Retinal vasculitis following intravitreal pegcetacoplan administration.

Purpose: To describe a case of retinal vaso-occlusive vasculitis with associated lid edema and conjunctivitis following intravitreal pegcetacoplan administration in a patient with geographic atrophy (GA). Observation: A 78 year old Caucasian woman presented with complaints of lid edema, conjunctival injection, loss of vision, and mild ocular discomfort eleven days after receiving an intravitreal pegcetacoplan injection in the left eye for geographic atrophy. Visual acuity on presentation was decreased to 20/400 from 20/200 previously in that eye. Eyelid edema and conjunctival injection were present with minimal anterior chamber reaction. Dilated fundus examination revealed hemorrhages throughout the retina and signs of retinal vasculitis. The patient subsequently developed hyphema and vitreous hemorrhage. Laboratory evaluations for common infectious and inflammatory causes including aqueous and vitreous cultures for bacteria and Herpes simplex PCR were normal or negative. A delayed hypersensitivity to pegcetacoplan was suspected and was treated with topical, oral subconjunctival and intravitreal steroids. Conclusion: This index report illustrates a case of retinal vaso-occlusive vasculitis associated with intravitreal pegcetacoplan associated with lid edema and conjunctival injection and subsequent hyphema and vitreous hemorrhage. Therapy with steroids topically, systemically, periocularly and intravitreally were used to treat the inflammatory process and prevent further visual loss.

Do Not Fall for This; Diagnostic Challenges in Orbital Floor Fractures With Extraocular Muscle Entrapment.

Extraocular muscles that are entrapped in orbital fracture sites require emergent surgical treatment. Muscle entrapment can present with subtle findings or mimic other conditions, contributing to delays in diagnosis. Here, we present two cases of extraocular muscle entrapment that were not immediately identified. By discussing the diagnostic challenge in these cases, we aim to increase the comfort of all physicians in identifying muscle entrapment in the emergency department.

Fiberglass intraocular foreign body with no initial ocular symptoms.

PURPOSE: To report a case of an occult intraocular foreign body missed on initial presentation. To our knowledge, this is the first reported case of fiberglass as an intraocular foreign body. METHODS: A case report in which the clinical presentation of the patient was documented by color anterior segment and fundus photographs, optical coherence tomography (OCT), and computed topography (CT) of the orbit. RESULTS: A 34-year-old male was referred for the evaluation of an acute unilateral preretinal hemorrhage of undetermined origin. Three months before his presentation, he had a foreign body sensation while cutting fiberglass, which lasted for several hours. He denied having any visual complaints until his presentation 3 months later. On anterior examination, a small paracentral corneal scar was noticed. There was no cell or flare. A small iris defect inferior nasal with an adjacent area of broad based peripheral anterior synechia on gonioscopy was noted. On funduscopy, a large subretinal elevation with an underlying hemorrhage adjacent to the disk with a white foreign body partially imbedded in the retina was seen. A vitreous hemorrhage was overlying the macula. Because there were no signs of infection or inflammation, surgical intervention was avoided. Barrier laser was performed around the subretinal elevation. CONCLUSION: Occurrence of intraocular foreign bodies, although not uncommon, has a varying presentation. Most often devastating and dramatic, clinical signs may not be obvious or appreciated on thorough examination, especially when the offending object is very small. Intraocular foreign bodies composed of inert material (i.e., glass/fiberglass) can leave the eye without inflammation, further making the diagnosis difficult.

Haptic-induced postoperative complications. Evaluation using ultrasound biomicroscopy.

OBJECTIVE: Evaluation of haptic-induced postoperative complications with single-piece intraocular lenses (IOLs) using ultrasound biomicroscopy (UBM). DESIGN: A retrospective case series. PARTICIPANTS: We looked at 5 pseudophakic eyes with noninfectious postoperative complications, after undergoing phacoemulsification with posterior chamber intracapsular IOL placement. METHODS: A review of clinical findings as well as UBM measurements looking at the distance of the IOL from the posterior surface of the pupil on each side of the lens. RESULTS: In all cases, UBM revealed malposition of the IOL, confirming IOL tilting and haptic displacement outside of the capsular bag. CONCLUSIONS: UBM is a useful tool for early diagnosis of uveitis-glaucoma-hyphema syndrome because it enables visualization of the exact position of the IOL in vivo. In such cases, localization of the lens and haptics are essential in devising treatment strategies, such as repositioning of the haptics, haptic amputation, or removal of the IOL.

Primary orbital liposarcoma misdiagnosed as thyroid associated orbitopathy.

