Correspondence
Preserved retinal sensitivity following spontaneous regression of soft drusen
Soft drusen are the clinical hallmark of intermediate age-related macular degeneration (AMD) and a major risk factor for late-stage disease. Soft drusen usually increase in size, area, and confluence with aging.1 Their natural life cycle may involve retinal pigment epithelium (RPE) changes, collapse, and macular atrophy or spontaneous regression.2 Pharmacologic and laser photocoagulation treatments intended to induce drusen regression have yet to show visual benefit.1,3 Early treatment of intermediate AMD before progression to macular atrophy and/or neovascular complications is an area undergoing intense study and would be a breakthrough.Symptomatic iris varix with enlargement following argon laser
Iris varix is a rare iris lesion that may be mistaken for a malignant neoplasm.1 Thirty-six cases have been described since 1975, most treated by resection without recurrence, although spontaneous regression has been reported.2 Most varices have been described as large, lobulated, well-circumscribed black or red lesions of the iris that may be associated with spontaneous hemorrhage, although smaller varices have been described as prominent, elongated, and tortuous vessels.2,3 Although benign, iris varices may be of sufficiently suspicious appearance as to warrant a detailed work-up to exclude other etiologies such as hemangiomas or melanomas.Intraocular pressure fluctuations in a professional woodwind musician with advanced glaucoma
Ocular hypertension and fluctuations in intraocular pressure (IOP) are critical modifiable risk factors for the development and progression of glaucoma. Transient IOP elevations while playing wind instruments have been observed in musicians with1 and without2,3 glaucoma. However, the comparative effect of trabeculectomy surgery on IOP fluctuations during wind instrument performance has not been previously described.Ischemic cranial nerve 6 palsy and lipemia retinalis in a patient with hypertriglyceridemia
Severe hypertriglyceridemia can occur as a primary (genetic) disorder or secondary to diabetes mellitus, hypothyroidism, alcohol use, or medications. Ophthalmic signs of hypertriglyceridemia include xanthomas, xanthelasmas, and corneal arcus.1 However, atypical presentations also can occur. Prior case reports describe presenting symptoms of intermittent vision loss due to associated hypertensive retinopathy or blurry vision from secondary central serous chorioretinopathy or branch retinal vein occlusion.Superior limbic keratoconjunctivitis following ptosis repair
Superior limbic keratoconjunctivitis (SLK) is an inflammatory condition of the superior bulbar conjunctiva, tarsal conjunctiva, and upper cornea of unknown etiology. The pathogenesis of SLK is unclear, although it has been linked to mechanical microtrauma, deficiencies in tear film quality, and immunologic dysregulation.1Meningococcal B vaccine-associated papillophlebitis and cilioretinal artery occlusion
Vaccine-induced optic neuritis is a known subtype of optic neuritis that has been reported following the administration of various types of vaccines, both viral and bacterial. Ocular symptoms vary significantly and can result in permanent vision loss. There has been only one case of optic neuritis following meningococcal B vaccine (Bexsero; GlaxoSmithKline, London, UK) administration that was reported on the Vaccine Adverse Event Reporting System (2016, VAERS ID 686394), but the details of the event are not thoroughly explained.Marjorin ulcer (squamous cell carcinoma) in a temporal artery biopsy wound
It is well recognized that postoperative and traumatic wounds and scars are susceptible to malignant degeneration, most commonly to squamous cell carcinoma (SCC).1 This phenomenon can occur months to decades after the inciting trauma.1 We describe a case arising from a temporal artery biopsy (TAB) site, demonstrating the importance of considering skin malignancy in any nonhealing incision. Informed consent for publication of this patient's case was obtained, adhering to the Declaration of Helsinki principles.Ultra-wide-field retinal imaging in tetralogy of Fallot before and after cardiac surgery
Congenital heart disease can be classified physiologically into 3 categories: volume overload, cyanotic, and obstructive. Cyanotic congenital heart disease (cCHD) includes lesions with right-to-left shunts or mixing abnormalities (e.g., transposition of the great vessels, persistent truncus arteriosus, tetralogy of Fallot).1 Tetralogy of Fallot (ToF) encompasses a variety of anatomic abnormalities, including a large and unrestrictive ventricular septal defect, right ventricular outflow tract obstruction, overriding of the aorta, and right ventricular hypertrophy.Traumatic direct carotid cavernous fistula following partial maxillectomy
