A case of glaucoma with choroidal hemangioma managed by nonpenetrating trabeculectomy

BACKGROUND: Nonpenetrating trabeculectomy was used in a patient with glaucoma complicated by diffuse choroidal hemangioma. CASE: A 12-year-old boy suffered from glaucoma with choroidal hemangioma in the left eye. Intraocular pressure was 28 mm Hg and visual acuity was 0.04. Nonpenetrating trabeculectomy was then performed. OBSERVATIONS: Postoperative intraocular pressure was controlled at around 15 mm Hg with pilocarpine hydrochloride eye drops. Visual acuity and visual field were preserved over 19 months after the operation. CONCLUSIONS: An increase in aqueous outflow resistance was considered to be the major mechanism in the rise in intraocular pressure, based on distinct dilatation and tortuosity of the episcleral blood vessels and congestion of Schlemm's canal. Therefore, construction of aqueous drainage by nonpenetrating trabeculectomy was effective. Retaining the trabecular meshwork was also considered effective in controlling complications such as choroidal hemorrhage and postoperative flat anterior chamber.     

A case with paraneoplastic optic neuropathy presenting bitemporal hemianopsia

A 43-year-old woman developed bitemporal hemianopsia seven years after surgical therapy for thyroid cancer. After total loss of vision in both eyes intracranial surgery was attempted but found no abnormalities around the optic chiasm. Bronchofiberscopic examination revealed adenocarcinoma of the left lung. Postmortem examination showed severe demyelination in the optic nerves especially around the chiasm. No tumor cells were seen intracranially. These findings were consistent with paraneoplastic optic neuropathy. This case suggests that paraneoplastic optic neuropathy can occur at the optic chiasm like other demyelinating diseases do.     

A case of pulmonary tuberculosis presenting with a choroidal tuberculoma

A 17-year-old woman was referred because of a choroidal mass, with marked decrease in vision, in her left eye. Her medical history was negative. However, preliminary examination revealed a positive skin tuberculin test (PPD) and a chest x-ray picture of pulmonary tuberculosis. Bronchoscopy documented the diagnosis. Findings of other systemic investigations were negative. Fluorescein angiographic findings were compatible with the clinical diagnosis of a choroidal tuberculoma. A regimen of antituberculous medications was started, and both the choroidal and the pulmonary lesions gradually subsided. To our knowledge this is the first reported case of nonmiliary tuberculosis that presented solely with a choroidal lesion.     

Complex juxtapapillary capillary hemangioma: A case report

BackgroundJuxtapapillary capillary hemangiomas can occur as isolated clinical abnormalities or a manifestation of von Hippel-Lindau (VHL) disease. Because of the location of these vascular tumors on or adjacent to the optic disc, any therapeutic treatment option involves risk. Management typically includes close monitoring, with treatment initiation as the tumor progresses or when vision is compromised. This case report reviews this condition while highlighting the treatment and potential complications associated with juxtapapillary capillary hemangioma.Case ReportA 14-year-old black male had juxtapapillary capillary hemangioma diagnosed during a routine eye examination. The patient complained of blurry vision in the right eye, and best-corrected visual acuities (BCVA) were 20/25 O.D. and 20/20 in the left eye. At the retinologist's discretion, no treatment was initiated, and the patient was advised to return in 4 months for a dilated retinal evaluation and referred for magnetic resonance imaging (MRI) with contrast of the brain. The patient was lost to follow-up and presented a year later when vision had deteriorated to 20/400 O.D. with an associated afferent pupillary defect. Enlargement of the juxtapapillary capillary hemangioma with increased fibrovascular growth, macular exudation, and subretinal fluid was observed O.D. Photodynamic therapy was initiated, and the patient experienced treatment complications, including a vitreous hemorrhage and serous retinal detachment. A scleral buckling procedure, vitreoretinal surgery, and endo-laser photocoagulation were performed. The patient's visual acuity improved from 20/400 to 20/60 O.D., with the development of a dense posterior subcapsular cataract, for which the patient had cataract extraction. Genetic testing was positive for a small deletion in codon 76 of the von Hippel-Lindau gene, and MRI of the brain was reported to be normal. Additional testing to rule out visceral organ involvement, including abdominal ultrasound scan, urinalysis, and blood chemistry were ordered, and the patient's family was also evaluated for the presence of the VHL gene.ConclusionThe clinical course of juxtapapillary capillary hemangiomas is highly variable, potentially leading to significant ocular complications. Currently, no definitive treatment guideline is available, and any therapeutic option involves inherent risk because of the location of these tumors. Because juxtapapillary capillary hemangioma may be the only manifestation of VHL disease, genetic and clinical screening of patients and their relatives is highly recommended. Early diagnosis and treatment may improve both the visual and systemic prognosis in patients with juxtapapillary capillary hemangiomas.     

A case of cavernous hemangioma of the retina]

A case of hemangioma of the retina is reported. Its typical ophtalmoscopic and fluorescein angiographic aspects are studied. The benign evolution is stressed in spite of a possible macular risk checked by argon laser therapy.     

A case of amputation neuroma presenting proptosis

A case of amputation neuroma, presenting incidious proptosis, was reported in a 44-year-old man. To the best of our knowledge the case seems to be the first report of amputation neuroma caused by trauma in the orbita.     

