Left Eye Research Articles

Addressing corneal opacity after herpes zoster infection

A 15-year-old boy was referred for corneal opacity evaluation. The patient had a previous herpes zoster virus (HZV) infection—varicella-zoster virus (VZV)—with ocular manifestation 1 year ago. After the infection, he developed a central corneal scar and decreased corrected distance visual acuity (CDVA) in the right eye. The slitlamp examination showed the right eye with central corneal opacity (involving anterior stroma), lacuna area between the haze, fluorescein negative, and no vascularization near the scar (Figure 1 JOURNAL/jcrs/04.03/02158034-202406000-00019/figure1/v/2024-05-21T162725Z/r/image-tiff ). The patient had been treated with oral valacyclovir and topical corticosteroids without any improvement of visual acuity or changes in opacity within the 1-year follow-up. His CDVA was 20/200 (−4.50 −0.75 × 25) in the right eye and counting fingers (−4.00) in the left eye. Intraocular pressure was 12 mm Hg in both eyes. Fundoscopy was normal in the right eye, but he had a macular scar in the left eye (diagnosed when he was 7 years). The left eye had no cornea signs. The patient has no comorbidity or previous surgeries. Considering this case, a corneal central scar in a 15-year-old boy, legally single eye only, and assuming it is an opacity in the anterior stroma, would you consider surgery for this patient? If so, which would you choose: Would you consider an excimer laser treatment of his ametropia while partially removing his opacity, a phototherapeutic keratectomy (PTK), or a PTK followed by a topography-guided treatment, femtosecond laser-assisted anterior lamellar keratoplasty (FALK), or deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (depending on the scar depth)? Would you consider prophylactic acyclovir during and after surgery? Would you consider any other surgical step to prevent delayed corneal healing-persistent epithelial defect? Before the surgical approach, would you consider treating this patient with topical losartan (a transforming growth factor [TGF]-β signaling inhibitor)? Would you first perform the surgery (which one) and then start the medication? Furthermore, if so, how long would you treat this patient? Would you consider treatment with another medication?

Corneal Transplantation in a Patient With Nonperforating Ocular Contusion Caused by a High-Pressure Washer: A Case Report

Purpose: This report details a rare case of a high-pressure washer injury that caused ocular contusion, vitreous hemorrhage, and irreversible corneal edema without perforation necessitating corneal transplantation. Methods: The medical chart of a patient with a high-pressure washer injury at Miyata Eye Hospital (Miyazaki, Japan) was retrospectively reviewed. Results: A 57-year-old man presented to our hospital with a contusion in the left eye caused by a high-pressure washer 1 day prior to the visit. The visual acuity in the left eye was hand motion. Slit-lamp examination of the left eye revealed the presence of corneal epithelial defects, conjunctival lacerations, hyphema, and lacerated iris. Mild clouding of the lens was observed in the anterior chambers, suggestive of cataract. Anterior segment optical coherence tomography revealed the presence of blood in the anterior chamber and a thickened and edematous cornea. Ultrasound examination revealed the presence of vitreous hemorrhage. Therefore, vitreous surgery and traumatic cataract removal were performed under general anesthesia. Postoperatively, the corneal edema and marked opacity persisted, accompanied by glaucoma, and the visual acuity was measured at 0.01. Penetrating keratoplasty was performed 1 year and 2 months after the injury, and scleral fixation of the intraocular lens was performed under local anesthesia 2 years after the injury. The final visual acuity was 0.1 under rigid gas-permeable contact lens usage 3.5 years after sustaining the injury, and the patient required anti-glaucoma drugs. Conclusions: Our patient presented with ocular trauma caused by a high-pressure washer. Corneal transplantation was required although no ocular lacerations were detected. Sufficient instructions must be provided on the usage of heavy machinery to develop a safe working environment.

Long-Term Follow-Up of Pediatric Excimer Laser-Assisted Penetrating Keratoplasty for Congenital Stromal Corneal Dystrophy.

