Correspondence
Management of positive dysphotopsia in a patient with prior refractive surgery
Dysphotopsias are bothersome visual phenomena experienced by patients after cataract surgery (CS). Positive dysphotopsias (PD) appear as light-related artefacts in various forms, whereas negative dysphotopsias are usually a temporal darkness or shadow in the visual field.1Implantation pearl cyst after uncomplicated clear cornea phacoemulsification mimicking an iris tumour
Epithelial downgrowth (ED) is a serious, although rare, complication of ocular surgery and trauma that can result in irreversible vision loss.1–6 In the ocular surgery group, cataract surgery, especially in the extracapsular era, accounted for 86% of cases1 related to vitreous loss, persistent hypotony, capsule rupture, multiple surgeries, delayed wound healing, wound fistulas, and iris incarceration. According to the literature, 82% of cases presented within the first year after intraocular surgery1,3 with retrocorneal membrane (48%), painful glaucoma (32%), positive Seidel test (24%), corneal edema (22%), hypotony (17%), painless glaucoma (14%), iritis (11%), and iris cyst (8%).Progressive optic nerve glioma: orbital biopsy technique using a surgical navigation system
An 11-year-old male child presented with worsening vision in his left eye. Examination and imaging revealed a left optic nerve tumour causing mass effect and optic neuropathy, without systemic evidence of neurofibromatosis. In view of the significant risk to visual acuity, a biopsy was deferred and chemotherapy was commenced. After initial stability, continued visual decline necessitated incisional biopsy. Surgical navigation was used to facilitate minimal access surgery avoiding bone removal. The system also precluded biopsy of cystic parts of the tumour, allowing successful intraoperative frozen-section confirmation of lesional tissue.A rare case of bilateral ocular neuromyotonia
Unilateral ocular neuromyotonia (ONM) is a rare entity, and bilateral ONM even more so, with and only 1 case having been reported previously in the literature. We present a rare case of bilateral ocular neuromyotonia whose course of treatment was complicated by side effects of carbamazepine.Mooren’s ulcerative keratitis after systemic pegylated interferon alpha2a in chronic hepatitis C
Interferon alpha (IFNα) is a subgroup of the IFN family that is involved in activation of immune responses against viral infection. IFNα2 is secreted by virus-infected cells and inhibits other cells from further infection. IFNα2 has been widely used to manage hepatitis C and multiple sclerosis.1 Although ocular complications with IFN administration occur in less than 1% of patients, they include retinal hemorrhage, cotton wool spots, cystoid macular edema, ischemic optic neuropathy, subconjunctival hemorrhage, dry eye, and Sjögren’s syndrome.Ethambutol optic neuropathy associated with enhancement at the optic chiasm
A 71-year-old woman was diagnosed with pulmonary Mycobacterium avium complex in 2006 and received multidrug treatment with ethambutol for 18 months between 2008 and 2009, with no ocular symptoms. Because of a progression in pulmonary nodules, ethambutol was restarted in 2015 at a total daily dose of 19 mg/kg along with rifampin and clarithromycin.Cerebellopontine angle astrocytoma producing Bruns nystagmus mimicking vestibular schwannoma
Cerebellopontine angle (CPA) extra-axial lesions (e.g., classically the vestibular schwannoma) may cause a characteristic neuro-ophthalmologic sign known as the Bruns nystagmus, a gaze-evoked horizontal nystagmus when looking away from the lesion and a gaze-paretic type nystagmus when looking toward the lesion. In contrast, intra-axial exophytic CPA astrocytomas are rare and, to our knowledge, have not been reported in the English-language ophthalmic literature previously as a cause of Bruns nystagmus.Childhood glaucoma in neonatal Marfan syndrome resulting from a novel FBN1 deletion
Marfan syndrome (MFS) is an autosomal dominant genetic disorder of the connective tissue. The majority of MFS cases involve mutations in the FBN1 gene encoding the protein fibrillin-1. Fibrillin-1 is a protein found in the extracellular matrix that is incorporated into the final structure of microfibrils.1 In 25% of cases, the disorder occurs sporadically.2 The most common clinical manifestations resulting from MFS are musculoskeletal, cardiovascular, and ophthalmic. Patients with MFS often present with tall stature, arachnodactyly, and scoliosis, but the severity of the disease varies.Subconjunctival injection of bevacizumab for recurrent conjunctival papilloma: a case report
