathic, but associations with a variety of infectious and inflammatory conditions have been described. Patients with suspected OPN should also be investigated for neoplasms in the form of optic nerve sheath meningioma or meningeal carcinomatosis, given they share important clinical and radiological features. We present a case of suspected idiopathic bilateral OPN that was particularly challenging, eventually revealing a neoplastic etiology.

Given the increasing incidence of obesity, bariatric procedures are gaining attention during the past decades, being one of the most effective methods of long-term weight loss. Nutritional optic neuropathy (NON) following bariatric surgeries is a rare but devastating complication caused by a complete lack or inadequate supply of nutrients for the normal function of nerve fibers. We report a case of bilateral anterior NON after a Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy, and present a review of the literature about neuro-ophthalmic complications associated with these procedures. Bariatric surgery may constitute an established risk factor for NON and both patient and physician have to be aware of the importance of closely monitoring vitamin depletions and neurologic and visual symptoms.

A 63-year-old woman with high hyperopia developed acute myopia of − 5.50 D with axial shallowing of anterior chamber and high intraocular pressure (IOP) in her left eye after 2 weeks of phacoemulsification surgery. She developed a myopic shift after 4 weeks in the right eye also which was operated 8 months ago for cataract. Laser peripheral iridotomy was ineffective in both eyes. Cycloplegic therapy was started for presumed aqueous misdirection syndrome (AMS) with antiglaucoma drugs in both eyes. A laser capsulo-hyaloidotomy was attempted in LE with no result. Pars plana vitrectomy (PPV) with iridectomy-zonulectomy-hyloidectomy (IZH) was done in both eyes after 2 years of onset and multiple recurrences associated with atropine withdrawal. Pseudophakic AMS can present as a myopic shift in refraction without a significant rise in IOP. Cycloplegic therapy is not well tolerated by multifocal intraocular lens patients. PPV with IZH has been effective in preventing relapses in our patient for 20 months (RE) and 23 months (LE).

We report a case of bilateral retinal hemorrhages with macular edema in a patient with dengue fever (DF). This patient also had cerebral hemorrhage. A 17-year-old female presented with sudden painless loss of vision in her both eyes for 2 days associated with redness of eyes. She was diagnosed having DF based on detected dengue immunoglobulin M in her blood sample. Fundus examination of both eyes showed preretinal and intraretinal hemorrhages. Optical coherence tomography showed neurosensory detachment and macular edema. This case report warrants the importance of ocular screening in a patient having systemic complications of DF.

The severe acute respiratory syndrome caused by coronavirus-2 can present with a broad spectrum of clinical manifestations, mainly respiratory, but also with different neurologic symptoms. On the other hand, the Ramsay Hunt syndrome (RHS) is a complication of varicella-zoster virus (VZV) reactivation presenting mainly in older patients, patients under stress, infection, or an immunocompromised state. We report a case of RHS in a young Mexican female patient who tested positive for SARS-CoV-2 in whom we believe that there is a strong possibility that VZV's unusual reactivation, presenting as RHS in a young patient, might have been a consequence of the immunological alterations induced by this coronavirus.

Orbital mucormycosis is a dreaded condition and may lead to fatal intracranial infection if it spreads to the intracranial sinuses. The infection is caused by fungi of the order Mucorales. Rhizopus has been reported to be the causative pathogen. The main route of infection is through inhalation of the fungal spores, which may cause lung infection. However, patients with diabetes, immunosuppression, and steroid use are more prone to the infection. We present a case of orbital mucormycosis in a patient who had recovered from coronavirus disease 2019. Early diagnosis and management helped salvage the vision of the patient.

Anisometropia is characterized by difference between the refractive errors of the eyes and can be classified into refractive and axial. Aniseikonia is one of the possible consequences of anisometropias. As a general rule, aniseikonia tends to be less significant when we correct axial anisometropias with spectacles and refractive anisometropias with contact lens. One of the possible causes of refractive anisometropias is aphakia, which can be a result of ocular trauma. Amblyopia is a visual neurological disorder characterized by inadequate consolidation of visual acuity, due to insufficient visual stimulation. We present a case of contact lens fitting in a patient with significant difference in axial length between the eyes, but without the corresponding anisometropia, since the patient became aphakic after blunt trauma during childhood affecting the eye with the longest axial length, and probably as a consequence of the aphakia, she did not become amblyopic.

We report the clinical findings and imaging in an 11-month-old male referred to the pediatric ocular oncology service for leukocoria. The diagnosis of concomitant myelinated nerve fibers and retinoblastoma group O/C was established. In this case, the association of these two conditions led to early diagnosis of retinoblastoma with successful treatment and good visual outcome.

Congenital fibrosis of extraocular muscles (CFEOM) is an inherited restrictive ocular motility disorder characterized by unilateral or bilateral horizontal and/or vertical gaze impairment with ptosis. Keratoconus is a bilateral asymmetrical corneal ecstatic disease with multifactorial etiology, including complex interaction of both genetic and environmental factors. We report a case of a 29-year-old female who presented with chief complaints of bilateral diminution of vision and drooping of eyelids since early childhood with a history of seizures for 1 year. Visual acuity at presentation was hand movement close to face with accurate projection of rays in both the eyes. Contrast-enhanced magnetic resonance imaging of the brain and orbit revealed partially empty sella, neurocysticercosis, and bilateral atrophy of extraocular muscles. On detailed examination, she was found to have CFEOM type 1A (CFEOM1A, autosomal dominant inheritance) with bilateral advanced keratoconus, bilateral sensorineural hearing loss, bilateral presenile cataract, and neurocysticercosis. The association of CFEOM1A, keratoconus, and sensorineural hearing loss is not reported in the literature to date. Whether this association is co-incidental or part of some new syndrome needs to be evaluated further.

Tumor-associated masquerading anterior scleritis (AS) is a rare syndrome with few case reports in the medical literature. Imaging studies play a crucial role in the correct diagnosis of this entity. Ultrabiomicroscopy (UBM) is a vital imaging tool in the study of anterior segment lesions and enables early diagnosis and treatment in these patients. We report the clinical and ultrabiomicroscopic findings of a patient with tumor-associated masquerading AS due to choroidal metastases from lung adenocarcinoma. A 65-year-old male patient with stage IV lung adenocarcinoma in remission presented with red eye and intense pain in his left eye refractory to nonsteroidal anti-inflammatory drugs. An AS was diagnosed and after no treatment response, ocular ultrasound (US), and UBM were ordered. Choroidal metastases were evidenced underlying the exact area of scleral inflammation. While the characteristics of metastases by US match those previously reported in the literature, UBM reveals novel characteristics, such as irregular thickening, intralesional heterogeneity, and a “lumpy-bumpy” pattern.

Acute retinal necrosis (ARN) is an ocular inflammatory disease characterized by panuveitis and retinal vasculitis. Herpes virus is strongly associated with ARN and can often be detected by polymerase chain reaction (PCR) of vitreous samples. The authors report a case of ARN associated with herpes simplex virus-2 (HSV-2) and Epstein–Barr virus (EBV) in an immunocompetent host. A 72-year-old man with a history of herpes zoster ophthalmicus presented with sudden vision loss in the left eye in the setting of hypertensive anterior uveitis and severe vitreous inflammation. ARN was diagnosed and antiviral and steroid treatment was initiated. Vitritis improved 1 week later and foci of retinal necrosis with occlusive vasculitis were observed. Three days later, a rhegmatogenous retinal detachment developed. Pars plana vitrectomy with retinopexy was performed and a vitreous PCR test was positive for both HSV-2 and EBV. Despite retinal reattachment, visual acuity did not improve. Prophylactic antiviral therapy was continued for the fellow eye. The coexistence of more than one virus in the ARN context is exceedingly rare and might be associated with poor visual outcomes.

The current study reports three cases of both adult and pediatric patients with a history of self-limited episodes of visual symptoms following ablative procedures for cardiac dysrhythmias. Neurological and ophthalmological evaluations were always unremarkable even when performed during the episodes. The visual disturbances subsided spontaneously, and none of the patients developed any kind of permanent visual damage.

Clonazepam belongs to the benzodiazepine group of drugs and has a quick onset and prolonged duration of action. It is frequently prescribed for treatment of anxiety disorder and panic attacks. Benzodiazepines are known to induce angle closure glaucoma in susceptible eyes but acute drug induced myopia is reported only with Chlordiazepoxide usage. We report the case of a 45-year-old woman who developed acute bilateral myopia after consumption of clonazepam which resolved completely after drug withdrawal.

Drug-induced acute angle closure glaucoma (AACG) is a blinding condition that requires urgent management. Unfavorable conditions encountered at the intensive care unit (ICU) represent an increased risk of developing AACG. A 60-year-old female complained of photophobia, pain, and vision loss in her right eye while hospitalized in the ICU for COVID-19 management. Symptoms developed after the use of nebulized ipratropium bromide and salbutamol, prone positioning, and darkroom conditions. The patient was discharged 3 weeks after and diagnosed with AACG the next day. Despite management with hypotensive eye drops and cataract surgery, the patient developed bilateral glaucomatous damage and vision loss in her right eye.

In this report, we discuss a case of a high myopic patient who underwent mechanical LASIK surgery in 2008 that respected the Randleman criteria for ectasia risk but incurred in a percentual thickness alteration (PTA) over 40%. The patient underwent reoperation in 2016 to correct the residual refractive error with wavefront-guided photorefractive keratectomy. At the time of the first surgery, the concept of PTA did not exist. Currently, a PTA that exceeds 35%–40% correlates with an increased risk of ectasia. We reviewed the literature focusing on the differences between the current rationale for post-LASIK enhancement and the selected strategy at the first reintervention. The purpose of this provocative case report is to emphasize the importance of personalized surgery in reoperations, always aiming for the welfare and best vision for the patient.

We report herein a case of a 17-year-old male who presented status postmotor vehicle accident resulting in severe polytrauma and reduced visual acuity in his right eye (OD). Best-corrected visual acuity (BCVA) was 20/400 OD and 20/20 in his left eye (OS). Slit-lamp examination confirmed normal anterior segment anatomy in both eyes (OU). Indirect ophthalmoscopy and subsequent fluorescein angiography confirmed the presence of multiple cotton-wool spots, intraretinal hemorrhages, a well-circumscribed area of macular whitening, and vascular tortuosity throughout the posterior pole and peripapillary region, all suggestive of an arterio-occlusive event OD, with a normal fundus examination OS. Imaging of the macula with optical coherence tomography demonstrated hyperreflectivity of the inner retina, along with subfoveal irregularities of the outer retinal segments OD. Systemic steroid therapy was initiated, and after 1 month, BCVA improved to 20/70 OD.

Nanophthalmic eyes are associated with increased scleral thickness, decreased uveoscleral outflow, and increased incidence of uveal effusion syndrome, exudative retinal detachment, and angle closure glaucoma. Lamellar sclerectomies can enhance uveoscleral permeability. We report a case of nanophthalmos with exudative retinal detachment, submitted to anterior lamellar sclerectomies. A 50-year-old male patient presented with high hyperopia who complained of progressive visual loss in the right eye. The best-corrected visual acuity was 20/400 in both eyes; fundoscopy showed peripheral choroidal detachments in both eyes and retinal detachment in the right eye. Ocular ultrasound revealed thickened scleral walls and short axial lengths in both eyes. Fluorescein angiography confirmed an exudative retinal detachment in the right eye. Two inferior lamellar sclerectomies were performed in the right eye. Postoperative period was uneventful; subretinal fluid was progressively reabsorbed with retinal reattachment.

We report a rare case of polymorphic amyloid degeneration (PAD) with in vivo confocal microscopy and anterior segment optical coherence tomography (AS-OCT). A 74-year-old female presented to our service for suspected Fuchs corneal dystrophy. Her best-corrected visual acuity was 20/25 right eye (OD) and 20/20 left eye (OS). Slit-lamp biomicroscopy revealed bilateral punctate, refractile deposits in the deep stroma in an annular distribution with relative sparing of the central cornea. The remainder of the ocular examination was within expected limits. Central pachymetry was 546 μ OD and 535 μ OS. AS-OCT demonstrated focal hyper-reflective lesions in the deep stroma. Specular microscopy showed normal endothelial cell count and morphology. Confocal microscopy highlighted bright, enhancing punctate lesions in both the anterior stroma and deep stroma with normal intervening spaces. The patient was managed conservatively. Altogether, PAD is a rare, sporadically inherited condition that presents in the elderly. Confocal microscopy can aid in the diagnosis.

The purpose of the study is to report a case of choroidal neovascularization (CNV) related to choroidal osteoma treated with intravitreal injections of bevacizumab. This was a case report in which antivascular endothelial growth factor intravitreal injections were used to treat choroidal osteoma-related CNV. A 27-year-old man with a history of blurred vision in his left eye for 15 days presented best-corrected visual acuity (BCVA) of 20/60. Fundus examination, ultrasonography, fluorescein angiography, and optical coherence tomography revealed a nasal and superior juxtapapillary choroidal osteoma with a choroidal neovascular membrane, associated with serous retinal detachment affecting the macula. After three intravitreal injections of bevacizumab, the patient improved to a BCVA of 20/30 and partial resolution of subretinal fluid. Choroidal osteoma with CNV may present a good response to bevacizumab therapy.

Hemolytic uremic syndrome (HUS) is one of the thrombotic microangiopathies characterized by intravascular hemolysis, thrombocytopenia, and end-organ damage. HUS is classified as typical (Shiga toxin producing Escherichia coli), atypical (uncontrolled complement activation), and secondary associated with other diseases. Ocular involvement is rare in atypical HUS (aHUS). Literature search using PubMed, Google scholar, Embase, etc., revealed very few case reports on ocular manifestations such as retinal detachment, putscher such as retinopathy, vitreous, and intraretinal hemorrhages, and optic atrophy that have been reported. Here, we report an atypical finding of posterior lenticonus and Grade I hypertensive retinopathy in a 13 years' boy diagnosed as aHUS with refractory hypertension who maintained stable vision after treatment with plasma exchange, mycophenolate mofetil, hemodialysis, and newer antihypertensive drugs (hydralazine).

Susac syndrome (SS) is a rare disease affecting the microvasculature of the inner ear, brain, and retina, which usually presents with the triad of hearing loss, encephalopathy, and branch retinal artery occlusions. This condition usually affects young women and treatment consists, in most cases, of immunosuppression. In this article, we report the case of a 35-year-old female patient with an incomplete SS, with visual and hearing manifestations.

