2026-08-13T16:12:02Z https://djcro.duke.edu/index.php/djcro/oai

oai:djcro.duke.edu:article/7 2024-04-25T05:10:35Z djcro:COR

oai:djcro.duke.edu:article/8 2025-03-24T09:20:21Z djcro:ONC

Multimodal Imaging and Follow-Up of a Nodule arising from Congenital Hypertrophy of the Retinal Pigment Epithelium Bellanda Candido Ferreira, Victor Maniar, Arpita Materin, Miguel Adenocarcinoma Adenoma Hypertrophy Multimodal imaging Retinal neoplasms Retinal pigment epithelium Ocular oncology Retina Ocular tumors CHRPE Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPE) is a benign ocular condition. Here, we present a rare case of a neoplasm arising from a CHRPE, diagnosed as retinal pigment epithelium (RPE) adenoma (epithelioma) or adenocarcinoma (malignant epithelioma). Utilizing multimodal imaging, we followed the lesion over a sixteen-month period, during which it showed stable size, absent exudation, and resolution of the overlying vitreous hemorrhage. Duke Eye Center 2024-04-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/8 10.62856/djcro.v1i1.8 Digital Journal of Case Reports in Ophthalmology; Vol. 1 (2023): Fall 2023 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/8/13 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/9 2025-03-17T06:28:29Z djcro:RET

An Unknown Pregnancy Presenting as Vision Loss: A case report Shaheen, Gulrukh Tang, Vincent Sitko, Kevin Yang Zhang , Alice preeclampsia pregnancy retina Hypertensive retinopathy (HTR) secondary to preeclampsia can present similarly to non-pregnancy related HTR. Here, we report a case of a patient who presented to our eye clinic for decreased vision bilaterally. Ocular exam and imaging revealed large serous retinal detachments affecting the central macula along with massive intraretinal edema. Due to concern for systemic pathology, the patient was referred to the emergency department (ED), where her blood pressure was found to be 200/110 mmHg. The patient was discovered to be pregnant and diagnosed with preeclampsia with severe features in the third trimester. After delivery of the fetus, the patient had complete resolution of visual symptoms. Since pregnancy-related ophthalmic manifestations are generally mild and reversible, ophthalmologists do not usually consider pregnancy-related disease in patients who are not known to be pregnant. However, it is important to keep these complications on the differential with women of child-bearing age.    Duke Eye Center 2024-11-01 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/9 10.62856/djcro.v5.9 Digital Journal of Case Reports in Ophthalmology; Vol. 5 (2024): Fall 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/9/18 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/12 2026-04-23T15:57:42Z djcro:PLASTICS

Optimal Illumination: The BFF Light Ma, Justin Brodie, Frank Jotsinghani, Disha McNeill, Lucas Fekrat, Sharon adjustable device illumination optimal surgical Background: Optimal illumination for procedures performed without the operating microscope remains challenging for the surgeon within some subspecialties. We present a novel device that provides unmatched illumination for such procedures and highlight its use during scleral buckle placement. Methods: A mode of illumination prioritizing precision, flexibility, portability, and compatibility in various procedural settings was developed. Using such a prototype, a proof-of-concept assessment quantified the number of manual light adjustments vs ceiling-mounted spotlight adjustments required during scleral buckle placement. Results: The Brodie-Fekrat Flex (BFF) Light, an ultrabright LED light connected to a flexible gooseneck, can mount on surgical microscopes, wrist-rests, ceiling-mounted spotlight handles, and even exam chairs. During scleral buckle placement, the BFF Light did not require intraoperative re-adjustment once positioned, whereas ceiling-mounted spotlights were repositioned 5 times on average. Conclusions: The BFF light provides reliable, bright illumination during procedures that do not require the operating microscope. This versatile device may also have applications in the clinic setting, even beyond ophthalmology. Duke Eye Center 2024-04-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/12 10.62856/djcro.v1i1.12 Digital Journal of Case Reports in Ophthalmology; Vol. 3 (2024): Spring 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/12/5 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/13 2026-04-23T15:44:51Z djcro:COR

Severe Vitamin A Deficiency and Xerophthalmia Leading to Corneal Perforation Shah, Riya Kim, Jae Barbosa, Joshua SY Lee, Patrick McDermott, Mark vitamin A deficiency xerosis nutritional optic neuropathy corneal perforation penetrating keratoplasty Purpose: To highlight the ocular manifestations and complications of severe vitamin A deficiency Observations: A 42-year-old female with history of alcoholism presented with severe malnutrition and vitamin A deficiency, xerosis, and optic neuropathy, which was complicated by corneal perforation. Conclusions: This case highlights the importance of considering nutritional deficiencies in patients presenting with chronic visual symptoms. The potential for severe vitamin A deficiency to induce corneal perforation necessitates its consideration in patients harboring risk factors such as alcoholism, inadequate nutritional intake, and conditions associated with malabsorption. Duke Eye Center 2024-06-18 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/13 10.62856/djcro.v1i1.13 Digital Journal of Case Reports in Ophthalmology; Vol. 4 (2024): Summer 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/13/9 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/14 2026-06-24T15:07:15Z djcro:NEURO

Tolosa Hunt Syndrome: An Atypical Presentation of a Rare Condition Zehden, Jason Basil Mathews Kostic, Maja tolosa-hunt orbital apex optic nerve corticosteroids ophthalmoplegia vision loss headache sterile inflammation Abstract Purpose: Tolosa-Hunt Syndrome (THS) is a rare disorder with signs and symptoms that mimic various other diseases. Diagnosis of THS, especially in atypical cases, can be challenging due to the need to exclude other diseases. Observations: A 59-year-old-male presented with acute vision loss of his left eye preceded by acute worsening of chronic headaches. Additionally, he had near complete ophthalmoplegia of this eye. He underwent extensive workup including numerous hematologic studies, cerebrospinal fluid studies, and neuro-radiological imaging studies. All tests had normal results except for an elevated ESR of 92 mm/hour and an abnormal MRI of the brain and orbits. The MRI revealed the left orbit as abnormal with proptosis and intraconal inflammatory change. It also showed abnormal enhancement of the left orbital apex and adjacent lateral aspect of the left sphenoid sinus. He was diagnosed with THS and rapidly responded to corticosteroid treatment. Conclusions and Importance: THS can be challenging to diagnose because it is a diagnosis of exclusion. An added difficulty with THS is the need to quickly recognize and diagnose it since early treatment with corticosteroids can produce a rapid treatment response and decreases the chance of severe residual symptoms. THS does not usually affect the optic nerve, but optic nerve damage can occur and involvement of the optic nerve further increases the urgency of diagnosing it and promptly initiating treatment. Duke Eye Center 2024-04-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/14 10.62856/djcro.v1i1.14 Digital Journal of Case Reports in Ophthalmology; Vol. 3 (2024): Spring 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/14/2 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/17 2025-11-18T12:32:29Z djcro:RET

