Deep Anterior Chamber Research Articles

Drug-induced myopia mimicking angle closure glaucoma – A diagnostic dilemma

A 17-year-old female patient presented with complaints of acute onset of headache with bilateral eye pain since 1 day, associated with H/O blurring of vision in both eyes. No H/O redness or watering of eyes, ocular trauma. Patient has H/O migraine for which she was on Sumatriptan. No H/O of any chronic illness or chronic medication. No H/O of any previous spectacle use or ocular treatment. The visual acuity in both eyes was recorded 5/60 with improvement with pinhole to 6/18. Subjective correction showed myopia of -4 D in right eye and -3D in left eye. The IOP measurement was 58 mm Hg in both eyes. Gonioscopy showed closed angles in both eyes. Ocular alignments were orthophoric and extraocular movements were free and full in all directions of gaze. Anterior segment examination of both eyes showed shallow anterior chamber. Undilated examination of fundus of both eyes was normal. Sumatriptan was stopped and patient was started on topical anti glaucoma drug and aqueous suppressant. Within a week of commencement of treatment, patient improved symptomatically with complete resolution of myopia with vision in both eye 6/6 and IOP becoming normal with deepening of anterior chamber.

Primary angle-closed diseases recognition through artificial intelligence-based anterior segment-optical coherence tomography imaging.

In this study, artificial intelligence (AI) was used to deeply learn the classification of the anterior segment-Optical Coherence Tomography (AS-OCT) images. This AI systems automatically analyzed the angular structure of the AS-OCT images and automatically classified anterior chamber angle. It would improve the efficiency of AS-OCT image analysis. The subjects were from the glaucoma disease screening and prevention project for elderly people in Shanghai community. Each scan contained 72 cross-sectional AS-OCT frames. We developed a deep learning-based AS-OCT image automatic anterior chamber angle analysis software. Classifier performance was evaluated against glaucoma experts' grading of AS-OCT images as standard. Outcome evaluation included accuracy (ACC) and area under the receiver operator curve (AUC). 94895 AS-OCT images were collected from 687 participants, in which 69,243 images were annotated as open, 16,433 images were annotated as closed, and 9219 images were annotated as non-gradable. The class-balanced train data were formed from randomly extracting the same number of open angle images as the closed angle images, which contained 22,393 images (11127 open, 11256 closed). The best-performing classifier was developed by applying transfer learning to the ResNet-50 architecture. against experts' grading, this classifier achieved an AUC of 0.9635. Deep learning classifiers effectively detect angle closure based on automated analysis of AS-OCT images. This system could be used to automate clinical evaluations of the anterior chamber angle and improve efficiency of interpreting AS-OCT images. The results demonstrated the potential of the deep learning system for rapid recognition of high-risk populations of PACD.

Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report

BackgroundPosterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.Case presentationA 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.ConclusionsThis case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

Anterior chamber and angle characteristics in Chinese children (6–11 years old) with different refractive status using swept-source optical coherence tomography

BackgroundThe anatomic structure of the anterior chamber (AC) helps to explain differences in refractive status in school-aged children and is closely associated with primary angle closure (PAC). The aim of this study was to quantify and analyze the anterior chamber and angle (ACA) characteristics in Chinese children with different refractive status by swept-source optical coherence tomography (SS-OCT).MethodsIn a cross-sectional observational study, 383 children from two primary schools in Shandong Province, China, underwent a complete ophthalmic examination. First, the anterior chamber depth (ACD), anterior chamber width (ACW), angle-opening distance (AOD), and trabecular-iris space area (TISA) were evaluated automatically using a CASIA2 imaging device. AOD and TISA were measured at 500, 750 μm nasal (N1 and N2, respectively), and temporal (T1 and T2, respectively) to the scleral spur (SS). Cycloplegic refraction and axial length (AL) were then measured. According to spherical equivalent refraction (SER), the children were assigned to hyperopic (SER > 0.50D), emmetropic (-0.50D < SER ≤ 0.50D), and myopic groups (SER ≤ -0.50D).ResultsOut of the 383 children, 349 healthy children (160 girls) with a mean age of 8.23 ± 1.06 years (range: 6–11 years) were included. The mean SER and AL were − 0.10 ± 1.57D and 23.44 ± 0.95 mm, respectively. The mean ACD and ACW were 3.17 ± 0.24 mm and 11.69 ± 0.43 mm. The mean AOD were 0.72 ± 0.25, 0.63 ± 0.22 mm at N1, T1, and 0.98 ± 0.30, 0.84 ± 0.27 mm at N2, T2. The mean TISA were 0.24 ± 0.09, 0.22 ± 0.09mm2 at N1, T1, and 0.46 ± 0.16, 0.40 ± 0.14mm2 at N2, T2. The myopic group had the deepest AC and the widest angle. Compared with boys, girls had shorter AL, shallower ACD, narrower ACW, and ACA (all p < 0.05). By Pearson’s correlation analysis, SER was negatively associated with ACD, AOD, and TISA. AL was positively associated with ACD, ACW, AOD, and TISA. In the multiple regression analysis, AOD and TISA were associated with deeper ACD, narrower ACW, and longer AL.ConclusionIn primary school students, the myopic eyes have deeper AC and wider angle. ACD, ACW, AOD, and TISA all increase with axial elongation. ACA is highly correlated with deeper ACD.

