Blurred Vision Research Articles

Soft Contact Lenses as a Good Option for Adolescent with Anisometropia

Introduction : Anisometropia is a condition of asymmetric refraction between the two eyes. Adequate anisometropia treatment, such as SCL (Soft Contact Lens) is required to provide binocular vision, patient comfort and also adolescent’s appearance.
 Case Illustration : A 16 years old woman came to the RS Khusus Mata Sumatera Selatan. She complained of blurred vision since 6 years ago, and not feeling comfortable using spectacle. The ophthalmologic examination revealed that uncorrected visual acuity was 2/60 ph 6/12 for right eye and on left eye is 6/30 ph 6/7.5. Best corrected visual acuity was 6/6 using S-7.00 on the right eye and left eye was 6/6 using correction S-3.00 but she was not comfortable. The base-curve measurement of the SCL was 8.60 mm for the both eyes and the diameter was 14.2 mm. After the contact lenses attached , obtained that S-7.00 D for the right eye and S-3.00 for the left eye could reach 6/6 in both eyes, she was more comfortable wearing SCL than spectacle.
 Discussion : Anisometropia can cause aniseikonia which is characterized by differences in the size of the image in the two eyes. One way to reduce aniseikonia by reducing the vertex distance, soft contact lenses canbe a choices to maintain binocular vision and minimalized the aniseikonia. Contact lenses significantly improved Adolescent’s appearance and activities, which lead to an overall improvementin satisfaction with vision correction, compared using spectacle.
 Conclusion : SCL is one of a good option for Adolescent with anisometropia that can provide good visual acuity, and also adolescent’s appearance.

THE EFFECTIVENESS OF INTRAVITREAL ANTI-VEGF INJECTION IN EALES' DISEASE: A CASE REPORT

Introduction : Eales’ Disease (ED) is an idiopathic inflammatory retinal vasculitis, affecting retinal veins of small and large caliber that results in extraretinal neovascularization with vitreous hemorrhage. The etiopathogenesis of ED is poorly understood. However, many studies have attributed inflammation as a response to mycobacterium tuberculosis. Treatment of this disease can be done with corticosteroids, anti-VEGF therapy, laser photocoagulation, and vitreoretinal surgery.
 Case Illustration : We reported a patient, a 31-year-old woman with complaints of blurred vision and floaters in both eyes. An initial examination showed the visual acuity of the RE was 0,1F1 and the LE was 0,1. Examination of the posterior segment found perivascular exudate and peripheral retinal neovascularization. We performed an OCT examination on both eyes and found that there was extensive macular edema, especially in the RE. Patient was diagnosed with ED and received steroidsas an initial treatment. But there was no improvement in both eyes. In addition, patient received two anti-VEGF injections in the RE and one injection in the LE and showed good improvement. After that injection, the posterior segment showed very minimal lesions on the macula and repeated OCT results showed normal central macular thickness.
 Discussion : Anti-VEGF may also play a role in the treatment and management of ED. This is because, besides inflammation, there is an increased expression of VEGF in vitreous patients with ED. Several case reported there is significant improvement in anti-VEGF injection in the management of patients with ED.
 Conclusion : Intravitreal anti-VEGF injection shows good results in ED that did not improve with steroid treatment.

ACETAZOLAMIDE INDUCED SECONDARY ANGLE CLOSURE GLAUCOMA: A RARE CASE REPORT

Introduction : Drugs such as topiramate, acetazolamide, methazolamide, buproprion, and trimethoprim- sulfamethoxazole potentially cause an elevation of IOP. Drug-induced glaucoma may be an ophthalmic emergency if not treated promptly and can results in permanent visual loss.
 Case Illustration : A 36-years-old female came to Glaucoma Unit at Cicendo National Eye Hospital with progressive blurred vision since 1 year ago, worsening in the past six months. Accompanying symptoms included pain, headache, halo, and conjunctival hyperemia. She had been diagnosed with glaucoma and received timolol maleate, acetazolamide, and glycerin. Seven days later, her visual acuity worsened to 3/60 ph 0.15 RE and 2/60 ph 0.15 LE, with high IOP in both eyes, with the higher IOP being >30 mmHg. The cup-to-disc ratio was 0.3 RE and 0,8 LE. The anterior segment showed shallow anterior chamber, mid-dilated pupil, and conjunctival injection (Figure 1.). Gonioscopy examination showed Schwalbe line of both eyes (Figure 2.). Acetazolamide was stopped, and one week later the condition resolved (Figure 3.).
 Discussion : Secondary angle closure glaucoma caused by acetazolamide is important to consider because most people tolerate acetazolamide well. The mechanism of closed-angle glaucoma can be pupillary block and non-pupillary block. Non-pupillary block is caused by thickening, forward movement the iris-lens diaphragm, rotation of the ciliary body, and choroidal effusion. This process is an idiosyncratic reaction to certain systemic drugs.
 Conclusion : Few cases were reported about secondary bilateral angle closure glaucoma due to acetazolamide. Treatment of angle closure glaucoma involves stopping acetazolamide