Retinopathy in a Patient With Influenza Associated Pancytopenia Ohri, Simran Zhang, Alice Yang pancytopenia anemic retinopathy influenza retinal hemorrhage aplastic anemia Retinal abnormalities can be manifestations of hematologic disturbances such as anemia and thrombocytopenia. Influenza associated pancytopenia has rarely been reported in the literature apart from cases involving bacterial superinfection or immunocompromised patients. We present a case of a 14-year-old female with influenza A who was found to be profoundly pancytopenic and developed intraretinal hemorrhages likely secondary to anemic retinopathy. Her hematologic workup was negative for underlying anomalies and she was diagnosed with severe aplastic anemia. The patient's retinal hemorrhages completely resolved over the course of seven months despite declining immunosuppressive therapy and continued persistent pancytopenia. Visual acuity improved from 20/200 to 20/25 in both eyes. Resolution of anemic retinopathy has traditionally followed a return to normal hematologic values. This patient's case shows that retinal hemorrhage may reabsorb despite continuing underlying pancytopenia, emphasizing the need for further investigation into the relationship between systemic hematologic disturbances and retinal complications. Duke Eye Center 2024-07-15 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/17 10.62856/djcro.v1i1.17 Digital Journal of Case Reports in Ophthalmology; Vol. 4 (2024): Summer 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/17/10 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/18 2026-06-24T15:20:49Z djcro:NEURO

Dramatic Hemorrhagic Papilledema After Surgical Resection of Meningioma See Ye King, Clarence Chin, Chee Fang Li Zhenghao, Kelvin To date there is no consensus regarding ophthalmology follow-up of patients with papilledema after resection of an intracranial mass. We present a case of drastically worsening papilledema after resection of an intracranial meningioma and discuss the possible mechanisms behind this. This article aims to highlight the potential utility of routine ophthalmology follow-up for patients with papilledema after resection of an intracranial mass. Further works could quantify the incidence of post-operative worsening or recurring papilledema, their association with a pathological cause, and its effect on vision. Duke Eye Center 2024-04-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/18 10.62856/djcro.v1i1.18 Digital Journal of Case Reports in Ophthalmology; Vol. 3 (2024): Spring 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/18/3 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/19 2025-11-18T12:17:20Z djcro:RET

Spontaneous peeling of an epiretinal membrane in an eye with treated proliferative diabetic retinopathy Sastry, Ananth Wisely, Clayton Patel, Sejal McNeill, Lucas Fekrat, Sharon diabetic retinopathy PVD epiretinal membrane ERM self-peeling An epiretinal membrane (ERM) usually occurs in eyes that have had a posterior vitreous detachment (PVD). Primary causes are typically unknown, but several secondary causes are known, such as retinal vascular disease. The presence of an ERM can exert traction on the neurosensory retina and can also contribute to the development of cystoid macular edema (CME). Rare ERM cases have shown spontaneous separation from the inner retinal surface, often leading to improved visual symptoms. We present a diabetic patient with proliferative diabetic retinopathy treated with panretinal laser photocoagulation who developed a marked ERM. Over a 5 year period, there was liquefaction and separation of the posterior hyaloid along with progressive and spontaneous release of the ERM, leading to improved foveal contour. This case demonstrates the self-peeling of a secondary ERM following PVD formation in an eye with treated proliferative diabetic retinopathy. Duke Eye Center 2024-04-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/19 10.62856/djcro.v1i1.19 Digital Journal of Case Reports in Ophthalmology; Vol. 2 (2023): Winter 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/19/14 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/21 2025-11-18T12:14:53Z djcro:PLASTICS

Replantation of avulsed eyelid followed by use of bioengineered dermal substitute Medsinge, Anagha Fowler , Amy Eyelid injuries secondary to dog bites are common, particularly ones involving the lacrimal system. Full thickness eyelid avulsion is less often seen after dog bites. We report an unusual case of a young female who underwent replantation of full thickness avulsed eyelid tissue after a dog bite. The skin of the grafted eyelid necrosed postoperatively and was replaced with bioengineered skin substitute resulting in good functional and cosmetic outcomes. Duke Eye Center 2024-04-25 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/21 10.62856/djcro.v1i1.21 Digital Journal of Case Reports in Ophthalmology; Vol. 3 (2024): Spring 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/21/4 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/23 2025-11-18T12:10:23Z djcro:RET

Progression of pentosan polysulfate sodium maculopathy following discontinuation Woo, Joshua Iftikhar, Mustafa Fekrat, Sharon Maculopathy Retina Drug Toxicity Pentosan polysulfate Examination of a 69-year-old woman with a family history of age-related macular degeneration (AMD) revealed bilateral macular atrophy with surrounding deposits evident on fundus autofluorescence (FAF). The extent of macular atrophy in this 69-year-old, lack of typical drusen, and FAF pattern did not support a diagnosis of AMD. Her clinical presentation was consistent with pentosan polysulfate sodium (PPS) maculopathy. Further questioning revealed that she had been taking 400 mg of PPS daily for 7 years (cumulative dose ~1000g) but had stopped 2 years ago. Review of available previous images demonstrated continued progression of the maculopathy after discontinuation of PPS. FAF demonstrated atrophy in both eyes 18 months after PPS discontinuation, as well as its progression over the subsequent 6 months. Her clinical presentation was consistent with PPS maculopathy, with evidence of progressive atrophy despite PPS discontinuation 2 years earlier.  Duke Eye Center 2024-09-12 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/23 10.62856/djcro.v1i1.23 Digital Journal of Case Reports in Ophthalmology; Vol. 5 (2024): Fall 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/23/15 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/24 2025-11-18T12:07:48Z djcro:IRD

Inherited Retinal Degenerations Masquerading as Age-related Macular Degeneration in Older Adults: Genetic AMD Masquerades Stephenson, Kirk Kirker, Andrew W Gregory-Evans, Cheryl Gregory-Evans, Kevin Pakzad-Vaezi, Kaivon age-related macular degeneration cone dystrophy inherited retinal dystrophy Stargardt disease Inherited retinal degenerations (IRD) classically present in youth, but may present in older adults. Misdiagnosis as age-related macular degeneration (AMD) can be avoided with appropriate investigations which may alter management and prognosis for some. We describe a retrospective case series of with IRD referred as AMD. An 82-year-old female had a bullseye maculopathy (CRX deletion) and a 72-year-old male had Stargardt disease with biallelic ABCA4 genotype. An index of suspicion in atypical ‘AMD’ cases combined with appropriate clinical and molecular investigations can achieve an IRD diagnosis altering management decisions. Duke Eye Center 2024-05-21 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/24 10.62856/djcro.v1i1.24 Digital Journal of Case Reports in Ophthalmology; Vol. 3 (2024): Spring 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/24/8 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/26 2026-06-24T14:54:57Z djcro:PLASTICS

