Introduction:The PRESERFLO® MicroShunt is an established filtrating surgery for moderate to advanced glaucoma, yet postoperative scarring may occur in up to one-third of cases, often requiring needling or revision. This case report describes a novel surgical approach in which a scar-compromised PRESERFLO® MicroShunt was connected to an Ahmed ClearPath® 250 mm2 implant to enhance aqueous outflow without introducing an additional tube into the anterior chamber. Case Presentation:A 64-year-old patient with advanced primary open-angle glaucoma and recurrent scarring after PRESERFLO® implantation underwent this combined procedure. To revive the failed PRESERFLO® MicroShunt, the Ahmed ClearPath® was used as an extension to the MicroShunt: the tube of the Ahmed ClearPath® was inserted into the PRESERFLO® MicroShunt and secured with a cross suture, followed by coverage with a scleral patch graft. Intraocular pressure decreased to 5-9 mm Hg and remained stable under minimal medication (dorzolamide eyedrops 3×/d) at the 3 months postoperative follow-up visit. Conclusion:This is the first case report that describes the outcome of the connection of the PRESERFLO® MicroShunt to an Ahmed ClearPath®. The described dual-device strategy preserved conjunctival tissue and obviated the need for a second tube in the anterior chamber. This approach represents an effective and tissue-sparing alternative for patients in whom a PRESERFLO® MicroShunt is well positioned but rendered insufficient by scarring.
Introduction:Irvine-Gass syndrome (pseudophakic cystoid macular edema) is a common postoperative complication of cataract surgery. While most cases resolve with topical therapy, refractory cases pose a therapeutic challenge. Case Presentation:A 60-year-old woman developed bilateral cystoid macular edema several weeks after uneventful phacoemulsification. Initial postoperative visual acuity was 20/20 bilaterally, declining to 20/100 despite topical corticosteroids and NSAIDs. Optical coherence tomography confirmed significant intraretinal cystic changes. Intervention:Bilateral intravitreal aflibercept (2.0 mg/0.05 mL) was administered. Outcome:Two weeks post-injection, optical coherence tomography demonstrated complete resolution of edema with restoration of best-corrected visual acuity to 20/20. Conclusion:Intravitreal aflibercept may be an effective treatment option for refractory Irvine-Gass syndrome.
Introduction Bisphosphonates are known to occasionally induce ocular and orbital inflammation. While most reported cases involve agents such as zoledronate or alendronate, reports associated with neridronate remain exceedingly rare. Early recognition is vital as this condition can be vision-threatening but typically responds well to treatment. Case Presentation We describe a 69-year-old man who developed fever and myalgia, followed by the abrupt onset of severe unilateral orbital inflammation 72 hours after receiving an intramuscular administration of neridronic acid. Clinical examination of the left eye revealed acute visual impairment, marked eyelid edema, erythema, ptosis, proptosis, diplopia, and chemosis. Ultrasonography showed posterior scleral thickening (T-sign), while CT and MRI demonstrated diffuse orbital inflammation and intraconal fat involvement with periarterial enhancement, in the absence of infectious foci. Laboratory tests showed elevated C-reactive protein (CRP) levels. Following the initiation of high-dose oral prednisone (1 mg/kg/day), the patient showed rapid clinical improvement within 48 hours and near-complete radiologic resolution by 15 days. Conclusion This case underscores the importance of recognizing neridronate-associated orbital inflammation as a potential adverse reaction, even following intramuscular administration. Despite its severe presentation, the condition typically demonstrates a rapid and favorable response to systemic corticosteroid therapy.
