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Figure S1-video composites of real time AU-011 mediated killing of 92.1MEL cells; Figure S2-Killing and binding comparison of free IR700 dye to VLP conjugated IR700 (AU-011) on HeLa and 92.1MEL cells; Figure S3-Demonstration of both the AU-011 dose and light fluence required for AU-011 killing activity on HeLa and 92.1 cells; Figure S4-Examples of the AU-011 EC50 binding and killing curves using 8 tumor cell lines and contributing to values supplied in Table 1; Figure S5-Example of the flow cytometry gating strategy used to obtain the values plotted in the mixed cell experiment shown in Figure 2; Figure S6-Companion confocal images showing time course uptake of AU-011 in 92.1MEL tumors implanted in the eyes of rabbits and quantified in Figure 4; Figure S7-H&E staining of 92.1MEL tumors implanted in rabbit eyes showing dose response effect of AU-011 8-9 days post-treatment.

The work outlined herein describes AU-011, a novel recombinant papillomavirus-like particle (VLP) drug conjugate and its initial evaluation as a potential treatment for primary uveal melanoma. The VLP is conjugated with a phthalocyanine photosensitizer, IRDye 700DX, that exerts its cytotoxic effect through photoactivation with a near-infrared laser. We assessed the anticancer properties of AU-011 in vitro utilizing a panel of human cancer cell lines and in vivo using murine subcutaneous and rabbit orthotopic xenograft models of uveal melanoma. The specificity of VLP binding (tumor targeting), mediated through cell surface heparan sulfate proteoglycans (HSPG), was assessed using HSPG-deficient cells and by inclusion of heparin in in vitro studies. Our results provide evidence of potent and selective anticancer activity, both in vitro and in vivo. AU-011 activity was blocked by inhibiting its association with HSPG using heparin and using cells lacking surface HSPG, indicating that the tumor tropism of the VLP was not affected by dye conjugation and cell association is critical for AU-011–mediated cytotoxicity. Using the uveal melanoma xenograft models, we observed tumor uptake following intravenous (murine) and intravitreal (rabbit) administration and, after photoactivation, potent dose-dependent tumor responses. Furthermore, in the rabbit orthotopic model, which closely models uveal melanoma as it presents in the clinic, tumor treatment spared the retina and adjacent ocular structures. Our results support further clinical development of this novel therapeutic modality that might transform visual outcomes and provide a targeted therapy for the early-stage treatment of patients with this rare and life-threatening disease. Mol Cancer Ther; 17(2); 565–74. ©2017 AACR.

The work outlined herein describes AU-011, a novel recombinant papillomavirus-like particle (VLP) drug conjugate and its initial evaluation as a potential treatment for primary uveal melanoma. The VLP is conjugated with a phthalocyanine photosensitizer, IRDye 700DX, that exerts its cytotoxic effect through photoactivation with a near-infrared laser. We assessed the anticancer properties of AU-011 in vitro utilizing a panel of human cancer cell lines and in vivo using murine subcutaneous and rabbit orthotopic xenograft models of uveal melanoma. The specificity of VLP binding (tumor targeting), mediated through cell surface heparan sulfate proteoglycans (HSPG), was assessed using HSPG-deficient cells and by inclusion of heparin in in vitro studies. Our results provide evidence of potent and selective anticancer activity, both in vitro and in vivo. AU-011 activity was blocked by inhibiting its association with HSPG using heparin and using cells lacking surface HSPG, indicating that the tumor tropism of the VLP was not affected by dye conjugation and cell association is critical for AU-011–mediated cytotoxicity. Using the uveal melanoma xenograft models, we observed tumor uptake following intravenous (murine) and intravitreal (rabbit) administration and, after photoactivation, potent dose-dependent tumor responses. Furthermore, in the rabbit orthotopic model, which closely models uveal melanoma as it presents in the clinic, tumor treatment spared the retina and adjacent ocular structures. Our results support further clinical development of this novel therapeutic modality that might transform visual outcomes and provide a targeted therapy for the early-stage treatment of patients with this rare and life-threatening disease. Mol Cancer Ther; 17(2); 565–74. ©2017 AACR.

