Combined Capsular Tension Ring and Segment Implantation in Phacoemulsification Surgery for the Management of Microspherophakia with Secondary Angle-Closure Glaucoma.

We present the long-term results of the implantation of a capsular tension ring (CTR) and Ahmed capsular tension segments (CTS) together for the management of mikrospherophakia in a 35-year-old female patient. The patient had uncontrolled secondary angle-closure glaucoma, despite previous laser peripheral iridotomy, and visual impairment due to lenticular myopia. Clear lens extraction was performed under general anesthesia. The capsular bag was stabilized with a classical CTR and two Ahmed CTSs sutured to the sclera. A single-piece hydrophobic acrylic intraocular lens (32.0 D for the right and 30.0 D for the left eye) was implanted in the capsular bag. The anterior chamber depth was stable, and intraocular pressure (IOP) was 10-12 mmHg in both eyes in the early post-operative period. The bag complex gradually moved forward, IOP gradually increased, and the left eye underwent trabeculectomy surgery in the 4th year of follow-up.

Peripapillary and Macular Vascular Density in Patients With Preperimetric and Early Primary Open Angle Glaucoma.

PRCIS: Decreased circumpapillary vascular density (cpVD) and average retinal nerve fiber layer (RNFL) thickness were detected at different locations in eyes with preperimetric glaucoma (PPG). Although RNFL loss was more prominent in preperimetric eyes, in early glaucoma, both cpVD and RNFL thickness showed comparable diagnostic ability. PURPOSE: To evaluate changes in circumpapillary and macular vascular density and investigate correlations between vascular and structural parameters in PPG and early glaucoma. METHOD: This cross-sectional study included a total of 27 patients with PPG in 1 eye and early primary open angle glaucoma in the fellow eye, as well as a control group consisting of 27 eyes of 27 healthy volunteers. All subjects underwent optical coherence tomography angiography (OCTA) imaging. RNFL and macular ganglion cell complex measurements were obtained simultaneously with vascular parameters by AngioVue OCTA using the single-scan protocol. cpVD was examined in 8 sectors. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve. RESULTS: In preperimetric eyes, average RNFL thickness and whole-image vessel density had comparable diagnostic performance (area under the receiver operating characteristic curve =0.853 and 0.753, respectively). Compared with the control group, PPG eyes had significantly lower RNFL thickness in all quadrants (P<0.001-0.003) except for the temporal quadrant, whereas cpVD differed only in the nasal inferior and nasal superior sectors (P=0.001 and 0.041, respectively). In early glaucoma eyes, cpVD differed significantly from controls in all sectors except for the inferotemporal, temporal inferior, and temporal superior sectors, whereas perifoveal macular vascular parameters differed in all quadrants (all P<0.05). cpVD was strongly correlated with RNFL thickness in the superior, nasal, and temporal quadrants (r=0.664, 0.698, and 0.649, respectively, P<0.001) and moderately correlated in the inferior quadrant (r=0.450, P<0.001). CONCLUSION: Although RNFL involvement is valuable in the diagnosis and follow-up of PPG, the change in nasal cpVD has an important place in these patients. The role of macular vascular parameters and macular ganglion cell complex in glaucoma follow-up becomes important in early glaucoma. Longitudinal studies are needed to determine the place of OCTA in the diagnosis and follow-up of glaucoma.

Discriminating performance of macular ganglion cell-inner plexiform layer thicknesses at different stages of glaucoma.

AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer (GC-IPL) parameters between all the consecutive stages of glaucoma (from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer (RNFL) parameters and optic nerve head (ONH) parameters. METHODS: Totally 147 eyes (40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography (OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve (AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients (P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio (AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the best GC-IPL parameters being minimum and inferotemporal (AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area (AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients. CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other (from glaucoma suspect to moderate-to-severe glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.

Ocular and Genetic Characteristics Observed in Two Cases of Fish-Eye Disease.

