Bilateral multifocal central serous retinopathy following mRNA COVID-19 vaccine.

We present a case of acute bilateral multifocal CSCR in a young healthy Caucasian female occurring 3 days after receiving the first dose of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. The true incidence of this adverse reaction might be underreported in asymptomatic unilateral or paracentral cases. We believe that the post-COVID-19 vaccination occurrence of CSCR is not a sufficient reason to withhold the second dose of the vaccine. Further studies are required to ascertain the best way to prevent and manage this complication.

Combining spectral domain optical coherence tomography of retinal nerve fiber layer and noncontact tonometry in mass glaucoma screening during the World Glaucoma Week.

PURPOSE: This study reports the combination of noncontact tonometry and spectral domain optical coherence tomography (SD-OCT) in mass glaucoma screening in the Lebanese population. METHODS: This cross-sectional study included Lebanese individuals who participated in a glaucoma screening campaign in March 2018 and March 2019 for World Glaucoma Week. Intraocular pressure (IOP) was measured by noncontact tonometry. Optic nerve head (ONH) and retinal nerve fiber layer (RNFL) scans were obtained using SD-OCT. Glaucoma suspects were defined as individuals having an IOP above 21mmHg in at least one eye and/or RNFL thinning in either the superior or the inferior quadrant. RESULTS: Among the 1116 individuals who were examined, 15.5% were found to be glaucoma suspects based upon their IOP readings, 15.5% based on OCT, and 3.0% based on both criteria combined. The mean vertical and horizontal disc diameter was 1.75±0.23mm and 1.57±0.22mm, respectively. Eyes that were suspects by OCT with normal IOP had thinner corneas when compared to eyes with normal OCT and high IOP (512.25µm vs. 559.12µm, P<0.0001). CONCLUSION: SD-OCT can be an easy and relatively fast component of mass glaucoma screening in addition to IOP measurement. Further studies are needed to establish this combination as a valid glaucoma screening method.

High intensity focused ultrasound cyclodestruction versus cyclodiode treatment of refractory glaucoma: A retrospective comparative study.

PURPOSE: To compare the efficacy of two cyclodestructive treatments for refractory glaucoma: High Intensity Focused Ultrasound (HIFU) cyclocoagulation and transscleral diode laser cyclophotocoagulation (cyclodiode). METHODS: A retrospective comparative single centre study including all patients who underwent cyclodestruction for refractory glaucoma by either HIFU cyclocoagulation or cyclodiode. "Refractory glaucoma" was defined as an uncontrolled high IOP despite medical treatment and at least one filtering surgery. Uncontrolled high IOP was defined as an IOP≥16mm Hg. The diagnosis of glaucoma was confirmed by automated visual field (VF) testing and peripapillary RNFL scans using a time-domain ocular coherence tomography device. Treatment success was defined as: postoperative IOP between 5mm Hg and 21mm Hg and IOP reduction greater than or equal to 20% as compared to preoperative values. RESULTS: Among the 99 eyes of 86 patients included in this study, 29 eyes were treated by cyclodiode and 70 eyes by HIFU. Median follow-up was 3 months (IQR 3-6) for the cyclodiode group and 6 months (IQR 3-8) for the HIFU group. Average preoperative intraocular pressure (IOP) was 34.3±11.1mm Hg (cyclodiode group) and 23±6.8mm Hg (HIFU group). The treatment success rate at last follow-up was 52% [34-70] for the cyclodiode group and 25% [15-35] for the HIFU group (P value=0.01). Kaplan-Meier survival analysis showed that the mean estimated time to failure was 5.9 months (4.4-7.5) for the cyclodiode group and 3.7 months (2.8-4.7) for the HIFU group (log-Rank test, P=0.02). A 2-line visual acuity loss was observed for 31% of the patients treated by cyclodiode and 17% for those treated by HIFU. In the cyclodiode group 4 cases of hypotony were reported vs. none in the HIFU group. CONCLUSIONS: The success rate was significantly higher for cyclodiode treatment as compared to HIFU cyclodestruction when treating refractory glaucoma. However, significantly fewer complications were observed with HIFU cyclocoagulation as compared to cyclodiode.

High intensity focused ultrasound as first line treatment in patients with chronic angle closure glaucoma at risk for malignant glaucoma.

