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.

Purpose: To describe the visual and topographical changes after accelerated corneal collagen cross-linking (ACXL) in keratoconus-affected eyes. Methods: Clinical records of patients with keratoconus-affected eyes that underwent ACXL treatment and had 24 months of follow-up were reviewed. Data regarding demographics, visual acuity (VA), refraction and Sheimpflug values before and post ACXL were analyzed. We included patients with keratoconus older than 12 years old, with corneal thickness greater than 400 microns and steepest keratometry <60 diopters by Sheimpflug (Pentacam), with reported uncorrected distant visual acuity (UDVA), manifest refraction and best-corrected visual acuity (BCVA) evaluation pre ACXL and 24 months after surgery. The exclusion criteria were: history of ocular trauma, anterior segment surgery, retinal detachment or any type of maculopathy. Results: 21 eyes were included. Mean age was 27 years. Mean uncorrected distant VA (UDVA) before the procedure was 1.01 logMAR (20/200 Snellen) and after 24 months improved significantly to 0.62 logMAR (20/83 Snellen) with a p value of 0.005. No statistical significant difference was found between preoperative and postoperative refractive, keratometric and pachymetric data. Induced astigmatism value was -1.11 D (range 0.13 D – 2.28 D). Conclusions: ACXL is a technique to prevent the progression of keratoconus, however refractive and VA changes could be expected after procedure. The observed changes must be considered when performing the procedure together with refractive surgery.

Purpose: To evaluate visual and refractive outcomes after intracorneal circular ring implantation with femtosecond laser for keratoconus treatment. Design: Prospective, cohort Methods: Were included 22 eyes of 16 adults patients with central keratoconus who had been implanted with continuous intracorneal circular ring (ICCR) MyoRing (Dioptex GmbH, Linz, Austria) in a pocket created by femtosecond laser (Ziemer Z6 LDV, Port, Switzerland). Visual and refractive outcomes, keratometry, pachymetry and asphericity were evaluated at one, three, six month and one year postoperative. Results: Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) improved from 1,33 (Standard deviation [SD]: 0,37) to 0,38 logMAR (SD 0,16) (p<.001) and from 0,25 (SD: 0,15) to 0,21 logMAR (SD: 0,23) (p=0,43) respectively at one year postoperative. Central keratometry, sphere, cylinder and corneal asphericity presented reduction of 8,13 Diopters (D) (p<.001), 5,42D (p<.001), 2,03D (p=0.01), 1,46 e2 (p=0,00) respectively. Visual, refractive and keratometric results did not reveal significant changes after the third month of follow up. Conclusion: Intracorneal circular ring implantation using femtosecond laser is an effective and safe procedure for central keratoconus treatment. Keratometric and refractive values can be effectively improved and good visual outcomes achieved. RESUMEN Objetivo: Evaluar los resultados visuales y refractivos tras el implante de anillo intracorneal circular continuo, usando láser de femtosegundo en el tratamiento de pacientes adultos con queratocono. Diseño: Prospectivo de cohorte. Materiales y Métodos: Se incluyeron 22 ojos de 16 pacientes, con diagnóstico de queratocono tipo central a los cuales se les implanto un anillo intracorneal circular continuo (ICCR), MyoRing (Dioptex GmbH, Linz, Austria) en un bolsillo creado con láser de femtosegundo (Ziemer Z6 LDV, Port, Switzerland). Se evaluó resultado visual, refractivo, queratometrías, paquimetría y asfericidad corneal al mes , tres meses, seis meses y a un año posoperatorio. Resultados: La agudeza visual sin corrección (AVSC) y la agudeza visual con corrección (AVCC) mejoraron de 1,33 (Desviación estándar [DE]: 0,37) a 0,38 logMAR ([DE]:0,16, p=0.001) y de 0,25 ([DE]:0,15) a 0,21 logMAR ([DE]:0,23, p= 0,43) respectivamente al año postoperatorio. La queratometría central, la esfera, el cilindro y la asfericidad corneal presentaron disminución de 8,13 Dioptrías (D) (p <.001), 5,42 D (p<.001), 2,03D (p=0.01) y 1,46 e2 (p<0,000) respectivamente. Los resultados visuales, refractivos y queratométricos no presentaron cambios significativos a partir del tercer mes posoperatorio. Conclusiones: El implante del anillo intracorneal circular continuo con láser femtosegundo, demostró ser un procedimiento eficiente y seguro para el tratamiento de queratocono tipo central, mejorando significativamente los valores queratométricos y refractivos, logrando buenos resultados visuales.

