Acuity Of Hand Motion Research Articles

A rare presentation of Nocardia Choroidal Abscess after Glioblastoma surgery.

to report the natural history of a rare ocular manifestation of endogenous Nocardia farcinica infection in an immunocompromised patient, with involvement observed in both the anterior and posterior segments of the eye. Given the patient's limited mobility, a handheld fundus camera was utilized for bedside anterior segment and ocular fundus examinations. The findings included visual acuity of hand motion, posterior synechiae, vitreal opacity, and a large choroidal abscess. We monitored the lesion's progression through a series of follow-ups. Despite not employing intravitreal drug therapy, we noted a significant reduction in the lesion's size until the patient's overall health deteriorated. This case contributes valuable information to our understanding of the natural history of a rare condition like Nocardia endophthalmitis. We highlighted the usefulness of a handheld fundus camera in aiding infectious disease specialists in assessing the immediate response to systemic treatment.

Sympathetic ophthalmia following corneal patch graft for corneal perforation

Introduction : Sympathetic ophthalmia (SO) is a rare, bilateral, diffuse granulomatous uveitis that usually occurs after open globe injury or intraocular surgery. We report a rare case of SO after the closure of corneal perforation using a corneal patch graft.
 Case Illustration : A 12 year old boy diagnosed as corneal perforation in the right eye, with visual acuity (VA) 20/100, underwent a corneal patch graft. He presented with redness and decreased vision in both eyes 2 weeks after surgery. The patient had VA of hand movements in the RE and 20/200 in the LE. Anterior segment examination showed a corneal patch graft with iris adherent to the graft posteriorly in RE, endothelial dusting, 2+ cells in both eye. Fundus examination showed optic disc oedema in both eye and inferior retinal detachment with macular involvement in RE. The patient was managed with pulse steroids for three days followed by oral steroids in tapering doses along with continued topical steroids. Three months follow-up showed improvement of VA to 20/60 in RE and 20/25 in LE
 Discussion : SO is thought to be an autoimmune response to uveal injury. The incarceration of uveal tissue in the wound is a major risk factor. SO has been reported 5 days to 66 years after penetrating insult to the eye. In this case, incarceration of uvea in corneal pacth resulted in SO 2 weeks after surgery.
 Conclusion : In a case of a perforated cornea, the possibility of iris incarceration in the wound is high and hence SO can develop

Solitary choroidal mass: A diagnostic dilemma

Abstract We report a case of 46-year-old male who had progressive visual loss in right eye for 1 month, preceded by pain. He had visual acuity of hand movement at presentation and examination revealed a choroidal mass lesion in the superior quadrant with exudative retinal detachment. Systemic workup was inconclusive. Fluorescein angiography revealed speckled fluorescence contrary to hypo fluorescence of choroiditis, and the presence of T sign on B-scan led us to the diagnosis of nodular posterior scleritis (NPS). The patient was treated with oral steroids and visual acuity recovered to 6/6. NPS can present as a choroidal mass resembling granuloma; careful workup and investigations can diagnose the entity and result in good treatment outcome.

A Study of Visual Improvement and Variation in IOP Following Nd-YAG Laser Capsulotomy

AIM: To study the visual improvement and to correlate the effect of energy used and number of shots with post procedural IOP spike following Nd-YAG laser capsulotomy cases. MATERIALS AND METHODS: A total of 36 patients presented with pseudophakia with PCO attending ophthalmology outpaient department at Rajah Muthiah medical college hospital during the period of October 2020 - December 2022 were included in the study. Patients with glaucoma, Uveitis, high myopia, posterior segment disorders will be excluded from the study. The patient will be subjected to visual acuity testing, detailed slit lamp examination, IOP measurement using Non-contact tonometer pre and post laser procedure and detailed fundus examination done and results were interpreted. OBSERVATION: Among the total 36 participants, 31.4% belong to age group 56 to 65 years followed by 28.6% in the age group 66 to 75 years. 51.4% were males and 48.6% were females. Of the total participants 28.6% had visual acuity of 6/24 in the affected eye and 22.9% had visual acuity of 6/36 in the affected eye.one subject presented with visual acuity of hand movements (HM) only in the involved eye.The mean pre-operative intraocular pressure among the participants was 1.85±0.73. 45.7% had preoperative IOP of 13 to 16 mmHg and 34.3% had preoperative IOP of 8 to 12. The mean number of YAG shots among the participants was 1.96±0.81. 36.3% were provided with 5 to 8 YAG shots and 33.3% with 2 to 4.The mean IOP among the participants in the preop was 14.03±2.92. The mean IOP immediately after the intervention was 15.29±2.83.The mean IOP 20 mins after the intervention was 17.43±2.96.Our study shows that the change in mean IOP after ND YAG LASER administration was significant with P value of less than 0.05 and also our study shows improvement in post laser BCVA with significant P values CONCLUSION: The study concluded that all patients had good visual recovery. The post laser IOP raise is minimal and transient. It varies with amount of laser energy used. Hence recommended to use minimum possible laser energy and must be followed up for raised intraocular pressure changes. Keywords: Intraocular pressure, Neodymium: Yttrium Aluminium GARNET Capsulotomy.

