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Purpose: To report an increasingly prevalent fundoscopic manifestation of syphilitic uveitis., Methods: Case report of a patient with acute retinal necrosis secondary to syphilis., Results: A 48-year-old man presented with decreased vision, anterior segment inflammation, and a wedge-shaped retinal lesion in the superior periphery, with a diaphanous leading edge extending down toward the superior arcade. The patient was HIV+ and poorly compliant with therapy. The top three differential diagnoses were herpetic necrotizing retinitis, syphilis, and lymphoma. An extensive lab workup was positive for syphilis. The patient was treated with IV penicillin G and demonstrated improvement in visual acuity and examination., Conclusion: There have been an increasing number of reports of syphilis patients, especially in the population of men who have sex with men, who present with fundus findings similar to acute retinal necrosis. These findings include a characteristic ground glass, translucent appearance of unifocal or multifocal lesions, primarily affecting the inner retina and sometimes associated with co-localizing occlusive vasculitis. Treatment with IV penicillin G is warranted and has demonstrated good visual recovery.

Purpose: To report a case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography., Methods: Case report., Results: A 61-year-old woman recently immigrated from China presented with round yellow-white retinal lesions in the left eye. The lesions were evaluated with multimodal imaging, including optical coherence tomography angiography. Subsequent serologic testing revealed a positive QuantiFERON-TB Gold test, whereas workup for other entities was negative. The patient was diagnosed with presumed intraretinal tuberculosis. She was started on systemic antitubercular therapy and the lesions regressed. The regression was documented with optical coherence tomography angiography., Conclusion: Case reports of primary intraretinal tuberculosis are uncommon. To the best of our knowledge, this is the first case to demonstrate optical coherence tomography angiography findings of presumed intraretinal tuberculosis.

Purpose: To describe two cases of catastrophic, bilateral retinal vascular occlusion after intravitreal (IVT) bevacizumab injection., Methods: Case series. Main outcome measures included clinical and fluorescein angiography findings., Results: Case 1-A 65-year-old woman with calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis syndrome developed acute, severe, bilateral visual loss 2 weeks after bilateral IVT bevacizumab injection for proliferative diabetic retinopathy. Examination and fluorescein angiography revealed moderate anterior chamber inflammation, bilateral perivascular retinal hemorrhages, and near total retinal vascular occlusion. Extensive testing revealed moderately elevated anti-B2 glycoprotein (antiphospholipid) antibodies. Case 2-An 85-year-old man with polymyalgia rheumatica and left eye exudative age-related macular degeneration experienced severe, bilateral, sequential visual loss in the left eye and then right eye approximately 3 weeks after IVT bevacizumab left eye injection. Examination revealed bilateral panuveitis, diffuse perivascular exudates, and intraretinal hemorrhages. Fluorescein angiography showed diffuse venous leakage. Extensive testing revealed an elevated antinuclear antibody and mildly elevated anticardiolipin antibody., Conclusion: Patients with underlying retinal vascular vulnerabilities may be at increased risk of catastrophic, bilateral retinal vascular occlusion after treatment with IVT bevacizumab. The moderate-to-severe intraocular inflammation in both cases and the contralateral involvement after unilateral IVT injection in Case 2 suggest a possible delayed immune-mediated mechanism.

