Ocular Findings Research Articles

The diagnosis of Adamantiades-Behçet disease: Clinical features and diagnostic/classification criteria.

Adamantiades-Behçet's disease (ABD) is a chronic-relapsing multisystemic inflammatory disease with unknown etiology first described by a Greek ophthalmology Benediktos Adamantiades and a Turkish dermatology Hulusi Behçet. Any organ or apparatus may be involved, though more often there is an involvement of oral and genital mucosae as well as ocular lesions, skin features, and vascular findings. Since there is neither laboratory nor radiological pathognomonic test, the diagnosis is basically clinical according to peculiar signs and symptoms of the disease. With the purpose of giving objectivity and homogeneity to the diagnosis, many authors in time introduced a long series of diagnostic and classification criteria for Adamantiades-Behçet's disease. This mini-review provides an overview of published diagnostic/classification criteria.

Correlation between Widefield Fundus Fluorescein Angiography Leakage Score and Anterior Chamber Flare in Behçet Uveitis

ABSTRACT Aims To investigate the correlation between widefield fundus fluorescein angiography (WF-FA) and anterior chamber laser flare photometry (LFP-flare) in Behçet uveitis (BU). Methods Patients with BU who underwent Heidelberg WF-FA between March 2016 and March 2018 were included. Demographics, ocular findings, LFP-flare, central macular thickness were retrospectively analyzed. Results Eighty-six patients (162 eyes) were included. There was a high correlation between WF-FA leakage score and LFP-flare (rho: 0.691, p < .001). For a flare value of 5.75 ph/ms or higher, the sensitivity for predicting angiographic leakage was 70% and the specificity was 94% (AUC: 0.897, p < .001). Flare values that were equal or above 7.6 ph/ms were found to be 100% specific for leakage in the WF-FA. Conclusion A strong correlation was found between WF-FA leakage and LFP-flare in patients with BU. High LFP-flare levels indicate subclinical posterior segment inflammation in clinically inactive BU.

COVID-19 and conjunctivitis: A contemporary literature review

Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its first appearance in December 2019, COVID-19 has been responsible for a number of global outbreaks and has claimed the lives of nearly three million people as of April 2021. High infection rate, loss of taste and smell, fever, cough, and severely adverse effects on the respiratory system have been the chief attributes of the virus. However, SARS-CoV-2 has been linked to other symptoms, many of which are extra-pulmonary or not directly related to the respiratory system. The impact of SARS-CoV-2 on various ophthalmic outcomes has been manifested in many reports and literature tracing the link between COVID-19 and ocular findings in patients suffering from COVID-19. One recurrent case report presented in the literature is related to the presentation of conjunctivitis in COVID-19 patients. Conjunctivitis is a viral infection causing inflammation in conjunctiva, episclera and eyelids resulting in a change of color in eyes, called pink eyes. Swelling, itching, pain, and eye burn are some of the common symptoms. The present study reviews the latest literature on the subject by focusing on the reports of conjunctivitis symptoms in patients with COVID-19.

Clinicoradiological profile and outcome of cavernous sinus syndrome with coronavirus disease-2019-associated rhino-orbito-cerebral mucormycosis.

With coronavirus disease 2019 (COVID-19) pandemic across the world, there had been an exponential increase in rhino-orbito-cerebral mucormycosis (ROCM). Extension of infection to cavernous sinus leads to cavernous sinus syndrome (CSS). This study aims to describe incidence, clinicoradiological profile, and outcome of CSS positive along with comparative analysis of CSS negative COVID-19-associated ROCM. This was a prospective and observational study conducted from May 1, 2021, to July 31, 2021. Subjects included ROCM with active or recovered COVID-19 (past 6 weeks) and were categorized and staged. CSS was defined as involvement of two or more of third, fourth, fifth, or sixth cranial nerve with one each direct and indirect qualitative neuroradiological features. Clinicoradiological features of CSS-positive and negative COVID-19-associated ROCM groups were compared. Incidence of CSS with COVID-19-associated ROCM was 28%. Mean age of subjects was 44 ± 15 years with 60% being males and 73% were proven ROCM. Significant differences seen across the CSS-positive and negative groups were ocular, nasal, and cerebral findings including eyelid and periocular discoloration, ptosis, proptosis, ophthalmoplegia, nasal discharge, mucosal inflammation, and fever. Oculomotor, trochlear, and abducens nerves were significantly involved more in CSS-positive group. Significant radiological findings across two groups included indirect features in orbit, nose, and paranasal sinuses along with direct features in cavernous sinus. Surgical intervention was more common in CSS-positive group. Mortality in CSS-positive group at 8-24 weeks was 13 and 27%, respectively. Extension of ROCM to CSS was more common in young males in advanced stages of proven ROCM with concurrent COVID-19. CSS-positive group had significant difference in clinicoradiological features involving orbit, nose, paranasal sinuses, and central nervous system as compared to CSS-negative group. This study highlights the need to develop an objective scoring system considering clinical and radiological features for diagnosis of CSS with COVID-19-associated ROCM.

