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To describe the ophthalmic findings and diagnosis of a case of intravascular large B-cell lymphoma. Clinical case observational report. A Spanish 51-year-old man referred to our hospital with a diagnosis of panuveitis. The patient presented with blurred vision, photophobia, fever, and weight loss. Ocular examination revealed anterior uveitis, vitritis, and multiple round and oval creamy spots on the posterior pole. Fluorescein angiography, optical coherence tomography (OCT), and angio-OCT were used for the ocular examination. The diagnosis of lymphoma was formulated on the basis of a random normal skin biopsy, which showed significant CD20 cellularity within the vessels and extensive CD3 expression. Intravascular lymphoma is a rare form of extranodal diffuse large B-cell lymphoma, often with delayed diagnosis because of the nonspecific symptoms. Hence, random skin biopsy could be useful in the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Anterior ischemic optic neuropathy (AION) is an ischemic disorder of the optic nerve and a common cause of acute, painless, permanent vision loss. It is divided into two types: arteritic AION (AAION) and non-arteritic anterior ischemic optic neuropathy (NAION). Although subretinal fluid associated with optic disc edema has been reported in cases of NAION, it is rarely described in AAION. Case Presentation: An 86-year-old female with a history of polymyalgia rheumatica presented with sudden vision loss in the left eye. Initial examination revealed left pallid optic disc edema with peripapillary hemorrhages. Optical coherence tomography (OCT) of the left macula showed intraretinal and submacular fluid. The patient was started on 50 mg of oral prednisone daily. The diagnosis of giant cell arteritis (GCA) was later confirmed with a positive temporal artery biopsy. Three weeks after presentation, an OCT was completed which demonstrated complete resolution of the intraretinal and submacular fluid. Although the presence of both intraretinal and subretinal fluid has been previously documented in cases of NAION, it is rarely reported in a patient with GCA. Conclusion: This is a newly described case of subretinal and intraretinal fluid in a patient with AAION. We postulate that the pathophysiology behind this is mediated by associated choroidal ischemia leading to altered permeability. OCT is an important imaging modality allowing for signs of GCA to be better characterized.

Purpose: The purpose of this study was to describe an atypical and severe case of giant cell arteritis (GCA). Methods: This was a case report description. Results: The authors report the case of a 76-year-old man who presented with severe and progressive bilateral visual loss. On presentation at the ophthalmology emergency room, the patient's right eye (OD) displayed aqueous flare, hyphema, rubeosis iridis, and dense posterior capsular opacification. After YAG laser capsulotomy, vitreous densifications, intraretinal hemorrhages, cotton wool spots, retinal ischemia, and vasculitis were observed in the fundoscopy. The patient's left eye (OS) also presented intraretinal hemorrhages and cotton wool spots around the temporal arcades. The diagnostic workup excluded infectious diseases, demyelinating diseases, and ocular ischemic syndrome due to carotid obstruction. Proteinogram revealed a monoclonal gammopathy, suggesting a possible hematologic condition. High-dose corticotherapy was initiated, which improved the vitreous densifications and enabled the visualization of the pale optic disk. The remaining study did not confirm the diagnosis of hematologic disease. During follow-up, bilateral VA deteriorated, with the development of progressive pallor in the OS optic disk. Follow-up fluorescein angiography demonstrated progressive retinal and choroidal ischemia. Finally, owing to high clinical suspicion, temporal artery Doppler ultrasound was performed, confirming the diagnosis of GCA. Conclusion: GCA may present multiple ocular features. The knowledge of these different presentations, including retinal and choroidal ischemia or uveitis, is critical for timely diagnosis and treatment initiation. Since patients with GCA often present with vision loss, ophthalmologists may be the first medical doctors who contact with these patients, being on the frontline of GCA diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of Current Retina Journal / Güncel Retina Dergisi is the property of Anadolu Kitabevi Basim Yayim Medikal Turizm Kirtasiye Tic. Ltd. Sti. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Choroidal atrophy is a common fundus pathological change closely related to the development of age‐related macular degeneration (AMD), retinitis pigmentosa, and pathological myopia. Studies suggest that choroidal endothelial cells (CECs) that form the choriocapillaris vessels are the first cells lost in choroidal atrophy. It is found that endothelial cells derived from human pluripotent stem cells (hPSC‐ECs) through the MESP1+ mesodermal progenitor stage express CECs‐specific markers and can integrate into choriocapillaris. Single‐cell RNA‐seq (scRNA‐seq) studies show that hPSC‐ECs upregulate angiogenesis and immune‐modulatory and neural protective genes after interacting with ex vivo ischemic choroid. In a rat model of choroidal ischemia (CI), transplantation of hPSC‐ECs into the suprachoroidal space increases choroid thickness and vasculature density. Close‐up examination shows that engrafted hPSC‐ECs integrate with all layers of rat choroidal vessels and last 90 days. Remarkably, EC transplantation improves the visual function of CI rats. The work demonstrates that hPSC‐ECs can be used to repair choroidal ischemia in the animal model, which may lead to a new therapy to alleviate choroidal atrophy implicated in dry AMD, pathological myopia, and other ocular diseases. [ABSTRACT FROM AUTHOR]

