Iridociliary measurements using the Anterion swept-source optical coherence tomography

Purpose: Anterior segment optical coherence tomography (AS?OCT) by a swept source can visualize the ciliary body. The study was performed for analyzing the feasibility of a new swept?source OCT (Anterion) device for measuring iris ciliary sulcus, ciliary body thickness, and iris thickness. Methods: It is a pilot study among 30 normal young participants and hospital employees with their consent. The ciliary body, iris thickness, and ciliary sulcus were measured and compared to the results in the literature. We obtained 28 good?quality results. The main outcome measures were iris thickness (near and away from the pupillary margin), ciliary body thickness, and iridociliary sulcus measurement. Results: The iris thickness 2.5 mm from the pupillary margin was 0.70 ± 0.10 mm in the right eye and 0.68 ± 0.11 in the left eye. Closer to the root, the iris thickness varied from 0.55 ± 0.16 mm (right eye) and 0.57 ± 0.12 (left eye). Ciliary body thickness: Right eye 0.59 ± 0.14mm (28 good images), left eye 0.58 ± 0.13mm; ciliary sulcus (inner angle): right eye 82.65 ± 26.6°, left eye 83.66 ± 30.1°. Conclusion: Anterion OCT is feasible in our setting for various measurements and can provide valuable inputs to ophthalmologists for the treatment of ocular diseases.

A Novel Dual-wavelength, Dual-function Laser System for Presbyopia and Glaucoma Treatments

To update the accommodation mechanisms and propose a dual-wavelength, dual-function laser system for presbyopia and glaucoma treatments.Study Design: Laser sclera softening (LSS) for increased accommodation of presbyopic eyes.Place and Duration of Study: New Taipei City, Taiwan, between Jan., 2023 and Feb., 2023.Methodology: Accommodation gain (AG) can be improved by: (i) thermal shrinkage of the scleral stroma and ciliary body, or (ii) softening of the scleral stroma (with temperature range of 700C to 900C), such that the the lens front and back curvature change (or lens thickening), leading to the thickening of ciliary body and its apex, and the increase of the space of ciliary body and lens equation (SCL), and the length of the posterior vitreal zonules (PVZ) increases.Results: A novel dual-color laser system having wavelength A and B, acting on the front-zone and back-zone of the sclera, respectively, where laser-A has a deep thermal penetration the sclera and ciliary body (CB) (0.5 to 1.0 mm); and laser-B has a shallow penetration depth in the sclera (0.3 to 0.5 mm), based on the optical property of the sclera. Laser-A (having a wavelength about0.8 to 0.98 um) leads to thermal shrinkage of the ciliary body such that the CLS is increased for accommodation gain which is much more effective than the prior art.Conclusion: The increase of AG can be achieved by scleral softening and ciliary body shrinkage which increase the SCL. A proposed novel dual-color laser system acting on the front-zone and back-zone of the sclera, respectively, could provide higher AG than that of single wavelength, or prior arts using scleral ablation. However, further clinical studies are required to justified the proposed novel system with predicted advantages and efficacy based on the optical properties of sclera.

New understandings of the pathogenesis of primary angle-closure glaucoma / 中华实验眼科杂志

Primary angle-closure glaucoma (PACG) is still one of the common blinding eye diseases in China.Because of the irreversibility of the vision loss it caused, the factors affecting the early development of glaucoma are of great concern.The understanding of static anatomic structure of high-risk anterior segment, such as shallow anterior chamber, short axial length, thick iris and large anterior lens cannot fully explain the transformation process of PACG, so the specific role of dynamic changes in the development of glaucoma should be further considered.This article expounded the differences in iris volume and dynamic process of elasticity between normal people and patients with PACG, the incoordination between lens and intraocular structure during eyeball development, the dynamic block and expansion of ciliary body, vitreous and choroid, and the latest research on the relationship between the abnormal ocular nerve and vascular system adjustment and change with the onset of PACG, in order to provide guidance for understanding the pathogenesis of PACG, accurate clinical diagnosis and formulation of treatment strategies.

Beneath the surface: a case report of metastatic iridociliary ring melanoma treated with pembrolizumab / Abaixo da superfície: relato de caso de melanoma metastático iridociliar em anel tratado com pembrolizumabe

ABSTRACT Iridociliary ring melanoma is an uncommon type of uveal melanoma. Clinical manifestation varies from asymptomatic cases to masquerade syndromes mimicking refractory glaucoma. Treatment options include radiotherapy and enucleation. Management of metastatic uveal melanoma remains discouraging. Novel therapies using immune checkpoint inhibitors are currently under study. We present a case of a 54-year-old Hispanic woman with progressive vision loss due to metastatic ring melanoma with anterior chamber seeding treated with pembrolizumab.