Bilateral Anterior and Posterior Lens Dislocation in Marfan Syndrome in Teenager : A Case Report

Introduction : The zonular defect leads to ectopia lentis, which is a hallmark of Marfan ocular abnormalities. Bilateral dislocation of lens in marfan’s syndrome occurs frequently in same location. In this case the lens of RE dislocated in the anterior chamber and the lens of LE was found in vitreous cavity. Iris fixation IOL and Yamane’s scleral fixation technique are prompt treatment for crystalline lens displacement.
 Case Illustration : A 14 year-old male patient came with chief complaint a painless blurred vision on LE since 2 weeks before visit Ophthalmologist. The BCVA in both eyes was 6/30 RE and 1/60 LE. There was no history of ocular injury nor development disorder. Lens dislocation in anterior chamber was found in RE and aphakic lens was found in LE during slit lamp examination. The IOP ODS were 9.7 mmHg and 3.0 mmHg. Further examination from funduscopy showed the lens of LE was seen in vitreous cavity.
 Discussion : Bilateral dislocation of lens in opposite position are quite rare. To avoid many of the potential complications, Iris Fixation IOL placement is preferred choice to improve visual impairment on the right eye. Yamane’s Scleral Fixation technique has been performed on left eye however challenging and time consuming it is, to achieve excellent improvement with minimal or no intra- and postoperative complications.
 Conclusion : This case shows that manifest of crystalline lens in marfan syndrome could happen differently to each eye. Different surgical approach especially IOL placement technique is crucial and must be considered carefully depends on the condition during surgery.

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.
 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.
 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.
 Conclusion : Recurrences in toxoplasma chorioretinitis affect visual acuity, and even with adequate therapy, recurrence is possible.

Ocular manifestations of granulomatosis with polyangiitis: report from a tertiary eye care center.

To report demographic characteristics and ophthalmological manifestations of patients with granulomatosis with polyangiitis (GPA) in a tertiary eye care center in Turkey. Medical records of patients with GPA-related ocular manifestations evaluated between 2013 and 2023 were included. Demographic and clinical characteristics of the patients including nature of systemic involvement, ophthalmologic symptoms and signs, laboratory investigations and treatment modality were reviewed. Twelve eyes of 10 patients (5 female/5 male) were included. The mean age was 57.2 ± 12.2 (35-71) years. Five (50%) patients were already diagnosed with GPA. Ocular involvement was the first manifestation of GPA in 3 patients. The remaining 2 patients had simultaneous systemic and ocular symptoms at presentation. Conjunctival hyperemia (9 eyes) and pain (7 eyes) were the most frequent presenting symptoms followed by blurred vision (3 eyes). The frequencies of ocular manifestations were as follows:episcleritis (3 eyes), isolated peripheral ulcerative keratitis (PUK) (3 eyes), scleritis (3 eyes), simultaneous PUK and scleritis (2 eyes) and periorbital mass (1 eye). Ophthalmological manifestations can be the initial findings in GPA. Since GPA can affect different structures of the eye, it sometimes might be challenging for ophthalmologists. Therefore, it is crucial for ophthalmologists to be well-informed about GPA-related ocular findings and to have a high index of suspicion for GPA. Although PUK associated with scleritis is highly suggestive for GPA, isolated cases of PUK or scleritis can be seen in GPA. Therefore, it is important to adopt a multidisciplinary approach, consider GPA in differential diagnosis, and benefit from accurate diagnostic tests.

Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report

BackgroundCardiac catheterization and endovascular procedures are extensively used in modern medicine, and procedural stroke is one of the major complications that the catheterization laboratory team may face in their everyday work. Recognizing the signs and symptoms of procedural stroke is crucial to ensuring appropriate management. We herein report a case of internuclear ophthalmoplegia that caused blurred vision, diplopia, and dizziness on lateral gaze as an unusual presentation of procedural stroke.Case presentationA 60-year-old Thai woman underwent right partial colectomy and was diagnosed with stage IV diffuse large B-cell lymphoma. Pre-chemotherapy echocardiography revealed mild left ventricular systolic dysfunction, and she therefore underwent diagnostic catheterization. Coronary angiography revealed normal coronary arteries, leading to a diagnosis of non-ischemic cardiomyopathy. After the procedure, she immediately developed dizziness and diplopia. During the right lateral gaze, she exhibited impaired adduction of the left eye and horizontal nystagmus of the right eye. A diagnosis of left internuclear ophthalmoplegia was made. Magnetic resonance imaging revealed a tiny area exhibiting characteristics of an acute infarct in the left paramedian midbrain, including the left medial longitudinal fasciculus, which explained the clinical picture. Another region of restricted diffusion indicating an acute infarct was detected in the right inferior cerebellar hemisphere. Magnetic resonance angiography revealed no significant cerebral artery disease. The patient achieved full neurological recovery 6 weeks after symptom onset.ConclusionThis report describes an uncommon presentation of procedural stroke that is likely to be misdiagnosed, especially by medical staff unfamiliar with internuclear ophthalmoplegia. Despite the good prognosis of internuclear ophthalmoplegia, appropriate stroke care is crucial in patients with procedural stroke because of the risk of multiple brain infarcts.

A reliable diabetic retinopathy grading via transfer learning and ensemble learning with quadratic weighted kappa metric

The most common eye infection in people with diabetes is diabetic retinopathy (DR). It might cause blurred vision or even total blindness. Therefore, it is essential to promote early detection to prevent or alleviate the impact of DR. However, due to the possibility that symptoms may not be noticeable in the early stages of DR, it is difficult for doctors to identify them. Therefore, numerous predictive models based on machine learning (ML) and deep learning (DL) have been developed to determine all stages of DR. However, existing DR classification models cannot classify every DR stage or use a computationally heavy approach. Common metrics such as accuracy, F1 score, precision, recall, and AUC-ROC score are not reliable for assessing DR grading. This is because they do not account for two key factors: the severity of the discrepancy between the assigned and predicted grades and the ordered nature of the DR grading scale. This research proposes computationally efficient ensemble methods for the classification of DR. These methods leverage pre-trained model weights, reducing training time and resource requirements. In addition, data augmentation techniques are used to address data limitations, improve features, and improve generalization. This combination offers a promising approach for accurate and robust DR grading. In particular, we take advantage of transfer learning using models trained on DR data and employ CLAHE for image enhancement and Gaussian blur for noise reduction. We propose a three-layer classifier that incorporates dropout and ReLU activation. This design aims to minimize overfitting while effectively extracting features and assigning DR grades. We prioritize the Quadratic Weighted Kappa (QWK) metric due to its sensitivity to label discrepancies, which is crucial for an accurate diagnosis of DR. This combined approach achieves state-of-the-art QWK scores (0.901, 0.967 and 0.944) in the Eyepacs, Aptos, and Messidor datasets.

Frequency of Optic Refractive Changes during Third Trimester of Pregnancy

Objective: To determine the frequency of optical refractive changes (myopia, hypermetropia) during third trimester of pregnancy.
 Material and method: This cross-sectional study recruited 86 participants who had pregnancy in third trimester of mean age 25 to 40 years of age and who are not diabetic, hypertensive and spectacle users in Eye OPD of Shalamar Hospital, Lahore. Their visual acuity for distance was determined by Snellen chart and Retinoscope. Chi-square was used for the comparison of qualitative variables.
 Results: VA and refractive errors are the physiological changes during pregnancy, they are mostly transient and resolved after postpartum. The results of this study showed the frequency of myopia was 91.9% and hypermetropia was 8.1%. So, the myopia was the refractive error that is mostly reported during third trimester of pregnancy with symptoms of blurred vision, headache, itching.
 Conclusion: Pregnancy causes refractive error and progressive reduction in visual acuity for distance and there is slight change in visual acuity for near. Myopia was the commonest refractive error during third trimester of pregnancy. The main symptoms reported during third trimester of pregnancy were blurred vision, itching and headache.

