Traumatic subtotal hyphema in a child with vitamin K deficiency.
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Atropine↗
Biomedical subjects
Jaime Levy
Publications and source records attributed to Jaime Levy.
Severe conjunctival and eyelid involvement in pemphigus vulgaris.
Pemphigus vulgaris (PV) is only rarely associated with severe ocular involvement. We present a case of PV with bilateral severe swelling, induration and thickening of eyelids, and multiple conjunctival and lid margin erosions, complicated by high intraocular pressure secondary to steroid treatment. After successful systemic immunosuppressive, steroid, and antiglaucomatous treatment, clinical features were resolved, and intraocular pressure returned to normal. Severe ocular diseases without dermatological involvement may be present in PV patients.
Adult↗
Intrasinus wood foreign body causing orbital cellulitis in congenital insensitivity to pain with anhidrosis syndrome.
A 2-year-old boy with congenital insensitivity to pain with anhidrosis (CIPA) was referred with a 2-day history of left periorbital swelling and mucoid conjunctival discharge. Marked worsening was noted despite intramuscular ceftriaxone treatment for 3 days, with marked proptosis, conjunctival chemosis, and a frozen eye. Orbital cellulitis was suspected. Ceftriaxone was intravenously administered. Orbital computed tomography (CT) disclosed an inflammatory process in the medial aspect of the left orbit with ethmoiditis. Improvement was not noted after external ethmoidectomy and drainage of the intraconal abscess. Repeat CT showed a recurrent intraconal abscess. A revision external ethmoidectomy was performed, and a bent wooden match was removed from the posterior aspect of the ethmoidal sinus, after which significant clinical improvement was noted. In patients with CIPA, accidental or self-penetrated foreign bodies must be kept in mind when treating all types of wounds.
Cellulitis↗
Ophthalmic manifestations in Langerhans cell histiocytosis.
Histiocytosis of childhood is characterized by localized or generalized proliferation of cells of the mononuclear phagocyte system and the dendritic cell system. In patients with Langerhans cell histiocytosis, the orbit is the most involved site encountered in ophthalmic practice, usually as a lytic lesion in the zygomaticofrontal suture. Patients usually present with acute or chronic periorbital swelling. Electron microscopic findings of Birbeck granules and positive staining for CD1 antigenic determinant confirm the diagnosis.
Eye Diseases↗
Endoscopic orbital decompression for Graves' ophthalmopathy.
BACKGROUND: In patients with Graves' ophthalmopathy, orbital decompression surgery is indicated for compressive optic neuropathy, severe corneal exposure, or for cosmetic deformity due to proptosis. Traditionally this has been performed through a transantral approach, but the associated complication rate is high. More recently, endoscopic orbital decompression has been performed successfully with significantly fewer postoperative complications. OBJECTIVE: To report our experience of endoscopic orbital decompression in patients with severe Graves' ophthalmopathy. METHODS: Three patients (five eyes) underwent endoscopic orbital decompression for Graves' ophthalmopathy at Soroka Medical Center between the years 2000 and 2002. The indications for surgery were compressive optic neuropathy in three eyes, severe corneal exposure in one eye, and severe proptosis not cosmetically acceptable for the patient in one case. An intranasal endoscopic approach with the removal of the medial orbital wall and medial part of the floor was performed. RESULTS: In all five eyes an average reduction of 5 mm in proptosis was achieved. Soon after surgery, visual acuity improved in the three cases with compressive optic neuropathy, and exposure keratopathy and cosmetic appearance also improved. The diplopia remained unchanged. No complications were observed postoperatively. CONCLUSIONS: Endoscopic orbital decompression with removal of the medial orbital wall and medial part of the floor in the five reported eyes was an effective and safe procedure for treatment of severe Graves' ophthalmopathy. A close collaboration between ophthalmologists and otorhinolaryngologists skilled in endoscopic sinus surgery is crucial for the correct management of these patients.
Adult↗
[Primary congenital glaucoma].