RESUMO O melanoma iridociliar em anel é um tipo incomum de melanoma uveal. As manifestações clínicas variam desde casos assintomáticos até síndromes mascaradas que mimetizam um glaucoma refratário. As opções de tratamento incluem radioterapia e enucleação. O manejo do melanoma uveal metastático continua desanimador. Novas terapias usando inibidores de checkpoint imunológico estão atualmente em estudo. Apresentamos o caso de uma mulher hispânica de 54 anos com perda progressiva da visão por um melanoma metastático em anel, com semeadura de câmara anterior, tratada com pembrolizumabe.

Melanoma del cuerpo ciliar en un adulto joven: reporte de caso / Ciliary body melanoma in a young adult: a case report

Resumen Reporte de un caso: Femenino de 29 años de edad sin comorbilidades, con baja visual progresiva en ojo derecho de 1 mes de evolución. A la exploración oftalmológica agudeza visual de ese ojo en 20/80, conjuntiva bulbar superior con vaso centinela, masa retroiridiana color naranja vascularizada que subluxa el cristalino hacia inferior. Por ultrabiomicroscopía se evidencia una masa en domo dependiente del cuerpo ciliar de 4.87x5.74mm con reflectividad interna media y regular. Se realiza primeramente BAAF reportando melanoma, después se hace enucleación con resultado histopatológico de melanoma amelanótico. Posterior, se realiza implante de prótesis cosmética y se encuentra en seguimiento por oncología sin presentar datos de actividad tumoral después de 4 años. Discusión: Los melanomas uveales son la causa más común de tumores malignos intraoculares primarios en adultos, localizados principalmente en coroides (90%), siendo extremadamente rara su aparición en el cuerpo ciliar (6%) e iris (4%). El abordaje de un tumor del cuerpo ciliar debe incluir una anamnesis y exploración física completa con estudios paraclínicos adecuados para poder discernir entre los diagnósticos diferenciales. El ultrasonido ocular es el estudio auxiliar más importante ya que brinda características típicas propias del tumor. El tratamiento continúa basado en el COMS con un pronóstico sombrío. Los factores de mal pronóstico son presencia de metástasis, tamaño del tumor, extensión extraocular y estirpe epitelioide. Limitaciones: No se contaban con todas las alternativas de tratamiento. Originalidad: Caso inusual en pacientes jóvenes y por su sitio.

Abstract: Case report: 29-year-old female with no comorbidities, with progressive vision loss in the right eye of 1 month's evolution. On ophthalmological examination, visual acuity was 20/80, superior bulbar conjunctiva with sentinel vessel, vascularised orange retroiridian mass generating a lens subluxation inferiorly. Ultrabiomicroscopy revealed a dome-shaped mass dependent on the ciliary body measuring 4.87x5.74mm with medium and regular internal reflectivity. A FNA was done and melanoma was reported, then enucleation was performed with histopathological findings of amelanotic melanoma. Subsequently, a cosmetic prosthesis was implanted and the patient has been followed up by oncology with no evidence of tumour activity after 4 years. Discussion: Uveal melanomas are the most common cause of primary intraocular malignant tumours in adults, mainly located in the choroid (90%), being extremely rare in the ciliary body (6%) and iris (4%). The approach to a ciliary body tumour should include a complete anamnesis and physical examination with appropriate paraclinical studies to be able to discern between differential diagnoses. Ocular ultrasound is the most important ancillary study as it provides typical features of the tumour. Treatment is still based on COMS and the prognosis remains poor. Poor prognostic factors are the presence of metastases, tumour size, extraocular extension and epithelioid lineage. Limitations: Not all treatment alternatives were available. Originality: Unusual case in young patients and because of its site.

Ultrasound biomicroscopy as a tool in the evaluation and management of ocular hypotony in uveitis

Purpose: Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony. Methods: This was a retrospective hospital?based interventional case?series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020. Results: Thirty?six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow?up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow?up. Conclusion: We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.

