Resolving Dilemmas in Ophthalmology: Challenging Cases, Diagnosis and Management

Foreword
Contents
About the Editors
Iris Neovascularization: An Enigma to Be Solved
	Case Report
	Dilemma: What Was the Cause of Unilateral NVI?
	Dilemma: What Could Be the Cause of Iris Neovascularization When the Probable Etiological Factor Had Been Removed? Could It Be Due to Retinal Ischemia Caused by Diabetic Retinopathy?
	Dilemma: Why Not an Anterior Placement of a Tube When It Is an Easier Procedure?
	References
Angle-Closure Glaucoma: An Uncommon Cause of a Common Finding
	Introduction
	Dilemma: Should We Have Done PI in Both Eyes?
	Dilemma: What Was the Cause of the Persistence of Such High Intraocular Pressures Despite PI? Was It Plateau Iris Syndrome? Or Was There Something Else?
	Dilemma: Could a Noncontact Method Like ASOCT Have Been Better Than Using a UBM Which Is a Contact Method?
	Discussion
	Dilemma: What Is the Correct Protocol for the Management and Treatment of Such a Case?
	References
Unilateral Vogt-Koyanagi-Harada Disease Associated with Non-arteritic Anterior Ischemic Optic Neuropathy in a Young Woman Presenting as Acute Angle-Closure Glaucoma
	Introduction
	Case Presentation
	Dilemma
	Dilemma
	Discussion
	Conclusion
	References
Endothelial Adherence of Asteroid Bodies Following Nd: YAG Laser Posterior Capsulotomy—An Unhealthy Union
	Introduction
		Case Report
		Dilemma: Can These Fine White Deposits on Corneal Endothelium Be Asteroid Bodies?
		Dilemma: Why Did These Asteroid Bodies Adhere to Corneal Endothelium?
		Dilemma: Can Uncomplicated Cataract Surgery Also Lead to Anterior Prolapse of Asteroid Hyalosis?
	Discussion
	Conclusion
	References
Spontaneous Posterior Dislocation of the Cataractous Lens in a Patient with Parkinson-Plus Syndrome
	Introduction
	Case Report
	Dilemma
	Dilemma
	Discussion
	Conclusion
	References
Pleomorphic Adenoma of a Subconjunctival Ectopic Lacrimal Gland
	Introduction
		Case Report
		Dilemmas of Diagnosis and Management
	Discussion
	References
Acute Unilateral Hypopyon Uveitis and Secondary Glaucoma in an Adult with Relapsing Acute Lymphoblastic Leukemia
	Introduction
	Case Report
	Dilemmas
		Follow-Up After Ocular and Systemic Treatment
	Discussion
	Conclusion
	References
Sturge Weber Syndrome: Search for the Stain
	Introduction
	Case Report
	Discussion and Dilemmas
		What Are the Causes of Unilateral Advanced Glaucoma?
		What Are the Classical Features of SWS?
		What Does Blood in the Schlemm Canal Signify?
		What Is the Significance of Glaucoma in SWS?
		Why Was PWS Missed on the Primary Examination?
		How Does Increased Choroidal Thickness Contribute to the Diagnosis of SWS?
		Can there be any Other Condition that Also Presents without PWS?
		What Is the Take-Home Message?
	References
Finding Red Where It Does Not Belong: Post-Traumatic Neovascularization of a Cataractous Lens
	Introduction
		Case Report
		Dilemma: What Could Be the Cause of the Nodular Brownish Lesion in the Left Eye?
		Dilemma: What Could Have Caused Blood Vessels on the Cataractous Lens? What Could Be the Inciting Factor for Such a Finding?
		Dilemma: What Was the Plan of Action in Such a Case?
		Dilemma: Why Was the Posterior Capsule Thickened and How to Manage Deposits on the Posterior Capsule?
	Discussion
	Conclusion
	References
Ocular Cysticercosis: Diving Into Depths of Sclera and Cornea
	Introduction
	Case Report
	Dilemma: What Is the of Cause Long-Standing Cystic Conjunctival Swelling Involving the Limbus and Adjacent Cornea?
