Surgical treatment outcomes in heavy eye syndrome - a case series.

Results: The study cohort comprised five patients, each presenting with unilateral high axial myopia and classic clinical features of HES, including large angle esotropia, hypotropia, and restricted abduction and supraduction. All patients displayed evident superotemporal globe prolapse on MRI imaging, corresponding to the downward displacement of the LR muscle and medial shift of the SR muscle.Following the surgical procedure, all patients demonstrated significant improvements in both vertical and horizontal deviations, effectively addressing the primary clinical manifestations of HES.Conclusions: In the management of HES, several surgical approaches have been explored, yielding mixed results. Our study, employing the technique of partial muscle splitting and scleral fixation, offers a promising avenue for effectively addressing this challenging condition. By adapting the full loop myopexy technique originally proposed by Yokoyama et al. we achieved satisfactory ocular alignment in all five patients. Notably, this approach mitigates the risk of anterior segment ischemia by preserving the unsecured portions of the SR and LR muscles along with MR retroequatorial myopexy.These findings support the consideration of this surgical technique as a safe and effective option for managing HES, providing both cosmetic and functional improvements to afflicted individuals.

Choroidal Metastasis as the Initial Presentation of Lung Cancer: A Case Report.

This case report presents an 82-year-old woman with decreased visual acuity. Clinical and multimodal evaluation revealed an elevated macular lesion with choroidal thickening. Fluorescein angiography and optical coherence tomography (OCT) showed characteristic patterns of choroidal metastasis. Thoracic CT scan confirmed a nodular mass in the right hilus, suggesting bronchogenic neoplastic process. A pleural biopsy demonstrated malignant neoplasia with characteristics of adenocarcinoma, and immunohistochemistry was positive for thyroid transcription factor 1 (TTF-1). These findings emphasize the critical role of ophthalmological examinations in early detection and intervention, as choroidal tissue is highly susceptible to metastasis, particularly from breast and lung cancers. Additionally, the poor prognosis associated with metastatic lung cancer underscores the urgency for prompt action.

Trabeculectomy Vs Non-penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes.

Introduction: Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma. Patients and methods: Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication. Results: Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively. Conclusion: Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.

Intravitreal aflibercept for idiopathic choroidal neovascularisation in paediatric age.

A boy in early adolescence presented with a 1-week history of visual acuity impairment in his right eye (RE). Fundus examination of the RE revealed an elevated yellow-greyish lesion in the inferior temporal juxtafoveolar area. Findings on optical coherence tomography, fluorescein angiography and optical coherence tomography angiography were compatible with active choroidal neovascularisation (CNV). In the absence of a primary ocular pathology and a potential systemic secondary cause, it was assumed an idiopathic aetiology of CNV. The child was treated with intravitreal injections of aflibercept, showing good anatomical and functional responses. No complications were recorded after the injections. CNV in children is a rare ocular condition that can lead to permanent visual acuity impairment. Although the therapeutic approach remains controversial, anti-vascular endothelial growth factor intravitreal injections represent a safe and effective therapeutic option for CNV in children.

Visual Field Defects in Patients With Optic Nerve Head Drusen.

Background Optic nerve head drusen (ONHD) are acellular deposits in the optic nerve head, whose pathophysiology remains not fully understood. Most patients with ONHD have visual field (VF) defects. This study aims to describe the VF defects observed in patients with ONHD and to compare the anatomical and functional impairment between visible and buried ONHD. Methods Patients with ONHD were retrospectively studied. The retinal nerve fiber layer (RNFL) average thickness and the ganglion cell complex (GCC) average thickness were collected from optical coherence tomography data. Visual field index (VFI), mean deviation (MD), and pattern standard deviation (PSD) were collected from 30-2 standard automated perimetry. An abnormal VF test was defined as having a Glaucoma Hemifield Test outside normal limits and/or a PSD with a p-value<5%. Eyes with superficial or buried ONHD based on visibility by slit-lamp ophthalmoscopy were compared. Results Sixty-six eyes of 36 patients were included in the study. The mean age was 39.6 ± 2.5 years. Forty-nine eyes (81.7%) presented a VF defect: concentric VF constriction in 19 (38.8%), arcuate scotoma in 16 (32.7%), enlarged blind spot in 9 (18.4%), unspecific VF defect in 8 (16.3%), and nasal step in 3 (6.1%). Thirty-four eyes (51.5%) had superficial ONHD and 32 eyes (48.5%) had buried ONHD. Patients with superficial ONHD were significantly older (p<0.001) and presented a significantly lower VFI (p=0.010), lower MD (p=0.002), higher PSD (p<0.001), thinner GCC (p<0.001), and thinner RNFL (p<0.001) than patients with buried ONHD. VF defects were present in 90.6% of eyes with superficial ONHD and 71.4% of eyes with buried ONHD (p=0.113). The type of VF defects differed between groups (p=0.020). Conclusions Functional and structural impairment is more evident in eyes with superficial ONHD, maybe because the presence of calcification leads to greater axonal damage. Buried ONHD is more prevalent in younger patients, progressing to a superficial location and becoming calcified with age.

