Objective:Ahmed glaucoma valve (AGV) implantation can lead to corneal decompensation in a significant proportion of patients. Anterior segment optical coherence tomography (ASOCT) evaluation may serve as a crucial tool for assessing AGV retention versus explantation and for planning Descemet stripping automated endothelial keratoplasty (DSAEK) in such cases. This study aims to evaluate the utility of ASOCT in guiding management decisions for AGV-related corneal decompensation. Materials and methods:In this prospective interventional study, 11 eyes with AGV-related corneal decompensation were evaluated using anterior segment 5-line raster-mode OCT measurements. Parameters assessed included stromal scarring, corneal thickness, and tube tip to endothelium (TTE) distance. ASOCT findings guided management decisions: four patients with nonfunctional AGVs underwent staged procedures (AGV removal with augmented trabeculectomy, followed by DSAEK), while seven patients underwent DSAEK alone (six with functional AGVs with TTE distance > 150 μm; one patient with a non-functional AGV refused consent for AGV explantation). Results:All patients demonstrated significant improvement in best-corrected visual acuity with well-controlled intraocular pressure. Graft attachment was successful in all cases except one patient who experienced detachment after one month. Based on our findings, we proposed a protocol for managing AGV-related corneal decompensation. Discussion:Tube shunt implantation effectively reduces intraocular pressure in eyes with uncontrolled glaucoma but can lead to significant endothelial cell loss and corneal decompensation. In this series, two major challenges were addressed: the decision regarding AGV tube removal and its risks, and the determination of a safe tube-tip-to-endothelium (TTE) distance to prevent graft damage after DSAEK. We considered a preoperative TTE greater than 150 μm to be safe for single-stage DSAEK without AGV modification, accounting for lenticule thickness and the anticipated reduction in corneal edema. ASOCT-guided measurement of TTE distance proved invaluable for predicting complications and guiding surgical decision-making, with outcomes that support our proposed management protocol. Conclusion:While performing DSAEK in patients with AGV-related corneal decompensation presents significant challenges, ASOCT is an essential modality for guiding surgical decision-making regarding AGV explantation versus retention and subsequent DSAEK.
Purpose:To describe a diagnostically challenging case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) in a young girl, presenting with features mimicking Vogt-Koyanagi-Harada (VKH) syndrome. Methods:An 18-year-old Asian Indian girl presented with sudden bilateral visual diminution and metamorphopsia for three days. Clinical examination and multimodal imaging were performed, including Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT), Fundus Fluorescein Angiography (FFA), Indocyanine Green Angiography (ICG), and Optical Coherence Tomography Angiography (OCTA). Systemic evaluation included the Mantoux test, QuantiFERON-TB Gold, HRCT of the chest, abdominal ultrasonography, and routine blood work. Results:BCVA was 20/40 in both eyes. Fundus examination revealed mild vitritis, multiple serous retinal detachments (SRD), and yellowish placoid lesions at the posterior pole. EDI-OCT showed SRD with bacillary layer detachment and mild choroidal thickening in both eyes. FFA revealed early hypofluorescence with late staining; ICG showed persistent hypocyanescent lesions localized to the posterior pole. OCTA demonstrated choriocapillaris flow voids. Mantoux and QuantiFERON-TB Gold were strongly positive; other systemic investigations were unremarkable. Given the absence of VKH prodromal features and features on multimodal imaging, a diagnosis of APMPPE was made. The patient was observed without corticosteroid therapy, and complete resolution of SRD and bacillary layer detachment occurred within 1 week. Discussion:The initial presentation with bilateral SRDs and BALADs strongly suggested VKH syndrome. However, the absence of systemic prodromal symptoms, combined with characteristic angiographic features, led to a diagnosis of APMPPE. The rapid, spontaneous resolution of these atypical detachments without corticosteroid therapy further confirmed the self-limiting nature of APMPPE, in sharp contrast to the prompt immunosuppression typically required for VKH. Conclusion:APMPPE can rarely present with atypical clinical features such as SRD and BALAD. Clinicians must integrate multimodal imaging with systemic evaluations to accurately differentiate it from VKH syndrome, thereby preventing misdiagnosis and avoiding unnecessary treatment.
