Combined Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) with Ab Interno Canaloplasty (ABiC) in Conjunction with Phacoemulsification: 12-Month Outcomes.

PURPOSE: To report the surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy (GATT) with ab interno canaloplasty (ABiC) in conjunction with phacoemulsification for primary open-angle glaucoma (POAG). PATIENTS AND METHODS: This prospective, interventional, non-comparative case series included POAG patients who underwent combined GATT and ABiC in conjunction with phacoemulsification performed between January 2018 and August 2018. Main outcome measures include surgical success rate, changes in intraocular pressure (IOP), number of antiglaucoma medications, corrected distance visual acuity (CDVA), and complications. RESULTS: We enrolled twenty eyes of 19 patients in our study. The mean age was 61.2 ± 6 years, and all the patients completed a 12-month follow-up. The overall success rate was 100%. The mean baseline IOP was 19.75 ± 4.68 mmHg, and at 12 months, the mean IOP was 13.30 ± 1.30 mmHg (IOP reduction of 32.7%). The baseline number of antiglaucoma medications was 3.4 ± 0.6 (range: 2 to 4 medications), and after 12 months follow-up, the number was reduced to 1.1 ± 1.0 (range: 0 to 2 medications). The CDVA for all 20 eyes was 0.85±0.58 LogMAR at baseline, and 0.16±0.30 LogMAR at 12-month follow-up. Only six eyes developed hyphaema, which had cleared by the first postoperative month, and three eyes needed medical treatment for postoperative IOP spikes. CONCLUSION: The 12-month results of our study suggest that combined GATT with ABiC in conjunction with phacoemulsification is a safe and effective alternative in decreasing the IOP and number of antiglaucoma medications in POAG patients.

Posterior segment optical coherence tomography findings in a case of nephropathic cystinosis.

Cystinosis is a rare autosomal recessive lysosomal storage disorder characterized by abnormal accumulation of intracellular cystine in various tissues including the brain, kidneys, bones, and eyes. Infantile nephropathic cystinosis is the most severe phenotype of cystinosis that has been associated with a wide spectrum of ocular features. In this report, the author describes a posterior segment spectral-domain optical coherence tomography (SD-OCT) finding that has not been previously reported in a case of nephropathic cystinosis.

Intracorneal Hematoma After Ahmed Glaucoma Valve Implant Surgery.

Intracorneal hematoma or hemorrhagic descemet detachment is a rare phenomenon. It has been previously described after nonpenetrating glaucoma surgeries such as canaloplasty, viscocanalostomy, and deep sclerectomy. In this report, we describe a rare case of intracorneal hematoma as a yet nondocumented complication after Ahmed glaucoma valve implant surgery.

Secondary implantation of implantable collamer lens (ICL) for correction of anisometropic hyperopia in a 3-year-old pseudophakic child.

We report the first case of secondary implantation of implantable collamer lens (ICL) for correction of anisometropic hyperopia in a 3-year-old pseudophakic child. The ICL implantation was considered in our patient due to parental noncompliance for contact lens and spectacles use for one year. In terms of efficacy, the preoperative refractive error of +7.00-1.75 diopter (D) reduced to +1.00-1.75 D. The uncorrected distance visual acuity (UDVA) significantly improved from 20/400 (preoperatively) to 20/50 (postoperatively). In terms of safety, after an uneventful implantation surgery, the ICL was well tolerated, and remained well centered, with no serious postoperative complications encountered over a 22-month follow-up.

Tuberculous Conjunctivitis in an Anophthalmic Socket.

Tuberculous (TB) conjunctivitis was not an uncommon condition before the early 20(th) century but is currently a rare occurrence, especially in the developed countries. We report a 27-year-old Saudi female who underwent enucleation of the right eye at the age of 20 following a penetrating eye injury. She had a history of miliary TB that was treated at the age of 22. She was presented with chronic purulent discharge from her right an anophthalmic socket for 2 months. Cultures for bacteria and fungi were sterile. There was no response to empirical topical antibiotics and steroids. Direct microscopic examination of conjunctival scrapings with the Ziehl-Neelsen staining revealed no microorganisms. Histopathological examination revealed epithelioid granulomas. Polymerase chain reaction was negative for Mycobacterium tuberculosis DNA. TB conjunctivitis was suspected from the history of miliary TB and presence of epithelioid granulomas. The definitive diagnosis was made after prompt resolution of the ocular signs with no recurrence only after systemic anti-TB therapy.

Implantation of spherical and toric copolymer phackic intraocular lens to manage amblyopia due to anisometropic hyperopia and myopia in pediatric patients.

