Fall 2017 Newsletter

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Fall 2017 Newsletter
7th Residency Announcement

Exciting Residency Announcement!

ACGME approves seventh resident complement; first increase in over 30 years!

Grand Rounds

Grand Rounds and Case Studies

Check out our weekly presentations



USC Ophthalmology Researchers Find More
Effective Treatments For Blinding Eye Diseases


Case Study: Couching Lenses, Hidden Pressure

Sastry Xu
Presenter: Ananth Sastry, MD, PGY-4 Discussant: Benjamin Y. Xu, MD, PhD


  • 57-year-old male presents following blunt trauma to right eye presents with pain and decreased visual acuity in the right eye five days after trauma
  • Remote past ocular history of intra-orbital foreign body (removed) in the right eye

Exam Findings

  • BCVA OD: HM; OS: 20/30
  • IOP OD: 48; OS: 14
  • Pupils: OD: Mydriatic, nonreactive; OS: Round, reactive, no RAPD
  • SLE OD (Figure 1): 2+ conjunctival injection, diffuse corneal microcystic edema, very deep anterior chamber with 2-3+ flare/haze, mydriatic iris, lens- poor view, cortical changes
  • SLE OS: Within normal limits
  • DFE OD: No view; OS: Within normal limits
  • Gonioscopy OD: No view; OS: Open to CB 360

Figure 1
Figure 1: Slit lamp photo of the right eye showing conjunctival injection, diffuse microcystic corneal edema, a deep anterior chamber with haze and flare and a mydriatic pupil


Differential Diagnosis

  • Phacoantigenic uveitis
  • Lens particle glaucoma
  • Angle recession
  • Microhyphema
  • Uveitic glaucoma/trabeculitis
  • Phacolytic glaucoma

Additional Investigations

  • CT scan (Figure 2): Lens notably absent within right globe; intact lens in left globe
  • B-scan ultrasonography (Figure 3): Mobile hyperechoic, ovoid structure within vitreous cavity visible on vertical axial, T3 and T6 views

Figure 1
Figure 2: CT scan of the orbit, axial view. Absent lens material from right globe. Hyperdense foreign object in anterior right orbit is likely residual intraorbital foreign body from prior trauma

Figure 2
Figure 3: B-scan ultrasonography of the right eye, vertical axial view. Hyperechoic, ovoid structure in anterior/inferior portion of the vitreous represents posteriorly dislocated lenticular nucleus




  • Phacoantigenic uveitis


  • The lens capsule is violated by trauma, which exposes a large quantity of lens particles to the anterior chamber.
  • Lens particles are seen as antigens and induce an IgG mediated type III hypersensitivity reaction.
  • An intraocular granulomatous inflammatory reaction ensues, which obstructs the trabecular meshwork and increases the intraocular pressure.


  • Topical and oral aqueous suppressants
  • Topical and oral corticosteroids
  • Cataract extraction (In this case, the patient required a pars plana vitrectomy and lensectomy.)

Prognosis and Future Directions

  • Prognosis depends on the extent of damage to uveal tissue secondary to granulomatous inflammation as well as glaucomatous damage to the optic nerve from increased intraocular pressure.


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Section Editors


Produced by: Monica Chavez, John Daniel and Mellissa Linton
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