Tubulointerstitial nephritis and uveitis syndrome is an uncommon clinical entity. Usually, renal involvement is moderate, and uveitis is acute, bilateral, anterior, and nongranulomatous (revised). We present the case of a 55-year-old female patient who went to the emergency department with complaints of asthenia, myalgia, and paresthesia. One week later, she complained of photophobia and was diagnosed with bilateral nongranulomatous acute anterior uveitis. The next day, due to hypotension and acute kidney injury, the patient was hospitalized. Renal biopsy showed tubulointerstitial nephritis. The patient was started on oral prednisolone, achieving uveitis resolution and renal function stability. After slow corticoid reduction, the patient presented uveitis recurrence complicated with bilateral optic disc (revised) edema and cystoid macular edema (CME) in the left eye. After oral prednisolone reduction, the patient suffered another relapse with CME worsening. We decided to initiate methotrexate 7.5 mg/week, achieving ocular and renal function stability.

We present the case report of a 6-year-old girl with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis associated with bilateral optic neuritis. She initially presented with disturbing behaviors and gait impairments and was hospitalized in the context of meningoencephalitis, without agent isolation and with inconclusive laboratory tests. After discharge, she noted a loss of vision with impaired color sensation and returned to the emergency department. Her best-corrected visual acuity was 20/400 in both eyes, and fundoscopy revealed bilateral optic disc edema. She was hospitalized once again. Anti-NMDAR antibodies were detected in serum and cerebrospinal fluid. The patient was successfully treated with a pulse of methylprednisolone, followed by a tapering regimen of prednisolone. She recovered to 20/20 vision in the right eye and left eye. Our report highlights additional aspects of anti-NMDAR encephalitis in children and suggests that the disease could present atypical visual manifestations, which requires multidisciplinary approaches.

We present a case of an orbital mass confirmed as Castleman disease (CD) with the histopathological and immunohistochemical review. CD in the orbit is uncommon and has been seldom reported. The case we present justifies the review due to the abnormal location and clinical presentation. Variety of the differential diagnoses that can arise from an orbital mass with these characteristics are also discussed.

Ocular perforating is the most dreaded scenario to confront in patients with scleromalacia perforans. Despite its low prevalence, the progression of scleral necrosis to exposed uvea represents one of the ophthalmic emergencies with a high risk of loss of ocular content whose surgical treatment is performed autologous or heterologous tissue patches. This study describes six patients referred to the ophthalmology service of the Edgardo Rebagliati Martins National Hospital in Lima with a clinic history of autoimmune diseases and scleromalacia perforans >10 mm size, treated with autologous fascia lata grafting in addition to topical and systemic immunosuppressive treatment.

Effective therapeutic options are limited to the management of exudative retinal detachments (RDs). The authors describe the resolution of the case following partial-thickness scleral resection. This 31-year-old male presented with a bilateral exudative RD. There was no history of steroid use either locally or systemically. The fundus eye showed typical of chronic exudative RDs. The axial length was 16.08 mm in the right eye and 15.17 mm in the left eye. Thickening of the sclera was evident in ocular ultrasound. Considering an axial length (nanophthalmic eye), four partial-thickness scleral resections were performed. The exudative RD resolved at 4 months. Partial-thickness scleral resections may be considered as an option for treating chronic exudative RDs patients with nanophthalmic eye.

The purpose is to report a case of horseshoe macular tear and its management. Case reports of a patient with blunt trauma including findings on clinical examination, color fundus photography, and spectral-domain optical coherence tomography (OCT). A 23-year-old presented with a blunt ocular trauma from a plastic toy in the right eye. Fundoscopy revealed a horseshoe macular tear associated with a partial posterior vitreous detachment (PVD). OCT confirmed a full thickness macular tear with radial extension and associated retinal thickening. The patient underwent conservative management and was followed closely showing a spontaneous resolution of the macular tear. Our case report describes an example of traumatic horseshoe macular tear; we hypothesized that the PVD and the secondary inflammation as a result of the trauma were responsible for the spontaneous resolution of macular tear in our case.

The objective is to report a case about corneal tattooing on leukoma in PUC Campinas Hospital. It is a retrospective case report, about 64-year-old patient with corneal opacity of the left eye without visual acuity. The patient was not satisfied with the esthetics of the leukoma and did not tolerate the use of a contact lens. For this reason, corneal tattooing with stromal micropuncture and pigment impregnation was indicated.

Rosacea is a dermatologic condition that affects the midfacial region. This chronic inflammatory disease can present with ocular manifestations distinguished by meibomian gland dysfunction, dry eye, and in severe cases, corneal ulceration and perforation. Neurotrophic keratopathy is an ocular condition with a reduced or absent corneal sensation associated with a corneal epitheliopathy. We present a 68-year-old man with both ocular rosacea and neurotrophic keratopathy who developed a corneal perforation. It was managed successfully with a tectonic keratoplasty in addition to topical steroids, lubrication, and oral tetracyclines. The perforation is explained by the superposition of both pathologies which lead to dry eye syndrome, along with chronic inflammation of the ocular surface. The effective follow-up and treatment of any epithelial defect in these patients is a major factor for corneal melting and perforation prevention.

We hereby describe a rare case of unilateral sphenoid wing dysplasia nonassociated with neurofibromatosis, which presented with pulsating proptosis with resting enophthalmos and with Valsalva-induced exophthalmos.

The idiopathic full-thickness macular hole is characterized by a total thickness anatomical defect in the foveal retina leading to a reduction of central vision. Although there are several reports about the natural course of the disease and its outcome, the spontaneous closure frequency varies widely in literature reviews. Treatment options include pars plana vitrectomy, pharmacological vitreolysis, and pneumatic vitreolysis. A 30-year-old male was referred to us with a complaint of decreased vision in his right eye and metamorphopsia for nearly 2 months without a history of trauma. The diagnosis was based on fundoscopic and optical coherence tomography (OCT). OCT revealed a large full-thickness idiopathic macular hole (422 μm) without vitreomacular traction. The intravitreal gas injection was performed. Three months later, in follow-up by OCT, total closure of the macular hole was noted. The aim is to report a case of idiopathic total thickness macular hole closure with a single application of C3F8 gas.

The objective is to report a rare case about spontaneous expulsive choroidal hemorrhage in PUC Campinas Hospital. It is a retrospective case report. A 102-year-old patient with untreated glaucoma and recent corneal ulcer was admitted in the emergency room with completely spontaneous uveal and crystalline exposure and submitted to evisceration. This report discusses about this rare entity and the development in this particular patient in the city of Campinas, São Paulo state, Brazil.

Juvenile glaucoma is a rare entity, starting below the age of 35–40 years, which is discovered as a casual finding in reviews or consultations for other reasons. It is inherited from autosomal dominant penetrance. It can lead to a loss of visual acuity. The treatment is similar to conventional glaucoma, although its control, when diagnosed, is usually late and usually leads to more complex management. The differential diagnosis of glaucoma by steroids, trauma, inflammatory, or congenital late diagnosis must be made. The main difference with other types of glaucoma is that it is generally asymptomatic, and there is no corneal edema or Haag striae. Surgery is an alternative when drug treatment fails. Through a real case, we want to introduce and develop this ophthalmological pathology. This is a 25-year-old male with a history of myopia, who at a casual check-in an optician's shop is found to have increased intraocular pressure (IOP). In the campimetry was seen a ring scotoma (right eye) and an arciform scotoma (left eye [LE]). Distant vision was preserved. In optical coherence tomography there was bilateral decrease of retinal nerve fiber layer thickness , and in the right eye (RE) gonoscopy showed a highly pigmented Grade IV open angle. Initially, pharmacological management was attempted (with carbonic anhydrase inhibitors, beta-blockers and prostaglandin analogs) by achieving it in the LE. However, the RE ended up with a trabeculectomy, obtaining, in the end, a good control of the IOP.

Weill–Marchesani syndrome is a rare connective tissue disorder, with a poorly understood etiology that has been primarily related to hereditary genetic factors, including mutations in ADAMTS10 and fibrillin-1. Clinically, it is characterized by a phenotype of short stature and brachydactyly, associated with joint stiffness and eye problems that begin to be noticed in childhood. There is little information about this disease in the Mexican population. This is a description of the case of a 17-year-old female patient with clinical feature compatible with this syndrome, as well as a brief review of the literature on this entity. The knowledge of this syndrome is important to achieve a timely diagnosis and prevent the complications associated with it.

The objective is to report a rare case about rhabdomyosarconma in PUC Campinas Hospital. This was a retrospective case report. A 9-year-old boy which presented a superior tarsal conjunctival lesion of the left eye which had a rapid growth in days. The patient underwent a biopsy which revealed an embryonal rhabdomyosarcoma stage III. The patient was submitted chemotherapy according to the Intergroup Rhabdomyosarcoma Study IV protocol and radiotherapy. This is a report discussed about this unusual tumor presentation in the city of Campinas, São Paulo state, Brazil.

Alport syndrome is a hereditary disorder characterized by sensorineural deafness, renal disease, and ocular abnormalities, including anterior lenticonus with high refractive errors. We report a case of Alport's syndrome with bilateral anterior lenticonus that was submitted to phacoemulsification and toric extended depth of focus (EDOF) intraocular lens (IOL) implantation. A 49-year-old male patient presented with progressive bilateral visual loss for 10 years. His past medical history included a diagnosis of Alport's syndrome, with renal transplantation 20 years ago. The best-corrected visual acuity was 20/80 in the right eye and 20/63 in the left eye. Examination showed anterior lenticonus and anterior subcapsular opacities. Phacoemulsification and toric EDOF-IOL implantation were performed in both eyes. Capsulorhexis was challenging because of a highly elastic anterior capsule, which was aided by the use of a viscoadaptive ophthalmic viscosurgical device. The postoperative period was uneventful, with good refractive and visual outcomes.

We present a case of an 18-year old female with intraocular cysticercosis in the form of a freely mobile cyst in the anterior chamber of the right eye,that was successfully removed by viscoexpression.

Introduction: Birdshot chorioretinopathy (BCR) is a bilateral and recurrent posterior uveitis with an uncertain natural history and visual prognosis. Currently, there is no consensus on the best treatment option and its total duration. Clinical Cases: We present a series of three clinical cases of patients with BCR diagnosed in different stages of the disease, which demonstrates the clinical spectrum of this pathology and their treatment with different immunomodulatory drugs. Conclusion: As shown in our series of cases, the early use of immunomodulatory drugs is recommended with a close monitoring and individualized treatment to achieve the best anatomical and functional results.

We report a case of floppy eyelid syndrome (FES) treated with surgical approach at the PUC Campinas Hospital in 2019. This was a retrospective case report. A 42-year-old male patient diagnosed with FES. The patient elected for surgical repair due to severity of his symptoms. A lateral pentagonal upper eyelid resection was performed in the left eye, and eyelid tissue from the patient was examined using light microscopy and immunohistochemistry that revealed chronic conjunctival inflammation and papillary conjunctivitis. The pentagonal wedge resection is an effective treatment method that produces immediate relief of symptoms. In our case, no recurrence was observed up to 6-month follow-up.

Objective: The objective was to describe a case of ocular myasthenia gravis (MG) in a pediatric patient. Design: This is a descriptive, retrospective study and case report. Methodology: For the purpose of the case report, we searched and analyzed the literature referring to the diagnosis and treatment of ocular MG (OMG) in children. Description: A previously healthy 5-year-old girl presented to the emergency room because of sudden-onset ptosis of the right upper lid without other symptoms. Her examination demonstrated fluctuating ptosis and limitation to downgaze in the right eye. Because of the fluctuation of the ptosis, OMG was suggested, and the patient was tested with ice-pack test and neostigmine test with positive results. Treatment with pyridostigmine was initiated with a good response. Discussion: OMG has a very low incidence in pediatric patients. It is a disorder characterized by impairing neurotransmission at the neuromuscular junction that generates extraocular muscle weakness. It is important that ophthalmologists have knowledge about this disease because it is a differential diagnosis when there is a patient who has ptosis, strabismus, or limitation of movements. There are no standard diagnostic criteria for this disease; the diagnosis is based on clinical presentation and pharmacologic, serologic, and electrophysiologic tests. The treatment is based on steroids and anticholinesterase drugs. Some patients will require plasmapheresis or immunomodulators.

A unilateral nonteratoid malignant ciliary body medulloepithelioma presented in a 13-year-old girl as a leukocoria with an extense vascularized retrolental membrane in her right eye. In this description, clinical documentation, posterior segment ultrasound, and ultrasound biomicroscopy were obtained, and an anatomopathological correlation was made by showing rosettes in some histological cuts stained by haematoxylin and eosin obtained from the mass and the membrane.

The study objective was to present multimodal imaging of definite ocular sarcoidosis (OS) in a young adult. A 52-year old woman consulted for 5 days of photophobia, ocular pain on movement, and redness in her left eye. Slit-lamp examination showed bilateral inferior granulomatous keratic precipitates, high cellullarity in the anterior chamber, posterior synechiae and hypopigmented subretinal lesions in the inferior vascular arcade, and nasal retina. In addition to the complete ophthalmic examination fundus photography (FP), fluorescein angiography (FA) and optical coherence tomography-angiography (OCT-A) were performed.Multimodal imaging of both eyes of the patient was performed. FP showed periphlebitis, hypopigmented subretinal lesions in the inferior temporal vascular arcade, and nasal retina. FA showed late diffuse capillary leakage from the subretinal lesions and optic nerve. OCT-A showed decreased choroidal capillary density, small hypo-intense gray areas of retinal capillary hypoperfusion, and presence of confluent and isolated areas void of flow in the deep plexus and choriochapillaris. With these findings on the multimodal imaging, chest computed tomography scan, and negative laboratory workup for other diseases, a presumptive diagnosis of OS was made which was subsequently confirmed with a positive skin nodule biopsy. The combination of OCT-A and other diagnostic methods allows a more detailed evaluation of structural and functional clinical findings in OS. There are few studies on OCTA findings in OS. Further studies with larger samples are needed in order to establish specific OCTA findings that could be used as diagnostic criteria.

Giant molluscum contagiosum (MC) is a rare nodular presentation of molluscum lesions. A diameter measuring more than half to 1 cm qualifies to be called as a giant MC. It has a strong predilection toward immunocompromised patients. A 45-year-old retropositive male presented with a large left upper eyelid swelling. After clinical evaluation, it was presumed to be a chronic lid abscess. On excision biopsy surprisingly, no purulent matter was obtained. A nodular mass was discovered which was confirmed to be giant MC on histopathology. No recurrence was found on follow-up. In immunosuppressed patients, MC has a chronic course and can rarely become large as a giant MC. CD4 lymphocytopenia and a phenomenon known as immune reconstitution inflammatory syndrome probably contribute to its pathogenesis. Giant MC must be kept in mind while evaluating an immunosuppressed patient coming with large lid swellings.