Carotid cavernous fistula (CCF) is a rare traumatic complication that can occur following iatrogenic interventions.1 We report a case of direct CCF (type A) developing following partial maxillectomy with the Le Fort I approach. This case report adheres to the ethical principles outlined in the Declaration of Helsinki as amended in 2013.Acute retinal necrosis from herpes simplex virus type 2: a case series
Acute retinal necrosis (ARN) is a potentially blinding condition characterized by rapidly progressive peripheral retinal necrosis with occlusive vasculopathy and prominent inflammatory reaction.1,2 Identification of a viral etiology can be done with polymerase chain reaction (PCR) testing of intraocular fluid, and prompt management is necessary to preserve vision. ARN caused by herpes simplex virus 2 (HSV-2) is rare, and our understanding is based on a few small case series.3 Here we present three cases of HSV-2 ARN in immunocompetent hosts with a prolonged clinical course of systemic and intravitreal antivirals.Delayed-onset abducens nerve palsy following parafalcine meningioma complicated by subdural hematoma
Meningiomas are slow-growing, benign brain tumors accounting for approximately 20% of primary intracranial masses.1 They may remain asymptomatic for long periods of time and can present with headaches, seizures, and other more site-specific symptoms. Although they are highly vascular structures, meningiomas do not typically produce subdural hematoma (SDH).2 Only 38 cases of meningioma associated with acute SDH have been reported in the English literature.1 We report a delayed-onset abducens nerve palsy due to an SDH associated with a parafalcine meningioma.Migratory orbital inflammation in rheumatoid arthritis
Orbital inflammatory disease is associated with several etiologies.1 Ocular manifestations of rheumatoid arthritis (RA), such as keratoconjunctivitis sicca, have previously been noted in the literature;2,3 however, migratory orbital inflammation is rare.Use of ripasudil for rapid resolution of acute hydrops in keratoconus
Acute corneal hydrops (CH) is characterized by marked stromal edema from the influx of aqueous humour through a tear in Descemet membrane.1 It is predominantly seen in patients with corneal ectasia and reported in up to 3% of patients with keratoconus.1,2 CH presents with an acute decrease in visual acuity, photophobia, and pain.1 Conservative management of CH includes topical hypertonic saline solution, cycloplegics, topical corticosteroids, topical antibiotics, and a bandage soft contact lens if needed for comfort.Unilateral vision loss in a patient with essential thrombocythemia
Essential thrombocythemia is a chronic myeloproliferative neoplasm that develops when megakaryocytes in the bone marrow produce an excess number of platelets.1 This chronic hematologic disorder is associated with a number of thrombotic and embolic complications, and prior cases of vision loss have been documented.1–6 We describe a rather unique case of essential thrombocythemia presenting with unilateral vision loss in a patient.Cotton-wool spots in patients with migraine
Cotton-wool spots (CWSs) refer to localized accumulations of axoplasmic debris in the retinal nerve fibre layer that result from interruption of ganglion cell axon organelle transport.1 The histologic hallmark is the cytoid body, which represents the terminal swelling of a disrupted ganglion cell axon that has expanded and accumulated mitochondria and other organelles and subcellular material.1 In an otherwise healthy person, even a single CWS is considered abnormal, and it is recommended that investigations for underlying systemic disease be initiated.Treatment of an orbital pseudomeningocele through an eyelid incision
Pseudomeningoceles (PMs) occur from extravasation of cerebrospinal fluid (CSF) into soft tissue secondary to a dural tear.1–3 Unlike a true meningocele, which is lined by arachnoid tissue, PMs are associated with the formation of a fibrous capsule.2 Although PMs can form due to surgical insults to the dural covering of the brain or spine, they can also occur secondary to trauma or congenital abnormalities.1,2 Clinical symptoms usually arise when there is mass effect on the surrounding structures.Experiences from a national webinar with recently matched Canadian ophthalmology residents for medical students
Canadian medical students interested in ophthalmology must participate in the Canadian Residency Matching Service (CaRMS) R-1 match,1 where they are assessed based on their academic and extracurricular profile (such as medical school performance record, custom résumés, volunteerism, leadership, research, reference letters, personal letters, and interviews) before they enter residency training. The most recent residency application cycle, completed in April 2021, brought medical students unique challenges secondary to the coronavirus disease 2019 (COVID-19) pandemic, such as canceled visiting electives, virtual interviews, limited clinical exposure, and limited in-person interaction with program faculty and residents.Use of topical allogenic fresh-frozen plasma drops in the treatment of ligneous conjunctivitis