This systematic review of biopsy proven cases of non specific orbital inflammation and sclerosing variant from 2010-2016 attempts to elucidate new findings regarding the demographic profile of the diseases. Discussion of histopathology is emphasized, as to describe the most common presenting features of non-specific orbital inflammation as well as to discuss its molecular profile. This review also discusses the therapeutic approach and discusses the “steroids vs. biopsy first” controversy regarding non-specific orbital inflammation. The incidence of IgG4 and its relationship to non-specific orbital inflammation is also discussed.

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.

Purpose: To determine the relation between manifest refractive error and cycloplegic refractive error in children and adolescents in Campinas - SP, Brazil, and to compare the results with previous published studies. Methods: Dynamic and static retinoscopy was performed in children and adolescents. To obtain cycloplegia, three drops of 1% cyclopentolate was instilled in each eye every 5 minutes. Maximum cycloplegic effect was achieved after 45 minutes. The working distance for retinoscopy was 67 cm. During retinoscopy, the room was dimly illuminated, and patients were instructed to look at a spot of light at a distance of 6 m. Retinoscopic findings were measured before and after cycloplegia. Results: Two hundred and twenty-two (222) eyes of one hundred and eleven (111) children and adolescents were included. The average age of the participants was 10 years (range 4 to 15 years); 57 (51%) were girls, and the other 54 (49%) were boys. The most common refractive error in younger children was hyperopia, whereas myopia was the most common error in older children. The value of the latent error (the difference between cycloplegic and non-cycloplegic error) increased with hyperopia, especially in younger patients. The value decreased gradually in patients with moderate hyperopia and myopia. Conclusion: The cycloplegic refraction is more sensitive than the subjective one to measure refractive error at all age groups especially in children and young adults. The cyclo-refraction technique is highly recommended to precisely measure the refractive error in momentous conditions such as refractive surgery, epidemiological research, and amblyopia.

Purpose: To determine the relationship between pseudostrabismus and predictors of increased frequency of this presentation in our environment: epicanthus and hypertelorism. Study design: Binary logistic regression to relate Pseudostrabismus and predictors, and odds ratio for risk assessment. Statistical analysis: Binary logistic regression to relate pseudostrabismus and predictors, and odds ratio for risk assessment. Results: The association of Pseudostrabismus with hypertelorism (62 children - 50%) and hypotelorism (20 children -16.1%) determined through the DI in our study population showed statistical significance (p <0.05). The multivariate analysis OR), who evaluated the risk of having the diagnosis of Pseudostrabismus in the presence of these predictors showed values of 3,276 for hypertelorism and 2,087 for hypotelorism. The results of the association of Pbismus with the epicanthus (50 children without-40.3% and 74 with -59.7%) did not show statistical significance (p> 0.05); however, multivariate analysis or logistic regression gave us a value of 1.949. Conclusions: In our study population, hypotelorism and hypertelorism are predictors of the diagnosis of Pseudostrabismus. The statistical analysis for this association is significant (p <0.5), and the risk (O.R) of having Pseudostrabismus in the presence of hypertelorism is three times more, and two times more in the presence of hypotelorism. The risk of having Pseudostrabismus per epicanthus is 2-fold (O.R.1.949), the statistical analysis for this association was not significant (p> 0.05). RESUMEN Objetivo: Determinar la relación entre pseudoestrabismo y los predictores de mayor frecuencia de presentación en nuestro medio: epicanto e hipertelorismo. Tipo de estudio: Observacional, con nivel relacional y transversal. Análisis estadístico: Regresión logística binaría para relacionar Pseudoestrabismo con predictores, y Odds Ratio (O.R) para la determinación del riesgo. Resultados: La asociación de pseudoestrabismo con hipertelorismo (62 niños, 50%) e hipotelorismo (20 niños, 16.1%) determinados a través de la DI en nuestra población de estudio, mostró significación estadística (p<0.05) e igualmente el análisis multivariado (O.R) que estudió el riesgo de tener el diagnóstico de Pseudoestrabismo en presencia de éstos predictores muestran valores de 3.276 para el hipertelorismo y de 2.087 para el hipotelorismo. Los resultados de la asociación de Pseudoestrabismo con el epicanto (50 niños sin 40.3% y 74 con 59.7%) no mostró significación estadística.(p>0.05), sin embargo el análisis multivariado o regresión logística nos dio un valor de 1.949. Conclusiones: Hipotelorismo e hipertelorismo, en nuestra población de estudio, son predictores para el diagnóstico de Pseudoestrabismo. El análisis estadístico para ésta asociación es significativo (p<0.5), y el riesgo (O.R) de tener Pseudoestrabismo en presencia de Hipertelorismo es tres veces más y dos veces más en presencia de Hipotelorismo. El riesgo de tener pseudoestrabismo por epicanto es de 2 veces más (O.R.1.949), el análisis estadístico para esta asociación no fue significativa (p>0.05).

