Acuity In Eye Research Articles

A Recurrent Nocardial Corneal Ulcer

Purpose: To present a case of recurrent <i>Nocardia</i> keratitis following the use of topical steroids.Case summary: A 57-year-old man presented with decreased visual acuity and conjunctival injection in the right eye which began 15 days prior. Slit-lamp examination revealed epithelial defects smaller than the circular infiltrate and empirical topical treatment was initiated. Since the corneal lesion improved with a therapeutic contact lens and topical antibiotics, a steroid eye drop was added. After 7 days, the corneal infiltrate worsened in a wreath-like pattern with a positive result on a KOH (potassium hydroxide) smear, and antifungal eye drops were started. However, <i>Nocardia</i> species was confirmed on the 9th day of culture. While complete epithelial regeneration was achieved after 10 days using amikacin eye drops, steroid eye drops were reused to reduce the corneal haze. Twenty days later, the corneal infiltrate and epithelial defects reappeared adjacent to the initial opacity, and a culture confirmed <i>Nocardia</i>. Gradual improvement was achieved with amikacin eye drops and oral Septrin. Ultimately, a combination of moxifloxacin, tobramycin, and bromfenac eye drops was tapered over several months, resulting in healing with mild opacity.Conclusions: <i>Nocardia</i> keratitis commonly arises from trauma involving soil, progresses slowly, and is often misdiagnosed as a fungal infection. While amikacin eye drops proved effective, prolonged topical treatment is essential. Early steroid use should be considered cautiously, as it may lead to recurrence and worsening of the corneal lesion.

Low Vision Rehabilitation Referral Characteristics for Patients with Neovascular Age-Related Macular Degeneration.

Background: Despite evidence that low vision rehabilitation (LVR) services can improve visual function in patients with neovascular age-related macular degeneration (nAMD), many patients are not directed to access these resources. This study was conducted to determine factors associated with LVR referral and to assess the visual outcomes from completed evaluations. Methods: The study comprised a retrospective, cross-sectional analysis of patients with nAMD. Referrals for LVR services were extracted from the electronic health record (EHR). The effectiveness of each evaluation was determined by assessing the change in best corrected visual acuity (BCVA) achieved after distance refraction. Costs, quality-adjusted life years (QALYs), and incremental costs per-QALY-gained were calculated based upon the better-seeing eye by using a willingness-to-pay threshold of $50,000/QALY. Results: Out of 560 eligible patients with nAMD, 110 were referred for LVR (19.6%). Referral was more common for individuals who qualified as having low vision, based upon the visual acuity of the better-seeing eye (adjusted odds ratio [aOR], 3.214; 95% confidence interval [CI], 1.920-5.380, p < 0.001), had bilateral nAMD (aOR, 1.592; 95% CI, 1.017-2.492, p = 0.042), or had commercial health insurance compared to those who had Medicare (aOR, 2.887; 95% CI, 1.041-8.009, p = 0.042). Most patients referred completed LVR appointments (86%). More than half of the patients achieved improved BCVA for their better-seeing eye (53%) yielding an average gain of 0.04 QALYs/patient at a cost of $3504/QALY. The estimated net monetary benefit was $1704 per evaluation completed. Conclusions: Most patients with nAMD achieved improvements in visual function after low vision evaluation, yielding improvements in vision-related quality of life at a reasonable cost.

Association between dietary inflammatory index and visual impairment among adults in the NHANES 2005–2008

The association between the dietary inflammatory index (DII) and visual impairment remains unclear. This study aimed to investigate the relationship between the DII and non-refractive visual impairment among US populations. A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2008, including dietary information and visual impairment assessment. Participants with presenting visual impairment, defined as presenting visual acuity in the better-seeing eye worse than 20/40, were included. Participants whose visual acuity in the better-seeing eye could be corrected to 20/40 or better through automated refraction, were classified as having uncorrected refractive error, while others were considered to have non-refractive visual impairment. Logistic regression models, restricted cubic spline (RCS) analysis, subgroup analyses, and propensity score matching (PSM) were performed to assess the association between DII and the prevalence of non-refractive visual impairment. After adjusting for potential confounding factors, a positive association was observed between DII scores and the prevalence of non-refractive visual impairment (odds ratio [OR] = 1.277, 95% confidence interval [CI] = 1.017–1.603, P < 0.05). RCS analysis demonstrated that there was no nonlinear relationship between them (P for nonlinear > 0.05). Furthermore, sensitivity analysis by PSM indicated the robustness of this positive association. This study revealed a positive correlation between the DII and the prevalence of non-refractive visual impairment among those with presenting visual impairment in the United States. Further prospective studies are warranted to confirm a causal relationship and elucidate the underlying mechanisms involved.

