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The New England Eye
Center Residents have prepared the following
cases from weekly Grand Rounds for your
education:
All newer cases can be found at TUSK (the Tufts University Sciences Knowledgebase).
June 2, 2005
Cristiana
Pieroni,
MD
Michael
B. Raizman,
MD
Shazia
Ahmed, MD
May 26, 2005
Supriya
Goyal, MD
Izumi
Yamamoto,
MD
Mitchell
Strominger,
MD
May 19, 2005
My
Hanh T. Nguyen, MD – Uveitis-Hyphema-Glaucoma
Syndrome Abstract: This
is a case of an 80-year-old female
who was referred from an outside
institution for recurrent episodes
of blurry vision and hyphema in her
right eye. Each episode was associated
with high intraocular pressures.
Past medical history significant
for bilateral cataract extraction
and lens implantation 22 years ago.
On examination, her BCVA was 20/20
OU and pressures were 20 OU. In the
right eye, she had 2+ cells (mostly
rbc?s), a patent PI, a sulcus PCIOL
in the vertical position, an intact
posterior capsule, and an area of
blood staining between optic and
capsule. In the left eye, there
was no cell or flare, two patent
PI?s, an ACIOL in the vertical position,
and an open posterior capsule.
There was no rubeosis, transillumination
defects OU,
pseudophakodonesis or pseudoexfoliation
OU. Gonioscopy revealed
open structures 360 degrees OU with
no PAS. A UBM revealed the
inferior haptic of the right eye sulcus
IOL pressing on the
ciliary body / iris junction. The superior
haptic was ok. The
patient was diagnosed with Uveitis-glaucoma-hyphema
(UGH) syndrome
OD. UGH Syndrome is caused
by mechanical excoriation of uveal
tissue by the IOL optic or haptic.
It often occurs weeks to months after
the cataract surgery, however, there
are reports in the literature
of UGH presenting 1 to 8 years postoperatively.
Our patient
presented with UGH 22 years s/p her
cataract surgery. Clinical
presentation, differential diagnosis,
pathogenesis, and treatment
of UGH Syndrome are discussed. Key
Words: UGH, uveitis, recurrent
hyphema, glaucoma, intraocular lens,
ACIOL, sulcus PCIOL, ultrasound biomicroscopy
(UBM), high IOP
Rhonda
B. Rosenberg, MD
Victor
Chin, MD
May 12, 2005
Stefanie
Schuman, MD
Jane
Loman, MD
Johanna
Choremis, MD
May 5, 2005
Cristiana
Pieroni, MD – Peripheral
ulcerative keratitis associated with
rheumaotid arthritis Abstract: 68
year-old woman with a history of severe
rheumatoid
arthritis presented with peripheral
ulcerative keratitis. She responded
well to treatment with lubrication,
conjunctival resection, oral
steroids and increased methotrexate.
However, the manifestation of
rheumatoid associated PUK reflects
a more aggressive systemic disease
with higher morbidity and mortality.
Key Words: peripheral ulcerative
keratitis, corneal melt, rheumatoid
arthritis.
Zinaria
Y. Williams, MD
Nancy
L. Flattem, MD – Best's Disease
Abstract: A six year old girl was referred
for retinal examination. She denied
any change in her vision, and her mother
noted no noticeable visual
difficluty. Past ocular and medical
histories were unremarkable.
Family history was negative for any
known eye disease. Clinical exam
revealed 20/40 vision bilaterally and
a normal anterior segment. Fundus
examination showed bilateral discrete
yolk-like macular lesions. OCT
displayed RPE thickening bilaterally.
ERG was normal,and the EOG was
unreliable. The clinical presentation
was classic for Best's
vitelliform macular dystrophy. The
mother and older brother had normal
appearing fundi. Upon further question,
the mother recalled a maternal
cousin that had an unknown eye disease.
Key Words: Best's disease, vitelliform
macular dystrophy, Arden ration,
electrooculogram, bestrophin, VMD2.
April 28, 2005
Dal
Chun, MD – Punctate Inner Choroidopathy Abstract: A
44 year-old mildly myopic white woman
presented complaining of recurrent
blurring of her vision in her right
eye over the course of 3
weeks. She also reported occasional
photopsia, but no floaters. Her
vision was 20/15 in each eye, but
she had a paracentral scotoma on
visual field testing. Anterior segment
examination was normal. Dilated
exam of the right eye revealed a
few small yellow lesions at the level
of the RPE in the parafoveal zone.