Introduction: Optic perineuritis (OPN) can mimic optic nerve sheath meningioma (ONSM) both clinically and radiographically, which may lead to misdiagnosis and inappropriate treatment. Case Presentations: We describe two cases of autoimmune-related OPN that were initially presumed to be ONSM. The first case involves a 61-year-old African American woman with longstanding vision loss and optic nerve sheath enhancement thought to be sarcoidosis due to its steroid responsiveness and subsequent resolution of radiographic findings. The second case involves a 51-year-old woman with a history of triple-negative breast cancer presenting with monocular vision loss that underwent radiotherapy for presumed ONSM, without any visual improvement. She was later diagnosed with chronic relapsing inflammatory optic neuropathy (CRION) due to absence of malignancy on imaging, unremarkable workup, and steroid-dependent, relapsing course. Conclusion: In both patients, the tram-track sign was seen on MRI, complicating the diagnostic process. These cases emphasize the importance of recognizing inflammatory optic neuropathies that can masquerade as neoplastic processes. Sarcoidosis is known to mimic ONSM, however there are currently no reports of CRION mimicking ONSM to our review. Given the therapeutic implications, including the potential for unnecessary radiation as in the second presented case, a thorough diagnostic workup is essential prior to initiating definitive treatment.
Purpose: We report a unique clinical presentation of a patient with undiagnosed neurologic symptoms in the setting of retinitis pigmentosa (RP) with Coats-like reaction and FLVCR1 mutation, expanding the presentation of FLVCR1 variants. Case: A 31-year-old Caucasian female with RP with Coats-like reaction initially presented to our clinic in August 2021 with worsening vision. Genetic testing identified the patient as heterozygous for FLVCR1 c.1092+5G>A and FLVCR1 c.1058C>T, p.(Thr353Met). The patient notably had a long-standing history of nyctalopia as well as complex neurologic symptoms without diagnosis. Neurologic presentation over 6 years included migraine headaches, decreased extremity strength, seizure-like episodes, and urinary incontinence. Progressive leg weakness and spasms eventually impaired weight bearing and ambulation. On presentation to the clinic again in February 2025, she reported progressive central vision loss, ocular pain OD, and persistent instability in her legs. Results: OCT revealed cystoid macular edema, attenuated retinal vessels, and a large lipid exudation in the fovea OD. The patient was initiated on anti-VEGF therapy in February. Follow-up OCT one month later revealed a reduction in lipid exudation. Conclusion: This case underscores the importance of considering an underlying FLVCR1 mutation in patients with retinitis pigmentosa and atypical neurologic symptoms. Despite prior genetic testing, this patient’s neurologic findings remained undiagnosed, highlighting the need for greater clinical awareness of neuro-ophthalmic manifestations of rare genetic disorders. Anti-VEGF therapy appears effective in reducing lipid exudation in Coats-like retinopathy.
Introduction:Cornea plana is a rare congenital corneal disorder characterised by marked corneal flattening, often with microcornea and shallow anterior chambers. It is classically associated with high hyperopia and accommodative esotropia. Case Presentation:We report a 35-year-old woman with a cornea plana spectrum phenotype in whom cycloplegic refraction revealed marked anisometropia (hyperopic astigmatism in the right eye and myopic astigmatism in the left eye) together with an alternating exotropia. Swept-source optical biometry demonstrated interocular axial length asymmetry, plausibly offsetting reduced corneal power to different degrees between the eyes and explaining the divergent refractive outcomes. This case highlights that axial length can substantially modify refractive expression in cornea plana spectrum phenotypes and that associated strabismus may not be limited to convergence-driven esodeviations. Conclusion:This case provides an educational example of how axial length asymmetry can modify the refractive expression of corneal hypopower in a cornea plana spectrum phenotype. It also illustrates that ocular alignment findings in this setting should be interpreted in the context of refractive development, visual acuity, and sensory status.
