Peripapillary Retinal Haemorrhages in Wernicke's Encephalopathy Following Bariatric Surgery in a Young Patient.

Wernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency (vitamin B1). It is characterised classically by a triad of ophthalmoplegia, confusion, and ataxia. WE is classically associated with alcoholism but increasingly has been observed due to other causes, particularly in undernourished post-bariatric surgery patients. Herein, we describe a case of WE following laparoscopic sleeve gastrectomy in a young male patient who presented with binocular horizontal diplopia and was found to have preretinal peripapillary haemorrhages. This case raises the awareness that posterior segment findings can occur in WE but have been under-reported previously.

Coexistence of Idiopathic Intracranial Hypertension with Unilateral Duane Retraction Syndrome Type 1 in an Adult Female.

Idiopathic intracranial hypertension (IIH) is a poorly understood condition, and its presentation can coexist with other diseases. Simultaneous IIH and Duane retraction syndrome (DRS) type 1 have never been reported to coexist in an adult patient. Herein, we report a 32-year-old obese female with a history of chronic renal failure who had a renal transplant rejection 6 years prior to presentation and was treated with oral steroids and immunosuppressive medications. She began to experience signs and symptoms of increased intracranial pressure (morning headache and binocular horizontal diplopia) and had limited abduction of one eye on examination. The case was later diagnosed as IIH with DRS type 1.

Heavy eye syndrome in a myopic patient with prior scleral buckle surgery for rhegmatogenous retinal detachment: Differential diagnosis and management.

PURPOSE: To present a challenging case of heavy eye syndrome (HES) in a 56-year-old female who previously underwent scleral buckle surgery in both eyes. OBSERVATIONS: Ophthalmic tests indicated a diagnosis of HES, confirmed using pre and postoperative magnetic resonance imaging (MRI). A silicone band loop myopexy was performed, successfully improving large angle esotropia at primary position and motility. CONCLUSIONS AND IMPORTANCE: MRI is essential to correctly identify HES, allowing a tailored surgical intervention that may lead to better outcomes for patients. Up to our knowledge, this is the first reported case of scleral fixated silicone band loop myopexy for HES in a previously scleral buckled patient.

Factors Affecting the Efficacy of Botulinum Toxin Injection in the Treatment of Infantile and Partially Accommodative Esotropia.

PURPOSE: We aimed to investigate the effect of botulinum toxin (BT) injection on the treatment of infantile and partially accommodative esotropia (PAET). METHODS: This retrospective cohort study included patients who received BT injections for infantile and PAET between January 2015 and December 2018. Treatment was considered successful if orthotropia, consecutive exotropia, or esotropia within 10 prism diopters (PD) was achieved. RESULTS: The overall success rate was 47.4%, with a mean follow-up period of 27.8 months in 403 children. BT treatment was considered successful in 37.1% of cases of infantile esotropia and 53.1% of cases of partially accommodative esotropia. The average deviation angle before starting treatment was 35.5 ± 13.9 PD. Side effects 1 week after BT injections included transient overcorrection (63.8%) and transient ptosis (41.7%). There were no significant differences in the success rates between the different doses of BT (P = 0.69). The angle of deviation at presentation was significantly associated with the success rate of BT injection (failed group, mean: 38.1 ± 15.3 PD vs. success group, mean: 32.6 ± 11.6 PD; P < 0.001). Other factors associated with higher success rates were overcorrection at 1 week and PAET, while multivariate logistic regression analysis showed that a smaller angle of deviation and overcorrection (1 week after injection) were associated with a higher success rate. CONCLUSION: A smaller angle of deviation and transient overcorrection were associated with a higher success rate, and no significant difference was observed in the success rates of different BT doses.

Retained Presumed Intraocular Cotton Fiber after Implantable Collemer Lens Implantation: A Case Report.