Introduction: Anterior ischemic optic neuropathy (AION) is an ischemic disorder of the optic nerve and a common cause of acute, painless, permanent vision loss. It is divided into two types: arteritic AION (AAION) and non-arteritic anterior ischemic optic neuropathy (NAION). Although subretinal fluid associated with optic disc edema has been reported in cases of NAION, it is rarely described in AAION. Case Presentation: An 86-year-old female with a history of polymyalgia rheumatica presented with sudden vision loss in the left eye. Initial examination revealed left pallid optic disc edema with peripapillary hemorrhages. Optical coherence tomography (OCT) of the left macula showed intraretinal and submacular fluid. The patient was started on 50 mg of oral prednisone daily. The diagnosis of giant cell arteritis (GCA) was later confirmed with a positive temporal artery biopsy. Three weeks after presentation, an OCT was completed which demonstrated complete resolution of the intraretinal and submacular fluid. Although the presence of both intraretinal and subretinal fluid has been previously documented in cases of NAION, it is rarely reported in a patient with GCA. Conclusion: This is a newly described case of subretinal and intraretinal fluid in a patient with AAION. We postulate that the pathophysiology behind this is mediated by associated choroidal ischemia leading to altered permeability. OCT is an important imaging modality allowing for signs of GCA to be better characterized. [ABSTRACT FROM AUTHOR]

Abstract Choroidal atrophy is a common fundus pathological change closely related to the development of age‐related macular degeneration (AMD), retinitis pigmentosa, and pathological myopia. Studies suggest that choroidal endothelial cells (CECs) that form the choriocapillaris vessels are the first cells lost in choroidal atrophy. It is found that endothelial cells derived from human pluripotent stem cells (hPSC‐ECs) through the MESP1+ mesodermal progenitor stage express CECs‐specific markers and can integrate into choriocapillaris. Single‐cell RNA‐seq (scRNA‐seq) studies show that hPSC‐ECs upregulate angiogenesis and immune‐modulatory and neural protective genes after interacting with ex vivo ischemic choroid. In a rat model of choroidal ischemia (CI), transplantation of hPSC‐ECs into the suprachoroidal space increases choroid thickness and vasculature density. Close‐up examination shows that engrafted hPSC‐ECs integrate with all layers of rat choroidal vessels and last 90 days. Remarkably, EC transplantation improves the visual function of CI rats. The work demonstrates that hPSC‐ECs can be used to repair choroidal ischemia in the animal model, which may lead to a new therapy to alleviate choroidal atrophy implicated in dry AMD, pathological myopia, and other ocular diseases.

Central serous chorioretinopathy (CSCR) is a retinal disease that may be complicated by the development of serous retinal pigment epithelial detachment (PED). The exact molecular mechanisms of CSCR have remained uncertain as well as there is no effective medical therapy. Herein, we describe a case of a 43-year-old male suffering from chronic CSCR with PED and visual acuity reduction (20/40) that showed improvement in visual acuity (20/25) and metamorphopsia 2 weeks after daily intake of 20 mg sildenafil tablets. Optical coherence tomography (OCT) scan showed resolution of PED with residual degeneration of the photoreceptor inner and outer segment layer and retinal pigmented epithelium. The patient continued treatment with sildenafil 20 mg for 2 months. Six months after the discontinuation of therapy, visual acuity was maintained, with absence of PED at OCT. Our case supports the hypothesis that phosphodiesterase type 5 (PDE-5) inhibitors may be an alternative in the treatment of patients with CSCR, alone or combined with other medications.