Cybersickness in People with Multiple Sclerosis Exposed to Immersive Virtual Reality.

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0-6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild-moderate disability (i.e., EDSS in the range of 2.5-6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0-2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild-moderate disability) and COP path length relating to the use of VR (pwMS with mild-moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.

DEL-1: a promising treatment for AMD-associated ER stress in retinal pigment epithelial cells

BackgroundAge-related macular degeneration (AMD) is an irreversible eye disease that can cause blurred vision. Regular exercise has been suggested as a therapeutic strategy for treating AMD, but how exercise improves AMD is not yet understood. This study investigated the protective effects of developmental endothelial locus-1 (DEL-1), a myokine upregulated during exercise, on endoplasmic reticulum (ER) stress-induced injury in retinal pigment epithelial cells.MethodsWe evaluated the levels of AMPK phosphorylation, autophagy markers, and ER stress markers in DEL-1-treated human retinal pigment epithelial cells (hRPE) using Western blotting. We also performed cell viability, caspase 3 activity assays, and autophagosome staining.ResultsOur findings showed that treatment with recombinant DEL-1 dose-dependently reduced the impairment of cell viability and caspase 3 activity in tunicamycin-treated hRPE cells. DEL-1 treatment also alleviated tunicamycin-induced ER stress markers and VEGF expression. Moreover, AMPK phosphorylation and autophagy markers were increased in hRPE cells in the presence of DEL-1. However, the effects of DEL-1 on ER stress, VEGF expression, and apoptosis in tunicamycin-treated hRPE cells were reduced by AMPK siRNA or 3-methyladenine (3-MA), an autophagy inhibitor.ConclusionsOur study suggests that DEL-1, a myokine, may have potential as a treatment strategy for AMD by attenuating ER stress-induced injury in retinal pigment epithelial cells.

Cancer-associated retinopathy as an initial presentation of gynecologic small-cell carcinoma

Abstract: A 56-year-old female presented with bilateral progressive blurred vision over 1 month. She has no known malignancy before her initial visit to our ophthalmologic clinic. Her best-corrected visual acuity decreased to hand motion from 30 cm in both eyes. Optical coherence tomography exhibited parafoveal thinning of outer retinal layers bilaterally. Fluorescein angiography and indocyanine green angiography disclosed hypofluorescent spots in late phase in both eyes. The suspicion of cancer-associated retinopathy (CAR) prompted us to investigate and refer for further systemic disease including occult malignancy. The patient was diagnosed with small-cell carcinoma of the endometrium or cervix, which is an extremely rare and aggressive neuroendocrine tumor. The patient was treated with oral prednisone with improved visual acuity. The patient expired from sepsis 2 months after her initial visit to our ophthalmologic clinic. In selected cases, CAR may present before the diagnosis of primary cancer. It is essential to recognize its ophthalmic manifestation for early discovery of primary malignancy.

Myopia Control Combination to Slow The Progression of Myopia

Myopia is the most common refractive eye disorder in the world. Myopia is characterized by the inability of the eye to focus light on the retina, resulting in blurred distance vision. The purpose of this study is to understand the effectiveness of various methods or combinations of myopia control that can be used to slow or prevent the progression of myopia. This study used the Systematic Literature Review research method. The data collection technique in this study was carried out by literature study by exploring scientific journals, articles, books, and related publications contained in recognized databases, such as PubMed, Google Scholar, Scopus, and so on. The data that has been collected is analyzed through three stages, namely data reduction, data presentation and conclusion drawing. The results showed that the combination of controls to slow myopia include orthokeratology, environmental modification, low-level red-light therapy, antimuscarinic agents, increasing outdoor time and combination therapy.

