Diffuse infiltrating retinoblastoma is an extremely rare form of retinoblastoma which is characterized by its atypical growth pattern. This unusual presentation adds complexity to the diagnostic process. The purpose of this paper is to report a rare presentation of diffuse infiltrating retinoblastoma presenting after an ocular trauma. We described a 7-year-old Filipino boy presenting with total hyphema following an ocular trauma. Comprehensive ophthalmologic clinical and diagnostic evaluations were performed including visual acuity, slitlamp biomicroscopy, ocular ultrasound, neuroimaging, and histopathology post enucleation to determine diagnosis. The misleading, atypical presentation of diffuse infiltrating retinoblastoma may delay diagnosis. While this dilemma is expected in these scenarios, it should be remembered that timing of diagnosis in retinoblastoma is crucial, as this also equates to optimal management. One should remain vigilant for these uncommon presentations especially in the setting of any intraocular inflammation in children.

Human ; Male ; Child: 6-12 Yrs Old ; Wounds And Injuries ; Visual Acuity ; Retinoblastoma ; Research Report ; Neuroimaging ; Inflammation ; Hyphema ; Contusions

PURPOSE: To evaluate the incidence and risk factors for ocular hypertension (OHT) in traumatic hyphema within 7 days after trauma. METHODS: A retrospective case series study of 265 traumatic hyphema inpatients from 2010–2016. OHT was defined as intraocular pressure (IOP) that exceeded 21 mmHg using two consecutive measurements by a Goldmann applanation tonometer within 7 days after trauma. The subjects were divided into two groups (OHT group and non-OHT group). Age, sex, best-corrected visual acuity (BCVA), IOP, hyphema grade, presence of systemic disease, and past history of glaucoma were compared between the two groups. RESULTS: Of the 265 patients, 95 (35.8%) developed OHT after traumatic hyphema. Of those 95 patients, 70 (73.7%) developed OHT within 1 day after trauma; 18 (18.9%) developed OHT 2–3 days after trauma; and 7 (7.4%) developed OHT 4–7 days after trauma. Compared to the non-OHT group, the OHT group had a lower visual acuity (p = 0.018) and higher IOP (p < 0.001). In addition. if the hyphema grade was higher the incidence of OHT was significantly higher (p = 0.017). Using multivariate logistic regression analysis, the BCVA (p = 0.045) and hyphema grade (p = 0.006) were associated with the incidence of OHT in traumatic hyphema within 7 days after trauma. CONCLUSIONS: The incidence of OHT in traumatic hyphema within 7 days after trauma was 35.8%. The BCVA and hyphema grade were associated with the incidence of OHT within 7 days after trauma.
Glaucoma ; Humans ; Hyphema ; Incidence ; Inpatients ; Intraocular Pressure ; Logistic Models ; Ocular Hypertension ; Retrospective Studies ; Risk Factors ; Visual Acuity

No abstract available.
Blood Stains* ; Child* ; Humans ; Hyphema*

PURPOSE: To report a case of hyphema after selective laser trabeculoplasty (SLT) in a patient with pseudoexfoliative glaucoma. CASE SUMMARY: A 77-year-old female was referred for elevation of intraocular pressure (IOP). Previously, she had been diagnosed with pseudoexfoliative glaucoma in the right eye and was using topical IOP-lowering agents. The best corrected visual acuity was 20/100 in the right eye and 20/40 in the left eye. IOP, measured with Goldmann applanation tonometer, was 32 mm Hg in the right eye and 20 mm Hg in the left eye. Gonioscopy revealed open-angle glaucoma with +2 trabecular meshwork pigmentation but without peripheral anterior synechiae or neovascularization. SLT was performed in the right eye. Two days later, the patient had sudden onset of blurred vision and pain in the right eye. Visual acuity was limited to light perception, and IOP was 34 mm Hg in the right eye. Slit-lamp examination revealed 1.1 mm hyphema with 4+ red blood cell count in the anterior chamber. Three weeks after the SLT, hyphema in the right eye disappeared, but IOP was measured to be 42 mm Hg. The patient underwent trabeculectomy in the right eye. CONCLUSIONS: SLT is an effective means of lowering IOP with low risk of complications. However, hyphema can rarely occur after SLT and can affect the outcome of the treatment.
Aged ; Anterior Chamber ; Erythrocyte Count ; Female ; Glaucoma ; Glaucoma, Open-Angle ; Gonioscopy ; Humans ; Hyphema* ; Intraocular Pressure ; Pigmentation ; Shiga Toxin 1 ; Trabecular Meshwork ; Trabeculectomy* ; Visual Acuity