There was no subretinal fluid, hemorrhage,
or neovascular membranes. These lesions
were hyperfluorescent on fluorescein
angiography with minimal leakage
late. The multifocal ERG recordings
for the right eye were depressed
in the area of the retina corresponding
to the scotoma on visual field testing.
The clinical findings and testing
suggested a diagnosis of punctate
inner choroidopathy which is more
commonly found in myopic women with
no prior viral prodrome or any signs
of anterior uveitis of vitritis.
Key Words: White dot syndrome,
punctate inner choroidopathy, myopic
female.
Zinaria
Y. Williams,
MD – Bilateral
branch retinal artery occlusions
and stroke due to multiple embolic
events Abstract: This is
a 55 year old woman with recurrent
bilateral branch retinal artery occlusions
and stroke with amnesia. She was
diagnosed with presumed paradoxical
embolism through a patent foramen
ovale. She is was treated with Coumadin
and aspirin. Key Words: branch retinal
artery occlusion, patent foramen
ovale, paradoxical embolism, stroke.
April 7, 2005
My
Hanh T. Nguyen, MD – Hansen's
Disease Abstract: This
is a case of a 38 year old male from
Cape Verde Islands who presented with
bilateral irritated eyes. On evaluation,
he was found to have lagophthalmos
with exposure keratopathy, low grade,
chronic, anterior bilateral uveitis,
peripheral neuropathy, and seven hypopigmented,
hypoanesthetic skin lesions. The patient
was diagnosed with leprosy or Hansen's
Disease.
Hansen's Disease is a chronic, granulomatous
disease affecting patients of all
ages and both genders, however, predominantly
those between ages 10 - 14 and 35
- 44. The disease is caused by Mycobacterium
leprae, which has an affinity for
skin, peripheral nerves, mucous membranes,
and anterior segments of eyes. Clinical
presentation, differential diagnosis,
pathogenesis, and treatment of Hansen's
disease are discussed. Keywords: tuberculoid,
lepromatous, leprosy, lagophthalmos,
iris pearls, chronic uveitis, ENL,
mycobacterium leprae, peripheral neuropathy.
Nancy
L. Flattem, MD– CMV Optic Neuropathy Abstract: A 29-year-old man diagnosed with
HIV one month prior presents with
poor vision OD. Exam reveals no light
perception and optic neuropathy OD.
Intravenous ganciclovir was initiated
and changed to oral ganciclovir for
prophylaxis of the remaining eye.
Two months later the patient pesented
with retinopathy of anemia in his
remaining good eye. The patient responded
well to blood transfusions and cessation
of ganciclovir. The patient has remained
free of CMV retinitis or other retinal
pathology in his remaining good eye
for eight years. Key Words: HIV,
AIDS, cytomegalovirus, retinitis, optic
neuropathy, retinopathy of anemia,
ganciclovir .
Shazia
Ahmed, MD
March 31, 2005
Jyotsom
Ganatra,
MD–
Superior Limbic Keratoconjunctivitis Abstract: 68
yo man with a history of Graves Ophthalmopathy
presented with a chief complaint of
chronic eye pain in both eyes. He had
a history of orbital radiation, orbital
decompression, and strabismus surgery.
Rose Bengal staining revealed filamentary
keratitis secondary to superior limbic
keratoconjunctivitis. Treatment with
Predforte eye drops was initiated and
conjunctival resection was recommended. Key
Words: Superior Limbic
Keratoconjunctivitis, Filamentary Keratitis,
Graves Ophthalmopathy.
Dal
Chun, MD – Retroiridal
Mass Abstract: A 71 year-old
white male was referred to our retina
service for evaluation of an incidental
mass found during routine cataract
surgery of the right eye 1 week prior.
The patient was asymptomatic and denied
any history of ocular trauma or surgery.
He was found to have a
pigmented mass abutting an otherwise
normal-appearing posterior capsule
at the 3:30 position of the right eye.
No iris architectural changes or
scleral transillumination was noted.
On ultrasound biomicroscopy, the
mass appeared as a ribbon-shaped linear
structure extending from the
ciliary body. On dilated fundoscopy,
a persistent hyaloid artery was
noted to extend anteriorly toward the
ciliary body mass. Based upon the history,
clinical findings, and ultrasound biomicroscopic
appearance of the lesion, it was determined
that the patient had a very
mild presentation of persistence of
fetal vasculature. He will be
reexamined in 6 months for any changes
to the mass. Keywords: Persistence
of fetal vasculature, persistent hyperplastic
primary vitreous, ciliary body melanoma,
double linear echo.