Purpose: To discuss the mechanism of injury and characterize the clinical features of ocular trauma associated with elastic cord exercise equipment band injuries in a consecutive series of patients seen at a single vitreoretinal surgery practice., Methods: We performed a retrospective review of all patients who were treated for blunt trauma from 2013 to 2020 at a single vitreoretinal practice., Results: Thirteen eyes from 11 patients met the inclusion criteria of possessing ocular trauma secondary to recoil from exercise bands. Presenting visual acuity ranged from 20/16 to HM (median: 20/32). The most frequently observed anterior segment pathologies were traumatic iritis (54%) and angle recession (31%). The most common posterior segment findings were vitreous hemorrhage (54%) and peripheral commotio retinae (54%). Three eyes (23%) required surgical intervention. Follow-up intervals ranged from 0 to 10 months (median: 1.75 months). Visual acuity at last examination ranged from 20/13 to 20/400 (median: 20/40)., Conclusion: A wide spectrum of serious ocular injuries requiring medical and surgical intervention can result from this form of blunt ocular trauma. The frequency of this event would be decreased by the use of sports goggles and careful inspection of equipment for wear and over use., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Purpose: To describe the ocular findings and subsequent workup of a 21-year-old woman with previously undiagnosed Fanconi anemia., Methods: Observational case report and literature review., Results: A 21-year-old healthy woman presented with bilateral retinal hemorrhages, telangiectasia, and severe ischemia with vascular leak. Systemic workup revealed anemia and thrombocytopenia. A diepoxybutane chromosomal breakage test confirmed the diagnosis of Fanconi anemia., Conclusion: Ocular complications are common in patients with Fanconi anemia and may be the presenting manifestation of the disease.

Purpose: The purpose of this study was to report a case of a Filipino woman with a history of breast cancer who presented with unilateral choroidal infiltration, which led to the diagnosis of sarcoidosis., Methods: Case report and literature review., Results: A 64-year-old Filipino woman with a history of breast cancer presented with unilateral choroidal nodules. Her blood tests were negative for common causes of choroidal infiltration (angiotensin-converting enzyme, lysozyme, Treponema pallidum particle agglutination), and Mantoux skin test and a chest x-ray were negative. Her diagnosis could only be made by biopsy of the two hypermetabolic paratracheal nodes seen on the positron emission tomography-computed tomography., Conclusion: Choroidal infiltration may be the presenting feature of sarcoidosis even in ethnicities known to have very low incidence of the disease. If the chest x-ray is negative and the clinical suspicion warrants it, a CT or positron emission tomography-computed tomography of the thorax may be helpful in identifying nonhilar mediastinal lymphadenopathy. As in our case, fine-needle aspiration biopsy of these nodes may lead to confirmation of the diagnosis.

Purpose: To describe a peculiar case of paraneoplastic vitelliform maculopathy/retinopathy in a patient with treated choroidal melanoma., Methods: A case report of a 58-year-old woman with a history of treated choroidal melanoma 16 years before developing visual changes in the setting of metastatic choroidal melanoma., Results: We demonstrate bilateral, multifocal vitelliform subretinal lesions and focal, neurosensory retinal detachment associated with metastatic melanoma., Conclusion: Paraneoplastic vitelliform maculopathy/retinopathy should be considered in patients with or without a history of melanoma, who have unexplained serous, vitelliform retinal detachments, especially with atypical or absence of leakage on fluorescein angiography.

Purpose: To report the clinical course of a patient with acute retinal necrosis resulting from a multidrug-resistant strain of herpes simplex virus 2., Methods: Observational case report., Results: A 17-year-old man with no identifiable immune deficiency presented with pain and decreased vision in his left eye. He had dense anterior and posterior segment inflammation with retinal whitening suggestive of acute retinal necrosis, which progressed despite treatment with intravenous acyclovir, methylprednisolone, and ganciclovir. A transition to intravitreal and intravenous foscarnet led to clinical improvement. Genetic analysis revealed the etiology to be a multidrug-resistant strain of herpes simplex virus 2., Conclusion: Antiviral resistance is an uncommon finding among viruses causing acute retinal necrosis in immunocompetent patients. Patients with these infections may be adequately treated with prompt recognition and a change in therapy to alternative antiviral agents such as foscarnet.

Purpose: To describe a case of chronic exogenous Exophiala dermatitidis endophthalmitis., Methods: Retrospective chart review and case report., Results: A 60-year-old man with history of chronic herpes zoster keratitis complicated by secondary fungal keratitis treated with penetrating keratoplasty presented with a white cataract, chronic anterior uveitis, and counting fingers vision in the left eye. Combined cataract extraction and diagnostic vitrectomy revealed positive cultures and polymerase chain reaction-based testing for E. dermatitidis-the same organism responsible for the keratitis. The patient was treated with multiple oral, intravenous, and intravitreal antifungal agents. Ultimately, the corneal infection recurred and the patient elected to undergo enucleation. Filamentous fungi consistent with E. dermatitidis infection were identified in the cornea of the enucleation specimen., Conclusion: Although rare, Exophiala species can cause exogenous endophthalmitis. Chronic endophthalmitis should be suspected in patients who develop persistent intraocular inflammation after infectious keratitis.