Prolapse of subconjunctival intraconal orbital fat is a rare cause of an intraorbital mass lesion. Over the past several years, we have seen a number of cases in which this prolapsed fat was confused pathologically with a neoplasm of adipocytic lineage, specifically pleomorphic lipoma and atypical lipomatous neoplasm (well-differentiated liposarcoma). We report the clinical, histopathologic, and immunohistochemical findings in 21 specimens from 17 patients, all of whom presented with prolapsed intraconal orbital fat. All specimens were routinely examined and processed for light microscopy. Immunohistochemistry for CD34, CD68, S100 protein, vimentin, alpha-smooth muscle actin, and Ki-67, and Giemsa, Masson trichrome, and alcian blue histochemical stains were performed. Clinical and follow-up information was extracted from a chart review. The mean age (+/-SD) of the patients was 65.6+/-11.9 years (range: 41 to 85 y); 2 were women and 15 were men. Subconjunctival prolapsed orbital fat was localized in the superotemporal quadrant or lateral canthus around the rectus muscle below the lacrimal gland. The lesions were unilateral in 10 and bilateral in 7 patients. No recurrence was clinically evident over a mean (+/-SD) follow-up time of 2.5+/-3.2 years (range: 1 mo to 13.5 y). Histopathologically, all specimens showed an admixture of mature fat, fibrous septae lacking hyperchromatic cells, adipocytes with intranuclear vacuoles (Lochkern cells), multinucleated giant cells with a wreathlike configuration of normochromatic nuclei (floret cells), and varying numbers of histiocytes, lymphocytes, plasma cells, and mast cells. "Control" sections of normal orbital fat showed occasional Lochkern cells but lacked floret cells. By immunohistochemistry, the floret cells expressed only CD34 and vimentin, whereas the Lochkern cells expressed CD34, S100 protein, and vimentin. We conclude that subconjunctival herniated orbital fat commonly contains multinucleated floretlike giant cells, fibrous septae, and Lochkern cells, features that may result in diagnostic confusion with pleomorphic lipoma and atypical lipomatous neoplasms. Importantly, specific diagnostic features, such as aggregates of bland spindled cells associated with wiry collagen, as seen in pleomorphic lipoma, and enlarged hyperchromatic cells within fibrous septae, as in atypical lipomatous neoplasms, are entirely absent in herniated orbital fat. Multinucleated floret cells present in prolapsed orbital fat likely represent a reactive phenomenon, as they are not present in normal orbital fat.

We review the clinical, histopathological, and ultrastructural findings and DNA phenotyping of a patient with Avellino corneal dystrophy exacerbated by laser in situ keratomileusis. The findings are reported and interpreted in the context of a literature review. The case highlights the possible difficulty of recognizing subtle dystrophic findings, as well as the importance of avoiding refractive surgical intervention in patients with Avellino corneal dystrophy to avoid exacerbation of dystrophic deposits in the cornea and subsequent reduction in vision.

Purpose: To determine whether viscoelastic materials effectively protect the corneal endothelium from air bubbles. Setting: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. Methods: Human eye-bank and rabbit eyes had a standardized phacoemulsification procedure with or without viscoelastic material (Healon® [sodium hyaluronate 1.0%], Healon GV® [sodium hyaluronate 1.4%], or Viscoat® [chondroitin sulfate 4.0%−sodium hyaluronate 3.0%]). The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy. Rabbit eyes with and without viscoelastic material (Healon or Viscoat) had a standardized irrigation/aspiration (I/A) procedure. The mucinous layer of the endothelium was examined after the procedure with transmission electron microscopy. Results: In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of human and rabbit corneas had many areas of cell loss in a pattern consistent with air-bubble damage. With Viscoat, endothelial cells remained intact. In the I/A experiment, the mucinous layer of Viscoat-exposed rabbit endothelium appeared thinner. In the same experiments without viscoelastic material or with Healon, the mucinous layer of the endothelium appeared normal. Conclusions: Viscoat effectively protected the endothelium from air-bubble damage. Viscoat appears to protect the endothelium by acting as a physical barrier. Its adherence is probably related to the way it interacts with the mucinous layer of the endothelium.

