Characterization of corneal deposition keratopathy in the setting of blood cell dyscrasia and a minimally invasive technique to clear the cornea in a single case.

PURPOSE: To report 3 cases of corneal protein deposition occurring in association with systemic disease, with one case demonstrating a novel technique for clearing corneal deposits. OBSERVATIONS: Three patients presented with corneal deposits associated with systemic disease. Corneal involvement was noted prior to diagnosis of systemic disease in two patients, leading to subsequent diagnosis of multiple myeloma or monoclonal gammopathy of undetermined significance. OCT revealed protein deposition at various corneal levels, including at different stromal depths in the two cases of multiple myeloma. A novel technique of posterior endothelial scraping was performed in one case with deep stromal deposits, leading to significant corneal clearing. CONCLUSIONS AND IMPORTANCE: This case series demonstrates that recognition of corneal deposits may precede the diagnosis of systemic disease. It incorporates the use of anterior segment OCT to characterize corneal deposits, and demonstrates a novel surgical technique for clearing certain types corneal deposits.

A case of ophthalmomyiasis interna in the Pacific Northwest.

PURPOSE: We report a case of ophthalmomyiasis interna successfully removed in toto with pars plana vitrectomy. OBSERVATIONS: An 84-year-old woman with recent close contact with lambs presented with a new floater. Examination revealed subretinal tracks pathognomonic for ophthalmomyiasis and a larva suspended in the vitreous. The larva was successfully removed in toto with pars plana vitrectomy by aspiration through the vitreous cutter. CONCLUSIONS AND IMPORTANCE: Aspiration with pars plana vitrectomy can be considered a primary therapeutic modality for botfly larvae suspended in the vitreous. In our case, in toto removal of the larvae reduced the risk of inflammatory reaction.

GRANULOMATOSIS WITH POLYANGIITIS (GPA) PRESENTING WITH FROSTED BRANCH ANGIITIS.

PURPOSE: To report a case of frosted branch angiitis in a patient with granulomatosis with polyangiitis. METHODS: Clinical case report. Imaging was obtained with pseudo-color scanning laser ophthalmoscope photographs, fluorescein angiography, spectral domain optical coherence tomography, and B-scan ultrasound. RESULTS: A 24-year-old woman with a clinical history of granulomatosis with polyangiitis who presented with acute vision loss was found to have frosted branch angiitis with concurrent posterior scleritis and orbital inflammation. These findings improved rapidly after initiation of high-dose intravenous solumedrol. CONCLUSION: This is a unique case of frosted branch angiitis associated with granulomatosis with polyangiitis. The authors are not aware of a previous report of this association. Although rare, retinal vasculitis should be recognized as a potential complication of granulomatosis with polyangiitis and can respond rapidly to prompt initiation of therapy.

Morgellons Disease Presenting As an Eyelid Lesion.

Morgellons disease is characterized by complaints of uncomfortable skin sensations and fibers emanating from nonhealing skin lesions. Morgellons disease is well-known in the dermatology and psychiatry literature, where it is typically considered a subtype of delusional parasitosis, but it has not yet been described in the ophthalmology literature. A patient with self-reported Morgellons disease is presented, who was referred for evaluation of left lower eyelid ectropion. She reported that her skin was infested with fibers that were "trying to get down into the eyelid." On examination, she had ectropion of the left lower eyelid, broken cilia, and an ulcerated left upper eyelid lesion concerning for carcinoma. Biopsy of the lesion was consistent with excoriation. Treatment of her ectropion was deferred out of concern for wound dehiscence, given the patient's aggressive excoriation behavior. This case is presented to make the ophthalmologist aware of this disorder and to highlight the appropriate clinical management.

Refractive error and visual function difficulty in a Latino population.

OBJECTIVE: To assess the association of correction of myopia, hyperopia, and astigmatism with self-reported near and distance visual function. DESIGN: Population based, cross-sectional study. PARTICIPANTS: A random sample of 4272 Latinos older than 40 years of age from Arizona with both ophthalmic examination and questionnaire data, including answers to the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25). METHODS: Cases of refractive error (RE) were defined as subjects who met at least 1 of the following criteria in both eyes: myopia, sphere -0.5 diopters (D) or less; hyperopia, sphere 1.0 D or more; or astigmatism, cylinder 0.75 D or more. Uncorrected refractive error (URE) was defined as having RE and achieving 2 lines or more of improvement in visual acuity in both eyes after refraction. The association between RE category and near and distance vision difficulty (as measured by the NEI VFQ-25 near and distance vision subscores) was modeled with ordinal logistic regression, adjusting for age, gender, diabetes, hypertension, income, education, and acculturation. MAIN OUTCOME MEASURES: Association between RE correction and near and distance vision difficulty by type of RE (myopia, hyperopia, and astigmatism). RESULTS: Of 4272 participants, 54% had RE. Forty-eight percent of these had myopia, 41% had hyperopia, and 11% had astigmatism. Fourteen percent of myopes, 21% of hyperopes, and 22% of astigmatics had URE. Subjects with myopia, astigmatism, and hyperopia were significantly more likely to report more distance vision difficulty than subjects without RE, regardless of whether they had correction (odds ratios [ORs], 1.7-3.7; P<0.005 for all). Subjects with corrected myopia reported less near vision difficulty than subjects without RE (OR, 0.8; 95% confidence interval [CI], 0.7-0.9). Subjects with uncorrected hyperopia and uncorrected astigmatism reported more near vision difficulty than those without RE (OR, 1.6; 95% CI, 1.2-2.2; and OR, 1.7; 95% CI, 1.0-3.0, respectively). Self-reported distance and near visual function scores were sensitive to nonvision variables, namely, age, gender, diabetes, high blood pressure, acculturation score, income, and education. CONCLUSIONS: In this population, correction of any type of RE is not entirely sufficient to restore distance visual function to the level of those without RE. More research is necessary to determine the reasons for this shortcoming.