Background:Chronic Kidney Disease (CKD) is a significant public health problem associated with considerable morbidity and mortality. It is known to cause retinal vascular changes and retinopathy that reflects changes occurring in the kidneys. Optical coherence tomography (OCT) is a promising biomarker for assessing retinal changes associated with CKD. This study was conducted to evaluate retinal alterations in patients with CKD using spectral-domain optical coherence tomography (SD-OCT), correlate these findings with biochemical parameters to facilitate early screening and timely detection, and assess disease progression. Materials and methods:This single-centre, cross-sectional study included 60 eyes of 60 patients with stage 3, 4, or 5 CKD. Data collected included age, sex, glycaemic status, serum electrolytes, blood urea nitrogen (BUN), and serum creatinine. Fundus examination and various OCT parameters were measured. Central retinal thickness (CRT) and central choroidal thickness (CCT) were measured manually at the subfoveal region. Automated segmentation was used to measure retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses across all quadrants and sectors using SD-OCT. Descriptive and inferential statistical analyses were applied to assess significance. Results:Most patients were in Stage 3 CKD, with the majority having a disease duration of 1-3 years. Mean retinal thickness reduced from stage 3 to 5 with no statistical significance, while choroidal thickness remained preserved. Inferior RNFL thickness declined significantly with worsening CKD, whereas temporal RNFL and GCC showed borderline significance. Retinal parameters did not differ by CKD duration. Elevated HbA1c was associated with increased retinal thickness and thicker inferior RNFL. Both hypernatremia and hyperkalemia were associated with reduced retinal thickness. A higher glomerular filtration rate (GFR) was positively correlated with inferior RNFL thickness. Discussion:The findings of this study suggest that chronic kidney disease is associated with progressive neuroretinal changes, particularly thinning of the inferior retinal nerve fibre layer, which may reflect underlying microvascular and neurodegenerative processes occurring in CKD. The preservation of choroidal thickness despite declining renal function indicates that neuroretinal alterations may precede detectable choroidal changes. The observed associations between OCT parameters and biochemical markers, including HbA1c, serum sodium, potassium, and GFR, further support the influence of systemic metabolic and renal status on retinal structure. Conclusion:The study highlights that chronic kidney disease is associated with neuroretinal alterations that become more pronounced as disease severity increases. Optical Coherence Tomography has emerged as an important biomarker for evaluating these retinal changes. Further, by correlating OCT findings with biochemical parameters, we can evaluate the impact of systemic parameters in CKD on the retina. Therefore, OCT is an important tool in CKD that helps with screening, monitoring, and assessing disease progression.
Introduction:Primary vitreoretinal lymphoma (PVRL) is a rare and aggressive subtype of intraocular lymphoma, most commonly associated with primary central nervous system lymphoma (PCNSL). It frequently mimics inflammatory retinal diseases and is therefore considered an important masquerade syndrome in ophthalmology. Early diagnosis remains challenging because clinical manifestations can resemble entities within the white dot syndromes (WDS) spectrum. We report a case initially diagnosed as white dot syndrome, followed by the diagnosis of PCNSL, in which later ocular progression led to the diagnosis of PVRL. Case presentation:A 57-year-old male presented with painless, progressive visual loss in the left eye (LE) starting in July 2021. At that time, he was diagnosed at another center with multiple evanescent white dot syndrome (MEWDS) and treated with systemic corticosteroids, with subsequent improvement of visual symptoms after a single treatment course. His medical history was significant for COVID-19 infection in September 2021, followed one month later by neurological symptoms. Brain imaging revealed a left frontal tumor, and surgical resection established the diagnosis of PCNSL (non-Hodgkin B-cell lymphoma). The patient subsequently underwent systemic and intrathecal methotrexate (MTX) therapy combined with whole-brain radiotherapy. One year later, ophthalmologic reevaluation at our center revealed a best-corrected visual acuity (BCVA) of 20/20 in the right eye (RE) and motion in the left eye (LE). The LE showed a relative afferent pupillary defect (RAPD), vitreous cells, and multiple subretinal white-yellow lesions, including subfoveal involvement, associated with peripheral pigmentary changes. Given the patient's medical history, the findings raised suspicion for intraocular lymphoma. A diagnostic vitrectomy was subsequently performed, confirming PVRL. Intravitreal MTX therapy was initiated. Despite treatment, BCVA in the LE was counting fingers, and extensive chorioretinal atrophy was observed. Although subtle changes in the central outer retinal layers were observed in the RE, BCVA was 20/25. The patient subsequently underwent autologous stem cell transplantation. However, the clinical course was further complicated by a relapse of PCNSL and a severe Escherichia coli sepsis. Discussion:Primary vitreoretinal lymphoma is well known for its ability to masquerade as chronic posterior uveitis or inflammatory chorioretinal diseases, including WDS. The presence of vitritis combined with multifocal subretinal infiltrates should raise suspicion, particularly in patients with a history of PCNSL. Corticosteroid responsiveness may further obscure the diagnosis by temporarily improving inflammatory-like manifestations. Because up to 80% of patients with PVRL develop CNS involvement or present with CNS disease first, ophthalmologic surveillance is essential. Multimodal imaging and a high index of suspicion are critical for timely diagnosis. Conclusion:Primary vitreoretinal lymphoma should be considered in the differential diagnosis of white dot-like retinal lesions, especially in patients with a history of CNS lymphoma. Recognition of this masquerade presentation is essential to avoid diagnostic delay and to ensure prompt multidisciplinary management.
