Poster 46

Poster Presentations Poster 46 Posterior Lens Pigmentation Heidi Wilgenburg, O.D., West Haven VA, 950 Campbell Avenue, West Haven, Connecticut 06516 Background: Blunt ocular trauma has been known to produce a characteristic ring of pigment deposition on the anterior capsular surface of the crystalline lens, first described by Vossius in 1903 and commonly referred to now as a Vossius ring. While less common, there have been some cases reported in the literature of pigmentation occurring independently on the posterior surface of the lens. These case reports have proposed mechanisms for posterior lens pigment deposition ranging from blunt ocular trauma to vitreal pigment dispersion associated with melanocytoma of the optic disc. This poster reviews possible sources of posterior lens pigmentation as well as differential diagnoses that should be considered and ruled out when pigmentation of the posterior lens is observed clinically. Case Report: A 58-year-old white male Vietnam veteran presented as a first-time patient for a routine eye examination with asymmetric intraocular pressures of 20 mmHg O.D. and 14 mmHg O.S. and dense pigmentation on the posterior lens capsule O.D. While the veteran denied any blunt trauma to the eye or orbit, his history was positive for a helmet blow to the head while in the service 38 years prior. Gonioscopy revealed open angles OU with moderate uniform pigment in the trabecular meshwork O.D. and light to no pigment observed within the angle O.S. On dilated exam, the anterior vitreous was free of pigment OU; the optic nerves were healthy with small, symmetrical cupping; and the peripheral retina was unremarkable OU. Bilateral ultrasound biomicroscopy revealed a ciliary body cyst O.D. Ocular findings from this case are supported by anterior segment photography and ultrasound biomicroscopy. Conclusions: This patient was diagnosed with pigment dispersion O.D., possibly secondary to previous trauma, and is being monitored for the development of secondary glaucoma. While there has not been an association established in the literature to date between ciliary body cysts and posterior lens pigmentation, the incidental finding presented in this case is interesting and leads the practitioner to consider other etiologies of pigment on the posterior lens. Poster 47 Herpes Simplex Keratitis Misdiagnosed as Poison Ivy: A Case Report Scott Caughell, O.D., and Elli J. Kollbaum, O.D., Indiana University School of Optometry, 800 East Atwater, Bloomington, Indiana 47401 Background: HSV keratitis is one of the most common causes of corneal blindness in the United States and a leading indication for corneal transplantation. There are approximately 20,000 new cases and 28,000 reactivations per year. Improper diagnosis and delayed treatment can

289 greatly increase the risk of corneal morbidity. Disciform keratitis arises when the virus infiltrates the stroma leading to corneal edema and opacification. Recurrence is very common with 1 of 4 suffering a reactivation within 5 years. Case Report: A 9-year-old white female presented to our clinic for a comprehensive exam with a chief complaint of recurring headaches. Gross observation of the patient revealed a para-central white opacity of the right eye. Visual acuity was 20/20-2 O.D. and 20/20 O.S. Slit lamp biomicroscopy revealed an elevated 1.5-mm dense circular white opacity just off the visual axis. This central opacity was surrounded by 3 smaller “satellite” lesions and microcystic edema. Further history was elicited. The mother reported that 3 weeks previous the patient experienced a red eye with pain, photophobia, epiphoria, and red blister-like lesions around the right orbit. The patient was taken to a primary care provider who administered a Benadryl injection on the assumption that the red eye and lesions were secondary to poison ivy; the patient only reported a slight foreign body sensation of the right eye. We diagnosed disciform keratitis and initiated aggressive topical antiviral therapy. Once assured that the lesion was not expanding, topical steroid treatment was started to minimize corneal inflammation and scarring since the lesion was in very close proximity to the visual axis. The inflammation resolved significantly and only a small opacity persists with 20/20 acuities O.S./O.S. Conclusion: This case could have resulted in far more significant corneal morbidity had treatment and diagnosis not been made during this “routine” exam. This case demonstrates the importance of thorough history and patient education. The patient’s parents are now properly educated about the possibility of recurrence and the need to seek treatment rapidly. Poster 48 Unexpected Complication Following Photodynamic Therapy: Retinal Pigment Epithelium Tear Jae Hee Han, O.D., May L. Chung, O.D., Nancy Shenouda-Awad, O.D., Angella Gentry, B.A., and Nancy N. Wong, Ph.D., VA Hudson Valley Health Care System, 100 Albany Post Road, Mail Code 620-123 Montrose, New York 10548 Background: Photodynamic therapy (PDT) utilizes verteporfin, a photo-sensitive liposomal bensoporphyrin cytotoxic agent. Laser activation results in formation of excited singlet oxygen and reactive oxygen intermediates. Endothelial cellular damage results from platelet activation, thrombosis and occlusion of choroidal neovascularization (CNV) vessels in age-related macular degeneration (AMD). The visual benefits of PDT for the treatment of predominantly classic subfoveal CNV have been demonstrated in the treatment of AMD with Photodynamic Therapy (TAP) study. Moreover, the Verteporfin in Photodynamic Therapy (VIP) investigation has reported that PDT prevents severe vision loss from occult subfoveal CNV. Reported ocular