Faculty Bibliography

PURPOSE: To report a case of an infant born at 30 weeks gestational age (GA) who, at 37 weeks GA, presented with bilateral acute retinal necrosis (ARN) syndrome and herpes simplex virus (HSV) encephalomalacia. METHODS: Observational case report. RESULTS: A premature infant was found to have ARN based on dilated funduscopic examination and positive HSV serologies. Herpes simplex virus encephalomalacia was diagnosed base on magnetic resonance imaging (MRI). CONCLUSION: To our knowledge, this is the youngest reported patient with ARN. This case demonstrates that neonatal ARN may present with posterior chorioretinal lesions and highlights the importance of considering HSV infection of the central nervous system with MRI findings of cystic encephalomalacia.

PURPOSE: To report a case of retinoblastoma infiltrating the iris and ciliary body detected on magnetic resonance imaging. METHODS: A retrospective case report with clinical evaluation, diagnostic testing, enucleation, and pathologic description. RESULTS: A 2-year-old boy presented with hyphema and was noted to have a fluffy whitish iris mass. Retinoblastoma with anterior chamber extension was suggested on magnetic resonance imaging. T2-weighted images demonstrated a hypointense mass with a superficial layer of focal marked hypointensity, consistent with hemorrhage or calcification. Enucleation was performed, and histopathology confirmed retinoblastoma infiltrating the iris and ciliary body. No further treatment was administered, and the patient remains free of associated disease at age 5 years. CONCLUSION: Retinoblastoma can invade the iris and ciliary body stroma. The use of magnetic resonance imaging in evaluating cases of anterior segment masses can demonstrate findings suggestive of retinoblastoma.

A cellular dermal graft (ADG) functions as a scaffold to harness nature's regenerative healing process. Frequently used in eyelid and orbital surgery, application of ADG to the globe has not been reported, to our knowledge. In a patient with a complicated ocular history, wound dehiscence with Ahmed valve extrusion developed. Several attempts to repair the extrusion were made with commonly used biomaterials, resulting in recurrent wound dehiscence. An ADG was placed with glue and then sutured to the edge of the dehiscence. The conjunctiva grew over the graft, allowing the wound to close. The wound site has been intact for more than 3 years. We report the first successful use to date of ADG on the globe. In difficult cases of wound repair on the globe, ADG may be an alternative to conventional graft materials

Sequestration of bacteria within the capsular fornices after cataract extraction with intraocular lens implantation can cause both acute and chronic inflammation. A case of persistent postoperative endophthalmitis caused by capsular sequestration of Cellulomonas is described. The patient underwent uncomplicated cataract extraction with intraocular lens implantation and subsequently developed acute postoperative endophthalmitis. Inflammation persisted despite several vitreous taps and the injection of intravitreal antibiotics. Definitive treatment required pars plana vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal and parenteral antibiotics. In patients with postoperative endophthalmitis, one must consider atypical organisms as the source and should consider explantation of the intraocular lens with capsular bag removal

PURPOSE: To document a case of peripheral ulcerative keratitis (PUK) that progressed to corneal perforation in the setting of recently diagnosed sarcoidosis. DESIGN: Observational case report. METHODS: A 42-year-old white woman presented with a 2-day history of tearing and decreased vision OD, secondary to PUK with corneal perforation. Slit-lamp evaluation revealed bilateral peripheral corneal thinning with vascularized scarring. History, clinical examination, chart review, peripheral lamellar keratoplasty, serologies, and bronchoscopy with biopsy were performed. RESULTS: After lamellar keratoplasty, visual acuity was 20/400 OD and 20/20 OS. She was treated with oral prednisone and high-dose Cytoxan therapy. One year postperforation, she received a limbus-to-limbus penetrating keratoplasty OD. One year after penetrating keratoplasty, the patient's BCVA OD is 20/40. She has stable scarring OS. Workup has revealed serologic and pathologic evidence of sarcoidosis without evidence of any other seropositive vasculitic disease. CONCLUSION: This patient represents the first known case report of PUK in sarcoidosis. Oral Cytoxan, steroids, and topical cyclosporine have stabilized the disease process in this patient

Visual loss resulting from retinal vascular disorders can be the presenting sign of serious systemic disease. Associations between retinal vein thrombosis and other systemic disorders have been well documented, but a comprehensive literature search failed to reveal any report of essential thrombocythemia as a cause of central retinal vein thrombosis. We describe the first young female patient with symptomatic visual loss due to central retinal vein thrombosis as her presenting symptom of essential thrombocythemia

A 60-year-old woman had a slow-growing cutaneous nodule of her left brow. After initial excisional biopsy, the lesion recurred within 1 week. After tissue diagnosis was confirmed, the recurrent mass was excised under frozen section control and the defect was reconstructed with a forehead flap. This unusual tumor involved the brow and eyelid, down to the level of the orbital septum. The patient remains free of disease after 20 months

The protozoan parasite Toxoplasma gondii is an important cause of ocular disease. Ocular toxoplasmosis (OT) can be a progressive and recurring disease that can threaten visual function. We present 2 cases of recurrent OT in immunocompetent patients for whom prophylaxis prevented recurrence of disease.

DESIGN: To report the second known case of post-traumatic endophthalmitis caused by Neisseria subflava. DESIGN: Interventional case report. METHODS: A two-year-old child with post-traumatic corneal laceration and uveal prolapse required medical and surgical therapy for endophthalmitis caused by multiple organisms including N. subflava. RESULTS: After aggressive therapy, patient had a favorable outcome without vision compromise. CONCLUSIONS: As there is still not a standard protocol for therapy for post-traumatic endopthalmitis, we recommend the use of broad-spectrum antibiotics via intravitreal, intravenous, and topical routes. Consideration of typical and unusual bacteria that have been reported to cause endopthalmitis, as well as the source of injury, should guide antibiotic choice