Scleral Discoloration Because of Minocycline Use: A Case Report and Review of the Literature.

In this case report, we highlight minocycline-induced scleral hyperpigmentation, combined with ear and fingernail discoloration that developed after over 15 years of use for rosacea in a 78-year-old male with multiple medical comorbidities. Minocycline, a tetracycline antibiotic, is used to treat rosacea and acne as well as some orthopedic infections. It is typically used for extended periods of time; long-term use of minocycline is associated with hyperpigmentation of the sclera, conjunctiva, retina, teeth, skin, subcutaneous fat, oral mucosa, tympanic membrane, and gingiva. This case highlights that hyperpigmentation is more likely to occur in older patients than in younger patients. Scleral hyperpigmentation is not associated with vision loss; however, cosmetic concerns can prompt discontinuation of minocycline. Nonetheless, after cessation, the lesions persist in some patients. Monitoring for hyperpigmentation in patients using minocycline is important, as the hyperpigmentation is more likely to be permanent with long-term use.

Corneoscleral xanthogranuloma treated with chemotherapy: The room for nonsurgical management.

PURPOSE: To describe a clinical case of corneoscleral xanthogranuloma, a rare manifestation of juvenile xanthogranuloma, and xanthoma disseminatum, which responded well to chemotherapy. METHODS: Interventional case report and literature search. RESULTS: A 9-year-old female patient with a disseminated disease showed complete regression of her corneoscleral xanthogranuloma with methotrexate and azathioprine therapy. CONCLUSION: Since they are potentially blinding, corneoscleral xanthogranulomas are commonly surgically excised. While surgical resection has been widely advocated in the literature, immunosuppressive therapy alone may be a pertinent management line of corneoscleral xanthogranuloma, especially with systemic involvement.

Changes in Scleral Architecture in Chronic Vogt-Koyanagi-Harada Disease.

PURPOSE: To describe scleral changes in chronic VKH. METHODS: Medical records of patients with chronic VKH were retrospectively reviewed. Change of scleral architecture was defined as progressive posterior bowing on OCT, axial length elongation, and/or increased myopia more than -1.0 D, not explicable by other etiologies. RESULTS: In total, 28 eyes (16 patients) with mean age of disease onset 32.5 ± 14.0 years were included in the study. Disease duration was 15.1 ± 10.2 years. Eight eyes (28.6%) showed progressive scleral architectural changes. Five eyes (18%) developed scleral changes on OCT, not seen on prior imaging (2-12 years earlier). One eye had posterior bowing on OCT with increased axial length, both eyes of a bilateral pseudophake developed increased myopia with increased axial length. Well-circumscribed chorioretinal atrophy within the arcade was associated with progressive scleral change. CONCLUSIONS: Progressive scleral change may develop as a late complication of VKH. The association with well-circumscribed chorioretinal atrophy suggests that chronic choroidal inflammation may be responsible.

Mycobacterium chelonae Scleral Abscess After Intravitreal Ranibizumab Injection.

PURPOSE: To report a case of Mycobacterium chelonae scleral abscess after an intravitreal injection of ranibizumab. METHODS: A 54-year-old female received an intravitreal ranibizumab injection for diabetic macular edema. Two weeks postinjection, a scleral abscess developed at the injection site. The patient was treated with incision and drainage of the abscess, subconjunctival injection of amikacin, topical clarithromycin and amikacin, and oral clarithromycin. RESULTS: After 4 weeks of treatment, the inflammation and infection resolved, and the patient returned to best-corrected preinjection visual acuity. CONCLUSIONS: Injection-site scleral abscesses are very rare and serious complications of intravitreal injections. Once the abscess is drained, it is possible to identify the organism and treat the infection with appropriate combination antibiotic therapy.

Episcleral infantile hemangioma successfully treated with topical timolol.

Episcleral hemangiomas are usually associated with neonatal hemangiomatosis. Recently, propranolol has been described for the treatment of this entity. We present for the first time a patient with an episcleral hemangioma without neonatal hemangiomatosis successfully treated with topical timolol.

Scleral jaundice may be unilateral: a case report.

Unilateral scleral jaundice is a rare and puzzling clinical phenomenon. Students and health practitioners are further bewildered and confounded when confronted with this subject during academic sessions, including examinations. This is partly attributable to a situation where both trainers and trainees alike rarely encounter such a case. We present this case report to draw attention to this rare type of sclera jaundice and to proffer explanations for its occurrence.

Nodular sclerochoroidopathy simulating choroidal malignancy.

A 55-year-old man who had multiple subretinal and choroidal yellowish lesions and episcleral nodules for 1.5 years was diagnosed as having nodular sclerochoroidopathy after developing classic features of posterior scleritis with choroidal and serous retinal detachment. Long-term therapy with steroids in combination with mycophenolate mofetil resulted in regressed posterior scleritis and nodular lesions, as well as improved visual acuity. Nodular sclerochoroidopathy should be suspected in patients with subretinal and choroidal lesions and should be distinguished from choroidal neoplasm.

Scleral nodule and bilateral disc edema as a presenting manifestation of systemic sarcoidosis.