Ocular findings and genetic test in Alström syndrome in childhood.

This study aimed to investigate the mutation spectrums and ocular features of Alström syndrome (AS) patients. Six AS patients from five unrelated families were included. Ocular and systemic examinations were performed in all subjects. Whole-exome sequencing (WES) was performed in the probands, and Sanger sequencing was performed for mutation validation and segregation analysis. Among the six patients, the first symptoms included nystagmus, poor fixation, and photophobia. Five patients had high hyperopia, four of whom (80%) were initially diagnosed with amblyopia before referral with prescribed corrective lenses and amblyopia treatment, but no improvement was obtained. Optical coherence tomography (OCT) revealed progressive damage to the photoreceptor layer, including blurred ellipsoid zone (EZ) and lack of interdigitation zone (IZ) within the macula, and thorough loss of photoreceptor layer in the peripheral retina. Electroretinograms (ERG) demonstrated severely diminished cone and rod responses. WES identified biallelic variants of ALMS1 in all the six patients, including two novels, c.3892C>T (p.Gln1298*) and c.2888_2897del (p.Ser963Thrfs*15) and five knowns, c.10819C>T (p.Arg3607Trp), c.2090C>A (p.Ser697*), c.4891C>T (p.Gln1631*), c.10825C>T (p.Arg3069*) and c.6430C>T (Arg2146*). In conclusion, this study expanded the ocular features and genotypic spectrum of AS. High hyperopia is a significant and common feature of AS. OCT and ERG are essential accessory techniques for the diagnosis of AS. If a patient had high hyperopia with a noneffective response to amblyopic treatment, the diagnosis of AS should be suspected, and detailed ocular examination, systemic evaluation, and genetic testing recommended.

Bilateral uveitis following nivolumab and ipilimumab treatment for mesothelioma

AbstractPurpose: Case report of a patient presenting with sudden onset of painful decreased vision in both eyes, diagnosed with Intermediate uveitis and keratitis. We will review the diagnostic pathway and the management of this case, as well as the correlation with the systemic treatment of that time.Results: A 63‐year‐old male presented in the Emergency department with bilateral red painful eyes and blurred vision. The patient had a past ophthalmic history of keratouveitis in RE and medical history of mesothelioma for which he had recently started treatment with Nivolumab and Ipilimumab. The visual acuity on presentation was 6/9 in the RE and 6/6 in the LE. Upon examination BE were hyperaemic, there was a past corneal scar in the RE and bilateral KPs. RE had +1 AC inflammation and LE traces of AC inflammation. No signs of posterior segment inflammation were seen in both eyes. The patient was treated initially with oral Aciclovir 400 mg BD and Pred Forte 1% in BE QDS. One week after initiation of treatment symptoms improved and a tapering regime of the local steroid treatment was given. Four weeks later the visual acuity in the RE was 6/12 and 6/9 in the LE. Upon examination there was +1 AC activity in BE and +1 vitreous activity. OCT demonstrated bilateral macular oedema. An FFA revealed bilateral optic disc hyperfluorescence. Upon further discussion of the patient's medical history it was revealed that both episodes of intraocular activity coincided with his infusions of Nivolumab and Ipilimumab. The patient was advised to discontinue the oral Aciclovir treatment and was initiated on intensive regime of local steroids which was tapered on improvement of the vision and the inflammation. Our ocular findings were communicated the patient's oncology team that decided to discontinue the above treatment.Conclusions: Nivolumab is an anti‐programmed cell death protein‐monoclonal. It is used for cancer treatment but case reports have emerged of uveitis and ocular surface disease. Ipilimumab is a humanized CLTA‐4 antibody and it can be associated with immune related adverse events such as uveitis. Our patient was switched to a different treatment protocol without further ocular inflammation and excellent visual outcome. Clinicians should raise their index of suspicion in side effects around the timing of treatment.

