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Purpose: To evaluate the intraocular pressure (IOP) control and graft survival after Ex-PRESS mini glaucoma shunt implantation in refractory postpenetrating keratoplasty glaucoma., Methods: The study included postpenetrating keratoplasty glaucoma cases unresponsive to medical antiglaucomatous therapy in whom 15 Ex-PRESS mini glaucoma shunt implantation was carried out. All glaucoma shunt implantations were performed in a separate session after penetrating keratoplasty. Nine operations were performed under general anesthesia and 6 were performed under local anesthesia. Topical antibiotherapy and topical corticosteroids were used during the postoperative first month., Results: Mean age of the study population was 37.4 years (range: 10 to 80 y). IOP decreased from 41.46 mm Hg (range: 26 to 80 mm Hg) to 12.06 mm Hg (range: 8 to 25 mm Hg) over a mean follow-up of 12.2 months (range: 8 to 19 mo) (P<0.001; Wilcoxon signed rank test). IOP was below 21 mm Hg in 14 of 15 eyes (93.3%) with or without antiglaucomatous drugs. Complete success (IOP<21 mm Hg without medication) rate was 86.6%. Average number of antiglaucomatous drug usage decreased from 3.20 (range: 2 to 4) preoperatively to 0.26 postoperatively (range: 0 to 3) (P<0.001; Wilcoxon signed rank test). In 93.3% of the cases, the decrease in IOP was 30% or above postoperatively. After Ex-PRESS implantation, clear grafts remained clear while edematous grafts became clearer due to IOP decrease. Neither biomicroscopy nor pachymetry showed worsening of preoperatively opaque grafts., Conclusion: Ex-PRESS mini glaucoma shunt implantation may be an effective procedure for refractory postpenetrating keratoplasty glaucoma with acceptable graft failure rates in short term.

We describe two temporary diplopia cases secondary to local septal infiltration anesthesia during septoplasty operation. Both of the diplopia cases resolved without any treatment. Although diplopia was not refractory in our cases, when injecting anesthetics, special care must be taken to avoid injection either into the artery or to the vein.

Purpose: To report a case of low-grade adenocarcinoma of the retinal pigment epithelium (RPE) in a young Asian woman., Methods: Interventional case report with histopathologic correlation., Results: A 28-year-old Asian woman with a year-long history of floaters presented with a dark pigmented lesion in the right eye. Partial lamellar sclerouvectomy was performed and histopathology revealed a retina pigment epithelial neoplasm consistent with a low-grade adenocarcinoma. The patient responded well to the surgery with no complications., Conclusions: Neoplasms of RPE are rare but must be differentiated from choroidal melanoma, as they do not tend to metastasize. Local resection can be a good option for peripheral RPE tumors.

Purpose: To report a case of a choroidal melanoma that presented with painful scleritis and choroidal effusion., Methods: Interventional case report with cytopathologic correlation., Results: A 78-year-old otherwise healthy woman presented with sudden, severe painful ocular inflammation and marked injection of the right eye over a 3-day period, consistent with scleritis. Upon referral, 360 degrees of scleral and conjunctival injection and peripheral choroidal effusion were found. In addition, a solid hemorrhagic, choroidal mass was evident, suspicious for melanoma. Fine needle aspiration biopsy of the choroidal mass confirmed necrotic melanoma. The melanoma was treated with iodine 125 plaque radiotherapy, and during surgery, the temporal sclera was markedly edematous and the orbital tissue was fibrotic, presumed related to inflammation. Two months after radiotherapy, the scleritis and choroidal effusion had resolved., Conclusion: Uveal effusion can rarely occur with uveal melanoma, particularly when the tumor is necrotic.

Objective: To evaluate retinoblastoma regression patterns following chemoreduction and adjuvant therapy., Participants: A total of 557 retinoblastomas., Methods: A retrospective medical record review following 6 cycles of chemoreduction and tumor consolidation (thermotherapy or cryotherapy). Regression patterns included type 0 (no remnant), type 1 (calcified remnant), type 2 (noncalcified remnant), type 3 (partially calcified remnant), and type 4 (flat scar)., Main Outcome Measures: Regression pattern., Results: Retinoblastoma regressions were type 0 (n = 10), type 1 (n = 75), type 2 (n = 28), type 3 (n = 127), and type 4 (n = 317). Tumors with an initial thickness of 3 mm or less regressed most often to type 4 (92%), those 3 to 8 mm regressed to type 3 (34%) or type 4 (40%), and those thicker than 8 mm regressed to type 1 (40%) or type 3 (49%). Factors predictive of type 1 regression included larger tumor base and closer foveolar proximity. Factors predictive of type 3 included older age, larger tumor base, macular location, closer foveolar proximity, and lack of consolidation. Factors predictive of type 4 included familial hereditary pattern, smaller tumor base, greater foveolar distance, and tumor consolidation., Conclusions: Following chemoreduction, most small retinoblastomas result in a flat scar, intermediate tumors in a flat or partially calcified remnant, and large tumors in a more completely calcified remnant.