Endophthalmitis Associated With XEN Stent Implantation

The aim of this study is to report the clinical characteristics, causative organisms, and treatment outcomes in patients presenting with endophthalmitis related to XEN stent implants. Retrospective, noncomparative consecutive case series. Clinical and microbiologic review was performed for 8 patients presenting to the Bascom Palmer Eye Institute Emergency Room between 2021 and 2022 with XEN stent-related endophthalmitis. Data collected included clinical characteristics of patients at presentation, organisms identified in ocular cultures, treatments received, and visual acuity at last follow-up. The current study included 8 eyes from 8 patients. All cases of endophthalmitis occurred >30 days after implantation of the XEN stent. At the time of presentation, there were external exposures of the XEN stent in 4 of 8 patients. Five of the 8 patients had positive intraocular cultures, all of which were variants of staphylococcus and streptococcus species. Management included intravitreal antibiotics in all patients, explantation of the XEN stent in 5 patients (62.5%), and pars plana vitrectomy in 6 patients (75%). At last follow-up, 6 of the 8 patients (75%) had a visual acuity of hand motion or worse. Endophthalmitis in the setting of XEN stents results in poor visual outcomes. The most common causative organisms are staphylococcus or streptococcus species. At time of diagnosis, prompt treatment with broad-spectrum intravitreal antibiotics is recommended. Consideration can be made to explant the XEN stent and perform early pars plana vitrectomy.

A Rare Case of Abiotrophia defectiva Bleb Associated Endophthalmitis.

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

MASSIVE BILATERAL SEROUS RETINAL DETACHMENT IN A YOUNG PATIENT WITH HYPERTENSIVE CHORIORETINOPATHY AND CHRONIC KIDNEY DISEASE.

Report a case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment in a young patient with chronic kidney disease. Observational case report. An 18-year-old man with Grade 5 chronic kidney disease, systemic high blood pressure, secondary acute pulmonary edema, and acute uremic syndrome was referred to our service complaining of bilateral decreased vision starting one week ago. The patient was treated at that moment with hemodialysis and losartan. At initial examination, the patient's blood pressure was 170/120 mmHg; dilated fundus examination evidenced optic disk edema, hypertensive chorioretinopathy, and massive serous retinal detachment with best-corrected visual acuity of hand motion in both eyes. The case was diagnosed as undertreated hypertension and was referred to the nephrologist for treatment adjustments. At 1-month follow-up, blood pressure was 160/90 mmHg; there was clinical improvement in both eyes but with ischemic sequelae. At the final follow-up 6 months later, blood pressure was 100/60 mmHg, best-corrected visual acuity was 20/80 in the right eye and count fingers at 2 min the left eye, and there was a complete resolution of the retinal serous detachment in both eyes. Patients with massive serous detachments due to systemic hypertension are atypical so it is of immense importance for the ophthalmologists to recognize the ocular manifestations of systemic diseases that put the patient's life at risk as in this case.