Ultrasonographic features of adenoma of the nonpigmented ciliary epithelium / 中华眼底病杂志

Objective:To analyze the ultrasonographic features of adenoma of the nonpigmented ciliary epithelium (ANPCE).Methods:A retrospective series of case studies. From January 2014 to October 2021, 31 patients (31 eyes) with ANPCE (ANPCE group) were diagnosed in the eye center of Beijing Tongren Eye Center of Beijing Tongren Hospital, Capital Medical University, and 17 patients (17 eyes) with ciliary body melanoma (control group) diagnosed at the same time were selected as the control group. There was no significant difference in age ( t=-0.564) and sex composition ratio ( χ 2=0.182) between the two groups ( P=0.576, 0.670). All patients underwent ultrasound biomicroscopy to obtain the measurement parameters: tumor height, maximum basal diameter, maximum diameter, ratio of maximum diameter to basal diameter and ratio of maximum diameter to height; tumor location, shape, internal echogenicity intensity, echogenicity uniformity, degree of sound attenuation, invasion of iris, anterior displacement of the iris, lens subluxation were observed. The measurement parameters and observation indexes of the two groups were compared by independent sample t-test and χ 2 test. Receiver operating characteristic (ROC) curve was drawn, area under the ROC curve (AUC) was determined, and parameter indicators with differential diagnosis value were screened. Results:The maximum diameter, height, maximum basal diameter, ratio of the maximum diameter to the maximum basal diameter, and the ratio of the maximum diameter to the height of the tumors in the ANPCE group and the control group were 5.64±0.98 mm, 4.24±0.59 mm, 3.66±0.71 mm, 1.58±0.34, 1.34±0.19 and 7.82±2.03 mm, 4.47±2.44 mm, 7.02±1.96 mm, 1.13±0.16, 2.09±1.06. The maximum diameter, the maximum basal diameter, and the ratio of the maximum diameter to the height of the tumor in the ANPCE group were all smaller than those of the control group, and the ratio of the maximum diameter to the maximum basal diameter was greater than that of the control group, and the differences were statistically significant ( t=-4.159,-6.808, -2.924, 6.257; P<0.05). The tumors in the ANPCE group were mainly spherical (87.1%, 27/31), with no significant acoustic attenuation (77.4%, 24/31), less invading the root iris (77.4%, 24/31), and the tumors were mostly located in the ciliary body coronal (74.2%, 23/31); tumors in the control group were mainly hemispherical (47.1%, 8/17) or spherical (47.1%, 8/17), with significant sound attenuation (76.5%, 13/17), most of the tumors invaded the iris (70.6%, 12/17), and the tumors were mostly located from the pars plana to the coronal (76.5%, 13/17). There were statistically significant differences in the position, shape, sound attenuation degree, and whether it invaded the iris between the two groups of eyes ( χ 2=15.132, 19.767, 13.118, 10.581; P<0.05). The results of ROC curve analysis showed that the ratio of the largest diameter to the largest base diameter, the degree of sound attenuation and the AUC of whether the iris was violated were higher, which were 0.881, 0.769, and 0.740, respectively. Conclusions:Ultrasound biomicroscopy is helpful in the diagnosis and differential diagnosis of ANPCE and ciliary body melanoma. The ratio of maximum diameter to maximum basal diameter, the degree of sound attenuation and whether it invades the root iris are important parameters to distinguish the two tumors.

Pay attention to the correct diagnosis and rational treatment of ciliary body tumors / 中华眼底病杂志

Ciliary body tumor is a rare intraocular tumor. Due to its unique anatomical location, its correct diagnosis and reasonable treatment are very difficult problems. In terms of diagnosis and differential diagnosis, ophthalmologists need to fully utilize the role of slit lamp microscope and transillumination experiment to capture secondary changes in the anterior segment caused by hidden ciliary body tumors, such as monocular localized cataract, lens indentation, and pigment dissemination, etc. Ophthalmological imaging methods, especially ultrasound biomicroscopy, can achieve the purpose of early detection and early diagnosis. According to the size, location and morphological characteristics of the tumor, a reasonable treatment plan is formulated. Since ciliary body tumors are mostly benign, the recurrence rate of local resection is low, which can satisfy the pathological diagnosis and preserve part of the patient's vision. Therefore, eye-preserving treatment should be advocated. However, enucleation remains the treatment of choice for tumors that are too large to be treated with local excision or radiation, eyes with refractory glaucoma, and tumors that do not respond to radiation therapy.

Progress in diagnosis and treatment of ciliary body lymphoma / 中华实验眼科杂志

Intraocular lymphoma with ciliary body involvement is extremely rare, which can be divided into primary and secondary types.The common pathological patterns are mucosa-associated lymphoid tissue B-cell lymphoma and diffuse large B-cell lymphoma, and T-cell lymphoma is relatively rare.The clinical manifestations of ciliary body lymphoma are similar to anterior uveitis.Hypopyon and secondary glaucoma can result from the disease, and the differentiating features include iris patches, iris neovascularization, and hyphema.Diffuse infiltration or space-occupying lesions of ciliary body lymphoma can be found by ultrasound biomicroscopy.Cytological and/or histopathological examination is the gold standard for its diagnosis.Immunohistochemistry, flow cytometry, cytokine analysis, and gene rearrangement are often used in combination to improve the diagnosis rate.Radiotherapy, chemotherapy, or combination therapy can achieve a better prognosis.This paper reviewed classification, pathological types, ocular manifestations, examinations, diagnosis, and treatment of ciliary body lymphoma to provide a reference for clinical practice.

Research progress in ultrasound cycloplasty for the treatment of glaucoma / 中华实验眼科杂志

Surgery to destroy the ciliary body is an effective means to reduce the intraocular pressure in glaucoma.Ultrasound cycloplasty (UCP) is a computer-aided automatic operation that produces high-intensity focused ultrasound to induce ciliary body coagulation through miniaturized transducers.UCP reduces intraocular pressure mainly by destroying ciliary process epithelial cells and increasing uveoscleral outflow.With a wide range of indications, UCP is mainly used for refractory glaucoma, including patients with or without history of anti-glaucoma surgery.It can reduce intraocular pressure safely and efficiently with good outcome, and can be used as a reproducible effective alternative to non-invasive glaucoma surgery.The effect of UCP is better in patients with angle-closure glaucoma, high intraocular pressure before operation, application of second-generation probe and long exposure time.In order to provide reference for clinical treatment and research, the indications, surgical procedures, precautions, mechanism of action, effectiveness, safety, factors affecting therapeutic effect and the deficiencies of researches about UCP in the treatment of glaucoma were reviewed in this article.

Clinical observation of high intraocular pressure after the removal of ciliary ring block in the treatment of malignant glaucoma by scleral cyclophotocoagulation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the short-term and mid-term effectiveness and safety of transscleral ciliary body photocoagulation in the treatment of high intraocular pressure after the removal of malignant glaucoma ciliary ring block.<p>METHODS: Retrospective study. A collection of 14 eyes of 14 patients with high intraocular pressure after ciliary ring block was lifted from 2016-10/2019-10 malignant glaucoma were treated with 810nm semiconductor diode laser transscleral ciliary photocoagulation. Follow-up 8.36±5.18mo, observation Best corrected visual acuity(BCVA), intraocular pressure and complications before and after surgery.<p>RESULTS: The intraocular pressure of 13.60±3.50mmHg at the last follow-up after treatment was different from 40.53±7.14mmHg before operation(<i>P</i><0.05); there was no difference between the BCVA at the last follow-up postoperative and preoperative(<i>P</i>>0.05). All patients had no difference to the last follow-up and serious complications.<p>CONCLUSION: The 810nm semiconductor diode laser transscleral ciliary body photocoagulation is effective in the treatment of malignant glaucoma. It is easy to operate, has fewer complications, can effectively reduce intraocular pressure, and has little damage to the best corrected vision after surgery.