Rhonda
B. Rosenberg,
MD – An Unusual Case of Unilateral
Open Angle Glaucoma Abstract: A
fifty four year old woman with pevious
ocular history significant for cataract
extraction with Posterior Chamber
Intraocular Lens Implant OU, pars
plana vitrectomy OU for vitreous
opacites was referred for
the managment of unilateral open ange
glaucoma. Patient's past medical
history was significant for CHF, HTN,
Liver Transplant, Familial
Amyloidosis. Patient had unilateral
elevated intraocular pressure with
visual field loss on maximal medical
therapy. Open angle glaucoma believed
to be due to depostion amyloid material
in angle. Patient's only other
ocular manifestation of the amyloidosis
was vitreous opacities. Due to
conjunctival scarring from previous
surgeries patient underwent a tube
shunt
instead of a trabeculectomy. Patient
requires close observation of the
contralateral eye for the developement
of secondary open angle glaucoma. Keywords: Secondary
Open Angle Glaucoma, Familial Amyloidosis.
March 24, 2005
Nancy
L. Flattem,
MD – Squamous cell carcinoma
of the lids and orbit Abstract: An
82 year old presented with a large
right tumor involving the right upper
and lower lids. On CT scanning, the
lesion invaded the right medial rectus
muscle, the globe, and the zygomatic
and temporal regions including the
temporalis muscle. A second primary
tumor was also identified in the hypopharynx.
Biopsy revealed well differentiang
squamous cell carcinoma. Exenteration
was considered for treatment, but due
to the extent of the lesion and the
patient's general medical health, observation
was chosen. The patient was placed
in hospice care. The patient died within
3 months. Keywords: squamous
cell carcinoma, eyelid lesion, basal
cell carcinoma, sebaceous cell carcinoma,
eyelid tumors, exenteration.
Izumi
Yamamoto, MD – Lacrimal
gland amyloidosis Abstract: 55 yo
F with 2 month history of upper eye
lid mass presented with increasing
pain. Presumed diagnosis was chalazion,
however Initial
I&D showed no drainage. CT of the
orbit showed sharply defined low
attenuating mass in lacrimal fossa.
Excisional biopsy was performed
and showed
amyloidosis of the lacrimal gland,
which is a rare condition with
handful reported cases in the past.
It is most likely primary
amyloidosis, however patient needs
evaluation to rule out secondary
causes of amyloidosis.
Key words: primary amyloidosis,
lacrimal gland mass, lid mass,
chalazion, lacrimal gland amyloidosis
Victor
Chin, MD
March 17, 2005
Stefanie Schuman,
MD – Basal cell carcinoma (BCC) Abstract: 44
year old woman complains of left lower
lid lesion for 2 months, now notices
she has lost lashes in that area. No
vision change,
no eye pain.
Key words: Basal cell carcinoma,
Hughes procedure, MOHS micrographic
surgery
David
Rhee, MD
March 10, 2005
My Hanh T. Nguyen, MD – Bilateral
facial palsy with Sjogren's syndrome Abstract: This
is a case of a 50 year old female who
presented with sudden onset ofbilateral
facial palsy. She also had xerophthalmia,
xerostomia, Raynaud's phenomenon, arthralgia,
myalgia, and fatigue. Careful examination
was unremarkable except moderate exposure
keratopathy OU. Systemic workup was
significant for positive anti- Ro /
SS-A, rheumatoid factor, and ANA in
a speckled pattern. Lower lip biopsy
revealed lymphocytic infiltration of
salivary glands. The patient was diagnosed
with Sjogren's syndrome withsimultaneous
bilateral seventh cranial neuropathy.
In Sjogren's syndrome, there are many
possible extraglandularmanifestations.The
occurrence of an associated neuropathy
with Sjogren's syndrome is not uncommon.
The peripheral nervous system is
more typically involved, particularly
the distal sensory nerves. Sjogren's
syndrome has been described to cause
neuropathy of all the cranial nerves
except VIII (vestibular), XI (spinal
accessory), and XII (hypoglossal).
