American Journal of Ophthalmology Case Reports

PURPOSE: This report details the characteristics of a case of bilateral optic neuropathy during treatment with oral lorlatinib for ALK-positive metastatic adenocarcinoma of the lung. OBSERVATIONS: A 57-year-old woman with metastatic adenocarcinoma of the lung receiving treatment with lorlatinib presented to the ophthalmology urgent care with bilateral loss of vision that had progressed to no light perception over the previous 2 weeks. She was hospitalized for an extensive autoimmune, infectious, neoplastic, and paraneoplastic workup, which revealed enhancement of both optic nerves extending up to the optic chiasm and an area of restricted diffusion in the splenium of the corpus callosum on MRI...

PURPOSE: To describe examination and findings in a case of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) with particular focus on the ocular sequelae from diabetes. OBSERVATIONS: Neovascular glaucoma is not a common manifestation of MELAS. CONCLUSIONS AND IMPORTANCE: We present a rare case of neovascular glaucoma in a patient with MELAS with a history of diabetes, hearing loss, and macular dystrophy. MELAS should be suspected in patients with this constellation of symptoms...

PURPOSE: To report 2 cases of enlarged foveal avascular zone (FAZ) on optical coherence angiography (OCTA) imaging in pediatric patients with cutis marmorata telangiectatica congenita (CMTC). OBSERVATIONS: A 10-week-old female and a 3-year-old male diagnosed with CMTC presented for retinal examination. Both had peripheral avascularity on fluorescein angiography (FA) and enlargement of the FAZ on OCTA in both eyes. CONCLUSIONS AND IMPORTANCE: Pediatric patients with CMTC should undergo ocular evaluation with not only FA, but also OCTA to more robustly evaluate the affected retina in this rare disease...

PURPOSE: To report a case of cyclic esotropia successfully treated with prismatic correction. OBSERVATIONS: A 9-year-old girl presented with intermittent esotropia and diplopia occurring over the previous 4 months. The patient had 30 prism diopters (PD) of esotropia at both distance and near. Ocular motility testing, other ophthalmic examinations, and brain magnetic resonance imaging revealed no abnormalities. At the third visit, the patient had 6 PD of intermittent esotropia without diplopia, and the eye position diary demonstrated esotropia every other day, which led to a diagnosis of cyclic esotropia with a 48-h cycle...

PURPOSE: To describe the presentation of lacrimal gland secretions mimicking a positive Seidel test following combined complex cataract surgery and endocyclophotocoagulation (ECP). OBSERVATION: The patient presented with a posterior subcapsular cataract (PSC) most likely secondary to chronic steroid use for a history of chemical burns from a firework injury in 2019. This injury resulted in symblepharon formation and limbal stem cell deficiency. He also developed glaucoma secondary to steroid response and angle structure damage...

PURPOSE: Patients with increased intracranial pressure and underlying hypertensive emergency may present with optic disc edema. Papilledema in this setting may be a predisposing risk factor for superimposed non-arteritic anterior ischemic optic neuropathy (NAION). We highlight the role of neuroimaging including diffusion-weighted imaging in magnetic resonance imaging that can help to differentiate visual loss from NAION versus papilledema in fulminant IIH with and without hypertension...

PURPOSE: To report a case of oculo-facio-cardio-dental (OFCD) syndrome secondary to a novel BCOR variant in a pediatric patient with congenital cataracts, microphthalmia, persistent fetal vasculature (PFV), focal chorioretinal hyperpigmentation, peripheral retinal avascularity, and foveal photoreceptor atrophy. OBSERVATIONS: A 3-month-old female patient was referred for bilateral congenital cataracts with microphthalmia. Her past medical history was significant for syndactyly of the toes, left bifid rib, atrial septal defect, patent ductus arteriosus, mitral regurgitation, pulmonary hypertension, anemia of prematurity, vesicoureteral reflux, and duodenal atresia...

PURPOSE: To describe a case of intraocular lens (IOL) tilt following transscleral IOL fixation with the Yamane technique and subsequent correction of tilt using 810-nm endoscopic diode laser. OBSERVATIONS: Our patient required lens exchange and secondary IOL implantation due to a dislocated 1-piece IOL in the bag causing iris chafe. After routine IOL fixation with the Yamane technique and a Zeiss CT Lucia 602 lens, the IOL tilted significantly in the immediate postoperative period...

PURPOSE: The term melanocytoma was recently proposed for intermediate-stage melanocytic lesions with specific histopathologic and molecular genetic features. Prior studies have demonstrated a heightened potential for these intermediate lesions to spread to regional lymph nodes, with decreased likelihood for distant spread, when compared to melanomas. OBSERVATIONS: Herein we present a case of a 28-year-old male who presented with a recurrent right lower eyelid margin combined cutaneous and palpebral conjunctival pigmented lesion, ultimately classified as a melanocytoma, to highlight this new nomenclature, characteristic histopathologic and genetic findings, and prognostic implications...