Aflibercept treatment for delayed retinotomy-associated choroidal neovascularization: A case report and literature review

Abstract: A 67-year-old male presented to our clinic with sudden onset of blurred vision and metamorphopsia of his left eye for 2 weeks. He had a history of combined rhegmatogenous retinal detachment and vitreous hemorrhage and underwent an uneventful pars plana vitrectomy, 360° scleral buckling, and drainage retinotomy for his left eye 3 years ago. The anatomic and visual outcomes after surgery were good, without complications. On examination during this visit, an orange–red subretinal mass connected to the previous drainage retinotomy scar was noted. Spectral-domain optical coherence tomography revealed severe subretinal fluid with type-2 choroidal neovascularization (CNV) mass at the superior nasal macular area in connection with the margin of the previous retinotomy scar. Fundus fluorescein angiography showed an active CNV. The patient underwent monthly intravitreal aflibercept in the left eye. After four doses of aflibercept, his CNV regressed with no recurrence on follow-up at 20 months. In conclusion, iatrogenic CNV is a rare complication following uneventful vitreoretinal surgery and can develop years after the operation. It is crucial to early diagnose and treat it with intravitreal antivascular endothelial growth factor treatment for a favorable outcome and long-term remission.

Paracentral acute middle maculopathy as the first sign of internal carotid artery dissection

Purpose: It is proposed to present a clinical case of a patient with a paracentral acute middle maculopathy (PAMM) as the first sign of presentation of severe internal carotid artery (ICA) dissection.Methods: An initial basic ophthalmologic examination of the patient was performed, followed by an optical coherence tomography (OCT) and an OCT‐angiography (OCT‐A) of each eye. Finally, the patient was evaluated by a neurologist, performing a cerebral and supra‐aortic trunks (SAT) computed tomography (CT) angiography.Results: We present a 54‐year‐old patient who came to the emergency room complaining of central blurred vision in his left eye (OS) during 24 h. On ophthalmological examination, it is remarkable a visual acuity (VA) of counting fingers at 1 m in OS. Eye fundus (EF) of OS showed small oval whitish macular lesions. Macular OCT of OS revealed hyperreflective bands in the internal nuclear layer (INL) and OCT‐A showed areas with low flow at deep capillary plexus (DCP) and macular vascular density (MVD) parameters decreased compared to the right eye (OD). During the examination, the patient began to feel a slight loss of strength in his right hemibody with dizziness, so he was explored by a neurologist and a cerebral and SAT CT angiography was performed, which reported severe left ICA dissection with an area of hypoperfusion in the territory of the left middle cerebral artery, but without intracranial vascular occlusion. Since there was no image of occlusion and given the mild neurological symptoms, endovascular treatment was rejected and anticoagulation with enoxaparin was established. Two months later, VA of OS improved to 1, with no significant lesions in the EF. The OCT of OS showed a slight thinning of the INL and the OCT‐A revealed a greater flow in the DCP with better MVD values.Conclusions: This entity should be considered in patients with visual disturbances. PAMM may be the first sign of ICA pathology.

A Case of Corneal Melt and Perforation Associated with Rheumatoid Arthritis Managed by Corneal Patch Graft

Corneal melt is a rare yet severe complication of Peripheral Ulcerative Keratitis (PUK), observed in patients with Rheumatoid Arthritis (RA). The mortality rate associated with corneal melt is high, warranting aggressive treatment. A 50-year-old female, a known case of RA for 20 years, presented with complaints of blurred vision, watering, irritation, and photophobia in both eyes for the last year, with worsening symptoms in the Right Eye (RE) for the past 15 days. She was diagnosed elsewhere in a private hospital with RE corneal melt and perforation and inferior corneal thinning in the Left Eye (LE), with an ulcer defect. She underwent corneal perforation suturing in the RE before reaching the present facility. On examination, a sutured corneal perforation was present in the RE, and corneal thinning and melt were seen para-centrally and inferiorly in the LE. Surgical treatment with RE corneal patch graft repair was performed. The patient was given oral methotrexate and prednisolone for aggressive systemic control of RA and to ensure the survival of the patch graft. The vision in the RE improved following the procedure, maintaining the tectonic integrity of the cornea. On follow-up, aleucomatous opacity was noted in the RE patch graft tissue. Corneal thinning in the LE was treated topically with artificial tears and antibiotic eyedrops, which eventually healed, forming macular corneal opacity. Overall, corneal patch graft repair enabled the maintenance of tectonic support and corneal integrity, as well as vision improvement in the patient with RA presenting with the complication of corneal melt and perforation.

