ABSTRACT
Coronavirus disease 19 (COVID-19) was first observed in Wuhan, China. The disease is caused by a virus (SARS-CoV-2), which spread around the world within a matter of weeks, leading to a large number of deaths. While the health crisis was managed on the ground, the scientific community focused on finding a means to stop it. Vaccine candidates such as the mRNA vaccines (Pfizer BTN162b2 and Moderna mRNA-1273), started to emerge. As these treatments came on the market recently, there is still concern about potential side effects, among them, Herpes Zoster Ophthalmicus (HZO).
Subject(s)
COVID-19 , Herpes Zoster Ophthalmicus , Humans , Herpes Zoster Ophthalmicus/diagnosis , Herpes Zoster Ophthalmicus/drug therapy , 2019-nCoV Vaccine mRNA-1273 , BNT162 Vaccine , SARS-CoV-2 , COVID-19/prevention & control , Vaccination/adverse effectsABSTRACT
INTRODUCTION: Toxic anterior segment syndrome (TASS) is a rare but serious complication of anterior segment surgery characterised by an acute sterile inflammation. The ICL implantation has gained popularity for the correction of moderate and high ametropias in cases where classical keratorefractive procedures are contraindicated. OBJECTIVE: The purpose of this case report is to present the evolution and management of toxic anterior segment syndrome after EyePCL implantation in a 19 year old hyperopic male patient. METHODS: Case report. RESULTS: The onset of the disease occurred in the first 48h postsurgery with a sudden loss of vision (with a VA of HM at 2m), mild photophobia and burning sensation in the absence of pain, severe inflammatory reaction of the anterior chamber with hypopyon, a Tyndall of 3+, cyclitic membrane and no posterior chamber inflammation. The evolution under antiinflammatory corticoid treatment along with topical antibiotic, mydriatic and hypotensor treatment was favorable with a BCVA of 7/10, resolution of hypopyon and complete detachment of the cyclitic membrane at day 5 postsurgery. A tapering of the corticoid treatment was started along with NAIDS and at one-month follow-up the patient got a 100% recovery of the visual function. CONCLUSION: The most important differential diagnosis to rule out is an infectious endophthalmitis. This case demonstrates that early diagnosis and management of TASS is essential in order to preserve the eye function and structures intact. Treated on time the eye can get a 100% recovery with no sequelaes.
Subject(s)
Endophthalmitis , Hyperopia , Uveitis, Anterior , Adult , Anterior Eye Segment/diagnostic imaging , Endophthalmitis/diagnosis , Humans , Hyperopia/complications , Hyperopia/etiology , Lens Implantation, Intraocular/adverse effects , Male , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Uveitis, Anterior/complications , Young AdultABSTRACT
PURPOSE: Retrospective study of local tolerability of a natural hydroxyapatite orbital implant wrapped with Vicryl(®) (polyglactin) mesh in patients undergoing enucleation. METHOD: Complications were classified into four types according to their management: type 1 if no reoperation was required, type 2 if additional surgery without grafting was required, type 3 if an oral mucosal graft was performed (major dehiscence) and type 4 if the complication required removal of the implant. RESULTS: Seven hundred and four patients with a median follow-up of 44 months. Five hundred and three patients were enucleated as a primary procedure and 201 after failure of conservative management. The overall complication rate was 12.07% (85 patients) with 68 type 1 complications, nine type 2 complications, three type 3 complications and five type 4 complications (0.71%). A total of 17 patients (2.42%) required additional surgery. The use of chemotherapy or radiotherapy before or after surgery did not influence the results. In univariate analysis, the tolerability was better in children than in adults. With multivariate analysis, only the diameter of the implant was an independent risk factor for complications (P=0.001). CONCLUSION: Use of a Vicryl(®) mesh-wrapped natural hydroxyapatite orbital implant after enucleation is particularly well tolerated including the pediatric population. A compromise should be sought with an implant large enough for good cosmetic results but small enough to avoid complications.