PURPOSE: Evaluation of high intensity focused ultrasound (HIFU) transscleral cyclocoagulation as an alternative to trabeculectomy in the treatment of refractory chronic angle closure glaucoma (CACG). METHODS: This prospective one armed single center pilot study was conducted on patients with medically uncontrolled CACG who underwent high intensity focused ultrasound (HIFU) cyclocoagulation as first line surgical treatment, using the Eye-OP1 HIFU device (Eyetechcare-Rillieux-la-Pape, France) driven by ultrasound biomicroscopic (UBM) ciliary body localization. All patients had documented progression of their glaucoma despite conventional medical and laser therapy. The primary efficacy outcome was intraocular pressure (IOP) reduction; secondary outcomes included changes in number of glaucoma medications and complications after cyclocoagulation. RESULTS: The study involved 8 eyes of 7 patients between May 2013 and September 2014. The average follow-up was 5.6±2.1 months. The mean IOP was reduced from 18.4±3.5mmHg preoperatively to 14.8±4.1mmHg 6 months postoperatively. The average number of glaucoma medications decreased from 3.4±1.1 at baseline to 3.3±0.7 after 6 months. Visual acuity remained stable (median 0.17 log MAR preoperatively and 0.19 log MAR at last follow-up visit). No significant side effect occurred during the 6 months follow-up period. CONCLUSIONS: HIFU cyclocoagulation appears to be a safe and reliable alternative to filtering surgery in the management of chronic angle closure glaucoma among patients with a high risk of malignant glaucoma.

Vitreoretinal surgery for shotgun eye injuries: outcomes and complications.

PURPOSE: To analyse the postoperative anatomic and functional outcomes in addition to complications after vitreoretinal surgery for patients with shotgun eye injuries related to hunting accidents. MATERIALS: Retrospective review of the clinical records of all cases of shotgun eye injuries presented between January 2000 and January 2011 and with a minimum follow-up of 1 year. Collection of demographics, type of injury, choice of management, complications and final surgical success with final visual acuity is reported. RESULTS: Twenty eyes of 19 patients (all male) with a mean age of 36.1 years (range 16-60 years) were included in the study. Mean postoperative follow-up was 47.5 months (range 15-118 months). Best corrected visual acuity (BCVA) at presentation ranged from perception of light to 20/200. Ten eyes had a penetrating injury and 10 others had a perforating injury. All the eyes underwent an initial vitrectomy and the intraocular pellet was removed in all the 10 penetrating injuries. Concurrent cataract surgery was performed in 12 cases, internal tamponade was used in 15 cases and a supplemental encircling scleral buckle was inserted in 12 cases. One additional vitreoretinal surgery was required in seven cases (35%) and two additional surgeries required in two other cases (10%). At last follow-up BCVA ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients had a flat retina except for two cases (10%) that developed severe proliferative vitreoretinopathy. CONCLUSION: These results suggest that vitreoretinal surgery can offer good visual rehabilitation in patients with shotgun eye injuries.

Traumatic flap dislocation 10 years after LASIK. Case report and literature review.

We report a case of traumatic partial flap dislocation 10 years after uneventful laser in situ keratomileusis (LASIK). The patient was treated bilaterally for hyperopia and astigmatism with LASIK. A superior-hinged corneal flap was created using the Moria M2 microkeratome (Moria SA, Antony, France) and the surgery was uneventful. Ten years later, partial flap dislocation was diagnosed after mild trauma. This case suggests that flap dislocations can occur during recreational activities up to 10 years after surgery. Full visual recovery is achievable if the case is managed promptly. Further studies should evaluate the potential protective role of an inferior hinge during LASIK.

Molecular Study of Three Lebanese and Syrian Patients with Waardenburg Syndrome and Report of Novel Mutations in the EDNRB and MITF Genes.

Waardenburg syndrome (WS) is a genetic disorder characterized primarily by depigmentation of the skin and hair, heterochromia of the irides, sensorineural deafness, and sometimes by dystopia canthorum, and Hirschsprung disease. WS presents a large clinical and genetic heterogeneity. Four different types have been individualized and linked to 5 different genes. We report 2 cases of WS type II and 1 case of WS type IV from Lebanon and Syria. The genetic studies revealed 2 novel mutations in the MITF gene of the WS type II cases and 1 novel homozygous mutation in the EDNRB gene of the WS type IV case. This is the first molecular study of patients from the Arab world. Additional cases will enable a more detailed description of the clinical spectrum of Waardenburg syndrome in this region.