PURPOSE: To present ocular findings and anterior segment-optical coherence tomography (AS-OCT) imaging findings of 2 cases of fish-eye disease (FED) involving 2 novel genetic variants of the lecithin-cholesterol acyltransferase (LCAT) gene. METHODS: A case report. RESULTS: A 46-year-old woman and 63-year-old man presented with blurred vision, burning sensation, and whitening of both eyes for 2 and 3 years, respectively. Ophthalmologic examination revealed slightly decreased visual acuity, yellowish-white diffuse corneal opacities causing corneal clouding, and dry eye disease bilaterally in both patients. AS-OCT imaging demonstrated diffuse hyperreflective corneal opacities predominantly located in the anterior stroma. On systemic examination, both patients had very low plasma high-density lipoprotein cholesterol levels. However, they did not have any systemic associations with familial LCAT deficiency or Tangier disease, which are differential diagnoses for corneal clouding and low plasma high-density lipoprotein cholesterol. Both patients were diagnosed with FED based on clinical findings. Furthermore, genetic analysis, in which novel variants of c.86A>G (p.Asn29Ser) in the first exon and c.1052A>G (p.Tyr351Cys) in the sixth exon on the LCAT gene were detected, confirmed the diagnosis. CONCLUSIONS: Although it is a rare genetic disorder, FED should be considered in the differential diagnosis of corneal clouding. Corneal lipid deposits, visible on AS-OCT are suggestive of FED, and genetic analysis can be used to confirm the clinical diagnosis. Finally, there may be a relationship between dry eye disease and LCAT enzyme deficiency disorders, which should be investigated in further studies.

Primary Conjunctival Tuberculosis.

A 12-year-old girl was referred to our clinic because of unilateral conjunctivitis not responding to treatment. In the left eye, lower bulbar and tarsal conjunctiva had a polypoidal appearance due to micronodules and there was a subconjunctival nodular mass in the inferior fornix. Systemic examination was unremarkable except for a left preauricular lymphadenopathy. Excision biopsy of the subconjunctival mass revealed a granulomatous inflammation with caseation necrosis, but acid-fast bacilli (AFB) was negative. Fine needle-aspiration biopsy of the preauricular lymph node was performed. In microbiological examination, both AFB and mycobacterial culture were positive. The isolated mycobacteria strains were identified as Mycobacterium tuberculosis complex and full remission was achieved with 6 months of anti-tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological and histopathological examinations should be performed both in conjunctiva and regional lymph node.

Ocular surface chemical injury treated by regenerating agent (RGTA, Cacicol20).

Objective: To present the successful outcome of regenerating agent (RGTA) treatment in a patient with severe ocular surface chemical injury. Methods: Case report Results: A 14-year-old female patient was admitted to our clinic following chemical burn in the left eye. Her best corrected visual acuity (BCVA) was 20/40; and she had total corneal and 75% conjunctival epithelial loss, corneal haze, and limbal ischemia for nine clock hours in the left eye. The patient had already received standard therapy consisting of patching, preservative-free artificial tears, topical netilmicin, topical dexamethasone, oral doxycycline, and vitamin C for two weeks. We initially cleaned the conjunctival necrotic tissues, applied the silicon hydrogel bandage contact lens, exchanged the topical netilmicin with preservative-free moxifloxacin and supplemented this therapy with RGTA (Cacicol20, Paris, France) once in two days. The BCVA of the patient improved to 20/20 and the ocular surface re-epithelization was completed on day 20. Conclusion: RGTAs are effective biological agents for the treatment of corneal epithelial defects following severe ocular surface chemical injuries.

Bilateral transient visual loss and meningeal irritation signs following retrobulbar anesthesia.

A 62-year-old man underwent an uneventful cataract surgery in the left eye following retrobulbar anesthesia. Fifteen minutes after the surgery, the patient had visual loss in his right (unoperated) eye, headache, dizziness, nausea, and vomiting. The bandage on the left (operated) eye was removed and the initial ophthalmic examination revealed bilateral dilated pupils with absence of light perception. His fundus examination and vital signs were unremarkable. Immediately, a computerized tomography (CT) was performed to scan both orbit and brain. The orbit CT revealed air bubbles within the left optic nerve sheath, which confirmed inadvertent injection and administration of anesthetic medications into the optic nerve sheath. Within three hours, meningeal irritation signs recovered spontaneously and visual acuity improved to 20/20 in the right eye and 20/40 in the left eye.

Purtscher-Like Retinopathy Associated with Atypical Hemolytic Uremic Syndrome.

A 25-year-old woman presented with acute bilateral blurred vision and history of headache, dizziness, and syncope for three days. Her visual acuity was 20/60 in both eyes. Fundoscopy revealed multiple bilateral peripapillary yellow-white patches like cotton wool spots, intraretinal hemorrhages and macular edema. The patient was diagnosed with Purtscher-like retinopathy based on the retinal findings and lack of trauma history. She was urgently admitted to the nephrology clinic due to thrombotic microangiopathy findings (hemoglobinemia, thrombocytopenia, and acute renal failure). After excluding thrombotic microangiopathy, the patient was diagnosed with atypical hemolytic uremic syndrome (aHUS) with the clinical and laboratory findings. Eculizumab treatment was added to hemodialysis and plasmapheresis therapy. Three months after starting treatment, retinal lesions regressed and visual acuity increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of Purtscher-like retinopathy associated with aHUS.