The purpose of this study was to report the rare presentation of bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and unilateral papillitis treated successfully with ...corticosteroid therapy. The methods used in this study include fundus photography and fluorescein angiography. A 40-year-old female presented to the emergency room with decreased vision, headache, and photophobia with fundus examination findings of bilateral creamy placoid lesions in the posterior pole and unilateral papillitis, macular edema, and disc hemorrhages. Fluorescein angiography demonstrated early hypofluorescence corresponding to the placoid lesions followed by late, irregular hyperfluorescent staining. Optical coherence tomography revealed peripapillary and macular edema of the left eye. The patient was treated with two retrobulbar corticosteroid injections and a course of oral prednisone with improvement in fundus findings and visual acuity at follow-up examination six weeks from the presentation. The presence of optic nerve and macular edema in APMPPE suggests severe chorioretinal inflammation for which systemic and local corticosteroids are a reasonable treatment option.
Retrobulbar hemorrhage may result in sudden accumulation of blood in the retrobulbar space which can lead to an orbital compartment syndrome. This potentially blinding condition is characterized by a ...rapid increase in intra-orbital pressure. While most commonly associated with orbital trauma, it may rarely occur with Valsalva events in patients on anticoagulants. In this report, we present a case of a retrobulbar hemorrhage secondary to self-induced vomiting, occurring in a patient on no anticoagulation medication.
A 61-year-old man with well-controlled diabetes mellitus type 2, cirrhosis from hepatitis C, alcohol abuse, and portal hypertension presented with painful vision loss and left orbital swelling. ...Imaging showed diffuse orbital, perineural, and pachymeningeal inflammation. He was initially diagnosed with neurosarcoidosis. However, cerebrospinal fluid analysis revealed central nervous system lymphoma, and lacrimal gland biopsy showed fungal organisms consistent with mucormycosis. The authors describe a case of Mucorales infection lacking sinonasal involvement and discuss the differential diagnosis and management of patients presenting with orbital and central nervous system inflammation from this uncommon fungal infection.
Abstract
Purpose
This article aimed to evaluate outcomes of resident-performed Descemet's stripping automated endothelial keratoplasty (DSAEK).
Methods
This is a case series of patients who ...underwent DSAEK performed by PGY-4 ophthalmology residents at Lyndon B. Johnson Hospital from January 2013 to August 2016 staffed by a fellowship-trained cornea specialist. Patients with less than 1 month of follow-up were excluded. Demographics, baseline ocular characteristics, and intraoperative data were recorded. Vision and graft status were recorded at 1 week, 1 month, 3 months, and the last follow-up visits. Surgical failure was defined as graft detachment within 1 week of surgery and/or primary graft failure within 3 months of surgery.
Results
Eighteen eyes of 18 patients who followed up for 14.9 months (±12.9) were included. Mean age of patients was 60.9 years (±13.2). Indications for DSAEK included pseudophakic bullous keratopathy (10), Fuchs endothelial dystrophy (4), and other causes of endothelial dysfunction (4). Eleven (61%) eyes had prior ocular surgery, and 7 (39%) had prior glaucoma surgery. There were no postoperative graft detachments and two (11%) primary graft failures. There was one primary graft failure in a glaucoma patient. Of the 16 graft successes, logMAR visual acuity improved by 0.46 logMAR (±0.73) from baseline.
Conclusion
With appropriate staffing by an experienced cornea surgeon, DSAEK with residents as the primary surgeons is a safe and effective procedure with reasonably good outcomes.
