BOTOX injection to treat strabismus after infant botulism type B infection

Purpose: The significance of botulinum toxin to ophthalmologists is twofold. Botulism, a medical emergency, frequently presents with ocular findings including blurred vision, diplopia, ptosis, and photophobia as a result of the neurotoxin produced by Clostridium botulinum. However, botulinum toxins also have therapeutic uses for medical conditions including strabismus. The safety and efficacy of Botulinum toxin A in patients with a history of botulism has not been reported. Observations: We report a 9-week-old infant, diagnosed with type B toxin positive infant botulism treated with human botulism immune globulin, who developed a large angle exotropia. The infant was treated with intramuscular injections of botulinum toxin A to the extraocular muscles resulting in a favorable initial response but ultimately required strabismus surgery. Clinical manifestations and management of botulism are reviewed and botulinum toxin in the treatment of pediatric strabismus is discussed. Conclusions and importance: This case demonstrates safe administration of onabotulinumtoxinA to an infant with a history of antitoxin-treated botulism, resulting in a transient improvement in control of infantile exotropia

Retinal Vasculitis: A Case Study

Purpose: To describe a case of idiopathic retinal vasculitis. Methods: Case report and literature review. Case: A healthy 25-year-old female presented with a one-week history of a large floater in her right eye. Patient’s subjective complaint of floaters, including the scotoma on VF and the FA findings were most consistent with retinal vasculitis displaying predominant venous involvement. However, findings for acute macular neuroretinopathy and multiple evanescent white dot syndrome (MEWDS) were present as well. Autoimmune and infectious disease panels were negative. Neuro consult and brain MRI showed nonspecific, non contributory findings. Several weeks later, following Medrol dose pack, patient reported significantly improved visual field and this was consistent with improved clinical and diagnostic findings. Conclusion: Although cases of retinal vasculitis have been linked to infectious, neoplastic, systemic and autoimmune diseases, idiopathic cases can present concurrently with other retinopathies

33g Hypodermic Needle-Guided Iris Suturing Technique.

The purpose of this study is to describe a novel 33g hypodermic needle guided iris suturing technique (33-GIST) for repair of iris defects and its adaptation for use to address a wide range of iris pathology in complex anterior segment reconstruction cases. Our approach uses a 33g hypodermic needle loaded with a 10-0 prolene suture within its lumen which is then used to directly introduce and manipulate the suture within the anterior chamber. Eliminating the need for a needle holder, this technique provides surgeons improved ergonomics and minimizes risk of trauma to adjacent tissues. Improving upon and addressing limitations of the original sewing machine technique described by Safran in 1995; iris repair using this technique has been applied successfully in 15 patients to achieve satisfactory visual and cosmetic outcomes without complications. Multiple iris suturing strategies can be combined on a given case to effect complex repair with this novel approach

Solitary fibrous tumor of the caruncle: a solitary location

A 78-year-old Caucasian male presented with diplopia and decreased vision in the left eye for 1 month, in addition to a painless fleshy lesion in the inner corner of the left eye for 3-month duration. His best-corrected visual acuity was 20/40 and 20/50. Slit lamp examination revealed a left medial conjunctival and caruncular lesion, measuring 6 mm by 4 mm. Histology of the excised mass showed a cellular submucosal spindle cell neoplasm without cytologic atypia and rare mitoses, immunohistologically diffusely positive for CD34 and STAT6, and negative for SMA. Based on these findings, solitary fibrous tumor was diagnosed. With the combined diagnostic power of light microscopy and immunohistochemistry, SFTs are diagnosed increasingly and more accurately in the orbit. With this first case report of a caruncular SFT, we believe that SFTs should remain on the differential for mesenchymal tumors of the conjunctiva and caruncle