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A patient who had been previously treated with retinal photocoagulation for severe retinopathy of prematurity. Ultrasound biomicroscopy revealed nearly spherical, thickened lens with complete angle closure. Fundus photography with diffuse chorioretinal scars consistent with previous photocoagulatio…

Pachyphakia, Microcornea, and Angle Closure A patient presented for right eyelid drooping and redness. The patient had a remote history of retinopathy of prematurity (ROP) which had been treated with extensive retinal laser ablation as a neonate. The patient was found to have pachyphakia, microcorn…

The multicolored appearance is due to needle shaped polychromatic peptide crystals in the cortex or nucleus of the lens. These are not generally visually significant.

Proliferative Sickle Retinopathy A 3-year-old female was referred to BPEI for treatment of congenital cataracts. After bilateral lensectomy and vitrectomy, the patient was noted to have elevated intraocular pressure. She underwent placement of BGI and was incidentally found to have vitreous hemorrh…

Persistent Pupillary Membrane, Complete Coloboma A pediatric patient was referred for iris abnormalities. Initial BCVA was 20/60 and 20/70 and exam showed dense central pupillary membranes and complete colobomas. Given obscuration of the visual axis and amblyopia, optical iridectomy and pupillary m…

Stickler Syndrome This presentation describes a teenage patient who presented with bilateral retinal detachments. He has a strong family history of Stickler Syndrome. Additionally, there is a family history of multiple types of cancers, specifically GI cancers. The patient underwent an exam under a…

Primary Congenital Glaucoma We present two cases of patients with primary congenital glaucoma (PCG) and buphthalmos who underwent cataract surgery and Glaucoma Drainage Implant (GDI). The first case is a young adult, VA 20/60 in the right eye and hand movements (struggle) in the left eye. Intraocul…

Restrictive Strabismus Secondary to a Large Encapsulated Non-Valved Glaucoma Drainage Implant Fibrotic Capsule A patient with a history of primary open angle glaucoma of both eyes and myopic degeneration with amblyopia and chronic poor central vision of the right eye presented with elevated intraoc…

Motility Disturbances after Glaucoma Drainage Device A patient with a history of traumatic angle recession glaucoma in the left eye presented with acute onset of double vision and persistent ocular soreness in the left eye. He denied generalized weakness or difficulty with respiration. His surgical…

These are caused by failure of the embryonic fissure to close during the second month of development in utero. The iris defect is also known as a "keyhole" pupil. Here, there is not only an iris defect, but also missing tissue in the lens (yellow arrow) and zonules. This can cause difficulties duri…

Recurrent Benign Sixth Nerve Palsy A young patient presented with acute onset of crossed eyes and diplopia. He reported no associated vision changes in either eye. His examination revealed right eye esotropia of 6 prism diopters (PD) in primary gaze, 14 PD in right gaze, and 4 PD in left gaze. The …

Nuclear 3rd CN Palsy with Vertical Gaze Palsy A patient with significant vasculopathy risk factors (DM, HTN, dyslipidemia), had a stroke affecting the right thalamus, midbrain, and right cerebellum due to basilar artery occlusion. He had a successful mechanical thrombectomy with a stent retriever a…

A pediatric patient with leukemic infiltrate of the optic nerve in both eyes.

Sturge Weber Syndrome An infant presented to clinic as a referral due to a cloudy right cornea and port wine birthmark. The parents did not notice any abnormal behavior from the infant. The patient’s intraocular pressure was 28 and 14, but limited exam was possible in the office setting. An exam …

Community-Acquired Methicillin-Resistant Staphylococcus Aureus (MRSA) Caused Episcleral Mass Resembling Granuloma A patient underwent bilateral medial rectus recession for a history of infantile esotropia. Ten days prior to the surgery, she developed a skin lesion on her forearm and was placed on c…

Blunt Right Eye Trauma with a Transected Inferior Rectus Muscle Resulting in Severe Right Hypertropia An adult patient was transferred to BPEI ER after suffering right eye trauma while using a pressure washer machine. Patient reported his right eye had been bleeding and swollen since the accident. …

Familial Exudative Vitreoretinopathy and Retinopathy of Prematurity An infant underwent ophthalmic examination. Born at 32 weeks, the infant weighed 680 grams and received high-flow nasal cannula for respiratory distress of the newborn. Dilated fundus examination of the right eye revealed periphera…