A 57‐year‐old male known case of diabetes mellitus presented with gradually bilateral decreased vision accompanied by ocular pain two weeks after diagnosis of SARS‐CoV‐2 infection. The results of examination and imaging were indicative of bilateral anterior ischemic optic neuropathy (AION) and massive choroidal ischemia, which may be associated with SARS‐CoV‐2‐induced damages, including endothelial damage, hypercoagulable state, and hypoxia. [ABSTRACT FROM AUTHOR]

Abstract A 57‐year‐old male known case of diabetes mellitus presented with gradually bilateral decreased vision accompanied by ocular pain two weeks after diagnosis of SARS‐CoV‐2 infection. The results of examination and imaging were indicative of bilateral anterior ischemic optic neuropathy (AION) and massive choroidal ischemia, which may be associated with SARS‐CoV‐2‐induced damages, including endothelial damage, hypercoagulable state, and hypoxia.

Central serous chorioretinopathy (CSCR) is a retinal disease that may be complicated by the development of serous retinal pigment epithelial detachment (PED). The exact molecular mechanisms of CSCR have remained uncertain as well as there is no effective medical therapy. Herein, we describe a case of a 43-year-old male suffering from chronic CSCR with PED and visual acuity reduction (20/40) that showed improvement in visual acuity (20/25) and metamorphopsia 2 weeks after daily intake of 20 mg sildenafil tablets. Optical coherence tomography (OCT) scan showed resolution of PED with residual degeneration of the photoreceptor inner and outer segment layer and retinal pigmented epithelium. The patient continued treatment with sildenafil 20 mg for 2 months. Six months after the discontinuation of therapy, visual acuity was maintained, with absence of PED at OCT. Our case supports the hypothesis that phosphodiesterase type 5 (PDE-5) inhibitors may be an alternative in the treatment of patients with CSCR, alone or combined with other medications. [ABSTRACT FROM AUTHOR]

Copyright of Current Retina Journal / Güncel Retina Dergisi is the property of Anadolu Kitabevi Basim Yayim Medikal Turizm Kirtasiye Tic. Ltd. Sti. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 67-year-old woman with paraplegia and acute painless vision loss in the right eye 6 months ago showed triangular regions of pigmentary change in both eyes suggestive of choroidal ischemia. Extensive workup showed negative results. The patient subsequently developed vision loss in her left eye. Brain biopsy revealed intravascular lymphoma. Purpose and Methods: To report a case of bilateral ocular ischemia caused by intravascular lymphoma with the presence of bilateral triangular sign of Amalric. Results: A 67-year-old woman was admitted to our hospital for progressive paraplegia and a 6-month history of acute painless vision loss in the right eye. Initial examination showed vision of counting fingers in the right eye and 20/20 in the left eye with normal anterior examination. Fundus examination revealed a likely previous central retinal artery occlusion in the right eye with pale nerve and attenuated vessels. Both fundi had triangular regions of pigmentary change known as the triangular sign of Amalric, indicative of choroidal ischemia. However, the left eye was asymptomatic. Neuroimaging revealed multifocal enhancing lesions throughout the central nervous system of unclear etiology. An extensive neurologic and systemic workup was unrevealing, including a brain biopsy, and empiric treatment for an unspecified inflammatory condition with intravenous corticosteroids was initiated. During her hospitalization, she developed acute painless vision loss in the left eye, and examination showed no light perception vision in both eyes with signs of acute retinal and choroidal ischemia in the left eye. A subsequent brain biopsy revealed intravascular lymphoma. Conclusion: Triangular pigmentary changes indicate choroidal ischemia and can be seen in many conditions. This patient presented with the triangular sign of Amalric in both eyes, including her asymptomatic left eye. Intravascular lymphoma should be considered in cases of concomitant inflammatory brain lesions and chorioretinal ischemia. [ABSTRACT FROM AUTHOR]