Conjunctival papilloma is an acquired benign neoplasm of the conjunctiva and is caused by human papillomavirus, which mostly develops in middle-aged males and often appears as sessile or pedunculated lesions.1–3. The recurrence of conjunctival papilloma is common and has a recurrence rate of >10%.1–3 The conventional therapeutic options include surgical excision and cryotherapy for eradication, but usually conjunctival papilloma recurs, and repeated excisions may lead to ocular surface damage.4,5 Topical interferon, topical mitomycin C, and oral cimetidine are therefore used as adjuvant treatments.Persistent pediatric primary canaliculitis associated with congenital lacrimal fistula
Primary canaliculitis is an uncommon infection of the lacrimal canaliculus. It is frequently misdiagnosed as chronic conjunctivitis or dacryocystitis, which results in delayed or improper treatment. The challenge of treatment is to eradicate the causative pathogens on the basis of maintaining the canalicular patency.1 We present a refractory case of primary upper canaliculitis associated with congenital lacrimal fistula.Eye drop safety seal causing ocular irritation following cataract and vitrectomy surgery
Applying medication directly to the eye was first reported in ancient cultures, and modern pharmacotherapy with eye drops is likely to have begun when pilocarpine and atropine were isolated as therapeutics in the late 19th century.1 Since then, eye drops have been used as a primary delivery method for many classes of medications. Just as with oral medications,2 patients have difficulty remembering the names, frequencies, and dosages of the eye drops they are taking.3 In addition, effective administration of drops can be difficult, especially for patients with problems with dexterity or low vision.Intraretinal macular hemorrhage due to high-power handheld blue laser
We recently reported various forms of maculopathies related to high-power handheld blue laser injury. This included subhyaloid/subinternal limiting membrane hemorrhage, epiretinal membrane, foveal schisis-like changes, outer retinal disruption, and full-thickness macular hole.1 Here we present a new manifestation of blue laser–induced maculopathy.Optic nerve hypoplasia in a patient with a de novo KIF1A heterozygous mutation
Kinesin superfamily proteins (KIFs) are molecular motors that use microtubules as a “rail” to transport membrane vesicles and organelles, protein complexes, and messenger RNAs (mRNAs). KIF1A drives the microtubule plus end toward the axon terminal, which is most prominent in polarized cells, including neurons, and is fundamental for neuronal function and survival. Kinesins have long been implicated in the pathogenesis of axonal neuropathies. We report a child with a de novo KIF1A gene mutation who was found to have bilateral optic nerve hypoplasia and atrophy.Case series: Merkel cell carcinoma of the eyelid
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine malignancy hypothetically derived from a precursor common to keratinocytes and Merkel cells.1 Only 5% to 10% of MCCs involve the eyelids and the periocular region,2 of which fewer than 100 cases have been reported to date.3,4 Here, we present 3 new patients with MCC of the eyelid and discuss diagnostic considerations.Chandelier scleral buckling for retinal detachment in Stevens-Johnson syndrome
A 40-year-old uniocular man presented with a 2-week history of a sudden decrease in vision in the left eye. Visual acuity was light perception with inaccurate projection of rays OD and counting fingers at 1 m, N48 OS. The patient had a history of loss of vision in the right eye 30 years previously because of postvaricella (chicken pox) Stevens-Johnson syndrome. The right showed a total leucomatous corneal opacity (Fig. 1). The left eye showed a vascularized corneal scar involving the nasal two-thirds of cornea, with superficial punctate keratitis.Ciliochoroidal detachment following pure sulfur hexafluoride injection in Descemet stripping automated endothelial keratoplasty
Descemet stripping automated endothelial keratoplasty (DSAEK) is an effective and safe treatment for Fuchs dystrophy and pseudophakic corneal edema, among other ocular conditions.1–3 The most common complication of this surgical procedure is graft detachment, which may be effectively resolved in most cases by rebubbling with air or gas (or both) to reposition the graft.1–3Haller cells: A risk factor for spontaneous orbital floor fracture?
