Photo Essays
YAG laser membranotomy for sub-inner limiting membrane hemorrhage due to ruptured macroaneurysm
A 65-year-old hypertensive woman was monitored owing to a macular macroaneurysm in the right eye (OR). She reported partial sudden vision loss in the preceding 2 days. Her corrected visual acuity was <0.05 in the OR and 1.0 in the left eye. Slit-lamp biomicroscopy and fundoscopic examination of the OR revealed initial cataract and preretinal hemorrhage over the macular region, macroaneurysm near the upper temporal arch, and local hard exudates (Fig. 1A). The diagnostic hypothesis was the ruptured macular macroaneurysm, with optical coherence tomography indicating sub-inner limiting membrane (ILM) hemorrhage (Fig.Blossoming vision: unusual donor tissue configuration in a jaundiced cornea tissue
A patient underwent a left phacoemulsification, intra-ocular lens (IOL) insertion, and Descemet membrane endothelial keratoplasty (DMEK). The donor tissue had excellent endothelial cell count and was compliant with regulatory screening protocols. The donor patient died from hepatic failure and was noted to be severely jaundiced, consistent with the diffuse yellow tinge found in the corneal stroma. A standard 8 mm DMEK peeling was initiated uneventfully, with the tissue being more robust and stiffer than normal.A 360-degree peripapillary hyper-reflective ovoid mass-like structure (PHOMS)
A 31-year-old woman developed papilledema from idiopathic intracranial hypertension. Enhanced-depth imaging optical coherence tomography (EDI-OCT) excluded optic disc drusen (ODD) but was notable for a peripapillary hyper-reflective ovoid mass-like structure (PHOMS), contiguous 360 degrees around the optic disc, forming a 3-dimensional torus (i.e., donut) (Fig.) Radial sections through the right optic nerve head are shown in the left column; a PHOMS is seen at each of the twelve clock-hours of the peripapillary region in the middle column and duplicated and shaded yellow in the right column.Roth spots as debut of multiple myeloma
A previously healthy 42-year-old man complained of sudden visual loss in the left eye 1 day before the consultation. Funduscopic examination showed the right eye with dilatation and tortuosity of the veins, multiple Roth spots, flame-shaped and dot-blot intraretinal hemorrhages. Optic nerve and foveola showed no alterations (Fig. 1.1). The left eye showed similar characteristics but with more abundant and confluent hemorrhages. A preretinal hemorrhage was present on the macula, which explains the sudden loss of vision (Fig.Lid abscess associated with personal protective eyewear in a COVID-19 medical unit
A 23-year-old nurse working in a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ward presented with a 1-week history of left upper brow and eyelid swelling and discharge from the upper brow. She had manicured her eyebrows with tweezers approximately 1 month before, but denied other trauma, sinus symptoms, or prior use of an eyebrow ring. She was clinically diagnosed with an eyelid abscess and started on trimethoprim/sulfamethoxazole and amoxicillin/clavulanic acid. Computed tomography imaging was not performed because the physical examination demonstrated only superficial findings.Massive orbital teratoma
This 41-year-old woman had a left eye mass that slowly enlarged from a grain-sized lesion of the eyelid at birth to the present fist-sized mass in the orbit (Fig. 1A). The left eye was blind since birth. She had no prior ophthalmic treatment. On examination the left eye had no light perception, and no recognizable globe structure was seen in the interpalpebral area or on magnetic resonance imaging (Fig. 1B). At surgery, exenteration was performed for the 8 cm × 6 cm lesion, which weighed 300 g (Fig.Retinal involvement in severe noncerebral malaria
A 20-year-old male patient complained of reduced vision after being admitted to a hospital in Bangladesh with 5 days of fever associated with convulsions and anemia (hematocrit 11%). Uncorrected visual acuity was 20/80 OD and 20/64 OS. Bedside dilated ophthalmic examination, registered using a portable fundus imaging device (Kowa Genesis-D), revealed white-centred hemorrhages in 4 quadrants, diffuse disc pallor, and preretinal macular hemorrhages in both eyes. The patient was diagnosed with malarial retinopathy, an ocular manifestation of Plasmodium falciparum infection.Bilateral cilioretinal artery occlusions in giant cell arteritis
