Unilateral Macular Choroidal Neovascularization; a Rare Manifestation in Chronic Myelogenous Leukemia.

PURPOSE: To report a case of chronic myelogenous leukemia (CML) treatment with imatinib mesylate in the remission phase who developed unilateral macular choroidal neovascularization (CNV). METHODS: A 45-year-old male marketer with a 5-year history of CML treated with imatinib mesylate presented with 2 months history of progressive vision loss and metamorphopsia in the right eye. RESULTS: Fundus examination of the right eye revealed grey-white elevated retinal lesion with indistinct borders in the macula and retinal telangiectasia in the temporal macula. Fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) confirmed the presence of CNV in the right eye. After treatment with anti-vascular endothelial growth factor (anti-VEGF), macular CNV regressed significantly. CONCLUSION: Macular CNV must be kept in mind as a rare ophthalmic manifestation of patients with CML under treatment with imatinib even in the remission phase.

Short prism adaptation test in patients with acquired nonaccommodative esotropia; clinical findings and surgical outcome.

PURPOSE: To evaluate the surgical outcomes in patients with acquired nonaccommodative esotropia operated on based on a short prism adaptation test (PAT) and to determine the subgroup of patients most responsive to PAT. METHODS: In this prospective interventional cases series, patients with acquired nonaccommodative esotropia were enrolled. Patients wore Fresnel trial lenses based on the results of alternate prism-cover testing. With the Fresnel prism in place, alignment was measured after 20 minutes. If deviation increased, the power of prism was increased to neutralize this angle. The test was repeated every 20 minutes to achieve motor stability. Patients were classified as either prism responders (if the angle of deviation increased >10Δ compared to the entry angle) or prism nonresponders. All patients underwent bilateral medial rectus muscle recession. Prism responders underwent surgical correction based on the enhanced angle. RESULTS: Of the 28 subjects enrolled, 14 (50%) were prism responders and 14 (50%) were classified as prism nonresponders. After 6 months, 100% of prism responders and 92.9% of nonresponders were aligned within 8Δ of orthotropia at distance and near fixation. None of the patients with an entry angle of >30Δ were prism responders. CONCLUSIONS: In our study cohort, a short PAT with an endpoint of motor stability in patients with acquired nonaccommodative esotropia was associated with a good surgical outcome and a low rate of over- and undercorrection. PAT may be unnecessary for patients with an angle of deviation of >30Δ.

Consequences of inadvertent intravitreal Mitomycin C injection.

BACKGROUND: Mitomycin C (MMC) as an alkylating agent is miscellaneous an antineoplastic, antibiotic and ophthalmic agent. Here we aim to report a case of inadvertent intravitreal MMC injection instead of Avastin in case of diabetic macular edema. CASE PRESENTATION: A 53 years old woman was planned to receive intravitreal Avastin injection, but accidentally, 0.05 ml of MMC 0.2% was injected. Best corrected visual acuity (BCVA) was 20/160 before injection. After 2 days, patient was referred to a tertiary referral eye center. BCVA was hand motion at presentation. Intraocular pressure was 4 mmHg. In slit lamp exams, conjunctival injection, corneal edema, Descemet fold, anterior chamber and anterior vitreous cells were presented. Pars plana vitrectomy with peripheral vitreous shaving and silicone oil tamponade was performed. Electroretinography showed undetectable responses. Ultrasound biomicroscopy showed ciliary body shortening and detachment. Optical coherent tomography showed diffuse retinal edema the day after surgery, subretinal fluid pockets in 2 weeks, and atrophy with undetectable and intertwined layers 2 months later. Gradually, like the retina, iris became atrophic and pigments were dispersed diffusely over the lens and endothelium. CONCLUSION: MMC is showed to be severely toxic to intraocular tissues. In our case, iris and ciliary body became atrophic. Ciliary body detachment induced hypotony. Moreover, MMC induces retinal necrosis and atrophy. Visual outcome is profoundly poor.

Anterior and posterior corneal curvature: normal values in healthy Iranian population obtained with the Orbscan II.

The objective of study was to determine the normative values of anterior and posterior best fit sphere (A-BFS and P-BFS) measured with Orbscan II Topography System. In this cross-sectional study, patients (age range: 18-40 years) referred to the Khatam Eye Hospital (Mashhad, Iran) were put in an observational cross-sectional study. The A-BFS and P-BFS were measured with the Orbscan II. The differences between genders, between right and left eyes, and age-related changes were evaluated. A total of 977 healthy participants consisted of 614 female and 363 male subjects aged 18-35 years participated. The average A-BFS in our study population was recorded as 43.060 ± 1.541 D (median: 43.00 D, mode: 43.10 D, range: 38.80-55.80 D). The average P-BFS in our study population was recorded as 52.702 ± 2.190 D (median: 52.60 D, mode: 53.10 D range: 46.9-62.20 D). The A-BFS and P-BFS were respectively 42.753 ± 1.629 and 52.327 ± 2.376 D in males and 43.242 ± 1.457 and 52.924 ± 2.041 D in females, which were statistically different between the genders (P < 0.001). However, A-BFS and P-BFS were not statistically different between right and left eyes (P = 0.649 and P = 0.688 respectively). In addition, A-BFS and P-BFS were not correlated with the age (r = 0.038, P = 0.096 and r = -0.142, P = 0.178 respectively). Considering 95 % confidence interval, A-BFS less than 43.13 D and greater than 42.99 D and P-BFS less than 52.80 D and greater than 52.60 D would be considered abnormal. Detailed description and analysis of A-BFS and P-BFS with Orbscan demonstrated that the obtained average value of BFS were higher in male than female and did not change with increasing age.