Adults are not Older-Adolescents: Comparing Clinical Findings among Adolescents and Adults with Persistent Post-Concussive Symptoms

<h3>Research Objectives</h3> To determine if clinical findings related to oculomotor, vestibular, balance, and cervical function differ between adolescents (age 12-17), younger adults (age 20-45), and older adults (age 46-65) with persistent post-concussive symptoms (PPCS). There is limited research on the prevalence of these clinical signs in adults with PPCS and how clinical presentations may differ between adults and adolescents. <h3>Design</h3> Retrospective case-control study. <h3>Setting</h3> Multi-center, community-based, private physical therapy practice specializing in the management of neurologic conditions, including concussion. <h3>Participants</h3> Patients presenting with PPCS (n = 481, mean 197 ± 154 days since injury) were divided into Adolescents (n=103), Younger Adults (n=195), and Older Adults (n=183). Physical assessments were categorized as ocular, cervical and vestibular/balance. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Prevalence of clinical findings on physical assessment related to oculomotility (smooth pursuits, saccades, near point of convergence [NPC]), vestibular/balance function (vestibulo-ocular reflex, head impulse test, dynamic visual acuity test, Romberg test), and cervical function (cervical range of motion [ROM] limitations, tenderness to palpation). <h3>Results</h3> Younger and older adults had a greater prevalence of NPC impairment (p< 0.001) as well as more abnormal vestibular (VOR [p< 0.001] and Head Impulse Test [p=0.017]) and balance (Romberg Test [p< 0.001]) findings. Adolescents had a higher prevalence of cervical impairments (ROM [p< 0.001] and palpation [p< 0.001]). There were no significant differences observed in ocular, vestibular/balance, or cervical findings between younger and older adults. <h3>Conclusions</h3> In this group of individuals with PPCS, adults demonstrated a different constellation of clinical findings compared to adolescents. Different presentations may inform different approaches to rehabilitation. Prospective evaluation is warranted. <h3>Author(s) Disclosures</h3> Nothing to disclose.

Clinical manifestations, laboratory characteristics, and treatment outcomes of ocular syphilis: A case series

AbstractPurpose: To describe the clinical and laboratory findings, ocular complications, and visual prognosis of patients with syphilis‐associated uveitis.Methods: Retrospective observational case series of patients diagnosed with ocular syphilis between January 2012 and April 2022 at a single tertiary referral centre in Portugal. Medical records of patients presenting with syphilis‐associated uveitis were reviewed.Results: Eighteen eyes from 10 consecutive patients were included. All patients were male and median age at diagnosis was 51 years (range 20–83). HIV coinfection was present in 3 patients, with two of these being newly diagnosed on presentation. All patients had a reactive serum treponema pallidum haemagglutination test and median serum rapid plasma reagin titre was 1:260 (range 1:1–1:520), with no significant difference between HIV‐positive and HIV‐negative patients (p = 0.222). A lumbar puncture was performed in seven patients, confirming the diagnosis of neurosyphilis in six patients. Bilateral involvement occurred in eight patients. The most frequent form of intraocular inflammation was posterior uveitis (33.3%), followed by panuveitis (27.8%) and anterior uveitis (27.8%). All patients were treated with intravenous penicillin, showing partial or complete resolution of the ocular findings. Visual acuity improved significantly from presentation to the last visit (0.7 logMAR, range 0–2; and 0.2 logMAR, range 0–0.7, respectively; p = 0.004). Five eyes (27.8%) had ocular complications from syphilis‐associated uveitis, including epiretinal membrane formation and cystoid macular oedema, with significantly worse visual prognosis (p &lt; 0.001).Conclusions: Ocular syphilis is re‐emerging as a prominent cause of uveitis. In our series, patients were characteristically middle‐aged men with posterior segment involvement. A relevant proportion of patients had HIV co‐infection. Despite good visual prognosis with standard treatment, ocular complications may compromise visual recovery.

Keratoconus in Thai population - a cross-sectional hospital-based study.