Ligneous conjunctivitis is a rare inflammatory condition characterized by chronic and recurrent deposition of fibrin-rich pseudomembranes on the palpebral conjunctiva.1 Firm membranes with a characteristic ‘woody’ induration usually occur bilaterally presenting since childhood.1,2 The formation of fibrinous pseudomembranes is caused by a mutation in the PLG gene, leading to deficient levels of type 1 plasminogen.1 Plasminogen is a precursor of plasmin, a molecule involved in the degradation of fibrin.Varicella-zoster virus-induced orbital apex syndrome with superior ophthalmic vein occlusion and malignant intraocular pressure rise
Orbital apex syndrome from varicella-zoster virus (VZV) is extremely rare, and approximately 20 patients worldwide have been reported with this condition.1 We report a patient with VZV-associated orbital apex syndrome and unusual malignant intraocular pressure rise from superior ophthalmic vein (SOV) thrombosis.Intravenous tocilizumab in the treatment of resistant optic perineuritis
Optic perineuritis (OPN) is a rare orbital inflammatory disease that mainly involves the optic nerve sheath and surrounding tissues. It is accompanied by eye pain and various levels of optic nerve dysfunction, such as decreased vision, visual field defect, and positive afferent pupillary defect. In contrast to optic neuritis, OPN is not a self-limited disease and always requires treatment.1Retinal pigment epithelium apertures associated with subretinal fluid and acquired vitellifom lesions in non-neovascular age-related macular degeneration
Classic features of non-neovascular age-related macular degeneration (AMD) include drusen, drusenoid retinal pigment epithelial (RPE) detachment, and RPE atrophy. More recent studies have shown that intra- and subretinal fluid also may complicate the non-neovascular form of AMD.1Importance of correlating radiohistopathologic features in lacrimal gland pleomorphic adenoma
Lacrimal gland pleomorphic adenoma (LGPA) is a common benign epithelial tumour of the lacrimal gland that frequently appears on imaging as a well-circumscribed lesion with no bony erosion.1 In some cases, it can present with atypical radiologic features and then needs to be correlated with histopathologic findings to ascertain a diagnosis.Corneal limbal xanthogranuloma in Erdheim-Chester disease
Adult orbital xanthogranulomatous disease is a rare non-Langerhans cell histiocytic condition with 4 clinical subtypes: adult‐onset xanthogranuloma, adult‐onset asthma with periocular xanthogranuloma, necrobiotic xanthogranuloma (NBX), and Erdheim–Chester disease (ECD). We report, to our knowledge, the first case of ECD with limbal infiltration.Uveal melanoma presenting as panophthalmitis in the absence of an intraocular mass
Uveal melanoma is the most common primary intraocular malignancy in adults, with 90% of cases originating from the choroid. While many patients are asymptomatic and the tumour is often diagnosed incidentally on routine eye examination, presenting symptoms can include decreased vision, flashes, or floaters.1 Less frequently, uveal melanoma can present with ocular or periocular inflammation simulating endophthalmitis or orbital cellulitis.2–7 In the majority of these cases, an intraocular mass will be identified on either computed tomography (CT), B-scan ultrasonography, or magnetic resonance imaging (MRI).Transplantation of autologous lamellar scleral graft for the treatment of corneal perforation
Corneal perforations are ocular emergencies and are distinct from lacerations in that there is tissue loss.1 Common etiologies include trauma, infection, underlying autoimmune disease, and loss of corneal innervation.1 If not treated promptly, corneal perforations can lead to profound vision loss, infection, phthisis, and/or globe loss.2 In developing countries, the number of corneal perforations is higher than in the developed world.1 Treatment options for corneal closure are contingent on many factors, including perforation size.Kodamea ohmeri keratitis
Kodamaea ohmeri is a yeast-like fungus and a rare but emerging pathogen.1 It has been identified as the causative organism in fungemia, funguria, endocarditis, cellulitis, and peritonitis, often with high fatality rates.1 To the best of our knowledge, there is only 1 previous report of K. ohmeri keratitis in the literature.2Rare case of extramacular choroidal macrovessel
