José I. Vela

Acute-Onset Endophthalmitis Caused by Alloiococcus otitidis following a Dexamethasone Intravitreal Implant.

Purpose: To report the first case of acute endophthalmitis caused by Alloiococcus otitidis after a dexamethasone intravitreal implant. Methods: A 74-year-old female was treated with intravitreal Ozurdex® in her left eye for central retinal vein occlusion (CRVO). Best-corrected visual acuity (BCVA) in the eye was 4/20. Intravitreal injection was uneventful. At 48 h after injection, she developed ocular pain and visual acuity had dropped to light perception. Endophthalmitis associated with intravitreal injection was suspected. Results: The patient did not show a favorable clinical response following systemic, intravitreal, and topical fortified antibiotics. We then performed a vitreous biopsy and removed the Ozurdex implant by pars plana vitrectomy. A vitreous culture was positive for A. otitidis. At the 2-month follow up, no inflammation was observed, but due to CRVO and probably aggravated by endophthalmitis, the fundus showed macular fibrosis. The final BCVA was finger counting at 30 cm in her left eye. Conclusions: In cases of an intravitreal implant associated with endophthalmitis, we recommend removal of the device because it may act as a permanent reservoir of organisms if it remains in the vitreous cavity.

Intraocular lens dislocation after whole-body vibration

We present 2 cases of intraocular lens (IOL) dislocation that appeared shortly after the patients exercised on a vibration platform. The first patient was a 71-year-old woman who presented with lens subluxation in her right eye and a complete posterior IOL dislocation in her left eye. The second case was a 62-year-old woman who presented with unilateral IOL dislocation within the capsular bag in her right eye. Timing from IOL implantation to dislocation was approximately 6 years and 4 years, respectively. Pars plana vitrectomy with removal of the dislocated IOL was performed in both patients. Whole-body vibration training has become increasingly popular as a form of exercise training. It reportedly may provide benefits in physical function and in some diseases, especially in older people. However, evidence-based protocols ensuring safety and efficacy in this population are lacking. We discuss vibration as a cause of late IOL dislocation.

Haemorrhage of a cavernous haemangioma of the optic disc in pregnancy.

A healthy 29-year-old woman presented at 20 weeks’ gestation with a 3-week history of a paracentral scotoma in her right eye. Visual acuity was 20/20 in both eyes. Fundus examination of the right eye showed a mass of numerous, grape-like, aneurysms filled with dark blood along the optic disc. White fibroglial tissue covered the surface. A triangular haemorrhage was observed in the macular area, under the internal limiting membrane, and stopping just at the …

Regression of late onset choroidal metastasis from a breast carcinoma with letrozole.

We report the case of a 50-year-old woman with a history of diabetes mellitus who underwent left breast lumpectomy and ipsilateral lymphadenectomy in 1994 because of an infiltrating ductal carcinoma. Chemotherapy followed by radiotherapy to the breast and nodal areas were performed. In 2010, in a routine screening for diabetic retinopathy, two choroidal elevated masses above and below the optic nerve associated to serous retinal detachment of her right eye were noted. The patient was asymptomatic. Carcinoma was positive for hormone receptor. Hormone treatment with letrozole was established. Complete regression of the choroidal metastasis was observed 3 months later. Ophthalmologic screening in asymptomatic patients with breast cancer has the advantage of being a noninvasive procedure and enables an early treatment in isolated cases. However, some studies are an argument against the usefulness of eye screening due to the low incidence of asymptomatic choroidal metastasis and the cost that involves performing it routinely in a large number of patients. Aromatase inhibitors are well-tolerated drugs that may be a powerful tool in the management of metastatic breast cancer that express hormone receptors.

Combined retinal detachment and candida chorioretinitis

To report a case of slowly progressive traction and rhegmatogenous retinal detachment after successfully managed candida chorioretinitis. A 44-year-old immunocompromised woman was treated with voriconazole for fungal chorioretinitis. Six months after onset she developed a combined retinal detachment. Slow progression of retinal detachment was observed and vitrectomy was performed. The macular area remained attached and visual acuity was maintained. Ophthalmologists should be aware of this unusual complication after the resolution of active candida chorioretinitis.

Pupillary block glaucoma in phakic eyes using 5000 centistoke silicone oil.

PURPOSE To describe pupillary block glaucoma in phakic patients undergoing vitrectomy and 5000 centistoke silicone oil injection. DESIGN Observational case reports. METHODS Vitrectomy and higher-viscosity silicone oil injection was performed in two phakic patients with proliferative diabetic retinopathy. RESULTS Both patients developed a pupillary block in the early postoperative period (1 week and 1 month after surgery). Unnoticed zonulysis during surgery, thought to be the main contributory cause, allowed access of the silicone oil between the iris and the lens. Although higher-viscosity silicone oil was used in both cases, an acute glaucoma developed. An inferior iridotomy was performed, resulting in a temporary resolution of the pupillary block. CONCLUSION Vitreoretinal surgeons should be aware of silicone-induced pupillary block glaucoma in phakic eyes, even when higher-viscosity silicone oils are used.