The purpose of the study is to present a case of indirect carotid cavernous fistula (CCF) successfully treated with endovascular approach. A 46-year-old male presented with a progressive, painless visual loss and conjunctival injection of the right eye with 1 month of evolution. On ophthalmology examination, the patient had best-corrected visual acuity of 20/30 in the right eye and an intraocular pressure (IOP) of 20 mmHg. The patient still had pulsating proptosis and an orbital bruit on the auscultation. Slit-lamp examination revealed corkscrew episcleral vessels. The patient was submitted a magnetic resonance angiography that confirmed the presence of an indirect carotid-cavernous sinus fistula. The patient was submitted to endovascular embolization by the transarterial approach to close the fistula with complete clinical and imaging resolution. Two months after the procedure, the visual acuity was 20/20, and the IOP was 8 mmHg. CCF is an uncommon disease and may be misdiagnosed when there are few signs and symptoms on presentation. Different subtypes of CCF cause different clinical signs, with varying speeds of onset and severity. The diagnosis is based on clinical findings and by imaging studies. However, the definite diagnosis is only possible with cerebral angiography. It is important to consider risks and benefits in relation to endovascular treatment, mainly in indirect CCF.

Here, we report the case of a 16-year-old patient with lesions on the upper eyelids, which were diagnosed as granuloma annulare. This is an uncommon site of presentation of this lesion type, which is more commonly found on the extremities such as the hands, ankles, and trunk. Excisional biopsy of the lesion was performed, and the patient presented with recurrence. The patient was started on systemic treatment and showed improvement of the clinical picture and reduction of the lesions, with continuous follow-up.

We report a case of visual alterations after the first use of poppers in a young male patient. A 32-year-old male patient with no past medical history presented with decreased central visual acuity and phosphenes in both eyes. He admitted the use of poppers a day before the symptoms began. Optical coherence tomography showed bilateral disruption of the ellipsoid zone. Poppers' use is increasing in young people and so is the possibility of visual and structural alterations that can persist over time as a result of macular toxicity.

The hypohidrotic ectodermal dysplasia (HED) is a rare genetic disease characterized by the absence or deficiency function of the ectodermal derivatives. Ocular involvement includes dry eyes, cataract, blefaritis, and alterations of meibomian glands. However, keratoconus has not been included as a manifestation in the literature. We report the case of a 17-year-old male who presented HED and keratoconus, an ocular manifestation seldomly related to this syndrome. The patient was submitted to a contact lens fitting, and the final visual acuity was 0.1 logMAR in both eyes. Therefore, to the best of our knowledge, our patient can be considered the fourth patient diagnosed with keratoconus and HED simultaneously worldwide. The uniqueness and rarity of this syndrome associated with keratoconus, as well as the satisfactory contact lens fitting, motivated this case report, which can provide useful information and alert to this possible etiological association.

A 22-year-old female patient was diagnosed to have HIV and treated by highly active antiretroviral therapy (HAART) since 2012 had developed a reduction of vision in both eyes secondary to cataract. The cataract was extracted from both eyes with no immediate postoperative complication. During follow-up, it was recognized that she had had bilateral Stage 3 macular hole in both eyes. The visual acuity in both eyes was 6/60 which did not improve with application of pinhole. Pars plana vitrectomy was done and sealed the macular hole in the left eye. The visual acuity remained the same in both eyes despite surgical intervention.

Toxoplasma retinochoroiditis is an entity of variable incidence according to the country and it is prevalent in Colombia and Latin America. The purpose of this report is to present two cases of toxoplasma retinochoroiditis with unusual associations with other retinal diseases. The first case corresponds to a young immunocompetent patient who developed toxoplasma retinochoroiditis in one eye and was treated. Six years later, he presented a similar picture in the contralateral eye and the same diagnostic was done. But the evolution was torpid and finally an herpetic acute retinal necrosis was confirmed. The second case corresponds to a healthy young patient, who developed toxoplasma retinochoroiditis and at the time of diagnosis he had exudative lesions in the same eye, that difficulted the diagnosis and were due to adult Coats´ disease.

Purpose: To describe a case of inferior bullous keratopathy caused by iris fibers resolved with laser diode 532. Case report: A 74-year-old woman consulted for a deterioration of visual acuity in the right eye, accompanied by foreign body sensation. A phacoemulsification surgery with IOL implant had been performed in both eyes three months before. Best-corrected visual acuity reached 20/40 in the right eye. Slit lamp examination revealed bullous keratopathy located in the inferior central quarter of the cornea of her right eye. Gonioscopy was performed to rule out having nucleus fragments in the inferior angle. With higher magnification, a pair of fine undulating fibers were observed coming from the anterior layers of the iris and making contact with the posterior face of the cornea. Photocoagulation of the iris fibers was performed with laser diode 532 and photodisruption with Nd-YAG laser, applied at the base of the fibers. After nine days, resolution of corneal edema, and disappearance of bullae was observed. Best-corrected visual acuity improved to 20/25. Conclusions: Photocoagulation of iris fibers with laser diode 532 complemented by photodisruption with Nd-YAG laser, in patients with iridoschisis, is an alternative to avoid endothelial decompensation and corneal edema, which may require corneal transplantation.

Purpose: To present a case of hemorrhagic occlusive retinal vasculitis (HORV) associated with intravitreal injection of vancomycin after pars plana vitrectomy (PPV). Methods: Single case report. Results: A 67-year-old woman presented with best-corrected visual acuity (BCVA) of 20/400 in the left eye. For clinical suspicion of chronic endophthalmitis, empirical treatment was initiated with vancomycin and ceftazidime without clinical improvement. The patient was submitted to pars plana vitrectomy. During surgery rhegmatogenous retinal detachment was observed and treated. At the end of surgery, intravitreal vancomycin was injected. After 18 days BCVA was counting fingers and fundus examination showed diffuse retinal vascular sheathing, intraretinal hemorrhages, and ischemic macular whitening. The clinical diagnosis was compatible with HORV secondary to retinal toxicity due to intraocular vancomycin. Conclusions: This case illustrates the importance of including intravitreal vancomycin during PPV surgery on the list of potential causes when investigating a case of suspected hemorrhagic occlusive retinal vasculitis.

Plasmablastic lymphoma (PBL) is a subtype of a rare and aggressive, non-Hodgkin’s lymphoma. It is usually associated with immunosuppression, HIV, or Epstein Barr virus and with a poor prognosis. It is characterized by a loss of the typical markers of mature B cells such as CD20 and expression of activated B-cell immunopheno-types associated with plasma cells. We present a case report of an HIV negative 21-year-old male with plasmablastic lymphoma of the right lower eyelid who underwent surgical resection and chemotherapy. Given the minimal accounts of PBL in the eyelid, the authors attempt to review the literature and cross match similarities with previous accounts of ocular involvement related to this malignancy.

A 43-year-old man presented with a decrease of vision in the left eye after blunt ocular trauma. Visual acuity was of 20/20 in the right eye and 20/100 in the left eye. Fundus examination revealed a choroid rupture and submacular hemorrhage. Three months after the trauma, it was evident the development of choroidal neovascularization (CNV). A serie of intravitreal injections of ranibizumab were initiated. The optical coherence tomography angiography (OCTA) demonstrated to be better than fluorescein angiography (FA) to show evidence of CNV, and was essential to follow up the progression and guide therapeutic decisions. Decision for treatment based on OCTA findings lead to an excellent visual acuity outcome with visual acuity of 20/25 seven months after the trauma.

Lymphomas are the most common primary orbital tumour in adults 60 years of age and older. We present a case of a 79-year-old woman complaining of redness in the right eye, tearing and diplopia. She had a history of a thyroid nodule with normal thyroid function, uncontrolled hypertension, and impaired fasting glucose. The Weiss coordimeter showed right eye lateral rectus palsy. Right 6th nerve palsy due to microvascular disease was assumed. At the follow-up visit performed six weeks later, there was a constant esodeviation of the right eye with proptosis and a temporal mass on the right ocular globe. The biopsy was diagnostic of non-Hodgkin’s lymphoma. Differential diagnosis of orbital masses is complex. Initial manifestations are non-specific and clinical suspicion of an orbital mass may not arise until the considerable growth of the lesion. The relevance of this case is its initial presentation with rapid evolution and the fact that the patient had thyroid disease. RESUMO Os linfomas são o tumor orbitário primário mais comum em adultos com mais de 60 anos. Os autores apresentam o caso clínico de uma doente de 79 anos de idade, que recorre ao Serviço de Urgência com hiperemia conjuntival do olho direito, lacrimejo e diplopia. Salientava-se, na história pregressa, a existência de nódulo tiroideu com função eutiroideia, hipertensão não controlada e anomalia da glicemia em jejum. O coordímetro de Weiss apontava para hipoação do músculo reto externo do olho direito. Assumiuse o diagnóstico de paralisia do sexto par craniano direito em contexto de provável doença microvascular. Na consulta de seguimento, seis semanas depois, apresentava uma esotropia com proptose, e uma massa temporal no olho direito A biopsia foi diagnóstica de linfoma não-Hodgkin. O diagnóstico diferencial de massas orbitárias é complexo. As manifestações iniciais não são específicas e a suspeita de presença da lesão pode não surgir até que haja um crescimento considerável da mesma. Este caso clínico assume especial relevância pela sua apresentação inicial com evolução rápida e pelo facto de a doente ter concomitantemente patologia da tiroide.

Pituitary apoplexy (PA) is a rare endocrine emergency, which can occur due to acute hemorrhage or infarction of pituitary gland, usually in the context of a pituitary macroadenoma. The most frequent ophthalmologic symptoms/sings are impaired visual acuity, visual field defects, and diplopia. A dense bitemporal hemianopic scotoma can cause a rare non-paretic diplopia, so-called hemifield slide phenomenon. This brief report describes a patient with this phenomenon caused by a PA from a pituitary macroadenoma.

The purpose of this study was to report the ocular findings in an unusual case of ectrodactylyectodermal dysplasia-clefting (EEC) syndrome and review the etiology and clinical presentation of similar situations in the literature. This study is an observational case report of a 13-year-old woman with complaints of epiphora and red eye. On examination, she presented with lachrymal punctal agenesis and neo-vascularization in both eyes. She was treated medically and without any surgical intervention. Corneal changes in EEC can have a variable presentation. The etiology of such keratopathy seems to be due to several factors and limbal stem cell deficiency (LSCD) being the newest factor involved. Recurrent infection from lachrymal drainage obstruction and tear film instability are other risk factors for disease severity and progression. Since these patients present several anomalies, it is important, to follow an interdisciplinary approach to reduce complications and provide the best possible medical care.

Manitoba Oculo-tricho-anal Syndrome (MOTA) is a rare autosomal recessive disorder characterized by eyelid coloboma, cryptophthalmos, anophthalmia or microphthalmia, abnormal hair growth from scalp to eyebrow, bifid or broad nasal tip, and gastrointestinal anomalies including omphalocele and anorectal malformations.1,2 We describe a multi-stage surgical approach to repair a right upper lid coloboma with an extensive congenital superomedial symblepharon obscuring the pupil in the context of MOTA. Surgical steps included reconstitution of the eyelid’s anatomical landmarks with dissection of the symblepharon invading the opacified cornea, freeing the pupillary axis, creation of a superior fornix, advancement of myocutaneous/periosteal flaps, and insertion of an implant to recreate the absent eyelid. This resulted in significant improvement of ocular surface protection, quality of life, and allowed for amblyopia treatment.

Purpose: To report the case of a patient with persistent vitreous hemorrhage in the right eye (RE) caused by occlusive retinal vasculitis secondary to tuberculosis. Methods: Male patient, 35 years old, with Indian ancestry, no history of previous systemic illness. First presented to our outpatient clinic with decreased visual acuity in the RE, lasting eight months. On exam, best-corrected visual acuity (BCVA) RE was <5/200 and BCVA in the left eye (LE) was 20/20. Keratic precipitates were visible and anterior chamber flare was described as 1+; extensive vitreous hemorrhage was present precluding fundus observation. Fundus fluorescein angiography (FFA) performed on his LE was normal. He was started on topical steroids and submitted to pars plana vitrectomy plus intraoperative retinal photocoagulation on his RE for peripheral retinal ischemia. Results: Post-surgery exam, BCVA in the RE was 20/100 and the LE was 20/20, no anterior chamber reaction bilaterally. Macular edema with exuberant vascular tortuosity and “phantom” vessels in RE. FA confirmed active occlusive vasculitis on the RE. Diagnostic workup was positive for a 28mm induration tuberculin test, supporting the diagnosis of ocular tuberculosis. The patient was started on anti-tuberculosis medication. Three months later, BCVA in the RE was 20/25 with no anterior chamber reaction in both eyes. Eighteen months later, the patient maintains good bilateral visual acuity without any evidence of disease reactivation. Conclusions: In the described clinical case, there was a good response after anti-tuberculosis treatment not associated with oral corticosteroid therapy, with improved visual acuity and remission of inflammatory angiographic signs, stressing the importance of searching tuberculosis etiology in cases of retinal vasculitis.

Haemolacria is a rare term that expresses the presence of blood cells in tears. It is commonly a benign process with diverse etiologies, from vascular diseases, trauma and neoplasms. We report the case of a 16 years old female patient who started with right hemicranial headache from moderate to severe pulsatile intensity, later bilateral epistaxis, bilateral otorrhea and hemolacria persisted for a month. Bilateral telangiectasias were found on the lower tarsal conjunctiva, tympani and on the back of the tongue, as we suspect in hereditary hemorrhagic telangiectasia. The diagnosis is clinical and based on Curaçao criteria, as definitive if the patient has 3 criteria. Management is to stop bleeding with tamponade or cauterization. Resumen La hemolacria es un término raro que expresa la presencia de células hemáticas en las lágrimas. Comúnmente es un proceso benigno que cursa con diversas etiologías, desde enfermedades vasculares, traumatismos y neoplasias. Presentamos el caso de una paciente de 16 años de edad que inició con cefalea hemicráneana derecha de moderada a severa intensidad de tipo pulsátil, posteriormente se le agregó, epistaxis bilateral, otorrea bilateral y hemolacria que persistió por un mes. En la exploración se encontraron telangiectasias bilaterales en la conjuntiva tarsal inferior, tímpanos y en el dorso de la lengua por lo que sospechamos en la Telangiectasia hemorrágica hereditaria. El diagnóstico es clínico y se basa según los criterios de Curaçao, como definitivo si la paciente presenta 3 criterios. El manejo consiste en detener la hemorragia con taponamiento o cauterización.