Purpose: To report the first case of a patient with essential thrombocythemia (ET) who presented with unilaterally extensive choroidal ischemia coinciding with central retinal artery occlusion (CRAO).Observations: A 64-year-old man presented with a classic sign of short posterior ciliary artery (SPCA) occlusion, Amalric triangular choroidal infarction, coinciding with CRAO in the left eye. He was later diagnosed as having ET due to a massive platelet count of 1,100,000 cells/mm3 and confirmed genetic testing. The magnetic resonance angiogram subsequently revealed severe occlusions of neuro-ophthalmic circulation. Interestingly, occult choriocapillaris occlusions were detected in the right eye despite being visually asymptomatic. Conclusion and importance: Patients with ET can present with concurrent CRAO and SPCA occlusion. Identifying the causes of such events is crucial as these can precede systemic thrombocytosis or hemorrhagic complications.

Purpose: We describe a healthy 37-year-old man with Bartonella henselae (B. henselae) neuroretinitis with concurrent central retinal vein occlusion and ischemic optic neuropathy resulting in optic atrophy and choroidal ischemia. Methods: Case report. Results: A 37-year-old man presented with unilateral decreased vision and a fundus examination consistent with neuroretinitis. Further imaging review supported a concurrent diagnosis of central retinal vein occlusion. Although initially negative, repeat serological testing for B. henselae infection was positive. Multimodal imaging displayed severe outer retinal disruption, ischemic optic neuropathy, and choroidal ischemia. The patient demonstrated near complete resolution of fundus findings and restoration of outer retinal architecture. Residual findings included optic disk pallor and ischemic choroidopathy. Discussion: B. henselae neuroretinitis may be associated with concurrent retinal vascular occlusive disease and ischemic optic neuropathy. Central retinal vein occlusion and choroidal ischemia leading to optic nerve atrophy are additional sequelae further expanding the clinical spectrum of this entity. [ABSTRACT FROM AUTHOR]

Preeclampsia is an obstetric complication that affects approximately 5% of pregnant women. The visual system may be affected with variable manifestations and variable intensity. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis may be related to the choroïdal ischemia secondary to arteriolar vasospasm. We report a case of 36-year-old woman who developed severe preeclampsia in her first pregnancy with blurred vision secondary to bilateral serous retinal detachment. [ABSTRACT FROM AUTHOR]

Temporal arteritis is a subacute systemic panarteritis with predilection over cranial arteries. Anterior ischemic optic neuropathy with or without the typical sectoral choroidal ischemia is the most common complication. However isolated multifocal choroidal ischemia is an uncommon finding in giant cell arteritis. We report a case of unilateral multifocal choroidal ischemia revealing a giant cell arteritis.

