Acuity In Eye Research Articles

CHEMICAL OCULAR INJURY BY POTASSIUM PERMANGANATE

Abstract Introduction & Objectives : Chemical ocular injury is an emergency case and commonly occured among children. Alkaline chemical ocular injury is more destructive especially due to saponification. One of the rare chemical ocular injury is alkaline trauma by Potassium Permanganate (KMNO4) Methods : A case of a three-year-old boy patient brought by his mother in emergency department at Cicendo Eye Hospital with severe pain, redness, and swelling of the left eye. Ten hours earlier, the patient was playing and accidentally exposed to KMNO4. Visual acuity of the right eye was 6/6 and the left eye was difficult to examine. Ophthalmological examination revealed superior and inferior palpebra are swelling, KMNO4 adhered tightly on conjunctival tarsal superior, inferior, and conjunctival bulbi inferior until fornix and temporal area. Cornea was hazed and iris shadow test positive so he was diagnosed with Chemical Trauma Ropper Hall grade II OS. Treatment begins with irrigation 2 litres of normal saline until pH 7 along with debridement of KMNO4 from conjunctival tarsal superior inferior and bulbi. The patient underwent installation of transplanted amniotic membrane and debridement under anasthesia Results : Management in the initial phase is irrigation. The definitive therapy requires surgery to speed up the healing process. Complications that often occur are corneal limbal cell deficiency, dry eye, symblepharon formation, secondary glaucoma, and complicated cataracts Conclusion : Alkali chemical injury is hazardous and can lead to severe vision threatening complications because of saponification. Prompt and aggressive management is required in such cases to give them the best chance of a more favourable outcome

Impact of posterior vitreous detachment on visual acuity after the implantation of a diffractive multifocal intraocular lens

Purpose: To investigate the effect of posterior vitreous detachment (PVD) on visual acuity (VA) after implantation of a diffractive multifocal intraocular lens (mIOL). Setting: Eye Clinic, Okayama, Japan. Design: Retrospective case series. Methods: This study evaluated 475 eyes of 475 patients who underwent cataract surgery with a TECNIS Multifocal ZLB00 lens implant between November 2017 and October 2019. Patient eyes were classified into the complete PVD group (PVD group) or the control group with no PVD/partial PVD (non-PVD group) and divided into 3 age categories: 65 to 69, 70 to 74, and 75 to 79 years. The postoperative VA of the PVD and non-PVD groups was compared between and within groups by age. Results: Distance-corrected near VA (DCNVA) was significantly worse in the PVD group than in the non-PVD group in all age categories (P ≤ .029). In the PVD group, both corrected distance VA (CDVA) and DCNVA were significantly worse in the 75 to 79 years age group than in the 65 to 69 and 70 to 74 years age groups (P ≤ .034). CDVA and DCNVA in the non-PVD group did not differ significantly between age categories. Conclusions: The results of this study suggest that complete PVD worsens near VA in eyes with a diffractive mIOL. Furthermore, eyes with complete PVD may show an age-related decline in both CDVA and DCNVA. In particular, eyes ≥75 years of age with complete PVD have a poor visual prognosis and should be given careful consideration when deciding whether to implant a diffractive mIOL.

Flap Striae: Managing and Understanding Post-LASIK Complication

Introduction: Flap striae is the most common postoperative complication, with a frequency ranging from 0.033% to 3.5%, according to studies involving over 1000 ocular cases. There is only one case in our hospital in 2023. In this case report, we will present a case of flap striae in a tertiary hospital because our findings are unusual and essential in symptomatic therapy and visual rehabilitation. Case Presentation: A 19-year-old female came with a chief complaint of impaired vision in her left eye for the past two weeks, followed by inability to focus, discomfort of the eye, a sensation of foreign body, and glare that occurred three days after she underwent bilateral myopia laser in situ keratomileusis (LASIK) surgery. A post-LASIK assessment found that both eyes had visual acuity 10/10, and the left eye's visual acuity dropped to 6/10. Slit lamp examination revealed flap striae were running from the superonasal to the inferolateral quadrant. The thickness disparities were measured using optical coherence tomography (OCT), ranging from 653 to 689 μm. The OCT pictures revealed a gap on the temporal side as well. This patient was diagnosed with flap striae and a flap repositioning procedure was performed. Conclusions: A flap repositioning surgery was performed to increase visual acuity and eliminate striae.