We evaluated the efficacy of tissue plasminogen activator in treating experimental suprachoroidal hemorrhage. Suprachoroidal hemorrhage was created in 30 white rabbit eyes by implanting four pieces of small, exogenously formed blood coagula into the suprachoroidal space. Animals were randomized for treatment with a surgical sponge soaked in 25, 50, or 75 μg of tissue plasminogen activator (tPA) or balanced salt solution (BSS®) as a control. The time when initiation and completion of clot dissolution occurred was established, and histological examination was performed to assess damage. Clot dissolution started within 30 min in the 50- and 75-μg tPA group, whereas it took 2.75 days in the control group; complete dissolution of blood clots took 4.5 h in the 75-μg tPA group and 14 days in the control group. Histological examination revealed a minimal change in photoreceptors within 6 h after treatment with 75 μg tPA. Treatment of suprachoroidal hemorrhage with tPA seems to be effective, but further investigations for determining the effective and nontoxic dose are required.

Homologous sclera and autologous fascia lata have been accepted as common wrapping materials for hydroxyapatite implantation; however, various problems have been observed, such as the risk of transmittable diseases such as AIDS or hepatitis. This report details the use of cadaver dura mater to wrap hydroxyapatite implants. For 73 eyes of 73 patients with hydroxyapatite implantation, cadaver dura mater was used to wrap the hydroxyapatite after enucleation or secondary implantation. Of the 73 patients, 20 had conjunctival erosion; however, all of the patients but 1 healed spontaneously within an average of 22 days. Only 1 of the 73 patients progressed to implant exposure requiring a dermis graft. The authors suggest that cadaver dura mater is a suitable wrapping material for hydroxyapatite implantation. [Ophthalmic Surg Lasers 1997;28:428-431.]

Purpose To evaluate the use of in vivo imaging of rabbit model of choroidal melanoma using high-frequency contrast-enhanced ultrasound (HF-CE-US) with two-dimensional (2D) or three-dimensional (3D) modes and to correlate the sonographic findings with histopathologic characteristics. Methods Five New Zealand white rabbits, which were immunosuppressed with daily cyclosporin A (CsA), were inoculated into their right eyes with aliquots of 1.5×10 6 /50 μl of 92.1 human uveal melanoma cells cultured in RPMI. At week 4, the tumour-bearing eyes were imaged using high-frequency ultrasound (HF-US) with microbubble contrast agent to determine the 2D tumour size and relative blood volume and by 3D mode to determine tumour volume. Histologic tumour burden was quantified in enucleated eyes by ImageJ software, and mean vascular density (MVD) was determined by counting vascular channels in periodic acid Schiff (PAS) without haematoxylin sections. Results Using HF-CE-US, melanomas were visualised as relatively hyperechoic regions in the images. The correlation coefficients of sonographic size and volume compared with histologic area were 0.72 and 0.70, respectively. The sonographic tumour relative blood volume correlated with the histologic tumour vascularity (r 2 =0.92, p=0.04). Conclusions There is a positive correlation between in vivo sonographic tumour volume/size and histologic tumour size in our rabbit choroidal melanoma model. HF-CE-US corresponds to MVD and blood volume.

Behçet's disease is 1 of the most common causes of uveitis in the Eastern world. Its common ocular complications are uveitis, cataract, and obliteration of retinal vessels. Phacoemulsification with intraocular lens (IOL) implantation in patients with Behçet's disease is known to be a safe procedure. We managed a patient with Behçet's disease who had aggravated uveitis and opacification of a hydrophilic acrylic IOL (ACRL-C160, Ophthalmed) 4 months after cataract surgery. Recalcitrant uveitis despite maximum tolerable medication and IOL opacification with vitreous opacity necessitated an IOL exchange and trans pars plana vitrectomy. After the procedure, the eye became quiescent. However, the visual acuity was 20/200 because of the obliteration of retinal vessels.

There have been numerous types of animal models of choroidal neovascularization (CNV) and retinal neovascularization (RNV). Understanding the pathobiology of CNV and RNV is important when evaluating and utilizing these models. Both CNV and RNV are dynamic processes. A break or defect in Bruchs' membrane is necessary for CNV to develop. This may be induced with a laser, mechanically via surgery, or in the setting of transgenic mice. Some of the transgenic mouse models spontaneously develop RNV and/or retinal angiomatous proliferation (RAP)-like lesions. The pathogenesis of RNV is well-known and is generally related to ischemic retinopathy. Models of oxygen-induced retinopathy (OIR) closely resemble retinopathy of prematurity (ROP). The streptozotocin (STZ) rat model develops features similar to diabetic retinopathy. This review summarizes general categories and specific examples of animal models of CNV and RNV. There are no perfect models of CNV or RNV and individual investigators are encouraged to choose the model that best suits their needs.