PURPOSE: To report the clinical characteristics of retinoblastoma patients whose diagnosis was difficult due to atypical ocular manifestations. METHODS: Among retinoblastoma patients who were diagnosed and treated from January 1999 to December 2014 at Seoul National University Children's Hospital, 6 patients whose diagnosis was difficult were retrospectively reviewed. Factors including age, sex, family history, initial findings, time to final diagnosis, histopathologic examination, additional treatment, and survival rate were evaluated. RESULTS: Among 6 patients, 5 were male, and the mean age at the initial visit was 32.9 ± 19.1 months. None of the patients had family history, and all presented with unilateral lesion at the initial visit. The initial diagnoses were Coats' disease and uveitis in 2 patients, respectively, and persistent hyperplastic primary vitreous and traumatic hyphema in 1 patient, respectively. During an intensive short-term follow-up of 8.3 ± 5.3 weeks, 2 patients showed malignant cells after external subretinal fluid drainage procedure, and 4 patients demonstrated increasing ocular size or calcification in imaging. These patients received enucleation under suspicion of malignancy and were finally diagnosed with retinoblastoma after histopathologic examination. There were 2 patients with optic nerve involvement, and 3 patients underwent additional systemic chemotherapy. Five patients were followed-up for 7.6 ± 6.3 years after enucleation, and the mean age at final follow-up was 10.6 ± 7.4 years. CONCLUSIONS: Retinoblastoma is one of the diseases in which early diagnosis and treatment are important. However, some cases are difficult to diagnose, even for experienced clinicians. If there are no typical manifestations such as mass or calcification and early findings show retinal detachment, glaucoma, pseudohypopyon, or hyphema, intensive short-term follow-up to exclude retinoblastoma is needed.
Diagnosis* ; Drainage ; Drug Therapy ; Early Diagnosis ; Follow-Up Studies ; Glaucoma ; Humans ; Hyphema ; Male ; Optic Nerve ; Persistent Hyperplastic Primary Vitreous ; Retinal Detachment ; Retinoblastoma* ; Retrospective Studies ; Seoul ; Subretinal Fluid ; Survival Rate ; Uveitis

PURPOSE: To report a case of cyclodialysis cleft with hypotony during Ahmed valve implantation. CASE SUMMARY: A 47-year-old male was referred for uncontrolled intraocular pressure (IOP) in the right eye. The patient had a history of ocular trauma and traumatic hyphema. He underwent pars plana vitrectomy, phacoemulsification and intraocular lens implantation 1 month prior due to rhegmatogenous retinal detachment. At the end of the Ahmed valve implantation surgery, the eye was hypotonic despite a deep anterior chamber. The hypotony continued and choroidal effusion developed. Anterior segment optical coherence tomography and gonioscopic examinations revealed small cyclodialysis clefts. After medical treatment with cycloplegics and steroids, choroidal effusion disappeared and IOP was normalized. CONCLUSIONS: Patients with previous ocular trauma or surgery could be prone to developing cyclodialysis cleft with hypotony. Inadvertent cyclodialysis cleft with hypotony can be treated with cycloplegics and steroids.
Anterior Chamber ; Choroid ; Glaucoma ; Humans ; Hyphema ; Intraocular Pressure ; Lens Implantation, Intraocular ; Male ; Middle Aged ; Mydriatics ; Phacoemulsification ; Retinal Detachment ; Steroids ; Tomography, Optical Coherence ; Vitrectomy

PURPOSE: In this study we evaluated the safety and efficacy of combined phacoemulsification and synechiolysis without aid of gonioprism lens and intraoperative intracameral tissue plasminogen activator (tPA) injection for angle-closure glaucoma. METHODS: The method used in this study was synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection following cataract surgery. RESULTS: A total of 20 patients with a mean age of 71.4 +/- 5.4 years were treated. Mean follow-up time was 31.3 +/- 24.3 months. Mean preoperative and last visit intraocular pressures (IOPs) were 21.70 +/- 9.50 mm Hg and 12.40 +/- 2.30 mm Hg, respectively (p < 0.0001). The mean number of glaucoma medications decreased from 2.40 to 0.30 (p < 0.0001). IOP was maintained below 16 mm Hg in all cases. No significant intraoperative and postoperative complications, hyphema, or fibrin reaction occurred. CONCLUSIONS: Combined phacoemulsification and peripheral anterior synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection is an effective and safe surgical procedure.
Cataract ; Fibrin ; Follow-Up Studies ; Glaucoma ; Glaucoma, Angle-Closure* ; Humans ; Hyphema ; Intraocular Pressure ; Phacoemulsification* ; Postoperative Complications ; Tissue Plasminogen Activator*