Pupilar block after cataract surgery

AbstractPurpose: To describe a case of pupillary block in a pseudophakic patient secondary to synechiae between the iris and the intraocular lens implanted in the capsular bag.Methods: 60‐year‐old woman presented severe diabetic retinopathy and cataract in her right eye. Phacoemulsification + hydrophobic monofocal intraocular lens in capsular bag was decided. The next day, we found a hemovitreous in right eye, observation was decided after performing ultrasound. As the condition did not resolve, a pars plana vitrectomy was performed. Seventeen days after the second surgery, the patient presented intense pain in her right eye, visual acuity of hand motion, IOP of 70 mm Hg, intense corneal edema, iris bombe, wide chamber and narrow in the periphery. Correct pseudophakia. Irregular pupil with mild non‐reactive miosis. Closed angle. Topical hypotensive drugs, oral acetazolamide, and IV mannitol were prescribed without response. Peripheral iridotomies were performed with good response. Mydriatics are added to force pupillary dilation.Results: The next day she presented an IOP 10. One month after the iridotomies she presented an IOP 12 and visual acuity of 0.6.Conclusions: Pseudophakic pupillary blocks rarely occur with current phacoemulsification techniques and capsular bag intraocular lens implantation. Complications inherent to surgery and patients (glaucoma, diabetes, children, previous early surgery) that predispose to a greater inflammatory context may be associated with the potential development of synechiae between the iris and the anterior intraocular lens / capsule, preventing the correct flow of the aqueous humour due to the pupillary block. In a study of the type of intraocular lens in a uveitic context, a greater association was found with hydrophobic intraocular lens than with other types. The ocation where the intraocular lens is implanted is also related, being greater in the intraocular lens in the anterior chamber or sulcus. Peripheral YAG laser iriditomies are a good therapeutic option but are not recommended intraoperatively because they can cause more complications than benefits.

Prevalence of intraocular tumours detected by ultrasonography in eyes with opaque media

ObjectifÉtudier la prévalence des tumeurs intraoculaires découvertes pendant une échographie de dépistage dans des yeux présentant un trouble de transparence des milieux. MéthodesExamen rétrospectif des échographies en mode B réalisées entre le 1er janvier 1994 et le 31 décembre 2013 dans des yeux présentant un trouble de transparence des milieux et qui ont reçu un diagnostic de cécité ou de phtisie du globe oculaire. Ont été exclues les échographies réalisées en vue d'un diagnostic d'endophtalmie aiguë, de décollement de la rétine ou d'hémorragie du vitré. RésultatsOn a réalisé une échographie en mode B dans 119 yeux aveugles qui présentaient un trouble de transparence des milieux. L’âge moyen des patients était de 59 ans; l'acuité visuelle se limitait, au mieux, aux mouvements de la main dans 89 yeux (74,8 %). On a noté une élévation de la pression intraoculaire dans 23 yeux (19,3 %) et de la douleur dans 30 yeux (25,4 %). La durée du suivi était ≥ 1 an dans 69 yeux (58 %), soit une moyenne de 64 mois (médiane : 56 mois; fourchette : 12–129 mois). Au sein de ce sous-groupe de 69 yeux, la fréquence des échographies se déclinait comme suit : plus de 1 fois par année dans 2 yeux (2,9 %), 1 fois par année dans 2 yeux (2,9 %), tous les 13 à 60 mois dans 43 yeux (62 %), tous les 61 à 120 mois dans 19 yeux (27,5 %) et moins fréquemment que tous les 120 mois dans 3 yeux (4,3 %). Par ailleurs, 16 yeux qui présentaient un trouble de transparence des milieux n'ont fait l'objet d'une échographie de dépistage qu'au moment de la visite initiale, tandis que 6 yeux n'ont fait l'objet d'une échographie qu'au moment de l’éviscération ou de l’énucléation. On n'a décelé aucune tumeur intraoculaire dans le cadre de la présente étude. ConclusionsDans notre étude, l’échographie de dépistage n'a mis au jour aucune tumeur intraoculaire dans des yeux présentant un trouble de transparence des milieux. Il serait intéressant de réaliser des études de plus grande envergure dotées d'un suivi de longue durée afin de déterminer l'utilité et la rentabilité du dépistage échographique périodique. La plus grande utilité de l’échographie se trouve peut-être dans le contexte d'une évaluation initiale, en cas de modification de l’état clinique et pendant le bilan préopératoire, afin d’éviter l’éviscération en présence d'un cancer occulte.

Immediate Vitrectomy for Acute Endophthalmitis in Patients with a Visual Acuity of Hand Motion or Better.

PurposeTo determine the efficacy of immediate pars plana vitrectomy as the primary treatment for acute endophthalmitis in patients with a visual acuity (VA) of hand motion (HM) or better.MethodsA total of 149 patients who were referred to a single center for acute endophthalmitis after cataract surgery over the 13-year study period were retrospectively analyzed. Only patients presenting with a VA of at least HM were included. Patients were initially treated with either primary vitrectomy or intravitreal antibiotic injection alone, and their visual outcomes and reintervention rates after initial treatment were compared.ResultsThere was no significant difference in the proportion of good (final VA ≥20 / 40) and poor (VA ≤ counting finger) visual outcomes between the groups. However, subgroup analysis of patients with a VA of HM (92 eyes) showed that the incidence of reintervention (14 of 72 eyes [19.4%] vs. 9 of 20 eyes [45.0%]) and poor visual outcomes (10 of 72 eyes [13.9%] vs. 8 of 20 eyes [40.0%]) were lower after prompt vitrectomy than after intravitreal antibiotic injection alone (p = 0.019 and p = 0.022, respectively). For those with a VA of at least counting finger, no significant difference was observed between the groups.ConclusionsFor patients with endophthalmitis presenting with a VA of HM, performing a prompt vitrectomy reduced the incidence of reintervention and poor visual outcomes than the administration of intravitreal antibiotics alone. Our results suggest that primary vitrectomy for patients with endophthalmitis presenting with a VA of HM could be more beneficial than intravitreal antibiotic injection alone.

