Spontaneous Anterior Lens Capsular Dehiscence Causing Lens Particle Glaucoma

To report acute onset lens particle glaucoma associated with a spontaneous anterior capsular dehiscence. A 66-year-old man presented with spontaneous anterior lens capsule dehiscence with an acute onset of right eye pain that was associated with white particles in the anterior chamber angle and intraocular pressure (IOP) of 55 mmHg. No trauma or other inflammatory antecedents were reported. A hypermature cataract was observed at slit lamp exam. After medical treatment without IOP control, we performed extracapsular cataract extraction and anterior vitrectomy. Anterior chamber aspirate confirmed the presence of macrophages. The postoperative IOP at one month was 16 mmHg OD without medication. Spontaneous dehiscence of the anterior lens capsule in a patient with a hypermature cataract may release lens cortical material, resulting in lens particle glaucoma. Prompt surgical removal of the lens material usually controls the high IOP, and the need for additional glaucoma surgery is not common.

A Case of Photodynamic Therapy of Juxtafoveal Choroidal Neovascularization in Angioid Streaks

PURPOSE: To report a case of verteporfin photodynamic therapy (PDT) for juxtafoveal choroidal neovascularization (CNV) secondary to angioid streaks. CASE SUMMARY: An 54-year-old male presented with metamorphopsia of the right eye. It was diagnosed as juxtafoveal CNV secondary to angioid streaks and treated with verteporfin PDT-Best corrected visual acuity (BCVA) and macular thickness by optical coherence tomography (OCT) were measured. Over 14 month follow-up period, baseline BCVA was 0.3 and it increased to 0.4 by the final examination, while macular thickness decreased from 264 micrometer to 229 micrometer. No side effects of PDT were noted. CONCLUSIONS: Verteporfin PDT for CNV-associated with angioid streaks does not appear to significantly alter the course of the disease undergoing enlargement and disciform transformation of the neovascular process. However, we expected that the actual clinical findings improved during short term follow-up. The severity of symptoms of CNV-associated with angioid streaks in a single patient varies over time, so long-term follow-up and careful examination is needed.

A Case of Postoperative Sphingomonas paucimobilis Endophthalmitis After Cataract Extraction

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.

A Case of Postoperative Sphingomonas paucimobilis Endophthalmitis After Cataract Extraction

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.

Analysis of RNFL Thickness and Optic Nerve Head Measured with OCT in Children

PURPOSE: To analyze peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters with regard to age in children by using optical coherence tomography (OCT). METHODS: We analyzed RNFL thickness and ONH parameters by using Stratus OCT Model 3000 (Zeiss-Humphrey) in two-hundred eyes of 100 children ranging in age from 5 to 14 years, with 5 males and 5 females for each age. RESULTS: The RNFL thicknesses for 100 children (200 eyes) in total were as follows: Mean 104.67+/-9.07 micrometer, superior 131.84+/-18.71 micrometer, temporal 78.49+/-12.91 micrometer, nasal 73.85+/-14.26 micrometer, and Inferior 133.87+/-18.58 micrometer. The parameters of ONH for 100 children (200 eyes) in total were as follows: optic disc area 2.80+/-0.21 mm2, rim area 1.85+/-0.28 mm2, cup to disc area ratio 0.34+/-0.08, horizontal cup to disc diameter ratio 0.47+/-0.11, and vertical cup to disc diameter ratio 0.49+/-0.11. In analyzed RNFL thickness and ONH according to age, there was a significant negative correlation among mean RNFL, inferior RNFL, and age (r=-0.258, p=0.000, r=-0.464, p=0.000). There was a significant positive correlation between nasal RNFL and age (r=0.135, p=0.028). There was a significant positive correlation between disc area and age (r=0.528, p=0.000). There was a significant negative correlation among the cup to disc area ratio, the horizontal cup to disc diameter ratio, the vertical cup to disc diameter ratio, and age (r=-0.170, p=0.008, r=-0.266, p=0.000, r=-0.155, p=0.014). CONCLUSIONS: OCT can be used to measure RNFL thickness and ONH parameters in children. Age had an effect on RNFL thickness and ONH parameters in children.

Penetrating Retrobulbar Orbital Foreign Body: A Transcranial Approach

We report the successful removal of a retrobulbar foreign body using a transcranial approach in a 63-year-old patient with a penetrating injury to the left eye. Initial ocular examination revealed a corneoscleral laceration, hyphema, a traumatic cataract, and vitreous hemorrhage. Visual acuity consisted only of the perception of hand motion. Computed tomography demonstrated an orbital foreign body in the retrobulbar area. Emergency corneoscleral suturing, phacoemulsification of the cataract, and vitrectomy with posterior vitreous detachment were performed. Fifteen days after the emergency operation, we successfully removed the orbital foreign body using a transcranial approach, although the foreign body was very close to the optic nerve. On fundus examination 6 months later, a white, fibrous lesion was seen inferior to the optic disc, and the corrected visual acuity was 20/30. These positive results may be due to the complete vitrectomy at the correct time performed by a retina specialist and the minimal pressure on the eyeball while removing the foreign body, which resulted from the use of a transcranial approach.