Cases reported "Eye Diseases"

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1/35. Macular ring in a patient with Terson's syndrome.

    PURPOSE: To report on a pigmented finding in the macula that is unique to Terson's syndrome, and was previously described only once. METHOD: A 49-year-old man underwent vitrectomy for vitreous hemorrhage due to Terson's syndrome. During surgery the retina was exposed, and a pigmentation was noticed around the macula. Follow-up of the macular finding is presented. RESULTS: At surgery a pigmented "ring" encircling the macula was revealed. Two and six months later, the pigmented line was still noticed, and an epiretinal membrane appeared in the temporal macula. CONCLUSION: Terson's syndrome may be associated with a pigmented "ring" encircling the macula, a finding that may be a result of a detachment of the internal limiting membrane (ILM). The epiretinal membrane that was later noticed, might also be related to the damage to the ILM.
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2/35. Corneal degeneration after silicone oil tamponade in a photorefractive keratectomy treated eye.

    Three years after uneventful excimer laser photorefractive keratectomy in both eyes, a 34-year-old man sustained a perforating injury in the left eye. The severe injury, followed by endophthalmitis and retinal detachment, necessitated vitrectomy, lensectomy, and an internal tamponade with silicone oil. One month after the accident and operations, disk-shaped corneal edema corresponding to the laser treatment zone appeared. The edematous region showed a circular, ring-like epithelial thickening at the borders and central corneal epithelial erosion. The anterior stroma developed a central opacity that was separated by a clear rim from the developing silicone-oil keratopathy with the typical band shape.
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3/35. Failure of operative treatment in a child with osteoporosis-pseudoglioma syndrome.

    A 6-year-old girl with osteoporosis-pseudoglioma syndrome had operative treatment of a distal femur fracture that failed. osteoporosis-pseudoglioma syndrome is an autosomal recessive syndrome combining severe premature osteoporosis with a bilateral eye disorder leading to early onset of blindness. Beginning in early childhood, the patient sustained multiple fractures of the left distal femur that were treated nonoperatively. At the age of 5 years the patient had a fracture of the left distal femur with an 80 degrees angulation in the sagittal plane. The patient was treated with internal stabilization because of gross bowing of the femur at the fracture site. Intraoperatively, anatomic reduction was achieved by insertion of a flexible nail but not without some intraoperative problems. Because of the severe osteoporosis, iatrogenic penetration and fracture of the femoral cortex by the nail occurred intraoperatively in the subtrochanteric region. In addition, a hip spica cast was applied. The nail was removed 1 week later. After 6 weeks wearing the hip spica cast, the patient's fracture healed with some shortening but with correction of the angulation in the sagittal plane. Internal stabilization seems to be potentially troublesome in patients with severe forms of this syndrome and severe bony deformities.
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4/35. Uncommon serious complications in stevens-johnson syndrome: a clinical case.

    We present an extremely serious clinical case of stevens-johnson syndrome, the evolution of which has been followed for 3 years. The etiology was unknown, although it was related with the administration of amoxicillin. We found a type III immunity mechanism involving immune complexes. The serious complications affected the skin, mucosae and internal organs. The present sequelae are: esophageal stenosis, pneumopathy with a 50% deficit of pulmonary perfusion and bilateral trichiasis.
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5/35. Laminated posterior vitreous cortex associated with idiopathic macular hole.

    PURPOSE: To report an unusual preretinal opacity associated with an idiopathic macular hole (MH) that was identified by optical coherence tomography. DESIGN: Observational case report. methods: A 59-year-old woman with a preretinal linear opacity running across an MH was examined by optical coherence tomography. RESULTS: Optical coherence tomography showed a full-thickness MH with a superiorly hinged flap. The preretinal opacity was identified as a part of a laminated vitreous cortex that was perpendicularly attached to the apex of the flap. A horizontal scan showed a partly double-layered posterior vitreous cortex. Two months later, the linear opacity disappeared coincident with a complete posterior vitreous detachment. The MH was closed by vitrectomy with peeling of the internal limiting membrane. CONCLUSIONS: Optical coherence tomography identified an unusual ophthalmoscopic presentation of a preretinal opacity as a part of laminated vitreous cortex associated with a "can-opener" MH.
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6/35. Internal ophthalmomyiasis presenting as endophthalmitis associated with an intraocular foreign body.