PURPOSE: There is insufficient literature reporting the concurrent occurrence of retinal ischemic lesions with optic neuritis. In this case report, we present a distinctive instance of Optic Neuritis with a positive Myelin Oligodendrocyte glycoprotein (MOG) antibody, accompanied by retinal ischemia manifesting as paracentral acute middle maculopathy (PAMM) lesions. OBSERVATIONS: Our patient is a 25-year-old female who tested positive for MOG antibodies and exhibited retinal PAMM lesions without any apparent underlying ischemic cause...

PURPOSE: To describe the use of FLACS (Femtosecond-Laser-Assisted Cataract Surgery) and pupiloplasty technique employed in a cataract surgery associated with iris-lens-zonule coloboma, as well as to report the advantages that FLACS can provide in this type of complicated surgery. OBSERVATIONS: During FLACS (Victus® - TECHNOLAS, Bausch and Lomb Incorporated, USA), after the docking procedure, the parameters of capsulotomy, fragmentation and incisions were manually adjusted...

PURPOSE: Wagner syndrome is an autosomal genetic vitreoretinopathy characterized by chorioretinal atrophy, avascular vitreous veils, reduced visual acuity and early retinal detachment in advanced cases. Management of Wagner syndrome usually results in observation then management of occurring complications. OBSERVATIONS: We report the case of a 9-year-old girl presenting with supposed Wagner syndrome that we managed with prophylactic encircling band and retinopexy in both eyes...

PURPOSE: To present a rare case of late-onset Pseudomonas aeruginosa orbital cellulitis following glaucoma drainage device (GDD) implantation due to suture erosion. OBSERVATIONS: A 65-year-old male with a history of aphakic glaucoma and two remote prior glaucoma drainage device (GDD) surgeries of the right eye presented with right orbital signs. On examination, exposed securing Gore-Tex suture material over the plate of a GDD in the inferotemporal quadrant was present...

PURPOSE: Tubulointerstitial nephritis syndrome with uveitis (TINU) is a rare, acquired syndrome characterized by interstitial nephritis with bilateral uveitis. We report a case of TINU with typical bilateral anterior uveitis complicated by an atypical, delayed-onset neuroretinitis in a 12-year old patient. OBSERVATION: A 12-year-old female with a 21-month history of TINU featuring chronic bilateral anterior uveitis presented with one week of blurred vision in her left eye...

PURPOSE: We report a rare case of microbial keratitis caused by Nigrospora oryzae . OBSERVATIONS: A 72-year-old Japanese woman was injured by plant debris and developed oval corneal ulcers and hypopyon in the anterior chamber. After 5 days, she complained of pain, redness, and vision loss in her left eye and was treated with antibacterial eye drops and an ointment (1.5 % levofloxacin hydrate, cefmenoxime hydrochloride, and sterilization and disinfection eye drops; SAN-IODE and ofloxacin ophthalmic ointment)...

PURPOSE: Foreign body reaction to non-absorbable alloplastic orbital implants utilized for bony reconstruction are infrequently documented in the literature. We present the workup and surgical management of a giant cystic mass encapsulating a patient's alloplastic orbital implant, which was ultimately deemed to be a result of foreign body reaction. OBSERVATIONS: A 41-year-old male patient with distant history of a right orbital floor fracture had undergone repair with the placement of a nylon foil implant...

PURPOSE: This report describes a case of Descemet membrane endothelial keratoplasty (DMEK) graft failure after non-clearing bullae over the area of the orientation mark on the graft. METHODS: Case report. RESULTS: The summary of the clinical presentation and workup is described, followed by a brief overview of the DMEK procedure and the gentian violet (GV) ink used to ensure the correct orientation of the DMEK graft. CONCLUSIONS: GV has a good safety profile; however, there are rare cases of adverse events...

PURPOSE: To describe a case of bilateral panuveitis in a patient with Stimulator of Interferon Genes (STING)-Associated Vasculitis with Onset in Infancy (SAVI). OBSERVATIONS: A 45-year-old patient diagnosed with SAVI presented bilateral panuveitis and uncontrolled secondary intraocular hypertension due to structural complications from uveitis. Multimodal imaging revealed the presence of intraretinal fluid and bilateral vasculitis. The patient was started with systemic methotrexate...

PURPOSE: We report a case of laser-induced retinopathy that posed diagnostic challenges with conventional spectral domain optical coherence tomography (SD-OCT), but was successfully diagnosed using adaptive optics-optical coherence tomography (AO-OCT). OBSERVATIONS: A 27-year-old man with a history of occupational laser device use presented with central scotoma and visual disturbances in the right eye. Conventional SD-OCT only revealed decreased reflectivity in parts of the foveal ellipsoidal zone band...

PURPOSE: To report a rare clinical finding of preretinal granules associated with atypical familial exudative vitreoretinopathy (FEVR) and perform a review of the literature. OBSERVATIONS: An asymptomatic 18-year-old male was referred for unilateral peripheral avascular retina evaluation in association with presumed FEVR. He was first noted to have white preretinal granules on fundus examination at five years of age. The lesions remained unchanged over the subsequent years...