The most common involvement is with
the trigeminal nerve. A thorough search
of the literature revealed only fourteen
cases of facial nerve involvement associated
with Sjogren's syndrome. Only two described
bilateral facial paresis. We report
the third known case of bilateral facial
palsy associated with Sjogren's syndrome. Key
Words: Sjogren's syndrome, facial
palsy, cranial nerve paresis, Lyme
disease, sarcoidosis, sicca complex,
keratoconjunctivitis sicca, Bell's
palsy, exposure keratopathy, Shirmer's.
March 3, 2005
Shazia
Ahmed, MD – North Carolina
Macular Dystrophy Abstract: North
Carolina macular dystrophy was originally
described by
Lefler in a large pedigree of patients
thought to descend from 3 Irish
brothers who settled in the North
Carolina mountains in the 1830's.
Despite its name, this disease is
not specific to people from North
Carolina, but has been documented
in unrelated families from Germany,
France, Britain, and Belize. It is
an autosomal dominant disease that
has been mapped to chromosome 6q16.
Affected patients may be completely
asymptomatic or complain of poor
visual acuity.
The disease process normally starts
in infancy and stabilizes by the
teenage years. This macular dystrophy
has been known to have high
phenotypic variability. A grading
system classifying the disease is
currently in use. Grade I patients
have drusen concentrated in the
fovea. Grade II disease has confluent
elevated subretinal material.
Grade III disease has chorioretinal
atrophy with hypertrophic fibrous
tissue and pigmentation at edge of
lesion. In addition, regardless of
staging patients may show evidence
of peripheral drusen. Complications
such as choroidal neovascularization
has been known to occur. Diagnosis
of this disease relies on clinical
exam, an extenive family history,
and
genetic testing. Currently there
is no known treatment for North
Carolina Macular Dystrophy. Key
words: North Carolina, macular
dystrophy, inherited dystrophy.
Victor
Chin, MD – Papilledema with a subacute
presentation. Abstract: A
13 year old boy presents to NEEC with
papilledema secondary to a large chronic
subdural hemorrhage caused by a left
temporal fossa arachnoid cyst. The
patient underwent surgery to evacuate
the hematoma and arachnoid fluid collection
with resolution of his symptoms. Trauma
induced rupture of bridging veins overlying
the cyst is the postulated mechanism
of his decompensation. Key Words: subarachnoid
cyst; papilledema; subarachnoid hemorrhage
.
February 24, 2005
Jane Loman, MD –
Third Nerve Palsy in 90 year old woman. Abstract:
90 year old woman who presented with
4 month history of left
frontal-temporal pain, binocular
vertical diplopia, and mild ptosis.
Ophthalmic exam revealed a partial
third nerve palsy with symmetric
pupils
but slightly sluggish OS. MRI/MRA
revealed a 1.5cm left cavernous sinus
aneurysm below the dural ring. Embolization
was unsuccessful.
Parasympathetic and sympathetic nerve
fibers to the pupil were thought
to be involved. Key Words: Third
Nerve Palsy, Cavernous sinus aneurysm,
internal carotid artery, pupil sparing.
My
Hanh T. Nguyen, MD – Candida Endophthalmitis Abstract: This
is a case of a 55 year old male with
HIV, DM, hepatitis C, and IVDA who
presented with progressively worsening
blurry vision, pain, and black spots
in his left eye. On examination,
he had visual acuities of 20/20 OD
and
20/60 OS, panuveitis OS, choroidal
infiltrate OD, and string of pearls
OS.
The patient was diagnosed with Candida
endophthalmitis OU, OS > OD.
n Candida endophthalmitis
is the most common form of endogeneous
endophthalmitis. Risk factors include
history of invasive procedures,
immunosuppressive diseases and therapy,
and chronic immune compromising,
debilitating illnesses. Clinical
presentation, differential diagnosis,
pathogenesis, and treatment of Candida
endophthalmitis are discussed. Key
Words: Candida albicans, candidiasis,
endophthalmitis, endogeneous, string
of pearls, uveitis, antifungal, choroidal
infiltrate, vitreous opacities, Roth
spot.
Dal Chun, MD
February 17, 2005
Nancy
Flattem, M.D. – Pseudoexfoliation
Glaucoma. Abstract: A
72 year old woman complains of episodes
of blurry, graying vision bilaterally
for several months. Examination reveals
very high intraocular pressures bilaterally
and end stage pseudoexfoliation glaucoma.