To evaluate the histologic changes in corneal structure after femtosecond laser preparation of posterior lamellar discs, more specifically, the smoothness of the stromal bed and the accuracy of the predicted depth of the horizontal lamellar cut.Nineteen human donor eyes unsuitable for transplantation were used. Femtosecond laser was used to prepare a horizontal lamellar cut in donor corneas at a depth of 400 microm. Transmission electron microscopy images were used to evaluate the changes in the corneal structure and to measure the damage zone. Scanning electron microscopy images were used to determine the relative depth of the horizontal lamellar cut, and the stromal bed was examined to determine the smoothness of the surface.Transmission electron microscopy images showed a mean damage zone of 6.8 +/- 3.1 microm, which consisted of irregularly oriented collagen fibrils and electron-dense granular material. The collagen lamellae, both anteriorly and posteriorly of the damaged zone, showed a regular parallel configuration. The relative depth of the horizontal lamellar cut as percentage of the total corneal thickness in the center and periphery was 70.4% +/- 4.5% and 55.6% +/- 5.9%. Scanning electron microscopy images of the stromal bed showed a relatively smooth surface.The femtosecond laser is effective to prepare a deep horizontal lamellar cut in a standardized method. The stromal bed is smooth and without extensive adjacent tissue damage. The is thinner in the center and thicker at the edges, which may produce a mild hyperopic shift after femtosecond laser-assisted Descemet's stripping endothelial keratoplasty.

Purpose The study was conducted to create a rapidly developing and reproducible animal model of subretinal choroidal neovascularization (CNV) that allows a time-dependent evaluation of growth dynamics, histopathologic features, and cytokine expression. Methods C57BL/6 and chemoattractant leukocyte protein-2 deficient (∆Ccl-2) mice were studied. Mice received single or combined subretinal injections of cultured retinal pigment epithelium (RPE; C57BL/6-derived), polystyrene microbeads, or phosphate buffer solution (PBS). Fluorescence angiograms were performed over a period of 3 weeks. Mice were euthanized on post inoculation day 3, 7, 10, 14, or 21, and their eyes were evaluated by light, confocal, and electron microscopy. Results CNV membranes occurred in all study groups with an overall incidence of 94.3%. They extended in the subretinal space through central breaks in Bruch’s membrane. CNV lesions were characterized by dynamic changes such as initiation, active inflammatory, and involution stages. CNV thickness peaked around PI day 7 and was greater in mice that received combined injections of RPE and microbeads or RPE cells alone. Small lesions developed in the control groups (microbeads or PBS only), in ∆Ccl-2, and old C57BL/6 mice. Variable expression of cytokines and growth factors was detected within the membranes. Conclusions Our murine model represents a reliable approach inducing CNV growth by subretinal injection of either RPE cells alone or RPE cells and microbeads. The development of CNV lesions is a dynamic process that relies in part on macrophage trafficking and age.

Purpose To report a case of proliferating trichilemmal cyst in a 55-year-old woman. Design Observational case report. Methods A 55-year-old woman sought treatment for a mass in the right upper eyelid. The lesion was excised twice previously, and recurred. The mass was reexcised and examined histopathologically. Results Light microscopy showed a cystic lesion lined by stratified squamous epithelium with a compact layer of eosinophilic keratin without granular cell layer. There was no atypia, mitosis, or stromal invasion. Conclusions Although proliferating trichilemmal cyst shows benign histopathologic features, clinical manifestations may mimic those of more aggressive tumors with local recurrences or distant metastasis. Wide excision of the lesion and close long-term follow-up is recommended.