The use of tocilizumab to treat recurrent thyroid eye disease previously treated with teprotumumab Pang, Naomi C Adam S Hassan tocilizumab teprotumumab thyroid eye disease The use of biologics in the treatment of corticosteroid-resistant thyroid eye disease has increased in popularity over the last several years. Here, we describe a patient with progression of symptoms despite multiple courses of corticosteroids, orbital decompression, and teprotumumab. The patient was successfully treated with tocilizumab and remains clinically stable 18 months status post treatment. Duke Eye Center 2024-08-30 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/26 10.62856/djcro.v1i1.26 Digital Journal of Case Reports in Ophthalmology; Vol. 4 (2024): Summer 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/26/12 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/27 2024-05-14T11:55:58Z djcro:COR

oai:djcro.duke.edu:article/28 2024-09-12T13:01:39Z djcro:RET

Occult nonmetallic intraocular foreign body: A case report Dr Syed Zafar Mandeep Lamba Diljeet Kaur Gahir Haya Qassem ocular trauma Retina iofb pediatric endophthalmitis Introduction Eye injuries are the leading cause of monocular blindness in children. Male patients outnumber female patients as victims of eye injuries by a ratio of 4:1. The most common causes of open globe injuries were sharp objects such as knives and scissors. Endophthalmitis is reported more in lacerated globes than ruptured globes. An aggressive prophylactic medical therapy protocol should be used in the future for patients at higher risk of developing endophthalmitis. We present a pediatric case of a penetrating globe injury.  Case report A 6-month-old child presented to the clinic with pain, epiphora and photophobia in the right eye. She was initially managed with topical steroids, topical antibiotics, cyclopentolate and then referred. During our examination, she was found to have a self-opposed entry wound at the limbus that appeared to be created by a sharp object. An opacified lens was clearly seen on handheld slip lamp examination. On B-scan ultrasonography we could identify a hyper-reflective area that was concerning for a foreign body in close contact with the retina. The patient underwent wound repair with Lensectomy Vitrectomy with Endolaser and subsequent removal of intraocular foreign body with injection of intravitreal antibiotics under General Anesthesia. During the surgery we discovered a small cilium which extended from the sclera, through the retina, and into the vitreous. The patient is now well but still awaiting to get a secondary intraocular lens insertion done. Discussion Intraocular foreign bodies carry a high risk of complications, especially when not detected promptly. OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only. B-scan ultrasonography is frequently ordered in this setting as a first line imaging study but has a suboptimal sensitivity for echo lucent foreign bodies. The majority of evidence in favor of CT as the imaging modality of choice for detection of IOFB comes from reports of metallic or otherwise radio-opaque (glass or stone) foreign bodies. In cases of less radio dense foreign bodies, CT imaging has reduced sensitivity.  Conclusion Proper diagnosis and urgent management is crucial for any globe injuries to prevent any further complications like endophthalmitis. Patients should follow a regular follow up schedule to maintain and restore his eye health. Duke Eye Center 2024-09-12 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/28 10.62856/djcro.v1i1.28 Digital Journal of Case Reports in Ophthalmology; Vol. 5 (2024): Fall 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/28/16 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/29 2025-03-17T06:35:19Z djcro:RET

Symptomatic Foveal Impingement following Posterior Vitreous Detachment Formation Ozizmirliler, Denizcan Saatci, Ali Osman A-57-year old visually asymptomatic healthy woman was examined by us first in 2016. On optical coherence tomographic (OCT) examination left foveal contour appeared as normal at that time (Figure A). In 2020, there was the evidence of vitreomacular adhesion despite the normal foveal contour in the left eye (Figure B). However, we noticed the left foveal inpingement related to detached posterior vitreous on OCT when she was reexamined with the complaint of left metamorphosia in 2024 (Figure C). Posterior vitreous detachment (PVD) is the vitreous gel liquefaction,and extracellular matrix changes  at the vitreoretinal interface characterized with the detachment of posterior vitreous cortex from the internal limiting membrane due to ongoing aging process.1 Gel liquefaction that exceeds the degree of vitreoretinal dehiscence may end up with anomalous PVD. We propose the term of ‘foveal inpingement’ to describe the subtle foveal contour change described above and believe that this term can gain recognition among the retinal physicians. Duke Eye Center 2024-10-21 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/29 10.62856/djcro.v5.29 Digital Journal of Case Reports in Ophthalmology; Vol. 5 (2024): Fall 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/29/17 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/33 2025-03-24T07:41:25Z djcro:RET

Anterior Vitreous Migration After 0.1cc Intravitreal Injection Morgan, Richard Weng, Peter Peralta, Esteban Valikodath, Nita Fekrat, Sharon vitreous prolapse Intravitreal injection complications anterior chamber complications aflibercept amd Intravitreal injection of anti-vascular endothelial growth factor agents such as aflibercept, bevacizumab, and ranibizumab are common treatments for retinal edema and neovascularization related to a number of retinal diseases such as age-related macular degeneration (AMD), retinal vein occlusion, and diabetic retinopathy. A double dose is used for refractory cases where standard dosing is insufficient to control disease progression. We present a case of a rare and potentially serious complication: vitreous prolapse into the anterior chamber following a double dose of intravitreal aflibercept injection. This case highlights the importance of close monitoring for patients who receive intravitreal injections, especially those that receive larger doses of medication. Duke Eye Center 2025-03-17 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/33 10.62856/djcro.v7.33 Digital Journal of Case Reports in Ophthalmology; Vol. 7 (2025): Spring 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/33/23 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/34 2026-06-24T15:05:36Z djcro:NEURO

Infiltrative Optic Neuropathy in Acute Lymphoblastic Leukemia with Negative Bone Marrow Biopsy: Detecting ALL Relapse via Ocular Symptoms Sevgi, Duriye Damla Kathy Dong Victoria Miller Denis Jusufbegovic infiltrative optic neuropathy leukemic optic neuropathy optic disc edema acute lymphocytic leukemia A 46-year-old woman with a history of acute lymphocytic leukemia (ALL) in remission and recent negative bone marrow biopsy was examined for right eye discomfort while inpatient for pancytopenia and cytomegalovirus enteritis. Initial exam showed 20/25 vision in both eyes, mild blurring of the nasal disc margin in the right eye, and a cotton wool spot in the left eye. MRI revealed enlargement and enhancement of the right optic nerve. Five days later, she developed blurry vision and transient positional vision loss in the right eye, with visual acuity declining to 20/40. Repeat exam showed grade 2 optic disc edema with flame hemorrhages, an infiltrative lesion in the right eye. Lumbar puncture revealed 94% blast cells. She was started on corticosteroids, and an Ommaya reservoir was placed for intrathecal chemotherapy. Ophthalmologists should suspect leukemic optic nerve infiltration in ALL patients with optic nerve edema, even after negative bone marrow biopsies. Duke Eye Center 2024-08-16 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/34 10.62856/djcro.v1i1.34 Digital Journal of Case Reports in Ophthalmology; Vol. 4 (2024): Summer 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/34/11 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/36 2025-03-17T06:27:31Z djcro:RET