Her pressures were significantly improved
with medical therapy. She will be closely
followed and will likely require additional
medications amd possibly laser surgery
and filtration surgery. Key Words: Pseudoexfoliation
glaucoma, beta blockers, prostaglandin
analogs, alpha-2 agonists, carbonic anhydrase
inhibitors, pharmacokinetics, pilocarpine,
mannitol, miochol, miostat.
Ioannis
P. Glavas, MD– Metastatic
eyelid mass from lung primary. Abstract: 70
yo asian male pt was referred to the
oculoplastics service for evaluation
of a rapidly growing painless eyelid
lesion associated with bleeding and
ectropion. The lesion first appeared
3 weeks prior to presentation. Excisional
biopsy was performed and histopathology
diagnosis was consistent with neuroendocrine
carcinoma of lung origin. Full body
CT scan revealed a 7mm right upper
lobe lung nodule, questional mediastinal
adenopathy, hepatic cyst and adrenal
masses. PET scan confirmed involvement
of lung, mediastinum, adrenals and
right clavicle. The eyelid lesion regrew
to the prebiopsy size in less than
3 weeks. The patient was referred to
oncology. He is currently undergoing
treatment with radio- and chemotherapy
for disseminated small cell carcinoma
of the lung. This case represents an
unusual eyelid metastasis as the first
presentation of primary small cell
carcinoma of the lung. Key words: Small
cell carcinoma, Lung metastasis, metastatic
eyelid tumor.
February 3, 2005
Rhonda
B. Rosenberg, M.D. -- Cystoid Macula
Edema Associated with Latanoprost
Use Abstract: An 84
year old white woman had decreased
vision in right eye 2 weeks after
being prescribed latanoprost for
choric open-angular glaucoma. Her
ocular history included OAG, S/P
ECCE OU with iris capture OD. Anterior
exam was stable OU. Biomicroscopic
fundus exam of the right eye revealed
prominent cystoid spaces in the
macula. Fluorescein angiography
was consstent with CME. Latanoprost
was stopped and patient was started
on Acular. Eight weeks later her
vision had recovered to her pre-CME
level. Key Words: Latanoprost,
Cystoid Macula Edema, Adverse Effects,
Aphakic, Pseudophakic
Izumi
Yamamoto, MD – Mooren's Ulcer
Abstract: 50 yo male was referred
to NEEC for sudden worsening of
previously
well healing peripheral ulcer,
which had overlying epithelial
defect and
significant crescent-shaped thinning
along the limbus. Corneal culture
and
extensive autoimmune work up were
both negative. Another area of
peripheral
epithelial defect developed adjacent
to the original ulcer along the
limbus. Mooren's ulcer was diagnosed
and successfully treated with topical
steroid without perforation. Key
words: Morren's ulcer, Peripheral
ulcerative keratitis, peripheral
corneal ulcer
James
Hung,
M.D.
January 27,
2005
Stefanie
Schuman, MD – Graves Ophthalmopathy
Visual field defect Abstract: Abstract:
Pseudotumor cerebri, or idiopathic
intracranial hypertension (IIH),
is a disorder associated with
increased intracranial pressure
of greater than 250 mm of water,
normal neuroradiologic imaging
apart from possible small ventricles,
and normal cerebrospinal fluid
analysis. Patients with IIH may
have pulsatile tinnitus, abducens
nerve palsies, and transient
obscuration of vision, all of
which tend to resolve with improvement
of IIH. In contrast, visual acuity
and visual field loss may persist
despite resolution of IIH. Treatment
of IIH has included weight loss,
diuretics, Digoxin, Corticosteroids,
and repeated lumbar puncture.