Purpose To report four cases of optic nerve neuropathy in three children treated with periocular carboplatin injections for unilateral or bilateral intraocular retinoblastoma. Design Retrospective, observational case series. Methods setting : University-based Ophthalmology Practice. study population : Four eyes of three children with retinoblastoma enucleated after nonsuccessful multimodality treatment including periocular carboplatin injections. observation procedures : The enucleated eyes were routinely processed and evaluated by light microscopy. A retrospective chart review of all four cases was performed. Results Three enucleated eyes (Reese-Ellsworth groups III and VB) were obtained from two children with bilateral multifocal retinoblastoma, and one eye (Reese-Ellsworth group IIB) was harvested from a child with unilateral retinoblastoma. All affected eyes underwent three to seven periocular carboplatin injections before enucleation. Additional treatment modalities included systemic chemotherapy, transpupillary thermotherapy, transscleral cryotherapy, and external beam radiotherapy. Histopathologic evaluation of the enucleated eyes revealed focal areas of ischemic necrosis or atrophy of the optic nerve along with dystrophic calcification and mild inflammation in the surrounding fibrovascular adipose tissue. Conclusions Periocular injections of carboplatin may be a useful treatment approach in the management of patients with advanced intraocular retinoblastoma and may minimize systemic side-effects. However, ophthalmologists and pediatric oncologists should be aware of potential marked local complications with periocular carboplatin delivery, including ischemic optic neuropathy. Modifying the injection site/location (for example, subtenon space) or adding other delivery routes adjuncts (for example, fibrin sealant) deserves further study.

A 69-year-old man developed stromal edema and a pocket of fluid in the laser in situ keratomileusis (LASIK) interface wound in the left eye after acute endothelial cell loss from complicated trabeculectomy. He eventually required penetrating keratoplasty along with cataract surgery. Histologic examination of the corneal button showed an edematous 720 microm central residual stromal bed, a 54 microm empty space at the level of the central interface wound, and a 154 microm LASIK flap. The endothelial cell count was 0 to 2 cells per high-power field, corresponding to a cell density of 450 to 500 cells/mm(2). Four years after LASIK, the central interface wound was susceptible to forming a pocket of serous fluid after the corneal endothelial function was compromised.

Purpose: We sought to demonstrate the histopathologic and ultrastructural features of conjunctival foreign body granulomas because of synthetic fibers and to compare them to other cases published in the literature. Methods: A 2- and a 7-year-old girl were referred for the surgical removal of slow-growing unilateral inferior conjunctival masses with a lack of primary trauma or surgery. In this report, we describe the light and electron microscopic findings of the 2 cases and review the literature of similar cases using the Medline database. Results: Histopathologic and ultrastructural examination of both specimens revealed a granulomatous inflammatory cell response, including histiocytes and multinucleated foreign body giant cells around acellular, uniform sized, oval to round birefringent fibers with manufacturing artifacts. Thirteen other patients with conjunctival synthetic fiber granulomas were identified from the literature. Conclusions: On the basis of the findings in our cases and the review of literature, it appears that conjunctival synthetic fiber granulomas are not a rare entity but are not recognized frequently by ophthalmologists. The most reliable clinical sign to suggest this diagnosis is the presence of a unilateral inferior conjunctival mass in a child or adolescent. Histopathologic and ultrastructural evaluation appears to be the only way to specifically diagnose this condition with certainty.

We investigated the in vivo effect of photodynamic therapy (PDT) using rose bengal on the development of posterior capsule opacification (PCO). Endocapsular phacoemulsification was performed on white rabbits, which were divided into 4 groups: control group; group 1, treated with visible light only; group 2, treated with rose bengal only, and group 3, treated with PDT. In the case of the PDT group, rose bengal dissolved in sodium hyaluronate was injected into the empty capsular bag and treated with visible light. Three months after surgery, the rabbits were sacrificed and the eyeballs enucleated. The obstruction rate of visible light caused by PCO was measured with an optical powermeter. The mean obstruction rate was 30.6% in the control group, 28.3% in group 1, 19.3% in group 2, and 14.3% in group 3. Group 3 showed a statistically significant decrease in PCO compared with the control group and group 1 (p = 0.0014). Our results suggest that PDT using rose bengal effectively decreased PCO in rabbit eyes.