Purpose: To describe a case of central serous chorioretinopathy after trabeculectomy surgery in an eye with microphthalmos in the setting of congenital rubella syndrome., Methods: A Case report with color fundus photographs, fluorescein angiography, and spectral domain optical coherence tomography., Results: A 46-year-old African American man, with a history of congenital heart disease and bilateral hearing loss, developed persistent vision loss in the left eye after trabeculectomy surgery. Ocular examination revealed bilateral salt-and-pepper retinopathy and a serous detachment in the macula of the left eye. Fluorescein angiography showed an early "smoke-stack" pattern of hyperfluorescence with progressive filling of the subretinal space consistent with central serous chorioretinopathy. Spectral domain optical coherence tomography documented both size and extent of the serous retinal detachment and showed several pigment epithelial detachments. B-scan ultrasonography confirmed the serous retinal detachment on the left but showed no evidence of posterior eye wall thickening or of retrobulbar fluid. An A-scan revealed an axial length of 21.8 mm on the right and 19.7 mm on left eye, confirming microphthalmos and supporting the suspected diagnosis of congenital rubella syndrome., Conclusion: Although uncommon, central serous chorioretinopathy can occur in anatomically small eyes after trabeculectomy surgery.

Purpose: The purpose of this study was to report novel autofluorescence and spectral domain optic coherence tomography findings in a case of Alport syndrome., Methods: Case report and literature review., Results: A 30-year-old woman with a history of Alport syndrome presented with a full-thickness macular hole in her right eye and evidence of vitreofoveal traction in her asymptomatic left eye. Both eyes had temporal macular thinning. She had anterior lenticonus and perimacular flecks characteristic of Alport syndrome. In addition, fundus autofluorescence revealed an interesting pattern of splotchy hypoautofluorescence in the periphery (in the absence of any peripheral retinopathy on examination), which has not been described previously., Conclusion: Macular hole in Alport syndrome results from basement membrane weakness and an abnormal vitreoretinal interface. Although this makes surgery in these cases challenging, careful separation of the posterior hyaloid and internal limiting membrane peeling with fluid gas exchange can lead to successful closure. Alport syndrome can also cause abnormalities in the retinal pigment epithelium/Bruch membrane leading to abnormal autofluorescence.

Purpose: To report successful treatment of persistent retinal edema associated with retinal vascular occlusion with ranibizumab after initial failure with bevacizumab intravitreal injections., Methods: A retrospective chart review of all patients undergoing treatment with intravitreal bevacizumab for retinal vascular occlusion was undertaken. Clinical features of patients who were switched to monthly ranibizumab because of persistent and/or worsening retinal edema despite multiple (six or more) monthly intravitreal bevacizumab injections were selected for review. The type of retinal vascular occlusion, age of the patient, visual acuity at each visit, number of intravitreal bevacizumab injections, optical coherence tomography findings at each visit, fluorescein angiography, and number of intravitreal ranibizumab injections with optical coherence tomography findings at each subsequent visit were recorded., Results: Six patients (five women and one man) were identified. Age ranged from 56 years to 74 years. Five had central retinal vein occlusion and one a branch retinal vein occlusion. All were treated with at least 6 sequential intravitreal bevacizumab injections (range, 6-13) before treatment with ranibizumab. All demonstrated an immediate and marked reduction in retinal edema that had not occurred with any of the previous treatments. The average central foveal thickness on optical coherence tomography was 592 µm before ranibizumab injection and 346 µm after the injection. Visual acuity improved in four of the six patients and was stable in the remaining two patients., Conclusion: Eyes of patients with persistent macular edema secondary to retinal vein occlusion despite bevacizumab may experience prompt improvement after initiation of intravitreal ranibizumab injections.