Pars plana vitrectomy and therapeutic keratoplasty in endophthalmitis and infectious keratitis.

To describe the anatomical and functional outcomes of patients with infectious keratitis (IK) and secondary endophthalmitis who underwent penetrating keratoplasty (PK) after pars plana vitrectomy (PPV) assisted by temporary keratoprosthesis (TKP). An observational retrospective case series was performed. Data were collected from January 2013 to July 2020. Patients over 18 years old with a clinical and microbiological diagnosis of IK, and clinical, ultrasonographic, and or microbiological diagnosis of endophthalmitis were included. Anatomical success was defined as infection resolution with preservation of the ocular globe integrity. No change or improvement of best-corrected visual acuity (VA) at the last follow-up was considered as a functional success. A total of 32 eyes of 32 patients were analyzed. The anatomic success was obtained in 87.5% eyes in which the infection was eradicated. The 63% patients maintained or improved their best-corrected VA, 37.5% ended up with hand motion VA. Our results suggest that PPV assisted by TKP followed by PKP can be a good approach for treating patients with endophthalmitis secondary to IK while allowing further visual improvement after an optical PK. Further prospective studies need to be done to evaluate final visual rehabilitation of these patients.

A rare case of post-laser-assisted in situ keratomileusis Scedosporium prolificans keratitis

A 21-year-old female presented with a stick injury in her right eye 6 months after an uneventful laser in situ keratomileusis (LASIK). Diffuse lamellar keratitis which responded well to the initial treatment with topical steroids, progressed rapidly within the next 3 weeks to develop corneal perforation. A microbiological examination revealed a rare fungus Scedosporium prolificans. The patient was successfully managed with topical voriconazole 1% and cyanoacrylate glue for corneal perforation. At the end of 7 weeks, keratitis healed with a best-corrected visual acuity of hand movements. Hence, a strong suspicion of infectious interface keratitis is warranted while treating post-LASIK keratitis.

Postvitrectomy endophthalmitis caused by Morganella morganii: a case report and literature review

BackgroundPostvitrectomy endophthalmitis is a rare and serious complication following vitreoretinal surgeries. Morganella morganii, an emerging gram-negative, facultative anaerobic rod, is related to severe nosocomial infections in various organs and thus has gained importance in recent decades. Morganella morganii infection following intraocular surgery is rarely reported.Case presentationWe report an immunocompetent patient with Morganella morganii-related endophthalmitis after vitrectomy for retinal detachment who presented with hand motion visual acuity, hypopyon and a unique retrolental exudative membrane. Initially, the patient was unresponsive to empirical intravitreal ceftazidime and vancomycin but recovered with vision preservation (20/63) after surgical removal of the membrane and silicone oil tamponade.ConclusionsMorganella morganii intraocular infection is often devastating, likely due to its high multidrug-resistance rate via intrinsic ß-lactamase production, multiple acquired traits related to additional genetic mechanisms, and fimbrial adhesion, urease production, and type III secretion system-associated biofilm formation. The above characteristics of M. morganii may lead to an inadequate response to empirical intravitreal antibiotics, and early surgical intervention should be considered.

