American Journal of Ophthalmology Case Reports

PURPOSE: Although conjunctivitis represents the most common ocular manifestation of COVID-19 infection, sight-threatening retinal involvement has been reported. Herein, we report and characterize with multimodal retinal imaging 5 cases of acute vision loss secondary to presumed chorioretinal vasculopathy temporally associated with COVID-19 infection with varying severity, visual morbidity, and treatment response, and review the available literature on the association between COVID-19 infection and retinal microvascular changes...

PURPOSE: Blindness is a well-known complication of filler injection in the glabellar region. Acute diplopia from filler injection without vision loss is a rare complication that typically results in clinical ophthalmoplegia which can have permanent sequelae. Here, we describe a patient who presented with acute diplopia with grossly intact full extraocular motility after glabella hyaluronic acid filler injection that resolved after 1 month. OBSERVATIONS: A previously healthy 43-year-old woman underwent her first hyaluronic acid injection in the glabella and developed immediate binocular double vision with severe pain and skin mottling above her right eyebrow and central forehead...

PURPOSE: To describe examination and imaging characteristics of presumed iris papulosa in a case of ocular syphilis. OBSERVATIONS: A 60-year-old man who presented with granulomatous anterior uveitis in his left eye was also noted to have an unusual vascularized iris papule associated with posterior synechiae at the nasal pupillary margin. Anterior segment OCT (AS-OCT) of the iris lesion demonstrated a hyperreflective anterior surface with multiple vascular lumen, internal hyperreflectivity, and shadowing...

PURPOSE: To present the clinical and histopathological characteristics of a rare case of ductal carcinoma in situ ex pleomorphic adenoma in the lacrimal gland. OBSERVATIONS: A 73-years-old Caucasian female presented with complaints of double vision and pain in the left eye region. Clinical examination revealed ptosis and exophthalmos of the left eye as well as diplopia on downward gaze. Magnetic resonance imaging of the left orbit demonstrated a 17 × 22 mm homogeneous tumor in the left lacrimal fossa...

PURPOSE: To report a patient with conjunctival and buccal neuromas and enlarged corneal nerves without Multiple Endocrine Neoplasia 2B (MEN2B). OBSERVATIONS: A 28-year-old female presented with progressively enlarging bilateral limbal conjunctival growths. Slit lamp examination was notable for enlarged corneal nerves and well-circumscribed gelatinous subepithelial limbal nodules. Systemic examination revealed similar lesions on the tongue. Conjunctival biopsy demonstrated a mucosal neuroma...

PURPOSE: To report two cases of benign essential blepharospasm (BEB) symptom relief in the setting of regular topical frankincense usage. OBSERVATIONS: The primary outcome measures for this report are (1) frequency of botulinum toxin (BT) injection appointments before and after the onset of regular frankincense usage and (2) patient report of symptoms. After starting frankincense, patient 1 decreased the frequency of her BT injection appointments from 5 to 8 months to 11+ months, eventually stopping BT injections altogether...

PURPOSE: To determine the role of intravitreal injection (IVI) of brolucizumab for extra-large pigment epithelial detachment (PED) secondary to macular neovascularization (MNV). OBSERVATIONS: A prospective, non-randomized, uncontrolled case series of three eyes of three patients with extra-large PED (maximum height >350 μm) due to untreated MNV was undertaken at a single center. All three eyes showed significant improvement in the PED height by week 4, with complete resolution by week 8 in two of the three...

PURPOSE: While corneal transplantation is known to have a potential risk of transmission of variant Creutzfeldt-Jacob Disease (vCJD), the magnitude of this risk has not been quantified. OBSERVATIONS: A case report is presented of a 73 year-old man with a penetrating keratoplasty graft from corneal tissue that was recalled after transplantation due to risk of vCJD because it was later discovered that the donor had traveled to the United Kingdom (UK). Probabilities of vCJD transmission were extrapolated using Creutzfeldt-Jacob Disease (CJD) mortality (incidence) rate, all-cause death rate, and rate of recovery for intended transplantation...

PURPOSE: Congenital protein C deficiency leads to a prothrombotic state that may result in potentially sight- and life-threatening thromboembolic attacks. In this report, we report two cases of infants with compound heterozygous protein C deficiency who underwent lensectomies and vitrectomies for the treatment of traction retinal detachments (TRDs). OBSERVATIONS: One two-month-old and one three-month-old female neonates with leukocoria and purpura fulminans received a diagnosis of protein C deficiency and were referred to ophthalmology...

PURPOSE: The aim of the study is to describe a case where Femtosecond Intrastromal Lenticule Extraction was used to address the refractive defect following topography-guided phototherapeutic keratectomy (topo-PTK) to regularise a scarred corneal surface after an initial LASIK flap formation attempt failed. OBSERVATIONS: A 23-year-old female experienced a thin and irregular corneal flap, during a microkeratome LASIK surgery of the right eye. Subsequently, she experienced epithelial ingrowth...