We present a case of a 71-year-old Caucasian male complaining of left lateral lower eyelid swelling after an insect sting sensation. Physical examination showed an oval shaped lesion (half a centimetre diameter), mobile, with well-defined edges, soft consistency, and erythema. Palpation was painless and without lymph node involvement. The patient had a history of metastatic prostate adenocarcinoma. One week later, the lesion showed rapid growth (two centimetres diameter) with central ulceration. Incisional biopsy was made. Immunohistochemistry findings were suggestive of a primary neuroendocrine carcinoma: Merkel Cell Carcinoma. The patient underwent surgery with wide local excision, regional lymphadenectomy, and eyelid reconstruction. Awareness of this type of tumor is crucial. A delay in diagnosis affects the prognosis of the disease significantly.

We herein describe the second case in the literature of an adult with a deep GA confined to the orbit. We could not identify any potential etiology from the patient’s history, and neither recurrence nor additional lesions have been noted after 2 years of follow-up.

A 32-year-old black woman came to our attention due to dissatisfaction with the cosmetic appearance of her blind left eye, with exotropia and leukocoria, interfering with her professional, social and personal life. At the slit lamp, we found a clear cornea, a quiet anterior chamber, a normal iris and a white pupillary refl ex due to white cataract and fi brotic retinal detachment. An Artisan® pupil occluder was enclavated retropupillary, keeping the cataract intact. Strabismus was surgically corrected. Despite the uneventful immediate post-operative course, two weeks after surgery, patient presented with posterior dislocation of the pupil occluder by release of one of the haptics, inducing cataract subluxation. Intracapsular cataract extraction was performed and the pupil occluder was repositioned anterior to the iris. At one year follow-up, the eye remains quiet. Exotropia was corrected and the pupil occluder is well centered with an excellent cosmetic appearance. Patient is extremely satisfi ed with the outcome.

We describe the treatment of lower eyelid cicatricial ectropion in a 24-year-old male using volumizing hyaluronic acid (HA) filler. One milliliter of Juvéderm Voluma® (Allergan) was injected directly under the skin in each lower eyelid to create a large bubble. The filler was dissolved with hyaluronidase (750 I.U. / side) 5 months later, achieving an excellent and stable functional and cosmetic result. There was a 2.4 mm improvement in MRD-2 with the filler in place, which decreased to 1.72 mm at 6 months after filler dissolution with hyaluronidase. This resulted in complete resolution of the signs and symptoms of corneal exposure. To date, there have been reports of low density HA injection for the treatment of cicatricial ectropion in elderly patients as well as infants with lamellar ichthyosis. In these cases, the HA was injected and left in place to dissolve spontaneously by itself. Our case is the first report of a HA with high G properties injected directly under the skin, followed by complete dissolution with hyaluronidase once the tissue expansion took place.

Purpose: To present a case of vaso-vagal syncope (VVS) after mydriatic eye drops in a patient with cutaneous hemangioma and intracerebral vascular abnormalities. Case report: A 41-year old woman presented to an ophthalmology clinic complaining of near vision disturbance. On examination, there was dilatation and telangiectasis of the conjunctival vessels on the temporal side of the right eye associated with right hemicranial and neck cutaneous involuted hemangioma ipsilateral to the conjunctival lesion. The patient experienced vaso-vagal syncope for approximately 15 minutes after mydriatic eye drops, 2 months prior to presentation. A magnetic resonance angiogram (MRA) showed right hypoplasia of the lateral and sigmoideus venous sinus ipsilateral to the external right hemangioma with predominantly compensatory drainage at the contralateral left system. At the neck vessels, the MRA showed dominant drainage through the lateral and jugular left sinus by the hypoplasia of the contralateral right system. Conclusion: This case shows the association of telangiectasis of the conjunctiva, and cutaneous hemangiomas of the head and neck with anomalies involving the central nervous system (CNS) as described by Pascual-Castroviejo in 1978, which they called cutaneous hemangioma–vascular complex syndrome. The diagnosis was made after the patient experienced VVS after mydriatic eyedrops instillation.

Purpose: To describe an hemiretinal vein obstruction secondary to a congenital arteriovenous malformation. Methods: Case report of a young patient with retinal arteriovenous malformation and hemiretinal vein obstruction. Results: A 9-year-old girl had a grade II retinal arteriovenous communication in her left eye. She presented with sudden loss of vision in her left eye, and a diagnosis of a hemiretinal vein obstruction secondary to a congenital arteriovenous malformation complicated with macular edema, capillary nonperfusion and neovascularization of the retina was made. She received intravitreal bevacizumab and multiple sessions of laser photocoagulation. Magnetic resonance imaging of the brain was normal and disclosed no signs of Wyburn-Mason syndrome. During follow up the patient remained with stable visual acuity, involuted disease, and persistent macular edema. Conclusions: Awareness of retinal vascular obstruction associated with arteriovenous communication may aid early recognition, and prompt treatment of potential complications, such as retinal and iris neovascularization.

Purpose: To report two patients with petechial hemorrhages in the skin of the face and eyelids and subconjunctival hemorrhages after they were exposed to acute severe gravitational force. Methods: Two patients developed Perthes syndrome after they were exposed to an unrestrained acute increase of gravitational force in a park attraction. One of them lost his consciousness for few minutes. The mechanism behind this entity is the sudden rise in the cervicofacial venous system pressure. Results: In our two cases there were no long-term complications encountered and there was spontaneous resolution. Conclusion: Perthes syndrome independently of the cause can lead to ophthalmic, neurological and even life threatening consequences. Proper clinical examination is warranted upon evaluating a patient with such entity.

Keratoacanthoma (KA) and Squamous Cell Carcinoma (SCC) are entities that often have been difficult to differentiate. Current thought establishes that Keratoacanthoma behaves similarly to a lowgrade squamous cell carcinoma. We present a case of an 80 year old female which history of present illness as well as clinical impression mimics Keratoacathoma (KA), but on histopathological examination resulted in Squamous Cell Carcinoma (SCC). We posit the use of novel histopathological and cytological advances, such as TGF-β sequencing and TGF-Alpha staining in assessing the specimen. Subtle differences should guide treatment for patients that need further resection and that might have orbital involvement.

Resumen Introducción: La arteritis de células gigantes (ACG) es una inflamación granulomatosa y necrotizante de arterias de mediano y gran calibre de etiología desconocida. La pérdida de visión rápidamente progresiva es una de sus complicaciones más graves dada su potencial bilateralidad e irreversibilidad. La enfermedad de Crohn (EC) es debida a la inflamación transmural y segmentaria del tracto gastrointestinal. Ambas entidades poseen una baja incidencia en nuestro medio, siendo excepcional la coexistencia de éstas simultáneamente en el mismo paciente. Caso clínico: Mujer de 77 años de edad con antecedentes personales de EC en tratamiento activo con Infliximab que acudió por disminución súbita de agudeza visual (AV) por su ojo izquierdo (OI). A la exploración oftalmológica la AV por su OI era de cuenta dedos a 30 cm y mostraba un defecto pupilar aferente relativo izquierdo muy manifiesto. Funduscópicamente el OI mostró un edema de papila pálido con hemorragias peripapilares. La paciente refería síntomas de ACG y alteraciones analíticas compatibles, por lo que tras ser diagnosticada de neuritis óptica isquémica anterior arterítica se procedió a la administración de dosis altas de glucocorticoides experimentando una mejoría analítica y clínica, aunque la pérdida de función visual fue permanente. Conclusiones: El Infliximab es un farmaco anti-TNFα empleado en la EC activa en casos refractarios al tratamiento corticoideo. Existen datos que sugieren que puede ejercer un efecto beneficioso en la inhibicion de la ACG al estar implicado el TNFα en la etiopatogenia de ambos cuadros. Sin embargo, en nuestra paciente no fue suficiente como medicacion previa y preciso dosis altas de corticoides, previniendo asi la bilateralidad del cuadro de ACG. Palabras clave: Neuropatia óptica isquémica anterior; arteritis células gigantes; enfermedad de Crohn;, Infliximab. Abstract Introduction: Giant Cell Arteritis (GCA) is a granulomatous and necrotizing inflammation of medium and large calibre arteries due to unknown etiology. Rapidly progressive loss of vision is one of the most serious complications given its irreversibility. Crohn's disease (CD) is a segmental and transmural inflammation of the gastrointestinal tract. Both entities have a low impact in our environment and it is exceptional the coexistence of these conditions in the same patient. Clinical case: We present a 77 year old woman with a personal history of CD in active treatment with Infliximab who showed a sudden visual loss in her left eye (LE). In the ophthalmological examination, the visual acuity was counting fingers at 30 cm and we observed a very clear left relative afferent papillary defect. Fundus showed a papiledema with peripapillary haemorrhages. The patient reported symptoms and laboratory abnormalities compatibles with GCA, so after being diagnosed of arteritic anterior ischemic optic neuritis we proceeded to the administration of high doses of glucocorticoids leading to analytical and clinical improvement, although the visual loss was permanent. Conclusion: Infliximab is an anti-TNFα drug used in active CD in cases refractory to corticosteroid treatment, data suggest that may have a beneficial effect on GCA inhibition because TNFα participate in the pathogenesis of both diseases. However, in our patient, it was not enough and she needed high doses of corticosteroids to avoid the bilateralism of the disease.

A 25-year-old woman presented with blurry vision, headache, nausea, and syncope. Humphrey visual field testing revealed bitemporal defects, but magnetic resonance imaging was negative for chiasmal pathology. Macular optical coherence tomography showed focal parafoveal disruption of the photoreceptor inner segment/outer segment junction and infrared imaging showed hyporeflective macular lesions in both eyes. Our case demonstrates a diagnosis of acute macular neuroretinopathy that presented with bitemporal visual field defects. To our knowledge, bitemporal visual field loss, mimicking chiasmal pathology, has not been reported previously in association with acute macular neuroretinopathy.

Resumen La enfermedad de Best es una distrofia macular que se caracteriza por un acúmulo de lipofuscina sobre el epitelio pigmentario de la retina. Existen cinco estadios diferentes basados en el examen del fondo de ojo incluyendo la neovascularización coroidea. Describimos el caso de un varón de 59 años que acude al servicio de oftalmología por disminución de agudeza visual en ambos ojos. El examen del fondo de ojo reveló lesiones viteliformes en ambas máculas. La angiofluorescinografía mostró una membrana neovascular coroidea en el ojo izquierdo. Confirmando el electrooculograma la enfermedad de Best. La aparición de neovascularización coroidea en la enfermedad de Best es una complicación infrecuente que puede ocurrir en etapas tardías. Las opciones terapéuticas más efectivas son la terapia antiangiogénica y la terapia fotodinámica con veteporfirina. Palabras clave: Enfermedad de Best; neovascularización coroidea; Ranibizumab inyección intravítrea. Abstract Best's Disease is a macular dystrophy characterized by a lipofuscin accumulation on the retinal pigment epithelium. Five stages have been described based on fundus examination, including choroidal neovascularization. We report a case of a 59-years-old male, presented to the Department of Opthalmology with visual loss in both eyes. Fundus examination revealed vitelliform lesions in both maculas. Fluorescein angiography showed a choroidal neovascularization in the left eye. The electrooculogram confirmed the diagnosis of Best's disease. Choroidal neovascularization is a rare complication of Best's Disease in late stages. The most effective therapeutic options are photodynamic therapy with veteporfirin and antiangiogenic therapy

Relapsing Polychondritis (RP) is a rare, recurrent and autoimmune multisystem disorder affecting cartilaginous structures, such as auricles, joints, nasal septum, larynx and tracheobronchial tree. Ocular manifestations may be observed in 42,3-65% of cases. Episcleritis and scleritis are the most common findings. However, RP is frequently misdiagnosed, leading to potentially severe, debilitating and, sometimes, fatal disease. There is no established standardized therapeutic protocol for RP. Current medical therapy is largely empiric and based on case reports. The aim of this paper is to document one case of ocular involvement in RP disease, emphasizing clinical and imaging findings that can help to establish an early diagnosis.

Secondary injuries caused by lightning strikes are not frequent; however, survivors have important sequel in organs and tissues. We describe two cases. The first one with lightning-induced maculopathy and the other case involving lens damage. This paper discusses factors that determine the extent of injuries and review the management for each one. The study and data collection complained with local legislation and with the principles of the Declaration of Helsinki.

Ten years after Baerveldt™ implantation, a woman underwent immunosuppressive therapy for necrotizing scleritis. She subsequently developed symptoms suggestive of endophthalmitis in the setting of tube exposure. Cultures isolated fungal Paraconiothyrium. She underwent two vitrectomies with anterior chamber washouts, Baerveldt™ device removal, and intraocular and systemic antifungal therapy. The endophthalmitis has since resolved.

Purpose: To describe a rare bilateral corneal ring-shaped opacity, not categorized as corneal dystrophy or degeneration occurring without any associated ocular or systemic disease. Methods: Case report and review of the literature. Results: The authors describe the clinical history and examination of an 80 years old man, with an asymptomatic bilateral and symmetrical ring-shaped corneal opacity in the deep stroma of the corneal mid-periphery. The surrounding corneal stroma was clear, and the tear film, epithelium and its basement membrane, Descemet’s membrane and endothelium were normal. This rare corneal anomaly was discovered by chance and its etiology is unknown. Conclusions: These rings may result from deposits of unknown origin or possibly a rare corneal dystrophy.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that still remains a public health problem in many countries. Its incidence in industrialized countries has been increasing during recent years due to HIV infection and immigration. Tuberculosis affects primarily the lung and lymph nodes but has the potential to infect almost every organ system and unusual presentations raise difficulties in differential diagnosis. The authors report a rare case of tuberculosis affecting the nasolacrimal system.

We report a case in which the vitreous was inadvertently stained with trypan blue during cataract surgery.