A Case of Posner-Schlossman Syndrome following after Strabismus Surgery

Purpose: To report one case of Posner-Schlossman syndrome following after strabismus surgery.Case summary: A 21-year-old male patient with a previous history of scleral buckling due to rhegmatogenous retinal detachment in right eye, underwent left lateral rectus muscle recession and medial rectus muscle resection surgery for the intermittent exotropia. He complained of blurred vision and pain in the left eye starting from the day after the surgery. When he visited the clinic on the fourth day post-surgery, his best corrected visual acuity was 20/50 and intraocular pressure was 44 mmHg in the left eye. Slit lamp examination revealed corneal edema, 2+ anterior chamber cells, deep anterior chamber, and an open angle in the left eye. After treatment with antiglaucoma eyedrops and steroid eyedrops, the intraocular pressure decreased to 13 mmHg. There were no signs of recurrence during the two-month follow-up period.Conclusions: Posner-Schlossmann syndrome, which occurs after strabismus surgery, must be diagnosed early and treated immediately.

Double-Bubble Technique Assisted by Holding Forceps: A Modified Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes With Scleral Fixated Intraocular Lens.

Several techniques have been developed for graft unfolding approaches in Descemet membrane endothelial keratoplasty (DMEK). However, despite these techniques, graft deployment and configuration in eyes with deep anterior chambers remain challenging in some cases. Therefore, in this study, we described a modified technique for DMEK, known as the "double-bubble technique assisted by holding forceps." This was a retrospective interventional case series. Patients who underwent DMEK between August 2022 and July 2023, including cases with a history of vitrectomy and scleral fixation of intraocular lens, were enrolled in this study. Two experienced surgeons performed DMEK. In brief, after graft insertion into the anterior chamber, the first bubble with a small volume of air was injected above the graft to open the tight roll, and the graft edge was held using a 25-gauge graft manipulator. The second bubble was injected underneath the graft for fixation, while the graft edge was grasped using forceps during gas injection. The graft was released from the forceps. Best spectacle corrected visual acuity, central corneal thickness, endothelial cell density, and incidence of postoperative complications were measured before and after DMEK. Eleven eyes of 11 patients were included in this study (mean follow-up period, 4.5 ± 4.4 months). Best spectacle corrected visual acuity and central corneal thickness significantly improved postoperatively ( P < 0.001). Rebubbling was required in 2 eyes; no other postoperative complications or primary graft failure were observed. The present technique enables safe and feasible DMEK surgery in vitrectomized eyes with scleral fixated IOLs and in those with a deep anterior chamber.