The diagnostic challenge of orbital tuberculosis in an otherwise healthy individual: A case report

Ocular tuberculosis occurs in 1.5-18% of all extrapulmonary tuberculosis cases, with orbital tuberculosis being a very small proportion of all cases of ocular tuberculosis. High variability of manifestations of orbital tuberculosis may result in delayed diagnosis. Children are the populations most affected by this disease. This study aims to report a case of orbital tuberculosis in a patient without systemic tuberculosis symptoms. We presents a 13-year-old girl who is reported protrusion of the right eye for four months. She complained diplopia and pain in the right eye radiating to the head. She reported no other systemic symptoms. Ophthalmological examination revealed that her best corrected visual acuity of the right eye was 0.25, and the left eye was 1.0. The movement of the right eye was limited to the superior, temporal, and nasal directions. Anterior segment examinations demonstrated proptosis of the right eye with 3 mm of lagophthalmos. The patient then underwent an orbitotomy and biopsy procedure. Histopathological analysis revealed chronic granulomatous inflammation with Langerhans cells, indicative of tuberculosis. The patient was diagnosed with proptosis of the right eye and multiple cranial nerve palsy due to orbital tuberculosis. The patient was subsequently prescribed an antituberculosis treatment and attended regular monthly follow-ups. Ten months after surgery and completed antituberculosis treatment, the proptosis improves and there is no further growth of the mass. Orbital tuberculosis is a rare condition and is often challenging to diagnose, particularly in healthy individuals. Thorough history taking, physical examination, and ancillary testing are essential to establish an accurate diagnosis. This case emphasizes the necessity for heightened suspicion of tuberculosis in atypical presentations, particularly in pediatric patients in endemic areas, to prevent morbidity and ensure timely treatment.

Treatment of Anisometropic Amblyopia in Children with Refractive Correction

Background: Amblyopia, commonly caused by anisometropia, is a leading cause of monocular vision loss in children. This study evaluates the effectiveness of refractive correction alone in treating untreated anisometropic amblyopia. Aim of the study: The aim of the study was to evaluate the effectiveness of refractive correction alone in treating untreated anisometropic amblyopia in children. Methods: This prospective study, conducted from February to July 2007 at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University and the National Institute of Ophthalmology, involved 28 children (ages 3–7) with untreated anisometropic amblyopia. Spectacles were prescribed, and visual acuity was monitored every 5 weeks until stabilization or resolution. Acuity improvement was analyzed based on age, baseline VA, and anisometropia type and degree. Results: Most children had a VA of 20/80 (19%) or 20/63 (23%), with a mean VA of .60 logMAR (20/80). Post-treatment, 56% achieved 20/20 VA. By 25 weeks, 18 participants reached no further improvement (IOD &gt; 2) and 8 reached IOD ≤ 1. Resolution rates varied by age but were not significant. Anisometropia degree significantly impacted resolution, especially 57% in the 0.50–&lt;1.00 D group. Baseline amblyopic eye acuity significantly correlated with resolution, notably 67% in the 20/50 group. Spherical equivalent only (≥0.50 D) showed 25% resolution. Conclusion: Refractive correction alone improves visual acuity and resolves amblyopia in one-third of children aged 3 to &lt;7 years with untreated anisometropic amblyopia, particularly in moderate cases (20/40–20/100).

Objective Visual Acuity Estimates in Amblyopia Are More Accurate With Optotype-Based P300 Than With VEP Measurements.