The purpose of this study was to highlight characteristic clinical and microscopic findings and report the long-term follow-up of pediatric excimer laser-assisted penetrating keratoplasty (excimer-PKP) for congenital stromal corneal dystrophy (CSCD). A 2-year-old Greek child presented with CSCD at our department. Clinical examination showed bilateral flake-like whitish corneal opacities affecting the entire corneal stroma up to the limbus. Genetic testing identified a mutation of the decorin gene (c.962delA). The variant was not present in the parents and represented a de novo mutation. The uncorrected visual acuity was 20/100 in both eyes. Excimer-PKP (8.0/8.1 mm) was performed on the right eye at the age of 2.5 years and on the left eye at the age of 3 years. Postoperatively, alternating occlusion treatment was performed. The light microscopic examination demonstrated a disorganized extracellular matrix of the corneal stroma characterized by a prominent irregular arrangement of stromal collagen lamellae with large interlamellar clefts containing ground substance, highlighted by periodic acid-Schiff- and Alcian blue-positive reaction detecting acid mucopolysaccharides. Electron microscopy showed disorganization and caliber variation of collagen lamellae and thin filaments within an electron-lucent ground substance. The postoperative course was unremarkable. Both grafts remained completely clear 14 years postoperatively. Corneal tomography showed moderate regular astigmatism with normal corneal thickness. The corrected distance visual acuity was 20/25 in both eyes. Excimer-PKP for CSCD might be associated with excellent long-term results and a good prognosis, particularly when the primary surgery is performed at a very young age. However, this requires close postoperative follow-up examinations by an experienced pediatric ophthalmologist to avoid severe amblyopia.

Custom-made ocular prosthesis: enhancing the iris position of post-evisceration patient

Individuals who have impaired vision as a result of illness or injury may have their appearance improved with the use of a prosthesis eye. To construct realism, symmetry, and a glance that appears natural, it is necessary to duplicate the size and arrangement of the iris with accurate pinpoint accuracy. This is crucial for developing a realistic-looking gaze. Eye loss has a profoundly debilitating impact on the mental state of the person who has suffered it. The ultimate goal of every ocular prosthesis procedure is to facilitate the patient's reintegration into society while preserving their healthy visage and self-esteem. This article provides a clinical report on the rehabilitation of a patient whose left eye had suffered intraocular foreign body damage following evisceration. A closer fit between the prosthesis and the ocular base tissue can be achieved with custom-made acrylic resin ocular prosthesis that are sized and shaped to fit the ocular socket of the patient. This close fit results in a more uniform distribution of pressure compared to factory stock eye prosthesis and is more cost-effective than stock eye prosthesis

Modulated Arc Therapy for hippocampal-avoidance whole brain radiation therapy: planning comparison with intensity modulated Radiation Therapy.

This study aimed to evaluate the modulated arc therapy (mARC) technique as a planning and treatment option for hippocampal sparing whole brain radiotherapy (HS-WBRT) following the Radiation Therapy Oncology Group (RTOG) 0933 dosimetric criteria. Computed tomography (CT) and magnetic resonance imaging (MRI) were selected retrospectively for 15 patients. Two types of plans were created for each patient, namely an intensity-modulated radiation therapy (IMRT) and a mARC plan. IMRT and mARC plans were compared in terms of plan quality indices, absorbed dose to organs at risk (OARs), number of monitor units (MUs), and treatment time. All plans in both techniques were considered clinically acceptable for treatment. However, IMRT plans presented a higher conformity (p = 0.01) as well as a higher homogeneity as compared to mARC plans, but this difference was not statistically significant (p > 0.05). In terms of the preservation of the hippocampus, it was observed that the IMRT plans achieved significantly lower doses for both 100% of its volume and for its maximum dose (p < 0.001). The evaluation of the remaining OARs showed that the IMRT technique resulted in lower doses, and significant differences were observed for the following organs: left cochlea (p < 0.001), left eye (p < 0.001), right eye (p = 0.03), both lenses of the eye (p < 0.001), and right optic nerve (p = 0.02). Despite these differences, the absolute differences in all dosimetric parameters were low enough to bear any clinical relevance. A drastic (close to 65%) and significant (p < 0.001) decrease was observed in the number of MUs for the mARC plans. This resulted in a substantial decrease in treatment time (60.45%, p < 0.001). It is concluded that the mARC technique is a feasible planning and treatment solution for HS-WBRT that meets the RTOG 0933 criteria. The main advantage of using mARC over IMRT for HS-WBRT is the considerable reduction in MUs and treatment time.