Neisseria gonorrhoeae is a important cause of ophthalmia neonatorum, and it can cause multiple complications in the newborn, including corneal perforation, panophtalmitis and blindness. We report a case of 1 month old newborn with bilateral infectious conjunctivitis and corneal unilateral commitment, with positive culture for gonococcus. ACT showed intraocular inflammatory involvement of the left eye. It is managed with intravenous antibiotic therapy, evolving with opacification , vascularization , progressive thinning of the cornea and athalamia of the left eye. It undergoes surgery for corneal patch and anterior chamber reshaping. During follow-up, eye ultrasound examination showed normal right eye and a smaller axial length and choroidal thickening of the left eye. RESUMEN Neisseria gonorrhoeae es una causa importante de oftalmía neonatal, pudiendo causar múltiples complicaciones en el recién nacido, incluyendo perforación corneal, panoftalmitis y ceguera. Se presenta caso de recién nacido de 1 mes de vida, con conjuntivitis infecciosa bilateral y compromiso corneal unilateral, además de cultivo positivo para gonococo. Tomografía axial computarizada de órbita mostró compromiso inflamatorio intraocular del ojo izquierdo. Se manejó con terapia antibiótica endovenosa, evolucionando con opacificación, vascularización, adelgazamiento progresivo de la córnea y atalamia del ojo izquierdo. Se sometió a cirugía para parche corneal y reformación de cámara anterior. Durante seguimiento, ecografía ocular mostró un examen normal del ojo derecho y una menor longitud axial y engrosamiento coroideo del ojo izquierdo.

Our purpose is to report a clinical case of bilateral macular edema caused by malignant hypertension in a 35-year old male. Patient presented with bilateral low visual acuity, massive macular edema, retinal hemorrhages and papilledema. Soon after he was diagnosed with other target-organ lesions, on heart and kidneys. After 6 months of controlled blood pressure, an increase in visual acuity and a small decrease of macular edema, we effectively treated the lower vision eye with two intravitreal ranibizumab injections, improving anatomy and function on both eyes. Even though we only treated one eye with ranibizumab, the contralateral eye also improved visual acuity and central macular thickness. This probably happened due to systemic absorption of ranibizumab. To the best of our knowledge, this is the first report of ranibizumab use in macular edema due to malignant hypertension.

We describe a patient with clinical history of intermittent haemolacria associated to hereditary hemorrhagic telangiectasia, first seen and diagnosed by the ophthalmologist.

Prolactinoma is the most common functional pituitary macroadenoma. It is usually treated with dopaminergic agonists; among them, cabergoline, that decreases tumor size and consequently the symptoms caused by the tumor. An uncommon complication to this treatment is alterations in the visual field. In the majority of cases, symptoms improve with the discontinuation of the drug. Owing to the diagnostic challenge, we present the following clinical case.

One rare form of anterior segment dysgenesis, Axenfeld-Rieger syndrome can be associated with glaucoma in half of the cases. We present an illustrative case managed with trabeculectomy complicated by angle closure.

Ocular involvement in patients with chronic myelomonocytic leukemia (CMML) is rarely reported, owing in part to the fact that the severe illness faced by many of these patients limits the feasibility of ocular examinations. Nevertheless, post-mortem examination of eyes from patients without ophthalmological symptoms and diagnosis of CMML has revealed ocular infiltration of atypical cells. We presented a 72-year-old man with two days of left-sided blurring of vision and an episode of transient visual obscuration associated to periorbitary pain. To our knowledge, this is the second case in peer-reviewed literature reporting the association between arteritic anterior ischemic optic neuropathy (AAION) and chronic myelomonocytic leukemia. A possible explanation is the fact that small vessel vasculitis, of unclear pathogenesis so far, complicates approximately 10% of CMML and presents as cutaneous vasculitis and lupus-like syndromes. Therefore, this may be in relation with the vasculitis of the short posterior ciliary arteries, which happens in cases of AAION.

The authors report a case presenting an spontaneous progressive enlarging lamellar macular hole through serial quantification by optical coherence tomography during a four year follow-up.

A patient with Birdshot retinochoroidopathy that presented with isolated optic nerve swelling is reported. Neuroimaging and serum testing for infectious or inflammatory etiologies were unremarkable. Indocyanine angiography revealed multiple round dark fundus lesions in both eyes. This raised suspicion for Birdshot retinochoroidopathy, which was confirmed with genetic testing. Ocular inflammation resolved following treatment with mycophenolate mofetil and a dexamethasone intravitreal implant.

Conjunctival melanoma is an uncommon tumor of the ocular surface, representing only 1.6% of all non-cutaneous melanomas. Overall metastasis rates range from 14-27%, with 10-40% occurring within the central nervous system (CNS). CNS involvement has shown to be the major cause of morbidity and mortality in these patients, with a median survival of between 2 and 10 months. Therefore, it is crucial to follow these patients closely throughout their lifetime to monitor for disease recurrence. We present a unique case of a 65 year-old woman with a well-documented history of recurrent conjunctival melanoma after multiple excisions. Routine follow up imaging revealed a new intracranial lesion, which presented an interesting diagnostic challenge.

Lentigo maligna (LM) affecting the periocular skin represents a challenge in its diagnosis and management. LM has a very slow rate of malignant transformation; however, with our aging population the progression towards malignant melanoma is concerning and can have potential life threatening consequences. We present a case of a 79-year-old male with a suspicious LM, who underwent surgical excision and reconstruction, to discuss the treatment options and suggest guidelines when confronting these controversial cases.

A case of Ollier's disease is presented, in a male adult with multiple enchondromas. The patient was reclassified as a Maffucci lymphangioma syndrome after two periocular lymphangiomas were surgically excised.

El síndrome de isquemia ocular es una patología rara, secundaria a hipoperfusión debido a estenosis o oclusión de las arterias carótidas común o interna. Varón, de 78 años, que acudió por disminución de agudeza visual progresiva, de meses de evolución, en su ojo derecho (OD). La Mejor Agudeza Visual Corregida (MAVC) en su OD era de no percepción de luz. La exploración biomicroscópica del polo anterior en OD reveló la presencia de microhipema y neovascularización iridiana en los 360º. La presión intraocular era normal. Mediante la exploración funduscópica y la angiografía fluoresceínica, se confirmó la presencia de signos de isquemia retiniana y coroidea, todo ello compatible con un posible síndrome de isquemia ocular. Se realizó panretinofotocoagulación, y se solicitó Eco-Doppler de Troncos Supraaórticos y angio-TC que confirmaron la presencia de una obstrucción completa en la arteria carótida interna derecha, no susceptible de tratamiento quirúrgico. A los 7 meses, el paciente permanece estable clínicamente, desde el punto de vista ocular y sistémico. En estos casos, es de gran trascendencia la evaluación sistémica del paciente, incluyendo realización de Eco-Doppler de TSA o angio-TC, y el abordaje multidisciplinar, pues un adecuado y precoz diagnóstico puede condicionar no solo el pronóstico visual, infausto en nuestro caso, sino también la supervivencia del paciente. Palabras clave: obstrucción carotídea, isquemia ocular, glaucoma, neovascularización, agudeza visual. Abstract Ocular ischemic syndrome is a rare condition, secondary to hypoperfusion due to stenosis or occlusion of the common or internal carotid artery. A 78 year-old male, who complained of progressive acuity visual loss, in his right eye (RE). His Best Corrected Visual Acuity (BCVA) in RE was No light perception. Biomicroscopic exploration of anterior segment revealed the presence of microhyphema and iris neovascularization in 360 degrees. Intraocular pressure was normal. Fundoscopy and fluorescein angiography confirmed the presence of retinal and choroidal ischemia, compatible with an ocular ischemic syndrome. Panretinophotocoagulation was performed, and Eco-Doppler of supraaortic trunks (SAT) and angio-CT were requested, and they confirmed the presence of complete obstruction of right internal carotid artery, surgically untreatable. Seven months ago, the patient remains clinically stable, with no ocular nor systemic changes. In these cases, systemic evaluation of the patients, including performance of Eco-Doppler of SAT or angio-CT, and the multidisciplinary approach, is crucial, as a prompt and adequate diagnosis can influence visual prognosis, awful in our case, and patient survival.

A 45-year-old man submitted to radial keratotomy 19 years ago acquired Cladosporium sp. infection in one of the incisions of the left eye. The infection was resistant to topical amphotericin B, topical natamycin and systemic fluconazole. The keratitis was cured with voriconazole 200 mg PO, BID for 10 days.

Resumen La queratopatía cristalina es una infección corneal de evolución crónica en la que podemos encontrar un infiltrado estromal blanco arboriforme asociado a una mínima reacción inflamatoria. La mayoría de los casos ocurren en córneas transplantadas en tratamiento con corticoides tópicos. Mujer de 91 años con antecedentes de perforación ocular tratada mediante queratoplastia penetrante excéntrica. Un año después presentó una agudeza visual de percepción de luz, gran reacción inflamatoria y un infiltrado corneal blanquecino de aspecto arboriforme. Se inició tratamiento con vancomicina intravenosa y vancomicina y amikacina intravítreas, tópicas e intracamerulares y se obtuvieron muestras de humor acuoso y del infiltrado corneal mediante arrastre con aguja de safil de 8/0 con resultado microbiológico positivo para Candida Parapsilosis. Se inició entonces tratamiento con voriconazol y trimetroprimsulfametoxazol tópicos con respuesta favorable. En la queratopatía cristalina, la reacción inflamatoria inducida en el huésped suele ser leve debida, en parte, a la escasa replicación de los microorganismos implicados. El caso que presentamos es atípico puesto que encontramos una intensa reacción inflamatoria; sin embargo tanto el aspecto biomicroscópico de la córnea, como el resultado del análisis microbiológico y la respuesta positiva al tratamiento, apoyan el diagnóstico de queratopatía cristalina por Candida Parapsilosis. Palabras clave: queratopatía, cristalina, infección, corneal,cándida Crystalline keratopathy is a corneal infection with chronic evolution in which we can find white branching aggregates in corneal stroma in absence of host inflammatory response. It most frequently occurs in corneal grafts with chronic topic corticosteroid treatment. 91-years-old woman with tectonic keratoplasty because of ocular perforation who presented one year later of surgery a best corrected visual acuity of light perception with intense inflammatory response and white branching aggregates in corneal stroma. Treatment with intravenous vancomycin and topic, intravitreal and intracameral vancomycin and amikacin was started. Aqueous humor and corneal infiltrate samples were obtained. The second one was acquired by dragging using a safil 8/0 needle. Microbiological study showed an infection by candida parapsilosis, so treatment with topic voriconazol and trimethoprim sulfamethoxazole was started with good clinical evolution. Crystalline keratopathy usually associates a small host inflammatory response, in part due to the poor replication of involved microorganisms. The case presented previously is an atypical one because of the intense inflammatory response, however, clinical appearance, microbiological results and treatment response are typical of crystalline keratopathy.

A 27-year-old woman with bilateral high myopia had anterior chamber iris-claw phakic intraocular lens implantation in her left eye under local anesthesia and with no intraoperative complications. The preoperative slit-lamp examination was normal, and she had no relevant past medical history. On the second postoperative day, patient developed fixed, dilated mydriasis, and one month later, an IOL subluxation was noted on examination. She had no history of intraocular hypertension and no mydriatic drops were used. She was ultimately diagnosed with Urrets-Zavalia syndrome. We removed the IOL and observed the patient for six months after fitting her with a colored contact lens. During this period of time, she complained of glare and photophobia and developed contact lens intolerance. To bring more comfort to the patient, we implanted a posterior chamber Implantable Collamer Lens (ICL) and performed iris cerclage in the left eye with good aesthetic and refractive outcome. Posterior chamber ICL implantation with iris cerclage proved to be a simple and effective approach in the management of this situation.

A 57 year-old woman presented an irritated right eye and right-sided enophthalmos with hypoglobus for the past year. The patient previously had an extensive right-sided cystic orbital schwannoma removed with orbital reconstruction 5 years ago. Imaging revealed an enlarged right orbit with medial wall collapse and inferior displacement of a floor plate implant. An anterior orbitotomy with placement of an enophthalmos implant, three 1 mm Medpor sheets, an orbital rim implant, and an oral mucosa graft in inferior fornix with a lateral strip were used to reconstruct the ocular malposition and right lower lid retraction. We report a successful case of a complex orbital reconstruction in a patient with orbital deformity subsequent the removal of a massive cystic schwannoma.

Fetal rhabdomyoma is a rare neoplasm composed of immature striated muscle cells that resemble rhabdomesenchymal cells during weeks 6-10 of embryogenesis. This tumor, though well-described in many anatomic locations, is most commonly found in the head and neck region. We report a case which highlights the difficulty in diagnosing a fetal rhabdomyoma in the lacrimal gland of a 56 year old woman. This case report gives an overview of this rare neoplasm, detailing the presentation, diagnosis, and management.

Retinal phototoxicity caused by light from endoilluminator used in vitrectomy has been described in the scientific literature. Xenon light can be one of the most harmful sources of radiation to the retina if adequate filters are not used as that radiation is near ultraviolet spectrum. We present herein a case series of patients who developed retinal phototoxicity induced by xenon light, after macular hole surgery. Macular phototoxic damage with foveal involvement remains a factual danger during vitrectomy using Xenon light as endoilluminator with inadequate filters.

A 53-year-old man with a history of multiple cutaneous facial squamous cell carcinoma (SCC) presents with a progressively enlarging cystic mass of his right brow for two months associated with periocular pain and numbness along the right side of his scalp. In addition, several subcutaneous lesions were noticed along the nasolabial and nasojugal areas. All lesions were excised and confirmed to be SCC on pathology with perineural spread observed with the primary brow lesion. The presence of a cystic lesion and/or multiple subcutaneous lesions should prompt consideration of a metastatic presentation of SCC. Furthermore perineural invasion of SCC can be associated with sensory and/or motor deficits.

Purpose: To describe five cases (four children) with ocular sequelae from honeybee or wasp sting injuries to the eye treated with anterior chamber irrigation to reduce venom concentration and subsequent complications. Design: Interventional case series. Methods: Patients with hymenoptera corneal sting injuries were treated in the operating room by performing an anterior chamber irrigation with balanced saline solution and triamcinolone in an effort to minimize the tissue damage induced by bee venom. Results: Early clearing of inflammation and more rapid recovery of baseline acuity were associated with early surgical intervention. Late complications included corneal decompensation, iris heterochromia, paralytic mydriasis, glaucoma and cataract; these complications are irreversible and sight threatening. Conclusion: Performing an early anterior chamber irrigation is a treatment option for this type of trauma, since it results in faster resolution and fewer late complications.

