Cystoid Macular Edema 18 Years after Anterior Chamber Phakic Intraocular Lens Implantation.

We report a case of a 54-year-old female patient who underwent PAC-IOL implantation 18 years prior to presentation. The patient had a best corrected visual acuity (BCVA) 20/20 in the right eye (OD) postoperatively with normal eye exam on routine follow-up since then. The patient presented for acute onset decreased visual acuity in the right eye. BCVA was 20/60, and exam showed blunted macular reflex with no evidence of inflammation. Optical coherence tomography (OCT) showed CME. She was started on topical treatment (ketorolac 0.5%) OD four times daily. Three weeks later, the patient had a BCVA of 20/20 OD with a normal macular reflex and an OCT showing the resolution of the CME. To our knowledge, this is the first reported case of a CME 18 years post PAC-IOL implantation. The possible cause of this incidence could be related to subclinical intraocular inflammation. Ophthalmologists should be aware of the possibility of such a latent CME post-PAC-IOL implantation.

Hydrophilic Lens Opacification after Intravitreal Anti-VEGF Injections: A Case Series.

Our objective in this retrospective case series was to report 4 cases of hydrophilic intraocular lens (IOL) opacifications after repeated intravitreal bevacizumab injections. This is a retrospective analysis of all the cases of IOL opacifications presenting to a tertiary referral ophthalmic center in Beirut between January 2013 and January 2019. Four cases were included in the study, of which one was treated for vitreal hemorrhage, the other for macular edema secondary to wet age-related macular edema, and the rest for macular edema secondary to diabetic retinopathy. The mean age of the patients was 71 years with a male predominance and a mean of 5 injections. The IOL opacifications appeared approximately 24 months after first bevacizumab injection. The opacification could be explained by multiple theories such as a possible anterior or posterior segment subclinical inflammation secondary to intraocular interventions, interaction between the hydrophilic properties of the IOLs and anti-vascular endothelial growth factor injection's content, impurities transmission during injection, or faulty IOL manufacturing.

Corneal Haze Secondary to Corneal Collagen Cross-linking in Keratoconus Patients: Treatment and Outcomes.

PURPOSE: The purpose of this study was to evaluate the outcome of patients presenting with mild-to-moderate corneal haze after undergoing corneal collagen cross-linking (CXL) for keratoconus (KCN) and their response to a proposed standardized topical steroid-based treatment. METHODS: This study included 19 eyes of 14 patients presenting with corneal haze after undergoing CXL for KCN. Corrected distance visual acuity, corneal thickness and Kmax values by Pentacam® Scheimpflug tomography, as well as subjective corneal haze changes were evaluated before and after a topical steroid- and cyclosporine-based treatment. RESULTS: Visual acuity improved after the completion of the treatment by 0.043 logMAR (P = 0.017) and Kmax values decreased by 1.17D (P = 0.0024), while the corneal thinnest pachymetry remained stable. Data collected from the examiner's slit-lamp examination description revealed that seven eyes had a decrease in haze compared to 12 eyes with stable or no changes in the haze. CONCLUSION: Our findings suggest an improvement in visual acuity and possible corneal flattening with decreasing Kmax after the completion of topical steroids with taper course treatment in patients suffering from corneal haze post-CXL. This paper also highlights the importance of postcross-linking anti-inflammatory treatment and close follow-up.

Asymptomatic haptic migration of phakic anterior chamber intraocular lens through the peripheral iridectomy.

OBJECTIVE: Case series of haptic migration in patients with angle-supported phakic anterior chamber intraocular lens (PAC-IOL: Phakic6H) through the superior peripheral iridectomy (PI). METHODS: Charts of 23 patients (35 eyes) with at least 6 months' postoperative follow-up were retrospectively reviewed. Evaluation included preoperative and postoperative cycloplegic and manifest refractions, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp examination, fundoscopy, corneal topography, and biometry. RESULTS: Mean UCVA was 1.67 ± 0.30 (1.17-2.00) for all 35 eyes preoperatively and 0.35 ± 0.25 (0.00-1.00) postoperatively (p < 0.001; 95% CI 1.21-1.44). BCVA had a mean of 0.31 ± 0.26 for all 35 eyes preoperatively, and a mean of 0.22 ± 0.25 postoperatively (p < 0.001; 95% CI 0.04-0.14). Haptic migration into the superior PI was noted in 8 eyes (23%). The first migration was noted 2 years postoperatively and the last 8 years after implantation (mean, 5.6 ± 2 years). There was no statistically significant difference in the BCVA and UCVA before and after haptic migration. Follow-up ranged from 8 months to 8.5 years. CONCLUSIONS: Angle-supported PAC-IOL implantation resulted in significant improvement in both UCVA and BCVA. However, there is a 23% incidence of haptic migration in our series with no sequelae on BCVA or harmful effect on the intraocular structures. This IOL movement may be explained by changes in aqueous dynamics at the level of the PI leading to migration of the haptic into the area of least resistance.

A Patient with Keratoconus, Nanophthalmos, Lipodermoids, and Pigmentary Retinopathy.

A 44-year-old male with no pertinent history other than poor vision for more than 25 years was examined. Best corrected visual acuity was 20/80 OD [MR: +14.25 +1.00 × 15°] and 20/200 OS [MR: +15.00 +1.50 × 175°]. Significant limitation in ocular movements and the presence of an orbital lipodermoid in the infero-temporal aspect of each eye were noted. Forced duction test was positive for the same directions of limitation indicating possible extraocular muscle fibrosis. Ophthalmoscopy was remarkable for the presence of peripheral bony spicules. Corneal topography was compatible with keratoconus (Kmax = 55.04D OD and 52.87D OS). A-scan revealed axial lengths of 16.96 mm OD and 16.32 mm OS, compatible with a diagnosis of nanophthalmos. OCT revealed diffuse macular thickening for both eyes with foveal thickness of 350 µm OD and 353 µm OS. Over the next 12 years the patient had stable visual acuity, manifest refractions and anterior segment examination. Ophthalmoscopy revealed only minimal progression of pigmentary changes. We report the first case of these simultaneous multiple findings which may refer to a possible syndromic association of congenital or early childhood onset.

Complete Visual Rehabilitation in a Patient with No Light Perception after Surgical Management of a Penetrating Open-Globe Injury: A Case Report.

Open-globe injuries with no light perception (NLP) carry a poor prognosis, and many ophthalmologists select a primary enucleation or evisceration as a result. We present a case of complete visual rehabilitation in a patient who presented with NLP after a zone III penetrating open-globe injury. We recommend patient counseling regarding decision making and management of ocular trauma with NLP, since timely intervention and close follow-ups may restore useful or complete vision even in severely traumatized eyes.