Association Between Primary Open Angle Glaucoma and Type II Diabetes Mellitus in Benghazi, Libya

Glaucoma, a leading cause of permanent blindness in the world, primarily affects older adults and is classified into four types, with diabetes mellitus potentially influencing the condition. The study aims to identify the link between Diabetes mellitus type two and Primary open angle Glaucoma. Subject and method A case-control study at Benghazi Educational Eye Hospital from December 2023 to February 2024. examined diabetic patients with and without glaucoma. Participants underwent ophthalmic examinations, including visual acuity, and gonioscopy. Patients with history of type two diabetes were included. The mean age of cases was significantly higher than controls [P=0.001]. There were significant differences in best corrected visual acuity between the two groups [P=0.035], Participants with high a [HbA1c] were more likely to have an advanced primary open angle glaucoma type. Participants with uncontrolled diabetes mellitus had higher intraocular pressure levels compared to the control group, [p=0.013]. There was a statistically significant difference in Retinal nerve fibers layers thickness in right eye, and Retinal nerve fibers layer thickness in left eye, between the case and control groups, [P= 0.041, 0.005 respectively. The age 66-75 years had a significantly higher risk of primary open angle glaucoma. A negative correlation between the duration of diabetes and Pattern standard deviation in left eye [ P = 0.051], as well as Visual Field left [P = 0.002]. The study reveals a significant link between diabetes mellitus type two and primary open angle glaucoma, with factors like higher intraocular pressure and older age causing higher incidence. early detection and management of risk factors could prevent or delay glaucoma onset.

Progression of macular retinoschisis following intravitreal aflibercept injection for myopic macular neovascularization—a case report and review of literature

BackgroundMacular retinoschisis (MRS) and myopic macular neovascularization (mMNV) are both potentially blinding complications of high myopia. In this case report, we highlight the progression of MRS after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for mMNV, as well as an extensive review of the literature on this topic.Case descriptionA 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye − 20/60 with − 16D, left eye − 20/20 with − 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml).ResultsOCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit.ConclusionIntravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options.

A Glistening Intraocular Lens: A Case Report

Introduction Cataract surgery with a posterior chamber intraocular lens (PCIOL) is one of the most performed surgeries in North America. A common complication of cataract surgery is the development of post-surgical opacities on the posterior lens capsule, known as posterior capsule opacification (PCO). When visually significant, PCO is treated with a YAG laser. Less commonly however, opacities can form within the lens implant itself known as lens glistening. Case Presentation An 86-year-old male patient with a history of macular retinoschisis and vitreoretinal traction in both eyes presented to the eye clinic with complaints of visual disturbance in the left eye over the course of 4 months. Clinical examination and diagnostic testing revealed stable retinal disease with new findings of PCIOLs with lens glistening, left eye greater than right eye. The patient was referred to the cataract surgeon and the decision was made to manage the lens glistening conservatively. Discussion Lens glistening can be managed with observation or intraocular lens (IOL) exchange depending on its impact on the patient’s quality of life or the degree to which the opacities preclude examination of the fundus.

Age-related changes of intraocular pressure in Dutch belted rabbits.

This study investigated intraocular pressure (IOP) in Dutch belted rabbits using two different tonometers, rebound tonometry (TonoVet Plus; TVP) and a Tonopen (Tono-Pen AVIA Vet; TPA). Post-pubescent male Dutch belted rabbits aged 36weeks (n = 10 animals) were used in the study. IOP measurements were conducted every 2weeks for 22weeks using TVP and TPA on both eyes of each rabbit. The average IOP measurements were compared by the paired Student's t-test. Pairwise Pearson's correlation coefficients and Bland-Altman statistics were used. The overall mean IOP measured with TPA was significantly higher than that with TVP (23.5 ± 4.9 vs. 21.8 ± 2.4mmHg for the right eyes; P = 0.045, and 23.0 ± 4.7 vs. 21.5 ± 2.4mmHg for the left eyes; P = 0.047). Both tonometers tended to show increased IOP readings with age, and positive correlations between IOP and age were observed with both TPA (r = 0.95, P < 0.001 for right eyes; r = 0.95, P < 0.001 for left eyes) and TVP (r = 0.91, P < 0.001 for right eyes; r = 0.64, P = 0.024 for left eyes). The average bias calculated by subtracting TPA from TVP was - 1.60(95% confidence intervals - 1.927, - 1.281)mmHg. IOP in post-pubescent Dutch belted rabbits tended to increase with age throughout the 22week study.

Una presentazione atipica della porpora trombocitopenica immune

The authors describe a case of idiopathic autoimmune thrombocytopenia characterized by the onset of visual disturbances due to macular haemor- rhage in the left eye.