Choroidal macrovessel (CM) is a rare, mostly unilateral vascular anomaly of the choroidal circulation.1 These abnormally large vessels may cause disturbances in the overlying retinal pigment epithelium (RPE) and the development of subretinal fluid. Some CMs can even masquerade as a choroidal tumour or parasitic infestation.1–3 Reports showing early filling of CMs during indocyanine green angiography (ICGA) suggest that most CMs are arterial in nature.1,3,4 The short posterior ciliary circulation is comprised of a medial and lateral posterior choroidal artery (PCA)5,6; the latter may represent the origin of most CMs and may explain why almost all previously reported CMs arise in the macula.Varied management of idiopathic intracranial hypertension in female-to-male transgender patients
Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, visual disturbances, papilledema, and headache. There is an association between sex hormone excess and IIH, particularly in patients undergoing hormonal therapy for gender transition.1 The increased androgen concentration during testosterone therapy for gender reassignment presents an opportunity for studying different treatment modalities. First-line treatment of IIH involves dietary changes and a carbonic anhydrase inhibitor such as acetazolamide.A masquerader epidemic: five heterogeneous ocular syphilis presentations
Syphilis is a spirochete infection transmitted through intercourse or congenital infection. Despite declining incidence since the 1990s, ocular syphilis has re-emerged in developed countries.1 We describe 5 distinct presentations of ocular syphilis to promote recognition of this increasingly prevalent disease.Wellness among Canadian ophthalmology resident physicians: a national survey
Residency is a particularly stressful and dynamic period during which learners must balance the demands of patient care, education, and personal responsibilities. Evidence of high levels of burnout among resident physicians has driven the development of initiatives and programs to help address this negative consequence of residency training. As a novel topic in the realm of medical education, more information is required to further characterize the sources of burnout and depression and the nuances of various specialities.Multiple myeloma with concurrent herpes zoster ophthalmicus: a case report
Hyperviscosity syndrome, which typically results from elevated serum levels of monoclonal protein, can present with bleeding, retinopathy, and neurologic symptoms.1 We present a case of hyperviscosity syndrome confounded by herpes zoster reactivation in a patient with newly diagnosed multiple myeloma.Delayed diagnosis of autosomal dominant optic atrophy until seventh decade of life
Autosomal dominant optic atrophy (ADOA) is the most common hereditary optic neuropathy, manifesting in approximately 1 in 50 000 people, and up to 1 in 10 000 in Denmark, owing to a founder mutation.1 Isolated ADOA typically manifests in the first 2 decades of life as bilateral painless progressive vision loss and is therefore mostly diagnosed in childhood to young adulthood. We present a series of 2 older patients, aged 63 and 64 years, who had delayed ADOA diagnosis as proband patients in their families, emphasizing the point that chronological age should not be the sole determining factor for ordering testing for ADOA in cases of unexplained optic neuropathy.Papilledema associated with COVID-19 multisystem inflammatory syndrome in children
Multisystem inflammatory syndrome in children (MIS-C), also called pediatric inflammatory multisystem syndrome, is characterized by a wide range of symptoms and can present a diagnostic challenge given its myriad presentations. On top of the more well-known inflammatory manifestations of MIS-C, recent reports have also surfaced of MIS-C causing increased intracranial pressure.1,2 MIS-C can present similarly to other systemic inflammatory disorders such as Kawasaki disease and can be especially difficult to distinguish from Kawasaki disease if a Kawasaki-like presentation is accompanied by a positive test for coronavirus disease 2019 (COVID-19).Late-onset bilateral epithelial ingrowth following rapid corneal decompensation owing to amantadine
Epithelial ingrowth (EI) can occur at the interface between the flap and the stromal bed of the patient's cornea following laser assisted in situ keratomileusis (LASIK) surgery. The introduction of corneal epithelial cells into the interface can happen during surgery or after the procedure owing to loss of contact inhibition and the presence of a pathway to the interface. Epithelial ingrowth is a relatively uncommon complication, with a reported incidence of 3.9% following primary LASIK and up to 12.8% following enhancement with a flap lift.Late progression of visual loss from ocular quinine toxicity