PURPOSE: To evaluate the efficacy of preoperative intravitreal bevacizumab injection (IVBI) and prognostic factors of surgical success in neovascular glaucoma patients, who underwent trabeculectomy. METHODS: A total of 58 patients (58 eyes) diagnosed with neovascular glaucoma who underwent trabeculectomy between 2003 and 2013 were enrolled in this retrospective study. Trabeculectomy with mitomycin C was performed between 2003 and 2006 and additional preoperative IVBI with the above mentioned technique was performed between 2007 and 2013. To evaluate the efficacy of preoperative IVBI, the patients were divided into the preoperative IVBI group and control group. Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured from preoperative to postoperative 12 months. To evaluate the prognostic factors related to surgical success, the following was investigated: age, lens status, preoperative IVBI, time interval between preoperative IVBI and trabeculectomy, previous vitrectomy and, postoperative complications. RESULTS: Trabeculectomy with mitomycin C only was performed in 26 eyes and additional preoperative IVBI was performed in 32 eyes. Surgical success was 81.3% in the IVBI group and 57.7% in the control group at postoperative 6 months (p = 0.012), and 78.1% in the IVBI group and 50.0% in the control group at postoperative 12 months (p = 0.021). Statistically significant IOP reduction effect was observed in the IVBI group (p = 0.048), and reduced anti-glaucoma eye drop usage was observed in the IVBI group (0.4) compared with 0.8 in the control group (p = 0.040). Postoperative hyphema (hazard ratio [HR] = 2.872, p = 0.044) and preoperative IVBI (HR = 0.280, p = 0.030) were considered risk factors for surgical failure in univariate analysis, however, only preoperative IVBI was statistically significant in multivariate analysis (p = 0.046). CONCLUSIONS: In neovascular glaucoma patients, preoperative IVBI before trabeculectomy is a good prognostic factor of surgical success and shows benefit in lowering the IOP and reducing anti-glaucoma eye drop usage at postoperative 1 year.
Glaucoma, Neovascular* ; Humans ; Hyphema ; Intraocular Pressure ; Mitomycin ; Multivariate Analysis ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Trabeculectomy* ; Visual Acuity ; Vitrectomy ; Bevacizumab

PURPOSE: To report a rare case of isolated neurogenic blepharoptosis secondary to eyelid trauma. CASE SUMMARY: A previously healthy 41-year-old male was evaluated for decreased visual acuity and blepharoptosis in the left eye after ocular trauma. On ophthalmologic examination, visual acuity in the left eye was hand motion, intraocular pressure was 29 mm Hg, hematoma and eyelid edema were minimal. The patient had complete unilateral ptosis with superficial upper eyelid laceration. Additional findings in the left eye included fracture of the medial orbital wall, hyphema, iris sphincter muscle tear, iridodialysis and conjunctival laceration. The other examinations were unremarkable with full ocular motility. Because of iris sphincter muscle tear and iridodialysis, the pupillary reaction could not be evaluated. His left upper eyelid drooped completely and levator function test (LFT) was 0 mm. He was diagnosed with an isolated neurogenic blepharoptosis and received oral prednisolone at a dose of 1 mg/kg per day for 7 days with gradual tapering. One month later, the patient had normal symmetric lid height and completely restored levator function.
Adult ; Blepharoptosis ; Edema ; Eyelids ; Hand ; Hematoma ; Humans ; Hyphema ; Intraocular Pressure ; Iris ; Lacerations ; Male ; Oculomotor Nerve ; Orbit ; Prednisolone ; Visual Acuity

A 50-year-old female was referred to our clinic with visual disturbance, hyphema and increased intraocular pressure (IOP) in her right eye 7 days after experiencing blunt trauma in that eye. She had undergone uncomplicated laser in situ keratomileusis (LASIK) on both eyes 10 years earlier. At initial examination, the best corrected visual acuity (BCVA) in her right eye was counting fingers at 2 feet with no correction. Central Goldmann applanation tonometry (GAT) showed an IOP of 7 mm Hg. Peripheral digital tonometry showed the IOPs in her right eye superiorly, nasally, temporally, and inferiorly were 36 mm Hg, 35 mm Hg, 34.5 mm Hg and 36.5 mm Hg, respectively. Slit-lamp examination showed diffuse epithelial and stromal edema and a blood clot 1 mm in height in the anterior chamber. Spectral domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) images showed a pocket of fluid between the LASIK flap and the underlying stroma. The patient was started on anti-inflammatory agent and IOP lowering agents. After 15 days of treatment, IOP measured with GAT was 10 mm Hg, slit-lamp examination showed that epithelial and stromal edema had disappeared, and OCT showed no fluid between the corneal flap and stroma.
Anterior Chamber ; Edema ; Female ; Fingers ; Foot ; Humans ; Hyphema* ; Intraocular Pressure ; Keratomileusis, Laser In Situ* ; Manometry ; Middle Aged ; Visual Acuity