Factors predicting redislocation or suture-break in eyes after scleral-fixated intraocular lens.

To investigate predictive factors for redislocation in patients with recurrent intraocular lens (IOL) dislocation following secondary scleral-fixated IOL (SFIOL) surgery. Two tertiary referral hospitals. Retrospective case series. Patients undergoing SFIOL surgery were grouped into redislocation and no-redislocation groups. Medical records of consecutive patients who underwent SFIOL surgery between June 2014 and December 2019 at two tertiary referral centers were reviewed. Data regarding patient demographics, treatment factors, anatomical and functional outcomes, and postoperative complications were recorded. We included 237 eyes of 225 patients (169 [75.1%] men). The redislocation group was more likely to have a younger mean age at the initial SFIOL surgery (redislocation vs no-redislocation, 55.4 vs 62.0 years, respectively; P=0.008), have a prior history of a previous suture-break (23 eyes, 52.3% vs 1 eye, 0.5%; P<0.001), and have undergone the initial SFIOL surgery using <1 mm-sized side-port incisions (17 eyes, 38.6% vs 32 eyes, 16.5%; P=0.002) than was the no-redislocation group. Additionally, the redislocation group had a higher occurrence of complications (P<0.001). Multivariable regression revealed that younger age, left eye involvement, aphakic status prior to the surgery, unremarkable primary IOL dislocation cause, need for ocular hypertension treatment and glaucoma surgery, and no large incision during the initial surgery were significantly (all P<0.05) associated with redislocation. Younger age, left eye involvement, postoperative complications like ocular hypertension and glaucoma, and techniques without large incisions increase the risk of redislocation. Conversely, lower risk factors include unremarkable surgery causes and a history of aphakic conditions.

Laser of the Haptic-Optic Junction to Fix a Tilted Yamane Intrascleral-Fixated Lens

Purpose: To report a case of tilted sutureless intrascleral fixated IOL, emphasizing its management with 23-gauge laser to strengthen the haptic-optic junction. Methods: Case report. Results: A 27-year-old man was referred for treatment of traumatic cataracts in his left eye. He underwent pars plana vitrectomy, lensectomy, membrane peel, and capsulectomy without complications. Five days after the surgery, he developed ocular hypertension that ultimately required insertion of an Ahmed glaucoma valve in the left eye. 16 months after the initial procedure, the patient underwent secondary lens implantation with a CT Lucia 602 IOL in the left eye using the Yamane technique. The day following surgery, the patient presented with a significantly tilted lens. Three weeks later, the patient underwent surgery for IOL repositioning. The manipulation of the haptics was ineffective in repositioning the IOL. The temporal sclerotomy was removed and a 23-gauge probe was used to laser both optic-haptic junctions while a light pipe held the lens in place. The tilt was corrected, and visual acuity improved to 20/40 at one year follow-up. Conclusions: Successful repositioning of tilted sutureless intrascleral fixated IOLs can be achieved using 23-gauge laser reinforcement at the haptic-optic junction. Consideration could be made to perform this laser at the time of implantation as a prophylactic approach to mitigate tilt and reduce the risk of reoperation.

Spiroplasma infection as a cause of severe congenital keratouveitis, cataract and glaucoma

BackgroundOnly seven cases of ocular Spiroplasma infection have been reported to date, all presenting as congenital cataracts with concomitant intraocular inflammation. We describe the first case of Spiroplasma infection initially presenting as a corneal infiltrate.Case presentationA 1-month-old girl was referred for a corneal infiltrate in the left eye. She presented in our hospital with unilateral keratouveitis. Examination showed a stromal corneal infiltrate and dense white keratic precipitates in the left eye. Herpetic keratouveitis was suspected and intravenous acyclovir therapy was initiated. Two weeks later, the inflammation in the left eye persisted and was also noticed in the right eye. Acute angle-closure glaucoma and a cataract with dilated iris vessels extending onto the anterior lens capsule developed in the left eye. The inflammation resolved after treatment with azithromycin. Iridectomy, synechiolysis and lensectomy were performed. Bacterial metagenomic sequencing (16 S rRNA) and transmission electron microscopy revealed Spiroplasma ixodetis species in lens aspirates and biopsy. Consequently, a diagnosis of bilateral Spiroplasma uveitis was made.ConclusionsIn cases of congenital cataract with concomitant intraocular inflammation, Spiroplasma infection should be considered. The purpose of this case report is to raise awareness of congenital Spiroplasma infection as a cause of severe keratouveitis, cataract and angle-closure glaucoma in newborns. Performing molecular testing on lens aspirates is essential to confirm diagnosis. Systemic macrolides are suggested as the mainstay of treatment.