AIM: To report a rare presentation of a large scleral nodule with bilateral disc edema as the initial manifestation of sarcoidosis. MATERIALS AND METHODS: Retrospective interventional case report. RESULTS: A 58-year-old woman was referred for evaluation of nodular scleritis. Slit-lamp examination showed a large scleral nodule superiorly in the right eye. Fundus showed bilateral disc edema. High-resolution computed tomography of the thorax showed mediastinal and bilateral hilar lymphadenopathy. Transbronchial lymph node biopsy showed epitheloid granulomas. The scleral nodule and disc edema resolved at 6 weeks with oral steroids. CONCLUSIONS: This case highlights a rare presentation of a large scleral nodule with bilateral disc edema as the initial manifestation of systemic sarcoidosis.

Iatrogenic conjunctival entrapment of cilium and scleral ulceration after subtenon steroid injection.

PURPOSE: To report the presence of an asymptomatic cilium in the subconjunctival area and an adjacent sterile scleral ulcer, together as a complication of subtenon injection of steroids, and the resolution of the ulcer despite the in situ cilium. METHODS: Medical management of a 51-year-old man, who was a known case of ankylosing spondylitis, with a 3-mm scleral ulcer located in the inferior palpebral area with one adjacent fully embedded cilium at the probable site of subtenon injection given for suspected acute iridocyclitis. RESULTS: On altering the medication, the ulcer resolved completely. This occurred despite the in situ cilium, which did not act as a nidus for infection or inflammation. CONCLUSIONS: The presence of cilia did not adversely affect the outcome of treatment of the adjacent ulcer. Therefore, if there is no exposure of the entrapped cilium through the conjunctiva, as was in this case, conservative management of the ulcer and not trying to remove the cilium seems to be a good alternative as opposed to reports in literature, which warrant its removal in most cases.

Microscopic scleral invasion in retinoblastoma: clinicopathological features and outcome.

OBJECTIVE: To describe the clinical and pathological features of patients with retinoblastoma and microscopic scleral invasion. METHODS: We reviewed all pathology slides of patients with microscopic scleral invasion who were included in 3 prospective treatment protocols (1988-2007). All patients received adjuvant chemotherapy (moderately intensive chemotherapy in the first 2 protocols or a more intensive combination in the third one). Only patients with cut-end invasion received orbital radiotherapy. RESULTS: Thirty-two of 386 patients had enucleated eyes with intrascleral (21 cases) and transscleral (11 cases) invasion. Of these cases, 20 had tumor invading the optic nerve beyond the lamina cribrosa, with 6 of these having tumor at the surgical margin. Sixteen were treated with moderately intensive chemotherapy and 16 received a higher-intensity regimen. Five-year overall survival was 0.77. Seven patients had an extraocular relapse (central nervous system metastasis, n = 4; systemic metastasis, n = 2; and involving the orbit, n = 3, isolated in 1 and combined with central nervous system disease in 2). All patients who had a relapse died. Patients receiving the intensive regimen had a significantly better outcome (P = .007). CONCLUSIONS: Microscopic scleral invasion might be a risk factor for extraocular relapse, and more intensive chemotherapy results in improved survival for these patients.

[Sclerochoroidal calcifications with vision-threatening choroidal neovascularisation]. / Sklerochoroidale Kalzifikationen mit visusbedrohender choroidaler Neovaskularisation.

BACKGROUND: Sclerochoroidal calcification is an uncommon ocular condition in elderly patients. The lesions are frequently bilateral and located at the superotemporal quadrant. The diagnosis is made by fundoscopic appearance, angiography and echography. HISTORY AND SIGNS: A 75-year-old man was referred with bilateral choroidal lesions and visual deterioration in the right eye. Examination revealed apart from old signs of a multifocal choroiditis also bilateral, elevated, yellow lesions located at the upper temporal arcades. In the right eye one lesion was accompanied by hemorrhages, edema and lipid exudates. A subsequent fluorescein angiography disclosed choroidal neovascularisation. Ultrasonography showed the characteristic findings of highly reflective lesions with acoustic shadowing. Serum calcium and phosphate levels were normal. THERAPY AND OUTCOME: Because of rapid visual deterioration on the right eye Ranibizumab (Lucentis) was injected intravitreal. CONCLUSIONS: Despite their good prognosis, sclerochoroidal calcifications associated with neovascular membranes can become a vision-threatening disorder.

[Scleromalacia associated with varicella-zoster virus]. / Varizella-zoster-Virus-assoziierte Skleromalazie.

BACKGROUND: Scleromalacia usually appears following vasculitis in systemic rheumatoid diseases, especially as a late symptom of rheumatoid arthritis. CASE REPORT: A 67-year-old woman was referred to our hospital for further evaluation with the diagnosis of a "fast-growing tumor" of the left eye. Sixteen months ago she had suffered from herpes zoster ophthalmicus-associated keratouveitis and trabeculitis in the same eye. Scleromalacia associated with varicella-zoster virus (VZV) was diagnosed after the biomicroscopic and gonioscopic examination of the eye was completed and a systemic disease had been ruled out. One week after beginning systemic application of acyclovir (5 x 800 mg daily) and prednisolone (30 mg daily), the anterior chamber inflammation regressed and a fibrosis seemed to appear in the atrophic scleral area. CONCLUSION: Although scleral atrophy mostly appears as a late sign of systemic rheumatoid diseases, it might also develop secondary to infectious diseases. Scleromalacia associated with varicella-zoster virus has been previously described only in a few cases. Scleromalacia is a vision-threatening complication of zoster ophthalmicus which responds well to combination therapy with systemic antiviral and anti-inflammatory agents.

Liberación de fármacos en el segmento posterior del ojo / Drug delivery to the back of the eye

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