Faculty Bibliography

Streptococcus agalactiae (SA) is a Group B Streptococcus, which is a common pathogen implicated in neonatal and geriatric sepsis. Endogenous bacterial endophthalmitis (EBE) is a condition that results from haematogenous seeding of the globe, during transient or persistent bacteremia. We document a case of a non-septic geriatric patient, who developed EBE after a transient bacteraemia with SA.

Ocular toxoplasmosis is the most common cause of posterior uveitis in the United States and worldwide. It commonly follows a relapsing course with the potential for multiple adverse visual sequelae and, rarely, blindness. Both immune-competent and immune-suppressed populations can develop severe relapsing disease. There is considerable debate regarding the initial treatment of ocular toxoplasmosis in both groups, with multiple antiparasitic agents commonly used with little evidence to support any particular regimen. The precise role of corticosteroids in treatment also has yet to be rigorously defined. Secondary prevention is commonly implemented in the immune suppressed population, but there is a lack of level one evidence to support its role in immune-competent patients, though it warrants future investigation.

PURPOSE: To describe a case of retrobulbar optic neuritis that presented within 3 weeks of adalimumab treatment initiation. METHODS: This index case was evaluated with visual field testing, brain magnetic resonance imaging, lumbar puncture, and laboratory evaluation, and treated with intravenous methylprednisolone followed by a steroid taper. RESULTS: Our patient made a full visual recovery, but was found to have extensive T2/FLAIR foci of hyperintensities that enhanced and had restricted diffusion on magnetic resonance imaging (MRI). Six months later, these demyelinating lesions still persisted and our patient was initiated on immunomodulatory treatment. CONCLUSION: With the extensive burden of disease at presentation and persistence of lesions on follow-up MRI, this unusual case seems to suggest an unmasking of an underlying demyelinating process by adalimumab. The clinician should be mindful of this association and monitor for any manifestations and treat appropriately.

Topiramate, a sulpha-based medication used in the treatment of migraine, has been documented as causing choroidal effusions, transient myopia and acute secondary angle closure glaucoma. We would like to report a case demonstrating these adverse effects and underscore the utility of ultrasound biomicroscopy in diagnosis and management.

BACKGROUND AND OBJECTIVE: Damaged optics of an intraocular lens (IOL) can impair visual functioning. Damage can occur during the manufacturing process, during implantation, or during post-implantation Nd:YAG laser posterior capsulotomy. An in vitro experiment was performed to identify the potential IOL damage patterns associated with the use of the Nd:YAG laser for posterior capsulotomy. PATIENTS AND METHODS: A review of the literature regarding Nd:YAG laser damage to IOLs was performed. The objectives were to describe the damage patterns to a sample IOL by performing virtual posterior capsulotomies. RESULTS: Patterns of damage were demonstrated and described. CONCLUSION: Although optic damage can occur with use of the Nd:YAG laser, it is infrequent and usually the result of improper depth of focus.

Comitant infantile exotropia is a rare entity and is far less common than infantile esotropia. It has been shown to be highly correlated with intracranial pathology. We report a case of a medulloblastoma in a child in whom it presented as an incomitant esotropia after surgical correction for comitant infantile exotropia