Purpose: We present an atypical case of mucopolysaccharidosis (MPS) type IIIC to contribute to the growing understanding of its clinical heterogeneity and expand the known phenotypic spectrum of the disorder. This report describes one of the oldest known patients with genetically confirmed MPS IIIC. Case presentation: The patient received genetic testing in her seventies, revealing variations in the HGSNAT and NAGLU genes, two genes associated with MPS III. Her clinical presentation consisted primarily of retinal dystrophy, diagnosed via clinical presentation in addition to OCT and ERG. The patient also showed signs of peripheral neuropathy which were initially presumed to be idiopathic. She did not exhibit the typical behavioral involvement and craniofacial abnormalities expected of MPS type IIIC. Conclusions: This presentation broadens the recognized clinical spectrum of MPS IIIC and may facilitate earlier diagnosis in adults with similar, seemingly idiopathic findings. Improved recognition of such atypical cases may support timely genetic testing and potential therapeutic options.
Introduction:Secondary glaucoma following combined corneal transplantation and artificial iris-intraocular lens (IOL) complex implantation represents a significant therapeutic challenge. Reports of surgical management in such complex eyes remain limited. We report a case of successful PreserFlo MicroShunt implantation for the management of secondary glaucoma following combined Descemet stripping automated endothelial keratoplasty (DSAEK) and Reper artificial iris-IOL complex implantation. Case Presentation:A 54-year-old woman with a history of right eye corneal perforation resulting in aphakia underwent combined DSAEK and Reper artificial iris-IOL complex implantation (Reper-NN LTD, Nizhny Novgorod, Russia). Six months after surgery, she developed secondary glaucoma with intraocular pressure (IOP) elevation to 30 mm Hg despite maximal tolerated medical therapy, accompanied by optic disc cupping, retinal nerve fiber layer thinning, and corresponding visual field defects. PreserFlo MicroShunt implantation was performed. Postoperatively, IOP decreased to 6 mm Hg with a well-functioning filtering bleb, and the corneal graft remained clear throughout the 3-month follow-up. Conclusion:To our knowledge, this is the first report describing PreserFlo MicroShunt implantation for secondary glaucoma following combined Reper artificial iris-IOL implantation and endothelial keratoplasty. This case highlights the potential role of PreserFlo as a surgical option for IOP control in highly complex anterior segment eyes.
Introduction: Dacryocystorhinostomy (DCR) is the gold standard treatment for nasolacrimal duct obstruction, with high long-term success rates. Failure most commonly occurs early, while late complications are rare and less well characterised. Common canalicular obstruction is an increasingly recognised cause of delayed failure. Case Presentation: This report describes a 71-year-old female who presented 10 years after sequential bilateral endoscopic DCR with spontaneous, simultaneous recurrence of bilateral epiphora. Endoscopic examination demonstrated patent nasal ostia with bilateral common canalicular obstruction. The patient had no identifiable risk factors for canalicular disease. She underwent revision bilateral endoscopic DCR with membranotomy and silicone intubation, with intraoperative findings confirming distal membranous obstruction. Complete symptom resolution was achieved at follow-up. Conclusion: This case highlights that late DCR failure may occur even after a decade and may be attributable to common canalicular obstruction. The unusual bilateral and simultaneous presentation raises the possibility of underlying inflammatory mechanisms. Clinicians should maintain long-term awareness of this rare complication.
Introduction: Lymphoedema-distichiasis syndrome is a rare inherited congenital condition in which accessory eyelashes emerge from the meibomian gland orifices on the posterior lamella of the eyelid margin. Case Presentation: We describe the first case of an anterior-posterior lamella eyelid split and tarso-conjunctival excision without a mucosal graft performed in a paediatric patient with distichiasis. Conclusion: This case report provides further evidence of the safety and efficacy of this procedure as an alternative to previous treatment modalities while demonstrating the feasibility of using the technique in paediatric patients.
