Multiple neoplasms: A case report

Patients diagnosed with Chronic Lymphocytic Leukemia (CLL) have an increased risk of developing second primary cancers. However, as far as we know, more than one type of subsequent malignancy in one patient has not been described.We report a case of two different skin cancers following CLL. A 68-year-old female patient, in whom CLL was diagnosed 5 years earlier, presented with a pigmentation in the left lower eyelid. Biopsy showed a melanoma. The tumor was excised and histopathological examination revealed a superficial spreading melanoma. Half a year later, a new pigmented tumor was seen in the transplant of the left lower eyelid. Biopsy was performed and histopathological examination showed an intraepithelial squamous cell carcinoma. This was treated with 5 fluorouracil 1% eyedrops.     

Multiple live subconjunctival dipetalonema: report of a case

Parasitic infestations of the eye have been reported since centuries, affecting various parts of the eye. Some are subtle, coexisting with vision, while many others damage and destroy, in part or totally, the gift of sight. This report describes a patient with live subconjunctival dipetalonema infestation of the right eye, with 22 parasites removed live in one sitting from one eye.     

Multiple evanescent white dot syndrome: a review and case report

Background: Multiple evanescent white dot syndrome (MEWDS) is a rare chorioretinal syndrome that usually presents with a unilateral, multifocal retinitis affecting mostly young women. The typical presentation includes multiple white spots extending from the posterior pole out to the mid‐peripheral retina, possible vitritis and a granular appearance to the fovea. Symptoms can include a prodromal flu‐like episode, photopsia, scotoma and decreased vision. Ophthalmoscopy is the most common method of diagnosing MEWDS but fluorescein angiography, electrodiagnostic testing, visual fields and optical coherence tomography can help confirm the diagnosis. MEWDS is usually a self‐limiting condition with complete visual recovery, although subsequent retinal sequellae may be possible. Case Report: A healthy 21‐year‐old myopic female presented with unilateral, sudden onset of photopsia, blurred vision and a ‘grey area’ in the temporal visual field. Initial examination found a vitritis, maculopathy and the presence of white dots in all four quadrants of the mid‐peripheral retina. A retinal ophthalmologist confirmed the diagnosis of MEWDS. Although the patient was less than compliant with the retinal specialist's recommendations, a subsequent examination found complete resolution of signs and symptoms. Conclusions: In the primary optometric setting, the uncommon syndrome known as MEWDS must be considered when the common symptoms of photopsia and blurred vision, combined with the atypical clinical presentation of white spots in the fundus appear in an otherwise healthy patient.     

Multiple retinal holes in the macular region: a case report

PURPOSE: To describe the first case of multiple retinal holes in the macular region successfully treated with vitrectomy. METHOD: A single case report. A 44-year-old man was treated for impaired vision caused by multiple macular holes in the right eye. RESULTS: Fundus examinations detected six retinal holes in the right macula and a giant macular hole in the left eye. Optical coherence tomography disclosed multiple vitreoretinal adhesions in the right macula. We vitrectomized the right eye to produce posterior vitreous detachment and then tamponaded the vitreous cavity with 20% SF(6) gas, resulting in closure of holes and improvement of the vision. CONCLUSION: Multiple macular holes may be treated by surgical posterior detachment combined with gas tamponade. Vitreoretinal adhesions are a possible cause of these holes. Similar multiple holes may have coalesced into one giant hole in this patient's left eye.     

Multiple excimer laser phototherapeutic keratectomies for Avellino corneal dystrophy: a case report

Dear Editor,I am Chihiro Koiwa,from the Department of Ophthalmology,Juntendo University Hospital.I am writing this letter to present a case of multiple excimer laser phototherapeutic keratectomies(PTKs)for Avellino corneal dystrophy(ACD).Corneal dystrophy is a common type of hereditary,noninflammatory,and bilateral corneal disorder that involves various pathological,histological,and clinical manifestations[1].Advanced molecular gene sequencing has identified specific mutations that are associated with most dystrophies of this type.ACD,also known as granular corneal dystrophy typeⅡ[2],is autosomal dominant and associated with the R124H mutation of the transforming growth factor beta-induced(TGFBI)gene and characterized by deposits consistent with both discrete granular and lattice corneal opacities[3-4].An analysis of the TGFBI gene is essential to differentiate ACD because heterozygous R124H mutation carriers have minimal corneal abnormalities,whereas homozygotes have severe visual impairment,starting from early childhood,and early postoperative recurrence of corneal opacity.     

