Bilateral dacryocystoceles in a pregnant woman.

The authors describe, for the first time, bilateral, sequential large dacryocystoceles during pregnancy and review the literature for this presentation. A 26-year-old, 15-week pregnant woman presented with OD epiphora, diplopia, and pain in the setting of an inferomedial orbital mass. Surgical exploration and histopathology were consistent with a dacryocystocele, and a dacryocystorhinostomy was curative. She returned at 34-week gestation, with an identical presentation on the left side. Review of the literature reveals that dacryocystoceles occasionally present in adults; however, bilateral involvement may be unusual. Bilateral dacryocystoceles have not been previously reported in a pregnant woman.

Deep penetrating orbitocerebral steel spring injury with minimal sequelae: a case report.

The authors report a penetrating orbitocerebral steel mattress spring injury without permanent ophthalmic or neurologic sequelae. A 44-year-old female mattress factory worker sustained an injury to her right orbit by a high-velocity projectile foreign body. Imaging revealed a metallic spring in the right orbit traversing the optic nerve and superior orbital fissure and lodging in the temporal lobe of the brain. Cerebral angiography demonstrated the steel coil around, but not damaging, the middle cerebral artery and other vessels. With a combined craniotomy and frontal orbitotomy, the spring was removed by meticulous counterclockwise rotation. Postoperatively, the patient had mild left-sided weakness that resolved after several weeks. Ocular examination was normal, including full extraocular movements and a visual acuity of 20/20 in each eye. The authors theorize that the spiral shape and on-axis rotational movement allowed the projectile to follow a path of least resistance penetrating deeply and coiling around, but not injuring, vital structures. Careful counterclockwise rotation under direct intracranial and intraorbital visualization was effective in removing the spring.

Anatomic and visual outcomes of noninfectious endophthalmitis after intravitreal triamcinolone.

PURPOSE: To describe the anatomic and visual outcomes of patients in whom noninfectious endophthalmitis developed after injection of intravitreal triamcinolone acetonide. DESIGN: Retrospective case series. METHODS: Ophthalmologic evaluations of patients in whom noninfectious endophthalmitis developed after intravitreal triamcinolone took place on the day of injection, at the time of presentation of noninfectious endophthalmitis, at the time of clearance of inflammation, and on follow-up examination. Seventeen eyes of 17 patients were identified from 2 institutions. Noninfectious endophthalmitis was identified based on history of visual loss immediately or soon after injection, lack of ocular pain, hypopyon, anterior or vitreous inflammation, and triamcinolone crystals present in the anterior or posterior chambers. Main outcome measures were Snellen visual acuity (VA) and mean foveal thickness by optical coherence tomography. RESULTS: Mean VA and mean foveal thickness on the day of injection of intravitreal triamcinolone were 20/132 (logarithm of the minimum angle of resolution [logMAR], 0.82 +/- 0.45) and 432 +/- 118 microm, respectively. Mean VA at time of noninfectious endophthalmitis (mean, 1.9 days after injection) was 20/4444 (logMAR, 2.35 +/- 0.98). At last follow-up (mean, 57.6 days), VA and mean foveal thickness were 20/56 (logMAR, 0.44 +/- 0.30) and 301 +/- 71 microm, respectively. CONCLUSIONS: VA and mean foveal thickness in all patients with noninfectious endophthalmitis after intravitreal triamcinolone improved to better than preinjection levels in this series. At last follow-up, no patient had sustained visual loss from noninfectious endophthalmitis. Noninfectious endophthalmitis after intravitreal triamcinolone may not exclude good visual and anatomic prognoses.

Is reduction in the risk of vision loss the only benefit of photodynamic therapy in predominantly classic subfoveal choroidal neovascularization?

PURPOSE: To emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV). METHODS: A retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT. RESULTS: After an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of fluorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was significantly larger than that post-PDT (p = 0.044). It was also significantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001). CONCLUSION: This study demonstrates a beneficial effect for PDT on the size of the NL and DS in SFCNV, which might be of great significance, particularly when PDT fails to prevent severe vision loss.