Introduction:Pachyvitelliform maculopathy (PVM) is a novel phenotype within the spectrum of pachychoroid disorders featuring subretinal fluid and yellowish, hyperreflective, and hyperautofluorescent deposits. This study aimed to characterize PVM through multimodal imaging and evaluate therapeutic responses to guide clinical management. Case Presentations:This retrospective study analyzed patient records from 2020 to 2025 at two ophthalmic centers. PVM was diagnosed based on subretinal hyperreflective material on optical coherence tomography (OCT), hyperautofluorescence, and increased choroidal thickness (>350 μm). Macular neovascularization was excluded via OCT angiography, fluorescein angiography (FA), and OCT. Outcomes following half-dose photodynamic therapy (hd-PDT) and subthreshold micropulse laser (SML) were evaluated. Seven patients with PVM were identified. At baseline, visual acuity did not exceed 0.5 Snellen in any case. Two eyes received hd-PDT (including one treated with combined SML and PDT), four received SML exclusively, and one was managed with observation only. Improvement in best corrected visual acuity occurred in 2 cases. While significant morphological restoration was observed in two eyes, it was also accompanied by atrophy of the outer retinal layers and retinal pigment epithelium. Only one patient achieved significant functional improvement following hd-PDT. One patient demonstrated the progressive evolution of vitelliform-like lesions from a simple form of central serous chorioretinopathy (CSC) over 60 months in the absence of prompt treatment. Conclusions:PVM represents a diagnostic challenge, often necessitating multimodal imaging to reliably distinguish it from macular dystrophies. Further large-scale studies are required to better establish the efficacy of available therapeutic approaches. Nevertheless, treatment modalities commonly employed in the management of CSC, such as PDT and SML, currently remain among the most viable options.
Introduction:Post-dural puncture headache is a well-recognized complication of neuraxial anesthesia caused by cerebrospinal fluid leakage and intracranial hypotension. Although usually self-limiting, persistent post-dural puncture headache may rarely be complicated by cranial nerve palsy. Case Presentation:We report the case of a 33-year-old postpartum woman who developed severe orthostatic headache after apparently uncomplicated epidural labor analgesia, followed by neck stiffness, auditory pressure, and horizontal diplopia due to abducens nerve palsy. Initial cranial computed tomography was unremarkable. Because symptoms persisted despite conservative therapy, magnetic resonance imaging of the brain and spine was performed and demonstrated findings consistent with intracranial hypotension and persistent spinal cerebrospinal fluid leakage. On postpartum day 15, a targeted epidural blood patch was performed under computed tomography guidance at the suspected leak site. This resulted in rapid clinical improvement, with complete resolution of symptoms within 2 weeks. Conclusion:This case highlights a rare neurological complication of post-dural puncture headache and supports the use of image-guided epidural blood patch in selected refractory cases.
Introduction:Ocular bartonellosis most commonly presents as neuroretinitis, whereas choroidal granulomas are rare and poorly characterized. This case highlights a rapidly progressive, tumor-mimicking choroidal granuloma, expanding the clinical spectrum, and highlighting the importance of early recognition. Case Presentation:A 42-year-old woman presented with decreased vision in the left eye and was found to have an elevated chorioretinal lesion with subretinal fluid, concerning for a choroidal neoplasm. Within 1 week, the lesion enlarged with significant visual decline. Serologic testing confirmed Bartonella henselae infection, supported by the presence of cat scratches on the arms and legs, establishing the diagnosis of ocular bartonellosis with choroidal granuloma. The patient was treated with oral doxycycline and a prednisone taper, resulting in rapid visual recovery from 20/200 to 20/20 and complete regression of the lesion. Conclusion:Bartonella-associated choroidal granulomas may present as rapidly progressive, tumor-mimicking lesions. Recognition of this rare presentation and early treatment can lead to favorable visual outcomes.