Studies in the epidemiology of keratoconus are limited in Southeast Asia. A study on the prevalence and characteristics of keratoconus in the Thai population could give a general idea of its impact. To study keratoconus prevalence in patients seeking refractive surgery and analyze the characteristics of keratoconus. Medical records from April 2015 to August 2018 were retrospectively reviewed. Keratoconus and keratoconus suspect prevalence in patients seeking laser vision correction were calculated. The characteristics of keratoconus patients were reviewed. The Amsler-Krumeich classification was used to determine the stages. Topographically, the types of cones were categorized into oval, nipple, pellucid marginal degeneration (PMD)-like, and astigmatic types. Keratoconus and keratoconus suspect prevalence were 1.66% and 0.68%, respectively. Out of the affected patients, 73.8% were male. The mean age at diagnosis was 25.25 ± 8.35 years. The presenting symptoms were blurred vision (87%) and itching (47%). Stage 1 was predominant, found in 39% of patients (followed by stages 2, 4, and 3, respectively). Ocular findings comprised the Munson sign (14.63%), the Rizutti sign (6.94%), Fleischer ring (28.14%), Vogt striae (24.95%), corneal scar (8.63%), prominent corneal nerve (2.81%), and corneal staining (7.69%). Mean uncorrected visual acuity (logarithm of the minimum angle of resolution [logMAR]) was 0.88 ± 0.64. Mean corrected visual acuity (logMAR) was 0.40 ± 0.49. Mean Q-value was -0.92 ± 0.63. The thinnest pachymetry was 459.39 ± 56.96 microns. The mean keratometry was 49.7 ± 6.64 diopters. Topographically, the types of cones were oval (57%), astigmatic (33%), PMD-like (5%), and nipple type (4%). Keratoconus prevalence among Thai patients seeking refractive surgery was 1.66%. Most patients were male and presented with the disease at a mild bilateral stage in their second decade of life.

A STUDY OF OCULAR MANIFESTATIONS AMONG COVID-19 AND POST COVID PATIENTS ATTENDING A TEACHING HOSPITAL, VISHAKAPATNAM

Introduction: At the end of 2019, the rapid spread of a new corona virus led to a Severe Acute Respiratory Syndrome, known as COVID-19, which was declared a pandemic in March 2020 by the World Health Organization. Until now, it already killed more than 2.7 million people worldwide. Among the patients with COVID-19, approximately 10% exhibited ocular symptoms. Objective: To study the ocular findings among covid and post covid patients who are attending a teaching hospital. Methods And Materials: In this cross-sectional study, we have examined total 200 patients who had either Active phase of Covid(136) ,Post Covid Syndrome(pcs)(46) or Chronic Covid disease(18). All the patients had undergone anterior segment evaluation. Visual acuity measured by snellen chart, Intraocular pressure (IOP) by NCT ,Dry eye evaluation, Fundus examination and Optical Coherence Tomography (OCT) were done only for patients with positive findings. Results: In this study, out of 200 Covid- 19 patients, 36 patients had clinical symptoms. Out of 36 patients, 23 were male and 13 were female aged between 18-75 years. We observed ocular findings such as Redness(7), Itching(5),tearing(8), FB sensation(6),blurring of vision(9) and swelling of eyelids(1). The ocular diseases observed were conjunctivitis(24 eyes),Dry Eyes(28 eyes),Glaucoma(10 eyes),Central serous chorioretinopathy(3 eyes), Mucormycosis(1 eye) and Herpes Zoster Ophthalmicus(1 eye). Conclusion: Almost 18% of patients had ocular abnormalities which required treatment and became asymptomatic in 1-4 weeks. Hence all covid and post covid patients should undergo ocular examination for period of 6 months to prevent further progression of the condition and possible complications.

Extrapulmonary Manifestations of COVID-19 in Mild/ Severe Patients

The coronavirus disease 2019 (COVID-19) caused the outbreak of viral pneumonia in Wuhan, China, in December 2019. It is principally identified with respiratory disease and pulmonary manifestations. However, based on various reports, COVID-19 infection not only affects the respiratory system but also infects other organs. Cardiac manifestations, gastrointestinal complications, liver dysfunction, musculoskeletal disorders, ocular findings, and hematological manifestations are among the published extrapulmonary clinical manifestations. Lack of awareness and attention to these extrapulmonary features might result in misdiagnosis, delayed diagnosis, incorrect treatment, and eventually an increase in the spread of the virus by unidentified individuals to others in the community. Therefore, the current study comprehensively reviews and discusses the extrapulmonary manifestations of COVID-19 in mild or severe patients.

