Introduction: Idiopatic Macular Telangiectasia (IMT) are a rare group of various entities presenting with incompetence, ectasia and/or irregular dilations of the juxtafoveolar capillaries of one or both eyes. Case Report: A 62 year old female with Glaucoma was sent to the Retina Department with a suspected diagnosis of retinal vein occlusion on the left eye (LE). Her best corrected visual acuity (BCVA) was 20/20 in the right eye (RE) and 20/25 in the LE. Slit lamp examination was normal; fundoscopy showed a cup-to-disc relation of 0.6 in the RE with normal macula and a cup-todisc relation of 0.7 in the LE with multiple perifoveal microaneurysms, inferior temporal hard exudates and edema comproved with macular optical coherence tomography; fluorescein angiography revealed an area of hyperfluorescence with juxtafoveolar telangiectatic vessels located inferiorly and temporally to the fovea, with progressive filling and late active leakage in the LE. The diagnosis of IMT type 1 was made and she was treated with a loading dose of intravitreal injections of ranibizumab followed by a fourth injection because of persistent macular edema. One month after, her BCVA was 20/20 in the LE with improvement of macular edema and macular árgon laser photocoagulation was performed. Three months after the laser treatment her LE BCVA was 20/20 with fundoscopy showing small macular hemorrhages and microaneurysms. Conclusion: Macular edema and exudation are the main cause of visual loss in these patients. This case suggests that ranibizumab and laser photocoagulation can be effective in the treatment of type 1 IMT.

Adenoid cystic carcinoma (ACC) of the lacrimal gland is a rare, life-threatening tumor often not diagnosed until advanced stages. This malignancy usually presents with nonspecific symptoms such as periocular pain and non-axial proptosis. We present a case of a 40-year-old female experiencing these symptoms, whose initial lacrimal gland biopsy was consistent with chronic dacryoadenitis. Reappearance and worsening of her symptoms after treatment led to a total dacryoadenectomy, which confirmed the presence of ACC. Close follow up of the clinical signs and imaging in this patient allowed us to suspect and finally diagnose an invasive malignancy that was masquerading as a chronic dacryoadenitis.

Castleman's disease is a rare lymphoproliferative disorder, comprising hyaline vascular elements, and plasma cells, which can be present in unicentric or multicentric forms. This disease rarely involves the orbit/eye globe. We report the case of a 55-year old patient who was found to have a focal lesion in the orbit. Histopathology studies revealed features consistent with Castleman's disease. The patient was treated with surgical resection and radiotherapy and was free of disease recurrence at 16-months follow up.

Purpose: To evaluate if high-resolution adaptive optics confocal scanning laser ophthalmoscopy (AO-SLO) can be used as an adjunct complementary diagnostic tool to spectral domain optical coherent tomography (SD-OCT) in characterizing three macular diseases: cone-rod dystrophy, acute retinal pigment epitheliitis (Krill's disease), and occult macular dystrophy. Methods: As part of a complete clinical examination, each patient was subjected to color fundus pictures, multimodal imaging scans with Heidelberg SpectralisTM and high-resolution retinal images with a custom built adaptive optics scanning laser ophthalmolscope (AO-SLO). The registered AO-SLO images were averaged to improve the signal to noise ratio and used to generate larger photoreceptor mosaics. Results: AO-SLO mosaics for all three conditions showed distinct, characteristic disruptions of the photoreceptors in areas that corresponded to the abnormalities observed on fundus photography and SD-OCT scans. Conclusions: AO-SLO defined fine structural changes associated with retinal pathology at the photoreceptor level that could not be achieved using standard diagnostic methods. A combination of adaptive optics scanning laser ophthalmoscopy (AO-SLO) and SD-OCT provided views of the retina with enhanced lateral and axial resolution. High-resolution, ultra-structural details of the retina may provide additional insights into the disease etiology, progression and management of patients with vision threatening macular diseases.