Microblepharon: a case report

Microblepharon is a rare congenital anomaly manifested by a vertical shortening of the eyelids. We describe the clinical presentation and surgical outcome of a patient with trisomy 21 and microblepharon. Microblepharon occurs in varying degrees and must be distinguished from ablepharon and cryptophthalmos. A variety of surgical options are available depending upon the degree of lid involvement.     

Pseudotoxocariasis: a case report

The authors describe a case where the initial diagnosis, clinical and laboratorial, was compatible with ocular toxocariasis. Therefore the follow-up added to a histopathologic examination disclosed a different diagnosis, proving the importance of the histopathologic examination, mainly in presumable diagnostics.     

Glaucomatocyclitic crisis: a case report

Glaucomatocyclitic crisis or Posner-Schlossman syndrome is a rare condition characterised by recurrent, unilateral attacks of secondary open-angle glaucoma in association with a mild anterior uveitis. During an acute attack the intraocular pressure is markedly elevated, normally over 40 mmHg. A typical case of glaucomatocyclitic crisis is presented. (Clin Exp Optom 1995; 78: 4: 144–147)     

Posner-Schlossman syndrome: a case report

BACKGROUND: Glaucomatocyclitic Crisis (AKA Posner-Schlossman syndrome) is a syndrome that affects patients between the ages of 20 and 50 years. It is characterized by a mild recurrent anterior uveitis associated with an out-of-proportion intraocular pressure spike in the same eye. The cause is unclear, but many theories exist. Some researchers have tried to connect it with primary open-angle glaucoma. CASE REPORT: A review of the record of a 41-year-old Hispanic woman with Posner-Schlossman syndrome is discussed. She sought treatment on multiple occasions with symptoms of mild pain, photophobia, and a blurry left eye. Examination revealed mild anterior chamber reaction and an intraocular pressure (IOP) spike in the same eye. She was treated with topical anti-inflammatory and pressure-lowering agents. Each individual flare-up was treated successfully, but the patient began to show equivocal signs of primary open-angle glaucoma (PDAG). She is currently treated prophylactically for POAG with a beta-blocker. No etiologic factor was identified in this patient. The differential diagnosis is straight-forward and the treatment is general uveitic therapy--minus cycloplegics--combined with an IOP-lowering drop. CONCLUSION: This is an interesting and relatively rare uveitic condition. The list of differential diagnoses is long, as is the theorized etiologies; however, clinically the condition is relatively quickly identifiable by the presence (and absence) of signs and symptoms.     

External ophthalmomyiasis: a case report

Many dipteran flies can cause ophthalmomyiasis, a potentially severe and vision threatening disease. We report a case of ophthalomyiasis caused by Oestrus ovis. Larvae of Oestrus ovis are confined to the surface of the eye and cause external ophthalmomyiasis. The presentation is similar to a viral conjunctivitis, with tearing, itching, hyperaemia and foreign body sensation. The disease is self-limiting and removal of the larvae is the most effective therapy. Identification of the species is important to estimate the risk of penetration of the globe.     