Traditional visual acuity (VA) measurements depend on subjective responses, which can be unreliable, especially with uncooperative participants. Objective measurements with visual evoked potentials (VEP) address this issue but can overestimate VA in amblyopia. This study aims to establish the P300 component of the event-related potential as an objective VA test for amblyopia and compare its performance to subjective (psychophysical) and VEP-based VA estimates. Psychophysical, VEP-based, and P300-based VA estimates were obtained for amblyopic and fellow eyes of 18 participants (aged 19-65) in a bicentric study. VEP-based VA was determined from the spatial frequency threshold derived from occipital cortex pattern-pulse responses to check-sizes ranging from 0.048° to 8.95°. P300 responses were collected using visual oddball sequences with circular optotypes. The threshold was estimated from the sigmoid function of parietal P300 amplitude versus optotype gap size. Mean VA values for amblyopic eyes were compared across methods. VEP-based VA of the amblyopic eyes overestimated psychophysical VA by 0.18 ± 0.06 logMAR (P = 0.0016). In contrast, P300-based VA showed no significant difference from psychophysical VA (0.00 ± 0.04 logMAR, P > 0.05). In amblyopia, P300-based optotype VA aligns more closely with psychophysical VA than VEP-based VA, suggesting that P300-based VA is a valid objective alternative for estimating VA in amblyopic eyes. This study highlights the potential of P300-based VA testing as a reliable and objective method for assessing VA in amblyopic eyes, offering a promising tool for clinical and research applications where traditional methods fall short.

A Case of Cataract Surgery after Radial Keratotomy with Enhanced Monofocal Intraocular Lens Implantation

Purpose: To report on a patient who achieved good visual performance following cataract surgery with implantation of an enhanced monofocal intraocular lens (IOL) after a previous radial keratotomy decades earlier.Case summary: A 53-year-old male, previously seen at our medical center as a glaucoma suspect, presented with decreased visual acuity in the left eye. He had radial keratotomy for myopia correction in both eyes 30 years prior at another hospital. Before cataract surgery, the distant visual acuity of his left eye was 0.5, which could not be corrected. Slit-lamp examination revealed an NO2NC2C3 (Lens Opacities Classification System III) cataract. Phacoemulsification with an enhanced monofocal IOL (ICB00; Johnson &amp; Johnson Vision, Santa Ana, CA, USA) was performed on the left eye. One month postoperatively, uncorrected visual acuity in the left eye was 1.0 for all distances: far, intermediate (66 cm), and near (40 cm). At 3 months, uncorrected visual acuity was 1.0 for far, 0.8 for intermediate (66 cm), and 0.32 for near (33 cm).Conclusions: Eyes that have previously undergone radial keratotomy may qualify for the insertion of an enhanced monofocal IOL during cataract surgery.

Visual Outcome after Cataract Surgery in a Tertiary Eye Hospital in Southern Region of Bangladesh

Background: Vision is a very important sense for human life which is directly related with education, performance of work and quality of life. Worldwide cataract is considered one of the leading causes of blindness and visual impairment. Cataract surgery is one of the most commonly performed procedures in ophthalmology. Cataract extraction with intraocular lens (IOL) implantation is the only surgical approach available mostly in developing countries. Objective: This study aimed to evaluate the visual outcome who have had their cataract surgery in a tertiary level eye hospital. Method: Prospective interventional study was conducted from 1st January 2019 to 31st December 2019 at Sheikh Fazilatunnesa Mujib Eye Hospital &amp; Training Institute (SFMEHTI), Gopalganj. It was a hospital based study of consecutive cataract-operated patients who had age-related cataract with vision 6/24 or less before surgery. For surgery all the patients were evaluated including their relevant investigations with trained ophthalmologist and allowed as fit for surgery. Total 8776 patients who admitted in this hospital and fulfill the eligibility criteria were included in this study. Patients in age of 40 - 80 years were included in the study. The most common procedure was phacoemulsification (PE) with posterior chamber intraocular lens (PCIOL) 4704 (53.6%) followed by small incision cataract surgery (SICS) with posterior chamber intraocular lens (PCIOL) implantation, operated in4072 (46.4%) eyes. Most of the surgery was done by well-trained ophthalmologists; whereas few surgeries were done by young ophthalmologists under the supervision of senior ophthalmologist. Result: Among 8776 patients operated, the most common group was 40-60 years (65.5%). The mean age of the patients was 60.47 years. Male patients were more (52.8%). In post cataract surgery patients, 5967 (68%) eyes had presenting vision &gt;6/18. Visual acuity (VA) &lt;6/60 was found in 176 (2%) eyes. In 8600 (98%) eyes visual acuity (VA) was improved after best correction. Poor visual outcome was significantly associated with the patients who were in older age, gender female, literacy, hearing impairment and SICS&amp; PE surgery techniques. Conclusion: This study observed that good visual acuity can achieved in cataract surgery. More attention should be given towards monitoring of cataract surgical outcomes and correction of refractive error after surgery. It is also important to meet the WHO standard of visual outcome after cataract surgery. Central Medical College Journal Vol 8 No 1 January 2024 Page: 7-11

