ABSTRACT
PHACE(S) syndrome is a neurocutaneous disorder with a hallmark finding of an infantile facial hemangioma (IFH) >5 cm. Eye examination of patients with PHACE(S) syndrome with no IFH at periorbital region is reported to be of low yield. We report a unique case of the syndrome with ocular manifestations without periorbital IFH or systemic findings. A 3-week-old female infant with right periauricular IFH >5 cm, extending to the neck and cheek and lower lip IFH was presented. Examination revealed pseudoptosis due to microphthalmia with esotropia and hypertropia. Both corneas were clear with diameters of 5 mm and 10 mm, right eye (RE) and left eye (LE), respectively. There was a posterior polar cataract with a poor view of the fundus RE. Ocular B-scan and magnetic resonance imaging (MRI) findings were suggestive of a dysmorphic globe, vitreous hemorrhage, spherophakia and persistent fetal vasculature RE and normal findings LE. Clinical evaluation, MRI, and MR angiography revealed no other systemic abnormalities. Subsequent follow-up visits revealed progressive clouding of the cornea with neovascularization and the development of phthisis bulbi RE at which point an ocular prosthesis was placed. The IFH was managed with dye laser and with oral propranolol. At 1 year, the patient has remained stable with no development of new local or systemic anomalies, regression of the periauricular and lip IFH, and normal development of the orbital structure RE with an ocular prosthesis in situ. Ocular involvement in patients with PHACE(S) syndrome may be present without periorbital IFH. Regardless of the location of the IFH and the presence or absence of a periocular component, it is recommended that they receive a full initial ophthalmological assessment.
ABSTRACT
Purpose: The Zepto nano-pulse precision capsulotomy is a novel device for capsulorhexis formation during cataract surgery. Few complications or challenges have been reported while using this device. The purpose of this paper is to highlight two intra-operative challenges that were encountered while using the Zepto device. Observations: CASE 1 - A 65-year-old with advanced primary open angle glaucoma (POAG) and an in situ Ahmed Glaucoma Valve located in the anterior chamber. During a planned phacoemulsification procedure, the tube became trapped between the suction cup of the Zepto device and the lens, resulting in a sudden complete collapse of the anterior chamber. The procedure was completed after appropriate interventions. On post-operative day 1 Descemet folds were visible, and corneal endothelial cell density was reduced from 2101 cells/cm2 preoperatively to 1355 cells/cm2 at 19 months postoperatively. CASE 2 - A 66-year-old female with secondary cataract from chronic inflammation post trabeculectomy for advanced POAG. During a planned phacoemulsification procedure, despite synechialysis for the 360° posterior synechiae, the iris tissue was sucked into the suction cup of the Zepto device and became incarcerated over the lens. The procedure was completed after a successful intervention. Conclusions and importance: Although not previously reported and possibly rare, intra-operative complications may be encountered while using the Zepto device, particularly in complex cataract cases. For the patient's safety and satisfactory post-operative and refractive outcomes, caution must be applied.
ABSTRACT
Background: To objectively measure visual function amongst Primary Open Angle Glaucoma (POAG) patients and compare these with age and sex-matched controls by describing the characteristics of visual function in relation to the severity of POAG. Methodology: A case-control study was carried out among 106 POAG patients and an equal number of age-sex matched controls attending Asokoro District Hospital, Abuja, and Eye Foundation Hospital Abuja from Nov 2012 to April 2013. The objective measures of visual function assessed include visual acuity (VA), contrast sensitivity (CS), colour vision (CV), and visual fields (MD) in the better eye (BE)]. Results: All measures of visual function were found to be reduced comparing cases to controls and this was statistically significant. VABE (0.39±0.73; 0.0017±0.02p<0.001); MDBE (-8.02±6.80; 0.17±0.3P<0.001); CSBE (1.46±0.59; 1.90±0.16p<0.001): Colour vision defects (54.7%; 6.6% p<0.001). In comparing mild; moderate; severe glaucoma: VABE (0.0053±0.03; 0.057±0.08; 0.766±0.90 p<0.001); MDBE (-3.46±1.93;-8.17±3.55;-16.43±6.01p <0.001); CSBE (1.88±0.26; 1.69± 0.37; 1.11±0.59 p<0.001): Color vision defects (20.6%; 31.6%; 86.9%) respectively (BE: Better Eye). While looking at the two independent groups above, mild and moderate were not statistically significant except for the visual field, but comparing mild with severe and moderate with severe, they had a statistically significant relationship across all the visual functions tested. In comparing controls with mild, color vision and visual field had a statistically significant difference. Comparing the groups with mild and moderate glaucoma, only visual fields as a visual function were statistically significant. Whereas comparing both groups with the severe group independently, they had statistically significant in all the visual functions tested. Conclusion: In conclusion, visual function was reduced in glaucoma patients as compared to controls. Visual acuity, contrast sensitivity and colour vision differed significantly in comparing mild with severe and moderate with severe. Color vision differed significantly in comparing mild to controls.