Ligneous conjunctivitis: a case report

BACKGROUND: Ligneous conjunctivitis is a rare condition characterized by chronic, recurrent conjunctivitis associated with pseudomembrane, and it may involve other mucous membranes in the mouth, nasopharynx, trachea, and vagina. We examined and treated a case of presumed ligneous conjunctivitis. CASE: The patient was a 10-year-old boy. His chief complaints were visual impairment, discomfort, and discharge, but no itching in his eyes. His upper eyelids appeared thick without swelling. He had a past history of surgery for lid entropion. His two siblings had similar follicular conjunctivitis. OBSERVATIONS: This case exhibited several characteristics of ligneous conjunctivitis, such as large follicles, recurrent pseudomembrane and normal level IgE in the serum. Indispensable characteristics of vernal keratoconjunctivitis, strong itching, and extensive papillary formation, were not found. In spite of the lack of woody hardness of the conjunctiva, other clinical findings led to the diagnosis of ligneous conjunctivitis. Definite histological diagnosis was not obtained, because of the lack of common histological characteristics among previously reported cases with ligneous conjunctivitis. The boy had developed corticosteroid glaucoma after instillation of dexamethasone 0.1% for 7 months at a previous time. We successfully treated this case with combined instillation of fluorometholon and cyclosporin after trabeculotomy. CONCLUSIONS: Ligneous conjunctivitis must be considered as one type of differential diagnosis of vernal keratoconjunctivitis. Cyclosporin is an effective alternative for the treatment of ligneous conjunctivitis, especially in a case with a possible history of corticosteroid glaucoma.     

Apert's syndrome: a case report

Apert's syndrome is a type of acrocephalosyndactylia that is from part of the great group of craniofacial synostoses. It is characterized by craniofacial dysmorphia and syndactylia on hands and feet, which differentiates it from Crouzon's disease. It is a rare affection that is often transmitted through an autosome dominant mode, but sporadic cases exist. We report the case of a 15-year-old girl who presented characteristic clinical signs of Apert's syndrome with normal karyotype without parental consanguinity. The Ser 252 Trp mutation of the FGFR2 gene was found, confirming the molecular diagnosis. This study illustrates the severity of ocular and neurological problems of untreated Apert's syndrome. The presence of hemoglobinopathy (Hb AS) is also a mark of its originality.     

Weill-Marchesani综合征

本文报告1例合并角膜厚度增加,伴先天性心脏病及并发性角膜内皮损害的Weill-Marchesani综合征(WMS)病例,并结合复习文献,对本病的发病机制、临床特征及诊治要点作一归纳介绍。患者为26岁女性,身高143cm,双手短指,高度近视[OD:0.3(sph-24.50-3.00x105cyl),OS:0.4(sph-24.50-3.50cylX70)],双眼球形晶状体伴晶状体脱位,继发性青光眼。超声生物显微镜检查示双前房浅,房角关闭。超声心动图检查提示先天性心脏病,肺动脉瓣狭窄。角膜厚度右眼:588μm,左眼:598μm。患者经YAG激光虹膜打孔后,前房加深,房角开放,眼压控制。2mo后测角膜内皮周边大量空洞并融合成片。我们认为,WMS患者角膜厚度增加很少被人认识,其所带来的对眼压测量的影响应该引起注意;YAG激光虹膜打孔对于急性期缓解WMS瞳孔阻滞,降低眼压,维持前房深度具有很好的疗效;WMS多合并先天性心脏病,应常规行超声心动图检查;晶状体脱位对周边角膜内皮造成的损害不能忽视。     

Bilateral keratoconus: a case report

Among corneal dystrophies, the keratoconus is one of the most frequently observed among young adults. A clinico pathological case is reported in a 13-year-old-girl of African origin. The diagnosis of bilateral keratoconus was established based on the obvious changes of the corneal curvature and thickness. After an unsuccessful attempt to improve vision with contact lenses, a keratoplasty was finally performed on one side to remove the pathological cornea. Its histopathological study found the characteristic changes of keratoconus: breaks of Bowman's layer and corneal thinning.     

Ocular neuromyotonia: a case report

Ocular neuromyotonia is a rare motility disorder occurring after tumor irradiation near the skull base or as a consequence of vascular abnormalities. Ocular myasthenia, convergence spasm and a cyclic third nerve palsy must be considered as differential diagnoses. The case of a 32-year-old woman suffering from intermittent diplopia six months after radiation therapy of a recurrent pituary gland adenoma is presented.