A 64-year-old Caucasian man was admitted to hospital with acute loss of vision after ingesting at least 3 grams of quinine, risperidone, and paracetamol. His medical history was significant for schizophrenia and nocturnal leg cramps. His usual medications were risperidone and quinine as required. No ophthalmic history was noted. An inpatient examination revealed bilateral no-light-perception vision and grossly constricted visual fields. Electrocardiogram showed sinus rhythm and blood tests, including glucose, haematology, liver, renal, coagulation profiles, and paracetamol levels were normal.Intrastromal voriconazole for refractory infectious crystalline keratopathy associated with Candida pararugosa
Infectious crystalline keratopathy (ICK) is an infrequent complication of long-term topical steroid use following penetrating keratoplasty,1 classically caused by Streptococcus viridans.2 It has been reported in association with local immunosuppression after any ocular surgery (lamellar keratoplasty, cataract surgery, trabeculectomy, corneal cross-liking, and laser in situ keratomileusis), as well as in contact lens wearers, herpetic and Acanthamoeba keratitis, and corneal anaesthesia.3,4 Besides α-haemolytic streptococci,2 multiple additional microorganisms have been causally linked to ICK, including Gram-positive or -negative bacteria, atypical mycobacteria, and fungi,3 most of them bearing biofilm-forming capacity.Cadaveric simulation improves ophthalmology resident confidence and preparedness for emergent ophthalmic procedures
Simulation-based training programs have become an essential tool in medical education.1 Surgical simulation on platforms, including the Eyesi, which are now widely adopted throughout ophthalmology training, reduces intraoperative complication rates.2 Even virtual training utilizing computer graphics and surgical models, which may be lacking in qualities provided by real-life scenarios or cadavers, helps trainees perform faster and with fewer errors compared with trainees who went without virtual training.Corneal imaging with optical coherence tomography assisting the diagnosis of mucolipidosis type IV
Mucolipidosis type IV (MPS-IV, OMIM #252650), a lysosomal storage disorder caused by dysfunctional mucolipin-1, is characterized by neurologic and visual impairment, developmental delay, and achlorhydria. MCOLN1 gene mutation identification is diagnostic but requires clinical suspicion. The latter is challenging, however, because most systemic and ocular findings are nonspecific and rarely evolve simultaneously.1 Bilateral corneal clouding is the earliest hallmark sign of MPS-IV. Unlike in other metabolic causes of corneal opacification, it is owing to preferential accumulation of abnormal material in the corneal epithelium as opposed to other corneal layers.Optical coherence tomography angiography in choroidal metastasis before and after treatment
Choroidal metastases represent the most common intraocular malignant tumor in adults.1 With the advent of optical coherence tomography angiography (OCTA), there is a unique opportunity to visualize choroidal vascular pathologies in more detail using a noninvasive technique concurrent with anatomical evaluation of the retina, retinal pigment epithelium (RPE), and choroid. Depth-selective characterization is one of the most significant advantages of OCTA, allowing better visualization of choroid circulation and, particularly, the choriocapillaris layer, which is the main source of perfusion to the RPE and photoreceptors.Late-onset recurrent Acremonium fungal keratitis after therapeutic penetrating keratoplasty
Fungal keratitis is a prominent cause of blindness worldwide. Therapeutic penetrating keratoplasty (TPK) has been demonstrated as an effective treatment for fungal keratitis that does not respond to antifungal medications. Recurrent fungal infection after TPK is uncommon but occurs typically within 2 weeks after surgery.1Endoscopic cyclophotocoagulation and Kahook Dual Blade trabeculotomy in combination with phacoemulsification
Convenient to perform alongside cataract surgery and relatively safe, minimally invasive glaucoma surgeries (MIGS) are growing in popularity. Few studies have examined the effect and safety of performing combined MIGS.Biopsy of a diffuse anterior chamber angle melanocytoma using a Kahook Dual Blade
A 68-year-old female was referred to the emergency ophthalmology clinic with a pigmented iris lesion and an intraocular pressure (IOP) of 38 in her left eye. Initial clinical assessment revealed the presence of a localized, flat, plaque-like peripheral and midperipheral iris lesion in one quadrant. Pigmented seeding on the rest of the iris surface and associated mild corectopia were observed. There were no notable episcleral sentinel vessels, and there was no iris neovascularization. On gonioscopy, heavy pigment invaded 8 clock hours of the angle (Fig.Crossed-quadrant homonymous hemianopsia in a monocular patient