Foveal Hypoplasia Related to Congenital Rubella.

Normal development of the fovea begins before midgestation and continues for several years after birth. Foveal hypoplasia is a condition in which the foveal pit and the foveal avascular zone do not fully develop. Several diseases are known to be associated with foveal hypoplasia; however, a direct association between foveal hypoplasia and congenital rubella has not been stated so far. This report describes a case of foveal hypoplasia detected during adulthood in a patient with known fetal exposure to maternal rubella infection and several ocular features of congenital rubella syndrome, including microphthalmia, congenital cataract, and pigmentary retinopathy. During follow-up, the visual acuity and ocular fundus changes remained stable.

Eyelid Infestation: A Case Report of Atypical Phthiriasis Palpebrarum.

Phthiriasis palpebrarum is a rare parasitosis of the eyelashes caused by Phthirus pubis. This report describes an atypical case of this disease. A 72-year-old female patient suffered prolonged symptoms of severe left eye pruritus for 18 months, refractory to conventional eyelid hygienic measures, and anti-histaminic and corticosteroid medications. Slit-lamp examination showed multiple translucent oval structures adherent to the upper eyelashes, and 18 crab-like lice, which were mechanically removed and characterized as Phthirus pubis. Treatment was started with corticosteroid and antibiotic ointment, vaseline, and Blephademodex® wipes (Laboratoires Théa, Auvergne-Rhone-Alpes, France). After 2 weeks, all symptoms had subsided completely. Although rare, phthiriasis palpebrarum may be easily confused with frequent palpebral pathologies like blepharitis. A careful slit-lamp examination is central for proper evaluation and diagnosis. Mechanical removal of the lice is the most effective treatment but should be complemented by topical and/or systemic treatment. This report presented an atypical case of this disease.

Outer Nuclear Layer as the Main Predictor to Anatomic Response to Half Dose Photodynamic Therapy in Chronic Central Serous Retinopathy.

PURPOSE: To evaluate the predictors for subretinal fluid resorption in patients with chronic central serous retinopathy (cCSR) submitted to half-dose photodynamic therapy (HD-PDT). METHODS: Observational, longitudinal, and retrospective study of patients with cCSR submitted to HD-PDT in a tertiary ophthalmology department in Portugal between January 2015 and February 2018. Best-corrected visual acuity (BCVA) and SD-OCT at baseline and 12 ± 3 months after treatment were performed. The central macular thickness (CMT), outer nuclear layer (ONL) thickness, integrity of the external limiting membrane (ELM), ellipsoid (EZ) and interdigitation zone (IZ), subretinal fluid (SFR) height, and choroidal thickness (CT) were evaluated. Patients were classified into responders and nonresponders based on SRF resorption. RESULTS: Sixty-one eyes of 42 patients were included; 75.4% were classified as responders. Final BCVA was significantly better in responders (p=0.002). The baseline ONL was thicker (p < 0.01) and intact ELM (67.2% vs. 16.4%), EZ (49.2% vs. 8.2%), and IZ (31.2% vs. 1.6%) were more prevalent in responders than in nonresponders. Anatomic response was correlated with a thicker ONL (rs (59) = 0.416, p=0.001 ∗ ), intact ELM (rs (59) = 0.261, p=0.04 ∗ ), EZ (rs (59) = 0.278, p=0.03 ∗ ), and IZ (rs (59) = 0.318, p=0.01 ∗ ). Binary logistic regression showed that a thicker ONL thickness increased the chance of an anatomic response to HD-PDT. The other evaluated retinal layers did not have statistical significance in the binary regression model. CONCLUSIONS: cCSR responders to HD-PDT have a better final BCVA, a thicker baseline ONL, and an intact baseline ELM, EZ, and IZ. However, ONL was the only predictor in a logistic regression model for SRF resorption.