Endogenous Endophthalmitis caused by Abiotrophia/Granulicatella Rosado, Janiece Yuan, Melissa Gong , Dan Bacteria Endogenous endophthalmitis Infection Retina Purpose To describe a case of endogenous endophthalmitis caused by the bacterium Abiotrophia/Granulicatella adiacens, which clinically appeared consistent with fungal endophthalmitis, in a young patient with a history of intravenous (IV) drug use. Observations A 22-year-old male presented with one week of pain and decreased vision in the left eye. He had a history of IV heroin use. Slit lamp and dilated fundus exam revealed significant intraocular inflammation concerning for endogenous endophthalmitis. The initial clinical impression was of fungal endophthalmitis given the appearance of vitreous opacities consistent with fungal balls. However, vitreous sampling revealed Abiotrophia/Granulicatella adiacens, a species of fastidious gram-positive cocci formerly known as nutritionally variant streptococci. Conclusion We describe Abiotrophia/Granulicatella species causing endogenous endophthalmitis in a patient with a history of IV drug use. Abiotrophia/Granulicatella have not been described previously to cause endophthalmitis. This atypical case expands the spectrum of microorganism’s clinicians should consider when diagnosing and treating endogenous endophthalmitis. Duke Eye Center 2024-11-25 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/36 10.62856/djcro.v5.36 Digital Journal of Case Reports in Ophthalmology; Vol. 5 (2024): Fall 2024 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/36/19 Copyright (c) 2024 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/39 2025-04-08T08:59:19Z djcro:RET

Multimodal Imaging of Punctate Outer Retinal Toxoplasmosis Donaldson, Rachel Lindeke-Myers, Aaron Apple, Daniel Maldonado, Ramiro Chorioretinitis pediatrics PORT recurrence toxoplasmosis We present multimodal imaging of a unique case of ocular toxoplasmosis in a young girl, marked by recurring macular lesions despite treatment and prophylaxis, progressing unusually to punctate outer retinal toxoplasmosis. An eleven-year-old girl, without significant medical history, presented with blurred vision and floaters. Initial assessment showed active macular chorioretinitis in her left eye, inactive scarring in her right eye, and positive IgG but negative IgM toxoplasmosis serologies. Treatment included intravitreal clindamycin, oral azithromycin, and prednisone for her right eye, followed by trimethoprim/sulfamethoxazole (TMP-SMX) prophylaxis. Recurrence in the right eye led to retreatment with clindamycin and TMP-SMX. Recurrences continued and punctiform gray-white lesions in her right eye's retina appeared. These were localized into the outer nuclear layer on OCT with signal hypertransmission and were hypoautofluorescent. Low immunoglobulin levels were identified, suggesting that conventional treatment and prophylaxis might be inadequate in patients with hypogammaglobulinemia. Duke Eye Center 2025-04-08 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/39 10.62856/djcro.v7.39 Digital Journal of Case Reports in Ophthalmology; Vol. 7 (2025): Spring 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/39/24 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/40 2026-06-24T15:17:45Z djcro:COR

Post Traumatic Lamellar Corneal Laceration Repair Using Shaped SMILE Lenticule. Sharma, Vijay Kumar Singh, Prabhjot Sharma, Ashok Kumar Guru Tegginakerimath Khullar, Srishti Corneal laceration repair SMILE lenticule Traumatic corneal laceration Epithelial ingrowth Customised SMILE lenticule A 24-years-old male with seven years history of recurrent symptoms following a 6 mm curvilinear laceration in right eye, involving epithelial ingrowth and stromal scarring, underwent surgical repair. The laceration dimensions were measured using Anterior Segment Optical Coherance Tomogrpahy (AS-OCT), and a Small Incision Lenticule Extraction (SMILE) derived graft was fashioned to match the defect. After scar excision, the graft was secured with fibrin glue. Postoperatively, the laceration healed without complications, and visual acuity improved from 20/80 to 20/30 at six weeks, with a stable, well-epithelialized graft. This case highlights the potential of shaped SMILE lenticule grafts as a sutureless, effective treatment for challenging corneal lacerations unresponsive to conservative therapy. Duke Eye Center 2025-01-13 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/40 10.62856/djcro.v6.40 Digital Journal of Case Reports in Ophthalmology; Vol. 6 (2025): Winter 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/40/20 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/41 2025-06-10T09:18:29Z djcro:GLAUC

Delayed Onset Corneal Edema Following Selective Laser Trabeculoplasty Leung, Devin Nezami, Sonia Theophanous, Christos A 64-year-old female with mild stage primary open angle glaucoma underwent uncomplicated SLT of the right eye. On post-operative day 1, the patient presented with pain, discomfort, and photophobia of the treated eye and was found to have microcystic corneal edema, markedly reduced visual acuity, and elevated intraocular pressure (IOP) of 42 mm Hg. The patient was started on oral acetazolamide and topical Brinzolamide/Brimonidine twice a day. On post-operative day 2, IOP improved to 15 mm Hg and the microcystic edema had resolved, but diffuse stromal corneal edema with Descemet’s folds remained and vision was markedly impaired. Topical prednisolone was initiated in the treated eye. The edema fully resolved and visual acuity returned to near baseline by post-operative week 5. This case describes a rare case of delayed onset corneal edema following SLT in the setting of subacute IOP elevation. Duke Eye Center 2025-03-03 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/41 10.62856/djcro.v6.41 Digital Journal of Case Reports in Ophthalmology; Vol. 6 (2025): Winter 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/41/22 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/45 2025-04-24T11:31:54Z djcro:UVEI

Juvenile Idiopathic Arthritis with Anterior Uveitis and Vasculitis Ayesha A. Nasir Melis Kabaalioglu Guner, MD Mehmet Eren Guner, MD fundus angiography juvenile idiopathic arthritis Optical Coherence Tomography uveitis vasculitis Abstract Purpose To report a case of Juvenile Idiopathic Arthritis (JIA) with anterior uveitis and vasculitis. Methods Report of one case. Results A 16-year-old female with a history of refractory JIA for ten years, was diagnosed with concurrent vasculitis on exam and underwent fluorescein angiography (FA). Treatment was changed to adalimumab and methotrexate to resolve ocular inflammation. Conclusion This report demonstrates a rare finding of JIA-associated uveitis with vasculitis. Future studies are needed to evaluate the incidence of posterior segment involvement in patients with JIA uveitis. Duke Eye Center 2025-04-24 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/45 10.62856/djcro.v7.45 Digital Journal of Case Reports in Ophthalmology; Vol. 7 (2025): Spring 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/45/25 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/47 2025-06-03T07:57:09Z djcro:UVEI

Posterior Scleritis with Optic Nerve Edema Presenting in a Case of Atypical Cogan’s Syndrome Mazdeyasnan, Layla Shabbir, Zian Lewis, Gregory atypical cogan's syndrome typical cogan's syndrome posterior scleritis sensorineural hearing loss optic neuritis Cogan's syndrome (CS) is a rare, systemic autoimmune vasculitis characterized by ocular and cochlear manifestations (Yaginuma et al.).  Features of typical CS are non-syphilitic interstitial keratitis (IK) within 2 years of Ménière-like sensorineural hearing loss, characterized by vertigo, instability, nausea, vomiting, and tinnitus (Espinoza et al.). Atypical CS is defined as having other forms of ocular inflammation (with or without IK), such as episcleritis, scleritis, optic neuritis, non-Ménière-like sensorineural hearing loss, or greater than 2 years between the ocular and audiovestibular manifestations.  Ocular involvement has a good prognosis with treatment; however, 38% of atypical CS patients become deaf in both ears. However, prompt diagnosis and treatment with oral Prednisone of at least 1 mg/kg/day can prevent permanent hearing loss (Grasland et al.). This disease can also affect multiple organ systems, and although it remains idiopathic, its proposed mechanism is believed to be autoimmune in nature (Espinoza et al.). We report the clinical course of a young female presenting with ocular and auditory symptoms without systemic involvement, ultimately leading to a diagnosis of atypical Cogan's syndrome. Duke Eye Center 2025-05-08 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/47 10.62856/djcro.v7.47 Digital Journal of Case Reports in Ophthalmology; Vol. 7 (2025): Spring 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/47/26 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/48 2025-11-18T11:55:30Z djcro:RET

