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, Ltd.Purpose To report a case of refractory open angle glaucoma (POAG) in an osteogenesis imperfecta patient who was successfully treated with combination microinvasive glaucoma surgery combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion. Observation A 57-year-old woman with a history of osteoporosis, breast cancer, osteogenesis imperfecta, with uncontrolled POAG in right more than left. Anterior segment examination revealed thin blue sclera, the optic nerve examination revealed glaucomatous cupping with cup to disc ration of 0.9 in right and 0.7 in left. Her IOP on six (6) medications was 26 mmHg in the right eye. After discussion of the risks and benefits, she agreed to undergo combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion surgery to lower her intraocular pressure. Her IOP at 6 months follow up was 13 in the right eye and a decrease number of medications from six (6) to three. Conclusion and importance Patients with OI have homogenously thinner sclera and conjunctiva which pose a challenge to traditional subconjunctival surgical methods. Combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion surgery are bleb sparing operations that enhances aqueous outflow to the aqueous veins and supraciliary space to lower intraocular pressure. © 2020 The Author(s).Purpose To report a rare case of a unilateral choroidal mast cell infiltration in a patient with aggressive systemic mastocytosis (ASM). Observations The patient is a man in his fifties with a diagnosis of ASM. He developed visual complaints in the right eye associated with an area of subretinal fluid on fundus examination. Visual acuity at presentation was 20/150 in the right eye and 20/25 in the left eye. After ophthalmic and radiologic imaging workup, the patient was diagnosed with presumed choroidal mast cell infiltrate. The index of suspicion was high due to the prior ASM diagnosis. External beam radiation and intravitreal injection treatments were offered but the patient declined. The patient was switched from interferon to a new targeted systemic therapy for ASM, midostaurin. Despite some mixed, temporary response in systemic symptoms/signs of ASM at four months, the choroidal lesion and subretinal fluid were stable with visual acuity at 20/125. Conclusion and importance Mast cell choroidal infiltration in ASM should be considered as part of the differential with acute/subacute vision changes. Diagnosis requires exclusion of other possibilities with ocular imaging and in this case, monitoring for development of other malignancies in which there were none. Midostaurin’s ocular response was not on par with systemic response. Additional localized ocular therapies may be required. © 2020 The Author(s).Purpose We evaluated a choroidal macrovessel using optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA). Observations A 79-year-old female presented with blurred vision in both eyes and metamorphopsia of the left eye. Mild cataract was noted in both eyes. Color fundus photography of the left eye revealed a red-orange tortuous vessel originating from the fovea and running in an inferior-temporal direction. Enhanced-depth imaging OCT revealed a large caliber choroidal vascular shadow and ambiguous line of the photoreceptor and retinal pigment epithelium layers. OCTA demonstrated a serpentine-shaped choroidal vessel. This anomalous vessel was seen by early phase ICGA as a rapidly perfused vessel connected to a vortex vein. We diagnosed this anomalous vessel as a choroidal macrovessel. We identified that cataract induced blurred vision in both eyes and choroidal macrovessel induced metamorphopsia in left eye. She was received cataract surgery for both eyes. The degree of metamorphopsia and the choroidal macrovessel of the left eye remains unchanged after a year of follow-up. Conclusions and importance OCTA and ICGA are useful techniques to diagnose choroidal macrovessels. © 2020 The Authors.Purpose To report two cases of LASIK flap stability after severe ocular trauma.Observations Two patients suffered open globe injuries several years after undergoing uneventful LASIK with femtosecond laser corneal flap. Both underwent primary ruptured globe repair, during which no LASIK flap dislocation was identified. Histopathologic examination of one of the cornea specimens confirmed an intact LASIK flap. Conclusion and Importance In these cases, the femtosecond LASIK flap remained in place despite significant injury to the cornea. The presence of a femtosecond LASIK flap did not complicate surgical management of the injury, and did not contribute to the patient’s loss of BCVA.Purpose To report a case of fungal keratitis after corneal collagen crosslinking (CXL) surgery. Observations We report a case of fungal keratitis after CXL for post-refractive surgery ectasia. The patient presented 12 days after surgery with a corneal ulcer that was culture positive for Alternaria species of fungus. She subsequently developed a bacterial superinfection. The keratitis resolved with medical therapy, although the patient required a penetrating keratoplasty (PKP) due to central corneal scarring. Selleck U0126 Conclusions and Importance To our knowledge, this is the first case of fungal keratitis as a complication after CXL in the United States and the first case of Alternaria infection after CXL using the Dresden protocol. Infectious keratitis is a rare but serious complication of CXL, and we suggest continued innovation of operative techniques that may reduce the risk of infectious keratitis. © 2020 The Authors.Purpose To describe features characteristic of vitreous hemorrhage in patients with Terson syndrome observed through a microsurgical scope. Methods Between May 2015 and February 2019, 12 eyes of 10 patients with vitreous hemorrhage occurring after subarachnoid hemorrhage (SAH) underwent pars plana vitrectomy. Results During vitreous surgery, we found 10 of 12 eyes did not have posterior vitreous detachment (PVD). Furthermore, we observed in 9 of the 10 eyes without PVD (90.0%) that there was no hemorrhage in the posterior vitreous cavity at the posterior pole while we removed vitreous hemorrhage. We confirmed that this clean space could be the posterior precortical vitreous pocket (PPVP). Conclusion and importance Terson syndrome may have no hemorrhage in the PPVP regardless of the presence of severe vitreous hemorrhage. The cases presented in our study may suggest one of the mechanisms of Terson syndrome. © 2020 The Authors.