Double small incision lenticule extraction lenticular graft in impending corneal perforation

Purpose The aim of this study was to evaluate the safety and efficacy of double stromal lenticules, extracted by femtolaser small incision lenticule extraction (SMILE) surgery, as a surgical adjuvant for sealing of impending corneal perforation. Patients and methods The study included 20 eyes of 20 patients with impending corneal perforation. Double corneal stromal lenticules obtained through SMILE surgery, with a central thickness of 65 μm for each lenticule, were fixed over the corneal impending perforation site by 10-0 nylon interrupted stitches. The patients were monitored for a minimum of 6 months and were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity measurements. Postoperative complications were recorded throughout the follow-up period. Results The mean age of the patients was 51.25±1.49 years. The mean thickness of the used double SMILE lenticules was 108.85±10.77 μm (range, 90–120 μm). The preoperative best spectacle-corrected visual acuity was counting fingers at 30 cm in four patients, whereas the other 16 patients had a visual acuity of hand movement. Postoperatively, the corneal perforations were successfully sealed in 16 (80%) patients, and 15 (75%) patients exhibited a statistically significant improvement in visual acuity (P=0.02). During the follow-up period of 6 months, there was evidence of one case of infection and two cases of sliding graft. There was no significant association between the patients’ data and the reported complications except the association between complications and hand movement visual acuity. Conclusion The use of double corneal lenticules was a safe and effective surgical adjuvant for corneal perforation closure. It is a simple and inexpensive temporary measure to improve the corneal condition for further definitive interventions.

A Case Report of Intraocular Radiotherapy with Strontium-90 for Juxtapapillary Retinal Capillary Haemangioma

Juxtapapillary retinal capillary haemangiomas are rare benign vascular tumors located adjacent to the optic disc. They may occur sporadically or in association with von Hippel-Lindau disease. Treatment modalities for juxtapapillary retinal capillary haemangiomas vary from observation to aggressive vitreoretinal surgery. A combination of different treatment modalities is often tried with modest success. We report a patient diagnosed with right-sided juxtapapillary retinal capillary haemangioma at the age of 36 in an amblyopic eye previously treated with patching and surgery. In 2013, at the age of 45 he presented with increasing shadow in his right visual field. The ophthalmological examination revealed a right-sided subtotal serous retinal detachment with 6.2×5.6×3.5 mm juxtapapilllary retinal capillary haemangioma and visual acuity of hand movements. He underwent vitreoretinal surgery, radiation of juxtapapillary retinal capillary haemangioma with intraocular strontium applicator and insertion of silicone oil, all in one session. We describe a novel treatment, the intraocular radiation with strontium. This can be applied in complicated cases where vitrectomy is necessary.

Management Patterns and Outcomes for Intravitreal Injection-Related Endophthalmitis.

This work describes the clinical management and outcomes in cases of presumed infectious endophthalmitis following intravitreal injection at a tertiary academic medical center. A retrospective review took place of eyes that presented to the Duke Eye Center over a 9-year period and were diagnosed with intravitreal injection-related endophthalmitis. Clinical presentation, management, microbiologic yield, visual outcomes, and complications were abstracted from medical records. Of 23 eyes diagnosed with postinjection endophthalmitis, 52.2% underwent anterior chamber tap (33.3% of which first underwent dry needle vitreous tap), 47.8% underwent needle vitreous tap, 17.4% underwent neither, and none underwent pars plana vitrectomy (PPV) for initial management. Subsequent PPV was performed in 6 eyes (26.1%). Mean visual acuity (VA) improved by 50 Early Treatment Diabetic Retinopathy Study letters at 6 months. Eyes that underwent initial anterior chamber tap had worse presenting VA than those that did not (P = .01). Eyes undergoing subsequent PPV had worse VA at presentation (P = .02) and at 6 months (P < .001). Eyes presenting with VA of hand motion (20/8000) or worse were more likely to undergo subsequent PPV (P = .02). Eyes with intravitreal injection-related endophthalmitis presenting with VA of hand motion or worse were more likely to undergo subsequent PPV. Future studies with larger cohorts may reveal whether earlier vitrectomy should be considered in these patients.