Purpose: Determine the benefits and challenges of combined femtosecond laser assisted cataract surgery with the Catalys® system (Abbott, Abbott Park, IL) and vitrectomy. Design: Retrospective study Methods: We retrospectively reviewed eight consecutive cases of combined femtosecond laser assisted cataract surgery with the Catalys® system and vitrectomy by a single surgeon. The University of Minnesota Institutional Review Board provided Expedited Review Approval for this project. Results: The study population was 25% male with mean age of 69.1 years, mean pre-operative intraocular pressure of 14.9 mmHg, and mean best corrected visual acuity of 0.44. All patients completed both portions of the combined procedure. There were no complications from the femtosecond laser portion with the mean vacuum time 163s (range 125-320s). Post-operative findings included intraocular pressure rise (25%), and persistent macular edema (38%). The mean intraocular pressure at month one was 16 mmHg with an improvement in mean best corrected visual acuity to 0.27 (range 0-0.52, p<0.05). Intraocular lens was centered in all cases, and mean manifest refraction spherical equivalent was -0.77 (range -2.75-0), which was not statistically significantly different than the target spherical equivalent of -0.59 (p=0.24). Conclusions: Combined femtosecond laser assisted cataract surgery with the Catalys® system and vitrectomy was not associated with significant complications, with an overall improvement in visual acuity.

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 describe the characteristics of the OBL and its possible relationship with flap and laser parameters. Study Design: Observational, descriptive and transversal investigation. Method: The study was performed on 76 patients undergoing FemtoLASIK with refractive suite WaveLight FS 200 and EX500 Excimer Laser (Alcon) from September to December 2016. Analyzed flap and laser variables, through absolute and relative frequencies, and odds ratio to identify factors that could increase the likelihood of OBL. Results: OBL was present in 15.8% of the cases, with a predominance (83.3%) of late OBL. A greater probability of OBL was obtained in patients with flap diameter of 8.0 mm (OR = 8.4 p = 0.004), laser energies greater than 0.80 mJ (OR = 62 p <0.001), channel length of 0, 7 mm (OR = 5.7 p = 0.01), suction time greater than 50 s (OR = 8.3 p = 0.01). There is no greater probability of OBL for thinner flap thickness (OR = 0.2 p = 0.06) or higher temperature (OR = 2.0 p = 0.26) Conclusions: A low incidence of OBL was obtained. Late OBL was the most frequent. There is a greater probability of this complication in surgeries with ablation energies greater than 0.80 mJ, flap diameters of 8.0 mm, channel length of 0.7 mm and suction time greater than 50 seconds. Resumen Objetivo: Describir las características de la OBL y su posible relación con parámetros del flap y del láser. Diseño: Investigación observacional, descriptiva y transversal. Método: Se realizó un estudio en 76 pacientes intervenidos por FemtoLASIK con la suite refractiva WaveLight FS 200 y EX500 Excímer Láser (Alcon) de Septiembre a Diciembre del 2016. Se analizaron variables del flap y del láser, a través de frecuencias absolutas y relativas, y el odds radio para la identificación de factores que podrían aumentar la probabilidad de OBL. Resultados: Se obtuvo presencia de OBL en el 15,8 % de los casos, con predominio (83,3 %) de OBL tardía. Se obtuvo mayor probabilidad de OBL en pacientes con diámetro del flap de 8,0 mm (OR=8,4 p=0.004), energías del láser superiores a 0.80 mJ (OR=62 p<0,001), longitud del canal de 0,7 mm (OR=5,7 p=0,01), tiempo de succión superior a 50 s (OR=8,3 p=0,01). No existe mayor probabilidad de OBL por menor grosor del flap (OR=0,2 p=0,06) o mayor temperatura (OR=2,0 p=0,26). Conclusiones: Se obtuvo una baja incidencia de OBL. La OBL tardía fue la más frecuente. Existe mayor probabilidad de presencia de esta complicación en cirugías con energías de ablación superiores a 0,80 mJ; diámetros del flap de 8,0 mm; longitud del canal de 0,7 mm; tiempo de succión superior a 50 segundos.