Retained intraocular foreign body is a known complication of ophthalmic surgery. The presence of intraocular cotton fibers after ophthalmic surgery is well-documented in different procedures including cataract and vitreoretinal surgeries. This report describes a case of retained cotton fiber after implantable collamer lens (ICL) implantation. This report describes a case of a 23-year-old female who was diagnosed with high myopia and mild astigmatism. The patient was selected to undergo ICL implantation in her right eye. The postoperative examination was done a few hours after the procedure, and a cotton fiber was incidentally found to be attached to the posterior surface of the ICL without causing visual disturbances or any other abnormal findings. This patient was followed up closely within the 2 postoperative weeks, and a 1-year follow-up did not reveal any change in the cotton fiber place or position, nor was there any other complication. In conclusion, cotton fibers are typically inert and usually do not lead to major complications. The decision of whether to surgically remove these fibers or not should only be made after weighing the benefits against the risks of such intervention. Recurrent inflammatory reactions or iridocyclitis related to the presence of cotton fibers could validate surgical intervention; however, the presence of cotton fibers solely does not necessitate early surgical removal.

Central Serous Chorioretinopathy Associated with Tadalafil.

We report a case of central serous chorioretinopathy (CSCR) associated with tadalafil, a phosphodiesterase 5 inhibitor medication. In this report, we describe a case of a 59-year-old male who presented with blurred vision in the right eye. On examination, he was noted to have serous macular, pigment epithelial detachments, and increased choroidal thickness. The diagnosis of CSCR was made, and the patient was asked to stop the offending agent. Three months after stopping tadalafil, the patient's visual symptoms and subretinal fluid resolved. In conclusion, prescribing physicians should be aware of tadalafil's ability to decrease vision and cause CSCR. The addition of CSCR to the list of tadalafil's side effects should also be considered.

Surgical outcomes of the Aurolab aqueous drainage implant (AADI) versus the Ahmed glaucoma valve for refractory paediatric glaucoma in Middle Eastern children.

OBJECTIVE: The Aurolab aqueous drainage implant (AADI) has the potential advantages of less encapsulation and greater cost-effectiveness than the Ahmed glaucoma valve (AGV). The aim of this study was to compare the surgical success and outcomes of the AADI compared to the AGV in Middle-Eastern children. METHODS: A comparative retrospective study of consecutive paediatric patients in a tertiary eye hospital was undertaken. Data collected included demographics, type of glaucoma, intraocular pressure (IOP), number of anti-glaucoma medications (AGMs) and any subsequent complications or further surgeries. ANALYSIS: The mean IOP, number of AGMs, surgical success and number of reoperations was compared for the two groups. Surgical success at each visit was defined as IOP of ≥6 mm Hg and ≤21 mm Hg or if the reduction of IOP was ≥20% reduced from baseline. RESULTS: A total of 126 tube surgeries (56 eyes in AADI and 70 eyes in AGV) were performed in patients aged ≤18 years from 2014 to 2019. No difference was observed in the mean IOP between the two groups except at the first month post-operative visit. After six months, the AADI group had a consistently significant lower mean number of AGMs. At last follow-up, 21 (37.5%) eyes in the AADI group were glaucoma medication-free vs 15 (21.4%) eyes in the AGV group (pp=0.047). Kaplan-Meier analysis showed equivalent cumulative probability of success at two years of 69.9% [(45.9%-84.9%)] for AADI vs 66.8% [(53.4%-77.1%])) for the AGV, respectively. Twenty-four eyes in the AGV group needed one or more subsequent surgeries, whereas 13 eyes needed one or more surgery in the AADI group. CONCLUSIONS: This study shows an acceptable safety profile for the AADI in children, with a rate of failure that is comparable to the AGV, but less need for glaucoma re-operation or glaucoma medication in the first post-postoperative year.

Olanzapine-Induced Acute Angle Closure.

BACKGROUND Drug-induced acute angle closure glaucoma is an uncommon ocular emergency that may follow the administration of certain topical and systemic medications. Acute angle closure can be triggered by various classes of drugs, including adrenergic agonists, anticholinergics, and serotonergic medications. Here, we report a rare case of drug-induced acute angle closure glaucoma secondary to olanzapine. CASE REPORT A 59-year-old male patient of Arabian Peninsula descent, known to have schizophrenia, presented to our Emergency Department with a 3-day history of right ocular pain and decrease in vision. He was started recently on olanzapine 5 mg once daily by his psychiatrist 1 week prior to the onset of his symptoms. The diagnosis of drug-induced pupillary block was made based on clinical and radiological findings. The patient was started on topical and systemic IOP-lowering agents. A therapeutic Nd: YAG laser peripheral iridotomy for the right eye was performed. On follow-up, his symptoms alleviated and clinical examination showed significant improvement. CONCLUSIONS The reported case highlights the importance of systemic medical history in secondary acute angle closure glaucoma. Physicians from other specialties should be aware of drugs triggering pupillary block and therefore be able to educate patients about symptoms of acute angle closure glaucoma.