When vision threatened, optic
nerve sheath decompression and
lumboperitoneal or ventriculoperitoneal
shunts are considered. Key
Words: Idiopathic
Intracranial Hypertension (Pseudotumor
Cerebri)
David Y Rhee, MD -- Non Arteritic
Ischemic Optic Neuropathy. Abstract: A
71 year old Albanian male presented
with "a
new
white cloud" in his vision
in the left eye. On examination,
the
patient exhibited an afferent pupillary
defect, optic nerve swelling
and an inferior arcuate visual
field defect. This presentation
will
discuss the diagnosis of ischemic
optic neuropathy, cover the
differential diagnosis, including
non-arteritic and arteritic optic
neuropathy, and discuss the management
and proposed pathophysiology. Key
Words: ischemic optic neuropathy,
non-arteritic, giant cell
arteritis
January 20, 2005
Arlene Bagga, MD – A 38-year-old man
with an eyebrow lesion Abstract: A
38-year-old man was referred to the
Oculoplastics Service with a mass
on his eyebrow that he noticed growing
over the past 3
years. Biopsy revealed histology consistent with chondroid
syringoma, a
benign lesion with malignant potential. The entire
lesion was
subsequently removed with clean margins, and the patient
will be
followed. Key Words: Chondroid Syringoma, Benign
Lid Lesion, Pilomatrical
Differentiation
My
Hanh T. Nguyen, M.D. – Eales Disease Abstract: This
is a case of a 33 year old healthy
Asian male who presented with
bilateral blurry vision and photophobia. On examination,
he had visual
acuities of 20/200 OD and 20/400 OS, bilateral vitritis,
retinal vasculitis,
and macular edema. -A systemic workup was negative
for sarcoidosis,
toxoplasmosis, syphilis, hemoglobinopathies, leukemia,
and HIV. PPD was
positive, however chest CT and blood and urine cultures
for AFB were
negative. The patient was diagnosed with Eales Disease.
Eales Disease, a diagnosis of exclusion,
is a primary idiopathic
obliterative retinal vasculopathy, affecting predominantly
the peripheral
retina. There is a male predominance with peak age
of onset between 20 and
40. It is bilateral in 50-90% of cases. Clinical
presentation,
differential diagnosis, pathogenesis, and treatment
of Eales Disease are
discussed. Key Words: Eales, retinal diseases,
vasculitis, phlebitis, ischemia,
neovascularization, vitritis, uveitis,
mycobacterium tuberculosis, vitreous
hemorrhage
January 13, 2005
Jane
Loman, MD– Conjunctival
Lesion Abstract: Purpose:
To describe a non-severe case of the
uncommon conjunctival involvement of
lichen planus. Design: Case Report Methods:
Description and clinical course of a
patient presenting with a
conjunctival lesion. Results: The patients
clinical symptoms, medical history, and
conjunctival biopsy were all consistent
with a diagnosis of conjunctival
lichen planus. Her symptoms and lesion
were self-limited and no
treatment was necessary. Her symptoms
included conjunctivitis and sore
gums. Her biopsies of both gingiva and
conjunctiva were consistent with
lichen planus that included subepithelial
band of lymphocytes. Conclusion: There
is a wide range of variabiility and severity
in symptoms and signs of lichen planus.
Lichen planus is uncommonly found
on conjunctiva and this is a detailed
report of the self-limited form of
this disease on the conjunctiva. Patients
should be aware of the signs
and symptoms of lichen planus affecting
other parts of the body such as
the skin, oral mucosa, esophagus, and
genitalia. Key Words: Conjunctiva,
Lichen Planus, Conjunctivitis, Conjunctival
Lesion, Conjunctival keratinization,
T cell-mediated
Victor
Chin, MD Abstract: An
80 year old woman presents to the
New England Eye Center with acute
painless monocular vision loss. Evaluation
reveals a central retinal artery
occlusion but workup does not reveal
a clear etiology. Paracentesis and
IOP lowering medications did not
improve the patient’s vision
and she remains at light perception
in her right eye.
January 6, 2005
Jyotsom
Ganatra. MD -- Limbal Dermoid. Abstract: 9 yo girl
referred for excision of mass on right
eye. Mass present since birth. Located
inferotemporally. Large elevated w/
cystic component invading sclera, cornea,
anterior chamber, iris and indenting
lens. Diagnosed as Dermoid. Decsion
to defer excision given that eye
is
amblyopic and surgery would involve
risks of retinal detachment, vitreous
hemorrhage, and significant anterior
segment reconstruction. Key Words: Dermoid,
Conjunctival Mass, Corneal Mass,
Congenital Lesion, Limbal Mass.
Nancy
Flattem, M.D. -- Ocular Toxocariasis.
Abstract: A 46-year-old man
with a history of amblyopia OS was
referred for vitritis OS. Examination
revealed 20/200 acuity OS with trace
vitreous cells, chorioretinal atrophy,
and with an old granulomatous choroidal
scar extending into the vitreous.
Fluorescein angiography revealed
no leakage. This granulomatous lesion
was consistent with toxocariasis.