Purpose: To describe significant vision loss caused by enlargement of chorioretinal scars related to sympathetic ophthalmia despite adequate control of intraocular inflammation., Methods: A case report of a 62-year-old man who developed sympathetic ophthalmia after a vitrectomy, which was successful in repairing a rhegmatogenous retinal detachment., Results: Progressive expansion of chorioretinal scars occurred despite successful control of intraocular inflammation related to sympathetic ophthalmia. The visual acuity declined from 20/20 to no light perception in the right eye and from 20/400 to light perception in the left eye over 11 years of follow-up., Conclusion: Progressive enlargement of chorioretinal scars and visual loss may occur despite adequate control of intraocular inflammation in patients with sympathetic ophthalmia. Similar patterns of scar expansion have been reported in eyes after laser photocoagulation, but we believe this is the first report of scar enlargement in the setting of well-controlled sympathetic ophthalmia.

Purpose: To report findings over 25 years of follow-up on a case of bilateral obliterative idiopathic juxtafoveolar retinal telangiectasis., Method: Case report., Results: A 25-year-old white man with obliterative idiopathic juxtafoveolar retinal telangiectasis presented with a visual acuity of 20/30 in the right eye and 20/40 in the left. Fluorescein angiography revealed bilateral enlarged foveal avascular zones and late perifoveal leakage. Six years after presentation, the foveal avascular zone had enlarged only slightly in both eyes and the leakage had almost entirely subsided. For the next 19 years, the visual acuity and clinical findings have remained unchanged. His most recent visual acuity was 20/25 in the right eye and 20/40 in the left. No treatment was given throughout the entire follow-up period of 25 years., Conclusion: Obliterative idiopathic juxtafoveolar retinal telangiectasis is a rare disorder that may initially progress with subsequent stabilization and good long-term visual outcome.

Purpose: To describe a patient with angioid streaks and optic nerve head drusen associated with familial tumoral calcinosis (FTC)., Design: Retrospective, observational case report., Methods: The patient's records were reviewed., Results: After receiving blunt trauma to the head, the patient presented with loss of vision in the left eye. Fundus examination revealed bilateral angioid streaks, optic nerve head drusen, and choroidal ruptures associated with subretinal hemorrhages. Subsequent physical, laboratory, and radiologic examinations revealed periarticular calcification, elevated serum phosphate levels, and normal calcium levels, consistent with FTC., Conclusions: FTC should be considered in the differential diagnosis for patients presenting with angioid streaks and optic nerve head drusen.

Purpose: To report a case of surgically induced necrotizing scleritis and optic neuropathy after pars plana vitrectomy as presenting signs of Churg-Strauss syndrome., Method: Case report., Results: A 59-year-old Asian man underwent a 20-gauge pars plana vitrectomy to remove a posteriorly dislocated intraocular lens. During follow-up, he developed unilateral necrotizing scleritis and optic neuropathy. Systemic evaluation and laboratory investigations revealed findings consistent with Churg-Strauss syndrome. Systemic corticosteroids therapy produced dramatic improvement in visual symptoms., Conclusion: Churg-Strauss syndrome should be considered in any patient who develops surgically induced necrotizing scleritis and/or optic neuropathy after pars plana vitrectomy. Prompt and aggressive treatment with systemic corticosteroids can result in marked improvement.

Purpose: To describe a patient with a giant pigment epithelial detachment (PED) successfully treated with intravitreal bevacizumab., Design: Retrospective, observational case report., Methods: The patient's records were reviewed., Results: An 81-year-old man with history of age-related macular degeneration was seen on routine follow-up examination with an asymptomatic PED temporal to the macula in the right eye and visual acuity of 20/40. The patient was observed. Ten months later, the patient was found to have decreased vision to 20/80 and massive enlargement of the PED, with extension from the temporal equator into the macula. Optical coherence tomography of the macula showed a PED with overlying intraretinal cysts. The patient was given injections of intravitreal bevacizumab for every 4 months (1.25 mg) with complete resolution of the PED and return to baseline visual acuity of 20/40., Conclusion: Giant PED secondary to exudative age-related macular degeneration can be successfully treated with intravitreal bevacizumab.