Unilateral Serous Macular Detachment Accompanying Cystoid Macular Edema Temporally Associated with COVID-19 Vaccination Elmi Sadr, Navid Hariri, Ramyar COVID-19 Cystoid macular edema Serous macular detachment Sinopharm Vaccination A 67-year-old male presented with progressive vision loss in his left eye seven days after receiving the second dose of the COVID-19 vaccine (BBIBP-CorV, Sinopharm, Beijing, China). Fundus examination and spectral-domain optical coherence tomography angiography (SD-OCTA; Optovue, Fremont, CA) showed serous macular detachment with cystoid macular edema (CME) in the left eye. The patient’s best-corrected visual acuity improved dramatically from counting fingers at 3 m to 20/32, and macular detachment and CME resolved significantly within 10 days, without any treatment. This observation suggests a potential link between transient serous macular detachment accompanying CME and the Sinopharm COVID-19 vaccination. Nevertheless, it is important to emphasize that vaccination against COVID-19 is highly recommended. Duke Eye Center 2025-06-02 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/48 10.62856/djcro.v7.48 Digital Journal of Case Reports in Ophthalmology; Vol. 7 (2025): Spring 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/48/27 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/49 2025-11-18T11:33:49Z djcro:UVEI

HLA-B27 positive juvenile idiopathic arthritis associated uveitis presenting with an acute onset and a chronic course: HLA-B27 positive JIA and bilateral panuveitis Maleki, Arash N/A Purpose: The occurrence of Human leukocyte antigen-(HLA-) B27-associated bilateral granulomatous panuveitis in a pediatric patient ultimately diagnosed with oligoarticular juvenile idiopathic arthritis JIA. Case Presentation: A 10-year-old girl was evaluated for redness, pain, and photophobia in both eyes (OU) with no other ocular or systemic symptoms. Her best-corrected visual acuity was measured at 20/20 and 20/40 right (OD) and 20/40 left (OS) eyes, respectively. A slit lamp examination revealed mutton-fat keratic precipitates OU, anterior chamber reaction 1+ and 4+ cells OD and OS, respectively, and anterior vitreous 2+ cells OU. During dilated fundoscopy, 1+ OS haze was observed. Intravenous fluorescein angiography depicted mild disc OS and peripheral vascular leakage OU. Indocyanine green angiography revealed hypocyanescent lesions in choroid OU indicating of choroiditis. All lab work-up were negative or within the normal limits except positive HLA-B27. She was started on aggressive corticosteroids therapy, followed by a gradual taper. A flare-up occurred while she was on a regimen of 10 mg oral prednisolone and two drops of prednisolone OU. Then, immunomodulatory therapy was initiated with adalimumab and oral methotrexate. The eyes remained in remission with this regimen until she developed arthritis in the left knee and wrist, along with bilateral sacroiliitis. The pediatric rheumatology team decided to transition to golimumab, concurrently increasing the dosage of methotrexate. Conclusion: Chronic bilateral panuveitis with an acute onset granulomatous anterior uveitis component may be indicative of HLA-B27 associated JIA. It can be coupled with a delayed onset oligoarticular JIA. Duke Eye Center 2025-07-18 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/49 10.62856/djcro.v8.49 Digital Journal of Case Reports in Ophthalmology; Vol. 8 (2025): Summer 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/49/28 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/53 2025-11-18T11:21:24Z djcro:GLAUC

Delayed suprachoroidal hemorrhage during anterior chamber decompression one day following tube shunt implantation : Delayed SCH after AC decompression post tube Mohit Jethi Weiner, Asher AC Decompression Baerveldt Glaucoma Suprachoroidal hemorrhage Tube shunt Suprachoroidal hemorrhage (SCH) is a rare but potentially devastating condition that can occur during or following ocular surgery and can lead to severe visual impairment. Glaucoma surgery carries the highest rate of SCH, especially delayed suprachoroidal hemorrhage (DSCH). In this case report, we describe an elderly female with severe primary open-angle glaucoma (POAG) who developed a SCH while performing an anterior chamber (AC) decompression at the slit lamp due to high IOP 1 day following glaucoma tube shunt implantation, and who was treated medically with good visual outcomes. We are not aware of any guidelines regarding the best management in such a clinically complex situation. Our good outcome may thus suggest that conservative treatment with high IOP maintenance may be an appropriate management option in a case of limited and non-appositional DSCH even in cases of severe glaucoma. Duke Eye Center 2025-08-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/53 10.62856/djcro.v8.53 Digital Journal of Case Reports in Ophthalmology; Vol. 8 (2025): Summer 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/53/30 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/55 2026-06-24T12:33:18Z djcro:COR

Cyclosporine as postoperative immunomodulating agent in penetrating keratoplasty for keratomycosis: a case series Peralta Chacon, Esteban Kim, Chris Tian, James Ahmed, Syed Ali Carlson , Alan Williams, Lloyd Purpose: This study evaluates the efficacy and safety of topical cyclosporine A (tCSA) 2% as an immediate postoperative immunosuppressant following penetrating keratoplasty (PKP) for fungal keratitis to reduce graft rejection and fungal recurrence.   Methods: A retrospective case series at Duke Eye Center included six patients who underwent PKP for keratomycosis (2023–2024). Patients received tCSA 2% for at least one week before transitioning to topical prednisolone. Outcomes included graft rejection, fungal recurrence, visual acuity, and corneal clarity over six months.   Results: Five distinct fungal pathogens were identified; no fungal recurrence or graft rejection occurred. Surgical outcomes were favorable, with tCSA treatment lasting 3–24 weeks, allowing for delay of prednisolone initiation.   Conclusion: tCSA may help manage inflammation while minimizing fungal recurrence, serving as a bridge to corticosteroids. These findings support its potential role in postoperative PKP care, warranting further research for standardized protocols. Duke Eye Center 2025-09-08 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/55 10.62856/djcro.v8.55 Digital Journal of Case Reports in Ophthalmology; Vol. 8 (2025): Summer 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/55/32 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/56 2026-06-24T12:48:13Z djcro:GLAUC