An 8-year-old boy with mild congenital lymphedema of both legs was noticed to have a conjunctival lesion of the right eye since birth. Topical corticosteroid eyedrops for slight irritation did not alter the appearance of the lesion. On ocular examination, diffuse conjunctival edema in the inferotemporal and inferonasal quadrants and mild injection of the right eye was noted. There was no edema on the left eye. Three extra rows of eyelashes (congenital distichiasis) were found bilaterally on upper and lower eyelids. Related systemic anomalies included mild aortic coarctation, left ventricular hypertrophy, and simian crease on each palm. Conjunctival edema and distichiasis are important ophthalmic features of the congenital lymphedema distichiasis syndrome.

Background: To report a case of a secondary plasmacytoma of the choroid., Methods: Interventional case report with cytopathologic correlation., Results: A 61-year-old male with a breast nodule and a 2-year history of multiple myeloma developed blurred vision and was found to have three confluent, ill-defined areas of choroidal thickening in the left eye. Cytopathology and immunohistochemistry of a transocular fine-needle aspiration biopsy of the largest lesion revealed atypical plasma cells diagnostic of plasmacytoma. Following external beam radiotherapy the choroidal tumors resolved completely., Conclusion: Secondary plasmacytoma, despite its rarity, should be included in the differential diagnosis of amelanotic choroidal tumors, particularly in patients with multiple myeloma. Radiotherapy is an effective treatment.

A 19-year-old woman was admitted with sudden severe pain and loss of light perception that began immediately after eyelid injection of the depot form of corticosteroid. Ecchymosis of the lower eyelid, corneal edema, and a fixed dilated pupil were noted. Fundus examination could not be performed because of corneal edema. Embolic material packed in the episcleral vessels was detected. With these findings, the diagnosis was anterior and posterior segment ischemia. Despite administration of an intravenous hyperosmotic agent, in addition to topical and systemic pulse corticosteroid (1.0 g/day), vision was not recovered. The most serious complication of intralesional injection of corticosteroid is vascular occlusion. This catastrophic complication after intralesional steroid injection should prompt immediate ophthalmoscopic fundus examination to allow early recognition of ischemic signs and immediate intervention.

We present clinical, radiological, and histopathological findings and treatment results of two infants with orbital eosinophilic granuloma. Both patients presented at 1 year of age with unilateral proptosis, periorbital edema, and a superotemporally located, ill-defined orbital mass on computed tomographic (CT) imaging, with bone erosion in one patient. After subtotal excision, histopathological examination revealed eosinophilic granuloma, and the proptosis resolved with no sign of orbital tumor recurrence or systemic involvement at 12 and 23 months follow-up. Eosinophilic granuloma is a rare childhood orbital tumor that may or may not present with osteolytic change.

Serious infection is uncommon after eye muscle surgery. Orbital cellulitis is a rarely reported but is potentially vision- and life-threatening complication after strabismus surgery. In this report, we describe a case of unilateral orbital cellulitis after strabismus surgery for sensory exotropia in a healthy adolescent boy.

Purpose: To determine whether the presence of noticeable strabismus creates a negative social bias against children., Methods: Photographs of two boys and two girls were digitally altered to create photographs of the same child in orthotropic, esotropic and exotropic states. Elementary school teachers rated their perceptions of the children's personal characteristics (using a 10-item list of personal characteristics) based on their responses to these whole-face photographs. The participants were also asked to answer five questions related to the first impressions created by the photographs., Results: Children with esotropia and exotropia were rated more negatively than orthotropic children on all 10 characteristics. Children with esotropia were rated more negatively than those with exotropia on most of these characteristics., Conclusions: Children with noticeable strabismus are viewed negatively. Hence, correction of strabismus may provide psychosocial benefits even when there is no hope of improving visual function.