Purpose: We review a case of invasive squamous cell carcinoma invading the cornea to discuss optimal management. Methods: Observational case report with histopathologic analysis. Results: Histopathology demonstrates corneal invasion by the tumor that appears to have been completely excised with a large therapeutic keratoplasty and adjuvant cryotherapy. Conclusions: Successful management of ocular surface squamous neoplasia (OSSN) requires removal of identifiably abnormal tissue without disruption of normal protective architecture, careful histopathologic analysis, and the employment of adjuvant therapy at the time of or subsequent to surgical excision.

Purpose: To present three male patients with subfoveal perfluorocarbon liquid after surgery for retinal detachment with macular involvement. Design: Interventional case series. Methods: Perfluorocarbon liquid extraction was performed by retinotomy and aspiration with a 25 or 38 gauge cannula. Results: Four months later, anatomic restoration was achieved, without rests of perfluorocarbon liquid, but with a severe defect in photoreceptors. Visual acuity remained unchanged. Conclusion: Subfoveal perfluorocarbon liquid extraction in patients with previous surgery of retinal detachment with macular involvement may imply bad functional outcomes, probably due to a previous damage of pigment epithelium and photoreceptors, aggravated by perfluorocarbon liquid toxicity. Resumen Objetivo: Presentar tres varones entre 43 y 63 años, con presencia de perfluorocarbono líquido subfo-veal tras cirugía de desprendimiento de retina con afectación macular. Métodos: Se realizó extracción mediante retinoto-mía y aspiración con cánula de 25 o 38 gauge. Resultados: A los 4 meses, se consiguió restauración anatómica, sin restos de perfluorocarbono líquido subfoveal, pero con defecto severo en los fotorreceptores. La agudeza visual no experimentó cambios significativos. Conclusión: La extracción de perfluorocarbono líquido subfoveal en pacientes intervenidos previamente de desprendimiento de retina con afectación macular suele conllevar un mal pronóstico funcional, posiblemente en relación con un daño previo de las células del epitelio pigmentario y los fotorreceptores, agravado por la toxicidad del perfluorocarbono líquido.

Combined venous lymphatic malformation is a benign, nonhereditary vascular anomaly. These unencapsulated hamartomas can be associated with spontaneous, recurrent hemorrhage leading to prop-tosis and pain. We describe a patient with this lesion to discuss the various management strategies and surgical challenges encountered with this condition.

Purpose: To evaluate the torsional effect of superior oblique muscle tenectomy. Design: Case report. Methods: Case report of a patient with horizontal strabismus and bilateral superior oblique muscle overaction, submitted to bilateral superior oblique tenectomy. Objective access of ocular torsion was performed using retinogra-phy and a computer software (Autocad 2009®). Results: The preoperative angle was 7.57 in the right eye and 0.66 in the left eye. Postoperative angle of torsion was 4.22 in the right eye and -1.50 the left eye. Conclusion: The presented case report suggests that superior oblique tenectomy has an extortion effect, decreasing the intorsion detected in case of superior oblique overaction. Resumo Objetivo: Avaliar objetivamente o efeito torcional da tenectomia do músculo oblíquo superior. Desenho: Relato de caso. Métodos: Estudo de paciente portador de estrabismo horizontal e hiperfungào bilateral dos oblíquos superiores, submetido à tenectomia bilateral. A medida objetiva da to-rgào ocular foi realizada mediante exame retinográfico e de um programa de computador (Autocad 2009®). Resultados: O ángulo de torgáo no período pré-operatòrio era de 7,57° no olho direito e de 0,66° no olho esquerdo. No período pòs-operatòrio, o ángulo de torgáo encontrado foi de 4,22° no olho direito e -1,50° no olho esquerdo. Conclusáo: O presente estudo suge-re que a tenectomia do músculo oblíquo superior tem efeito extorsor, diminuindo a intorgáo encontrada nos casos de hiperfungáo deste músculo.

Purpose: To report a quick reopening of a spontaneously closed full thickness macular hole. Design: Case report. Methods: A 68-year-old patient with stage III full thickness idiopathic macular hole in one eye was followed up for thirteen months with fundus photography and optical coherence tomography (OCT). Results: Twelve days after the first examination, that detected the macular hole, OCT scans revealed the closure of the macular hole associated to the development of a small epiretinal membrane (ERM). One month later, the patient was admitted to the emergency unit, complaining of progressive visual loss over the past three days. OCT examination showed a full-thickness macular hole, very similar to the previously closed, and a progression of the ERM. The patient was submitted to pars plana vitrectomy with internal limiting membrane peeling and removal of ERM. Surgical repair resulted in significant functional and anatomic outcome. Conclusion: The reopening of a spontaneously closed macular hole is remarkably uncommon and has been reported previously in two patients. A rigorous follow-up is mandatory, because these macular holes can quickly reopen, as demonstrated in this case report. RESUMEN Propósito: describir un caso de rápida reapertura tras cierre espontáneo de un agujero macular de espesor completo. Diseño: caso clínico. Métodos: Paciente de 69 años con agujero macular de espesor completo estadío III en un ojo que es seguido durante 14 meses mediante retinografías y tomografía de coherencia óptica (OCT). Resultados: Doce días tras la exploración inicial, los cortes de la OCT revelaron el cierre del agujero macular asociado al desarrollo de una pequeña membrana epiretiniana (MER). Un mes más tarde, el paciente acudió a urgencias por disminución de agudeza visual progresiva desde hacía tres días. La exploración mediante OCT mostró un agujero macular de espesor completo, muy similar al que previamente se había cerrado, y una progresión de la MER. El paciente fue sometido a vitrectomía pars plana (VPP) con pelado de membrana limitante interna y remoción de MER. La cirugía resultó en buenos resultados anatómicos y funcionales. Conclusión: La reapertura tras cierre espontáneo de un agujero macular es muy infrecuente y ha sido descrita en tan solo dos casos hasta ahora. Es necesario un seguimiento estrecho, pues estos agujeros pueden reabrirse rápidamente, como mostramos en este caso.

Microphthalmos with orbital cyst is a rare and severe non-hereditary ocular developmental anomaly. Pathologically it represents a failure in the closure of the embryonic fissure at the 7-14 mm stage of gestation, resulting in a congenital microphthalmia and the formation of a colobomatous cyst in different degrees. We present a patient with this condition to emphasize the complexity in the decision making process and review the various management strategies to obtain the best long term results. RESUMEN Microftalmos con quiste orbital es una rara y grave anomalía ocular no-hereditaria del desarrollo. Patológicamente representa una falla en el cierre de la fisura embrionaria en la fase de 7-14 mm de gestación, resultando en una microftalmía congénita y la formación de un quiste colobomatous en diferentes grados. Presentamos a un paciente con esta condición para enfatizar la complejidad en la toma de decisiones en el proceso y revisar las diferentes estrategias de manejo para obtener los mejores resultados a largo plazo.

We report the management of a non-traumatic rhegmatogenous retinal detachment in a pediatric patient in the context of a genetic syndrome associated with failure of type 2 collagen synthesis, which manifests itself in ocular, hearing, facial, bone and joint abnormalities. We describe the clinical presentation and surgical repair technique that included lensectomy, vitrectomy, peeling of vitreoretinal proliferative membranes, giant retinal tear management and prolonged use of intraocular silicone oil. Long-term clinical follow-up was observed. We highlight this case report as a therapeutic challenge in a deaf and high myopic child, with motor disabilities and atypical vitreoretinal disorders that have generated technical difficulties in surgical resolution. There is also little scientific references in the literature. This disease represents a clinical model of abnormal vitreoretinal interaction. RESUMEN Presentamos el manejo de un desprendimiento de retina regmatógeno no traumático en paciente pediátrico, en el contexto de un síndrome genético asociado a falla de síntesis de colágeno tipo 2 que se manifiesta en alteraciones oculares, auditivas, faciales y osteoarticulares. Se describe presentación clínica del cuadro y técnica de reparación quirúrgica que consistió en lensectomía - vitrectomía - pelaje de membranas de proliferación vitreorretinal - manejo de desgarro retinal gigante - retinopexia y tamponamiento prolongado con aceite de silicona. Se efectuó seguimiento clínico a largo plazo. Destacamos este caso por ser un desafío terapéutico en un niño sordomudo, alto miope, con discapacidad motora y que posee alteraciones vitreorretinales atípicas que generan dificultades técnicas en su resolución quirúrgica, existir una escasa literatura mundial de referencia y representar un modelo clínico de interacción vitreorretinal anómala.

We describe herein a case of a 25 year-old female with main complain visual acuity loss in his left eye (OS) associated to a choroidal melanoma. Treatment with plaque brachytherapy using I125 was started. It was observed improvement regarding tumor size and best-corrected visual acuity (BCVA). However, at 39 months of follow up on brachytherapy, fundoscopic signs of radiation-induced retinopathy (microaneu-rysms, retinal hemorrhages, hard exudates, and neovascularization) were observed. Fluorescein angiography confirmed the diagnosis of radiation-induced retinopathy, with large areas of ischemia and neovascularization. Focal argon photocoagulation was used as treatment with excellent results in 5 years follow-up.

The rare, non-caseating, granulomatous disease known as Melkersson-Rosenthal syndrome (MRS) can be diagnostically difficult especially when not presenting as the characteristic triad of facial palsy, facial edema, and fissured tongue.¹ We present a case of a 65-year-old female with a 15-year history of recurrent bilateral upper eyelid swelling previously unsuccessfully treated for a presumed lid allergy and rosacea. Following imaging and histopathology results, she has now been diagnosed with Melkersson-Rosenthal syndrome. Since this disease is typically refractory to treatment, she is being followed and treated with cosmetic eyelid skin reduction if necessary during inactive stages of the disease.

Thyroid Orbitopathy (TO) is characterized by exophthalmos, palpebral retraction and compressive optic neuropathy (CON) in the more severe cases. Orbital decompression surgery is carried out in these cases to preserve vision. The study presents a 56 year old masculine patient, who is a smoker with hypertension. In 2009, he was diagnosed with Graves' disease with a slight TO that progressed to severe TO with CON, after he was treated with radioactive Iodine to control hyperthyroidism. An orbital compression surgery by nasal endoscopy was carried out with excellent visual and aesthetic results. Objectives: To show the results of the orbital decompression by endonasal endoscopy, besides the analysis of the complications and factors associated with TO progression in this patient. Results: The results of the surgery were satisfactory, as regard to the exophthalmos and the intraocular pressure decrease plus the visual acuity, colour vision and visual field improvement. He suffers strabismus after surgery. Conclusion: We concluded that the surgery results were satisfactory in this patient and strabismus was a complication after surgery. Smoking and iatrogenic hypothyroidism were the factors worsening the thyroid orbitopathy.

In an effort to keep up with the ever rising cost in the current private practice setting, ophthalmology practices are becoming busier, implementing innovative and cost-effective procedures. This has led to a significant decrease in the amount of time that the physician spends with the patient, which eventually may jeopardize the quality of care. We recently encountered a case of poor doctorpatient communication in which all ethical principles and limits of patient care were trespassed leaving the patient as a blind victim. We present the case hoping to touch upon every doctor's conscience to remember the primary role of a physician in educating patients and treating without inflicting harm as a way to offer better and safer quality of health care. Resumen En un esfuerzo para soportar los incrementos de los precios en las prácticas médicas privadas, los oftalmólogos se han visto en la necesidad de incrementar el número de pacientes, al igual que implementar procedimientos innovadores de costo beneficio adecuado. Esto ha llevado irremediablemente a disminuir el tiempo que el médico le dedica a cada paciente, lo que puede eventualmente comprometer la calidad del tratamiento. Recientemente encontramos uno caso de pobre comunicación médico-paciente, en el que se traspasaron los principios éticos llevando al paciente a la ceguera irreversible. Presentamos este caso con la esperanza de crear conciencia recordando que el rol primordial del médico es la educación y el tratamiento sin infligir daño al paciente, ofreciendo un mejor y seguro servicio de salud.

Summary: It is necessary to heighten the level of knowledge about glaucoma because of the real danger of blindness that it represents, which could minimize serious consequences. Objective: To identify the level of knowledge of patients with glaucoma about their illness. Methods: A descriptive cross-sectional study was undertaken on the Glaucoma Service of the Ophthalmological Center of the Dr. Salvador Allende University Hospital, between January and March of 2010. The cohort included 947 patients with primary open-angle glaucoma who came to the Service during this period, and the sample consisted of the first 100 patients who fulfilled the inclusion criteria (willingness to participate in the study and an appropriate level of communication to respond the survey). A survey of the National Eye Health Education Program 2020 Vision was employed (Bethesda, USA). The results were evaluated a based on responses to true or false questions. The percentage method was used for the calculation of the frequencies in each case. Results: Women (62.0%) and patients between 50 and 69 years of age (43.0%) predominated. The risk factor most commonly recognized was family history of the illness (94.0%) and the least commonly recognized were racial characteristics (21.0%). The asymptomatic character of the disease was clearly understood (93.0%), but there were incorrect answers on the increase of the intraocular pressure. 87.0% of those interviewed were certain that the illness could only be controlled, but only 9.0% knew visual recovery was not possible. 100.0% erroneously identified intraocular pressure as the only diagnostic indicator of the disease. 69.0% demonstrated a mid-level of knowledge about their illness, and 19.0% an appropriate level. Conclusions: In the patients evaluated, the mid-level of knowledge prevailed. Resumen Es imprescindible elevar el nivel de conocimientos sobre glaucoma por el peligro real de ceguera que representa, lo que podría minimizar sus graves consecuencias. Objetivo: Identificar el nivel de conocimientos de enfermos glaucomatosos sobre su enfermedad. Métodos Se realizó un estudio descriptivo y transversal en el Servicio de Glaucoma del Centro Oftalmológico del Hospital Universitario Dr. Salvador Allende, entre enero y marzo de 2010. El universo estuvo constituido por los 947 pacientes con glaucoma primario de ángulo abierto que acudieron al Servicio en el periodo y la muestra por los primeros 100 que cumplieron los criterios de inclusión (disposición de participar en el estudio y adecuado nivel de comunicación para responder la encuesta). Se aplicó una encuesta del National Eye Health Education Program 2020 Vision (Bethesda, USA). Los resultados fueron evaluados según el conocimiento demostrado por los pacientes de acuerdo con el tipo de respuesta (cierto o falso). Se utilizó el método porcentual para el cálculo de las frecuencias en cada caso. Resultados Predominaron las mujeres (62,0%) y los pacientes entre 50 y 69 años de edad (43,0%). El factor de riesgo más reconocido fue el antecedente familiar de la enfermedad (94,0%) y las características raciales el menos (21,0%). Fue claramente identificado el carácter asintomático de la enfermedad (93,0%), pero no hubo respuestas correctas sobre el aumento de la presión intraocular. El 87,0% de los encuestados consideró cierto que la enfermedad sólo puede ser controlada y el 9,0% conocía lo referente a la no recuperación visual. El 100,0% valoró erróneamente la presión intraocular como único proceder diagnóstico y el 76,0% correctamente la dilatación pupilar. El 69,0% demostró un nivel medio de conocimientos sobre su enfermedad y el 19,0% un nivel adecuado. Conclusiones En los pacientes evaluados, predominó el nivel medio de conocimientos. Palabras clave: percepción, riesgo, glaucoma, conocimientos, enfermedad.

