Choroidal metastasis from an occult primary diagnosed by fine-needle aspiration: a case report.

Choroidal masses are rarely the first presentation without the primary tumor being discovered. We described fine needle aspiration biopsy (FNAB) of a choroidal mass for diagnosis and determining the primary site. The patient, a 50-year-old Caucasian male without significant past medical history, presented with visual disturbances and headaches. Intraoperative ocular FNA was performed which was sparsely cellular showing a few loosely cohesive sheets and singly arranged epithelial cells with moderate amount cytoplasm, round large nuclei and prominent nucleoli. Immunohistochemical stainings on the cell block material showed positive staining of cytokeratin and negative staining of melanoma markers. The diagnosis of metastatic adenocarcinoma was rendered. During clinical follow up studies, the patient was found to have a PET positive lung nodule and multiple visceral metastasis.

Intravitreal bevacizumab in the treatment of choroidal neovascularization from a traumatic choroidal rupture in a 9-year-old child.

PURPOSE: To describe a case in which a 9-year-old boy who sustained a traumatic choroidal rupture, and later developed choroidal neovascularization (CNV), was successfully treated with intravitreal bevacizumab. METHODS: Comprehensive ophthalmic evaluation, including fundus photography, fluorescein angiography, optical coherence tomography, and B-scan ultrasonography, was done to follow the patient's course and response to treatment over a 2-month period. RESULTS: Preinjection visual acuity was 20/200. Fluorescein angiography showed significant leakage, and optical coherence tomography revealed macular edema. One month after injection, visual acuity was 20/20, with resolution of leakage and edema by fluorescein angiography and optical coherence tomography, respectively. CONCLUSION: There was dramatic improvement in visual acuity from a single intravitreal injection of bevacizumab. This case shows promise for future applications of bevacizumab as treatment of CNV arising from a traumatic choroidal rupture.

Perforated corneal ulcer with subsequent endophthalmitis in a patient with graft-versus-host disease.

PURPOSE: To describe a case of a perforated corneal ulcer leading to a bacterial endophthalmitis in a patient with graft-versus-host disease (GVHD). METHODS: Clinical history and examination; slit-lamp photography; surgical intervention; laboratory evaluation including microbiology, polymerase chain reaction (PCR), flow cytometry, and cytopathology. RESULTS: A diagnostic and therapeutic pars plana vitrectomy was performed. The vitreous aspirate was evaluated with microbiology; PCR for herpes simplex, herpes zoster, and cytomegalovirus; flow cytometry; and cytopathology. The patient received intravitreal antibiotics and antifungal and antiviral medication. The vitreous culture grew Staphylococcus epidermidis. CONCLUSION: Patients with GVHD are at risk for corneal ulcers with subsequent perforation. Commensal ocular flora may seed the vitreous and cause an endophthalmitis. Patients with GVHD may develop a vitritis from many causes including viral, fungal, and bacterial etiologies or a relapse of their original disease. When patients with GVHD present with vitritis, consideration should be given to obtaining a large vitreous aspirate to establish the etiology.

Reduced need for corneal epithelial debridement during vitreo-retinal surgery using two different viscous surface lubricants.

PURPOSE: Corneal clarity is frequently reduced during vitrectomy and scleral buckling surgery secondary to epithelial edema, requiring epithelial debridement to improve visibility. The presence of toxic preservatives in the corneal lubricant solutions is hypothesized to be a contributing factor to epithelial edema during vitreo-retinal surgery. DESIGN: Interventional study. METHODS: We compared prospectively the corneal clarity and epithelial debridement frequency in 71 patients within a single institution in whom either Goniosol (2.5% methylcellulose, boric acid, edetate disodium, sodium borate, potassium chloride, water, and 0.01% benzalkonium chloride) or GenTeal gel (0.3% hydoxypropyl-methylcellulose, carbopol 980, phosphonic acid, sorbitol, water, and 0.028% sodium perborate) was used as a corneal lubricant during the course of vitrectomy surgery using sutured contact lenses. Corneal clarity was subjectively graded in a scale of I to IV during surgery. Statistical analysis was made between these two groups for parametric and categorical data. RESULTS: All eyes started with a corneal clarity grade of I (best possible). Corneal clarity decreased significantly faster in eyes where Goniosol was used to a median grade of III at 1 hour of surgical time. In eyes where GenTeal gel was used, corneal clarity decreased much slower, to a median grade of I at 1 hour of surgical time. The difference in frequency of epithelial debridement was also statistically significant: 54% and 14% for Goniosol and GenTeal eyes, respectively. Other factors that may cause corneal epithelial edema and affect corneal clarity were not statistically different between the Goniosol and the GenTeal groups, including median operative time, estimated intraocular pressure, pre- and intraoperative topical solutions and medications, and number of prior ocular procedures. CONCLUSIONS: The use of GenTeal gel as a corneal lubricant maintains corneal clarity longer than Goniosol during the course of vitrectomy surgery using a contact lens viewing system, limiting the need for epithelial debridement.