Orbital malignancy can mimic thyroid associated orbitopathy (TAO) due to overlap of clinical and radiographic findings, which include proptosis, extraocular muscle (EOM) enlargement on imaging, and EOM restriction with diplopia. We report a case of primary orbital liposarcoma masquerading as TAO which required exenteration.

Massive intracorneal cyst in a patient with no ocular symptoms.

OBJECTIVE: To report a rare case of intracorneal cyst with no ocular symptoms. METHODS: A case report of an intracorneal cyst that was treated with lubrication and intraocular pressure lowering medication is discussed. RESULTS: There was no increase in cyst size nor were there any new symptoms reported after 5 months of follow-up. CONCLUSIONS: Intracorneal cysts are believed to be caused by a sequestration of corneal limbal cells in the stroma from congenital or traumatic reasons. Because of the slow growing nature of intracorneal cysts, we highlight that surgical excision is not always warranted in patients, especially if the vision is already poor and if no symptoms are present.

360° retinectomy for the treatment of complex retinal detachment.

PURPOSE: To review the anatomical and functional outcomes of eyes that underwent 360° retinectomy for a variety of indications and compare them with previously published results. METHODS: Retrospective case series. We reviewed the data of 40 patients (41 eyes) who underwent pars plana vitrectomy and 360° retinectomy. The principal indication for surgery in this series was retinal detachment after penetrating trauma (26 of 41 eyes [63%]). Anatomical success was defined as complete retinal reattachment or attachment posterior to the scleral buckle, if present. RESULTS: Thirty of the 41 eyes (73%) had follow-up of at least 6 months after 360° retinectomy, and of these, 11 eyes (37%) had recurrent retinal detachment. Seven of the latter eyes underwent repeat pars plana vitrectomy with anatomical success in 6 eyes (86%). Overall, anatomical success was achieved in 25 of 30 eyes (83%) with follow-up of ≥ 6 months after ≥ 1 operations (including 360° retinectomy). Visual results were limited with only 4 of 35 eyes (11%) in which visual acuity could be tested achieving ambulatory vision, which may reflect the preponderance of posttraumatic retinal detachments in this series. CONCLUSION: The anatomical results of this series are comparable with those in the reported literature and indicate that vitrectomy with 360° retinectomy can be beneficial in the management of complex retinal detachments in otherwise unsalvageable eyes.

Two cases of keratoconus associated with spontaneous corneal perforation.

We present 2 cases of spontaneous corneal perforation in patients with keratoconus. The first patient developed a corneal scleral fistula 1 year after her initial diagnosis of hydrops. We conclude that adequate eye care education, allergy prophylaxis, and fall precautions may be necessary in patients with keratoconus to prevent corneal perforations. Medical and surgical treatments are both viable first-line treatments for corneal perforations.

Descemet's Membrane Detachment Caused by the Improper Injection of Sodium Hyaluronate.

A case of a Descemet's membrane detachment (DMD) caused by the inadvertent intracorneal injection of sodium hyaluronate was presented. This was concluded after chemical analysis of a viscous substance found in a patient's cornea showed to be a breakdown product of sodium hyaluronate. Surgical correction of the detachment included removing the viscous substance and tamponading the detachment with an air bubble. Although other gases such as sulfur hexafluoride (SF6) provide longer means of tamponade, they have increased postoperative risks like glaucoma associated with their use. Air can provide an effective means of tamponade with minimal postoperative risks.

Two (+)-alpha,4-dimethyl-2-oxocyclohexaneacetic acids: hydrogen bonding in a terpenoid gamma-keto acid and in a diastereomeric lactol.

The (+)-(alphaS,1S,4R)-diastereomer of the title structure, C10H16O3, aggregates in the solid as non-symmetric dimers with disorder in both carboxyl groups [O...O = 2.710 (5) and 2.638 (5) A]. The two molecules constituting the asymmetric unit pair around a pseudo-twofold rotational axis and differ only slightly in their distances and angles, but one methyl group displays rotational disorder absent in the other molecule. Five intermolecular C-H...O close contacts exist, involving both ketone groups. The (+)-(alphaR,1R,4R)-diastereomer exists in the crystal in its closed-ring lactol form, (3R,3aR,6R,7aR)-2,3,3a,4,5,6,7,7a-octahydro-7a-hydroxy-3,6-dimethylbenzo[b]furan-2-one, C(10)H(16)O(3), and aggregates as hydrogen-bonded catemers that extend from the hydroxyl group of one molecule to the carbonyl group of a neighbor screw-related along b [O...O = 2.830 (3) A and O-H...O = 169 degrees]. One close intermolecular C-H...O contact exists involving the carbonyl group.