Ocular involvement in primary antiphospholipid syndrome: results of an extensive ophthalmological evaluation performed in the APS-Rio cohort.

To study ophthalmological manifestations in a well-characterized primary antiphospholipid syndrome (PAPS) cohort (APS-Rio) and compare them with a healthy control group. We examined PAPS patients and controls with an extensive ophthalmological evaluation, which included anamnesis, visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and retinography of the anterior and posterior segments of the eye. PAPS group also underwent angiography exam and optical coherence tomography using spectral domain technology (SD-OCT). 98 PAPS patients and 102 controls were included. The most common symptom in PAPS was amaurosis fugax (34.7% vs. 6.9%; p = .001). In the multivariate analyses, Raynaud's phenomenon was associated with amaurosis fugax (OR 3.71, CI:1.33-10.32; p = .012), and livedo correlated with hemianopia (OR 6.96, CI:1.11-43.72, p = .038) and diplopia (OR 3.49, CI:1.02-11.53, p = .047). After ophthalmological evaluation, 84 PAPS patients had ocular involvement (1.0% glaucoma, 94.0% posterior findings, 62.7% anterior findings, and 56.6% both posterior and anterior findings). Vascular tortuosity was more frequent in the PAPS group (63.2% vs. 42.2%; p = .002), as well as peripheral tortuosity (29.6% vs. 7.8%; p < .001). After excluding patients with atherosclerotic risk factors, peripheral vascular tortuosity was still statistically associated with PAPS (35.0 vs. 7.8%, p < .001). Triple positivity was more frequent in PAPS patients with peripheral vascular tortuosity than in those without this ocular finding (34.5% vs. 15.9%, p = .041). Vasomotor phenomena are importantly related to ocular symptoms in PAPS. Vascular tortuosity was a frequent finding in PAPS patients. Peripheral vascular tortuosity was associated with triple positivity and might be a biomarker of ischemic microvascular retinopathy due to PAPS.

Conjunctival Swabs Reveal Higher Detection Rate Compared to Schirmer Strips for SARS-CoV-2 RNA Detection in Tears of Hospitalized COVID-19 Patients.

Purpose: To determine the prevalence of SARS-CoV-2 in tear samples and to investigate whether it correlates with ocular findings and patients’ prognosis in Brazil. Methods: Tears were collected using Schirmer strips (SS) and conjunctival swabs (CS) from patients hospitalized with laboratory-confirmed SARS-CoV-2 infection. Samples were analyzed using qRT-PCR. Demographic and clinical data, ocular symptoms, and Schirmer tests (ST) were collected from patients. Charlson Comorbidity Index (CCI) was used to rate comorbidities, and patients were monitored until hospital discharge or death. Results: There were 61 hospitalized patients, 33 of which were diagnosed with COVID-19. Within the confirmed COVID-19 patients, SARS-CoV-2 was detected in 18.2% (n = 6) of CS and 12.1% (n = 4) of SS samples. Subjective and objective parameters for dry eye syndrome (e.g., ST COVID-19: 8.3 ± 6.4mm, non-COVID-19: 8.9 ± 6.6mm, p > 0.05) were comparable between COVID-19 (n = 33) and non-COVID-19 patients (n = 28). Among the 16 COVID-19 patients exhibiting ocular symptoms, only tearing was reported significantly more frequently when tear samples were positive for SARS-CoV-2 (p < 0.05). Strikingly, patients whose tears tested positive for SARS-CoV-2 had significantly inferior CCI (pos.: 34.0 ± 31.8%, neg.: 67.6 ± 36.4%, p < 0.05) and higher mortality rates (pos.: 50.0%, neg.: 7.4%, p < 0.01). Conclusions: SARS-CoV-2 was detected with a prevalence of 18.2% on the ocular surface. Decreased CCI and increased mortality rate in the positive tear group suggests that viral detection may relate to prognosis and highlight the need of personal protective measures for healthcare professionals. Most of the patients, regardless of COVID-19 diagnosis, had low tear production and eye discomfort, possibly pointing to the need for artificial tear use during hospitalization.