Challanges Prepupillary Iris Claw Implantation In Irregular-Shaped Pupil

Introduction : For decades secondary implants carry a greater risk of high complications. The iris claw technique is popular because of the safe and fast IOL implantation. But, in this case there is a difficulty where the pupil shape is irregular so that it is a challenge for enclavation the haptic on the prepupillary iris.&#x0D; Case Illustration : A man, 39 YO, came with complaints of blurred right eye after surgery on the right eye 6 months ago. Vision 1/60 with pinhole reaching 20/70, , deep anterior chamber with VH 4, positive iris tremulans, with irregular shape in temporal regio where is the main port where the first operation was performed, not centrally located pupil. There was no intraocular lens found in the lens. The patient was planned for the installation of a Secondary IOL in the right eye with a prepupillary iris claw and endodiathermal pupilloplasty to returns the pupil to the central position. One day after surgery, visual acuity was 1/300, IOP was 30 mmHg and the descment fold. The anterior chamber is difficult to evaluate. 4 weeks after surgery, Vision was 20/70, cornea was clear and IOP was 17mmHg without the need for return surgery.&#x0D; Discussion : Until now, there is still no consensus regarding the best management options to correct aphakia without adequate lens capsule support. Endothermal diathermy pupilloplasty itself aims to create and maintain an appropriate pupil size.&#x0D; Conclusion : Even though there are complications, the installation of the iris claw on the prepupillary is still a safe technique for aphakic correction.

Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy

Introduction : Encephalofacial angiomatosis, also known as Sturge-Weber Syndrome (SWS), is a rare, non- hereditary condition affecting multiple organs. Glaucoma occurs in almost 70% SWS children, more commonly when the port-wine stain involves the upper eyelid skin. Secondary glaucoma was present due to elevated venous pressure.&#x0D; Case Illustration : An 8-year-old boy with typical port-wine stain involving eyelid, came with recurrent painful right eye (RE) and headache in the past 3 months. He was diagnosed with SWS at 1 year and was on daily doses of carbamazepine and valproic acid for seizure control. His best visual acuity and intraocular pressure were 0.5/60 RE, 6/38 LE, 38 mmHg RE, 28 mmHg LE, respectively. Examination revealed Cup-disc-ratio (CDR) 0.9-1.0 RE and 0.5-0.6 LE. During the first three months, he showed favourable outcome with timolol and latanoprost (controlled IOP with target of &lt;12 mmHg and markedly similar Cup-Disc Ratio). However, at 4th and 5th month visit, his IOP significantly increased despite of additional regiments, thus underwent trabeculectomy on both eyes for preserving his sight. After procedure, his IOP remained stable &lt;12mmHg with maintained bleb, deep anterior chamber, also attached posterior segment.&#x0D; Discussion : Treatments of secondary glaucoma of SWS typically involved surgery with significantly lower success rate compared to Primary Congenital Glaucoma. Trabeculectomy or tube shunt surgery should be performed with caution due to risks of choroidal effusion and hemorrhages.&#x0D; Conclusion : Secondary glaucoma in children with SWS is common and challenging. Trabeculectomy should be pursued when the benefit outweighs the risks, even with a slim chance, to preserve the vision.

Chamber shallowing technique for challenging DMEK cases: Tucking cellulose spears under the speculum to augment posterior pressure.

Some anterior chambers do not readily shallow because of insufficient posterior pressure and/or very deep anterior chamber anatomy, which can make unscrolling descemet membrane endothelial keratoplasty (DMEK) tissue more challenging with an unmodified tap technique. We present a hands-free method for augmenting posterior pressure by temporarily tucking cellulose sponges under the blades of the eyelid speculum. The sponges transfer some of the eyelid speculum's weight onto the bulbar surface posterior to the iris, thereby indenting the sclera and causing the iris diaphragm to bulge further forward. This hands-free technique can transform a potentially challenging DMEK case into a more straightforward one by facilitating both a shallow anterior chamber and a bimanual unscrolling technique. However, it only works in bicameral eyes with a vitreous body (e.g., an eye with penetrating keratoplasty, vitreous syneresis, and axial myopia) and will not work in unicameral eyes after vitrectomy (e.g., an eye with an Anterior Chamber Intraocular Lens (ACIOL)).