	Dilemma: Clinically Conjunctival Cystic Appearing Swelling Turned Out to Be Intrascleral. What Is our Surgical Plan Now?
	Dilemma: What Systemic Evaluation Is Warranted in Such a Case of Ocular Cysticercosis? Do We Need to Look for Cysticercosis Elsewhere Too?
	Discussion
	References
Moving Backward Is Not Retreating: Management of Pigment Dispersion Syndrome (PDS) Post Photorefractive Keratectomy (PRK)
	Introduction
		Case Report
		Dilemma: What Could Be the Cause of Exercise-Induced Blurry Vision?
		Dilemma: Why did PDS Present 9 Months After an Uneventful PRK?
		Dilemma: Should a Patient Diagnosed with PDS Be Denied Refractive Surgery?
		Dilemma: Can these Patients of PDS Have Severe Complications Following Refractive Surgery?
	Discussion
	Conclusion
	References
Chemical Keratopathy: Caught on the Hop
	Dilemmas
	Introduction
	Case Report
	Discussion
	References
Toric IOL in Irregular Astigmatism: Are We Addressing the Real Issue?
	Introduction
	Case Report
		Dilemma: What Will Be the Surgical Management Options for Such a Patient?
		Dilemma: How to Do a Pre-Cataract Workup in a Patient with PMCD?
		Dilemma: Was Toric IOL the Right Choice for a Patient with PMCD?
	Discussion
	References
Advanced Keratoconus with Hydrops: Light at the End of the Tunnel
	Introduction
	Case Report
		Dilemma: How to Manage a Case of Acute Hydrops in a Previously Undiagnosed Keratoconus Patient?
		Dilemma: Does Every Case of Keratoconus Progress Toward the Hydrops Stage?
		Dilemma: What Are the Treatment Options Available in the Case of Acute Corneal Hydrops? Why and How Did We Decide on Intervention in the Present Case?
		Dilemma: What Is the Role of Scleral Contact Lenses in Visual Rehabilitation Post-Hydrops Recovered Corneas?
		Dilemma: How to Manage Dense Visual Axis Central Scarring Post Hydrops?
	Discussion
	References
The Masters of Mimicry: Atypical Viral Presentation
	Introduction
	Case Report
		Dilemma: What Could Be the Cause of Microcystic Epitheliopathy in the Absence of Any Medications in This Patient? What Was the Clue to Etiology?
		Dilemma: Can Viral Involvement Cause Exclusive Epitheliopathy?
		Dilemma: What Are Other Unusual Associations with Corneal Epitheliopathy?
		Dilemma: Could It Be Corneal Dystrophy?
		Dilemma: How to Manage Such a Case Without a Confirmed Diagnosis?
	Discussion
	Conclusion
	References
DMEK Triple Procedure in a Case of Delayed Complications Following Bilateral Cosmetic Iris Implants: The Road Seldom Traveled
	Introduction
	Case Report
		Dilemma: What Are Cosmetic Iris Implants? How Do They Differ from Therapeutic Prostheses?
		Dilemma: What Should Be the Management of Such a Case of Complications Associated with Cosmetic Iris Implants?
		Dilemma: Can a Combined Corneal and Cataract Procedure Be Planned, or Should the Surgeries Be Done in Multiple Stages?
		Outcome and Follow-Up
	Discussion
	Conclusion
	References
Malpositioned Phakic IOL: When You Cannot Turn It Loose
	Introduction
	Case Report
		Dilemma: What Can Be the Cause of Unilateral Suboptimal Vision with Low Vault 1 Week After Uneventful Phakic IOL Implantation?
		Dilemma: Do We Always Need to Intervene in Cases of a Low Vault?
		Dilemma: How Should One Proceed Ahead in Such a Case?
		Dilemma: How to Recognize the Correct Orientation of PIOL?
		Dilemma: What Could Have Gone Wrong That Resulted in Reverse Lens Implantation in One Eye?
		Dilemma: How to Avoid Reverse Implantation of IPCL?