An 82-year-old man presented with painless sequential vision loss of his right eye (OD). Ten days earlier, he presented to another hospital for left eye (OS) vision loss. His vision was Light perception only OD and No light perception OS. Fundoscopy demonstrated bilateral cilioretinal artery occlusions with chalky white optic disc swelling OS (Fig. A, B). Although he denied symptoms of giant cell arteritis (GCA) and had normal inflammatory markers, his clinical examination was suspicious for GCA, which was confirmed by temporal artery biopsy.Reticular keratic precipitates
A 56-year-old woman with Treponema pallidum haemagglutination test and venereal disease research laboratory–positive syphilitic panuveitis presented with a vision of counting fingers close to face and an intraocular pressure of 36 mm Hg in the left eye. Slit-lamp examination of the left cornea was clear with fine, arborizing pigment in a reticular pattern on the corneal endothelium with a few surrounding old keratic precipitates (KPs) in Arlt's triangle (see Fig. 1).Asymptomatic familial bilateral severe retinal vascular tortuosity
A 15-year-old girl and her 40-year-old mother presented with abnormal fundi, with significant tortuosity of the retinal vessels in both eyes. They were asymptomatic and had no other abnormal findings. Furthermore, systemic complications were not confirmed. Familial retinal arteriolar tortuosity (FRAT) is a rare hereditary disease that is very similar to that observed in our patients. The condition of our patients differs from FRAT in that it was accompanied by severe venous tortuosity. No similar cases have been previously reported.Ophthalmic artery occlusion after dermal fillers injection
A young female patient developed left-sided headache, periorbital pain, and acute loss of vision within a few minutes after receiving left-sided nasal hyaluronic acid dermal fillers. Visual acuity of her left eye was no light perception, with a grade 4 relative afferent pupillary defect. Posterior segment examination revealed marked edema of the posterior pole with absence of cherry-red spot, suggestive of an iatrogenic ophthalmic artery occlusion. Multiple emboli (A, arrows) were seen within the central retina artery and branching arterioles.Fibrin membrane pupillary block after cataract surgery in a patient with diabetes
A 52-year-old man with diabetes presented with a flat anterior chamber in the right eye on the 30th postoperative day after manual small-incision cataract surgery. His best-corrected visual acuity was 20/40. Slit-lamp examination (Fig. 1) showed clear cornea with a flat anterior chamber. Posterior chamber intraocular lens was in the bag and in position posteriorly. Fibrin membrane was seen attached to the pupillary margin, causing complete pupillary block. The finding was confirmed with an ultrasound biomicroscopy (Fig.Medial orbital dermoid cyst
This healthy 35-year-old woman presented with a 2-year history of painless, progressive proptosis in the right eye. There was no lid retraction or dysthyroidism. Her acuity, pupils, confrontation field, motility, and ocular examination findings were normal. Orbital computed tomography showed a large well-circumscribed retrobulbar cyst with intraluminal contents near the ethmoidal-maxillary suture line. The cyst was drained through a transcaruncular incision. Keratin contents and hair were removed, and the inner lining was cauterized with bipolar.Bilateral curvilinear chorioretinal streaks
A 46-year-old Caucasian woman presented with distorted vision in both eyes. Visual acuity was 20/25 OD and 20/50 OS. Fundus examination showed bilateral concentric chorioretinal streaks (Fig. A, B), which were hyperfluorescent on fluorescein angiography (Fig. C, D). The scars had formed in a curvilinear pattern called Schlaegel lines associated with multifocal choroiditis and panuveitis (MCP). She developed choroidal neovascularization (CNV) and was treated with photodynamic therapy. Her visual distortions resolved and vision improved to 20/20 OD and 20/25 OS.Scleral needling technique
Scleral needling technique is a novel, safe, and simple alternative to suturing for effectively securing leaking sclerotomies in microincision vitrectomy surgery. After air–fluid exchange and trocar cannula removal (A), air bubbles are visualized at the site of wound leakage by dripping balanced salt solution over the open sclerotomy (B). A closed 30-gauge needle syringe is perpendicularly inserted full thickness through the sclera adjacent to the scleral opening and removed immediately (C). The wound is then pressed with a blunt cannula.Labyrinth opacification of intraocular lens
The image corresponds to an opacified intraocular lens composed of hydrophilic acrylic material, causing important impairment of visual function in the patient. There are many reports of opacified lens composed of different materials, but it seems to affect hydrophilic acrylic lenses in most cases.Imaging the inferior oblique using optical coherence tomography