The effect of topical 1 % atropine on ocular dimensions and diurnal rhythms of the human eye

The effect of topical 1 % atropine on the diurnal rhythms of the human eye was investigated. Participants wore an activity monitor on Days 1–7. A set of measures (epochs) encompassing intraocular pressure (IOP), ocular biometry, and retinal imaging were obtained on Day 7 (baseline), followed by eight epochs on Day 8, and one on Day 9 from both eyes of healthy participants (n = 22, 19–25 years). The sleep time of participants (collected via actigraphy) was used as a reference in scheduling epochs. Topical 1 % atropine was instilled in the dominant eye on Day 8, 2 h after habitual wake time, using the fellow eye as control (paired-eye design). Sinusoids with a 24-h period were fitted to the data, and a non-linear mixed-effects model was used to estimate rhythmic statistics. There were no interocular differences in any of the measured parameters at baseline. Comparing pre- versus post-atropine in treated eyes revealed lower IOP, deeper anterior chamber (ACD), decreased crystalline lens thickness and shorter axial length (AL). The same trends were observed when comparing atropine-treated versus fellow control eyes, except for IOP and AL (no differences). Both atropine-treated and fellow control eyes showed significant diurnal variations in all ocular parameters, with atropine-treated eyes revealing larger AL and retinal thickness amplitudes, smaller vitreous chamber depth (VCD) amplitudes, and a significant phase advancement for ACD and VCD. There were no interocular differences in choroidal thickness rhythms. In conclusion, while ocular diurnal rhythms persisted after instillation of 1 % atropine, many rhythmic parameters were altered.

Influence of Ocular Biometry Parameters on the Predictive Accuracy of IOL Power Formulas in Patients with High Myopia.

The aim of this study was to investigate the influence of ocular biometry parameters on the predictive accuracy of 10 intraocular lens (IOL) power formulas in patients with high myopia (HM). We analyzed 202 eyes of 202 patients. The ocular biometry was determined preoperatively using an IOLMaster700. The associations between the biometry parameters and the prediction error (PE) 1month postoperatively were assessed. HM was defined as an axial length exceeding 26.50mm. In patients with HM (n = 108), the K6, Emmetropia Verifying Optical (EVO), Olsen, and Barrett UniversalII (BUII) formulas had the lowest absolute PEs among the 10 formulas. The ocular biometry parameters were not associated with the PE of K6, EVO, Olsen, or BUII. A longer axial length in HM eyes was associated with myopic outcomes by Kane, Hoffer QST, and VRF and hyperopic outcomes by Holladay2 and T2. Steeper keratometry, a deeper anterior chamber, and a thicker lens were associated with a hyperopic shift in HM eyes when using VRF, Kane, and Hoffer QST, respectively. In patients without HM (n = 94), there was no difference between the formulas in absolute PE. The significant associations between the biometry parameters and PE in patients with HM were not present in patients without HM. K6, EVO, Olsen, and BUII displayed high accuracy in HM eyes and were not influenced by preoperative biometry parameters. For the remaining formulas, the preoperative keratometry, anterior chamber depth, lens thickness, and axial length were possible error sources underlying an inaccurate IOL power prediction in patients with HM.

Bilateral Glaucoma Drainage Device (GDD) Implantation in Steroid Induced Glaucoma

Objective: This study aims to report a case of Bilateral Glaucoma Drainage Device (GDD) implantation surgery in a patient with Steroid Induced Glaucoma. Case Presentation: A 18-year-old male patient with steroid-induced glaucoma and allergic conjunctivitis. The patient also complained about red eyes and itchy in both eyes and had been using steroid eye drops for 5 years. The patient also complained about headaches and blurry vision. The patient had undergone trabeculectomy surgery 5 months ago on the left eye. The visual acuity was 6/6 on the right eye and 6/7.5 on the left eye. His intraocular pressure (IOP) on the right eye was 24 mmHg, and his left eye was 23 mmHg with conjunctival left eye bleb, flat, and fibrosis. The patient then underwent a non-valve Virna’s GDD implant surgery on the right eye. On day two post-GDD, the IOP was 4 mmHg, and the COA was shallow, so reform the COA. At the first month follow-up, the patient's right eye pressure was still in normal condition with no complications, and then the plan was for left eye Virna’s GDD implantation surgery. At the first month follow-up after left eye GDD implantation, the visual acuity was 6/9 on the right eye and 6/24 on the left eye, with IOP RE 11mmHg and LE 16mmHg, from anterior segment deep anterior chamber, no plate exposed, no leakage, and tube not attached to the corneal endothelium. The patient's intraocular pressure was still in normal condition in both eyes, and no complications was found, although the patient was still using low-dose topical steroid eye drops. Conclusion: In steroid-induced glaucoma, after trabeculectomy failure, the implantation of GDD is the most effective option in controlling high IOP and slowing down glaucoma progressivity.