		Dilemma: Despite the Upper Four Holes Lying Superiorly Under the Lid, Can IPCL Still Be in Reverse Configuration??
	Discussion
	Conclusion
	References
Idiopathic Polypoidal Choroidal Vasculopathy Appearance Under Aflibercept Treatment
	Introduction
	Case Description
		Dilemma
	Discussion
	Conclusion
	References
Spontaneous Late Reopening of a Successfully Operated and Closed Full-Thickness Macular Hole: A Case Report
	Introduction
	Case Report
		Dilemmas
		Dilemma
	Discussion
	Conclusion
	References
Bilateral Ocular Ischemic Syndrome
	Introduction
	Epidemiology and Pathogenesis
	Systemic Association
	Dilemmas in the Reported Case
	Case Report
	Diagnosis and Management
		Dilemma: Why Not Bilateral Central Retinal Vein Occlusion (CRVO) or Proliferative Diabetic Retinopathy (PDR)?
	Prognosis
	Discussion
	References
Rare Case of Granulomatosis with Polyangiitis: Ocular Involvement
	Dilemmas
	Introduction
	Epidemiology
	Pathology
	Case Details
		Diagnosis
	Discussion
	References
Advanced Glaucoma in Angle Closure in a One-Eyed Patient: Can Surgery Be the Last Savior for the Vision?
	Case Report
	Discussion
	References
Tackling the Triple Trouble: Operated Trabeculectomy, Miotic Non-dilating Pupil, and Hard Brown Cataract
	Introduction
	Case Report
	Discussion
	Conclusions
	References
Subretinal Setae: Treat It or Leave It?
	Introduction
	Case Presentation
	Dilemma
	Discussion
	Declarations
	References
Primary Vitreoretinal Lymphoma
	Introduction
	Discussion
	References
Endogenous Endophthalmitis: Too Much Information Leads to Confusion
	Introduction
	Discussion
	Conclusion
	References
Acute Angle Closure Following a Snake Bite: Are We Missing It?
	Introduction
	Discussion
	References
Infectious Keratitis, Toxic Endotheliitis, and Severe Anterior Uveitis Following Bee Sting Corneal Injury
	Case Report
	Discussion
	Conclusion
	References
Unilateral Optic Disc Edema in a Young Male
	Case Report
	Discussion
	Conclusion
	References
Opacified Intraocular Lenses: Unclear for Both Patient and Doctor
	Introduction
	Glistening Versus Opacification
	Case I
	Case II
	Case III
	Case IV
	Case V
	Conclusion
	References
Dual Dystrophy: Multiple Dilemmas
	Introduction
	Case Report
	Dilemmas
	References
Challenges in the Management of a Unique Case of Bilateral Nanophthalmic Glaucoma
	Introduction
	Case Report
	Discussion
	Conclusion
	References
High-Altitude-Associated Purtscher-Like Retinopathy: A Diagnostic Dilemma
	Introduction
	Case Report
	Discussion
	References
Diagnostic and Therapeutic Challenges in Childhood Glaucoma
	Introduction
	Scenario 1: The Puzzle of the Absent Iris
		Case 1
		Case 2
		Genetics Study of Both Cases of Aniridia
		Clinical Pointers
	Scenario 2: Look Beyond the Cloudy Cornea
		Case
		Ancillary Investigations
		Clinical Pointers
	Scenario 3: Beware of the “Usual Treatment”
		Clinical Pointers
	Scenario 4: Look at the Whole Baby
		Case
		Clinical Pointers
		Lesson to Learn
	References
Delayed Presentation, Deeper Peril: Ophthalmia Nodosa
	Introduction
	Case Presentation
	Dilemma
		Were the Lesions Identified Actually Setae in this Case?
		What Should Be the Management of These Cases Upon Initial Presentation and What Are the Challenges Faced in Managing Them?
		What to Do If the Patient Does not Respond to the Initial Treatment Regimen?
		Which Other Structures Can Be Involved in Ophthalmia Nodosum?