Purpose: To describe the characteristics of myopic choroidal neovascular membranes of hispanic subjects treated with a loading dose of Ranibizumab (Lucentis®). Study design: Non-randomized prospective observational case study. Methods: Five eyes of 5 patients with naïve CNV secondary to pathological myopia were recruited for this study. Demographics, basal best-corrected visual acuity, grade of myopia, angiographic and tomographic features were obtained at baseline. A loading dose of three monthly Ranibizumab (Lucentis®) injections were given to the recruited subjects. After completion of the loading dose, a complete ophthalmological evaluation, angiography and spectral domain optical coherence tomography (SD-OCT) were obtained subsequently at six and twelve months of follow-up. Results: The mean age of patients was 45 years. The mean spherical equivalent refractive error was -13.85. At baseline, the mean number of letters was 61.4 and at follow-up to 12 months the mean number of letters was 73.2. The central foveal thickness and subfoveal choroidal thickness decreased in all cases. After loading dose there was no persistent nor recurrent leakage from treated CNV on fluorescein angiography. FAF evidenced an increase in the area of atrophy, with a special circle pattern around the CNV. Conclusions: This study showed a functional and morphologic improvement at 12 months in five Colombian subjects treated with a loading dose of 3 Ranibizumab monthly injections.

Purpose: To describe the results of selective laser trabeculoplasty for patients with open-angle glaucoma during a 2-year period. Study design: Descriptive, retrospective, and longitudinal study. Method: A descriptive, retrospective, and longitudinal study was conducted among 40 eyes of 20 patients who underwent selective laser trabeculoplasty from 2012 to 2015 and received topical antiglaucoma medication. The following variables were measured: uncorrected visual acuity, best-corrected visual acuity, and intraocular pressure before treatment and during monitoring controls after 1 day, 7 days, 1 month, 3 months, 6 months, 12 months, and 24 months. Results: No significant differences were identified between uncorrected visual acuity preoperatively and at 1 year (p=0.091) or between preoperative uncorrected visual acuity preoperatively and at 2 years (p=0.827). Best-corrected visual acuity preoperatively and at 1 year showed no statistical significance (p=0.125); however, best-corrected visual acuity preoperatively and at 2 years had statistical significance (p=0.007). Mean ± standard deviation of preoperative intraocular pressure at 2 years had decreased from 17.28±5.7 to 13.05±2.4 mm Hg (statistically significant; p=0.00) and the success rate was 75%. Although the mean ± standard deviation of preoperative for drug use at 2 years decreased from 1.90±1.1 to 1.65±1.3, no significant difference (p=0.058) was identified. No complications were identified. Conclusions: Selective laser trabeculoplasty is an effective and safe treatment that reduces intraocular pressure as well as the number of drugs required by patients with open-angle glaucoma.

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.

Purpose: To report use of widefield fluorescein angiography (FA) for targeted therapy of Coats' disease and familial exudative vitreoretinopathy (FEVR). Study design: Retrospective, non-comparative, consecutive case series. Material and Methods: Patients diagnosed with Coats' disease or FEVR and evaluated with widefield FA, treated with indirect laser from January 1, 2003 to December 31, 2012. Visual acuity (VA) and anatomic status of eyes was evaluated. Results: 17 eyes were treated for Coats' disease, and 25 eyes treated for FEVR. Mean VA in the Coats' group was 20/384 at baseline, and mean VA at the last follow-up was 20/258. In the FEVR group, mean VA was 20/100 at baseline, and 20/358 at last follow-up. None of the Coats' eyes required enucleation or additional surgical intervention. Two of the eyes with FEVR required surgery due to advanced disease. Conclusion: Widefield angiographyguided laser therapy in Coats' disease and FEVR led to visual and anatomic stability in these diseases.

Background: Ophthalmology is the most technologydriven specialty among all the medical specialties. Advances in retinal imaging have proven fundamental to many paradigm shifts in our understanding and treatment of ocular disease. Methods: Literature review. Discussion: This article provides an overview of current, state-of-the-art retinal imaging technologies, as well as highlights many emerging imaging technologies that we believe are likely to transform the provision of eye care. Conclusions: The second decade of the 21st century is an exciting time to be an ophthalmologist, and especially a retinal specialist. However, studies of diagnostic accuracy are more prone to bias than many other forms of clinical research. With the likely imminent proliferation of ocular imaging techniques, standardized and robust methods for their clinical validation will be essential, with reporting of results according to standards for reporting of diagnostic accuracy recommendations.

Diabetic macular edema (DME) is the most common cause of moderate visual loss in diabetic patients. The current treatment of choice for DME is anti-VEGF treatment. Even though recent clinical trials have shown that anti-VEGF treatment is superior to laser photocoagulation there are certain concerns regarding its sustainability over the long term. Most patients that undergo pharmacological inhibition with anti-VEGF agents need multiple monitoring visits that include OCT imaging and multiple injections. There is a theoretical concern regarding systemic thrombo-embolic events with chronic VEGF suppression. Pars plana vitrectomy (PPV) by increasing the vitreous cavity oxygenation, relieving vitreomacular traction and removing cytokines from the vitreous cavity may cause long term resolution of DME without the aforementioned concerns.