A 75-year-old male presented to the clinic reporting that upon waking up from a nap 4 days earlier, he noticed he could “only see in certain spots.” He has an ocular history of moderate-stage primary open-angle glaucoma in both eyes, dry eye syndrome, and pseudophakia. He had previously undergone enucleation of his blind, painful right eye due to neovascular glaucoma from a previous central retinal vein occlusion. He was a former smoker, and his medical history is significant for multiple myeloma, bladder cancer, pulmonary embolism, hypertension, and hyperlipidemia.Superior oblique myositis following targeted therapy for papillary thyroid carcinoma
Papillary carcinoma of the thyroid gland (PCTG) constitutes 80%–85% of thyroid cancers globally. Despite early lymphatic invasion, PCTG has a relatively indolent course and rarely metastasizes outside of the neck.1 Metastasis to the brain from PCTG is even more uncommon and usually occurs in the context of widely disseminated disease. While the mainstay of treatment for intracranial metastasis from PCTG includes surgical excision and radiotherapy, recent advances into our understanding of the molecular pathways governing PCTG have facilitated development of novel targeted chemotherapeutics.Simple limbal epithelial transplantation (SLET) in conjunction with keratoplasty for severe congenital corneal opacities
Congenital corneal opacities (CCO) are rare, with an incidence of 1 in 26,000 to 37,000 live births.1,2 There is a wide spectrum of CCO disease severity from mild and small opacities to fully opaque cornea with severe lens involvement and vascularization or conjunctivalization of the cornea. The severe form of CCO is usually associated with large corneal opacity and the presence of extensive superficial corneal vascularization. Such eyes may have conjunctival epithelial ingrowth, which can increase the risk of allograft rejection.Junctional scotoma in moyamoya disease
A 66-year-old Hispanic woman presented to the eye clinic with chronic, progressively worsening vision in the right eye over 2 years associated with right-sided temporal headaches, cutaneous allodynia of the scalp, and jaw claudication. She denied fevers, chills, joint pains, nausea, photophobia, phonophobia, personal history of autoimmune disease, and family history of hereditary ophthalmological diseases. Her ocular history included pterygium removal from the OD. Seven years prior to presentation, she had an episode of light-headedness, blurry vision for 30 minutes, a severe headache, and mild weakness of the left hemiface and left body lasting 2 hours.Senior-Loken syndrome secondary to IQCB1 mutation in association with retinitis pigmentosa
Senior-Loken syndrome (SLS) is a rare autosomal recessive disease characterized by nephronophthisis and early-onset retinal degeneration.1 Nephronophthisis leads to end-stage renal failure. Several genes can cause SLS, including NPHP1-6 and NPHP10.2 We herein report a case of SLS type 5 caused by IQCB1 mutation.Conjunctival and periorbital petechiae presumed secondary to self-inflicted asphyxiation in a pediatric patient
The presence of petechiae of the face and conjunctiva is a well-described finding seen in strangulation injuries. These petechiae are commonly seen post-mortem in deaths by asphyxia and are consequently used in forensic analysis.1 Conjunctival and facial petechiae have also been noted to occur in nonfatal asphyxia, and their presence may be a sign that a severe strangulation injury has occurred.2 The mechanism for facial and conjunctival petechial hemorrhages in asphyxia is thought to be rupture of capillaries with little connective tissue support secondary to local pressure elevation from continued arterial flow while venous output is obstructed.Murine typhus presenting as pseudotumor cerebri
Murine typhus is an acute infection transmitted by rodent or cat fleas carrying gram-negative, obligate intracellular bacteria, Rickettsia typhi. This vector for transmission is most often carried on rodents, but opossums are thought to be a reservoir in suburban settings.1 Associated with overcrowding, pollution, and poor hygiene, murine typhus has been documented worldwide, but the majority of cases in the United States are in Texas and California.2Central retinal artery occlusion associated with Sweet syndrome
A 64-year-old Caucasian man presented with a 1-day history of acute painless vision loss in the right eye. On examination, his visual acuity was hand motions OD and 20/30 OS. His intraocular pressures were normal OU and he had a 3+ relative afferent pupillary defect OD. The anterior segment examination was unremarkable OU. Fundoscopic examination of the right eye revealed a cherry red spot (Fig. 1A). No vitreous cell, vasculitis, or chorioretinitis was noted OU. A fluorescein angiogram of the right eye showed an arterial filing line (Fig.