Case Report: EEG Picture in a Patient with Post-Stroke Epilepsy

Introduction: Epilepsy is a chronic brain disorder that affects people all over the world. Seizures are the most common neurologic symptom in stroke patients. Approximately 10% of all stroke patients have experienced seizures, and post-stroke seizures generally begin several years after the stroke. Case Illustration: A male patient, 55 years old, Balinese, Kinan, came to the emergency room of Prof. Dr. I.G.N.G. Ngoerah General Hospital with complaints of seizures. The first seizure occurred on December 19, 2021, with a pattern of glancing at the left eye then, followed by full-body twitching, which lasted approximately 5 minutes and stopped on its own. The patient said that before the seizure, the patient was well conscious; during the seizure, the patient was unconscious, and after the seizure, the patient regained consciousness as before the seizure. Then, the seizure repeated the next day (December 20, 2021) with the same pattern and duration, but the patient was not taken for treatment. On physical examination, the patient was alert with vital signs and general physical examination within normal limits. Neurologic examination revealed no focal neurologic deficits. Electroencephalography (EEG) examination showed intermittent slow activity in the left and right fronto-centro-occipital areas. Computed tomography scan (CT-Scan) examination of the head without contrast revealed a hypodense image in the right temporo-parietal lobe. The patient then received anti-epileptic drug (OAE) therapy, OAE therapy given Phenytoin 200 mg every 12 hours intra-orally, Folic Acid 1 mg every 24 hours intra-orally, and anti-platelet and anti-hypertension continued. Discussion: Post-stroke seizure (PSS) is an episode of convulsion that occurs either single or multiple after a stroke, which is thought to be due to irreversible or reversible brain damage. At the same time, post-stroke epilepsy is convulsions after a stroke that occur at least two revivals without provocation with a distance between revivals of more than 24 hours. PSS classification is divided into early post-stroke seizure, where seizures occur onset two weeks early post-stroke, and late (delayed) post-stroke seizure if seizures occur onset after two weeks post-stroke. Post-stroke seizures' most common electroencephalography (EEG) waves are generalized slow waves, focal slowing, focal sharp and slow waves, and periodic lateralized epileptiform discharges (PLEDs). However, 5.1% of patients have normal EEG. The administration of anti-convulsants to prevent recurrent seizures is recommended by the European Guidelines of The European Stroke Organization. In comparison, prophylaxis is not recommended for patients with post-stroke. Keywords: Post-stroke Epilepsy, Stroke, Electroencephalography

Neuroprotective effects and mechanisms of action of artemisinin in retinal ganglion cells in a mouse model of traumatic optic neuropathy

IntroductionTraumatic optic neuropathy is known to be a critical condition that can cause blindness; however, the specific mechanism underlying optic nerve injury is unclear. Recent studies have reported that artemisinin, considered vital in malaria treatment, can also be used to treat neurodegenerative diseases; however, its precise role and mechanism of action remain unknown. Therefore, in this study, we aimed to investigate the impact and probable mechanism of action of artemisinin in retinal ganglion cells (RGCs) in a mouse model of traumatic optic neuropathy induced by optic nerve crush (ONC). MethodsONC was induced in the left eye of mice by short-term clamping of the optic nerve; oral artemisinin was administered daily. The neuroprotective effect of the drug was assessed using Tuj-1 staining in RGCs. In addition, the inflammatory response and the expression levels of phosphorylated tau protein and tau oligomers were observed using RT-qPCR, TUNEL assay, and fluorescence staining to investigate the underlying mechanisms. ResultsArtemisinin increased the survival rate of RGCs 14 days after ONC. Artemisinin significantly reduced the levels of inflammatory factors such as CXCL10, CXCR3, and IL-1β in the retina and decreased the apoptosis of RGCs. Moreover, downregulation of the phosphorylation of tau proteins and the expression of tau oligomers were observed after artemisinin treatment. ConclusionOur results suggest that artemisinin can increase the survival rate of RGCs after ONC and reduce their apoptosis. This effect may be achieved by inhibiting the inflammatory response it triggers and downregulating tau protein phosphorylation and tau oligomer expression. These findings suggest the potential application of artemisinin as a therapeutic agent for neuropathy.