A case of pediatric idiopathic intracranial hypertension presenting with divergence insufficiency

An 11-year-old female presenting diplopia only at distance was found to have comitant esotropia of 20 prism diopters (PD) at distance and normal alignment at nearer proximity. Other ocular movement, including abduction, was normal and a thorough neurologic examination was also normal. The deviation angle of esotropia was increased to 35 PD in 6 months, and a brain magnetic resonance imaging with venogram at that time demonstrated no intracranial lesion. A lumbar puncture showed increased opening pressure but the cerebrospinal fluid composition was normal. The patient was diagnosed as having idiopathic intracranial hypertension and treated with oral acetazolamide. Three months after treatment, the deviation angle decreased to 10 PD. This is a case report of divergence insufficiency in pediatric idiopathic intracranial hypertension, with an increasing deviation angle of esotropia. Although sixth cranial nerve palsy is a common neurologic manifestation in intracranial hypertension, clinicians should be aware of the possibility of divergence insufficiency. Also, ophthalmoparesis may not be apparent and typical at first presentation, as seen in this case, and therefore ophthalmologists should be aware of this fact, while conducting careful and proper evaluation, follow-up, and intervention.     

Linear nevus sebaceous syndrome presenting as circumscribed choroidal hemangioma

A 4-year-old female with a unilateral circumscribed choroidal hemangioma and secondary total exudative retinal detachment. A nasal skin scar-like lesion incised to confirm a histopathologic diagnosis of linear nevus sebaceous. Further imaging disclosed asymmetry of the lateral ventricle frontal horns, suggestive of the diagnosis of linear nevus sebaceous syndrome. The choroidal hemangioma was treated with I-125 episcleral brachytherapy (apical dose of 45 Gy). At 6 months post-radiation, the tumor showed regression with total resolution of exudative retinal detachment.     

A case of von Hippel-Lindau disease with papillary capillary hemangioma treated by photodynamic therapy

BACKGROUND: Laser photocoagulation of papillary hemangioma in von Hippel-Lindau disease often causes visual loss. Therefore, we applied photodynamic therapy for one patient. CASE: A 36-year-old male had 3.2 x 2.6 mm capillary hemangioma of the optic disc associated with a fibrovascular membrane and exudative retinal detachment involving the whole macular area in his left eye. His visual acuity was 0.08. TREATMENT: Two days after the intravenous injection of 2 mg/kg of hematoporphyrin derivatives, the eye was irradiated with a dye laser of 630 nm wavelength, with irradiance of 637 mW/cm2 and a radiant exposure of 150-250 J/cm2. The exudative retinal detachment and hemorrhage in the tumor increased from day 1, but the tumor and exudative changes began to resolve after 3 weeks. The fibrovascular membrane was removed by vitrectomy. Three years after the treatment, the tumor was completely resolved, but the patient's visual acuity was 0.1 due to atrophy of the optic nerve and pigment epithelium of the macula. CONCLUSION: Although further investigation on optimal radiance avoiding damage to the optic nerve is still needed, photodynamic therapy is a promising therapeutic option for papillary hemangioma.     

Management of large-angle esotropia

If large-angle esotropia is defined as 80 D or more, and if the surgery induces no limitation of movement or incomitance, there is an excellent likelihood that four-muscle surgery in one operation will result in a residual deviation between 15 D of convergent strabismus and 15 D of divergent strabismus.     

A case of circumscribed choroidal hemangioma in Sturge-Weber syndrome in China

We present a case of circumscribed choroidal hemangioma (CCH) in Sturge-Weber syndrome in a 30-year-old woman with congenital port-wine stains on the left side of face involving the upper eyelid, cheek and the nose, and she had undergone facial hemangioma surgery 3 years ago suggestive of Sturge-Weber syndrome. She presented with a 1-month history of rapidly decreased visual acuity (VA) to counting fingers in the left eye which had no prior history of visual problem. And there was no evidence of glaucoma. At 3 months after the treatment of the standard photodynamic therapy (PDT) the VA was 20/200. For some reasons, we have no idea about the changes of tumor thickness and subretinal fluid. We confirmed the curative effect of PDT treatment for CCH because of the significantly improved VA in the bad eye.     

A case of bilateral silent sinus syndrome presenting with chronic ocular surface disease

The silent sinus syndrome is characterized by atelectasis of the maxillary sinus in the setting of subclinical maxillary sinusitis and obstruction of the osteomeatal unit. The resultant expansion of orbital volume causes enophthalmos and hypoglobus. A review of the literature reveals only unilateral cases. The authors present a case of bilateral silent sinus syndrome presenting with chronic ocular surface disease. A 56-year-old man was referred for tarsorrhaphy to treat a chronic recurrent corneal ulcer. Exam revealed an area of corneal thinning in the left eye. The patient appeared cachectic and there was enophthalmos, hypoglobus, and lagophthalmos on both sides, left worse than right. Due to the patient's appearance and a history of sinonasal malignancy, recurrent malignancy was suspected. A systemic workup was unrevealing, and radiographic studies showed the features of silent sinus syndrome bilaterally. The patient underwent sinus surgery and placement of a left orbital floor implant.