Giant cell arteritis is a systemic granulomatous vasculitis affecting medium to large arteries. An arteritic anterior ischemic optic neuropathy is the most common cause of permanent visual loss. Giant cell arteritis is very rare among Asians. We report six patients with biopsyproven arteritic anterior ischemic optic neuropathy. Demographic data, clinical manifestations, laboratory findings, treatment, and visual outcome are described in detail and compared with Caucasian patients. We found no differences in any clinical features except for sex preference. Moreover, perioptic nerve sheath enhancement was observed in half of our patients. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of choroidal ischemia in a neonate after single, bilateral, intravitreal bevacizumab (IVB) injection for severe zone 1 aggressive posterior retinopathy of prematurity (AP-ROP). Methods: A six-week-old baby, born at a gestation age of 28 weeks and birth weight of 1.08 kg, presented at a postconceptional age of 34 weeks for ROP screening. On examination, both eyes revealed engorged iris new vessels with poorly dilating pupils. Retinal examination showed media haze, severe zone 1 APROP with confluent new vessels, severe plus disease, and early vitreous condensation at the edge of new vessels for 12 clock hours. The child was treated bilaterally, with single IVB injection before laser. After 16 hours, hypotony and exudative retinal detachment with patches of choroidal whitening suggestive of choroidal ischemia were seen. Results: The child was treated with topical steroids and cycloplegic drops and exudative retinal detachment resolved on the tenth day. Initial resolution of new vessels showed recurrence after two weeks and was treated with laser photocoagulation. Stable retinopathy status was noted up to six months follow-up. Conclusion: Choroidal ischemia secondary to a single IVB injection for the treatment of AP-ROP could be an unusual complication which raises the concern of its use as a monotherapy in neonates. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study was to describe the clinical presentation of an unusual evanescent, exudative, choroidal pseudo-tumor with acute painful onset, and propose a pathogenesis. Methods: We carried out a retrospective, observational study using the case series of three patients presenting with an evanescent, exudative, choroidal pseudo-tumor with acute painful onset. Ultra-widefield fluorescein and indocyanine green angiography (ICGA) using the Heidelberg Retina Angiograph and the Staurenghi 230 SLO Retina Lens were used to propose a pathogenesis of this unusual entity. Results: In all three cases, acute ocular pain led to discovery of an exudative, partially hemorrhagic choroidal mass (thickness 2.4 mm-4.1 mm on ultrasound) that quickly regressed within weeks. In the subacute phase, all patients showed choroidal circulation abnormalities on dynamic wide-field ICGA in the affected quadrant, with delayed arterio-venous filling in two patients, and a poorly-defined vortex vein in the third. The choroidal circulation abnormalities resolved within 8-12 weeks, simultaneously with the spontaneous resolution of the choroidal pseudo-tumor. The findings evoked a self-resolving vortex vein occlusion in the corresponding quadrants with acute, painful choroidal exudation. Conclusions: An evanescent, exudative, hemorragic choroidal pseudo-tumor with acute painful onset may be caused by a vortex vein occlusion. Future patients need to be studied with ICGA in the acute phase to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

The article presents the case of a 31-year-old male who was presented due to blurred vision in both eyes for 10 days. Among the examinations made were fundus biomicroscopy, fluorescein and indocyanine green angiography, and spectral domain optical coherence tomography. He was diagnosed with bilateral serous retinal detachment showing acute myeloblastic leukemia.

Purpose: To describe the clinical, optical coherence tomographic, and angiographic findings in patients with acute toxoplasmic retinochoroiditis (RC) associated with serous retinal detachment (SRD). Methods: The study included 60 eyes with acute toxoplasmic RC. Results: Of 60 eyes, 14 (23.3%) were found to have SRD. The SRD was visible on fundus examination in 6 cases and detectable only by optical coherence tomography (OCT) in the 8 remaining cases. It involved the fovea in 9 eyes. There was evidence of associated choroidal ischemia on fluorescein angiography and indocyanine green angiography in 5 eyes. Findings seen at the acute stage gradually resolved over a period of 2-6 weeks in all patients. Conclusions: SRD, accurately detected by OCT, is a common complication of acute toxoplasmic RC that should be considered as a potential cause of visual loss. Choroidal ischemia might contribute to the development of such complication. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 31-year-old man who was diagnosed of choroidal ischemia resulting from a decompression sickness accident. The symptoms experienced by the patient included the presence of scotoma on the left eye and decrease of vision. Several tests were performed on the patient including optical coherence tomography, fluorescein angiography, and clinical ophthalmologic examination.

A 24‑year‑old healthy male presented with a chief complaint of blurred vision in the right eye for 1‑week. Fundus examination indicated right exudative retinal detachment and choroidal ischemia. The patient responded well to anti‑toxoplasmosis medications and steroids. Exudative retinal detachment and choroidal ischemia are atypical presentations of ocular toxoplasmosis. However, both conditions responded well to anti‑parasitic therapy with steroid. [ABSTRACT FROM AUTHOR]