Retinal Racemosal Hemangioma Associated with Intracranial Vascular Malformation (Wyburn -Mason Syndrome) - Case Report.

To describe a case of Wyburn-Mason syndrome in a young child with initially declined treatment leading to delayed intervention. Case report. We report a 6-year-old boy with mild periocular trauma following a fall, who was incidentally found to have a retinal arteriovenous malformation (AVM) associated with a brain AVM, indicative of Wyburn-Mason Syndrome. The patient's visual exam was unremarkable except for a visual acuity of 20/150 in the right eye, corrected to 20/60, and 20/30 in the left eye, along with mild proptosis and facial asymmetry. Radiosurgical management was proposed but declined by the caregivers due to fear of complications. Eighteen months later, the patient presented with neurological deterioration, manifesting as left hemiparesis. The patient received antiangiogenic therapy with sirolimus (inhibitor of the mammalian target of rapamycin, mTOR) and underwent a catheter-based embolization procedure that partially occluded the brain AVM without complications. The patient showed partial recovery of strength but experienced a deterioration in visual acuity in the right eye to 20/400. This report highlights an extremely rare malformation that associates ocular and cerebral vascular malformations. It underscores the importance of correlating various signs and symptoms to suspect it and emphasizes the need for adherence and follow-up.

Quality of Life Survey Using NEI VFQ-25 in Japanese Patients With Fuchs Endothelial Corneal Dystrophy.

To assess the quality of life in Japanese patients with Fuchs endothelial corneal dystrophy (FECD) using The National Eye Institute Visual Function Questionnaire. Here, 34 patients with FECD (FECD group) and 13 healthy individuals (control group) completed the National Eye Institute Visual Function Questionnaire Japanese version by interview format. The association between dominant eye corrected distance visual acuity and composite score (component 11) or subscales in the FECD group was evaluated using Spearman rank correlation coefficient. The average age was 65.8±11.9 and 60.1±7.9 years in the FECD and control groups, respectively. Corrected distance visual acuity was significantly lower in the FECD group (0.021±0.21 logarithm of the minimum angle of resolution) than in the control group (-0.61±0.055 logarithm of the minimum angle of resolution) (P<0.0001). Composite scores were significantly lower in the FECD group (77.6±11.0) than in the control group (89.2±7.0) (P=0.0006). All subscale scores were lower in the FECD group, particularly for distance vision and mental health (81.4±13.1 and 84.0±15.6, respectively) than in the control group (90.7±12.0 and 95.7±5.7) (P=0.022 and P=0.0046, respectively). Corrected distance visual acuity in the dominant eye did not significantly correlate with composite scores or subscales in the FECD group. Quality of life is lower in patients with FECD than in healthy individuals, particularly regarding distance vision and mental health.

Simple ab externo lens capsule removal in intraocular lens reuse and intrascleral fixation for intracapsular lens dislocation: A case report.