Preliminary analysis of the relationship between foldable capsular vitreous body implantation and ciliary body function in traumatic eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical efficacy and safety of the foldable capsular vitreous body(FCVB)implantation in the treatment of severe ocular trauma and also explore the effect of ciliary body function on the FCVB implantation. <p>METHODS: This study retrospectively analyzed 10 cases(10 eyes)with severe ocular trauma which had accepted FCVB implantation performed in Affiliated Xiaolan People's Hospital, Southern Medical University from January 2018 to July 2020. Ciliary body function was judged by score which was made by preoperative examination results. The case which scored 5 or less was studied as ciliary failure: 8 eyes scored more than 5, 2 eyes scored 5 or less. Followed up for 1-31mo, the postoperative best corrected visual acuity(BCVA)and intraocular pressure, anterior chamber, retinal reattachment, FCVB condition and adverse reactions were observed. <p>RESULTS: The operations of 9 eyes with aphakia eyes were successful. Iridodialysis occurred during the operation of 1 eye with lens. Retinal reattachment was found in all 10 eyes, and the position of FCVB in all patients was proper. There was no severe adverse reactions. Comparing the preoperative and postoperative BCVA and intraocular pressure, the difference was not statistically significant(<i>P</i>>0.05). In the group(8 eyes)that ciliary body function scored more than 5, 2 eyes had a supplementary operation individually, 1 eye underwent 2 supplementary operations. In the group(2 eyes)which scored 5 or less, supplementary operations were performed 5 times in 1 eye, only 1 time in the other one case. <p>CONCLUSION: Implantation of FCVB is a safe option to treat severe ocular trauma. But the postoperative visual acuity cannot be improved. The ciliary body function associates with persistent intraocular hypotension and shallow anterior chamber after FCVB implantation.

Intraocular medulloepithelioma – A review of clinical features, DICER 1 mutation, and management

Intraocular medulloepithelioma is a nonhereditary neoplasm of childhood arising from primitive medullary epithelium. It most often involves the ciliary body. Most patients present between 2 and 10 years of age with loss of vision, pain, leucocoria, or conjunctival congestion. The mass appears as a grey-white ciliary body lesion with intratumoral cysts. Presence of a neoplastic cyclitic membrane with extension to retrolental region is characteristic. Secondary manifestations like cataract and neovascular glaucoma may be present in up to 50% and 60% patients, respectively. These could be the first signs for which, unfortunately, about 50% patients undergo surgery before recognition of the hidden tumor. Systemic correlation with pleuropulmonary blastoma (DICER1 gene) has been documented in 5% cases. Histopathology shows primitive neuroepithelial cells arranged as cords closely resembling the primitive retina. Histopathologically, the tumor is classified as teratoid (containing heteroplastic elements) and nonteratoid (containing medullary epithelial elements), each of which are further subclassified as benign or malignant. Retinoblastoma-like and sarcoma-like areas may be seen within the tissue. The treatment modality depends on tumor size and extent of invasion. For small localized tumors (?3-4 clock hours), conservative treatments with cryotherapy, plaque radiotherapy, or partial lamellar sclerouvectomy (PLSU) have been used. Plaque brachytherapy is generally preferred for best tumor control. Advanced and extensive tumors require enucleation. Rare use of intra-arterial and intravitreal chemotherapy has been employed. Systemic prognosis is favorable, but those with extraocular extension and orbital involvement show risk for local recurrence and metastatic disease, which can lead to death.

Meduloepitelioma de cuerpo ciliar. Reporte de un caso y revisión de la literatura / Ciliary body medulloepithelioma. Case report and literature review

Introducción: Se presenta el caso de un paciente de 10 años de edad a quien se le realizó el diagnóstico de meduloepitelioma de cuerpo ciliar con posterior enucleación. Objetivo: Presentar las principales características clínicas, abordaje diagnostico y terapéutico de un paciente con meduloepitelioma de cuerpo cilar, realizando una revisión de la literatura existente de esta patología. Diseño del estudio: Reporte de caso. Resumen del caso: Paciente masculino de 10 años de edad que presentó perdida de agudeza visual asociada a dolor ocular, al examen oftalmológico se encontró masa en cámara anterior. Se realizó biopsia de lesión iridiana diagnosticándose meduloepitelioma de cuerpo ciliar con posterior enucleación. Conclusión: Se presentó el caso de un niño con meduloepitelioma de cuerpo ciliar, exponiéndose las manifestaciones clínicas, su diagnóstico y tratamiento, así como la revisión de la literatura existente.

Background: We present the case of a 10-year-old patient who underwent a diagnosis of ciliary body medulloepithelioma with subsequent enucleation. Objective: To present the main clinical characteristics, diagnostic and therapeutic aproach of a patient with a ciliary body medulloepithelioma, carrying out a review of the existing literature of this pathology. Study design: Case report. Case summary: A 10-year-old male patient presented with loss of visual acuity associated with ocular pain. Ophthalmological examination revealed a mass in the anterior chamber. A biopsy of an iris lesion was made, diagnosing a ciliary body medulloepithelioma with subsequent enucleation. Conclusion: The case of a child with ciliary body medulloepithelioma was presented, exposing the clinical manifestations, their diagnosis and treatment, as well as the review of the existing literature.