Challenges in The Management of Ocular Syphilis in Human Immunodeficiency Virus Patient: A Case Report

Background: The incidence rate of syphilis has been increasing in recent years. Ocular syphilis can manifest at any stage of syphilis, either with or without Human Immunodeficiency Virus (HIV) co-infection. Case Illustration: A 52-year-old man presented with a complaint of blurred vision persisting for the past 6 months. Visual examination revealed NLP (no light perception) in the right eye and 6/30 in the left eye. Syphilis serology testing was positive. Patient were diagnosed with latent syphilis with ocular syphilis, along with stage I HIV infection. Patient were treated with benzathine penicillin also with antiretroviral therapy for the HIV infection. Conclusion: Syphilis and HIV often occur together and can influence each other. Syphilitic ulcers can serve as the port of entry for HIV infection. In HIV-infected individuals with syphilis, the symptoms of syphilis can be varied due to the immunocompromised state. Benzathine penicillin G is a first-line therapy for ocular syphilis.

Novel A-type scleral suture technique for sulcus-fixated intraocular lens tilt

This report describes the first use to the authors' knowledge, of a simple technique for repositioning a tilted intraocular lens (IOL) after scleral fixation. A 76-year-old woman presented with sudden blurred vision in the right eye. She had previously undergone IOL scleral fixation due to traumatic cataract and acute angle-closure glaucoma. IOL tilt was revealed on examination, and repositioning was performed with polypropylene sutures across the pupil from limbus to limbus by forming an A shape to stabilize the IOL and prevent rotation. 6 months after the repositioning surgery, the IOL was well positioned and the patient's corrected distance visual acuity improved from counting fingers to 20/25. This surgical technique was successfully performed for a patient with IOL tilt. It decreased operative time and corneal damage while increasing IOL stability. The procedure was a safe and effective alternative to IOL exchange for a patient with inadequate capsular support.

Digoxin‐induced retinal toxicity after acute kidney injury in a patient with dilated cardiomyopathy: A case report

Aims/Purpose: We would like to report a case of digoxin‐induced retinal toxicity.Methods: Observational case report. Clinical follow‐up was performed using optical coherence tomography and electroretinography.Results: A 50‐year‐old female patient was referred to our clinic with symptoms of blurred vision and a whitening of the central visual field. She had no prior ophthalmic history but had underlying diseases including hypertension, hyperlipidaemia, dilated cardiomyopathy, systemic lupus erythematosus and chronic kidney disease. She had been admitted to the department of nephrology due to acute renal impairment, presenting with flank pain and oliguria. At the initial examination, her best‐corrected visual acuity was 0.5 in the right eye and 0.4 in the left eye. The Ishihara colour vision test revealed 3/17 and 1/17 in the right and left eye, respectively. Optical coherence tomography showed blurring and thickening of the ellipsoid zone in both eyes. Electroretinography demonstrated decreased cone cell function. She had been taking digoxin 0.125 mg for dilated cardiomyopathy for the past 2 years. Following the onset of acute renal impairment, her serum digoxin level was found to be 2.95 ng/mL, more than twice the normal range [0.6–1.2]. Suspecting digoxin intoxication, we consulted with her cardiologist and decided to discontinue digoxin. 3 weeks after discontinuing the medication, she reported improvement in the whitening of central visual field. Her best‐corrected visual acuity improved to 0.7 in the right eye and 0.6 in the left eye, and the Ishihara colour vision test showed 16/17 in both eyes. OCT demonstrated normalization of the ellipsoid zone thickness, and ERG showed ongoing recovery of cone cell function.Conclusions: Digoxin toxicity is known to result in visual disturbances—including decreased visual acuity, blurry vision and central scotoma with altered colour perception—caused by direct dysfunction of photoreceptors. Symptoms are gradually recovered within days to months after discontinuation of the medication. When facing visual problems in a patient with comorbidities, it is important to elicit a complete history, with all drug and detailed complaints, and to include a drug adverse effect. If a drug intoxication was suspected, medical consultations should be obtained.

Balint syndrome: an unusual triad

The paper investigates a case of sudden loss of vision in a patient with recent history of blurred vision of right eye diagnosed with Central retinal artery occlusion (CRAO). The point of interest of this case report is that the clinical features are something different from those of a CRAO and revealed cardinal triad of simultanagnosia, optic ataxia, and oculomotor apraxia which are conclusive of a rare clinical entity known as Balint syndrome.