Varicella-zoster virus reactivation causing herpes zoster ophthalmicus (HZO) after SARS-CoV-2 vaccination - report of three cases.

PURPOSE: We are reporting 3 patients who presented acute zoster ophthalmicus (HZO), an activation of varicella-zoster virus, after mRNA anti-SARS-CoV-2 vaccination, seen directly or referred to our center. CASES: A 73-year-old woman with history of ocular sarcoidosis presented HZO in the right V1 dermatome 16 days after a single booster dose of vaccination (Pfizer BioNTech). A 69-year-old woman presented HZO in her V1 left dermatome, occurring 10 days after her first dose of Pfizer BioNTech vaccine. A 72-year-old woman with no history of autoimmune pathology, candidate for cataract surgery, presented 13 days after the first dose of a Moderna mRNA vaccine with an eruption in the left V1 dermatome. All patients presented the VZV infection after their first dose of a mRNA type of vaccine. Treatment with Valacyclovir 1000 mg × 3/ day for 7-14 days was efficient in all cases. CONCLUSION: Vaccines have been reported in the past to trigger different types of side effects such as viral or flu-like symptoms. It is only logical to note many different side effects for SARS-CoV-2 vaccines as the population vaccinated is exceeding any other number in history. VZV is one of the more severe side effects that can, however, be treated. It is quite obvious that, as far as mRNA vaccines are concerned, and probably also other anti-SARS-CoV-2 vaccines, that the benefit of vaccination certainly outweighs the possible but very low risk of ocular side effects that can mostly be treated.

Oxygen and glucose distribution after intracorneal lens implantation.

PURPOSE: Insertion of an implant in the cornea to achieve corneal multifocality has been suggested as a solution for presbyopia. However, unresolved issues related to nutrient transport need to be resolved. Our aim was to find the best lens position and influence lens transport properties in order to optimize nutrient supply to corneal cells. METHOD: An axisymmetric corneal model was built to simulate the nutrient transport in the cornea. Oxygen and glucose concentrations were calculated for normal cornea and intracorneal lens wearing conditions. The simulation considers the different tissue layers (epithelium, stroma, and endothelium) as well as layer and solute concentration dependent consumption. RESULTS: The minimum oxygen tension in the cornea was found to be higher when the lens was placed at 3/4 of the corneal thickness. Moreover, in this position, the influence of the inlay diffusivity was smaller than at more anterior or posterior placements. The diffusivity of the inlay affects the way nutrients will be transported through the cornea. The threshold where glucose may diffuse through or around the implant was found to be 1/100th of the stromal diffusivity. CONCLUSIONS: Computational methods are especially attractive to study nutrient transport in the cornea due to the difficulties associated with in vivo or in vitro measurements. The exact parameters that dictate the corneal metabolism are not known. However, the combined analysis of oxygen and glucose distribution is valuable in order to predict the complex physiological changes that arise under intracorneal lens implantation.

Management of corneal ectasia and cataract following photorefractive keratectomy.

A 42-year-old man was referred to our clinic 18 months after bilateral photorefractive keratectomy (PRK). He had been on topical prednisolone acetate for 12 months because of post-PRK grade 4 haze. On his first visit, visual acuity was limited to light perception in both eyes because of moderate haze, significant corneal ectasia, and a white cataract. A 2-step surgical approach was elected in both eyes. First, a deep anterior lamellar keratoplasty was performed. Six weeks later, phacoemulsification with intraocular lens implantation was performed. Compared with a triple procedure combining penetrating keratoplasty and cataract surgery in 1 stage, the 2-step approach may lower the risk for corneal graft rejection and reduce ametropia.

[Histopathological study of corneal lamella excised after complications of myopia treatment with LASIK]. / Etude histopathologique d'une lamelle de cornée excisée après complications de traitement de myopie par Lasik.

BACKGROUND: Several complications may occur after Lasik surgery, some of which can lead to corneal scarring and irreversible visual loss. We report such a case, with a clinicopathologic correlation. HISTORY AND SIGNS: A forty-seven-year-old patient with a - 6 D myopia had a Lasik performed with a 160 micron Moria microkeratome. This was complicated by the occurrence of a free cap which was sutured 3 times and of an epithelial ingrowth which was scraped. THERAPY AND OUTCOME: A superficial lamellar graft was performed 1S year later because of persistent photophobia and discomfort. Three weeks later the patient had a clear graft and was symptom free. Light microscopy showed an epithelial ingrowth, peripheral breaks and folds of Bowman's membrane, peripheral folds of superficial stroma with fibrosis and compensatory corneal epithelium acanthosis. There is keratolysis of the central stroma. By electron microscopy, the disrupted stroma showed activated fibroblasts, and the superficial epithelium is immature. Pathogenesis of these complications is discussed. CONCLUSIONS: The patient's clinical symptoms are to a certain extent explained by the histopathological findings. Epithelial ingrowth must be treated in time to avoid keratolysis.

Corticosteroid-induced central serous chorioretinopathy in patients with ocular inflammatory disorders.

BACKGROUND: Development of central serous chorioretinopathy (CSC) following the administration of corticosteroids by diverse routes is a well-known fact. We report acute visual loss after the use of systemic corticosteroids in three patients with long-standing ocular inflammatory disorders in whom CSC could initially be misinterpreted as a worsening of the primary inflammatory condition. METHODS: We analyzed the clinical findings and the fluorescein and indocyanine green (ICG) angiographic signs in those three patients. RESULTS: The first patient had birdshot chorioretinopathy with minimal functional impairment for several years without treatment. When visual acuity and fields deteriorated, systemic corticosteroids were administered resulting in improved inflammatory and functional parameters during the first 2 months. Subsequently, the visual acuity of his left eye decreased due to CSC. The second patient had Vogt-Koyanagi-Harada disease with five episodes of acute inflammation. She was treated each time with systemic corticosteroids, but thrice her visual acuity deteriorated, caused by CSC. The third patient presented with scleritis of his right eye related to relapsing polychondritis. Massive oral corticosteroids were given, soon followed by the development of CSC in the right eye. Fluorescein and ICG angiographic signs were typical for CSC in all three patients. Cyclosporine was introduced in the two first patients and cyclophosphamide in the third patient, in parallel with tapering of oral corticosteroids. Progressive regression of CSC occurred in all three patients. CONCLUSION: The potentially deleterious effects of corticosteroids, favoring CSC, are well-known. They should be borne in mind when an unexpected clinical and angiographic evolution compatible with CSC develops in an uveitis patient treated with corticosteroids.