The paper discusses the development of the theory of ethnodesign, therefore focusing on packaging examples analysis, the design of which embrace the motifs of Russian and Belarusian cultures. For the ...first time, a classification of possible types of ethnocultural components is proposed, on the basis of which a unique verbal-visual component of ethnodesign may be formed. The study suggests a refined definition of the concept of “ethnomarker” from the point of view of design theory, and develops the structure of ethnodesign of a product tested through the example of packaging. The process of design analysis made for the following provisions: firstly, ethnocultural components, depending on their ability to associate a design product with any ethnos, are unequal and are divided into two groups — dominant and secondary; secondly, each ethno-cultural component has such a characteristic as ethno-identifying ability (proposed for the first time); thirdly, ethno-identifying ability depends on the degree of popularity and uniqueness of a particular ethnomarker. Structural and semantic analysis of packaging samples in the “Slavic style” made it possible to identify the most frequently used ethnocultural components. Among them are ethnonyms and their derivatives (Russian, Russia, Slavic, in Russian), digital fonts imitating Cyrillic writing, national costume and its elements, ethnocultural landscape, unique motifs of decorative and applied art, folklore characters, images architectural structures, household. Secondary ethnocultural components, as a rule, were widespread ornamental motifs, images of traditional management, visual display of the mentality of an ethnic group, color palette of design.
Lung damage, along with the pathology of the upper respiratory tract and kidneys, constitute the classic triad of Wegener's granulomatosis with polyangiitis (GPA). The special features of pulmonary ...pathology in this disease include the possibility of asymptomatic course. A case of asymptomatic lung damage in a patient with GPA has been reported. Despite clear signs of drug-induced clinical and laboratory remission, routine computed tomography (CT) revealed progressive changes in lung parenchyma as multiple foci with destruction, which regressed after treatment with cyclophosphamide. The importance of instrumental examination, including CT of the chest at the onset of GPA and during the subsequent follow-up, was emphasized.
Ophthalmology Review: A Case-Study Approach, Second Edition by renowned experts Kuldev Singh, William Smiddy, and Andrew Lee is a practical, case- based reference covering a wide array of common to ...serious ophthalmic conditions encountered in daily practice. The new edition reflects significant advances in ophthalmologic surgery and additional quick-reference material. The focus is on patient management problems and how to handle them and optimally manage the patient. A cadre of esteemed contributors discuss diagnostic methods, evaluation, contraindications, and patient management issues for a full spectrum of clinical disorders, with significant clinical pearls gleaned from hands-on expertise. A full spectrum of subspecialties are reflected in nearly 100 ophthalmology cases presented in 11 sections, encompassing the cornea and external disease, lens, glaucoma, retina, uveitis, tumors, posterior segment complications, ocular trauma, neuro-ophthalmology, pediatrics, and oculoplastic surgery. Each succinct case walks readers step by step through patient history, the examination, differential diagnoses, test interpretation, definitive diagnosis, medical and/or surgical management, rehabilitation, and follow up, with handy key point summaries. Key Features * Hundreds of tables, full-color images, and line drawings enhance clinical understanding * Presents patient management problems, focusing on diagnosis, problem-solving, and treatment * Disorders of the retina such as diabetic retinopathy, retinal vein and artery occlusion, AMD, myopic degeneration, chorioretinopathy, vitreous hemorrhage, and retinitis pigmentosa * Neuro-ophthalmologic conditions including optic neuritis, various types of nerve palsy, internuclear ophthalmoplegia, and anisocoria * Pediatric eye conditions -- from leukocoria and torticollis -- to optic nerve hypoplasia This is an essential exam review resource for ophthalmology residents... Its systematic approach provides an ideal teaching tool for ophthalmologists to use in courses and grand rounds.
Leukemia is a systemic malignancy that can compromise various physiological functions, including vision. We report a case of a 37-year-old male presenting with worsening bilateral central vision ...loss, fatigue, shortness of breath, and ankle edema. Ophthalmic examination revealed extensive retinal hemorrhages, Roth spots, and subhyaloid hemorrhages, consistent with leukemic retinopathy. Further hematologic workup confirmed chronic eosinophilic leukemia. The patient showed systemic and visual improvement after prompt treatment with imatinib. This case highlights the importance of ophthalmological assessment in diagnosing leukemia, as ocular manifestations may often be the first sign of hematological disease.
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