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.