Dissecting Trabeculectomy Filtering Bleb Masquerading as Ocular Surface Squamous Neoplasia Peralta Chacon, Esteban Arpita S. Maniar Alan D. Proia Syed A. Ahmed Miguel Materin A 79-year-old woman with a history of glaucoma and bilateral trabeculectomies presented with a large conjunctival mass concerning for ocular surface squamous neoplasia. Examination revealed a large, keratinized, vascularized lesion overlying the superior bulbar conjunctiva and cornea. Ultrasound biomicroscopy demonstrated a well-defined, encapsulated mass. The lesion was excised with amniotic membrane graft placement. Histopathology revealed findings consistent with a failed glaucoma filtering bleb, including keratinized stratified squamous epithelium, subepithelial edema, fibrovascular tissue, and dense collagen. No evidence of dysplasia or malignancy was found. Postoperatively, visual acuity improved to 20/20 with a well-formed bleb and controlled intraocular pressure. This case illustrates an unusual presentation of a failed filtering bleb mimicking ocular surface neoplasia and highlights the importance of histopathologic evaluation in differentiating benign postoperative changes from malignancy. Clinicians should consider filtering bleb complications in the differential diagnosis of conjunctival masses in patients with prior glaucoma surgery. Duke Eye Center 2025-08-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/56 10.62856/djcro.v8.56 Digital Journal of Case Reports in Ophthalmology; Vol. 8 (2025): Summer 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/56/29 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/58 2025-11-18T10:26:50Z djcro:RET

Successful Closure of a Recurrent Full-Thickness Macular Hole with Medical Therapy: A Case Report: Medical therapy for macular hole Vroman, Jenna Farr, Arman Grewal, Dilraj full-thickness macular hole macular edema pars plana vitrectomy medical therapy non-surgical therapy A 73-year-old male with a past medical history of pseudophakia and posterior vitreous detachment (PVD) in both eyes, epiretinal membrane (ERM) in his right eye (OD), lattice degeneration OD, and prior, localized retinal detachment OD status post laser retinopexy presented with progressive vision loss OD. The patient was found to have a full thickness macular hole (FTMH) which was successfully closed with pars plana vitrectomy (PPV), the standard of treatment for a primary FTMH. Six years postoperatively, the macular hole reopened. The recurrent FTMH was managed with intravitreal injection of  triamcinolone acetonide (Kenalog) 2.0 mg/0.05 mL and topical dorzolamide-timolol 2%/0.5%, ketorolac 0.4%, and prednisolone acetate 1% drops. This conservative management resulted in complete resolution of the recurrent FTMH. This case illustrates the efficacy of topical therapy in managing recurrent FTMH, highlighting a non-surgical alternative in select patients. Duke Eye Center 2025-09-08 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/58 10.62856/djcro.v8.58 Digital Journal of Case Reports in Ophthalmology; Vol. 8 (2025): Summer 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/58/31 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/63 2026-01-20T12:16:21Z djcro:COR

Corneal Keloid: A Case Report Manusree Bhatter Christian Robertson Lai Jiang corneal keloid nodule keratinization benign Corneal keloids are rare, benign corneal lesions that are often misdiagnosed due to their resemblance to other corneal opacities. Our patient is a 56-year-old male with a past eye history of cataract surgery and left eye injury in childhood who presented with a chief complaint of 6 months of aching left eye pain associated with worsening vision and light sensitivity. On slit lamp examination, a single, well-circumscribed, smooth, and pearly white corneal nodule was identified. Anterior segment OCT was completed to further evaluate this lesion. The patient underwent subsequent superficial keratectomy, and histopathological evaluation revealed cornea with stroma composed of variably dense collagen with focal sclerosis and facets of epithelium within the stroma and focal keratinization of the epithelium consistent with corneal keloid. Here, we will further discuss this case of a corneal keloid and discuss the clinical features, histopathology, and surgical outcome of this patient. Duke Eye Center 2025-10-02 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/63 10.62856/djcro.v9.63 Digital Journal of Case Reports in Ophthalmology; Vol. 9 (2025): Fall 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/63/33 Copyright (c) 2025 Duke Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/66 2026-06-24T15:13:59Z djcro:GLAUC

Ab externo complete glaucoma drainage device occlusion with bulbed polypropylene suture Liebman, Daniel Nolan, Cormac Lin, Michael ab externo occlusion Glaucoma glaucoma drainage device hypotony tube ligation We present a novel ab externo glaucoma device occlusion method for patients with hypotony following glaucoma drainage device placement. In this case study, a patient with symptomatic hypotony due to cyclophotocoagulation after glaucoma drainage device implantation underwent occlusion of the drainage device via a modified ab externo approach. After externalizing the tube through a corneal paracentesis incision, a bulbed 3-0 polypropylene suture fragment was inserted into the tube, with subsequent reinsertion of the occluded tube into the anterior chamber. Intraocular pressure increased from 4 mmHg to teens in the first month after the procedure, peaking at 18mmHg at post-operative month four, and stabilizing at 10mmHg on dorzolamide at 14 month follow-up. Visual acuity improved from 20/1000 to 20/400. The technique improves upon previously-described occlusive methods owing to its technical simplicity, safety, minimal invasiveness, and reversibility. Duke Eye Center 2026-04-13 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/66 10.62856/djcro.v10.66 Digital Journal of Case Reports in Ophthalmology; Vol. 10 (2026): Spring 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/66/37 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/67 2026-04-23T15:14:27Z djcro:UVEI

A Case of Resistant Serpiginous Choroiditis Successfully Treated with Chlorambucil Monotherapy: Chlorambucil in Serpiginous choroiditis Moxam, Jillene Saigal, Khushi Khan, Shawn Maleki, Arash Purpose: Serpiginous Choroiditis is an inflammatory condition that presents with etiology such as choroidal inflammation, leading to the loss of the choriocapillaris, atrophy or damage to the overlying retinal pigment epithelium. Diagnosis of serpiginous choroiditis is made from retinal imaging such as optical coherence tomography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography. Patients with serpiginous choroiditis present with symptoms such as metamorphopsia, scatoma, and reduced central vision.  Treatment can range from high dose oral corticosteroid, intravitreal steroid, or immunosuppressive drugs such as chlorambucil. Methods: A 70-year-old male presented to our clinic with blurry vision and metamorphopsia in his right eye. Results and Discussion: Slit lamp exam was normal; however, Fundus exam revealed peripapillary atrophy extending from the disk nasally and supratemporally and presence of an elevated grayish lesion supratemporal to the optic nerve head in the macula with pigment. Optical coherence tomography revealed subretinal fluid within the macula and near the disk. A complete uveitis workup was completed with serological markers within normal range confirming the diagnosis of SC. The patient was started on oral corticosteroid and administered intravitreal bevacizumab. He was later started on chlorambucil with weekly dose adjustments to a dose of 24 mg daily with sustained WBC count between 3000-4500 cells/μl for 12 weeks with no recurrence of subretinal fluid. This treatment requires further study but provides a foundation for larger patient studies. Conclusion: chlorambucil monotherapy, has shown promise as a successful approach to induce durable remission and potentially cure serpiginous choroiditis.   Duke Eye Center 2025-11-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/67 10.62856/djcro.v9.67 Digital Journal of Case Reports in Ophthalmology; Vol. 9 (2025): Fall 2025 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/67/34 Copyright (c) 2025 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/69 2026-02-27T12:49:33Z djcro:UVEI