RESUMEN Objetivo: Reportar el caso de un paciente con queratocono unilateral verdadero en el ojo derecho asociado a fibrosis localizada en la órbita ipsilateral. Métodos: Hombre de 25 años de edad con agudeza visual progresiva en el ojo derecho con diagnóstico de queratocono unilateral y fibrosis orbitaria unilateral. El ojo derecho con una agudeza visual de 20/800 que mejoraba a 20/40 con una refracción de -7.50 -6.00 x 175°, presentando signos clínicos de queratocono. Los movimientos oculares muestran limitaciones en la mirada hacia arriba en todas las posiciones. El ojo y órbita del lado izquierdo sin ninguna alteración con una agudeza visual de 20/20. Resultados: Se realizó tomografía computada, confirmando el diagnóstico de fibrosis orbitaria en la órbita derecha, las topografías corneales a través del tiempo mostraron progresión evidente del queratocono en el ojo derecho y estabilidad en el ojo izquierdo. Conclusiones: El queratocono unilateral verdadero es una condición rara. La asociación de queratocono unilateral con alteraciones unilaterales de párpados y órbita se ha descrito previamente. Sin embargo, según nuestro conocimiento, este es el primer reporte de fibrosis orbitaria asociado con queratocono. ABSTRACT Purpose: To report a case of a patient who presented with true unilateral keratoconus in his right eye associated to a localized fibrosis in his ipsilateral orbit. Methods: A 25-year old male with progressive visual acuity loss in the right eye was diagnosed with unilateral keratoconus and unilateral orbital fibrosis. Right eye visual acuity was 20/800 improving to 20/40 with a refraction of -7.50 -6.00 x 175° and he presented with clinical signs of keratoconus. Eye movements showed limitations in the upper gaze of the right eye in all positions. The fellow eye and orbit were under normal limits and visual acuity was 20/20. Results: Computed Tomography scan confirmed the diagnosis of orbital fibrosis in the right orbit and corneal topographies during a time span showed evident keratoconus progression of the right eye and stability in the left eye. Conclusions: True unilateral keratoconus is a rare condition. Association of unilateral keratoconus with unilateral eyelid and orbital conditions has been previously reported. Nevertheless, to our knowledge, this is the first report of orbital fibrosis associated with keratoconus.

Purpose: Report technique utilizing multilayered folded dehydrated amniotic membrane for refractory scleral delle management. Methods: A 3 x 2 centimeter dehydrated amniotic membrane was folded four times onto itself, with the basement membrane side on the exterior, to yield a 7.5 x 10 millimeter graft. This was sutured into the delle using four 9-0 vicryl sutures. Once adequate fixation of the multilayered folded graft was obtained, a primary conjunctival closure was performed using five 9-0 vicryl sutures. Total surgical time was fifteen minutes. Results: This technique was utilized on one patient with a refractory scleral delle after undergoing pterygium excision outside of my institution with bare sclera technique and intra-operative mitomycin C application. No post-operative complications or recurrence of the delle occurred after 9 months of followup. Conclusion: This technique provides an alternative efficient management of refractory scleral dellen while avoiding use of donor corneal or scleral tissue.

Acanthamoeba Keratitis. A Case Report Case report: A 33 year-old male, with hyperemic painful eye and no improvement after antibiotic and corticoid topic therapy. By biomicroscopy: annular infiltrate with inferior de-epithelialization, and limbal inflammation. Due to the suspicion of Acanthamoeba keratitis, we started treatment with clorhexidine 0.02%, polimyxin B+neomicin+ gramicidin (Oftalmowell^®) and propamidine isethionate (Brolene^®). A microbiological diagnosis confirmed the presence of Acanthamoebae, and diagnosis of Acanthamoeba keratitits was established. We observed a satisfactory evolution, with formation of a central corneal leukoma, followed by penetrating keratoplasty, with good results. Discussion: Clinical and microbiological early diagnoses are fundamental, since inappropirate treatment will lead to the development of cysts, and treatment resistance. Acanthamoeba keratitis, early diagnosis, microbiological diagnosis. Caso clínico: Varón de 33 años con ojo hiperémico, doloroso, sin mejoría tras tratamiento con antibióticos y corticoides tópicos. A la exploración biomicroscópica: infiltrado anular desepitelizado por la parte inferior, con limbitis. Ante la sospecha de queratitis por Acanthamoebae, se inició tratamiento con clorhexidina 0.02%, polimixina B+neomicina+gramicidina (Oftalmowell^®) e isetionato de propamidina (Brolene^®). El estudio microbiológico confirmó el crecimiento de Acanthamoebae, por lo que se estableció el diagnóstico de queratitis por Acanthamoeba. La evolución fue satisfactoria, con formación de leucoma corneal central, que llevó a queratoplastia penetrante, con buenos resultados. Discusión: Un diagnóstico precoz, clínico y microbiológico es fundamental, pues un tratamiento inicial poco acorde dará lugar al enquistamiento y resistencia al tratamiento. Palabras clave: Queratitis por Acanthamoeba, diagnóstico precoz, diagnóstico microbiológico.

Case reports: We report a few cases of a Portuguese family with Meretoja syndrome. Complete ophthalmological examination and tests such as pachymetry and Ocular Response Analyzer (ORA) were performed. The clinical spectrum of patients was variable. Visual acuity ranged from 20/20 to count fingers, depending on the degree of dystrophy and keratitis. They all had lattice corneal dystrophy type II and keratitis of varying severity. Discussion: Meretoja syndrome is a systemic amyloidosis and it is characterized by cranial neuropathy, corneal dystrophy and mild signs of polyneuropathy. This form of disease lacks specific treatment.

Granulocytic Sarcoma is an uncommon manifestation of AML that can affect the orbit. A 10 year-old girl presented with a history of 1 day old proptosis (OS). The patient also presented with diplopia in the inferior quadrants OS. No other significant alterations were seen during her ophthalmological exam, with the exception of proptosis (OS). A CT scan displayed an extraconal mass to the left orbit. The mass had a molding contour with minimal bone destruction. A lateral orbitotomy was later performed. Subsequent histopathological examination and immunohistochemistry confirmed the diagnosis of granulocytic sarcoma. The systemic work-up was normal. The patient later underwent chemotherapy plus radiotherapy, and is now free of systemic disease after a 18-month follow-up. Resumo Sarcoma Granulocítico é uma forma incomum da Leucemia Mielóide Aguda e pode acometer a órbita. Apresentamos uma criança de 10 anos, feminina, que apresentou uma história de proptose no olho esquerdo há 1 dia. A paciente também apresentava diplopia on quadrante inferior do olho esquerdo. Não havia outras alterações ao exame clínico. Tomografia Computadorizada da órbita mostrou uma massa extraconal na órbita esquerda, com contornos em “moldura” sem destruição óssea. Foi realizada uma orbitotomia lateral com biópsia do tumor. O exame histopatológico confirmou o diagnóstico de Sarcoma Granulocítico. Exame clínicoradiológico não mostrou doença sistêmica. A paciente foi submetida a tratamento com quimioterapia e radioterapia e está livre de doença sistêmica após 1 ano e meio de seguimento.

Because eyelid ophthalmomyiasis externa is uncommon, it can be confused easily with a hordeolum or chalazion. We report a case of a 28-year-old patient with lower eyelid myiasis simulating a hordeolum. The patient underwent extraction using a simple surgical technique. The extracted worm was a Dermatobia hominis larva. Resumen Porque la oftalmomiasis externa es inusual, esta entidad puede ser confundida fácilmente con un orzuelo ó chalazión. Reportamos un caso de un paciente de 28 años con una miasis del párpado inferior simulando un orzuelo. Utilizando una simple técnica quirúrgica, una larva de Dermatobia hominis fue extraída en este paciente.

Purpose: We report a case of reversible amantadine-induced corneal edema in a patient with Parkinson's disease and early Fuchs' endothelial dystrophy. Methods: Case report of patient managed by the Cornea & External Disease service at Texas Tech University Health Sciences Center. Results: Clinical findings during the course of treatment including visual acuity, slit lamp examination, specular microscopy, and pachymetry are described. Conclusion: Amantadine is known to cause the onset of endothelial dysfunction and visual impairment even after years of treatment. Fortunately, its effects on the cornea have been shown to be mostly reversible in patients with a near normal endothelial count and function. However, more recent evidence suggests the possibility of irreversible edema despite discontinuation of the drug. Therefore, amantadine-induced endothelial dysfunction in a patient with a significantly reduced endothelial count and/or functionality may also lead to irreversible corneal edema and vision loss. For this reason, we suggest a screening examination for endothelial disease prior to initiating amantadine therapy.

Purpose: To describe the management and outcome of a patient who presented pseudophakic high myopia treated with a collagen polymer (collamer) implantable contact lens (iCL). Methods: A 51-year old man with a traumatic cataract since childhood had a phacoemulsification with an intraocular lens (IOL) implantation in another center on his left eye nine months before our evaluation. The uncorrected visual acuity (UCVA) was 20/800 in the left eye with a best-corrected visual acuity (BCVA) of 20/30. The manifested refraction was -10.00 (-2.00 × 130). We decided to perform an ICL implantation as an alternative to correct his refractive defect. Results: After an uneventful ICL implantation the patient's UCVA in his left eye was 20/30, and the manifested refraction was +1.00 (-1.00 × 130). No complications were experienced. Conclusions: Implantable collamer lenses offer a safe and effective alternative for patients with pseudophakic ametropia. Resumen Objetivo: Describir el manejo y resultado de un paciente con alta miopía pseudofáquica tratado con un lente intraocular de colámero (colágeno polímero), ICL (implantable collamer lens). Métodos: Masculino de 51 años de edad con antecedente de catarata traumática desde la infancia realizándose facoemulsificación con implante de lente intraocular en el ojo izquierdo en otro centro nueve meses previos a nuestra evaluación. La agudeza visual sin corrección era de 20/800 en el ojo izquierdo, con una agudeza visual mejor corregida de 20/30. La refracción manifiesta era de -10.00 (-2.00 × 120). Decidimos implantar un ICL como una alternativa para corregir el defecto refractivo. Resultados: Después de la colocación del ICL la agudeza visual sin corrección en el ojo izquierdo fue de 20/30 con una refracción manifiesta de +1.00 (-1.00 × 130). No se presentaron complicaciones. Conclusiones: Los lentes implantables de colámero (ICL) ofrecen una alternativa segura y eficaz en pacientes con ametropía pseudofáquica.

Case Report: A 43 year old male patient, with no history of previous disease was examined in the Medico Legal service of Santiago, one year after a mandibular tooth extraction (tooth #17). The patient developed an infection: an abscess of mouth floor, cervical abscess, temporal subperiosteal abscess and ophthalmoplegia resulting in optic atrophy. Discussion: The anatomical access through the orbit is demonstrated to be between the third mandibular molar and the inferior ophthalmic vein, through the facial spaces to the orbit. The authors alert the specialist of the rare but potentially severe consequences of dental extraction. Communication between professionals involved can avoid both severe sequelae as well as medical-legal complications. Resumen Reporte del Caso: Masculino, 43 años sin antecedentes mórbidos examinado en el servicio Médico Legal de Santiago un año después del suceso, posterior a exodoncia dentaria mandibular (pieza 17) presentó cuadro infeccioso: absceso piso boca, absceso cervical, absceso temporal subperiostico y oftalmoplejía culminando con atrofia óptica. Discusión: Por lo infrecuente del caso considerando que la infección comenzó en la mandíbula, a juicio de los autores explicamos la vía de acceso anatómica entre el tercer molar mandibular y la vena oftálmica inferior y como los gérmenes a través de de los espacios faciales alcanzaron la órbita, se alerta a los especialistas sobre las consecuencias de una exodoncia dental. La comunicación efectiva inter disciplinaria entre los profesionales involucrados evita complicaciones de tipo médico- legales y secuelas definitivas al paciente.

Purpose: Report a case of anterior uveitis secondary to use of zoledronic acid for osteoporosis treatment. Methods: Case Report Results: Unilateral anterior uveitis as an idiosyncratic reaction to the use of zoledronic acid for osteoporosis treatment. Conclusion: The use of zoledronic acid is a popular option to treat osteoporisis due to its convenient yearly dose. Although ocular effects including uveitis related to the use of bifosfonates have been well described, this side effect is frequently overlooked by the specialists utilizing this medication. The clinicians utilizing zoledronic acid have to be aware of this sight altering reaction to the use of this medication. More importantly, ophthalmologists must consider zoledronic acid treatment as a differential diagnosis of anterior uveitis. Resumen Propósito: Reportar un caso de uveitis anterior secundario al uso de ácido zoledrónico en el tratamiento de osteoporosis. Método: Reporte de caso Resultados: Uveitis anterior unilateral asociado al uso del ácido zoledrónico para el tratamiento de osteoporosis que resolvió con tratamiento de prednisolona tópica por 6 semanas. Conclusión: En la actualidad, el uso del ácido zoledrónico en el tratamiento de la osteoporosis postmenopáusica es popular por su conveniente dosificación anual. La uveitis anterior es una reacción idiosincrática del ácido zoledrónico que los especialistas como endocrinólogos, internistas, ginecólogos deben tener muy presente en el tratamiento de sus pacientes. Más importante aún, los oftalmólogos deben considerar la utilización del ácido zoledrónico como un diagnóstico diferencial de una uveitis anterior aguda.