A perplexing case report of concomitant multiple sclerosis and myasthenia gravis

Introduction &amp; Importance: The co-occurrence of multiple sclerosis (MS) and myasthenia gravis (MG) within the Middle East and North African Region (MENA) has been scarcely reported in current literature. This rare case report explores the pathophysiological mechanisms and potential avenues of treatment modalities. Such insights can potentially facilitate the development of more efficacious and targeted treatment modalities and perhaps pave the way for disease prevention. Case Description: 29-year-old female patient presented with diplopia of two weeks duration associated with occasional blurred vision in the left eye. On physical examination, she was discovered to have marked left eye ptosis. A visual evoked potential (VEP) test was performed, which revealed asymmetrical delay. MRI imaging revealed a few white matter hyperintense foci noted at both periventricular regions and the corpus callosum with the characteristic appearance of Dawson’s fingers and thus MS was diagnosed. An anti-acetylcholine receptor antibody test returned positive, confirming the diagnosis of concurrent MG. Clinical Discussion: Proposed pathophysiological mechanisms underlying the concurrent manifestation of both diseases include, among others, the involvement of HLA haplotype and non-HLA genotypes, as well as the immunogenetic influence of specific transcription factors. Notable HLA haplotype genes include DRB1 and HLA-DQ5 genes. In contrast, non-HLA genes include the interleukin-4 receptor (IL4RA) and factor forkhead box P3 (FOXP3). Conclusion: Considering the similar immunological background of the two diseases, ideally, a single therapeutic modality could be used for management. This will hopefully simplify the patient’s treatment regimen and may ultimately reduce the treatment cost and patient burden.

Erdafitinib-induced bilateral multifocal serous retinal detachments and severe dry eye related unilateral peripheral ulcerative keratitis in a patient with metastatic urothelial carcinoma

Background: A case of bilateral multifocal serous retinal detachments and dry eye complicated with unilateral peripheral ulcerative keratitis (PUK) during erdafitinib therapy is described. Case description: A 76-year-old male underwent a baseline examination two months after initiating 8 mg erdafitinib therapy (April 2023) due to metastatic urothelial carcinoma. Left subfoveal serous retinal detachment was observed initially but the treatment was resumed as he was asymptomatic. In May 2023, bilateral multifocal subretinal fluid pockets were identified, and the patient was still asymptomatic. However, in June 2023 he complained of bilateral redness and a stinging sensation in his right eye. Bilateral severe dry eye and right PUK were diagnosed. He was prescribed dexamethasone eye drops and sodium hyaluronate artificial tears for both eyes. One week later corneal staining decreased, and progression of PUK ceased. Erdafitinib therapy was discontinued in June 2023 due to the planned transurethral prostatectomy. By July 2023, after discontinuation of the drug and administration of the topical treatment, the dry eye improved and the PUK became inactive. There was also resolution of subretinal fluid pockets in the right eye and a reduction of subretinal fluid pockets in the left eye. After the reinitiation of erdafitinib therapy, serous retinal detachments recurred in both eyes in September 2023, but both corneas remained stable with topical low-dose dexamethasone, cyclosporine-A and artificial tear usage. Conclusion: Erdafitinib therapy may lead to concurrent anterior and posterior segment complications. Multidisciplinary monitoring is crucial for patients undergoing erdafitinib therapy to prevent possible visual disturbances.

Retinal focal nodular gliosis have varied clinical courses requiring tailored management: a case series