An 81-year-old woman presented for a routine follow-up of her dry age-related macular degeneration (Fig. 1A). She had normal eye balance and no history of strabismus. Optical coherence tomography (OCT) radial scan, using Triton OCT (Topcon, Tokyo, Japan), showed a round area behind the sclera, slightly inferior to the macula in her right eye (Fig. 1B, 1C). The vertical cuts (Fig. 1D) showed its fascicular organization. The morphology and position suggest that this structure was the inferior oblique muscle.Severe vernal keratoconjunctivitis complicated by anaesthetic abuse
A 22-year-old man with a history of atopy and vernal keratoconjunctivitis presented for a nonhealing complete corneal epithelial defect of the right eye (Fig. A, B). Biomicroscopy was notable for giant papillae on everted lids (Fig. C). Infectious etiologies were ruled out. The patient disclosed a 2-week history of daily topical anaesthetics use. A diagnosis of severe vernal keratoconjunctivitis complicated by anaesthetic abuse was made. Despite outpatient treatment, he presented 1 month later with a dense sterile stromal infiltrate (Fig.Insidious transpalpebral fistula secondary to scleral buckle
A 78-year old man was referred to the emergency eye clinic with a 3-month history of pain, discharge, and redness from the right upper eyelid. He had attended the ophthalmic emergency department 7 times in the past year, having been diagnosed with recurrent infective conjunctivitis. He had a history of right retinal detachment surgery that was repaired with scleral buckle and cryotherapy over 10 years ago with subsequent vitrectomy and silicone oil insertion. Of note, the scleral buckle was left in situ at the time of his second operation.Floriform cataract
A 6-year-old girl presented with decreased vision in the right eye detected during a school-screening program. The best-corrected visual acuity was 20/120 in the right eye and 20/20 in the left eye. On retro-illumination, there were petal-shaped opacities arranged in a flower-like pattern. Prominent embryonic suture lines separating the petals completed the “floriform” pattern. A peripheral circular zone of lenticular haze with a few spokes or “riders” was also present. She was diagnosed as having a floriform cataract, a rare subtype of congenital cataract with an autosomal dominant inheritance.Capsular delamination of the crystalline lens and iridoschisis
Capsular delamination or true exfoliation of the lens is a relatively rare disorder and describes a condition in which there is a thin, fluttering capsular membrane on the anterior surface of the lens. Slit-lamp microscopy of an 81-year-old man shows localized superior iridoschisis and dense cataract with a circular scrolled leaf of the anterior capsule floating in the anterior chamber (Fig. 1A). The intraocular pressure was 23 mm Hg. Anterior segment image of swept-source optical coherence tomography clearly shows the splitting of the superficial lamella with an attached floating flap waving in the anterior chamber (Fig.Arterioarterial collaterals due to a prepapillary vascular loop
A 57-year-old male with floaters in the left eye for 3 weeks presented to our institute. He reported recurrent vitreous hemorrhages in this eye since childhood. The right fundus was unremarkable. The left fundus demonstrated a prepapillary vascular loop (PVL) and retinal vascular anastomoses crossing the temporal raphe (Fig. 1). Ultra-wide-field fluorescein angiography disclosed arterial filling of the PVL and peripheral arterioarterial collaterals without leakage.Berger's space hemorrhage missing the visual axis
A 30 year-old female was hit in the left eye with a toy, resulting in a hyphema. Blood was noticed to be trapped in Berger's space (potential space between the lens and vitreous) as the hyphema cleared (Fig. 1). Surprisingly, the visual axis was spared despite the boat-shaped hemorrhages seen on retroillumination, and vision had improved from 20/150 to 20/25. No retinal tears nor detachments were found. Berger's space blood is considered to be a type of vitreous hemorrhage. With a clear traumatic cause and symptom improvement, this patient was observed.Congenital sessile angioma
A 14-year-old Hispanic girl recently emigrated from Honduras presented for right eye redness; an incidental left eye conjunctival vascular lesion was noted. Neither the patient nor her parents had noticed the left eye lesion previously. Our diagnosis is a congenital sessile angioma, measuring 7.2 mm × 5 mm (W × H). There are no signs of other systemic or syndromic processes occurring, and the patient is neurologically intact. The right eye was noted to have meibomian gland dysfunction.