Purpose To investigate the conditions under which bubbles form during phacoemulsification. Setting Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. Methods In the first part of the study, the partial pressure of oxygen (pO 2 ) was used as a surrogate measure for the partial pressure of air. Irrigation solutions packaged in glass and plastic containers were studied. A directly vented glass bottle was also tested. The pO 2 of the various irrigation solutions was measured as the containers were emptied. In the second part, phacoemulsification procedures were performed in rabbit eyes with different power settings and different irrigation solutions. Intracameral bubble formation during the procedure was recorded. Following the phacoemulsification procedures, the corneas were stained for F-actin and examined for endothelial injury. Results The initial pO 2 in irrigation solutions packaged in glass bottles was about half that at atmospheric levels; in solutions packaged in plastic, it was at atmospheric levels. As irrigation solutions were drained from the container, the pO 2 of the solution tended to rise toward atmospheric levels. The rate of pO 2 increase was markedly reduced by using a directly vented glass bottle. In the phacoemulsification procedures, bubble formation was most likely to occur with higher pO 2 and higher power settings. Observation of bubbles by the surgeon was highly correlated with endothelial damage. Conclusions Keeping the pO 2 low reduced the risk of endothelial damage, especially at higher phacoemulsification powers. The packaging of irrigation solutions was the most important factor in controlling the initial pO 2 of the solution. The pO 2 can be minimized throughout a phacoemulsification procedure by using a directly vented glass bottle.

We describe an unusual case of composite lymphoma (CL) in the orbit. The clinical history and biopsy specimen of an 82-year-old woman with a right orbital mass were evaluated. The orbital biopsy contained a dense lymphocytic infiltration and nodules of large lymphocyte that immunostained positive for CD20. Flow cytometric immunophenotyping showed two distinct populations of cells, confirming the diagnosis of a simultaneous follicular lymphoma (FL) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The patient was treated with CD20 antibody (rituximab) and is in remission at 3 months follow-up.

BACKGROUND: Attachment of a keratomileusis lenticule without sutures is a commonly used technique that reduces surgery time and makes the procedure more simple. Detachment of the lenticule after surgery is a difficult complication to manage. PATIENTS AND METHODS: Three cases of lenticular detachment occurred among 74 eyes of microkeratome in situ keratomileusis without suture. After thorough washing of the lenticule and stromal bed, the lenticules were reattached with air drying. RESULTS: In the first eye, the lenticule was reattached successfully with air only. In the second and third eyes, epithelial growth along the interface appeared after reattachment. In spite of removing the epithelium from the interface and suturing the lenticule to the stromal bed four times, the epithelial growth recurred along the interface. Peripheral corneal neovascularization forced the surgeon to abandon more trials of resuturing. In the second eye, the lenticule was discarded because the epithelial growth along the interface could not be blocked. In the third eye, the edge of the lenticule was buried into the stroma, mimicking epikeratoplasty. All three eyes retained useful visual acuity. CONCLUSIONS: A detached lenticule after microkeratome keratomileusis is difficult to replace without epithelial growth in the interface. This complication may be managed successfully. [J Refract Surg. 1996;12:175-179.]

Purpose To report a case of minimal change nephrotic syndrome (MCNS) after photodynamic therapy using verteporfin. Design Interventional case report. Methods After four cycles of photodynamic therapy, general weakness with generalized edema developed in an otherwise healthy 66-year-old woman, resulting in dyspnea and ascites. Urinalysis showed heavy proteinuria (4+) with decreased serum total protein and albumin, and increased total cholesterol levels, suggesting nephrotic syndrome. Renal biopsy and pathologic diagnosis were performed. Results Renal biopsy revealed normal glomeruli and tubulointerstitium by light microscopy, with no immunoglobin or complement deposition. Transmission electron microscopy showed diffuse effacement of the foot processes of visceral epithelial cells, which is the characteristic finding of minimal change nephrotic syndrome. Conclusions We herein report a case of minimal change nephrotic syndrome after photodynamic therapy using verteporfin.

Infestation of humans or other vertebrates by dipterous fly larvae is called myiasis. Larvae can infest several parts of the body, most commonly cutaneous tissue. Occasionally, infestation of ocular tissue could occur resulting in internal ocular or external (conjunctival or eyelid) ophthalmomyiasis.1–5 The most common species causing external ophthalmomyiasis in the US is the sheep botfly, Oestrus ovis .6 The human botfly, D hominis , is the primary cause of cutaneous myiasis in Central and South America, but only rarely causes external ophthalmomyiasis.1,2,5 Several case reports of external ophthalmomyiasis owing to D hominis occurring in the US exist in the literature; however, every case reports a history of recent travel to tropical American countries.1 To our knowledge, there have been no previously identified cases of external ophthalmomyiasis secondary …