AS-OCT of cyclitic membrane pre and post treatment with rtPA in the anterior chamber.

We present the case of a 40-year-old male, who presented to the ophthalmology emergency department with pain and visual loss in his left eye 10 days after an intravitreal injection of a split medication. At the exploration, we found an intense corneal edema in the left eye with endothelial dusting and ciliary hyperemia. LE fundus was impracticable due to anterior chamber opacity. Because of the corneal edema, we performed an anterior segment optical coherence tomography (AS- OCT), visualizing a cyclitic membrane with pupillary block and inflammatory cells in the anterior chamber. There are different treatments to lyse the cyclitic membrane; in this case, we managed the cyclitic membrane with 0,05 ml of intracameral recombinant tissue plasminogen activator (rtPA), a highly potent fibrinolytic protein. We disinfected the eyelids and the conjunctival sac with Povidone Iodine solution, applied topical anesthesia with double anesthetic, and injected 0,05 mL rtPA solution into the anterior chamber using an insulin syringe with a 30-gauge needle. Intracameral rtPA was prepared under sterile conditions using 50 mg vials of rtPA diluted with 50 mL of sterile water to create a 1 mg/ mL solution. Four hours after rtPA treatment, the cyclitic membrane lysed, obtaining pupillary mydriasis. The AS OCT before and after the treatment with intracameral rtPA was of high utility as it allowed the visualization of the cyclitic membrane and its removal.

Anterior uveitis and vasculitis in primary infection with VZV in a diabetic patient.

We present a case of ocular involvement in the context of a varicella zoster virus primary infection, in a 30-year-old man with type 1 diabetes. The ophthalmological examination revealed unilateral anterior uveitis resistant to topical treatment, which was complicated by association of vitritis and onset of retinal vasculitis diagnosed by angiography fluorescein. Herpetic eye involvement was confirmed by anterior chamber PCR for varicella- zoster virus. In addition, we started the treatment with oral valacyclovir 1 gram every 8 hours and 15 mg oral corticosteroid with very satisfactory results, without observing any side effects. Very few cases have been published on this topic, given the low prevalence of this ocular complication.