    Ophthalmomyiasis interna infestation by fly larva can present in various forms. A 3-year-old girl with a 15-day history of pain, redness, and tearing of the right eye was referred to our clinic with the diagnosis of endophthalmitis associated with an intraocular foreign body, based on clinical and ultrasonographic findings. The patient underwent pars plana vitrectomy, during which an 8-mm long larva was encountered within the vitreous cavity. It was removed and identified as a cattle botfly. The patient developed a retinal detachment 1 month postoperatively, but the family refused further treatment and the patient was lost to follow-up. Ophthalmomyiasis should be included in the differential diagnosis of endophthalmitis and intraocular foreign bodies in patients from rural areas.
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7/35. Clinicopathologic correlation and pathogenesis of ocular and central nervous system manifestations in Hallervorden-Spatz syndrome.

    We have correlated the clinical and histopathologic features of the eyes and central nervous system in a patient with Hallervorden-Spatz syndrome who died at age 11 years. The main ocular findings included degeneration of photoreceptors, marked thinning of the outer nuclear and outer plexiform layers, retinal gliosis, narrowing and obliteration of blood vessels with a perivascular cuffing of pigment cells, and degenerative changes in the retinal pigment epithelial cells with accumulation of melanolipofuscin. The positive findings in the brain included a symmetrical, partially destructive lesion of the globus pallidus, especially in its internal fibers and neurons; in addition, we noted gliosis, widely disseminated axonal spheroidal bodies, which were most numerous in the globus pallidus and pars reticulata, as well as deposits of iron. Our histopathologic findings implicate three possible mechanisms, namely, lipid peroxidation, a deficiency of fatty acid membrane components, and increased cGMP which, either singly or in combination, are responsible for a pathogenesis that is common to the eye and brain in Hallervorden-Spatz syndrome.
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8/35. Vitreoretinal traction and perimacular retinal folds in the eyes of deliberately traumatized children.

    The pathophysiology of perimacular folds in eyes of deliberately traumatized children is disputed. The authors reviewed the clinical and forensic records and systemic and ocular findings at autopsy of three children with perimacular retinal folds who died after being violently shaken. Two of the children suffered direct head trauma in addition to being shaken; one patient was violently shaken without any physical or forensic evidence of direct head trauma. No direct ocular trauma was detected. In each case, the vitreous had partially separated from the retina but remained attached to the internal limiting membrane at the apices of the folds and the vitreous base, implicating traction in the pathogenesis of these folds. Although some intraocular findings in deliberately traumatized children may be explained by direct head injury, the possibility of both direct head trauma and shaking must be considered. Perimacular folds may develop without direct ocular or head trauma and may constitute evidence supporting violent shaking.
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9/35. Molteno rip-cord suture hypopyon.

    Seven of 27 eyes developed hypopyons following removal of a 4-0 chromic suture that had been placed intraoperatively in the lumen of the tube of a Molteno implant as a temporary occlusion device. The hypopyons were sterile to anterior chamber tap and in six of seven cases resolved with only routine antibiotic coverage. Surgeons contemplating using an internal chromic suture occlusion in molteno implants, however, should be aware of this potential problem and adopt a conservative, noninvasive approach.
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10/35. Ocular and orbital toxicity following intracarotid injection of BCNU (carmustine) and cisplatinum for malignant gliomas.

    Eleven patients treated with intracarotid BCNU, cisplatinum, or BCNU and cisplatinum in combination for recurrent malignant gliomas were followed with serial ophthalmologic examinations for 2 to 11 months. Eight patients developed significant visual loss ipsilateral to the side of infusion. Secondary glaucoma and internal ophthalmoplegia were new complications observed after BCNU treatment. An unusual pigmentary retinopathy, previously unreported, was seen in patients treated with cisplatinum. One patient also developed a cavernous sinus syndrome after the intracarotid administration of cisplatinum.
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