Purpose: To report and define the clinical presentation, treatment regimens, and visual outcome of 2 cases of actinomyces keratitis in Puerto Rico. Methods: A retrospective chart review was conducted on two patients diagnosed with Actinomyces Keratitis by corneal culture in the Puerto Rico Medical center from August 2007 to November 2007. Results: Both patients had a history of a previous trauma associated to vegetable matter. Patients had corneal ulcers ranging from 2 to 3 mm in diameter and were all initially treated with topical fourth generation quinolones and vancomycin ophthalmic solution. Antifungal treatment was eventually prescribed to all patients, with topical natamycin 5% every 1 to 2 hours being the most common. One patient was diagnosed with Actinomyces keratitis 3 weeks after initial symptoms. He was treated with eventually only with penicillin G ophthalmic solution and ceftazidime every 2 hours. The other patient was diagnosed with an Actinomyces keratitis 6 weeks after initiation of symptoms. A cephalosporin was eventually added to the treatment regimen of the later patient. The one treated with penicillin G and ceftazidime recovered a visual acuity comparable to his baseline acuity. The other one required a corneal transplantation. Conclusions: Actinomyces keratitis was initially misdiagnosed and treated as a fungal keratitis in both cases. Penicillin G ophthalmic solution and oral treatment combined with a ceftazidime ophthalmic solution was an effective treatment in an early actinomyces keratitis. A delay in diagnosis and prolonged treatment delay of Actinomyces keratitis is associated with significant co morbidity. There is limited literature regarding Actinomyces keratitis clinical experience. Resumen Propósito: Reportar y definir la presentación clínica, régimen de tratamiento, y resultados en visión, de 2 casos de keratitis por Actinomyces en Puerto Rico. Métodos: Se realizó una revisión retrospectiva de dos pacientes diagnosticados con keratitis por Actinomyces en el periodo de Agosto 2007 a Noviembre 2007 Resultados: Ambos pacientes tuvieron historial de trauma asociado a materia vegetal. Ambos, presentaron con ulceras de cornea de 2 a 3 mm de diámetro. Inicialmente ambos pacientes fueron tratados con gotas oftálmicas de vancomicina, y quinolonas de 4ta generación. El tratamiento antifungal, fue eventualmente implementado en ambos casos. Uno de estos pacientes fue diagnosticado con keratitis por Actinomyces, 3 semanas luego de los síntomas iniciales. Este fue tratado eventualmente con gotas oftálmicas de penicilina G y ceftazidina, cada 2 horas. El otro paciente fue diagnosticado con keratitis por Actinomyces, 6 semanas luego de los síntomas iniciales. Se añadió eventualmente una solución oftálmica de una cefalosporina. El paciente que fue tratado con gotas oftálmicas de penicilina G y ceftazidina, logró mejorar significativamente su agudeza visual. Conclusiones: La keratitis por Actinomyces fue inicialmente diagnosticada en ambos casos. La penicilina G, y ceftazidina en solución oftálmica fueron efectivas en el tratamiento temprano de la keratitis por Actinomyces. El retraso en el tratamiento apropiado, esta asociado a una co-morbilidad significativa. La literatura científica es bien limitada en cuanto a la experiencia clínica en keratitis por Actinomyces.

Background: To report a case of giant reservoir cyst (GRC) following aqueous shunt (AS) surgery in a Sturge-Weber Syndrome (SWS) patient with refractory glaucoma. Design: Interventional case report Methods: One case of GRC occurring after superotemporal quadrant implantation of nonvalved single plate Molteno drainage device, without intraoperative complications, is described. In the case, a four-year-old boy who has SWS developed secondary glaucoma and after unsuccessful topical treatment he was underwent a valve implant surgery using a standard technique. Visual acuity was never possible to be measured because of mental retardation. Results: The patient was followed every week during the first month, when athalamia was diagnosed. The anterior chamber was reforming and after that patient missed follow-up for one month when returned to the clinic with proptosis, inferonasal dystopia and restriction in ocular motility. Ultrasound (USB) and magnetic resonance imaging (CT) was consistent with GRC. Patient was promptly treated and the eye returned to its normal position. Unfortunately it was not possible to reestablish the patient's vision once a total retinal detachment was further diagnosed. Conclusion: GRC is a rare complication that may occur following AS surgery. Early recognition and intervention are of great relevance to achieve the best outcome possible and try to preserve visual function. Resumo Objetivo: Relatar um caso de cisto gigante de retenção (CGR) após a realização de cirurgia filtrante com implante de tubo em um paciente com síndrome de Sturge-Weber (SWS) e glaucoma refratário. Desenho do estudo: Relato de caso Métodos: Um caso de aparecimento de CGR Após cirurgia antiglaucomatosa, sem intercorrências, para implante de tubo de Molteno não valvulado (em quadrante temporal superior) em uma criança de 4 anos, sexo masculino, portadora de SWS e que apresentava glaucoma secundário, será descrito. após insucesso com o tratamento medicamentoso tópico a criança foi submetida a cirurgia para implante de tubo de drenagem usando a técnica padrão. Devido ao retardo mental da criança, não foi possível a avaliação da acuidade visual. Resultados: Após o procedimento, o paciente foi reavaliado semanalmente durante o primeiro mês sendo, então, diagnosticado atalamia. A câmara anterior foi refeita com sucesso e após este procedimento o paciente não compareceu aos retornos por um mês quando, então, retornou apresentando: proptose, desvio nasal-inferior do globo e restrição da motilidade ocular. Foi submetido a ultrassonografia ocular (US) e ressonância nuclear magnética (RNM) compatíveis com CGR. O paciente foi prontamente tratado sendo restabelecido o correto posicionamento do globo, mas infelizmente houve provável comprometimento da visão, uma vez que foi diagnosticado descolamento de retina. Conclusão: CGR é uma complicação rara que pode ocorrer após cirurgia filtrante com implante de tubo. O reconhecimento precoce e a rápida intervenção são fundamentais para se conseguir o melhor resultado possível na tentativa de preservar a função visual.

Introduction: Retinal cavernous hemangioma is a rare congenital vascular hamartoma, usually unifocal and unilateral. The authors present a rare case of an exuberant cavernous hemangioma located at the optic disc and review the pathology. Case Report: a 59-year-old male presented with sudden vision loss in the left eye (OS), caused by spontaneous vitreous hemorrhage. A lesion was found in the ocular fundus OS consistent with a cavernous hemangioma of the optic disc. This diagnosis was supported by ultrasound and functional evaluation of the optic disc and was confirmed by angiography. Skin lesions and central nervous system involvement were excluded. The lesion has been stable with a good visual acuity. Meanwhile, there was a second vitreous hemorrhage with complete spontaneous resolution. Discussion and Conclusions: Although the usual location of the retinal cavernous hemangioma is the peripheral retina following the course of a vein, it can appear in any location, including macula and optic disc. Vitreous hemorrhage is the most common complication and can lead to the diagnosis. The majority of patients only need regular follow-up, but complications as vitreous hemorrhage without spontaneous resolution or with frequent recurrences may need treatment with cryotherapy, laser photoco-agulation or posterior vitrectomy. Resumo Introdução: O hemangioma cavernoso da retina é um hamartoma vascular congénito raro, geralmente unifocal e unilateral. Os autores apresentam um caso raro de hemangioma cavernoso do disco óptico e fazem uma revisão desta patologia. Caso Clínico: Doente do sexo masculino, de 59 anos, surge com perda súbita de visão à esquerda, causada por hemovitreo espontâneo. Apresentava uma lesão no fundo ocular compatível com hemangioma do disco óptico, hipótese apoiada por estudo ecográfico e exames funcionais e confirmada por estudo angiográfico. Foi feito o despiste de lesões cutâneas associadas e de lesões do sistema nervoso central. A lesão tem-se mantido estável com boa AV, tendo apenas ocorrido um segundo episódio de hemovítreo, com reabsorção total. Discussão E Conclusóes: O hemangioma cavernoso da retina localiza-se geralmente na retina periférica ao longo do trajecto de uma veia, mas pode surgir em qualquer localização, incluindo mácula e disco óptico. O hemovítreo é uma das complicações mais frequentes, podendo levar ao seu diagnóstico. A maioria destes doentes é apenas vigiada regularmente. No entanto, complicações como hemovítreo recorrente frequente ou denso que não reabsorve, poderão necessitar de tratamento com crioterapia, laser ou vitrectomia posterior.

Purpose: To report a rare case of spontaneous scleral perforation In a patient with ocular rosacea and Its surgical management. Methods: Case report. Results: A 52 year-old woman with a history of ocular rosacea diagnosed 9 years earlier presented with a spontaneous scleral perforation in the left eye. On examination, axial facial redness with erythematous papules was present. Slit lamp examination of the left eye revealed meibomian gland dysfunction, conjunctival injection, marked peripheral corneal thinning, neovascularization and lipid deposition in the cornea temporally. A discreet round scleral perforation temporal to the limbus measuring approximately 1 mm in diameter, with protruding vitreous was present. The scleral perforation was repaired with a homologous scleral patch graft sealed into position with fibrin glue and 4 sutures of 10-0 monofilament nylon. One month postoperatively, her best corrected visual acuity was 20/25. Conclusion: Scleritis can be a rare complication of severe ocular rosacea. A homologous scleral patch graft proved successful in treating this condition. Patients with ocular rosacea severe enough to induce scleritis require systemic therapy and close monitoring. Resumo Objetivo: Relatar um caso raro de perfuração escleral espontânea em paciente com rosácea ocular tratado cirurgicamente com enxerto escleral. Métodos: Relato de caso. Resultados: Paciente feminina, 52 anos, com diagnóstico prévio de rosácea ocular há 9 anos procurou atendimento oftalmológico apresentando perfuração escleral espontânea no olho esquerdo. Ao exame, notavase eritema facial e pápulas eritematosas. A biomicroscopia do olho esquerdo revelou disfunção meibomiana, hiperemia conjuntival, afinamento corneano periférico, neovascularização e depósitos lipídicos na região temporal da córnea. Na região temporal da esclera, observava-se área de perfuração escleral, medindo aproximadamente 1 mm de diâmetro, através da qual se percebia protrusão vítrea. A perfuração escleral foi tratada cirurgicamente com um enxerto homólogo de esclera fixado com cola de fibrina e 4 suturas com fio de mononylon 10-0. Um mês apos o procedimento cirúrgico, a acuidade visual corrigida era 20/25. Conclusão: Esclerite pode ser uma complicação rara das formas graves de rosácea ocular. O enxerto escleral homólogo mostrou-se eficaz no tratamento da perfuração escleral secundária a rosácea ocular. Pacientes portadores de rosácea ocular e esclerite requerem tratamento sistêmico e acompanhamento frequente por um oftalmologista.

Las fistulas Carótido - Cavernosas (Carotid cavernous fistulae - CCF) son conecciones anormales arterio-venosas dentro del seno cavernoso. Ellas están típicamente asociadas a trauma, pero pueden ocurrir espontáneamente. La pérdida progresiva de visión ha sido clásicamente la indicación para terapia intervencional. Nosotros presentamos un caso de un bebé varón de 18 semanas de edad con una CCF y pérdida de visión secundaria a ambliopía por una parálisis de VI par. El paciente fue exitosamente tratado con terapia oclusiva para la ambliopía. Un caso similar ha sido previamente reportado en la literatura, y fue manejado con técnicas intervencionales endovasculares. Nosotros presentamos un manejo conservador cuando la funciones intraoculares y del nervio óptico son estables

Electrical and lightning-induced injuries are common and have known ocular manifestations. We report the case of a man injured by power lines who demonstrated a macular hole associated with electrical injury. This is the first to our knowledge to document the natural history of a macular hole after electrical injury using OCT.

Purpose: To report a case of cutaneous squamous cell carcinoma metastasis to the orbit via peri-neural invasion. Method: Case report. Results: Metastasis of a cutaneous squamous cell carcinoma to the orbit via peri-neural invasion confirmed by histopathology analysis. Conclusion: The ophthalmologist must have a high index of suspicion of cutaneous malignancy metastasis via peri-neural invasion when approaching a patient with unexplained facial paralysis associated to an orbital tumor. Resumen Propósito: Reportar un caso de metástasis de un carcinoma cutáneo de células escamosas a la órbita vía diseminación peri neural (DPN) y realizar una revisión literaria de esta entidad. Método: Reporte de caso. Resultados: Metástasis de un carcinoma cutáneo de células escamosas vía DPN a la órbita confirmado por estudios histopatológicos. Conclusión: El oftalmólogo debe tener presente el concepto de DPN de una malignidad cutáneo de la cara cuando aborda un paciente con parálisis facial inexplicada asociado a tumor orbitario. El Denominador Común de una Parálisis Facial Inexplicada, Tumor de Órbita y Carcinoma Cutánea de Células Escamosas: Diseminación Peri neural de una Malignidad Cutánea.

La queratitis nodosa es una reacción inflamatoria ocular a los pelos de insectos, pero ha sido descrita también en individuos que tienen contacto con tarántulas. Las lesiones que se han relacionado incluyen granulomas de conjuntiva, infiltrados corneales alrededor de los pelos urticantes, uveítis anterior e inclusive infiltrados en la retina. La tarántulas pertenecen al género conocido con Theraphosidae, un subgrupo de los Mygalomorphos (que deriva del griego mygale: ratón de campo). Aunque todas ellas son venenosas, algunas de ellas pueden ser manipuladas con relativa seguridad. Sus mecanismos de defensa son las mordeduras con sus colmillos, pero también levantan y agitan las patas traseras, y al hacerlo disparan los pelos urticantes que se encuentran en el dorso de su abdomen.

PURPOSE: To report a case of silicon exoplant extrusion 10 years after scleral buckle surgery. METHODS: Case Report. RESULTS: The patient agreed to the enucleation of the right globe with the extruded scleral buckle, due to the symptoms of this phthisical eye. DISCUSSION: Scleral buckle surgery has a wide range of complications, either at the short- or long-term interval after the procedure. Due to these, lifelong yearly follow up of patients with scleral buckling implantation is justifiable and mandatory.

The authors report two cases of cicatricial pemphigoid and describe the nature of the cutaneous, oral and ocular lesions, emphasizing the devastating effects of the latter. With regard to the diagnosis, they stress the importance of adequate sampling for direct immunofluorescence reactions. The therapeutic approach is discussed focusing the available tools for the ophthalmologist.

Purpose. To report an unusual case of a retained intra-orbital wooden foreign body in a 6-year-old child. Methods. Case Report. Results. A fragment of wood stick was removed from the left orbit of a 6-year-old with history of proptosis and vision diminishment after probable penetrating eyelid trauma 45 days before the consult. Discussion. Intra-orbital foreign body (IOF) has to be managed with thorough clinical history and ophthalmic examination complemented with broad spectrum systemic antibiotics and adequate imaging studies for a guided surgical intervention. More importantly, organic IOF has to be highly suspected by the clinician when managing pediatric ocular trauma.