The correlation of anterior segment structures in primary congenital glaucoma by ultrasound biomicroscopy with disease severity and surgical outcomes

PurposeTo evaluate the anterior segment structures using ultrasound biomicroscopy (UBM) in primary congenital glaucoma (PCG) and explore their correlation with disease severity and surgical outcomes.MethodsClinical information of PCG patients who underwent UBM prior to their first glaucoma surgeries from September 2014 to March 2021 were reviewed. The study included 214 UBM images of 154 PCG eyes and 60 fellow unaffected eyes. Anterior segment characteristics were analyzed. UBM parameters, including the iris thickness (IT) at variant distances from the pupil edge and iris root, anterior chamber depth (ACD), and pupil diameter (PD), were compared between two groups and their relationship with clinical factors and surgical outcomes were analyzed in PCG eyes.ResultsPCG eyes had unclear scleral spur, thin iris, wide anterior chamber angle, deep anterior chamber, rarefied ciliary body, elongated ciliary processes, and abnormal anterior iris insertion. ITs were thinner, ACD was deeper, and PD was larger in PCG eyes than fellow unaffected eyes (all P < 0.001). In PCG eyes, thinner ITs correlated with bilateral involvement and earlier age at presentation, and larger PD correlated with earlier age at presentation (P = 0.030) and higher intraocular pressure (P < 0.001). Thinner IT2 (P = 0.046) and larger PD (P = 0.049) were identified as risk factors for surgical failure.ConclusionUBM is a powerful technique to exam anterior segment structures in PCG. The anatomical features are associated with disease severity and surgical outcomes, providing essential clinical insights.

Nanophthalmos with angle closure glaucoma, a challenging case

Link of Video Abstract: https://youtu.be/eGhTbOkaaQI Introduction: Nanophthalmos basically is a simple microphthalmos with clinical characteristics of short axial length (AL), shallow anterior chamber (AC), high lens to eye volume ratio, small cornea and thick sclera, associated with angle closure glaucoma. We report a case of nanophthalmos with angle closure glaucoma and cataract who underwent trabeculectomy and end up with malignant glaucoma. Pars plana vitrectomy (PPV) and phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation was done to manage the case. Case Description: A 41-year-old man came with blurred vision in the right eye with redness and headache for 8 weeks. Intraocular pressure (IOP) was 46 mmHg, visual acuity was counting fingers at 2 m with nystagmus. Slit lamp examination revealed short axial length (AL), shallow anterior chamber (AC), small corneal diameter and high lens to eye volume. Trabeculectomy with 5FU was done with complication of malignant glaucoma. After PPV combined with phacoemulsification and PC IOL implantation, IOP was 14 mmHg, visual acuity 0.125 with deep AC. Conclusion: Surgical intervention in nanophthalmos with angle closure glaucoma must be managed with good preparation. Malignant glaucoma in this case can be managed with pars plana vitrectomy and phacoemulsification without scleral procedure.

Global risk factor analysis of myopia onset in children: A systematic review and meta-analysis.

This work aimed to comprehensively assess the risk factors affecting myopia in children to develop more effective prevention and treatment strategies. To this end, data from database were employed to assess the relationship between the incidence of myopia and its risk factors. We searched eight databases online in June 2022. Cohort studies were included that measured the connection between risk factors and myopia. Eligibility was not restricted by language. The Newcastle-Ottawa Scale (NOS) was used to measure the risk of bias and conducted GRADE evaluation to determine the certainty of evidence. Potential risk factors with positive or negative results were seen. Inplasy Registration: https://inplasy.com/inplasy-2022-4-0109/. Evidence that risk factors for myopia are mixed, comprising both positive (20) and null (17) findings. In 19 cohort studies on 3578 children, girls were more likely to develop myopia (RR: 1.28 [1.22-1.35]). Myopia can occur at any age, from early childhood to late adulthood. Children whose parents had myopia were more likely to develop myopia. Longer outdoor activities time (RR: 0.97 [0.95-0.98]) and less near-work time (RR: 1.05 [1.02-1.07]) appeared to be significantly decrease the incidence of myopia. Children with lower SE, longer AL, a lower magnitude of positive relative accommodation, worse presenting visual acuity, deeper anterior chamber, and thinner crystalline lens may be related to myopia onset. The burden of myopia in underprivileged countries is higher than in developed countries (RR: 5.28 [2.06-13.48]). The quality of evidence for the evaluated factors was moderate to low or very low. Genetic factors, environmental factors (such as excessive use of electronic products, and poor study habits) and lifestyle factors (such as lack of outdoor activities, poor nutrition, etc.) are the main risk factors for myopia in children. Myopia prevention strategies should be designed based on environmental factors, gender, parental myopia and eye indicators in order to explore a lifestyle that is more conducive to the eye health of children.