This study aimed to report and recall a simple method to remove the lens capsule ab externo when performing intrascleral fixation of an intracapsular intraocular lens (IOL) dislocation with reuse of the IOL. A 43-year-old Japanese male patient underwent pars plana vitrectomy, phacoemulsification, and IOL fixation for rhegmatogenous retinal detachment in the right eye 10 years prior. A 3-piece IOL was intraocularly fixed during the initial procedure. In December 2023, the patient presented with intracapsular IOL dislocation in his right eye, causing the IOL to descend into the vitreous cavity enveloped by its entire capsule. During surgery, an intravitreal dislocated IOL was placed over the iris with the entire capsule. The haptics on 1 side of the IOL were placed outside the eye through the corneoscleral wound. Subsequently, the lens capsule and Soemmerring's ring surrounding the haptics were removed. After the haptics were placed back over the iris, the same extraction procedure was performed for the remaining haptics. The IOL was intrasclerally fixed using a flange technique through the intrascleral tunnel at the 4 and 10 o'clock positions. One week postsurgery, the best-corrected visual acuity of the right eye was 20/16, and the corneal endothelial cell density was recorded as 2923 cells/mm2 (preoperative: 1650 cells/mm2). In cases of 3-piece IOL dislocation, employing the ab externo technique for lens capsule extraction has been proven to be a straightforward and efficient method. This approach facilitates the removal of the lens capsule around the IOL. If subsequent damage to the IOL is identified, it allows for easy conversion to replacement.

Orbital apex syndrome secondary to sinusitis

The orbital apex disorders include superior orbital fissure syndrome, cavernous sinus syndrome, and orbital apex syndrome. A 50-year female patient presented to hospital with complaints of right eye heaviness since 3 days, decrease vision since 5 days. Right sided headache, right eye blurred vision, ptosis of right eye lid for 1 week. On ophthalmologic examination ptosis and blurred vision in right eye seen. Visual acuity in right eye shows counting fingers close to fingers (CFCF), exotropia, extraocular movements reduced. Computed tomography paranasal sinus (CT PNS) plain and contract showed bilateral sphenoid, right maxillary and right posterior ethmoid sinusitis. Magnetic resonance imaging (MRI) brain showed ill-defined type 2 hyper intensity at right orbital apex and right cavernous sinus showing moderate enhancement with adjacent dural thickening and abnormal enhancement of anterior clivus suggestive of Infective etiology. Right anterior and posterior ethmoidectomy, right fronto-spehenoidectomy, right orbital decompression done.

Four-year outcomes after intravitreal aflibercept for macular neovascularization in patients with pathologic myopia.

The natural course of the visual acuity in eyes with myopic macular neovascularization (myopic MNV) is poor. Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents have demonstrated safety and efficacy in the short-term for managing myopic MNV. The purpose of this study was to determine the 4-year outcomes of intravitreal aflibercept (IVA) injections. A retrospective monocentric study including 49 eyes of 48 patients diagnosed with myopic MNV. These patients underwent treatment with IVA using the pro re nata (PRN) regimen after the first injection. The minimum follow-up duration was 4 years. The patients had an average age of 63.8 years and an average axial length of 29.7 mm. The mean number of IVA injections was 1.6, and 30 eyes (61.2%) had a single injection. At the baseline and at 1-, 2-, 3-, and 4-years, the mean best-corrected visual acuities (BCVAs) were 20/45, 20/41, 20/43, 20/51, and 20/53, respectively. The differences in the BCVA at the different times from that at the baseline were not significant. IVA therapy with the PRN regimen provides a 4-year visual benefit in eyes with myopic MNV, and it is better than the reported natural course in maintaining the BCVA.

Association Analysis of Telomere Length and Vision in a Large Community-Based Survey

ABSTRACT Purpose To investigate whether there is a direct, age-independent association between telomere length and visual acuity decline in a large community-based cohort study. Methods Participants older than 40 with linked leukocyte telomere length (LTL) were enrolled in NHANES. LTL was assayed using qPCR from the participants’ blood samples. Best corrected visual acuity (BCVA) of the better-seeing eye was analyzed, with visual impairment (VI) defined as BCVA ≥ 20/40. LTL was grouped into quartiles, and its association with BCVA and VI was evaluated after adjusting for covariates. Results Among the 4,480 enrolled participants, the weighted means of age, BCVA, and telomere length were 56.1 ± 11.9 years, 0.05 ± 0.08 logMAR, and 5,662 ± 36 base pairs, respectively. The proportion of VI was 2.6%. After adjusting for covariates including sex, ethnicity, education, family poverty income ratio, general health status, hypertension, diabetes, smoking, and body mass index, BCVA was significantly worse in participants with shorter LTL, with a significant trend (p = 0.002). However, after further adjusting for age, the association between LTL and BCVA was no longer significant, without a trend (p = 0.640). No significant association or trend between LTL and VI was found in the stepwise logistic model. Conclusions No age-independent association between LTL and BCVA was found. Our study indicates LTL may not serve as a biomarker for age-related visual acuity decline.