Purpose: Retinal focal nodular gliosis (FNG), also known as vasoproliferative tumors (VPTs), are rare, benign vascular tumors associated with exudation with no current consensus on management. Herein, we describe the varied clinical course and management of three patients with retinal focal nodular gliosis, one of whom is associated with retinitis pigmentosa. Observations: Case 1 is a 76-year-old female who presented with reduced vision and distortion secondary to a vitreous hemorrhage and epiretinal membrane (ERM) as complications of a known small peripheral retinal focal nodular gliosis. She underwent vitrectomy for the hemorrhage to relieve vascular traction and the ERM peel and the tumor was kept under observation. Case 2 is a 24-year-old female with genetically uncharacterized retinitis pigmentosa-like phenotype who presented with gradual loss of central vision in one eye due to cystoid macular oedema (CMO). She was found to have two peripheral retinal areas of focal nodular gliosis located inferonasally. Tumors were treated with cryotherapy and adjuvant intraocular steroid implant to control the CMO. Case 3 is a 28-year-old female with retinitis pigmentosa secondary to genetically confirmed variant in CRB1 gene who presented with intractable right eye cystoid macular oedema and localized inferior serous retinal detachment secondary to a large inferotemporal focal nodular gliosis. Her left eye has no light perception vision due to previous extensive serous retinal detachment and anterior segment ischemia. The right eye tumor was managed with multiple rounds of cryotherapy and laser therapy to control the serous detachment. Despite this, the condition progressed and was ultimately treated with plaque brachytherapy. Unfortunately, this resulted in an extensive retinal inflammation causing annular tractional retinal detachment which was treated with combined pars plana vitrectomy and scleral buckle. Conclusions: We characterized the retinal phenotype of three patients with retinal focal nodular gliosis (vasoproliferative tumors) and found them to have varied clinical courses requiring tailored surgical management. The case associated with retinitis pigmentosa had a known pathogenic variant in Crumbs homolog-1 (CRB1) gene affecting retinal structure and exhibited a more severe clinical course. It is therefore important for patients with retinal dystrophies to undergo thorough peripheral examinations and detect FNG early as they may require prompt, aggressive treatment.

Reading Left-To-Right and Right-To-Left Orthographies: Ocular Prevalence, Similarities, Differences and the Reasons for Orthographic Conventions

ABSTRACT Purpose We compare right-to-left and left-to-right orthographies to test the theory, derived from studying the latter, that small temporal asynchronies between the two eyes at the beginning and end of every fixation favor ocular prevalence for the left eye in the left hemifield and the right eye in the right hemifield. Ocular prevalence is the prioritizing of one eye’s input in the conscious, fused binocular percept. Method We analyze binocular eye-tracking data from the reading of multiline Arabic and Hebrew text by 28 Arabic (M = 28.7, SD = 7.2 years, 71% female) and 16 Hebrew (M = 30.1, SD = 7.9 years, 50% female) native speakers, respectively. Results Critically, the complex pattern of asynchronies in Arabic and Hebrew resembles that reported for the left-to-right orthographies, English and Chinese, but with some particular differences that we attribute to left hemisphere specialization in word recognition. Conclusion We conclude, first, that the oculomotor musculature plays an embodied role in the perception and cognition associated with reading. We further discuss how the evident hemispheric asymmetries in parafoveal lookahead may be reflected in the nature of the conventions of right-to-left scripts. We articulate the claim that the orthographic conventions of a language tend to reflect reading direction and hemispheric differences.

Clinical characteristics and treatment outcomes of patients with IgG4-positive ocular adnexal marginal zone B-cell lymphoma.

To explore the clinicopathological characteristics of immunoglobulin G4 (IgG4)-positive ocular adnexal marginal zone B-cell lymphoma (OAML) and associated patient treatment outcomes. Medical records from patients diagnosed with IgG4-positive OAML treated at the West China Hospital between January 2016 and August 2023 were retrospectively analyzed. This study included data from 22 patients (11 males, 11 females), aged between 36 and 83 years, with disease durations from 1 month to 30 years. Sixteen cases exhibited unilateral ocular involvement (ten left eyes, six right eyes), while six exhibited bilateral involvement. Common clinical symptoms included ocular masses, eyelid swelling, and proptosis, with the orbit and lacrimal gland being the most commonly impacted sites. Among the 22 patients, 13 who were clinically suspected of having IgG4-related ophthalmic disease (IgG4-ROD) underwent serum IgG4 testing pre-operatively, revealing elevated IgG4 levels in 11 of these patients. The use of computed tomography and magnetic resonance imaging facilitated the evaluation of the location and size of lesions. All 22 patients received surgical treatment. Subsequently, 14 of these patients underwent local radiotherapy, five received post-operative chemotherapy, and three were closely observed. The follow-up period of patients in this study was 3-77 months, with an average follow-up time of 36 months. Except for one patient who died of disease progression, all others showed favorable prognoses with significant improvements. These results support the classification of IgG4-positive OAML as a distinct OAML sub-type with clinical features that partially overlap with IgG4-ROD. Therefore, accurate differentiation between OAML and IgG4-ROD is imperative, necessitating timely surgical intervention and precise pathological diagnosis to prevent diagnostic errors and inappropriate treatment. Currently, no standardized treatments for IgG4-positive OAML exist, but our results suggest that standard OAML therapies are generally efficacious.