Giant cell arteritis (GCA) is a systemic vasculitis that can cause blindness in the elderly. GCA is a medical emergency since it frequently causes blindness if left untreated. Blindness can even occur in a small percentage of patients who undergo treatment. The etiology remains unknown. Presenting symptoms of GCA vary widely and visual manifestations are an extremely common mode of presentation. All physicians must have a high level of suspicion to diagnose and initiate early and aggressive treatment, which in most patients can arrest but rarely reverses the disease. Early and prolonged high-dose corticosteroids remain the cornerstone of GCA treatment. In symptomatic patients, the combination of abnormal levels of C-reactive protein in addition to Westergren erythrocyte sedimentation rate has 97% specificity in the laboratory diagnosis of GCA. The gold standard for diagnosis is the temporal artery biopsy, but biopsy-negative GCA cases have been reported. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of hyperglycemia and intraocular glucose delivery on ischemic retinal injury. Methods: Experimental diabetes was induced in age- and sex-matched Wistar rats by an injection of streptozocin. The functional and structural retinal injury in these rats after a period of pressure-induced retinal ischemia was compared with the injury in appropriate controls and with rats made hyperglycemic by an injection of systemic glucose. The effect of high intraocular pressure–induced ischemia with the use of several different isotonic substrates in the elevated reservoir (isotonic sodium chloride solution, glucose, 2-deoxyglucose, and lactate) was also determined. Electroretinography, reverse transcriptase polymerase chain reaction, and histologic examination were used to assess the retinal injury. Results: Streptozocin-induced diabetes, glucose injection–induced preexisting hyperglycemia, and intraocular glucose delivery during ischemia markedly reduced the functional and structural ischemic retinal injury. Neither postischemic hyperglycemia nor the intraocular delivery of lactate significantly affected the ischemic injury; however, the intraocular delivery of 2-deoxyglucose significantly exacerbated the retinal injury. Conclusion: Preexisting hyperglycemia and the intraocular delivery of glucose markedly attenuate ischemic retinal injury. Clinical Relevance: These findings highlight fundamental differences in energy metabolism between brain and retina, have important implications for the pathophysiology of diabetic retinopathy, and may lead to novel therapeutic strategies for ischemic retinopathies. [ABSTRACT FROM AUTHOR]

• PAN should be considered in the differential diagnosis of patients with ocular inflammation. • PAN can cause multiple retinal vascular complications. • Ocular involvement in PAN has been reported to occur in 10%–20% of patients. Polyarteritis nodosa is a systemic vasculitis characterized by necrotizing inflammatory lesions affecting the middle and small arteries. A 23-year-old male presented to our ophthalmology clinic with a 1-day history of sudden vision loss in his left eye. Posterior segment examination the left eye showed optic disc borders were faint, hyperemic and fluffy with cilioretinal artery occlusion signs present. Optical coherence tomography revealed the presence of localized intracellular edema from optic disc to superior-hemi of fovea, including fovea. On optical coherence tomography angiography, there was a decrease in vessel density in the superficial and deep capillary plexus in the area matching the cilioretinal artery trace, and choroidal vessel density decreased. Wide field fundus fluorescein angiography showed a large choroidal filling defect (ischemia area) and the cilioretinal artery were not filled in the temporal quadrant. These findings made us think that short ciliary arteries were affected and were the causal of the choroidal ischemia and infarction of optic nerve. PAN-associated choroidal ischemia, cilioretinal artery occlusion and ischemic optic neuropathy are rare. If ischemic retinal condition is seen in young patients, PAN should be considered in the differential diagnosis as it may cause life-threatening complications in its advanced stages. [ABSTRACT FROM AUTHOR]

A case study is presented of a 70 year-old woman presented for a sudden blurry vision in her right eye. It mentions that medical examination revealed previous history of recurrent bilateral fugax amaurosis. It mentions that the patient had increased erythrocyte sedimentation rate (ESR) with a with a high level of C reactive protein (CRP) and she was diagnosed with Giant cell arteritis. It mentions that the patient received intravenous dose of methylprednisolone for three days.

The article describes the case of a 52-year-old man who developed vision loss in his right eye following cocaine use. Results of color photography and fluoresceine angiography showed triangular sites of choroidal ischemia after the distribuion of the posterior ciliary arteries. Further examinations revealed watershed cerebral infarcts and abdominal infarction. The case emphasizes the susceptibility of the posterior ciliary vessels to vasospasm following cocaine inhalation.