Delayed manifestation of a full-thickness traumatic macular hole: Probable causes and consequences – A case report

A 23-year-old male experienced a cricket ball injury to his right eye 1 day ago. Right eye visual acuity was counting fingers close to face. He presented with anterior uveitis, commotio retinae, and vitreous hemorrhage. Steroids and cycloplegics were given. Fundus showed resolved vitreous hemorrhage, a healthy optic disc, patchy epiretinal membrane, choroidal ruptures, peripapillary scarring, and 20/80 vision on follow-up. Patient developed a full-thickness macular hole 11 months after trauma, decreasing vision to 20/120. Exam and optical coherence tomography showed no abnormal posterior vitreous detachment. Macular hole surgery closed the hole with a normal foveal contour without improving vision. At the last follow-up 6 months after surgery, the hole was closed and vision improved to 20/120. A delayed traumatic macular hole unrelated to vitreomacular traction or cystoid macular edema deroofing has not been reported in literature. Traumatic macular hole development may be delayed by secondary epiretinal membrane contraction, ocular movements, or expansion of choroidal rupture.

Orbital compartment syndrome after pterional craniotomy for arachnoid cyst resection

Abstract Orbital Compartment Syndrome (OCS) represents a critical medical emergency characterized by heightened orbital pressure, jeopardizing blood flow and posing a risk to the optic nerve. Often stemming from surgical procedures such as craniotomies for arachnoid cyst resection, OCS necessitates swift diagnosis and intervention. We report the case of a 77-year-old female in São Paulo, Brazil, who underwent left pterional craniotomy for arachnoid cyst resection. Postoperatively, she manifested reduced visual acuity in the left eye, restricted ocular movement, and peripalpebral hematoma indicative of orbital compression syndrome. Computed tomography scans confirmed pneumocephalus and pneumo-orbital complications, prompting an immediate diagnosis of OCS. Immediate interventions, including lateral canthotomy and cantholysis, were employed, resulting in successful decompression and substantial symptom improvement within a 10-day period. This case underscores the significance of preoperative imaging, prompt diagnostic measures, and collaborative postoperative care in managing orbital complications following neurosurgery.

Internal limiting membrane separation and posterior vitreous hyperreflective dots: novel OCT findings in Purtscher-like retinopathy

BackgroundPurtscher or Purtscher-like retinopathy is diagnosed by retinal hemorrhages and areas of retinal whitening on fundus examination, as well as a reduction in visual acuity due to microvascular occlusion of the precapillary retinal arterioles. We describe novel optical coherence tomography (OCT) findings of internal limiting membrane (ILM) separation and posterior hyperreflective dots in a case of Purtscher-like retinopathy in this report.MethodsA 33-year-old man with acute pancreatitis and alcohol-induced liver disease presented to the retina department complaining of four days of painless vision loss in both eyes. Both eyes’ anterior segment examination and intraocular pressure were normal. Dilated fundus examination of both eyes revealed confluent areas of retinal whitening, hemorrhages, and cotton-wool spots over the posterior pole, indicating Purtscher-like retinopathy. OCT scans through the macula revealed dense inner retinal reflectivity, thickening, and loss of retinal layer stratification, as well as outer retinal layer shadowing and islands of ILM separation, posterior vitreous hyperreflective dots, and minimal subfoveal fluid, all of which corresponded to areas of retinal whitening on fundus photographs. The patient was given a brief course of systemic steroids.ResultsOn the tenth day after the presentation, visual acuity in the right eye had improved to 6/18 and finger counting at 1 m in the left eye. The retinal findings had faded. The retina had reverted to its normal thickness on the OCT scans, with minimal hyperreflectivity remaining. The ILM separation and posterior vitreous hyperreflective dots were no longer present.ConclusionFollowing Purtscher or Purtscher-like retinopathy, we believe inflammation could play a major role in the development of these two novel OCT findings. This case offers an additional perspective on the underlying mechanisms responsible for the retinal manifestations observed in Purtscher or Purtscher-like retinopathy.

Gene therapy for neovascular age-related macular degeneration by subretinal delivery of RGX-314: a phase 1/2a dose-escalation study

Frequent anti-vascular endothelial growth factor A (VEGF-A) injections reduce the risk of rapid and severe vision loss in patients with neovascular age-related macular degeneration (nAMD); however, due to undertreatment, many patients lose vision over time. New treatments that provide sustained suppression of VEGF-A are needed. RGX-314 (currently known as ABBV-RGX-314) is an adeno-associated virus serotype 8 vector that expresses an anti-VEGF-A antigen-binding fragment, which provides potential for continuous VEGF-A suppression after a single subretinal injection. We report results on the safety and efficacy of subretinal injection of RGX-314 in patients with nAMD. For this open-label, multiple-cohort, multicentre, phase 1/2a, dose-escalation study conducted at eight sites in the USA, we enrolled participants with nAMD aged 50-89 years who had previously been treated with anti-VEGF injections into five cohorts (with five different doses of RGX-314). To be eligible, participants had to have macular neovascularisation secondary to nAMD with subretinal or intraretinal fluid in the centre subfield, be pseudophakic (after cataract removal), and have a best-corrected visual acuity (BCVA) in the study eye between 20/63 and 20/400 for the first participant in each cohort and between 20/40 and 20/400 for others. Subretinal injection of RGX-314 was done without a pre-bleb by a wet-laboratory-trained vitreoretinal surgeon. Cohort 1 received 3 × 109 genome copies per eye, cohort 2 received 1 × 1010, and cohort 3 received 6 × 1010. Two additional dose cohorts (cohort 4: 1·6 × 1011; cohort 5: 2·5 × 1011) were added. Participants were seen 1 day and 1 week after administration of RGX-314, and then monthly for 2 years (up to week 106). The primary outcome was safety of RGX-314 delivered by subretinal injection up to week 26. This analysis includes all 42 patients enrolled in the study. This study is registered with ClinicalTrials.gov, NCT03066258. Between May 12, 2017, and May 21, 2019, we screened 110 patients for eligibility and enrolled 68. 42 participants demonstrated the required anatomic response to intravitreal ranibizumab and then received a single RGX-314 injection (dose range 3 × 109 to 2·5 × 1011 genome copies per eye) and were followed up for 2 years. There were 20 serious adverse events in 13 participants, of which one was possibly related to RGX-314: pigmentary changes in the macula with severe vision reduction 12 months after injection of RGX-314 at a dose of 2·5 × 1011 genome copies per eye. Asymptomatic pigmentary changes were seen in the inferior retinal periphery several months after subretinal injection of RGX-314 most commonly at doses of 6 × 1010 genome copies per eye or higher. There were no clinically determined immune responses or inflammation beyond that expected following routine vitrectomy. Doses of 6 × 1010 genome copies or higher resulted in sustained concentrations of RGX-314 protein in aqueous humour and stable or improved BCVA and central retinal thickness with few or no supplemental anti-VEGF-A injections in most participants. Subretinal delivery of RGX-314 was generally well tolerated with no clinically recognised immune responses. RGX-314 gene therapy provides a novel approach for sustained VEGF-A suppression in patients with nAMD that has potential to control exudation, maintain vision, and reduce treatment burden after a single administration. Results from this study informed the pivotal programme to evaluate RGX-314 in patients with nAMD. RegenxBio.

Atypical Form of Unilateral Optic Neuropathy Caused by Ocular Toxocariasis

Purpose: To report an atypical form of ocular toxocariasis presenting as unilateral optic neuropathy.Case summary: A 75-year-old man was referred to our clinic owing to the recently developed visual difficulty in his right eye. The visual acuity of the right eye was 0.4, a relative afferent pupillary defect was positive in the right eye. On slit lamp biomicroscopy, anterior chamber inflammation and vitreous cells and haze were detected in the right eye. On fundus examination, optic disc swelling and focal retinitis around the optic disc were found in the right eye. Fluorescein angiography revealed focal retinitis along with leakage near the optic disc in the right eye. Serology was positive for Toxocara IgG. Under the suspicion of an atypical form of ocular toxocariasis, the patient was treated with local and oral steroids and albendazole. Subsequently, optic disc swelling and vitreous inflammation improved, but the final visual acuity was 0.125 with pale optic disc and central visual field defects in the right eye.Conclusions: In patients suspected of optic neuritis, when the anterior chamber and vitreous inflammation and uveitis are accompanied, ocular toxocariasis can present atypically and requires attention because may have a bad prognosis owing to irreversible optic nerve damage.

Клинический случай проникающего ранения глазного яблока с внутриглазным инородным телом

Today, injuries to the eyeball are the most common cause of visual impairment in people of working age. Perforated wounds of the eyeball are the most severe of all injuries, especially in combination with an intraocular foreign body. Purpose. To evaluate the effectiveness of organizing surgical care for a patient with a penetrating eyeball with an intraocular foreign body. Material and methods. Clinical example. Patient K., 38 years old, complained of decreased visual acuity in the right eye. The patient could not cope without outside help. From the anamnesis: five months ago he was injured (mine-explosive injury). He received conservative therapy in another clinic. Subsequently, he did not receive any surgical ophthalmological treatment. Vision decreased gradually. Left eye with a penetrating wound from 2016. Complex surgical treatment was performed. Results. As a result of combined surgical treatment, social rehabilitation of a patient of working age was achieved. Conclusions. High-tech medical care for patients with penetrating wounds of the eyeball should be provided to the maximum extent, which allows to shorten the rehabilitation period, speed up recovery and obtain a high functional result. Keywords: eyeball, penetrating injury, intraocular foreign body, vitreoretinal surgery

Risk Factors for Worsening Morphology and Visual Acuity in Eyes with Adult-Onset Foveomacular Vitelliform Dystrophy

PurposeTo explore clinical risk factors and optical coherence tomography (OCT) features associated with worse visual acuity (VA), progression of disease, choroidal neovascularization (CNV), and atrophy in eyes with adult-onset foveomacular vitelliform dystrophy (AOFVD). DesignSingle-center, retrospective, observational cohort study ParticipantsPatients seen at Duke Eye Center between January 2012 and May 2023 with a diagnosis of AOFVD confirmed via OCT and fundus autofluorescence. MethodsBaseline and final visit images from eyes with AOFVD were examined. Disease stage was assigned, and presence of atrophy or CNV was determined. Clinical and OCT features associated with progression to atrophy and CNV were determined using t-tests and chi-square analysis. Correlation with lower VA was determined using linear regression. Outcome MeasuresAssociation of clinical characteristics and OCT features with worse VA, progression of disease, CNV, and atrophy as determined by independent t-tests, chi-square analysis, and linear regression (p<0.05). Results101 eyes (63 patients) met inclusion criteria for this study, with mean follow-up duration of 48 months (SD 31 months). 51% of eyes progressed beyond baseline staging during follow-up; among baseline stage 1 eyes, incidence of atrophy was 0.068/person-year; incidence of CNV was 0.022/person-year. Risk factors for worse final VA were baseline presence of vitreomacular traction (VMT) (p=0.006), ellipsoid zone attenuation (p=0.024), increased lesion height and width (p<0.001). Predictors of progression include diabetes mellitus (p=0.012), statin use (p=0.031), presence of hyperreflective foci (p=0.012), and increased lesion width and volume (p=0.034, p=0.040). Predictors of atrophy include the baseline presence of VMT (p=0.018), decreased choroidal thickness (p=0.027), and greater maximal height, width, and volume of the lesion (p=0.031, p=0.020, p=0.009, respectively). Lower baseline VA (p=0.031) and increased lesion volume (p=0.042) were associated with CNV. ConclusionsClinical and OCT imaging features at baseline may prove useful in stratifying patient risk for progression, atrophy, CNV, and worse VA. Features such as statin use, diabetes, baseline VA, and laterality should be accounted for. OCT features such as lesion size, VMT, ellipsoid zone attenuation, choroidal thickness and hyperreflective foci may impart greater risk of poor outcomes. Future prospective analysis accounting for the time to development of atrophy and CNV is needed.

Allogenic Simple Limbal Epithelial Transplantation: An Approach to Bilateral Recurrent Pterygia and Limbal Stem Cell Deficiency

Abstract: A 44-year-old man presented with bilateral total limbal stem cell deficiency after multiple failed surgeries for recurrent pterygia in both eyes over the last 11 years. His best corrected visual acuity (BCVA) in both eyes at the time of presentation was hand movement, projection of rays accurate. Owing to bilateral involvement, allogenic simple limbal epithelial transplantation (Allo SLET) was performed in the right eye. The limbal biopsy was taken from the wife of the patient. Complete ocular surface epithelialization was achieved in 26 days. The patient has completed 15 months of postoperative follow-up with stable ocular surface and BCVA 6/12 in the RE. He is on systemic and topical immunosuppressants with no side effects to date.

Assessment of Microvascular Changes After Rhegmatogenous Retinal Detachment Repair Using Wide-Field Swept-Source Optical Coherence Tomography Angiography.

Our objective was to evaluate retinal microvascular changes and visual outcomes following rhegmatogenous retinal detachment (RRD) repair using wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). The study included 116 eyes of 111 patients with macula-off (n = 68) or macula-on (n = 48) RRD treated with a single successful procedure, 79 fellow eyes, and 183 eyes of control patients imaged with WF SS-OCTA (3 ×3, 6 ×6, and 12 ×12 mm images). Mixed-effects multiple linear regression models were used for statistical analysis. Vessel density (VD) and vessel skeletonized density (VSD) of the superficial capillary plexus (3 ×3 mm scans) and full-thickness retina (12 ×12 mm) were significantly reduced in RRD eyes compared to fellow and control eyes. Decreased VSD and VD in all layers (3 ×3 mm and 6 ×6 mm) were significantly associated with greater preoperative extent of retinal detachment (P < 0.05) and poorer postoperative best-corrected visual acuity (BCVA) in RRD eyes (P < 0.05). Macula-off status was associated with increased foveal avascular zone irregularity (12 ×12 mm, P = 0.02). Decreased VD on WF SS-OCTA is associated with poorer postoperative BCVA following RRD repair. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Evaluation of the Amblyopia tracker app

PurposeThe Amblyopia tracker app has been developed to be a tool for parents to monitor changes in vision at home during amblyopia treatment. The aims of this study were to evaluate the feasibility and repeatability of parents testing their children at home and to compare home test results to an assessment in clinic by an orthoptist.MethodsChildren (age < 18 years) with amblyopia (interocular acuity difference of ≥ 0.2logMAR) were recruited. Parents were asked to test their child with the app three times during a two week period followed by an online questionnaire about the usability. Participants also tested within 48 h of their appointment where the measurement was repeated by an orthoptist.ResultsOut of 277 potential participants contacted, 37 completed three home measurements, mean age 6.8 years (SD 2.94). Home tests comparisons were made between test two and three to ensure familiarity with the process. Paired t-tests showed no statistically significant difference for either eye or the interocular acuity difference (IAD). However, 29% had a difference in IAD of more than 0.1logMAR on repeated testing, with a maximum of 0.4logMAR difference in the IAD. Questionnaire responses from the parents who participated were predominantly positive with 97% of respondents saying they would use it if were available. Comparison of home and clinical measurements (n = 23, mean age 6.72 SD 2.60) showed no statistically significant differences for either eye or interocular acuity difference (paired t-test, p > 0.3 in all cases).ConclusionResults show no statistically significant differences for the Amblyopia tracker app when used by parents at home on repeated testing, or between the home test by a parent and the test by a clinician. However, variability in the results does indicate that further improvements are required to ensure the results can be used as a reliable clinical tool.

The Features and Treatment Effects on Keratoepitheliopathy for Meibomitis-Related Keratoconjunctivitis.

Meibomitis-related keratoconjunctivitis (MRKC) is characterized by meibomitis with corneal epithelial abnormalities, and can be divided into two types: MRKC accompanied with phlyctenular keratitis, and MRKC accompanied with keratoepitheliopathy that is similar to superficial punctate keratopathy (SPK). The purpose of this retrospective study was to investigate the characteristic features of keratoepitheliopathy and treatment outcomes for MRKC. This study involved 27 eyes of 18 MRKC patients (3 males and 15 females). National Eye Institute (NEI) scores and visual acuity were compared at pre and post treatment. All subjects were treated with a small-dose administration of clarithromycin. Keratoepitheliopathy characteristic to MRKC, yet different in appearance from SPK, was noted in 24 of the 27 eyes. Fluorescein staining revealed granular epithelial lesions generally larger than SPK that coexisted with small dark spots. In 17 eyes, keratoepitheliopathy was located within the pupillary zone, and the visual acuity in 12 eyes was less than 1.0. Our findings showed significant improvement in the NEI score in MRKC (p < 0.0001) and in visual acuity (p = 0.0157) post treatment, and the characteristic features of keratoepitheliopathy in MRKC that are often associated with decreased visual acuity were elucidated. The treatment of clarithromycin was found to be effective for MRKC with keratoepitheliopathy.

Pattern electroretinography response in amblyopic adults

IntroductionAmblyopia is generally a unilateral disorder, defined by at least a difference of two lines of visual acuity between both eyes with the best-corrected visual acuity, a decrease in contrast sensitivity, and a decrease in stereopsis. Pattern electroretinogram (PERG) is a noninvasive technique that provides a retinal biopotential and is a highly sensitive indicator of changes in the macular area. Our aim was to evaluate if there are differences in the retinal response of an amblyopic eye compared with a normal eye (NE).MethodsWe evaluated twenty-four adult volunteers, twelve amblyopes (mean 43.42 ± 12.72 years old), and twelve subjects with NE (mean 35.58 ± 12.85 years old). None of the subjects in the two groups had comorbidities. A complete optometric examination was performed including parameters such as visual acuity (VA) by far and near with ETDRS chart, eye alignment with cover test, and evaluation of retinal cells response with PERG.ResultsThe refractive error found in the NE group of subjects had a mean of − 0.95 ± 1.65D, while the amblyopic group showed a mean of − 2.03 ± 4.29D. The VA in amblyopic eyes had a mean of 0.38 ± 0.20 logMAR. Analyzing PERG data, we observed significant differences in the P50-N95 amplitudes of the amblyopic group compared with the NE group (p < 0.0001–amblyopic eye vs. NE; p = 0.039–fellow eye vs. NE).DiscussionThese findings suggest that amblyopic patients may also present other impairments beyond the visual cortex. PERGs seem to be an important complementary examination in the diagnosis of other impairments in amblyopia.

Reliability of Binocular Esterman Visual Field Test in Patients with Glaucoma and Other Ocular Conditions.

The binocular Esterman visual field test (EVFT) of 120 points was the first method to quantify the defects in the binocular visual field. It is used in many parts of the world as a standard test to determine whether an individual has the visual capabilities to drive safely. In Japan, it is required for the grading and issuance of visual disability certificates. The purpose of this study was to determine the reliability of the EVFT results. We studied 104 patients who had undergone the binocular EVFT at Mie University Hospital. Their mean age was 68.0 ± 11.4 years, and the best-corrected visual acuity of the better eye was 0.18 ± 0.38 logMAR units. The EVFT was performed twice on the same day, and the results of the first and second tests were compared. The mean Esterman scores for the first and second test were 89.3 ± 30.5 and 89.1 ± 30.2, respectively, and the test times were 338.9 ± 86.8 and 336.7 ± 76.4 s, respectively. The differences were not significant (p = 0.69 and p = 0.33). In the Bland-Altman analyses (second-first test) of the Esterman scores, the mean difference was 0.38 without significant fixed errors (p = 0.20) or proportional errors (p = 0.27). The limits of agreement within the 1.96 standard deviation were -8.96 to +9.45 points. The agreement rate for the most peripheral 24 test points was significantly lower than the agreement rate for the other 96 test points (p < 0.01). The agreement rate of the upper visual field was significantly lower than that of the lower field (p < 0.01). The overall reliability rate of the EVFT is acceptable, but the peripheral and upper test points have relatively low reliability rates. These findings are important for interpretations of the EVFT results.

Conversion to faricimab after prior anti-vascular endothelial growth factor therapy for persistent diabetic macular oedema

BackgroundTo assess the anatomical and functional outcomes in eyes with persistent diabetic macular oedema (pDME) on chronic anti-vascular endothelial growth factor therapy switched to intravitreal faricimab.MethodsPatients with pDME on chronic...

Management of Lateral Canthal Coloboma in Goldenhar Syndrome: A Rare Case Report

Introduction : Goldenhar syndrome is a rare congenital disorder characterized by a wide range of physical anomalies affecting the face, ears, eyes, and spine.&#x0D; Case Illustration : Patient, female 19-year-old, complained of growing mass and blurry vision on right eye since childhood. The patient also has an asymetric face with the right side being smaller then left. She also has hearing disorder on her right ear. Ophthalmology examination revealed right eye's visual acuity is 6/120, lateral canthus coloboma , trichiasis and mass on the inferior palpebral, and conjunctiva attached to the cornea. Left eye is within normal limit. The right ear appears deformed, with no ear canal and preauricular skin tags. Patient underwent conjungtiva tumor excision and given labia mucosa graft with canthoplasty. Histology examination revealed benign lipomatous tumor. Patient feels more confident after oculoplasty surgery.&#x0D; Discussion : Goldenhar syndrome is a rare condition caused by abnormal development of the first and second branchial arches. It is characterized by a wide range of ocular features, including eyelid and iris coloboma, conjungtiva dermoid or dermolipoma, and more. Beside ocular features, other features are ear malformations, facial asymmetry, cleft lip or palate, and vertebral anomalies. It was unique case because an unformed canthus was found due to a large of conjunctival fornix mass. Appropriate management is necessary for a fulfilling life, though the disorder can have significant psychosocial effects.&#x0D; Conclusion : Goldenhar syndrome is a rare disease with numerous symptoms and its management is crucial for individuals to have a fulfilling life despite its potentially significant psychosocial impacts.

Recurrence in Toxoplasma Chorioretinitis: A Case Report

Introduction : Toxoplasma is the most common cause of chorioretinitis and recurrency of toxoplasma chorioretinitis often occur. Recurrences risk factors are patients above 40 years, patients with de novo toxoplasmosis lesions or with less than one year after the first episode, macular area involvement, lesions greater than one disc diameter, congenital toxoplasmosis, and bilateral compromise.&#x0D; Case Illustration : Female, twenty years old, complained blurred vision on the RE for two years. The patient had a history of cat contact and no systemic manifestation. Anterior segment examination in both eyes is normal with right eye visual acuity 1/60 and left eye visual acuity VA 6/6. Posterior segment examination on the left eye showed normal limit while the right eye showed hyperpigmentation in inferotemporal optic disc and nasal macula. Retina showed hard exudate. Macula showed yellow- white exudate with subretinal bleeding and macular star appearance. Foveal reflex under normal limit. Toxoplasma serology was IgG (+) and IgM (-). The patient has been treated with cotrimoxazole 2x960mg and methylprednisolone 1x32mg.&#x0D; Discussion : Visual acuity is severely damaged in recurrence toxoplasma chorioretinitis. There are several factors that affect the recurrences of toxoplasma chorioretinitis. In this patient, the risk factors found are de novo lesion, lesions greater than 1 disc diameter, and macular involvement. Cotrimoxazole can reduce recurrence in toxoplasma chorioretinitis but still recurrency can occur.&#x0D; Conclusion : Recurrences in toxoplasma chorioretinitis affect visual acuity, and even with adequate therapy, recurrence is possible.

Terson Syndrome: A Rare, Treatable Visual Loss After Subarachnoid and Intraventricular Hemorrhage

Abstract&#x0D; Introduction : Intracranial pathologies commonly affect vision through optic neuropathy. However, visual loss could be due to vitreous hemorrhage as in Terson syndrome. This report warns us rare cases of visual loss after intracranial hemorrhage that requires totally different management than more commonly found optic neuropathies.&#x0D; Case Illustration : Female, 46 years old, had a severe headache and decreased consciousness two days later. CT angiography revealed wide subarachnoid hemorrhage and intraventricular hemorrhage causing hydrocephalus. She received emergency lumbar drainage followed by digital subtraction angiography and flow diverter device. Postoperative she regained consciousness, CT scan showed reduced ventricular size without residual hemorrhage, yet visual acuity of left eye reduced to hand movement and did not improve until one month later. Ophthalmologic examination showed vitreous hemorrhage of the left eye. Right eye was normal. Vitrectomy was planned to clear the vitreous hemorrhage.&#x0D; Discussion : Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, cerebral hemorrhage, or traumatic brain injury. The proposed mechanisms were transmission of subarachnoid blood to the optic nerve sheath and rapid effusion of cerebrospinal fluid into the optic nerve sheath due to sudden increase of intracranial pressure. It compresses central retinal vein, causing vascular rupture. The manifestations could be vitreous, subhyaloid, subretinal, or intraretinal hemorrhage. Visual prognosis is good in those resolved spontaneously or receiving vitrectomy in nonresolving cases.&#x0D; Conclusion : Visual loss from intracranial hemorrhage or trauma could be caused by intraocular hemorrhage. It deserved different management than optic neuropathies. Prompt recognition should improve the management and the prognosis of rare cases such as Terson syndrome.