Vision-Related Quality of Life After Fyodorov-Zuev Keratoprosthesis in China.

The purpose of this study was to assess vision-related quality of life (VR-QoL) and its determinants in patients with implanted Fyodorov-Zuev (MICOF) KPro. Eighty-eight patients with bilateral corneal blindness who underwent unilateral Fyodorov-Zuev (MICOF) KPro implantation were included in this cross-sectional study. VR-QoL was assessed using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Univariate analyses and multivariate linear regression were used to identify VR-QoL determinants. Eighty-eight patients, aged 50.00 ± 13.72 years, with a mean postoperative time of 5.13 ± 3.31 years, were included. The composite NEI-VFQ-25 score improved from 17.04 ± 5.60 to 46.00 ± 19.21 (P < 0.01) after Fyodorov-Zuev (MICOF) KPro implantation. The multivariate linear regression analysis results showed that the postoperative composite score was correlated with postoperative visual acuity (VA) of the operative eye (B = -21.66, P < 0.01). Improvement in NEI-VFQ scores was associated with better postoperative VA of the operative eye (B = -18.67, P < 0.01) and poorer preoperative VA of the fellow eye (B = 7.11, P < 0.05). VR-QoL in patients with bilateral corneal blindness was significantly impaired but improved after Fyodorov-Zuev (MICOF) KPro implantation. Improvement in VR-QoL was inversely associated with postoperative VA of the operative eye but positively correlated with preoperative VA of the fellow eye. This study affirmed that Fyodorov-Zuev (MICOF) KPro was an effective alternative for patients with corneal blindness with respect to VR-QoL.

Student Gadget Habits With Eye Disturbance And Visual Acuity

Vision is one of the problems that need to be considered because vision is crucial as it plays a vital role in various aspects of life, including the educational process. Vision is additionally a factor that contributes to a decline in an individual's quality of life. The increasing use of gadgets raises concerns about the negative effects it has on vision function. The objective of this research was to identify the relationship between the habit of using gadgets with physical eye complaints and visual acuity in students. The research design was cross sectional with a population of 196 with a sample of 100 respondents. The variable of habit of using gadgets was measured using a questionnaire, subjective complaints using a questionnaire and visual acuity was measured using the Snellen Chart. The statistical test used is Chi Square. The results showed that the majority of the habit of using gadgets was in the bad category (69%), the majority of the eye physical complaints were low (55%), and the majority of the visual acuity was normal (75%). The results of the chi square statistical test between the habit of using gadgets with physical eye complaints did not have a relationship (p = 0.648) and the relationship variable between the habits of using gadgets and visual acuity also had no relationship (p = 0.708). Several factors that are thought to influence this result are the age of the respondents, the majority of whom are teenagers (92%), the indicators in eye physical complaints are dominated by eye fatigue (60%) while other complaints have a low impact on complaints in general. Other physical complaints do not appear much. presumably because when the respondents felt tired, they rested their eyes. The decrease in visual acuity is a long-term damage, while the habit of using gadgets in the majority of respondents is classified as a bad habit, but due to other factors such as young age, nutritional intake, and maintained activity patterns can slow down the process of decreasing visual acuity. It is hoped that this research can develop how long the use of gadgets can have an impact on decreasing visual acuity.priority in various child health and education programs. With the right understanding and action, we can help create a healthier and more potential future generation.