Primary congenital glaucoma (PCG) is a rare genetic disease usually diagnosed during the first year of life. It occurs because of developmental anomalies of the chamber angle that prevents drainage of aqueous humor, thereby elevating intraocular pressure. Its incidence is 1 in 10,000 live newborns in Western societies and 1 in 1,200 live newborns in the Arab-Bedouin population of the Negev region in Israel. Most cases of PCG appear to be sporadic. The cytochrome P4501B1 gene located within the GLC3A locus on chromosome 2p21 is mutated in individuals with PCG. The triad of epiphora, photophobia, and blepharospasm is classical for PCG. General anesthesia is usually required for an adequate examination of intraocular pressure, corneal diameter, optic disc, and axial length in young children. Congenital glaucoma is almost always managed surgically, with medical therapy being used only as a temporizing measure before surgery or when surgical intervention has repeatedly failed. At least 50% of eyes with PCG presenting at birth will become legally blind (visual acuity < 6/60). Patients with PCG require follow-up examinations throughout their lives.
Aryl Hydrocarbon Hydroxylases↗
Langerhans cell histiocytosis with periorbital cellulitis.
PURPOSE: To report a case of Langerhans cell histiocytosis presenting as periorbital cellulitis. DESIGN: Interventional case report. METHODS: A 3-year-old girl presented with periorbital swelling of the right upper lid laterally of two days' duration. A history of recent eye trauma was reported. RESULTS: Computed tomography showed a soft tissue mass that eroded the frontozygomatic suture. The lesion was debulked through a lateral orbitotomy. Electron microscopy disclosed Birbeck granules. Immunohistochemistry stained positively for CD68 and CD1a antigenic determinants. CONCLUSIONS: Although rare, Langerhans cell histiocytosis can cause acute periorbital cellulitis in children. Trauma can induce an inflammatory response, allowing for earlier diagnosis of the orbital lesion.
Antigens, CD↗
Active spontaneous bleeding from optic disc neovascularization during fluorescein angiography.
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Adult↗
Consecutive central retinal artery and vein occlusions in primary antiphospholipid syndrome.
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Adult↗
Bacterial keratitis after laser subepithelial keratectomy.
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Adult↗
Laser in situ keratomileusis for correction of myopia in eyes after retinal detachment surgery.
PURPOSE: To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) for correction of myopia in eyes with previous retinal detachment surgery. METHODS: A retrospective review was conducted of all consecutive eyes that underwent LASIK after retinal detachment surgery. Data was collected regarding previous ocular surgery and its time prior to LASIK, intra- and postoperative complications, and visual outcome measures pre- and postoperatively. RESULTS: Ten eyes with previous retinal detachment surgery were scheduled for LASIK. One eye was excluded from data analysis as LASIK was aborted due to inadequate microkeratome suction because of conjunctival scarring. Nine eyes underwent an uneventful LASIK procedure. On average, LASIK was performed 130+/-123 months following retinal detachment surgery. Postoperative LASIK follow-up was 14.8+/-12.5 months. No significant intraoperative, postoperative, or retinal complications were observed. The mean preoperative spherical equivalent refraction was -9.00+/-3.00 diopters (D), uncorrected visual acuity (UCVA) was 0.06+/-0.02, and best spectacle-corrected visual acuity (BSCVA) was 0.64+/-0.16. At the end of follow-up, the mean spherical equivalent refraction was 0.65+/-0.88 D, mean UCVA was 0.57+/-0.14, and mean BSCVA was 0.72+/-0.19. Differences between BSCVA before and after LASIK were statistically significant (P=.038). At final follow-up, the safety index was 1.22 and efficacy index was 1.01. CONCLUSIONS: Laser in situ keratomileusis was found to be a safe and efficient option for treating refractive errors in eyes with previous retinal detachment surgery.
Adult↗
Herpes simplex virus keratitis after laser in situ keratomileusis.