The evolutional and developing mindset in management of ocular trauma in recent ten years / 中华实验眼科杂志

The main developments and progresses of the mindset for the management of ocular trauma in China were summarized into the following 6 aspects:the emphasis on management of wound has been transferred from outside to inner site of the wound;emergence of the idea of continuous treatment;wound involving both anterior and posterior segments should be considered integratedly as an inseparable part in terms of surgical management;the zone of ciliary body receives more attention;assessment prior to the surgeries is insufficient for decision of enucleation;between vitreous body and retina,the stress of surgical management should be focoused on retina.We should pay attention to the evolutional and developing mindset in management of ocular trauma in recent ten years,it will help us to sort out the treatment ideas and summarize the treatment experience.

Therapeutic effect of two surgical methods for refractory glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the clinical efficacy and safety in the treatment for refractory glaucoma by two kinds of cyclodestructive procedures.<p>METHODS: A retrospective study of 50 patients(50 eyes)with refractory glaucoma diagnosed in our hospital between January 2018 and October 2018. Ultrasound cyclo plasty(UCP)were performed on 30 eyes and cyclocryotherapy were performed on 20 eyes, introcular pressure(IOP), pain grade scores and complications after operation were followed up.<p>RESULTS: The average IOP of the UCP group on 1d, 1wk, 1mo and 3mo were 29.27±10.40, 23.87±8.61, 25.27±9.95, 23.70±10.06mmHg compared with 43.97±10.39mmHg before operation. The average IOP of the cyclocryotherapy group on 1d, 1wk, 1mo and 3mo were 22.15±7.78, 20.80±8.44, 22.50±7.12, 24.20±8.43mmHg compared with 47.30±8.53mmHg before operation. The IOP in both group was significantly reduced(<i>P<</i>0.01). The pain grade scores of patients in the UCP group at 1d, 1wk, 1mo and 3mo after surgery were significantly lower than those before operation(<i>P</i><0.05), but there was no significant difference in the cyclocryotherapy group at 1d after surgery(<i>P></i>0.05). There were no serious complications in the UCP group, four eyes appeared conjunctival hyperemia and one eye appeared superficial punctuate keratitis; but there were 16 eyes(80.00%)in the cyclocryotherapy group: ten eyes appeared conjunctival hyperemia and six eyes appeared anterior chamber hemorrhage. <p>CONCLUSION: UCP is safe and convenient surgery for refractory glaucoma, and has significant effect on reducing intraocular pressure, alleviating ocular pain and decreasing complications.

Maculopatia hipotônica pós ciclodiálise traumática por arma de fogo / Hypotonic maculopathy post traumatic cyclodialysis with firearms

Resumo Um traumatismo ocular contuso pode gerar uma vasta gama de lesões intraoculares que são dependentes da quantidade de energia que o objeto transfere ao olho durante o impacto. As lesões da íris, malha trabecular e corpo ciliar podem repercutir na drenagem do humor aquoso. A ocorrência de uma ciclodiálise caracterizada pelo descolamento do corpo ciliar da parede escleral, criando uma comunicação entre a câmara anterior e o espaço supracoroidiano, pode provocar importante redução da pressão intraocular. Esta diminuição pressórica é a responsável pela ocorrência da maculopatia hipotônica que pode cursar com diminuição irreversível da acuidade visual. Não existe consenso na literatura sobre o tratamento das ciclodiálises. Neste relato, descrevemos um caso de ciclodiálise traumática pós impacto com projétil de arma de fogo tratada com aplicação de laser de argônio.

Abstract Blunt eye trauma can generate a wide range of intraocular lesions that are dependent on the amount of energy the object transfers to the eye during the impact. Lesions of the iris, trabecular meshwork and ciliary body may influence aqueous humor drainage. The cyclodialysis which is characterized by the detachment of ciliary body from the scleral wall, creating a communication between the anterior chamber to supracoroid space, can cause a several reduction of intraocular pressure. This pressure decrease is responsible for the occurrence of hypotonic maculopathy which may induce a severe impact on visual acuity. There is no consensus in the literature about cyclodialysis treatment. In this report, we describe a case of traumatic cyclodialysis after impact with a firearm projectile treated with argon laser photocoagulation.