Nasopharyngeal carcinoma (NPC) in the ophthalmic practice: A serious neoplasm presenting initially to ophthalmologists.

PURPOSE: Nasopharyngeal carcinoma (NPC) is an aggressive malignant tumor that arises from the nasopharyngeal epithelial lining. Most patients with NPC present with a neck mass or cranial nerve palsy. It is infrequent for patients with NPC to present to an ophthalmologist initially with ophthalmic complaints and absence of prior diagnosis of NPC. We are reporting a series of six NPC cases that presented solely with ophthalmic complaints, to attract the attention of ophthalmologist to such a serious neoplasm. METHODS: A retrospective observational study of all consecutive patients diagnosed with NPC based on their initial ophthalmic presentation with no prior diagnosis of this neoplasm. Patients presented for the first time to two tertiary eye hospitals. Data were collected by the chart review for demographics, clinical presentation, radiological imaging, treatment regimen, and follow-up. Histopathological review of their tissue specimens was conducted by two pathologists. RESULTS: We had six patients who presented for the first time to our ophthalmic service complaining mostly of limitation of extraocular muscle motility with or without diplopia (4/6), orbital or facial pain (2/6), and disturbance in vision (2/6). The age ranged from 35 to 92 years with a mean of 58 years. A male predominance was observed with male-to-female ratio of 5:1. The cases are described along with their imaging and histopathological findings. Relevant literature review was also presented. Most of our patients (5/6) received combination of radiotherapy and chemotherapy. One patient refused treatment and 2 eventually passed away after 7 months. CONCLUSION: Ophthalmologists may play a major role in diagnosing such patients accurately and referring them for early management and better prognosis.

Intraocular Lens Dislocation into the Anterior Chamber because of Repeated Eye-Poking in a Patient with Leber's Congenital Amaurosis.

The dislocation of a posterior chamber intraocular lens (PC IOL) because of constant eye rubbing is unusual and has never been reported in a child with Leber's congenital amaurosis (LCA). A 4-year-old full-term girl with an ocular history of LCA presented to the emergency room with a single-piece PC IOL dislocated into the anterior chamber (AC) of the left eye. There was no history of trauma or any other surgical intervention. A specific behavior known as Franceschetti's oculo-digital sign is a characteristic feature of LCA; this sign consists of repeated pressing, poking, and rubbing of the eyes with knuckles and fingers to stimulate the photoreceptors. This behavior caused the dislocation of the PC IOL into the AC. The dislocated IOL was explanted, and the patient was provided with aphakic glasses.

Traumatic subhyaloid macular hemorrhage with complete resolution following Neodymium-Doped Yttrium Aluminium Garnet Laser.

PURPOSE: To report a case of traumatic subhyaloid macular hemorrhage with severe sudden vision loss treated successfully with Neodymium-Doped Yttrium Aluminium Garnet Laser (Nd:YAG laser). OBSERVATIONS: A 16-year-old boy presented to the eye clinic with acute vision loss secondary to blunt trauma by a stone to his left eye 3 days prior to consultation that caused subhyaloid macular hemorrhage. Nd:YAG laser was performed to open the hyaloid membrane and allow the blood to diffuse into the vitreous cavity and be absorbed. The patient demonstrated complete recovery as his visual acuity went from counting fingers to 20/20 within 20 days. No complications due to the treatment were reported. CONCLUSIONS AND IMPORTANCE: To the best of our knowledge, there have been no reported cases of subhyaloid macular hemorrhage treated with Nd:YAG laser in which the etiology was trauma and showed full, rapid recovery with no sequelae.