Introduction:In cataract surgery for eyes with corneal opacity, reduced intraoperative visibility remains a major surgical challenge. To enhance intraoperative visualization, OQrimo, a robotic medical device approved in Japan, was used to hold a light guide. Outcomes of 3 eyes from 2 cases are reported. Case Presentation:Case 1: A 48-year-old man developed bilateral corneal opacity from graft-versus-host disease following umbilical cord blood transplantation for acute myeloid leukemia. At age 45, he underwent penetrating keratoplasty in the right eye but declined surgery in the left eye. Bilateral cataract surgery under general anesthesia was performed. Due to poor visibility under the surgical microscope in both eyes, a 25-gauge light pipe was inserted into the vitreous cavity and stabilized using OQrimo, thereby improving intraoperative visibility and enabling successful cataract surgery in both eyes. Case 2: A 74-year-old man had previously undergone pterygium excision with conjunctival autograft transplantation for a lesion involving the pupillary area of the left eye. Residual central corneal opacity remained, and cataract surgery was performed 6 months later. Due to poor microscopic visibility, a 25-gauge light pipe was inserted into the vitreous cavity and held using OQrimo. While visualization improved, the weight of the OQrimo arm caused ocular deviation, preventing stable positioning and necessitating its discontinuation. Conclusions:OQrimo effectively enhanced intraoperative visibility in cataract surgery for eyes with corneal opacity, although stable positioning was occasionally challenging.
Introduction: Influenza A can cause extrapulmonary complications, including ocular manifestations. We present a rare case of extensive bilateral retinal ischemia in a pediatric patient following influenza A infection, involving acute macular neuroretinopathy (AMN), paracentral acute middle maculopathy (PAMM), and cotton-wool spots. Case Presentation: A 10-year-old boy presented with bilateral blurry vision 4 days after confirmed influenza A infection. Ophthalmologic evaluation revealed best-corrected visual acuity (BCVA) of 20/150 OD and 20/125 OS, with optical coherence tomography (OCT) demonstrating hyperreflective bands in the inner nuclear layer, outer plexiform layer, and outer nuclear layer, consistent with simultaneous AMN and PAMM. Cotton-wool spots were also present. The patient was treated with intravenous methylprednisolone, followed by oral prednisolone. BCVA improved to 20/20 in both eyes at 10 months, with complete resolution of OCT findings. Conclusion: This case highlights the importance of early ophthalmologic assessment in children with visual symptoms following viral infections and suggests a potential role for corticosteroid treatment in severe post-viral retinal ischemia. Further studies are needed to clarify the efficacy of corticosteroids in such cases.
Introduction:Dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists, such as tirzepatide, have significantly advanced the management of type 2 diabetes mellitus and obesity. However, emerging safety signals have raised concerns regarding rare ocular adverse events. Case Presentation:We report a case of an obese patient undergoing treatment with tirzepatide who presented with progressive, painless visual loss in the left eye 2 weeks after symptom onset. Four weeks prior to presentation, she had initiated tirzepatide therapy for weight reduction at a dose of 15 mg once weekly without standard dose titration. Best-corrected visual acuity was 20/20 in the right eye and counting fingers at 1 meter in the left eye. Fundus examination revealed hyperemic optic disc oedema with peripapillary flame-shaped haemorrhages. Automated perimetry demonstrated a central scotoma. MRI of the brain and orbits excluded intracranial pathology and showed no optic nerve enhancement. Intravenous methylprednisolone was administered, after which visual acuity improved to 20/40. Conclusion:Regulatory and pharmacovigilance data suggest that NAION may represent a very rare adverse event associated with GLP-1 receptor agonists, with observational studies indicating a possible association for tirzepatide, although absolute risk appears low and causality remains unproven. While the relationship between dual GIP/GLP-1 receptor agonists and NAION remains controversial, clinicians - particularly ophthalmologists - should remain vigilant and consider this potential risk when evaluating the benefit-risk profile for individual patients.
Cornea plana is a rare congenital corneal disorder characterised by marked corneal flattening, often with microcornea and shallow anterior chambers. It is classically associated with high hyperopia and accommodative esotropia. We report a 35-year-old woman with a cornea plana spectrum phenotype in whom cycloplegic refraction revealed marked anisometropia (hyperopic astigmatism in the right eye and myopic astigmatism in the left eye) together with an alternating exotropia. Swept-source optical biometry demonstrated interocular axial length asymmetry, plausibly offsetting reduced corneal power to different degrees between eyes and explaining the divergent refractive outcomes. This case highlights that axial length can substantially modify refractive expression in cornea plana spectrum phenotypes and that associated strabismus may not be limited to convergence-driven esodeviations.
