Painless Orbital Bone Infarction in a Child with Sickle Cell Anemia: A Case of Misdiagnosed Periorbital Cellulitis

BACKGROUND Sickle cell orbitopathy is a rare complication of sickle cell disease that closely mimics other conditions, such as orbital cellulitis and osteomyelitis. We report a case of painless orbital bone infarction masquerading as periorbital cellulitis in a child with sickle cell anemia. CASE REPORT A 4-year-old Saudi girl with sickle cell disease presented to our hospital with vaso-occlusive crisis characterized by bilateral lower limb pain and painless left orbital swelling. On examination, she had swelling of the left upper eyelid with redness and mild ptosis (margin reflex distance 1 was 2 mm) without proptosis. Magnetic resonance imaging with contrast showed bilateral sub-periosteal heterogeneous collections (2×0.8×2.1 cm in the superolateral wall of the left orbit and 1×0.6 cm in the inferolateral wall of the right orbit), with intermediate-to-high T1 signal intensity and high T2 signal, causing a mass effect on the adjacent superior and lateral rectus muscles. The patient was treated with systemic antibiotics and supportive treatment for vaso-occlusive crisis under the care of the pediatric team and was discharged without complications. CONCLUSIONS The diagnosis of sickle cell orbitopathy can be challenging, and an accurate diagnosis is essential to ensure appropriate management. Thus, we report the case of a 4-year-old child with painless sickle cell orbitopathy masquerading as pre-septal cellulitis.

Unilateral High Intraocular Pressure, Cataract, and Retinal Detachment in Waardenburg Syndrome

Waardenburg syndrome was first described in 1951 by Dutch ophthalmologist Petrus Johannes Waardenburg (1886-1979). It is an auditory-pigmentary syndrome that results from a lack of melanocytes in the hair, skin, eyes, or stria vascularis of the cochlea. It accounts for more than 2% of congenitally deaf individuals [Indian J Otolaryngol Head Neck Surg. 2015 Sep;67(3):324-8]. Affected people usually have neurosensory hearing loss, forelock pigmentation loss, iris heterochromia, and medial canthus dystopia, and their first-degree relatives have the same features of this syndrome. The following is a report of an unusual and rare presentation of ocular findings in Waardenburg syndrome. A 25-year-old male presented for eye examination due to gradual loss of his left eye visual acuity over the last few years with characteristic features of Waardenburg syndrome along with high intraocular pressure (IOP), cataract, and retinal detachment (RD) in one eye.

Three-Year Results of Management of Adult-Onset Coats' Disease by Possibly Targeting Placental Growth Factor

We report long-term results of treatment with intravitreal injection of aflibercept in a newly diagnosed case of adult-onset Coats' disease. A 40-year-old Philipino male was referred to our Eye Center complaining of vision reduction for the past three months in his right eye. Examination revealed visual acuity of 0.1 in the affected right eye with normal vision of 1.0 in his left eye. Fundal examination of the right eye showed temporal retinal telangiectasia with massive exudation reaching the macula. The left fundal examination was normal. The patient’s optical coherence tomography (OCT) demonstrated massive exudative thickening. The patient was managed with one intravitreal injection of aflibercept followed by focal laser, with successful anatomical and subjective outcomes that were maintained after three years. Aflibercept's profile targeting both vascular endothelial growth factor (VEGF) and placental growth factor seems to show favorable outcomes when compared to other purely anti-VEGF treatment options. We therefore believe that aflibercept is an excellent adjunctive therapy in cases of adult-onset Coats’ disease with macular edema. To our knowledge, this is the first case treated with laser and intravitreal aflibercept with a long three-year follow-up suggesting the significant role of aflibercept in vascular permeability and supporting its use as a valuable therapeutic option for Coats’ disease.