An investigative study on the correlation between refractive status and ocular biometric parameters in 3-6-year-old children in Shunyi District, Beijing, China

Objective: To investigate the relationship between refractive status and ocular biometric parameters in preschool children in Shunyi District, Beijing. Methods: This cross-sectional study employed a random cluster sampling method to measure the ocular axial length (AL), corneal curvature(CR), anterior chamber depth, and horizontal corneal diameter (WTW) using an optical biometer in 3-6-year-old children from 11 kindergartens in Shunyi District, Beijing. The ratio of AL to corneal curvature radius (AL/CR) was calculated. Cycloplegic refraction was performed using 1% cyclopentolate, and the equivalent spherical diopter (SE) was calculated. Ocular biometric parameters were compared among different age groups and refractive statuses. Correlation and regression analyses were conducted between SE and ocular biometric parameters. Results: A total of 1, 142 children completed the examination, with a mean age of (4.52±0.87) years, including 119 three-year-olds, 487 four-year-olds, 362 five-year-olds, and 174 six-year-olds. Among them, 554 were boys and 588 were girls. The mean SE of the examined children was (1.19±0.81) D, AL was (22.27±0.67) mm, corneal curvature radius was (7.73±0.25) mm, and the anterior chamber depth was (3.33±0.67) mm. The mean SE for three-, four-, five-, and six-year-old children was 1.18, 1.19, 1.21, and 1.13 D, respectively. SE showed correlations with AL, AL/CR, and anterior chamber depth (r=-0.350, -0.542, -0.083; all P<0.05), but no correlation with WTW or corneal curvature radius (P>0.05). Among children with different refractive statuses, SE showed stronger correlations with AL and AL/CR in myopic, hyperopic, and highly hyperopic children compared to emmetropic children, and the correlation tended to be stronger with increasing age. The linear regression equations for SE and AL, AL/CR were SE=10.64-0.42·AL and SE=21.48-7.043·AL/CR, respectively. Conclusions: The refractive status of 3-6-year-old children in Shunyi District, Beijing, showed minimal changes. Myopic children had longer AL, deeper anterior chamber, and slightly steeper cornea.

Hypocalcemic cataract secondary to idiopathic hypoparathyroidism in an adolescent.

Idiopathic hypoparathyroidism is a rare endocrine disorder characterized by hypocalcemia secondary to inadequate parathyroid hormone secretion. Hypocalcemia-related cataract is most often observed in patients with postoperative hypoparathyroidism, whereas primary hypoparathyroidism-related cataract is rare and displays slow progression. Cataract usually occurs in people aged 18 to 50 years. Here, we describe a 17-year-old boy with bilateral cataract and a history of hypocalcemic tetany who was diagnosed with idiopathic hypoparathyroidism. Phacoemulsification with implantation of a monofocal aspherical intraocular lens was performed in the right eye; 6 months later, it was performed in the left eye. Elevated phosphorus and diminished calcium were observed in blood and aqueous humor. A deep anterior chamber, relatively thin central corneal thickness, large white-to-white distance, and thin lens were also observed. During follow-up, neither eye displayed intraocular lens decentration; best-corrected visual acuity was 20/20 in both eyes. These findings suggest that ophthalmologists should be vigilant when hypocalcemic tetany and cataract are present, especially in adolescents and young adults.