	Discussion
	References
Neovascular Glaucoma: A Race Against Time
	Introduction
	Case Report
	Discussion
	Conclusion
	References
Microspherophakia
	Introduction
	Were the Two Children Syndromic or Was It Merely a Case of Sporadic Microspherophakia?
	References
The Bumpy Road to Clear Vision: A Case of Unwanted Calcification of Hydrophilic Acrylic IOL Following DMEK Superimposed on Penetrating Keratoplasty
	Introduction
	Case Report
	Discussion
	Conclusions
	References
Bilateral Malignant Glaucoma in a Young Girl with Plateau Iris
	Introduction
	Case Report
	Management Dilemmas
	Further Dilemma in Management
	Discussion
	References
Panophthalmitis: The Great Masquerader!
	Introduction
	Case Report
		Case 1
		Case 2
	Discussion
	References
Peripheral Exudative Hemorrhagic Chorioretinopathy: The Maverick Mimic
	Introduction
	The Case
	Dilemmas for Diagnosis
		The Resolution
	The Management
	Discussion
	References
Isolated Ocular Behcet’s Disease
	Introduction
	Case Report
	Discussion
	Conclusion
	References
Posterior Polar Cataract and FLACS: Problems and Solutions
	Introduction
		FLACS in Posterior Polar Cataracts
			Creation of a Precise Capsulotomy
			Anterior Segment Optical Coherence Tomography Imaging
			Lens Fragmentation
	References
There’s Evil in My Eye: Pediatric Ophthalmology Challenge—Goldenhar Syndrome with Complex Strabismus and Dense Amblyopia
	Discussion
	Conclusions
	References
Dilemmas in Serpiginous-Like Choroiditis
	Introduction
	Case Report
	Dilemmas
	References
Alport Syndrome: An Aberrated Lens
	Introduction
	Diagnostic Dilemmas
	Clinical History and Examination
	Investigations
	Final Diagnosis and Management
	Discussion
	References
Severe Blunt Ocular Trauma: Reconstructing and Rehabilitating—Test of Patience!
	Introduction
	Discussion
	References
A Long Tale of Angle Closure Glaucoma and Complications: The Fight Is Still On!
	Case Details
	Dilemmas
	References
Unusual Management of Endothelial Touch by Glaucoma Drainage Tube in a One-Eyed Patient
	Introduction
	Discussion
		Newer Entity
		Landmark Studies
	Postoperative Sequelae
		Hypotensive Phase
		Hypertensive Phase
		Stable Phase
	Complications Associated with Glaucoma Drainage Devices [12]
		Early Complications
		Late Complications
	Conclusion
	Advantages of the New Technique
	References
Herpetic Keratitis: A Diagnostic Dilemma
	Case Report
	Discussion
	Conclusion
	References
Dry Eyes and Bariatric Surgery!
	Case Details
	Discussion
	References
A Stitch in Time Saves Nine: Optic Neuritis in a Keratoconus Patient
	Presentation and Workup
	Diagnosis, Referral, and Management
	Discussion
		Typical Versus Atypical Optic Neuritis
		Optic Neuritis in the Era of Biomarkers
	Investigations in Optic Neuritis
		Advances in the Treatment of Optic Neuritis
	Conclusion
	References
Ethambutol Toxicity: Jekyll and Hyde of Ethambutol
	Introduction
	Discussion
		Dilemma 1
		Dilemma 2
		Dilemma 3
		Dilemma 4
	Conclusion
	References
Dilemmas of ICE Syndrome
	Introduction
	Discussion
		Etiopathogenesis
		Clinical Presentation
		Investigations
		Diagnostic Dilemmas
		How to Arrive at the Diagnosis?
		Management
			Medical Management
			Laser Peripheral Iridotomy
		Surgical Management
	Conclusion
	References
The Tilted Torted Optic Disc
	Disc Tilt
	Prevalence of Tilted Discs [6–8]
	Tilted Disc on Imaging
	Tilted Discs and Visual Field Defects
	Disc Torsion
	Myopic Tilted Discs and Glaucoma
	Summary
	References