Glaucoma due to ciliary body cysts and pseudoplateau iris: a systematic review of the literature / Glaucoma associado a cistos de corpo ciliar e íris pseudoplateau: revisão sistemática da literatura

ABSTRACT The diagnosis of angle-closure glaucoma secondary to iridociliary cysts is challenging and lacks compiled literature support. We present a rare case of bilateral angle-closure glaucoma associated with pseudoplateau iris due to multiple ciliary cysts and conducted a systematic review of the literature to find similar case reports published between November 2006 and November 2016. Only 19 case reports present treatment modalities, and most cases required more than one therapeutic approach for controlling the intraocular pressure. Pseudoplateau iris attributed to iridociliary cysts should be considered in the differential diagnosis of patients with narrow angles, particularly those with ocular hypertension and glaucoma, in which management is complex. In addition to gonioscopy, ultrasound biomicroscopy is considered the conclusive method for accurate diagnosis.

RESUMO O diagnóstico de glaucoma de ângulo fechado secundário a cistos iridociliares é desafiador e não possui suporte da literatura compilada. Apresentamos um caso bilateral raro de glaucoma de ângulo fechado associado à íris pseudoplateau devido a cistos ciliares múltiplos e realizamos uma revisão sistemática da literatura de relatos de casos similares publicados entre novembro de 2006 e novembro de 2016. Apenas 19 relatos de casos apresentaram as modalidades de tratamento e na maioria deles foi necessário mais de uma abordagem terapêutica para controlar a pressão intra-ocular. Íris pseudoplateau atribuída a cistos iridociliários deve ser considerada no diagnóstico diferencial de pacientes com ângulos estreitos, particularmente aqueles com hipertensão ocular e glaucoma, em que o manejo é complexo. Além da go nioscopia, a biomicroscopia ultra-sônica é considerada o método conclusivo para o diagnóstico correto.

Changes in location parameters of the ciliary body and its correlation with narrow angle in patients with acute primary angle closure glaucoma / 眼科新进展

Objective To observe the positional variation of the ciliary body in eyes with acute primary angle-closure glaucoma (APACG) by ultrasound biomicroscopy (UBM),and to analyze the association between anterior chamber angle width and location parameters of the ciliary body in patients with APACG.Methods The subjects were divided into APACG group and normal control group and examined by UBM,and the clearer images were collected for quantitative analysis,followed by measurement of parameters including angle open distance 500 (AOD500),trabecular meshwork-ciliary process distance (TCPD),iris-ciliary process distance (ICPD),sclera-ciliary process angle (SCPA) and ciliary body length 500 (CBL500).Results Totally 89 patients (89 eyes) were enrolled in this study,including 57 patients with APACG (APACG group)and 32 normal controls (normal control group).According to the age-sex paired t test,the average of 23 pairs of measured data showed that the AOD500,TCPD,ICPD,SCPA,and CBL500 were (0.050 4 ± 0.031 0) mm,(0.499 6 ± 0.192 4) mm,(0.112 6 ± 0.089 2)mm,(35.317 0 ±4.575 2)° and (1.060 4 ±0.290 2)mm in the APACG group,and (0.242 6 ±0.078 5)mm,(0.741 7 ±0.240 4) mm,(0.272 6 ±0.218 8) mm,(44.913 0 ±10.089 2) ° and (0.633 0 ± 0.405 4)mm in the normal control group,respectively;and APACG group presented smaller AOD500,TCPD,ICPD and SCPA but larger CBL500 than normal control group,with significant differences (all P ＜ 0.01).Correlation analysis showed that TCPD,ICPD,SCPA and CBL500 were significantly correlated with AOD500 in APACG group.Conclusion Ciliary bodies are more anteriorly rotated in eyes with APACG,and anterior chamber angle width is associated with location parameters of ciliary body.

IgG4‑related intraocular inflammation masquerading as ciliary body melanoma in a young girl.

Immunoglobulin G4 (IgG4‑related diseases) affects various tissues and organs of the human body. Orbital, adnexal, and scleral inflammations were already reported in the medical literature. To the best of our knowledge, we report the first case of intraocular IgG4‑associated inflammatory mass in the ciliary body mimicking as a melanoma in a 23‑year‑old female from Northeast India. Characteristic histopathology, immunohistochemistry in the tissue, protein chemistry, and raised serum IgG4 were supportive for the diagnosis. As this newly diagnosed disease has multi‑organ affection and little is known about its pathogenesis particularly in eye and adnexa, the present case will open many challenges in clinico‑pathological diagnosis and research in the future.