UNLABELLED: To describe a case of transient bilateral vitreomacular traction syndrome associated with topical 1% pilocarpine ophthalmic solution in both eyes as a treatment for advanced glaucoma. OBSERVATIONS: Spectral-domain OCT demonstrated bilateral vitreomacular traction syndrome after initiation of topical 1% pilocarpine solution in both eyes for advanced glaucoma. Follow-up imaging revealed the resolution of vitreomacular traction after cessation of the drug without a complete posterior vitreous detachment...

PURPOSE: To present a case of extrapulmonary sarcoidosis presenting with ocular and cutaneous involvement. OBSERVATIONS: We report a 54-year-male who presented with bilateral redness of eyes, photophobia, and diminished vision for a week. The best corrected visual acuity in the right eye was 6/60 and the left eye was counting fingers close to face (CFCF). He also had multiple brown plaques on the nape of the neck, chest, back, and arms. Furthermore, he was on multiple antipsychotic drugs for schizophrenia for 3 years...

PURPOSE: To report two cases of nasolacrimal duct obstruction (NLDO) caused by orbital fracture reconstruction with an implant successfully treated with endoscopic dacryocystorhinostomy (EnDCR). OBSERVATIONS: Two patients presented with NLDO after orbital fracture reconstruction with an implant. Case 1 was a 67-year-old female. She became aware of epiphora in her left eye after undergoing orbital fracture reconstruction with an implant for a left orbital floor fracture 14 years previously...

PURPOSE: Intratumoral bacteria and their potential application to cancer immunotherapy have been a topic of interest in recent studies. To our knowledge, bacteria in uveal melanoma have not been previously reported. OBSERVATIONS: We describe a patient with a large choroidal melanoma, measuring 18 × 16 mm in basal dimension and 15 mm in ultrasonographic thickness, managed by plaque brachytherapy. At the time of plaque removal, a prophylactic scleral patch graft was placed to protect from anticipated scleral necrosis...

PURPOSE: To assess the relationship between improving blood flow via arteriovenous (AV) sheathotomy without vitrectomy and the total number of anti-vascular endothelial growth factor injections (VEGF) required to treat branch retinal vein occlusion (BRVO). METHODS: In this prospective, clinical case series, 16 eyes of 16 patients at the Toho University Sakura Medical Center with best-corrected visual acuity (BCVA) of 20/40 or worse due to macular edema associated with BRVO were analyzed for 12 months...

PURPOSE: To describe the evaluation, diagnosis, and treatment of vitreoretinal lymphoma presenting as frosted branch angiitis in a patient with diffuse large B-cell lymphoma (DLBCL). OBSERVATIONS: A 57-year-old woman with a history of non-Hodgkin lymphoma and recent DLBCL relapse presented with frosted branch angiitis that raised suspicion for an infectious retinitis but was found to be vitreoretinal lymphoma. CONCLUSIONS AND IMPORTANCE: This case primarily highlights the importance of considering vitreoretinal lymphoma on the differential diagnosis of etiologies of frosted branch angiitis...

PURPOSE: To describe a case of bilateral retinal pigmentary changes in the setting of immune checkpoint inhibitor therapy (ICIT). OBSERVATIONS: A 69-year-old man with a history of advanced cutaneous melanoma was started on combination ICIT with nivolumab and ipilimumab and stereotactic body radiation therapy. Soon after, he developed photopsias and nyctalopia with findings of discrete retinal pigmentary changes bilaterally. Initial visual acuities were 20/20 and 20/30 in the right and left eye, respectively...

PURPOSE: To present a case of keratoconus progression following gender-affirming hormone therapy. OBSERVATIONS: A 28-year-old male-to-female transgender patient with potential past ocular history of subclinical keratoconus presented with subacute worsening myopia of both eyes (OU), 4 months after initiation of gender-affirming hormone therapy. A diagnosis of keratoconus was established based on slit-lamp exam and computerized corneal tomography. Notable indices were central corneal thinning and inferior steepening OU with maximum corneal curvatures of 58...

PURPOSE: To report two patients with a complication of Yamane intrascleral haptic fixation surgery (ISHF) with the Zeiss CT Lucia 602 lens: severely tilted intraocular lens (IOL) leading to significantly decreased vision in the early post-operative period. OBSERVATIONS: We report two patients presenting with severely tilted IOL implants one day and one month following Yamane ISHF. The first patient is a monocular 81-year-old woman referred for treatment of cornea edema...

PURPOSE: To describe the spatial distribution and morphologic characteristics of macrophage-like cells called hyalocytes in the posterior vitreous cortex of a patient with unilateral partial posterior vitreous detachment (PVD) using coronal plane en face optical coherence tomography (OCT). OBSERVATIONS: A 54-year-old male with sickle cell disease (HbSC genotype) presented with a partial PVD in one eye. Rendered volumes of a slab extending from 600 μm to 3 μm anterior to the inner limiting membrane (ILM) revealed hyperreflective foci in the detached posterior vitreous cortex suspended anterior to the macula, likely representing hyalocytes...