Toxocariasis usually occurs in young
children who are exposed to Toxocara
carni cysts from young puppies or
unwashed root vegetables. In the
intestines the cysts develop into
larvae which
spread throughout the vasculature to the lungs,
brains, liver, or eye.
The classic ocular toxocariasis findings are choroidal
granulomatous
lesions with fibrovascular stalks into the vitreous.
Inflammation may
be controlled with steroids. Anthelmintic agents
may also be used,
though an increase in inflammation may be incited. Key words: ocular toxocariasis,
granuloma, parasite, roundworm, Toxocara
canis, vitritis
David
Rhee, MD -- Submacular Hemorrhage. Abstract: A 71-year-old
female presents with decreased vision
due to submacular hemorrhage. The
submacular hemorrhage may be due
to choroidal neovascularization from
age related macular degeneration
or idiopathic polypoidal choroidal
neovascularization. This talk discuss
this etiology, diagnosis and management
of submacular hemorrhage, including
pneumatic displacement, submacular
surgery and tissue plasminogen activator.
Key Words: submacular hemorrhage,
submacular surgery, laser photocoagulation,
tissue plasminogen activator, retinotomy,
pneumatic displacement, age related
macular degeneration, idiopathic
polypoidal choroidal vasculopathy.
December 23, 2004
Zinaria
Williams, MD -- Infectious crystallinekeratopathy
in a corneal graft -- 72-year-old
man with a complicated past ocular
history including penetrating keratoplasty
(PK) in 1995 for cornealdecompensation
OS, recurrent uveitis OU, and advanced
inflammatory glaucoma OS presented
for a regular follow-up visit complaining
of pain OS for 1 week. Infectious crystallinekaratopathy
found within corneal graft OS. Despite
aggressive treatment with topical
antibiotics, his condition worsened
and he underwent a PK.
Izumi
Yamamoto, MD -- 38-year-old male
presented after a self-sealed corneal
penetrating injury by powered steel
brushes. Small
intraocular foreign body was found
in the AC angle by careful gonioscopy.
Management of anterior chamber intraocular
foreign body and metallosis are discussed. Key
Words: Intraocular foreign body,
Anterior chamber foreign body,
Anterior chamber Angle foreign body,
Metallosis,
Post-traumatic endophthalmitis,
Corneal penetrating injury,
ERG,
Ruptured globe.
David Rhee, MD -- 68 y/o male with
one month history of decreased vision
OD
December 9, 2004
Linda
Semela MD -- Hydroxychloroquine
Toxicity -- rare but severe. Early
detection to
prevent and minimize toxicity is essential. Screening
for retinal toxicity
is still subject of debate. The focus of this GR is
to present the current recommendations
for screening and toxicity management
published by the AAO and to talk about
the role of mfERG as an objective
screening tool in asymptomatic patients. Key words: Hydroxychloroquine, rheumatoid arthritis,
retinal toxicity,
screening recommendations, risk status,
management, mfERG
Shazia
Ahmed, MD -- Diagnosis and
management of acute posterior multifocal
placoid pigment epitheliopathy -- Acute
posterior multifocal placoid pigment
epitheliopathy is a chorioretinal
inflammatory condition first described
by Dr. Gass in 1968. Classically
the disease process affects young
adults and tends to be bilateral.
It can present with decreased visual
acuity, scotomas, or metamorphopsias.
One third of the patients present with
a flu-like syndrome. On fundus examination,
the retina is known to have multiple
subretinal placoid yellow-white lesions
mostly located in the posterior pole
that are approximately 1 disc diameter
or less in size. The condition is self
limited and full recovery may require
6 months. While many physicians do
not treat APMPPE, some advocate the
use of prednisone for an associated
systemic vasculitis or macular involvement. Key
words: acute posterior multifocal
placoid pigment epitheliopathy, inflammatory
disease, chorioretinopathy
Steven
N. Truong MD -- 9-year-old
boy who failed vision screening at
school. Referred to evaluation
after seeing several optometrists and
ophthalmologists without improvement
of vision. Upon examination and ancillary
testing, he was found to have Stargardt’s
disease. Key words: School
vision screening; Stargardt’s
disease; Fundus flavimaculatus
November 8, 2004
Cornea
Cases -- Johanna Choremis, MD
November 4, 2004
Cristiana Pieroni,
MD
Johanna
Choremis, MD
Ioannis
P. Glavas, MD
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