Acute angle-closure glaucoma concurrent with COVID 19 infection; case report.

INTRODUCTION: To report three cases that developed acute angle-closure glaucoma on the background of hyponatremia due to COVID 19 infection. METHODS: Data of patients with positive PCR result for COVID 19 infection and concurrent findings of acute angle-closure glaucoma were analysed retrospectively. RESULTS: The common characteristic of all cases was positive PCR test for COVID 19 infection taken from the nasopharyngeal swab 4 or 5 days ago. Their serum sodium levels were lower than 135 mmol / L. At the initial ophthalmic examination, all cases had diffuse corneal edema with shallow anterior chambers and mid-dilated non-reacting pupils.The choroid was evaluated as normal by ocular ultrasonography. Intraocular pressures (IOP) of the first, second, and third cases were 35 mmHg, 44 mmHg, and 40 mm Hg, respectively. 5-10 cc/kg mannitol was given to all patients intravenously within 30 min. Simultaneously, they began to use oral acetazolamide, topical pilocarpine, beta-blocker, and prednisolone acetate drops.After stabilization of IOP, Neodymium-doped yttrium aluminum garnet;(ND: YAG) Laser iridotomy was performed on all patients. No additional fluid therapy was given to the patients other than mannitol, and it was determined that the blood sodium level remained at normal levels after diuresis. DISCUSSION: Hyponatremia is the most common electrolyte disorder in COVID 19 infection. Hyponatremia may cause an angle-closure attack in patients with shallow anterior chamber angles.Therefore, one should be aware of the possibility of angle-closure glaucoma in patients who develop hyponatremia due to COVID 19 disease. Suspected patients should be referred to the ophthalmology department.

Effects of glaucoma and central corneal thickness on optic nerve head biomechanics.

PURPOSE: To evaluate effects of glaucoma and central corneal thickness (CCT) on optic nerve head biomechanics. METHODS: Four groups were formed according to CCT measurements and the presence of glaucoma. Glaucomatous patients with thin (< 510 µ) and thick (> 570 µ) corneas composed groups 1 and 3, respectively. Nonglaucomatous patients with thin and thick corneas composed groups 2 and 4, respectively. Real-time elastography (RTE) was performed on all groups, and optic nerve strain rate (ONSR), orbital fat strain rate (OFSR), and strain ratio of orbital fat to the optic nerve and medial and lateral parts of the optic nerve (SROFON, SROFMON, SROFLON, respectively) were obtained and compared between groups. The correlations between CCT and these parameters were also investigated. RESULTS: Statistically significant difference was not found between groups in terms of strain rate of optic nerve and orbital fat, SRFON, SROFMON and SROFLON. There was a positive correlation between ONSR and OFSR and mean CCT in patients with CCT thinner than 510 µ (p: 0.03 r: 0.26, p: 0.01 r: 0.32 respectively). CONCLUSION: SROFON, SROFLON and SROFMON values did not differ between glaucomatous and nonglaucomatous patients with thin or thick CCTs. The correlations between CCT and OFSR and ONSR were found to be statistically significant in patients with thin CCT.

Clinical time course of the neglected giant sebaceous gland carcinoma.

In this report, we discussed the progression from the initial presentation until surgical intervention, clinical course, and devastating outcome of a neglected giant sebaceous gland carcinoma of the eyelid in a poorly compliant elderly patient. A 79-year-old woman was referred for treatment of a giant ulcero-nodular lesion in the right upper eyelid. Nine months before, an orange lesion arising from the tarsal conjunctiva in the upper eyelid was observed in her examination undergone in the healthcare center where she initially presented, and the cornea appeared transparent. Surgical excision was recommended, which she declined. The examination three months before in the same center revealed that the lesion invaded the globe and anterior segment architecture could not be visualized. She was then recommended surgical removal of the eyeball, which she also refused. Radiological imaging demonstrated a 33x35 mm mass lesion in the superior lateral of orbit with exophytic growth and invasion of the globe and no systemic metastases were found. Total orbital exenteration surgery was immediately planned and performed. Histopathological examination revealed sebaceous gland carcinoma. Elderly patients with poor compliance should discuss their condition with a psychiatrist and should be managed by a multidisciplinary approach. This way, patients with eyelid malignancies can be encouraged to undergo surgery and receive early treatment, decreasing the need for exenteration, improving clinical outcomes, and reducing the risk of morbidity and mortality.

Evaluation of Anterior Segment Parameters in Pseudoexfoliative Glaucoma, Primary Angle-Closure Glaucoma, and Healthy Eyes.

OBJECTIVES: To evaluate anterior segment parameters measured by dual Scheimpflug corneal topography in pseudoexfoliative glaucoma (PEXG), primary angle-closure glaucoma (PACG), and healthy eyes. MATERIALS AND METHODS: One hundred forty-three eyes of 86 patients were included in this study. Forty-seven eyes of 38 patients with PEXG, 30 eyes of 15 patients with PACG, and 66 eyes of 33 healthy subjects were evaluated. Patients who underwent previous ophthalmic surgery and contact lens wearers were excluded. After full ophthalmological examination, mean central corneal thickness (CCT), white-to-white horizontal corneal diameter (WTW), pupillary diameter (PD), anterior chamber volume (ACV), anterior chamber depth (ACD), and mean anterior chamber angle were measured by dual Scheimpflug corneal topography and compared between the three groups. Statistical analyses were done using Statistical Package for Social Sciences for Windows 18.0 program. RESULTS: No statistical difference was found in mean age or gender among the study groups (p>0.05). There were also no statistical differences in CCT, WTW, or PD among the groups (p=0.568, p=0.064, p=0.321, respectively). ACV, ACD, and mean anterior chamber angle values were significantly lower in the PACG group compared to the other groups (p=0.000 for all). There was no statistically significant difference in these measurements between the PEXG and normal eyes. CONCLUSION: ACV and depth and mean anterior chamber angle were statistically different (lower) in PACG when compared with PEXG and healthy eyes. Dual Scheimpflug corneal topography can be used as an objective method for the measurement of anterior segment parameters in glaucoma.