PURPOSE: To evaluate the safety and efficacy of implantation of the Visian Implantable Collamer Lens phakic intraocular lens (pIOL) (spherical and toric models) for management of amblyopia due to anisometropic hyperopia and myopia in children. DESIGN: Retrospective case series. SETTING: Tertiary care eye specialty hospital, Dhahran, Saudi Arabia. METHODS: Eyes of patients who underwent the implantation of the pIOL for refractory anisometropic amblyopia were identified. None of the patients were compliant with spectacle/contact lens correction. Preoperative and postoperative clinical evaluation included visual acuity, cycloplegic refraction, slitlamp microscopy, intraocular pressure, orthoptic evaluation, anterior chamber depth, and ICL vault. RESULTS: A total of 11 eyes (9 myopic, 2 hyperopic) of 11 patients aged 5 to 15 years were identified. Of the 9 myopic eyes, 6 eyes received spherical ICLs and 3 received toric ICLs. Both hyperopic eyes received spherical ICLs. Preoperatively, the mean cycloplegic refractive spherical equivalent (CRSE) was -11.07 D (range -7.75 to -21.88 D) in myopic eyes, and +8.75 D (range +8.63 to +8.87 D) in hyperopic eyes. The mean corrected distance visual acuity (CDVA) was 20/171 (range 20/40 to 20/400) in myopic eyes, and 20/130 (range 20/60 to 20/200) in hyperopic eyes. At a mean follow-up of 16.8 months (in myopic eyes), the mean CRSE was -1.40 D (range 0 to -2.25 D), and mean CDVA was 20/51 (range 20/20 to 20/100). In hyperopic eyes, at a mean follow-up of 15 months, the mean CRSE was +1.82 D (range +1.75 to +1.88 D) and the CDVA had improved to 20/25 in both eyes. Although complications occurred in the 2 hyperopic eyes, the complications were either temporary or visually insignificant and did not necessitate reoperation or ICL explantation. CONCLUSION: ICL implantation may be considered a safe and effective treatment option for refractory amblyopia due to anisometropic hyperopia or myopia in children who are noncompliant with conventional therapy. FINANCIAL DISCLOSURE: The authors have no financial or proprietary interest in a product, method, or material described herein.

Idiopathic Peripapillary Subretinal Neovascular Membrane in a Young Woman with Recurrence of the Lesion during Pregnancy after Treatment with Intravitreal Bevacizumab.

We report a 27-year-old woman who was diagnosed with idiopathic peripapillary subretinal neovascular membrane (PSRNVM) in her left eye with best-corrected visual acuity (BCVA) of 20/160. She had been treated by three monthly doses of intravitreal bevacizumab (1.25 mg/0.05 ml) at 4-week intervals, which showed a favorable response. The treatment led to regression of the choroidal neovascular membrane (CNVM) with complete resorption of subretinal fluid and improvement of BCVA to 20/25. Subsequently, recurrence of the CNVM was observed during pregnancy (28 months after treatment). To the best of our knowledge, this is the first report of recurrence of idiopathic PSRNVM during pregnancy.

Behcet's disease presenting as intracranial hypertension due to cerebral venous thrombosis.

The non-parenchymal central nervous system's (CNS) involvement in Behcet's disease (BD) is considered rare. We herein report a case of BD complicated by intracranial hypertension (ICH) due to cerebral venous thrombosis (CVT) in a 25-year-old Saudi male. Our patient presented with a four-week history of increasingly severe headache, nausea and diplopia, which were preceded by previous recurrent intermittent oral and genital ulcers, history suggestive of acneiform lesions and arthralgia over the past two years. Ophthalmic examination disclosed normal visual acuity (20/20) in both eyes with bilateral 6th nerve palsy and papilledema. Both eyes showed no signs of anterior or posterior segment inflammation. Oral and genital ulcers were found on physical examination with no other lesions. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain showed lack of flow in the right transverse and sigmoid dural sinuses suggestive of venous thrombosis. On lumbar puncture, the opening pressure was greatly raised. After a comprehensive screening for prothrombotic conditions, a diagnosis of BD with ICH due to CVT was made. The patient was then treated by oral prednisolone, azathioprine, colchicine, cyclosporine, as well as anticoagulation, which resulted in significant clinical improvement.

Urrets-Zavalia syndrome after implantable Collamer lens placement.

We describe the case of a healthy 28-year-old woman who underwent implantation of a posterior chamber, phakic, toric, implantable Collamer lens (ICL) in both eyes for correction of bilateral high myopia with astigmatism. On the first postoperative day the patient developed increased intraocular pressure (IOP) and a fixed, mid-dilated pupil in her left eye. The elevated IOP was corrected within 3 days by medical treatment. However, the pupil remained mid-dilated and nonreactive to both light and accommodative effort during 2 months of follow-up; there was no reaction to pilocarpine (0.125% or 4%) eyedrops. The patient was diagnosed with Urrets-Zavalia syndrome (UZS), which has been reported in association with ICL implantation only once previously.