Purpose: To review standard management of blind painful and non-painful eyes at risk for neovascular glaucoma, and report the management strategies of four cases. Method: Case series and literature review. Patients: The first two cases described are blind, painful eyes secondary to neovascular glaucoma, treated with intracameral bevacizumab injections. The third case, a blind, painful eye with uncontrolled glaucoma in a patient unsatisfied with her eye appearance due to white retained lens material at pupillary margin and a large prominent bleb, was treated with a combination of bleb revision, vitrectomy, lensectomy and endocyclophotocoagulation. The fourth case, a blind, non-painful eye with secondary radiation retinopathy at risk for neovascular glaucoma was treated with laser photocoagulation to prevent neovascular glaucoma and pain. Results: The first two cases of blind, painful eyes with neovascular glaucoma had reduction in neovascularization and pain after intracameral bevacizumab injections and/or laser therapy. The third case had resolution of pain and transient decrease in intraocular pressure after a combined surgery. The blind, non-painful eye in case 4 with a history of radiation retinopathy had stable intrao pressure and no progression to neovascular glaucoma or pain. None of the four cases progressed to enucleation or evisceration. Discussion: Retinal interventional management should be considered in blind painful and non-painful eyes to help control symptoms, treat or prevent progression to neovascular glaucoma and prevention of enucleation or evisceration.

Acknowledgements: This report was made possible with the support of Bayer Healthcare. To guarantee the independence of the report and the working group's conclusions, the content of this report was developed exclusively by the authors, without any influence from Bayer HealthCare, The herein opinions do not reflect Bayer HealthCare's position or opinion. The working group did not receive any honoraria to participate in the development of this report.

To report the surgical outcome and visual rehabilitation of a patient with Fuchs' dystrophy diagnosed with endothelial dysfunction associated with subepithelial and deep corneal scar and advanced cataract, treated with DMEK combined with phacoemulsification and intraocular lens (IOL) implantation, followed by phototherapeutic keratectomy (PTK).

Although the presence of central corneal opacities could limit the visual prognosis, Descemet Membrane Endothelial Keratoplasty (DMEK) was performed and completely resolved corneal edema and opacities on the visual axis. A rigid contact lens fitting was necessary to treat irregular astigmatism postoperatively.

A single case description of a novel surgical treatment using hard palate to correct an upper eyelid deformity after traumatic laceration. The surgical procedure is described with accompanying diagram to illustrate the technique. The eyelid margin was successfully restored with proper anatomical outcome, as seen up to at least eighteen months post-operatively in the presented case. Our technique can be applied to the correction of small eyelid defects in other patients.

A 71-year-old man diabetic and smoker was treated with brachytherapy for a choroidal melanoma. Two years later he developed a radiation optic neuropathy and a contralateral vein occlusion. He received subtenon triamcinolone and then, he underwent a phacoemulsification surgery and one intravitreal injection of antiangiogenic, with functional and anatomical improvement. The radiation optic neuropathy is a chronic progressive vasculopathy induced by supra-threshold doses of ionizing radiation. The risk occurs when the total dose is more than 50 Gy or the daily fraction size exceeds 1,8 Gy. The vein occlusion could be related to risk factors. Several treatments have been used for radation papillopathy. Resumén Varón 71 años diabético y fumador, tratado con braquiterapia por melanoma coroideo. A los dos años presenta una neuropatía óptica por radiación y trombosis venosa contralateral. Se trata con corticodes subtenonianos y posteriormente, se interviene de cataratas y se introduce antiangiogénico intravitreo, con buen resultado. La neuropatía óptica por radiación es una vasculopatía progresiva y crónica secundaria a una radiación ionizante supraumbral. Ocurre cuando la dosis total recibida excede de 50 Gy o la dosis diaria de 1,8 Gy .La trombosis venosa podría estar relaciona con los factores de riesgo existentes. Diferentes tratamientos han sido propuestos para la papilopatía por radiación.