Turner Syndrome: Ocular Manifestations and Considerations for Corneal Refractive Surgery.

Turner Syndrome (TS) is the most common sex chromosome abnormality in females and is associated with physical changes, hormone deficiencies, increased risk of autoimmune disease, and ocular complications. In this article, we review the main ocular findings associated with TS and discuss their significance for the patient considering refractive surgery. We also present four cases of TS to highlight the clinical findings that may be present in these patients. The most common ocular manifestations include refractive errors, strabismus, and amblyopia. Less commonly, patients with TS may present with keratoconus, cataracts, glaucoma, uveitis, or other disorders of the posterior segment. When considering corneal refractive surgery in a TS patient, clinicians should perform a thorough ocular history, ask patients about hormone therapy and autoimmune conditions, and pay particular attention to any of the associated ocular symptoms of TS.

Optical coherence tomography findings in three patients with Werner syndrome

BackgroundWerner syndrome is a rare, autosomal recessive disorder characterised by premature aging. It is a typical hereditary progeroid syndrome that can be difficult to diagnose owing to its rarity and the similarity of some of its symptoms, such as juvenile cataracts, to other common ophthalmologic conditions. Early onset of bilateral cataracts is currently used as the ophthalmological feature for Werner syndrome; however, ophthalmologists often find performing a detailed examination of the medical history and genetic testing for Werner syndrome at the time of an ophthalmologic consultation challenging. If a unique ocular finding was observed on ocular examinations in cases of juvenile bilateral cataracts, we could consider Werner syndrome as a differential diagnosis. Case presentationWe documented the cases of three patients with Werner syndrome in whom thinning of the retina in the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) were observed using optical coherence tomography (OCT). Visual field tests revealed the loss of visual field mainly owing to glaucoma.The thinnig of the choroidal thickness (CT) in three patients was also observed using enhanced depth imaging (EDI)-OCT.ConclusionsThree patients have thinning of the RNFL, GCC, and choroidal thickness and the loss of visual field. These findings suggest the need for including Werner syndrome in the differential diagnosis when patients presenting with juvenile cataracts of unknown cause also show abnormal retinal and choroidal thinning in the OCT images.

Predictive values of systemic inflammation biomarkers in proliferative vitreoretinopathy associated with primary rhegmatogenous retinal detachment

ABSTRACT Clinical relevance Proliferative vitreoretinopathy (PVR) is still the leading cause of surgical failure after rhegmatogenous retinal detachment (RRD) repair. The factors that can predict the development of PVR remain to be elucidated. Background This study evaluates the predictive values of the systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in patients with primary RRD with and without PVR. Methods A total of 150 patients with RRD and 51 age- and sex-matched healthy participants were included in the study. Patients who developed PVR within three months after surgery were enrolled as PVR cases (n = 75, Group 1), and those who did not develop PVR were enrolled in RRD without the PVR group (n = 75, Group 2). Ocular examination findings and medical records of all participants were analysed retrospectively. Peripheral blood samples were collected, and systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratios were calculated. The systemic immune-inflammation index calculation formula is: (Neutrophil/lymphocyte) × Platelet. Results The median neutrophil-to-lymphocyte ratio and systemic immune-inflammation index levels were significantly higher in Group 1 patients compared to Group 2 and the control groups (p = 0.01, for both). However, the groups were similar regarding median platelet-to-lymphocyte ratio (p = 0.917). The optimal cut-off values of neutrophil-to-lymphocyte ratio and systemic immune-inflammation index were calculated as 1.72 (with 72% sensitivity and 48% specificity) and 407.9 (with 72% sensitivity and 49.3% specificity), respectively, for predicting PVR development in patients with RRD. Conclusion Neutrophil-to-lymphocyte ratio and systemic immune-inflammation index may be useful biomarkers for predicting the risk of PVR development in RRD patients.

The Ocular Surface Symptoms and Tear Film Parameters during and after COVID-19 Infection.