A Case Report of Systemic Steroid Therapy for False Brain Tumors in Children

Study design: Case report. Purpose: to study the efficacy of systemic steroid in pediatric pseudotumor cerebri. Introduction: Pseudotumor cerebri is a condition caused by elevated intracranial pressure presenting most commonly with headache. It is a diagnosis of exculsion. Methods: A 15 year old girl presented in our OPD with headache since 3months, more in the posterior aspect, continuous type with severe intensity, non - radiating. On examination, her best corrected visual acuity in right eye was 6/9 and left eye was 6/6parts. She had normal anterior segment, normal IOP. Fundoscopy showed both optic discs edematous, pink in color with blurry disc margins, tortuous disc vessels, edematous peripapillary area. Rest of the retina was normal. Lumbar puncture showed elevated opening CSF pressure and normal CSF composition. Hence, she was diagnosed with IIH. She was started on oral prednisolone 1mg/kgbw once a day dosage, oral acetazolamide 250mg once a day, topical nepafenac 0.1% one drop thrice a day and timolol 0.5% eye drops twice a day. Discussion: The main goals of treatment are alleviation of symptoms, including headache, and preservation of vision. Steroids were commonly used for treating IIH in the past, but cause significant long - term side effects, such as weight gain, that are undesirable in IIH patients. Furthermore, withdrawal of steroids can cause rebound intracranial hypertension. Thus, steroids should not be used routinely for IIH treatment. Results: By the end of one month, patient was relieved of symptoms, best corrected visual acuity was 6/6 in both eyes with normal IOP, normal optic disc in both eyes. Conclusion: Steroids are an effective way of managing idiopathic intracranial hypertension in pediatric patients.

Case report: A Unique Case of Brainstem Anesthesia and Contralateral Amaurosis Following a Sub-Tenon Block.

To report and discuss a case of brainstem anesthesia and contralateral amaurosis following a sub-Tenon block. Single surgical case report of a patient who underwent an uncomplicated pars plana vitrectomy for an epiretinal membrane peel in the left eye following a sub-Tenon anesthesia technique. Post-operatively, the patient experienced symptoms of brainstem anesthesia as well as akinesia, a non-reactive pupil, and reduced visual acuity in the contralateral eye which gradually resolved within 24 hours. Imaging was within normal limits and did not reveal any anatomic abnormalities. Despite the use of a blunt-ended cannula in a sub-Tenon block, there is a non-negligible risk of it penetrating surrounding structures such as the optic nerve sheath. This case emphasizes the importance of monitoring for brainstem anesthesia and contralateral eye affections in patients both intra- and post-operatively.

Overcoming Barriers: Diagnosis of High-Grade Melanoma: Perspective from a Clinical Case

We present the case of a 30-year-old male patient with loss of visual acuity in the left eye. The imaging study detected a lesion of high suspicion of tumor in the left eye. Enucleation of the left eye was performed, confirming the diagnosis of choroidal melanoma by histopathological study. Subsequently, the disease progressed with neoplastic activity in the lungs, liver, lymph nodes and central nervous system. A case description is provided along with a bibliographic review, focusing on the approach and prognostic factors in patients with metastatic disease.

A Case of Compressive Optic Neuropathy Caused by Orbital Emphysema

Purpose: We report a patient with compressive optic neuropathy (CON) in whom visual acuity (VA) was restored after removing conjunctival emphysema through the conjunctiva.Case summary: A 55-year-old man was transferred to emergency department complaining of decreased VA in the right eye after trauma to the right temporal side of the head. The best-corrected visual acuity (BCVA) was 0.6 in the right eye. We confirmed a relative afferent pupillary defect and limited eye movement inferiorly in the right eye. The patient had blown his nose several times while being transferred to the hospital. On silt-lamp examination, there was conjunctival emphysema of the right eye. Orbital computed tomography showed a medial wall fracture of the right orbit and orbital emphysema above the optic canal. The P100 wave was delayed in the visual evoked potential (VEP) exam, and there was a decreased peripheral visual field on the Humphrey visual field test. Based on these findings, we diagnosed CON and treated him accordingly. To decompress the intra-orbital area, we injected mannitol intravenously, applied intraocular pressure-lowering and antibiotic eye drops in the right eye, and removed part of the conjunctival emphysema through the conjunctiva. At the 3-week follow-up, the BCVA had improved to 1.0 in the right eye with a normalized P100 wave on the VEP exam.Conclusions: In a case of CON caused by orbital emphysema after trauma, it is important to decrease the intra-orbital pressure as soon as possible to enable a good prognosis for the VA.