Topiramate is a drug used in the treatment of epilepsy, migraine, bulimia and other pathologies. We report a case of a 40-yearsold woman, presented to the emergency department of ophthalmology with blurred vision in both eyes and bilateral acute angle closure. Her medications included topiramate started 6 days before. Secondary angle closure glaucoma due to topiramate was diagnosed. The medication was discontinued and she was treated with topical antiglaucoma medications, intravenous mannitol and cyclopegics. At the 5-days follow-up visit, vision, intraocular pressure, and angle anatomy had returned to normal. The acute angle-closure glaucoma occurs due to edema of the ciliary body and uveal effusion that produces an anterior motion of the iris-lens diaphragm, with ocular hypertension and acute myopia. Resumen El topiramato es un fármaco usado en epilepsia, migraña, bulimia y otras patologías. En el párrafo siguiente describimos un caso de una mujer de 40 años, que recibía tratamiento con topiramato, que acudió al servicio de urgencias oftalmológicas por disminución de agudeza visual brusca de ambos ojos con cierre angular bilateral. La paciente fue diagnosticada de glaucoma de ángulo cerrado secundario a topiramato. La medicación se suspendió y se trató con medicación antiglaucomatosa tópica, manitol intravenoso y ciclopléjico. A los 5 días, la visión, presión intraocular y anatomía angular habían vuelto a la normalidad. El cierre angular agudo por topiramato se produce debido al edema del cuerpo ciliar y efusión ciliocoroidea que producen un desplazamiento anterior del diafragma iridocristaliniano originando un cierre angular, hipertensión ocular y miopización aguda.

Purpose: To assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness, measured with Spectralis® OCT, in healthy and glaucomatous subjects, through of inter-examiner variability, intratest and inter-test with and without software of followup. Methods: Cross-sectional and prospective study with 37 controls (63 eyes) and 33 patients with glaucomatous optic neuropathy (55 eyes). Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated. Results: Low inter-examiner, intra-test and inter-test variability, with ICC>0,75 e CV<10%, in both control group and patients with glaucoma. Conclusions: The Spectralis® OCT shows excellent reproducibility of RNFL measurements, validating it as an useful tool for monitoring the progression of glaucoma. Resumo Objectivos: Avaliar a reprodutibilidade das medições da camada de fibrasnervosas peripapilar (CFN), obtidas com o Spectralis® OCT, em indivíduos saudáveis e com neuropatia óptica glaucomatosa, através da variabilidade inter-examinador, intra-exame e inter-exame com e sem o software de followup. Métodos: Estudo transversal e prospectivo, com 37 controlos (63 olhos) e 33 doentes com neuropatia óptica glaucomatosa (55 olhos). Calculou-se o coeficiente de correlação intraclasse (CCI) e o coeficiente de variação (CV) das medições da CFN. Resultados: Verificou-se baixa variabilidade inter-examinador, intra-exame e inter-exame, com valores de CCI>0,75 e CV<10%, tanto no grupo controlo como no grupo dos doentes com glaucoma. Conclusões: O Spectralis® OCT apresenta uma excelente reprodutibilidade nas medições da CFN, validando-se como uma ferramenta útil para a monitorização da progressão do glaucoma.

Purpose: To further characterize the clinical presentation, diagnosis, and current treatment strategies of IgG4-related ophthalmic disease. Methods: Review and analysis of seven cases orbital inflammatory syndrome found to be biopsy positive for IgG4. Results: We present seven cases of IgG4-related ophthalmic disease, a previously unknown entity that has only recently been identified as a treatable systemic disorder. Management included surgical excision, systemic steroids, steroid-sparing immunosuppression, and radiotherapy. Conclusions: These cases illustrate the importance of including IgG4-related ophthalmic disease in the differential diagnosis of periorbital or orbital masses. Prompt recognition of this entity by clinicians can allow for effective treatment with corticosteroids. Treatment with steroid-sparing immune suppressants and radiotherapy has shown promise in chronic or refractory disease, nonetheless tumor excision may ultimately be necessary.

Allogeneic hematopoietic stem cell transplantation is considered the standard of care for hematological and lymphoid malignancies. One of the complications associated to this therapy is an immunemediated reaction known as graft versus host disease with repercussions towards many organs and tissues. In this article, ocular complications of graft versus host disease will be reviewed.

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.

This case series report aimed to describe lamellar macular holes associated with the use of normal fluence photodynamic therapy.