Severe unilateral hypopyon uveitis secondary to Zoledronate infusion masquerading as endophthalmitis: Zoledronate-associated hypopyon uveitis Cheng, Brian Zafar, Sidra Hwang, Bryce Calotti, Martin Kim, Julie Bowe, Theo Beca, Flavius Mehta, Sonia Dunn, James Garg, Sunir Deaner, Jordan Zoledronate is a bisphosphonate medication used to treat osteoporosis and metastatic bone disease. We report an 81-year-old female who developed severe unilateral hypopyon-associated anterior and intermediate uveitis after her first intravenous zoledronate infusion for osteoporosis, initially concerning for endogenous endophthalmitis. Her visual acuity (VA) at presentation was hand motion (HM). Given the abrupt symptom onset and the initial severity of her presentation, there was concern for endogenous endophthalmitis. The patient underwent a vitreous tap, intravitreal antibiotics, and an unrevealing systemic work-up. Treatment comprised frequent topical corticosteroids, high-dose oral corticosteroids, and zoledronate cessation. Her intraocular inflammation resolved completely, although she later developed macular edema. At 3-month follow-up, VA improved to 20/70. Ocular inflammation following bisphosphonate use is rare and can have variable presentation. Our case underscores the importance of detailed medication history and considering drug-induced uveitis in acute intraocular inflammation. Prompt recognition and appropriate treatment can result in favorable visual outcomes. Duke Eye Center 2026-02-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/69 10.62856/djcro.v10.69 Digital Journal of Case Reports in Ophthalmology; Vol. 10 (2026): Spring 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/69/35 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/71 2026-04-27T20:43:58Z djcro:RET

Pseudomonas stutzeri endogenous endophthalmitis and Giant retinal tear management with short term tamponade T E, ASHRAYA NAYAKA JAYAKUMAR, KALAIVANI Endogenous endophthalmitis giant retinal tear Pseudomonas stutzeri short term tamponade We report a rare case of endogenous endophthalmitis caused by Pseudomonas stutzeri in a healthy young male with no systemic illness or identifiable risk factors. The patient presented with acute painful vision loss in the right eye and was diagnosed clinically and microbiologically. Vitreous cultures confirmed P. stutzeri, while blood cultures grew Elizabethkingia meningoseptica. Early pars plana vitrectomy and targeted intravitreal ceftazidime led to infection resolution and visual improvement. However, the patient subsequently developed a giant retinal tear (GRT)-associated retinal detachment. A two-stage vitrectomy using short-term perfluoro-n-octane (PFCL) tamponade followed by silicone oil tamponade successfully restored retinal anatomy and improved final vision to 20/60. This is the first reported case of P. stutzeri endogenous endophthalmitis in an immunocompetent individual. The case underscores the importance of early surgical intervention, tailored antibiotic therapy, vigilant follow-up, and the utility of PFCL in managing complex GRTs, even in unexpected and aggressive ocular infections. Duke Eye Center 2026-04-27 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/71 10.62856/djcro.v10.71 Digital Journal of Case Reports in Ophthalmology; Vol. 10 (2026): Spring 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/71/40 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/72 2026-04-25T15:36:32Z djcro:RET

Subretinal fluid overlying a drusenoid pigment epithelial detachment in an eye with dry age-related macular degeneration Paola Saboya Karthik, Naveen Fekrat, Sharon age-related macular degeneration subretinal fluid drusenoid pigment epithelial detachment Age-related macular degeneration (AMD) is a leading cause of irreversible blindness worldwide. It is generally classified into two forms: dry (non-neovascular) AMD and wet (neovascular) AMD. Wet AMD is typically characterized by subretinal fluid (SRF) resulting from choroidal neovascularization. We present a rare case of dry AMD with a drusenoid pigment epithelial detachment (PED) and overlying SRF, mimicking wet AMD. This case demonstrates that SRF can also occur in eyes with dry AMD, especially in the presence of a large drusenoid PED. Possible mechanisms include mechanical stress from confluent drusen, the presence of an avascular serous PED, and age-related retinal pigment epithelium dysfunction. Previous studies have reported similar cases with a low rate of progression to wet AMD. This case emphasizes the diagnostic challenge of relying solely on SRF to identify wet AMD and highlights the importance of accurate classification to avoid unnecessary intravitreal anti-VEGF injections. Duke Eye Center 2026-04-25 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/72 10.62856/djcro.v10.72 Digital Journal of Case Reports in Ophthalmology; Vol. 10 (2026): Spring 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/72/39 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/77 2026-04-29T13:32:58Z djcro:RET

Ellipsoid Zone Loss as a Retinal Complication after Chimeric Antigen Receptor T-Cell Therapy: A Case Report Zhang, Eliana-Ruobing Lederer, David Elliott adverse ocular effects CAR-T cell therapy ellipsoid zone optical coherence tomography reversible photoreceptor disruption We report a novel case of transient ellipsoid zone (EZ) disruption with subsequent spontaneous recovery following CD19-targeted CAR-T cell therapy for B-cell lymphoma. A 57-year-old male presented with gradual vision decline two months post-treatment. While clinical examination was unremarkable, optical coherence tomography (OCT) revealed bilateral EZ attenuation. Over five months of observation, serial OCT imaging documented complete EZ restoration, which correlated with improved visual acuity. This represents the first report of reversible EZ disruption linked to CAR-T therapy. The findings mirror phenomena seen in acute syphilitic posterior placoid chorioretinitis and following ocriplasmin injection. This case of reversible EZ loss suggests that previously reported visual complications in CAR-T patients, typically attributed to neurotoxicity, could have a retinal origin. We therefore recommend incorporating OCT imaging into the standard assessment of CAR-T patients experiencing visual symptoms to aid in the diagnosis and monitoring of this potential complication.  Duke Eye Center 2026-03-30 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/77 10.62856/djcro.v10.77 Digital Journal of Case Reports in Ophthalmology; Vol. 10 (2026): Spring 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/77/36 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/80 2026-04-13T15:38:40Z djcro:PEDS

Approaches to Low Vision Care in Patients with Uveal Coloboma: An African Perspective: Low Vision Care for Uveal Coloboma Arogbokun, Sunkanmi Barstow, Elizabeth telescope Brachymetatarsia coloboma uveal coloboma low vision Introduction Low vision management plays a critical role in pediatric care, significantly improving children’s daily activities and quality of life. Case Report This case report examines the unique challenges and interventions used in managing a 14-year-old girl of Black African descent with uveal coloboma and brachymetatarsia at ECWA Eye Hospital, Kano, Nigeria. She presented with severe vision impairment (1.8 logMAR in the right eye and 1.0 logMAR in the left eye) and minimal improvement with subjective refraction. Low vision aids, including a 6´ monocular telescope and +6.00 D spectacle magnifier, improved her distance vision to 0.0 logMAR and her near vision to 0.8M at a 13-cm distance. Non-optical interventions such as relative distance magnification, improved lighting, contrast enhancement, and ergonomic adjustments further improved comfort and functionality. Counseling on accommodative footwear and available surgical options supported management of her brachymetatarsia. Conclusion The therapy resulted in significant visual and quality-of-life improvements. This case contributes valuable data to the understanding of rare pediatric low vision conditions in Africa. Duke Eye Center 2026-04-13 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/80 10.62856/djcro.v10.80 Digital Journal of Case Reports in Ophthalmology; Vol. 10 (2026): Spring 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/80/38 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/84 2026-06-18T13:02:44Z djcro:COR

