Cilioretinal Artery Occlusion as the First Clinical Manifestation of Ocular Syphilis

PURPOSE: To report a case of a neurosyphilis patient with cilioretinal artery occlusion as the first manifestation. CASE SUMMARY: A 58-year old man presented with a visual impairment which developed 5 days earlier in his right eye. During initial evaluation, the visual acuity in the right eye was 0.02. On fundus examination, a whitening adjacent to the macula was observed and fluorescein angiography showed filling delay and late leakage of the cilioretinal arteries. The patient was diagnosed with cilioretinal artery occlusion. Two weeks after his initial visit, visual acuity in the patient's right eye improved to 0.7 and retinal whitening was decreased on fundus examination. Three months later, a visual decrease in the right eye reoccurred and the visual acuity was 0.01. Anterior chamber cell reaction with hypopyon was observed on slit lamp examination and vitreal opacity was noted during fundus examination. Among the numerous tests performed in order to determine the cause of uveitis, RPR antibody and treponemal antibody were found positive. The patient was diagnosed with neurosyphylis and 2 weeks after intravenous administration of penicillin, visual acuity improved to 0.7 and anterior chamber cell reaction as well as vitreal opacity decreased. CONCLUSIONS: The authors reported a case of cilioretinal artery occlusion suspected secondary to neurosyphilis.

The Efficacy of Fibrin Glue in Surgical Treatment of Conjunctivochalasis With Epiphora

PURPOSE: To investigate the efficacy of fibrin glue used in conjunctival resection for conjunctivochalasis with epiphora. METHODS: Twenty-three patients (42 eyes) with conjunctivochalasis without nasolacrimal duct obstruction underwent conjunctival resection using either absorbable sutures (11 patients, 20 eyes, Group 1) or fibrin glue (12 patients, 22 eyes, Group 2) to attach the conjunctiva to the sclera. Outcomes recorded were improvement of epiphora, postoperative discomfort, and operation time. Postoperative discomfort was analyzed only in one eye (right eye) in case that the both eyes were operated. RESULTS: Epiphora completely improved in 6 eyes (30%) in Group 1 and 8 eyes (36.4%) in Group 2, partially improved in 9 eyes (45%) and 8 eyes (36.4%), and did not improved in 5 eyes (25%) and 6 eyes (27.2%), respectively (p=1.000). On the first day postoperatively, postoperative eye discomfort developedin 7 eyes (63.6%) in Group 1 and 5 eyes (41.7%) in Group 2 (p=0.414). Throughout the following week, the discomfort lasted in 6 eyes (54.5%) in Group 1 and 1 eye (13.6%) in Group 2 (p=0.027). The mean operation time was 25.0 (+/-2.6) minutes in Group 1 and 12.0 (+/-2.4) minutes in Group 2 (p<0.001). CONCLUSIONS: The success rates were similar in the two groups. However, the use of fibrin glue significantly reduces the postoperative discomfort and the operation time. Therefore, the use of fibrin glue in conjunctival resection of conjunctivochalasis seems to be an effective method.