Long-term outcomes of the MICOF keratoprosthesis surgery

PurposeTo evaluate long-term anatomical and functional outcomes of the MICOF keratoprosthesis to treat end-stage corneal blindness. DesignRetrospective review of consecutive clinical case series. ParticipantsBetween October 2000 and October 2015, at the Department of Ophthalmology of Chinese PLA General Hospital (PLAGH), a total of 132 eyes of 131 patients had undergone a MICOF keratoprosthesis implantation. Of those, 91 eyes of 90 patients were included in this study. MethodsPreoperative information, surgical procedures, and postoperative data were collected for each included eye. Main outcome measuresBest-corrected visual acuity (BCVA), keratoprosthesis retention, and significant postoperative complications were reported. ResultsThe most common indications for surgery were chemical or thermal burns (68.1%, 62 of 91 eyes) and explosive injury (12.1%, 11 of 91 eyes), followed by Stevens-Johnson Syndrome (10.0%, 9 of 91 eyes), Sjögren's syndrome (4.4%, 4 of 91 eyes), mucous membrane pemphigoid (3.3%, 3 of 91 eyes) and multi-penetrating keratoplasty failure (2.2%, 2 of 91 eyes). The mean follow-up duration was 8.38 ± 3.22 years (range: 5–17.25 years, median: 7.67 years).All patbients had a preoperative visual acuity of hand motions or worse. A MICOF keratoprosthesis significantly improved patients' visual function with bilateral end-stage corneal blindness. Postoperative visual acuity improved to 20/200 or better in 41 eyes (45.1%, of 91 eyes) and to 20/100 or better in 32 eyes (35.2% of 91 eyes) at the last follow-up visit. Preexisting glaucoma was present in 17 (18.7% of 91 eyes). The most common postoperative complications were overgrowth of the surface mucosa (31.9%, 29 of 91 eyes), glaucoma (25.3%, 23 of 91 eyes), retro-prosthetic membrane (15.4%, 14 of 91 eyes), keratoprosthesis device extrusion (15.4%, 14 of 91 eyes), superficial tissue thinning (14.3%, 13 of 91 eyes), endophthalmitis (13.2%, 12 of 91 eyes), titanium frame exposure (13.2%, 12 of 91 eyes), optical cylinder ante-displacement (13.2%, 12 of 91 eyes), cornea melting (7.7%, 7 of 91 eyes), retinal detachment (6.6%, 6 of 91 eyes) and aqueous humour leakage (2.2%, 2 of 91 eyes). 84.6% (77 of 91 eyes) of the eyes retained their initial keratoprosthesis at the latest follow-up. ConclusionsA MICOF keratoprosthesis is a reliable approach to rescue vision in end-stage corneal blinded patients and has better retention than a Boston Kpro TypeⅡ.

Choroidal Tuberculoma Presenting with Exudative Retinal Detachment in a Young Male: A Case Report

An 18-year-old male student presented with a 1 month history of poor vision in the right eye. Ocular examination revealed visual acuity of hand movement and 20/20 in the right and left eyes, respectively. Inflammatory cells were present in the anterior chamber of the right eye. Fundus examination revealed a right exudative retinal detachment with a tuberculoma in the superotemporal quadrant, whereas the left eye was normal. There was a positive history of contact with a relative with pulmonary tuberculosis. The patient was treated with a combination of antituberculous therapy and oral corticosteroids for 6 months following which the lesion resolved completely with full recovery of vision to 20/20 in the right eye.

Endophtalmitis associated with flange exposure after a 4-flanged canabrava fixation techique

A 101-year-old woman who underwent 4-flanged intrascleral fixation intraocular lens (ISF IOL) technique surgery in her left eye (elsewhere) 6 months prior to her presentation, was referred to our department due to pain and loss of vision for the previous 4 days. The patient presented with left eye visual acuity of hand motion, conjunctival hyperemia, hypopyon, vitritis, and 2 polypropylene flanges exposed throughout the conjunctiva. Endophthalmitis was diagnosed followed by urgent treatment with vitreous and anterior chamber tap, and intravitreal injections of antibiotics and steroids. Cultures revealed Streptococci viridans infection. No further surgical intervention was performed due to patient opposition. The infection resolved within a few weeks; however, phthisis bulbi developed subsequently. ISF IOL with 4 polypropylene flanges has gained popularity. A rare complication of flange extrusion might lead to endophthalmitis. Studies evaluating short- and long-term complications of this technique are warranted.

Medical management of acute loss of vision in tuberculous meningitis: A case report

Blindness and vision impairment are unpredictable complications of tuberculous meningitis (TBM) that are often unrecognized in the acute stages of illness due to inability to assess vision in patients with depressed levels of consciousness or confusion. We present a patient with definite TBM confirmed by positive Xpert MTB/RIF assay of cerebrospinal fluid (CSF) who developed binocular blindness two weeks after diagnosis and initiation of standard anti-tuberculosis treatment (ATT). Ophthalmological exam demonstrated complete bilateral abducens nerve palsies, impaired pupillary responses to light, normal optic discs, and visual acuity of hand motion only in each eye. Brain CT showed progressive enlargement of the third and lateral ventricles. We managed the patient medically with dexamethasone, acetazolamide, and substitution of moxifloxacin for ethambutol. Serial brain CTs confirmed gradual resolution of hydrocephalus. The patient had complete neurological recovery at six months except for residual blindness in the right eye. Visual acuity in the left eye recovered to normal (20/20). The assessment and management of vision impairment in TBM is discussed.