Superior oblique paresis after endoscopic brow lift: A case report.

Key Clinical Message: Although a forehead lift is generally a safe surgery, it has well-known complications. Iatrogenic SO paresis is one of the rare complications following forehead lifting procedures which almost resolves spontaneously. Abstract: This report aims to introduce a woman with superior oblique (SO) muscle paresis following the brow and forehead lift procedure. A 30-year-old woman with a history of brow and forehead lift surgery was referred to the ophthalmic emergency department complaining of vertical diplopia. A right eye hypertropia was obvious at the left gaze. A Park's three-step test showed right eye superior oblique paresis. Other ophthalmic examinations including slit-lamp examination, tonometry, and dilated fundoscopy were unremarkable for both eyes. After a 3-month follow-up period, she had no diplopia. No sign of SO paresis was apparent in her ocular motility examinations. Iatrogenic SO paresis is one of the rare complications following forehead lifting procedures which almost resolves spontaneously.

Clinical approach to a child with hemophagocytic lymphohistiocytosis and bilateral optic nerve head infiltration: A case report and brief literature review.

Key Clinical Message: Infiltrative optic neuropathy in hemophagocytic lymphohistiocytosis is rare but could potentially lead to visual loss. Cytomegalovirus (CMV) optic neuritis, drug toxicity, and CNS involvement with increased intracranial pressure (ICP) are differential diagnoses that have to be considered. Abstract: In this report, we introduced a known case of hemophagocytic lymphohistiocytosis (HLH) with progressive visual loss due to bilateral optic nerve head (ONH) involvement. A 9-year-old boy with a history of HLH from 6 months ago was referred to the ophthalmic emergency department with a complaint of painless progressive blurred vision in his right eye. The fundus examination found an optic disc swelling and peripapillary hemorrhage in the right eye. The left fundus examination showed a mild ONH blurred margin. Systemic evaluations including brain and orbital MRI with gadolinium enhancement and CSF analysis showed optic nerve and brain involvement with tumoral cells. Despite systemic chemotherapy with etoposide, the disease had a progressive course so in the last follow-up visit, fundus examination revealed disc swelling, retinal edema, and epiretinal hemorrhage in both eyes and visual acuity deteriorated to no light perception and counting fingers in the right and left eye, respectively. ONH involvement in HLH is rare but could be sight-threatening. Differential diagnoses that should be investigated include neoplastic infiltrative optic neuropathy, cytomegalovirus (CMV) optic neuritis, drug toxicity, and CNS involvement with increased intracranial pressure (ICP).

Orbital Cholesterol Granuloma: Report of Two Cases.

Purpose: To report two rare cases of orbital cholesterol granuloma (CG) presenting with ptosis and proptosis. Methods: The first case was a 31-year-old male presented with progressive ptosis of the left eye (LE) during the past year and the second case was a 35-year-old male presented with proptosis of the right eye (RE) for 5 months ago. Orbital computed tomography revealed a cystic well-demarcated lesion in the superotemporal orbit with adjacent bone erosion in the LE of the first case and the RE of the second case. Results: In both cases, the tumor was excised completely through an anterolateral orbitotomy approach. Histopathological evaluation showed fibroconnective tissue with cholesterol clefts surrounded by granulomatous inflammation consistent with the diagnosis of CG. The symptoms of patients were resolved after surgery. Conclusions: CG of the orbit is a rare lesion that commonly occurred in the superotemporal area. Erosive bone expansion is the characteristic finding of this lesion that can be mistaken with lacrimal gland malignancies. Hence, it is essential to keep CG in mind in the differential diagnosis of lacrimal gland masses.

Hypertensive retinopathy and Purtscher-like retinopathy in a child with complement 3 glomerulopathy.

We report the case of a 15-year-old boy with hypertensive retinopathy and Purtscher-like retinopathy eventually diagnosed with complement 3 glomerulopathy (C3G). The patient presented with bilateral severe painless visual loss and posterior pole cotton wool spots, optic disk and macular edema, and macular star-shaped hard exudate depositions, arterial narrowing, and venous tortuosity, indicative of hypertensive retinopathy (with an initial blood pressure of 210/130 mm Hg) and Purtscher-like retinopathy. He was subsequently diagnosed with C3G based on results of a kidney biopsy. There was a mild visual improvement on follow-up examination, and optic disk swelling and subretinal fluid and cotton wool spots resolved.

Growth and neurodevelopmental status in patients with retinopathy of prematurity treated with intravitreal bevacizumab: a case-control study.

BACKGROUND: The current study aimed to evaluate growth and neurodevelopmental status in patients with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB). METHODS: This historical cohort study was conducted on neonates with ROP who were treated with IVB and age and birth weight-matched controls who did not need IVB. Apgar score less than five, history of blood transfusion and history of infectious diseases were among exclusion criteria. Indirect ophthalmoscopic examinations were performed till complete retinal vascularization. Growth and neurodevelopmental status were evaluated by Age and Stages Questionnaire (ASQ) at the ages of 6, 12, and 18 months. Developmental milestones were assessed in five areas (gross motor, fine motor, personal-social status, problem-solving, and relationship) and overall issues. RESULTS: A total of 34 cases and 36 controls were included in the present study. Birth weight and corrected gestational age were not statistically different between the groups. In a follow-up period of 18 months, bevacizumab was effective as a primary treatment in the treatment of severe cases of ROP. There was no significant difference between the two groups regarding the five areas and overall issues in follow-up intervals (P > 0.05). CONCLUSIONS: The obtained results did not show any growth and neurodevelopmental differences between treatment-naïve infants and those receiving IVB for the treatment of ROP.