This study aimed to evaluate the ocular surface parameters of post-COVID-19 patients when compared to healthy controls. Patients after symptomatic SARS-CoV-2 infection, as confirmed by a PCR test of their nasopharyngeal swab sample, were enrolled. Complete ophthalmic examination, including visual acuity test, intraocular pressure measurement (IOP), slit-lamp examination, tear osmolarity test, central corneal thickness, endothelial cell number measurements, non-invasive keratograph break-up time (NIKBUT), meniscus height, and the Schirmer's test were performed and compared with the controls. It must be noted that there were 36 COVID-19 patients and 25 control subjects included in the study. Eye itching and burning (19%) were the most common symptoms of COVID-19 infection, followed by a subjective decrease in vision (17%), conjunctivitis and eye pain were present in 11%, and 6% of the patients had episcleritis. The mean time from initial infection was 6.5 ± 3.9 (range 1-24 weeks). Meniscus height was not significantly changed between the COVID-19 (0.34 ± 0.13 mm) group and the control (0.33 ± 0.12 mm, p = 0.88) group. In addition, the NIKBUT-1 (p = 0.88; 7.22 ± 4.60 s and 6.91 ± 4.45 s) and NIKBUT average (p = 0.91, 12.30 ± 5.86 s and 11.77 ± 4.97 s) test results showed no significant change either. Neither was a significant result found in the IOP (p = 0.17, 14.56 ± 2.10 mmHg and 14.11 ± 1.96 mmHg); the Schirmer test (p = 0.18, 20.22 ± 7.92 mm and 20.02 ± 7.17 mm); Tosm (p = 0.16, 294.42 ± 54.51 mOsm/dL and 299.33 ± 5.65 mOsm/dL); CCT (p = 0.06, 549.15 ± 28.98 vs. 539.21 vs. 29.08 µm); nor the endothelial cell density (p = 0.07, 2516.64 ± 287.61 vs. 2454.21 ± 498.60 cells/mm2). Through this study it was not revealed that there were any significant differences between the post-COVID group and control group in the objective measurements of ocular surface conditions, when performed after the acute phase of COVID-19. The exact incidence and mechanism of ocular findings, especially dry eye disease, in correlation with SARS-CoV-2 requires further research.

Water-borne oculoglandular tularemia: Two complicated cases and a review of the literature

BackgroundIn this study, we presented two cases of late diagnosed complicated oculoglandular tularemia and reviewed the clinical features of oculoglandular tularemia in cases reported in the last ten years. MethodTularemia was diagnosed when serum microagglutination test (MAT) was ≥ 1/160 titer or when there was at least a four-fold increase in MAT titers measured over a two-week interval. We searched the oculoglandular tularemia cases reported in the last 10 years in the PubMed and Google Academic engines. ResultsCase 1 (19 M) and case 2 (15 M) had complaints of fever and burning in the eye. In both cases, the diagnosis of tularemia was delayed. Lymph node suppuration developed in both cases. A total of 19 cases of tularemia were found within the search. In the cases of oculoglandular tularemia reported in the last 10 years, submandibular and preauricular lymphadenopathy were most common after ocular findings and fever. The mean time to diagnosis was 41 ± 94 days, and the complication rate was 31.5%. ConclusionTularemia should definitely be considered in cases of fever and ocular findings, especially in endemic areas. In non-endemic areas, a good anamnesis and clinical suspicion can help diagnose the disease early and reduce the complication rate.

Evaluation of diplopia as a vital and remarkable ocular finding among cancer patients.

Diplopia is an important and debilitating symptom of malignancies due to different pathogenetic mechanisms. Data is lacking in the literature because of the rarity of the diplopia in patients with cancer. We aimed to evaluate the etiological and clinical factors of diplopia in patients with different types of cancer. We retrospectively investigated 22 cancer patients with diplopia who were admitted between 2018 and 2021. The diagnosis of primary cancer, the underlying factors causing diplopia, and the life expectancy after diplopia were evaluated. Among available data of 620 cancer patients applied to our ophthalmology department, 22 (3.55%) had diplopia. Paralytic strabismus was found in 19 patients and restrictive strabismus was found in 3 patients. Among the paralytic cases, 6th nerve palsy was found to be the most common with a rate of 68%. In 18 of 22 (82%) patients, the cause of diplopia was due to orbital or brain metastasis or local invasion. Two patients had diplopia secondary to radiotherapy and 2 had diplopia due to chemotherapy. Metastasis is the most common cause of diplopia in patients with cancer and screening for metastasis is crucial as soon as diplopia begins for a better life expectancy.

Reply: Ocular Findings in Children With Multiple Inflammatory Syndrome.

Reply: Ocular Findings in Children With Multiple Inflammatory Syndrome.