Corneal Melt Associated with Subcutaneous Allergen Immunotherapy: Corneal Melt and Allergen Immunotherapy Hsu, John Wisely, C. Ellis Sura, Amol allergies corneal melt immunologic trigger subcutaneous allergen immunotherapy peripheral ulcerative keratitis Subcutaneous allergen immunotherapy (SCIT) is not typically associated with serious ocular complications. We report a 53-year-old male who developed corneal melt and was diagnosed with peripheral ulcerative keratitis (PUK) in the setting of SCIT for severe seasonal allergies. The patient presented with bilateral eye pain, redness, and photophobia following immunotherapy injections, with examination revealing a peripheral corneal melt in the right eye with thinning, neovascularization, and conjunctival overgrowth. Infectious and autoimmune workup was noncontributory. Treatment with oral and topical steroids and periocular tacrolimus was initiated, though incompletely effective. SCIT was then discontinued, resulting in resolution of the epithelial defect and ocular inflammation. We propose that SCIT acted as an immunologic trigger for corneal melt, potentially through a hyperreactive immune response and immune complex deposition in limbal vasculature. This case highlights the importance of monitoring for ocular complications during allergen immunotherapy and broadening the differential for corneal melt to include any potential immunologic disturbances. Duke Eye Center 2026-06-18 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/84 10.62856/djcro.v10.84 Digital Journal of Case Reports in Ophthalmology; Vol. 11 (2026): Summer 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/84/42 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/85 2026-06-24T15:11:32Z djcro:PLASTICS

Post-traumatic Anterior Globe Luxation Case Report Nassaf, Othmane Daoui, Abdessamad Bouslous, Nabil Moustaine, Omar Background: Post-traumatic anterior globe luxation is an exceptional ophthalmic emergency characterized by anterior displacement of the globe beyond the palpebral fissure, often associated with devastating optic nerve and orbital injuries. Most cases follow high-energy trauma and require complex surgical management. Case Presentation: A 28-year-old man presented to CHU Mohammed VI (Agadir, Morocco) with traumatic globe luxation after a finger assault beneath the superior orbital rim. The left globe was incarcerated posteriorly behind markedly edematous eyelids with visual acuity 1/10 (LogMAR 1.0), profoundly limited motility, conjunctival chemosis, and intraocular pressure 20 mmHg. Slit-lamp and fundus examinations revealed no open-globe injury or optic nerve damage. Under topical anesthesia, manual reduction was performed using a Desmarres lid retractor to disengage edematous eyelids while applying gentle posterior-inferior pressure on the globe (Figures 1-3). Post-reduction treatment included oral prednisone 1 mg/kg/day × 5 days and topical antibiotic-steroid therapy × 10 days. Results: Within 48 hours, pain resolved completely, intraocular pressure normalized to 14 mmHg, motility markedly improved, and visual acuity recovered to LogMAR 0.0 (10/10). At 1-month follow-up, the patient had normal ocular examination with no sequelae. Conclusions: When optic nerve function is preserved, prompt manual eyelid disengagement and globe reduction under topical anesthesia represent a simple, effective approach yielding excellent visual and anatomical outcomes. Rapid intervention minimizes ischemia and secondary corneal damage, emphasizing the value of conservative management in selected traumatic globe luxation cases. Duke Eye Center 2026-06-18 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/85 10.62856/djcro.v10.85 Digital Journal of Case Reports in Ophthalmology; Vol. 11 (2026): Summer 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/85/41 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/88 2026-08-05T20:54:04Z djcro:RET

Perfused Central Retinal Vein Occlusion in the Setting of Intense Exercise and Dehydration Zhu, Ashley Ivakhnitskaia, Jane Konstantinou, Eleni impending central retinal vein occlusion exercise retinopathy dehydration Purpose: To report a case of exercise-induced impending central retinal vein occlusion (CRVO) in a young, otherwise healthy athlete.  Observations: A young athletic woman presented with acute blurry vision following repeated high-intensity exercise with inadequate hydration. Visual acuity was minimally affected. Fundus examination revealed venous dilation, vascular tortuosity, and scattered intraretinal hemorrhages without macular edema. Systemic evaluation did not identify underlying risk factors. A diagnosis of impending CRVO was made. The patient was managed conservatively with advice to improve hydration and temporarily reduce strenuous physical activity.  Results: Symptoms and retinal findings resolved spontaneously within one month. The patient subsequently resumed her usual exercise routine with adequate hydration and no recurrence.  Conclusions and Importance: Impending CRVO can occur in young, healthy individuals in the setting of dehydration and excessive physical exertion. Recognition of these modifiable risk factors is important, as conservative management may lead to complete recovery without intervention.  Duke Eye Center 2026-08-05 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/88 10.62856/djcro.v11.88 Digital Journal of Case Reports in Ophthalmology; Vol. 11 (2026): Summer 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/88/44 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology

oai:djcro.duke.edu:article/90 2026-07-16T18:43:31Z djcro:PEDS

Heavy Eye Syndrome With Asymmetric Ocular Surface Disease: Over a Decade of Follow-Up.: Dry Eye in Heavy Eye Syndrome Demirtas, Taflan Deniz Yigit, Tolga Yildirim, Senihe Rengin dry eye disease heavy eye syndrome high myopia strabismus fixus ocular surface disease dry eye heavy eye strabismus Heavy eye syndrome (HES) is a rare form of acquired strabismus associated with high axial myopia and mechanical displacement of the globe and extraocular muscles. We report a 23-year-old male with HES who presented with severe asymmetric dry eye symptoms predominantly affecting the more elongated eye. Magnetic resonance imaging demonstrated inferomedial globe displacement with characteristic superior rectus and lateral rectus muscle displacement. Schirmer test values and tear film break-up time were markedly reduced, particularly in the affected eye. The patient was managed conservatively with topical cyclosporine and preservative-free lubricants and was followed for 10 years. Despite persistent ocular misalignment, ocular surface findings and symptoms improved substantially during follow-up, while corneal tomography, macular optical coherence tomography, and specular microscopy findings remained stable. Although a coincidental coexistence cannot be excluded, this case suggests that mechanical alterations in HES may contribute to ocular surface instability and asymmetric dry eye disease.  Duke Eye Center 2026-07-15 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://djcro.duke.edu/index.php/djcro/article/view/90 10.62856/djcro.v11.90 Digital Journal of Case Reports in Ophthalmology; Vol. 11 (2026): Summer 2026 2997-3317 eng https://djcro.duke.edu/index.php/djcro/article/view/90/43 Copyright (c) 2026 Digital Journal of Case Reports in Ophthalmology