Orbital floor fractures most commonly occur as a consequence of trauma through either buckling or hydraulic forces acting on the orbit. Spontaneous orbital floor fractures have been described in the literature usually in the setting of thyroid eye disease (TED). We present the case of a patient with a history of a spontaneous floor fracture associated with anteriorly displaced ethmoid air cells. We propose a pneumatic mechanism of spontaneous floor fracture in patients with Haller cells.Immunoglobulin G4–related dacryocystitis
Immunoglobulin G4 (IgG4)–related dacryocystitis is a rare condition characterized by elevated serum IgG4 levels and IgG4-positive lymphoplasmacytic infiltration in the lacrimal sac.1 In the periocular region, IgG4-positive lymphoplasmacyte infiltration commonly occurs in the lacrimal gland, extraocular muscles, orbital soft tissues, and the infraorbital nerve.1 Clinicopathologic characteristics of IgG4-related dacryocystitis are not fully understood. Herein, we report the case of a patient with IgG4-related dacryocystitis.Treatment of choice for patients with EGFR mutation–positive non-small cell lung carcinoma presenting with choroidal metastases: radiotherapy or TKIs?
It is not uncommon for patients with non-small cell lung cancer (NSCLC) to develop choroidal metastases (CM). External beam radiotherapy (EBRT) has traditionally been considered the treatment of choice for CM as it offers high response rates and quick relief of symptoms. However, new targeted treatments can offer an effective, alternative treatment strategy for patients harbouring specific genetic abnormalities.Hantavirus retinitis and concurrent hemorrhagic fever with renal syndrome
Hantavirus infection of the retina has not been reported in the literature. We describe the first case of presumed hantavirus retinitis and concurrent hemorrhagic fever with renal syndrome (HFRS), which presented with typical symptoms of HFRS and subsequent vision loss because of posterior necrotizing retinitis.Corneal etching in femtosecond laser-assisted cataract surgery
Femtosecond laser technology can be used in cataract surgery to perform the capsulotomy, lens fragmentation, and corneal incisions. Compared to traditional cataract surgery, femtosecond laser-assisted cataract surgery (FLACS) can offer potential advantages such as enhanced intraocular lens centration1,2 and decreased phacoemulsification power.3,4 However, the potential for increased utility and safety over conventional techniques has not been definitively established.5,6 Though FLACS is generally a safe procedure, complications can include suction loss, anterior capsule tears or tags, posterior capsule rupture, dropped nuclei, or vitreous loss.Eyelid fungal infections are rare, and often associated with predisposing factors. We present the case of a child with an ulcerated lesion of fungal etiology on the eyelid.
An 8-year-old male presented with right periocular swelling, redness, pain, watering, and sloughing of skin over the lower eyelid of 3 weeks’ duration. As per his parents, the child had a history of probing for right congenital nasolacrimal duct obstruction conducted elsewhere, immediately after which the signs and symptoms occurred. However, no further details were available regarding the procedure. He had received intravenous cephalosporins elsewhere for the lesion but had showed no improvement.Synergistic innervational downshoot: a distinct vertical dysinnervation pattern and its unique management
Synergistic divergence (SD), first described by Barany et al.1 and later studied electromyographically by Wilcox et al.,2 is a rare but well-established horizontal congenital cranial dysinnervation disorder (CCDD).3–12 In addition to unusual synergism affecting horizontal muscles, there are many reports in the literature regarding anomalous vertical synergism.7,10–12 In 1996, Weinacht et al. described synergistic innervations between lateral rectus (LR) and ipsilateral vertical acting muscles under vertical Duane’s retraction syndrome.Microcystic macular edema in a case of tobacco–alcohol optic neuropathy
Microcystic macula edema (MME) is characterized by hyporeflective spaces limited to the inner nuclear layer of the parafoveal region.1 It is distinguished by foveal sparing. MME is believed to be caused by retrograde Müller cell degeneration, although trans-synaptic degeneration and vitreous traction may be involved.2,3 First described in multiple sclerosis, MME is seen in various inflammatory and noninflammatory optic neuropathies as well as other retinal pathologies (Table 1).4,5 Diagnosis is made on the basis of optical coherence tomography (OCT) demonstrating characteristic changes in the parafoveal region.Atypical transient subretinal exudation following photodynamic therapy for chronic central serous retinopathy: a case report
Central serous retinopathy (CSR) is a common ocular disease of young and middle-aged adults that affects men more than women. It manifests as the accumulation of central subretinal fluid (SRF) with or without the presence of retinal pigment epithelial detachment (RPED) and is often associated with reduced visual acuity (VA) or metamorphopsia.1 Most cases of idiopathic CSR resolve spontaneously; however, chronic cases in which the SRF persists longer than 3 months may require treatment.2 In cases of CSR with a focal leak, retinal laser photocoagulation may be an appropriate treatment option to accelerate the resorption of SRF and improve VA.