PURPOSE: To report two cases of herpes simplex virus (HSV) keratitis after laser in situ keratomileusis (LASIK). METHODS: Interventional small case series. Two patients underwent uneventful LASIK. History of herpes labialis in one patient and herpetic eye disease > 10 years prior to intervention in the other patient was reported. Both patients developed stromal herpetic keratitis 6 weeks and 2 years after the procedure, respectively. RESULTS: Treatment consisting of topical steroid drops and topical and systemic antiviral therapy was administered. Recurrences of the herpetic keratitis were seen after tapering of the topical steroids; four and three recurrences were observed, respectively. Final visual acuity was > 6/9 in both cases. CONCLUSIONS: Herpetic keratitis after LASIK is an uncommon, possibly under-reported, entity. Even patients without history of herpetic eye disease can present with this complication. Oral antiviral prophylaxis may be appropriate when performing LASIK on patients with a history of ocular or systemic HSV infection.
Acyclovir↗
Late bilateral keratectasia after LASIK in a low myopic patient.
PURPOSE: To report a rare case of late bilateral ectasia developing after LASIK for low myopia without preoperative risk factors. METHODS: A 21-year-old man underwent bilateral uneventful LASIK for low myopia of -2.75 diopters in both eyes. Preoperative corneal pachymetry was 531 microm in the right eye and 526 microm in the left eye. The total ablation depth was 46.8 microm in the right eye and 42.2 microm in the left eye. Preoperative corneal topography was normal and did not reveal forme fruste keratoconus. RESULTS: Twenty-four months postoperatively, the patient developed bilateral inferior keratectasia of +0.50 -3.00 x 72 degrees in the right eye and +1.00 -2.75 x 99 degrees in the left eye. CONCLUSIONS: Late keratectasia may follow LASIK for low myopia despite a thorough preoperative work-up.
Adult↗
Two cases of pneumococcal keratitis following myopic LASIK.
PURPOSE: To report two cases of pneumococcal keratitis after LASIK. METHODS: Retrospective interventional small case series of two patients who underwent bilateral LASIK for myopia and developed pneumococcal keratitis after surgery. This complication was encountered 2 days after surgery in one eye in both cases. The corneal flap was lifted, and irrigation and cultures from the stromal bed performed. Topical and subconjunctival antibiotics were started. RESULTS: Culture revealed Streptococcus pneumoniae in both cases. The infiltrates responded well to treatment. One year after the procedure, uncorrected visual acuity is > 20/40 in both cases. CONCLUSIONS: Pneumococcal keratitis can complicate LASIK. Patients should be informed of this potential complication, as prompt treatment is crucial.
Adult↗
Treatment of subfoveal choroidal neovascularization secondary to choroidal nevus using photodynamic therapy.
A 52-year-old man sought treatment for decreased vision in his right eye for 3 weeks. Visual acuity was 20/120. Examination revealed an elevated choroidal nevus at the posterior pole. Fluorescein and indocyanine green angiographies disclosed fibrovascular pigment epithelial detachment extending under the fovea. The patient was treated by two sessions of photodynamic therapy with verteporfin. Visual acuity improved to 20/40. The fibrovascular pigment epithelial detachment area diminished and the fovea is clear of lesion. Seven months after the last treatment, visual acuity remains stable. Photodynamic therapy with verteporfin could be an effective option for treating subfoveal choroidal neovascularization secondary to choroidal nevus.
Choroid Neoplasms↗
Posteriorly dislocated capsular tension ring.
A 69-year-old man who had pseudoexfoliation and significant nuclear cataract underwent cataract surgery in his right eye. At the beginning of the phacoemulsification, inferior zonulolysis was observed and a capsular tension ring was implanted. Anterior vitrectomy was also performed because of vitreous in the anterior chamber at the end of surgery. A tear in the posterior capsule could not be identified. Three days after surgery, the capsular tension ring was observed partially in the anterior vitreous. A 3-port pars plana vitrectomy was performed and the ring was removed. Three weeks later, the eye developed retinal detachment and was successfully repaired. Retinal complications can develop if the capsular tension ring moves into the vitreous.
Aged↗