Postsurgical Cystoid Macular Edema following Posterior Chamber Toric Phakic Intraocular Lens Implantation Surgery: A Case Report.

PURPOSE: To describe a case of cystoid macular edema (CME) developing after posterior chamber toric phakic intraocular lens (PIOL) implantation. METHODS: Case report. RESULTS: A 33-year-old male underwent implantation of toric implantable collamer lenses (ICL), a new generation of PIOLs, for both eyes. Preoperative best spectacle-corrected distance visual acuity (BCVA) was 20/25 in the right eye and 20/32 in the left eye, with a manifest refraction of -9.25 -4.0 × 4° and -9.75 -4.25 × 171°, respectively. On day 1 postoperatively, the left eye had an uncorrected distance visual acuity (UDVA) of 20/60 with a refraction of +2.0 -3.5 × 11°. Despite the rotation of the PIOL, the cylindrical refractive component persisted in the left eye with a refraction of +2.0 -3.5 × 11°. Two weeks after the initial surgery, he presented with a decrease in his visual acuity in the left eye. The UDVA and BCVA were both 20/100 in the left eye with a refraction of +2.0 -4.25 × 3°. Dilated fundus examination and macular optical coherence tomography revealed a CME in the left eye. Following topical nepafenac therapy and explantation of the ICL, we observed a complete resolution of the CME at 3 months with an improvement in BCVA to 20/32 in the left eye. CONCLUSIONS: To our knowledge, this is the first reported case of postsurgical CME following toric ICL implantation. In cases of phakic eyes with an intact posterior capsule, postsurgical CME can develop, thus highlighting the purpose of this report.

Analysis of age as a possible prognostic factor for transcanalicular multidiode laser dacryocystorhinostomy.

Purpose. To assess the prognostic value of age on the outcome of transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in patients with acquired nasolacrimal duct obstruction (NLDO). Methods. The medical records of TCL-DCR performed between March 2009 and September 2013 were reviewed retrospectively. Inclusion criteria include over 20 years of age, similar mean follow-up period, and similar mean duration of stenting. The main outcome is surgical success. The effect of age on success rate is also evaluated. Results. The anatomical success was 52% in Group 1 (20-30 years), 56% in Group 2 (31-40 years), 64% in Group 3 (41-50 years), 76% in Group 4 (51-60 years), and 88% in Group 5 (over 60 years). The statistical difference among Group 1 and Group 5, in terms of surgical success rate, was found to be significant (P = 0.009). Additionally, the 20-30-year-old patients had a failure rate 6.76 times higher than that of the over-60-year-old patients (P = 0.009; 95% CI, 1.605-28.542). Conclusion. TCL-DCR is a surgical treatment option for NLDO for which a skin incision can be avoided. The success rate of TCL-DCR for younger population is lower when compared with elderly population.

Peripapillary retinal nerve fiber layer changes in asymptomatic essential thrombocythemia patients.

PURPOSE: To investigate peripapillary retinal nerve fiber layer (RNFL) changes using optical coherence tomography (OCT) in patients with asymptomatic essential thrombocythemia (ET). MATERIALS AND METHODS: A consecutive case-control series of 30 patients with asymptomatic ET and age-similar, gender, refractive error, race-matched controls underwent a comprehensive eye examination and OCT of the peripapillary RNFL. Subjects with glaucoma, diabetes mellitus, hemoglobinopaties or other ocular diseases and those who underwent any retinal treatment were excluded. Inferior, superior, nasal and temporal peripapillary RNFL thicknesses were analyzed. One randomly selected eye per subject was compared with those of healthy ones. RESULTS: In the ET patients, the peripapillary RNFL thickness was particularly thin at the temporal quadrant (61.38 ± 9.82 µm, mean ± SD), and the difference was statistically significant (p = 0.036) when compared with the control group (71.24 ± 10.28 µm). The average RNFL thickness was 88.73 ± 12.26 µm in the ET patients and 96.91 ± 13.66 µm in the control group. Although the difference was not statistically significant (p = 0.226), the average RNFL was 8.44% thinner in ET patients than in healthy subjects. CONCLUSIONS: Asymptomatic ET patients may have peripapillary RNFL thinning as a result of their systemic illness. This study is the first to demonstrate peripapillary RFNL changes in asymptomatic ET patients.

Management of diplopia in patients with blowout fractures.

PURPOSE: To report the management outcomes of diplopia in patients with blowout fracture. MATERIALS AND METHODS: Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. The inferior wall alone was involved in 22 (56.4%) patients, medial wall alone was involved in 14 (35.8%) patients, and the medial and inferior walls were involved in three (7.6%) patients. Each fracture was reconstructed with a Medpore® implant. Strabismus surgery or prism correction was performed in required patients for the management of persistent diplopia. Mean postoperative follow up was 6.5 months. RESULTS: Twenty-three (58.9%) patients with diplopia underwent surgical repair of blowout fracture. Diplopia was eliminated in 17 (73.9%) patients following orbital wall surgery. Of the 23 patients, three (7.6%) patients required prism glasses and another three (7.6%) patients required strabismus surgery for persistent diplopia. In four (10.2%) patients, strabismus surgery was performed without fracture repair. Twelve patients (30.7%) with negative forced duction test results were followed up without surgery. CONCLUSIONS: In our study, diplopia resolved in 30.7% of patients without surgery and 69.2% of patients with diplopia required surgical intervention. Primary gaze diplopia was eliminated in 73.9% of patients through orbital wall repair. The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery.