Anterior Vitreous Research Articles

Successful treatment of Keratitis caused by Mycobacterium chelonae and an overview of previous cases in Europe

Introduction and purposeMycobacterium (M.) chelonae is responsible for a half of relatively rare nontuberculous mycobacteria (NTM) keratitis. We report a case of M. chelonae keratitis in a woman following sclerocorneal suture extraction after cataract surgery.ResultsA 70-year-old woman presented with a red eye and corneal infiltration of her left eye six weeks following sclerocorneal suture extraction after an elective cataract surgery in another institute. She complained of a sharp, cutting pain and photophobia. Since initial corneal scrapes and conjunctival swabs proved no pathogen using culture and PCR methods, non-specific antibiotics and antifungal agents were administered. As keratitis was complicated by an inflammation in the anterior chamber and vitreous, samples of the vitreous fluid were sent for microbiologic examination. DNA of Epstein-Barr virus (EBV) was repeatedly detected. Since the intrastromal abscess had formed, corneal re-scrapings were performed and M. chelonae was detected using culture, MALDI-TOF MS and PCR methods. Therapy was changed to a combination of oral and topical clarithromycin, intravitreal, topical and intracameral amikacin, and oral and topical moxifloxacin. The successful therapy led to stabilization. The optical penetrating keratoplasty was performed and no signs of the infection recurrence were found.ConclusionsThe diagnosis of nontuberculous mycobacterial keratitis is difficult and often delayed. An aggressive and prolonged antimicrobial therapy should include systemic and topical antibiotics. Surgical intervention in the form of corneal transplantation may be required in the active and nonresponsive infection. In the presented case this was necessary for visual rehabilitation due to scarring.

Clinical characterizations and molecular genetic study of two co-segregating variants in PDZD7 and PDE6C genes leading simultaneously to non-syndromic hearing loss and achromatopsia

BackgroundAutosomal recessive non-syndromic hearing loss (NSHL) and cone dystrophies (CODs) are highly genetically and phenotypically heterogeneous disorders. In this study, we applied the whole exome sequencing (WES) to find the cause of HL and COD in an Iranian consanguineous family with three affected individuals.MethodsThree members from an Iranian consanguineous family who were suffering from NSHL and visual impairment were ascertained in this study. Comprehensive clinical evaluations and genetic analysis followed by bioinformatic and co-segregation studies were performed to diagnose the cause of these phenotypes. Data were collected from 2020 to 2022.ResultsAll cases showed congenital bilateral NSHL, decreased visual acuity, poor color discrimination, photophobia and macular atrophy. Moreover, cornea, iris and anterior vitreous were within normal limit in both eyes, decreased foveal sensitivity, central scotoma and generalized depression of visual field were seen in three cases. WES results showed two variants, a novel null variant (p.Trp548Ter) in the PDE6C gene causing COD type 4 (Achromatopsia) and a previously reported variant (p.Ile84Thr) in the PDZD7 gene causing NSHL. Both variants were found in the cis configuration on chromosome 10 with a genetic distance of about 8.3 cM, leading to their co-inheritance. However, two diseases could appear independently in subsequent generations due to crossover during meiosis.ConclusionsHere, we could successfully determine the etiology of a seemingly complex phenotype in two adjacent genes. We identified a novel variant in the PDE6C gene, related to achromatopsia. Interestingly, this variant could cooperatively cause visual disorders: cone dystrophy and cone-rod dystrophy.

Anterior Vitreous Objective Assessment in Uveitis: An Anterior Segment Swept Source Optical Coherence Tomography Study

ABSTRACT Purpose To assess inflammatory changes in the anterior vitreous (AV) using a swept source anterior segment optical coherence tomography (SS-ASOCT) and to correlate them with uveitis features and clinical grading of intraocular inflammation. Methods 140 eyes from 96 patients were included in this observational, cross-sectional study: 40 ACTIVE uveitis, 40 INACTIVE uveitis and 60 CONTROLS. All eyes underwent intraocular inflammation clinical grading (anterior chamber (AC) cells counting and vitreous haze evaluation) and AV imaging with SS-ASOCT. Cells seen in the AV on OCT were manually counted using imageJ. Vitreous reflectivity variation was indirectly measured by calculating the vitreous/iris pigment epithelium (VIT/IPE) relative intensity. These OCT-based parameters were compared across the groups and correlated with inflammation clinical grading. Results The mean [SD] number of AV OCT cells was significantly higher (both p < 0.001) in ACTIVE uveitis (12[9.8]) compared to INACTIVE uveitis (4.5[3.5]) and CONTROLS (4[3.1]). In ACTIVE uveitis the number of AV OCT cells was significantly and positively correlated with the AC cells (p = 0.04), the VIT/IPE relative intensity (p = 0.0002), the uveitis anatomical classification (INTERMEDIATE UVEITIS, p = 0.02) and the vitreous haze clinical grading (p < 0.0001). The mean[SD] VIT/IPE relative intensity of the AV increased from CONTROLS (0.12[0.01]) to INACTIVE uveitis (0.15[0.01]) to ACTIVE uveitis (0.17[0.02]), but with no statistically significant differences. Conclusions We were able to visualize and objectively evaluate changes occurring in the AV in eyes with uveitis by means of a commercially available SS-ASOCT. OCT-cells in the AV could represent an adjunctive tool in the objective evaluation of intraocular inflammation.

Клинический случай трансплантации аутологичной сетчатки у пациента с оперированным рефрактерным макулярным разрывом

In the last few years, autologous retina transplantation has been repeatedly mentioned in foreign literature as a new method of treating primary through and recurrent refractory macular holes of large diameter. Purpose. To discuss the results of a clinical case of autologous retina transplantation in a patient with recurrent macular hole. Material and methods. A patient with recurrent macular hole, partial optic nerve atrophy, operated on in 2017, was under observation. There is a MH with a diameter of 1600 microns on the OCT of the macular zone. The course of the operation. At the first stage, the remains of the anterior vitreous were removed. Next, the vitreous chamber was tamponaded with perfluorodecalin. The retinal flap was cut out in the lower part of the middle periphery. With the help of endothermocoagulation, the flap is delimited and mobilized. Next, the flap was dislocated to the macular area. The MH is closed by the dislocated retina. A fringing laser coagulation of the retina was performed around the removed part of it. After that, the patient is left lying on his back on the operating table for 1 hour. After a double examination after 30 minutes and 1 hour, after making sure that the flap is in the correct position, the tamponade of the glassy chamber of perfluorodecalin, the trocars are removed, stitches are applied. After 4 days, perfluorodecalin was replaced with silicone oil. Results. On the first day, according to the results of OCT, the macular opening is closed, the thickness of the retina in the central zone is 619 microns. The corrected visual acuity remained at the same level. 2 weeks after surgery, the retinal thickness is 505 microns, the corrected visual acuity is 0.02, the flap is fixed, the macular rupture is closed. 1.5 months after surgery, after removal of silicone oil, visual acuity was without correction, retinal thickness. Conclusion. The autologous retina transplantation method can be used in the treatment of recurrent macular hole. Keywords: transplantation, autologous retina, macular hole

Efficacy and Safety of Switching from Adalimumab Originator to SB5, Adalimumab Biosimilar for Noninfectious Uveitis

ABSTRACT Purpose To evaluate the efficacy and safety of switching from adalimumab originator (Humira, AbbVie) to SB5, adalimumab biosimilar (Adalloce, Samsung Bioepis) in patients with noninfectious uveitis (NIU). Methods Fifteen patients (29 eyes) with NIU who were switched from adalimumab originator to SB5 and followed up for 6 months or longer were retrospectively included. Data consisted of best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), anterior chamber (AC) cell grade, anterior vitreous (AV) cell grade, vitreous haze grade, central macular thickness (CMT, μm), and macular volume (MV, mm3) at pre-switching, 2, 4, and 6 months post-switching. Results There were no significant differences in BCVA, AC and AV cell grades, and vitreous haze grades at 2, 4, and 6 months post- compared with pre-switching, and no significant differences in CMT and MV at 2 and 6 months post-switching. CMT and MV decreased from 260.55 ± 67.44 μm and 8.37 ± 1.14 mm3 at pre-switching to 244.14 ± 60.31 μm (p = 0.032) and 8.11 ± 1.20 mm3 (p = 0.027) at 4 months post-switching, respectively. There was no recurrence of uveitis, as defined by AC cell grade, vitreous haze, or BCVA. Four patients (27%) were switched back to adalimumab originator after a mean of 9 weeks, due to discomfort during the injection (three patients) and technical difficulty with the new injection device (one patient). No other adverse events occurred after switching to SB5. Conclusion Switching from adalimumab originator to SB5 for NIU does not result in clinically significant differences in treatment efficacy and safety.

Subconjunctival deferoxamine for corneal rust deposits associated with ocular siderosis: A case report

Introduction: Ocular siderosis is a vision-threatening condition resulting from intraocular iron toxicity. This case re-establishes a role for subconjunctival deferoxamine, a chelating agent uncommonly used in ophthalmology, as an adjunctive treatment for ocular siderosis. Case Report: A 37-year-old healthy male presented two months after an injury at work with intermittent pain and blurry vision in the right eye. Presenting visual acuity (VA) was 20/100 in the right eye. With delayed presentation, the patient already had ocular siderosis with corneal rust deposits and retinal damage. The patient underwent pars plana vitrectomy (PPV) with surgical view impaired by corneal deposits and intraocular metallic intraocular foreign body (IOFB) that disintegrated upon attempted removal. At six months postoperatively, VA was 20/70 in the right eye, and examination revealed worsened diffuse, pigmented subepithelial deposits in the central cornea, iris atrophy, cotton wool spots, optic nerve pallor, and a residual IOFB in the anterior vitreous, consistent with worsened ocular siderosis. Superficial keratectomy was performed in combination with repeat PPV to improve surgical visualization and aid in IOFB removal. An amniotic membrane was placed and a subconjunctival injection of deferoxamine was administered. The cornea was well-healed with significantly improved siderosis and no epithelial defects on 2-week postoperative follow-up. Visual acuity was 20/60 at last follow-up two months postoperatively after second surgery. Conclusion: In treating ocular siderosis, subconjunctival injection of deferoxamine can be a useful addition to surgical IOFB removal to prevent the accumulation of iron deposits in the anterior segment of the eye.

A quantitative sonoelastography evaluation of ocular and periocular elasticity after intravitreal ranibizumab injection

We evaluated changes in ocular and periocular elasticity by ultrasound (US) elastography in intravitreal ranibizumab-treated eyes and the healthy fellow eyes of patients with neovascular AMD. The study was performed on 52 eyes of 26 volunteers who ranged in age from 59 to 89 (mean 72±7.78) years old. The study group consisted of the patients with neovascular AMD treated with intravitreal ranibizumab. The fellow eyes (without choroidal neovascularization) of the study group were selected as the control group. All patients were examined with sonoelastography before intravitreal injection and at 1day, 1week, and 1month after intravitreal injection. All images were acquired with a Toshiba Aplio 500 ultrasound system (Tokyo, Japan) including software with a combined autocorrelation method and a multifrequency linear probe. The elastography values of the anterior vitreous (AV), posterior vitreous (PV), retina-choroid-sclera complex (RCS), retrobulbar fat tissue (RF), optic nerve head (ONH) and retrobulbar optic nerve (RON) were measured in each eye. There were 13 male (50%) and 13 female (50%) participants in our study. Anterior vitreous, posterior vitreous, RCS, retrobulbar fat tissue, ONH, and RON US elastography values were similar in both groups (P˃0.05 for all). On the other hand, there was a positive correlation between the difference between baseline and 1-month PV sonoelastography values and age (r=0.47, P=0.035). A single dose intravitreal Ranibizumab (Lucentis®, Genentech, USA) injection does not alter the elasticity of ocular and periocular structures.

Vascular occlusion in a patient with posteriorly dislocated double IOL

Age and uncontrolled hypertension are well established risk factors for retinal vascular occlusion. IOL (intraocular lens) implantation following intraoperative posterior capsule rupture has an increased risk of IOL dislocation in the posterior segment. We came across a case of infero-temporal branched retinal vein occlusion followed by a direct injury by a mobile IOL which was posteriorly dislocated. The patient also had one another posteriorly dislocated IOL which was stuck in the anterior vitreous. This case highlights the need for the urgent removal of a posteriorly dislocated mobile IOL, which should precede the placement of a secondary IOL to avoid ocular complications.

Acute Effects of Neodymium-Doped Yttrium Aluminum Garnet Laser Capsulotomy on Anterior Segment Parameters in Capsular Bag Distension Syndrome.

Background: Capsular bag distension syndrome (CBDS) can be effectively treated using either Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy or surgery. Assessing anterior segment, particularly immediately after Nd:YAG laser capsulotomy, could provide clinically relevant information on ocular dynamics, refractive changes, and complication mechanisms, especially in late postoperative CBDS. Objective: To explore the acute effects of Nd:YAG laser posterior capsulotomy on anterior segment parameters in late postoperative CBDS. Methods and results: In this study, 20 patients underwent Nd:YAG laser posterior capsulotomy after cycloplegia, during which milky-white fluid material migrated into the anterior vitreous. Anterior segment parameters were assessed before and immediately after laser using Scheimpflug-Placido topographer. The main outcome measures were differences in best-corrected visual acuity (BCVA), aqueous depth (AqD), anterior chamber volume (ACV), iridocorneal angle (ICA), corneal volume (CV), and central corneal thickness (CCT) at the baseline versus at immediately after laser. The mean age and duration since surgery for CBDS presentation were 70.25 ± 6.21 and 6.15 ± 1.31 years, respectively. The AqD, ACV, ICA, and spherical equivalent increased significantly compared with baseline (4.18 vs. 4.02 mm, p = 0.001; 177 vs. 173.55 mm3, p = 0.004; 51.15° vs. 50.15°, p = 0.023; -1.00 vs. -2.00 D, p = 0.003, respectively). These changes were also associated with significantly improved BCVA an hour after capsulotomy [0.2 (0.05-0.2)] relative to baseline [0.3 (0.2-0.5)], (p = 0.001). CCT and CV decreased nonsignificantly; horizontal AC diameter and K1 and K2 increased nonsignificantly (p > 0.05). Conclusions: Nd:YAG laser posterior capsulotomy appears to be an effective CBDS treatment for acutely improving vision, potentially due to immediate refractive changes caused by altered anterior segment parameters.

Acute myeloid leukemia relapsing in the vitreous

A 47-year-old female was a known case of acute myeloid leukemia (AML-M5) and presented with a diminution of vision in the right eye (OD) for two weeks. Examination revealed pigmented cells in the anterior vitreous of both eyes with vitritis OD. She was further treated with vitreous biopsy and diagnostic vitrectomy under air OD. The cytology examination of the vitreous biopsy revealed infiltration with myeloblasts confirming the diagnosis of extramedullary relapse of AML inside the vitreous. She was further treated with intrathecal chemotherapy. She did not have any further relapse till two years after her last follow-up. This case highlights a rare location of extramedullary relapse of AML inside the vitreous which has not been reported as per the literature search. Moreover, diagnostic vitrectomy under air helped in getting more undiluted vitreous fluid, which also helped in confirming the relapse with cytology examination.

Imaging of anterior vitreous inflammation with swept-source anterior segment OCT

A 54-year-old male with panuveitis presented with 2+ vitreous haze, 2+ vitreous cells and vitreous opacities (A). Swept-source anterior segment optical coherence tomography (AS-OCT) (ANTERION, Heidelberg Engineering) imaging demonstrated hyperreflective foci suggestive of vitreous cells and vitreous opacities (white arrows, A-B) in the anterior vitreous. Following treatment with prednisone, exam demonstrated resolved vitreous opacities, 0.5+ vitreous haze, and 0.5+ vitreous cells (C), corresponding to a decrease in hyperreflective areas seen with AS-OCT (D). Despite posterior synechiae, swept source AS-OCT permitted high-resolution visualization of the anterior vitreous. With further image processing and analysis, this suggests a potential utility of AS-OCT for the objective longitudinal evaluation and monitoring of anterior vitreous inflammation.

Hypersonic vitrectomy in intraoperative posterior capsular rupture with retained nuclear fragments.

In our report, we present the hypersonic vitrectomy (Vitesse, Bausch and Lomb) being employed for anterior vitreous liquefaction and removal in posterior capsular rupture. The capsular tear with nucleus drop during conventional phacoemulsification was managed by vitrectomy using the hypersonic vitrector after posterior-assisted levitation followed by intraocular lens (IOL) implantation. The minimal cortical and epinuclear lens particles in the anterior chamber and vitreous were also liquefied with a stoke length of 30 to 40 μm and aspirated via the Vitesse vitrectomy system. The same probe performs the vitrectomy and the nucleus removal. The postoperative period was uneventful with clear cornea, normal fundus, and 20/20 best-corrected visual acuity (BCVA). The hypersonic vitrectomy utilizes the ultrasound power of 29.5 kHz and a stoke length of 0 to 60 μm for liquefaction of the vitreous. It can be a safe alternative for vitrectomy and lens removal in a single setting.

Watching the cell: The future of imaging in uveitis

AbstractBeing able to image individual immune cells and their live behaviour in the retina will be critical to improving our understanding and management of patients with posterior uveitis. While we can observe cells in the anterior chamber and vitreous, this often does not always reflect retinal inflammation. Many of our measures of inflammation also are indirect, such as vascular leakage, macular oedema or deterioration in the electroretinogram. I will discuss our pre‐clinical work towards this goal, efforts across the wider field and the translational pathway forward for application to uveitis patients.

Mystery of changing choroidal thickness.

Mystery of changing choroidal thickness.

Corneal Curvature, Anterior Chamber Depth, Lens Thickness, And Vitreous Chamber Depth: Their Intercorrelations With Refractive Error In Saudi Adults

Background: Ocular biometrics, such as corneal curvature, axial length, anterior chamber depth, and lens thickness, play a significant role in the development of refractive error and are essential in many clinical and research applications. Objective: To determine means and ranges for corneal curvature, axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and their intercorrelations with refractive error in Saudi adults. Methods: A total of 120 eyes of 60 hyperopic and 60 myopic subjects aged 19-26 years old were enrolled in this comparative cross-sectional study. Axial Length (AL), Anterior Chamber Depth (ACD), Lens Thickness (LT), and Vitreous Chamber Depth (VCD) were measured by the SONOMED ultrasound E-Z SCAN AB5500+, A-scan, with a contact technique. An ophthalmometer measured the refractive status objectively by auto-refraction and the corneal radius of curvature. Results: The findings showed that the myopic eyes had a deeper ACD(3.70±0.27mm) than hyperopic eyes (3.28±0.32mm), P=0.0001. However, the hyperopic eyes had a thicker LT (3.84±0.24mm) than the myopic eyes (3.81±0.19mm), P=0.640. The mean of the corneal radius of curvature for the myopic eyes was slightly more curved (7.87±0.23mm) than for the hyperopic eyes (7.95±0.27mm), P=0.602. The myopic eyes had a higher axial length/corneal radius AL/CR ratio (3.12±0.11) than hyperopic eyes (2.89±0.06), with P=0.0001. Myopic spherical equivalent (SPH) positively correlated with VCD and AL/CR ratio, P=0.0001. Vitreous chamber depth/Axial length ratio (VCD/AL) in the myopic eyes was higher (0.693±0.041) than in the hyperopic eyes (0.677±0.018), P=0.000. Hyperopic SPH was positively associated with the VCD/AL ratio, P=0.0001. Conclusion: Myopic eyes had a deeper VCD than hyperopic eyes; there was a strong positive correlation between VCD and myopic SPH. There was a strong positive correlation between the AL/CR ratio and myopic SPH and a VCD/AL ratio and the hyperopic SPH. Thus, the study suggests the possible utility of the AL/CR ratio while assessing the development of myopic refractive error and the VCD/AL ratio when evaluating hyperopic eyes and their associated complications.

Non-cystic macular thickening on optical coherence tomography as an alternative to fluorescein angiography for predicting retinal vascular leakage in early stages of uveitis

To evaluate the relationship between non-cystic thickening of the macula on optical coherence tomography (OCT) and retinal vascular leakage on fluorescein angiogram (FA) in patients with uveitis. A cross-sectional study of patients seen in the uveitis clinic. Patients with any degree of inflammatory cells in the anterior vitreous were included, provided that no macular cyst or subretinal fluid or macular atrophy was observed in OCT. The correlation between OCT features and best corrected visual acuity (BCVA), the degree of inflammation, and FA findings were examined. The severity of vascular leakage in FA was graded for optic nerve, macula and posterior and peripheral leakage. We used generalized estimation equation to assess the associations between macular thickness and volume with angiographic scores. A total of 43 patients (100 exam data) met inclusion criteria. There was a significant relationship between OCT parameters (central macular thickness, 3 mm and 6 mm perifoveal macular thickness as well as total and central macular volume) with angiographic scores (macular, optic disc, posterior and peripheral vascular leakage score) (all P values < 0.0001). The correlation between the 6 mm perifoveal thickness and peripheral vascular leakage score (R = 0.76; P < 0.001) was stronger than the correlation of CMT with this angiographic score (R = 0.69; P < 0.001). Non-cystic thickening of the macula on OCT, especially in perifoveal area, is a reliable predictor of the presence of retinal vascular leakage in patients with uveitis.

A Case of Unilateral Pseudoglioma of Eye in A Neonate

Pseudoglioma is a condition presenting as leukocoria other than retinoblastoma. Persistent hyperplastic primary vitreous is a type of pseudoglioma in an ocular developmental defect in which the hyaloid vasculature within the vitreous overgrows and fails to regress.In this case , 25 days old female child presented with the complaints of white pupillary reflex in the right eye since birth. Baby was born to second degree consanguineous parents. The child was born at full-term by normal delivery. The Antenatal period was uneventful. No history of oxygenation and birth trauma. Anterior segment examination of the right eye showed a shallow anterior chamber and leukocoria. Lens was cataractous and vascular. The left eye was normal. Examination under anesthesia revealed normal corneal diameter and Intraocular pressure in both the eyes. Fundus examination was normal in the left eye and cannot be performed in the right eye. Ultrasound B-scan in the right eye showed an echogenic band in the posterior surface of the lens and on colordoppler arterial blood flow was seen in the band. Hence, the patient was diagnosed to have Anterior persistent hyperplastic primary vitreous in the righteye.In this case ,child is advised to undergo Right lensectomy with cautery of the persistent anterior hyaloid stalk and anterior vitrectomy.&#x0D;

Presumed Latent Tuberculosis-related Intermediate Uveitis Manifesting as Recurrent Vitreous Hemorrhage

Purpose: We report a case of recurrent vitreous hemorrhage in a patient with presumed latent tuberculosis-related intermediate uveitis, and we review the literature.Case summary: A 58-year-old male visited our clinic complaining of ocular pain, conjunctival hyperemia, decreased vision, and uncontrolled intraocular pressure (IOP) in the left eye. The best-corrected visual acuity (BCVA) was 0.4 and the IOP of the left eye was 34 mmHg. Slit lamp examination revealed conjunctival hyperemia, corneal edema, and inflammatory cells in the anterior chamber and anterior vitreous; fundus examination revealed mild vitreous opacity attributable to vitritis. The high IOP and the intraocular inflammation were treated with antiglaucoma agents and corticosteroids under the impression of chronic anterior uveitis and uveitic glaucoma. Of the tests performed to identify the cause of the uveitis-related vitreous hemorrhage, the interferon-gamma release assay was positive. A presumptive diagnosis of latent tuberculosis-related uveitis was made after pulmonary tuberculosis was excluded by our respiratory internal medicine department. Isoniazid was administered for 9 months. The vitreous hemorrhage recurred 1 month after antituberculosis therapy commenced but, at 2 months, all of the hemorrhage was absorbed and the BCVA improved to 1.0 without further recurrence.Conclusions: Intraocular tuberculosis can present with various clinical manifestations. If tuberculosis-related uveitis is presumed, tests for latent and manifest tuberculosis should be scheduled to allow of early diagnosis and immediate antituberculosis therapy.

Limited pars-plana vitrectomy for optimizing surgical outcome in subluxated cataracts undergoing femtosecond laser-assisted cataract surgery.

We propose a technique for combined femto laser-assisted cataract surgery (FLACS) and limited vitrectomy from the pars-plana site for optimization of surgical results in subluxated cataracts. FLACS creates a free-floating, customised capsulotomy, minimizes stress on compromised zonules, and prechops the nucleus, effectively reducing the ultrasonic power as well as the forces required to chop the nucleus. The area of zonular dehiscence creates a direct communication between the irrigation fluid and the anterior vitreous, leading to its hydration. Trans-limbal vitrectomy creates a continuum between the liquefied vitreous and the main wound, leading to further vitreous loss, and exaggeration of the zonular weakness, while pars-plana vitrectomy avoids this by cutting the liquefied vitreous, near its attachment, thereby preventing further hydration and causing lesser stress to the zonules. A combination of these procedures, along with a capsule support device, gives favorable surgical outcomes in moderate to severe subluxations.

A case of anterior persistent hyperplastic primary vitreous associated with morning glory disc anomaly and retinopathy of prematurity like retinopathy in a term-born child

BackgroundAssociation of morning glory disc anomaly (MGDA) with persistent hyperplastic primary vitreous (PHPV) has been reported earlier. Retinopathy of prematurity (ROP) like retinopathy in preterm babies with optic disc anomalies has also been published. Our case is unique in terms of presence MGDA, PHPV, unilateral ROP like retinopathy in a term infant with normal birth weight.Case presentationA 5-month-old girl, born at term with a birth weight of 3750 g, presented with anterior PHPV, MGDA and ROP like retinopathy. In order to prevent retinal detachment, she received 360 degree barrage laser photocoagulation at the edge of the optic disc excavation of the left eye. In the follow-up a month later, laser scars were found in her left fundus without other complications.ConclusionPHPV and MGDA with ROP like retinopathy in term and normal weight baby is rare. The peripheral avascular retinal area, caused by the dragging of the defected optic disc, might have been more vulnerable to the oxygen change after birth which resulted in ROP like retinopathy. High sensitivity to oxygen results in a series of changes such as upregulation of VEGF and IGF-1 may cause ROP-like retinopathy.