Faculty Bibliography

Ocular Baylisascaris procyonis infection results from ingestion of infective eggs of B. procyonis, the raccoon ascarid. Herpes simplex virus type 2 (HSV-2) infection of the retina is the result of either primary infection or reactivated disease. Herein, we report a case of a 12-year-old female resident of the Bronx in New York City, who presented with pan-uveitis and vision loss. Initial evaluation for etiologic causes was nondiagnostic. Serology for anti-Baylisascaris procyonis antibodies in serum and vitreous fluid were both positive. Polymerase chain reaction (PCR) of vitreous fluid was positive for HSV-2. Treatment with vitrectomy, albendazole, and acyclovir resulted in mild improvement of visual acuity. The atypical presentation of B. procyonis in this case, as ocular larva migrans with a peripheral granuloma and retinal detachment, underscores the importance of maintaining a high degree of suspicion for this pathogen even in non-diffuse unilateral subacute neuroretinitis (DUSN) patients in urban areas. This case further illustrates that it is possible to have coexisting infections in cases of posterior uveitis.

Megalocornea in isolation is a rare congenital enlargement of the cornea greater than 13 mm in diameter. Patients with megalocornea are prone to cataract formation, crystalline lens subluxation, zonular deficiencies and dislocation of the posterior chamber intraocular lens (PCIOL) within the capsular bag. A 55-year-old male with megalocornea in isolation developed subluxation of the capsular bag and PCIOL. The PCIOL and capsular bag were explanted, and the patient was subsequently implanted with an anterior chamber iris claw lens. An anterior chamber iris claw lens is an effective option for the correction of aphakia in patients with megalocornea.

22q11.2 Deletion syndrome is one of the most common microdeletional syndromes, with an incidence of 1:4000 live-births, and potentially affects every organ in the body. More than 180 associated clinical features have been reported and not one phenotypic feature is present in 100% of cases. Ocular manifestations reported based on early childhood examinations include eyelid hooding, strabismus, posterior embryotoxon, retinal vessel tortuosity and refractive errors. Keratoconus has been reported once before in association with 22q11.2 deletion syndrome in a young adult. We report the second case of keratoconus in association with 22q11.2 deletion syndrome.

Optic nerve head drusen can be associated with peripapillary choroidal neovascularization, in both the pediatric and adult population. These membranes can involve the macula, causing significant visual loss. Herein, we present a case that required treatment with an anti-VEGF agent. The patient failed to respond to the initial agent, but subsequently responded to a change of agent. Adult patients with macular degeneration involving peripapillary choroidal neovascularization associated with optic nerve head drusen may require individualized treatment plans.

A 55-year old pseudophakic man with megalocornea presented with a progressive monocular diplopia. On examination the patient was found to have subluxation of the posterior chamber intraocular lens (IOL)/capsular-bag-complex. Surgical removal of the complex was performed resulting in aphakic status. The patient was subsequently fitted with a custom contact lens for aphakia, with successful visual rehabilitation.

A 47-year-old woman with a medical history of pseudoxanthoma elasticum and associated choroidal neovascularisation that was successfully managed with intravitreal bevacizumab injections developed non-squamous non-small cell lung carcinoma. The patient's oncological medication regimen included systemic bevacizumab. During the 22 months that the patient received systemic bevacizumab for management of her malignancy, intravitreal bevacizumab injections were held and the patient's visual acuity remained stable and the subretinal space was free of fluid leakage.

Burkholderia cepacia, a Gram-negative bacterium commonly found in water and soil, is a rare cause of endophthalmitis. The authors report a case of a penicillin-allergic patient who presented 15 days after an uneventful injection of ranibizumab for neovascular age-related macular degeneration with culture-positive B cepacia endophthalmitis. Initial antibiotic therapy using non-penicillin-based medications was not successful in eradicating the bacteria. Subsequent treatment with a third-generation cephalosporin resulted in complete resolution of the infection. B cepacia should be included among the bacterial species that may cause endophthalmitis after intravitreal injections.

Silent sinus syndrome is a rare acquired condition that typically presents as enophthalmos and hypoglobus due to atelectasis of the maxillary sinus. The chronic negative pressure in the sinus slowly retracts the orbital floor, altering orbital anatomy and affecting the function of orbital contents. The authors present the first case of acute vertical diplopia as the presenting symptom of silent sinus syndrome.