Introduction:Sparganosis mansoni is a parasitic infection caused by the plerocercoid larva of Spirometra mansoni, a tapeworm commonly found in amphibians and reptiles. Humans become accidental hosts through ingestion of contaminated water or undercooked intermediate hosts, with larvae capable of migrating to subcutaneous tissues, the eyes, or the central nervous system. Case Presentation:This case describes a rare presentation of ocular sparganosis in a middle-aged man with no known exposure to traditional risk factors. The live S. mansoni larva, discovered within the Tenon's capsule and measuring 22 cm, underscores the diagnostic challenge and the importance of considering parasitic infections in atypical orbital masses. Conclusion:This case highlights the diagnostic challenges of ocular sparganosis, particularly when clinical signs are subtle and conventional tests are inconclusive. To our knowledge, based on a structured review of the available literature, this appears to be the first reported case of sparganosis localized exclusively to Tenon's capsule. Clinicians should consider parasitic infections in the differential diagnosis of atypical subconjunctival or orbital masses, especially in endemic regions. Public health education regarding the risks of exposure to untreated water sources remains critical in preventing such infections.
Introduction:Glial fibrillary acidic protein (GFAP) astrocytopathy is a rare autoimmune central nervous system disorder defined by GFAP-IgG antibodies in cerebrospinal fluid (CSF). Optic disk edema is reported in up to half of cases, but detailed ophthalmic descriptions remain limited. Case Presentation:A 68-year-old man presented with transient visual obscurations in his right eye, triggered by postural changes. His history included fatigue, weight loss, tremor, vertigo, and progressive cognitive decline, for which he had already been evaluated by multiple specialists. Ophthalmologic examination demonstrated a reduced visual acuity (0.4 right eye; 0.7 left eye), diffuse sensitivity loss on perimetry, and bilateral optic disk edema. CSF analysis showed pleocytosis and elevated protein with normal opening pressure. MRI of the brain revealed subtle radial perivascular enhancement, and MRI of the spinal cord showed lesions compatible with myelitis. GFAP-IgG antibodies were detected in CSF, confirming the diagnosis. High-dose intravenous methylprednisolone resulted in rapid clinical improvement, with complete resolution of optic disk edema and radiological abnormalities. Conclusion:GFAP astrocytopathy should be considered in patients with unexplained bilateral optic disk edema, particularly in combination with encephalitis or myelitis and negative aquaporin-4/MOG antibodies. CSF testing for GFAP-IgG is essential for diagnosis. Prompt corticosteroid therapy often leads to marked clinical improvement. Comprehensive oncological screening remains mandatory, given that concomitant neoplasms are associated with an increased risk of relapse. In such cases, long-term immunotherapy should be considered.
Introduction: Capture of the intraocular lens (IOL) optic by the iris or pupillary margin is defined as iris capture, and this postoperative complication occurs after scleral-sutured IOL fixation and sutureless intrascleral fixation. However, the optimal placement of iris sutures for preventing recurrence has yet to be adequately described. Case Presentation: We report on the case of a 72-year-old man with ocular hypertension 1 year after scleral-sutured IOL fixation in the left eye who was referred for iris capture. Although topical medication was initially used to relieve the iris capture, it later became refractory. Iris suturing was initially performed at the 12 and 6 o’clock positions. However, at 1 month postoperatively, recurrent iris capture was subsequently observed. As a result, a second iris suturing procedure centered at the 8 o’clock position was performed at the documented capture site. In this second iris suturing procedure, which is shown in the online supplementary intraoperative video, an additional suture was placed at the documented 8 o’clock capture site. The clinical course has remained favorable and there has been no recurrence observed. Conclusion: Current results suggest that iris suturing is an effective treatment option for recurrent iris capture after scleral-sutured IOL fixation. Moreover, further recurrence may be prevented by utilizing suture placement guided by the documented site of recurrence.
