The aim of this report is to present a patient with traumatic optic nerve sheath hematoma (ONSH), a rare diagnosis with high potential for visual sequelae. This case involves a 41-year-old male who presented promptly following blunt trauma to the right eye and orbit that resulted in acute vision loss. Following computed tomography and ophthalmic examination, a diagnosis of ONSH was made and medical therapy with methylprednisolone was initiated. He reported significant improvements in visual symptoms following intravenous corticosteroid therapy. Although the patient reported significant improvements and had normal Snellen visual acuities in follow-up, he continued to have an inferior visual field defect at 1 week in the affected eye. ONSH causing subsequent localized compression of the optic nerve is a rare mechanism of traumatic optic neuropathy in patients following head trauma. The localized compartment syndrome of the optic nerve and subjective visual symptoms were relieved following corticosteroid therapy with no initial need for surgical decompression. Although central visual acuity returned to baseline, the patient had a persistent visual field defect and relative afferent pupillary defect.

We present a novel approach for performing an Nd:YAG laser posterior capsulotomy under general anesthesia with the patent in a seated position. We illustrate this approach in 2 cases, a young child and an adult patient with developmental delay. This technique may facilitate YAG capsulotomy in patients who cannot sit for the procedure.

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A. The Comprehensive Lissencephaly Panel performed on our patient (The University of Chicago Genetic services Laboratory) identified a denovo likely pathogenic variant (c.4501A>T; p.Ile1501Phe) in the DYNC1H1 gene (NM_001376.4). The Isoleucine at 1501 position is highly conserved through species and most in silico algorithms predict to be deleterious to the protein function. Mutationtaster (http://www.mutationtaster.org) , Provean (http://provean.jcvi.org) , Polyphen2 (http://genetics.bwh.harvard.edu/pph2/)deleterious, SIFT (https://sift.bii.astar.edu.sg) -tolerated