Choroidal detachment and hypotony following selective laser trabeculoplasty: a case report

BackgroundSelective laser trabeculoplasty (SLT) is relatively safe and effective in lowering intraocular pressure (IOP). However, although rare, complications can occur after SLT. This report describes a patient with choroidal detachment due to hypotony following SLT without anterior chamber (AC) inflammation.Case presentationA 67-year-old man was referred for elevated IOP in his left eye with advanced glaucomatous visual field loss. He had previously been diagnosed with idiopathic uveitic glaucoma in the left eye, for which he underwent laser iridotomy, trabeculectomy, and cataract surgery. At the first visit, the IOP of his left eye measured by Goldmann tonometry was 28 mmHg despite maximally tolerated medical treatment. SLT was performed in his left eye, resulting in an IOP of 7 mmHg 7 days later. At 3 weeks post-procedure, the patient experienced ocular pain and decreased visual acuity in his left eye. Slit-lamp examination revealed deep anterior chamber depth and no inflammation reaction, but the IOP in his left eye was 4 mmHg, and both fundus and B-scan ultrasonography showed serous choroidal detachment. All anti-glaucoma agents were stopped, and the patient was started on treatment with oral prednisolone and cyclopentolate eye drops. Three weeks later, choroidal detachment had resolved and the IOP in his left eye had stabilized at 8 mmHg. Follow-up 3 months later showed that the IOP in his left eye remained stable.ConclusionsChoroidal detachment-related hypotony is a rare complication of SLT. This possible complication following SLT should be informed to the patients and considered when performing the procedure.

A Rare Case of Abiotrophia defectiva Bleb Associated Endophthalmitis.

To report a rare case of Abiotrophia defectiva bleb associated endophthalmitis (BAE). In this case report of a patient with BAE, the authors describe the features of severe and rapid onset, associated retinitis, and a favorable outcome after aggressive early intervention. A 75-year old female presented that decreased visual acuity of hand motions with elevated intraocular pressure of 39 mm Hg in the left eye. Her past ocular history was notable for severe primary open angle glaucoma with uneventful trabeculectomy and cataract surgery in both eyes 7 years prior. Examination revealed conjunctival injection and an opaque avascular cystic bleb along with anterior chamber cellular reaction with a B-scan ultrasound concerning for vitritis. Abiotrophia defectiva was isolated from the vitreous tap within 48 hours and confirmed later with 16S ribosomal RNA sequencing. After initial vitreous tap and inject and subsequent PPV, her BCVA had improved to 20/500 at post operative week 1 and then improved to 20/40 at post-operative month 2. Her exam was notable for resolved corneal edema, a deep and quiet anterior chamber, and resolved intraretinal hemorrhages. This is one of the first BAE cases with rapid identification of Abiotrophia defectiva. Abiotrophia defectiva was isolated from the initial vitreous tap within 48 hours and confirmed with 16S ribosomal RNA sequencing. This case highlights that rapid identification of Abiotrophia defectiva may be indicative of a greater bacterial load and should prompt aggressive intervention and that the visual prognosis can be favorable.

Anterior segment optical coherence tomography characteristics and management of a unique spectrum of foreign bodies in the cornea and anterior chamber.

To report anterior-segment optical coherence tomography (ASOCT) characteristics of different types of corneal and anterior chamber (AC) foreign bodies (FBs) and their usefulness in diagnosis and management. This is a retrospective descriptive clinical study involving 11 eyes of 11 patients who presented at the outpatient department of a tertiary ophthalmic care center from January 2017 to January 2022. All patients had a diagnosed or suspected corneal FB. All participants underwent a comprehensive ophthalmological examination, followed by slit-lamp photography and ASOCT. FB removal was done where required by an external, internal, or combined approach. The mean age of patients was 28.2 (7-53) years. Ten were male, and one was female. Seven patients had a definitive positive history of injury; in one, there was a history suggestive of trauma, one had the post-operative complication of scleral buckling surgery, and two patients had a history of insect fall in the eyes. Three patients had acute, four had sub-acute, and four had chronic presentations. Descemet's membrane (DM) breach was suspected in three cases of deep FB, which was later confirmed on ASOCT. In two cases, DM was presumed to be intact clinically, but ASOCT showed an AC penetration. The FB was removed in seven patients, one via slit-lamp, one via an external approach, two via an internal approach, and three via a combined approach. ASOCT facilitates non-invasive rapid imaging of ocular tissue at various depths, provides an accurate assessment of FB characteristics, and thereby serves as an additional tool in our armamentarium for diagnosis and management of deep corneal and AC FBs.