SummarySarcoidosis is an autoimmune granulomatous disease that can affect any organ system in the body. Ocular and orbital manifestations are relatively common. Osseous involvement is rare and usually involves bones of the appendicular skeleton. We present an unusual case of an erosive sarcoid granuloma in a 48-year-old woman that involved the orbital apex. This case highlights diagnosis, treatment, and the importance of full systemic workup to determine the extent of the disease. Case ReportA 48-year-old, African American woman with a past medical history significant for nonischemic cardiomyopathy presented to the cardiology clinic at the University of Kansas Hospital for follow-up examination. She complained of a 1-week history of parieto-occipital headache and progressive vision loss in the right eye. She denied eye pain, flashes/floaters, diplopia, or changes in vision in her left eye. Neurology was consulted, and the patient was transferred to the emergency department for a stroke workup. Computed tomography (CT) of the head without contrast showed no abnormalities.On ophthalmological examination, her best-corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye, with no afferent pupillary defect (APD). There was a mild temporal restriction on confrontation visual field testing in the right eye; the visual field was full in the left eye. The dilated posterior segment appeared unremarkable in each eye. The patient was discharged with a diagnosis of an atypical migraine and was instructed to follow-up at the outpatient ophthalmology clinic the following week.Two days later, the patient presented to the emergency department with worsening of her symptoms. On examination, visual acuity in the right eye was hand motions; in the left eye, 20/20. There was a new APD in the right eye. Intraocular pressure (IOP) by Tono-Pen (Reichert Technologies, Depew, NY) was 14 mm Hg in the right eye and 13 mm Hg in the left eye. Visual field by confrontation was restricted in all quadrants except superotemporally in the right eye and full in the left eye. Dilated fundus examination again revealed an unremarkableappearing optic nerve head, macula, vessels and periphery in each eye.With no abnormalities seen on the dilated fundus examination, workup for a posterior optic neuropathy was initiated. A CT of the brain without contrast was repeated, and no abnormalities were noted. A CT of the orbits without contrast showed an abnormal soft tissue lesion with an aggressive erosive process involving the posterior right orbit and ethmoid sinus (Figure 1). CT of the chest without contrast showed mediastinal and bilateral hilar lymphadenopathy as well as multiple bilateral lung nodules concerning for sarcoidosis or lymphoma ( Figure 2). Positron emission tomography scan showed increased fluorodeoxyglucose uptake within the region of the right ethmoid sinus and metabolically active supraclavicular, mediastinal, hilar, periportal, and inguinal lymphadenopathy with diffuse increased uptake of the spleen. Lumbar puncture ...
HistoryA 51-year-old woman with a history of acute myeloid leukemia (AML) in remission and no past ocular history presented emergently at the University of Kansas Hospital with binocular diplopia and right-sided ptosis of 3 days' duration. The patient also complained of fatigue. She originally attributed her symptoms to allergies, stating that she had also recently experienced mild rightsided eye discharge and sinus pressure. Past medical history was significant for mild hypertension and AML with myelodysplasia-related features that was treated about 6 months prior with haploidentical peripheral stem-cell transplantation. The patient was a former smoker (40 pack-years) and had a family history of glaucoma (sister). She had recently finished a regimen of fluconazole for prophylaxis after stem-cell transplantation and was also taking acyclovir, letermovir, dapsone, and tacrolimus. TreatmentIntrathecal chemotherapy was started on day 3, and the patient was discharged 4 days later with plans for weekly intrathecal chemotherapy (Figure 3). The
Purpose To report the recent rate of acute postoperative endophthalmitis following cataract surgery at the University of Kansas Medical Center (KUMC) where postoperative topical antibiotics were excluded. Methods This was a retrospective chart review of patients who underwent phacoemulsification with or without intraocular lens insertion as standalone surgery from February 2018 through August 2020. Those undergoing combination surgeries were excluded. All patients received intracameral moxifloxacin at the conclusion of cataract surgery but were not prescribed postoperative topical antibiotics. Acute postoperative endophthalmitis was defined as occurring within six weeks after surgery. Results There were 2,218 standalone cataract surgeries performed on 1,418 patients. Zero cases of acute postoperative endophthalmitis were identified (0%). There were no systemic adverse reactions to intracameral moxifloxacin administration in the 41 patients with a preexisting fluoroquinolone allergy. Conclusion The recent rate of acute postoperative endophthalmitis following cataract surgery at KUMC using intracameral moxifloxacin without postoperative topical antibiotics is 0%.
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