Introduction:Traumatic optic neuropathy (TON) is an acute injury to the optic nerve caused by direct or indirect trauma, often resulting in vision loss. Endoscopic transsphenoidal optic nerve decompression (EOND) is a minimally invasive technique designed to relieve pressure on the optic nerve. This systematic review evaluates the efficacy, safety, and visual outcomes of EOND in patients with TON. Methods:A systematic search of PubMed, Scopus, and Google Scholar was conducted for articles published between 2014 and 2024. Keywords included "optic nerve decompression", "traumatic optic neuropathy", and "endoscopic optic nerve decompression". After screening 42 articles, 16 studies met the inclusion criteria and were analyzed. Results:All included studies used the endoscopic transsphenoidal approach. The mean visual recovery rate was 58.4%. All patients received postoperative corticosteroids. Study populations ranged from 11.7 to 68.1 years, including 24 females and 354 males. Postoperative complications were reported in 25% of studies, most commonly cerebrospinal fluid (CSF) leaks. Discussion:Our findings demonstrated that endoscopic endonasal optic nerve decompression (EOND) is a safe and effective option for traumatic optic neuropathy (TON) patients unresponsive to steroids, with a mean visual recovery rate of 58.4% and a low complication profile, most commonly CSF leaks. While EOND offers clear advantages over traditional approaches, including minimal invasiveness and excellent visualization, the heterogeneity of existing data and the limited number of high-quality studies underscore the need for standardized protocols and further prospective research to optimize patient selection and surgical timing. Conclusion:EOND is a safe and effective intervention for TON patients unresponsive to medical therapy, offering minimal scarring, improved visualization, and rapid recovery. However, the limited number of studies and the heterogeneity of data highlight the need for further high-quality research to optimize outcomes.
Objective:To report a rare case of spontaneous, delayed-onset pupillary block in a pseudophakic, vitrectomized eye with a prior Nd: YAG posterior capsulotomy, and to emphasize the importance of maintaining a high index of suspicion even in anatomically protected eyes. Methods:We describe the clinical presentation, imaging findings, differential diagnosis, and management of a 78-year-old female with well-controlled primary open-angle glaucoma who presented with acute angle-closure symptoms in a previously vitrectomized, pseudophakic eye. Multimodal imaging, including anterior segment optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM), was utilized to rule out malignant glaucoma and aqueous misdirection. Results:Slit-lamp examination revealed iris bombe and appositional angle closure in the left eye. Anterior segment OCT confirmed a shallow anterior chamber, while UBM excluded ciliochoroidal effusion and anterior rotation of the ciliary body. A diagnosis of acute pupillary block was established. Nd: YAG laser peripheral iridotomy (LPI) resulted in immediate resolution of symptoms and normalization of intraocular pressure. Discussion:Although pupillary block is generally considered unlikely in pseudophakic and vitrectomized eyes, this case demonstrates that it may still occur despite prior Nd:YAG posterior capsulotomy. Progressive anatomical changes may contribute to delayed obstruction of aqueous flow. Careful clinical examination, combined with anterior segment OCT and UBM, is essential for distinguishing pupillary block from other causes of secondary angle closure, particularly malignant glaucoma and aqueous misdirection. Conclusions:This case demonstrates that pupillary block can occur spontaneously even in eyes with prior vitrectomy and YAG capsulotomy. Progressive anatomical changes may lead to delayed iris-lens apposition. Early diagnosis and treatment with LPI can reverse the condition and preserve vision. Clinicians should consider pupillary block in the differential diagnosis of acute angle closure, regardless of prior surgical history.
Objective:To report a case of a Stellate Multiform Amelanotic Choroidopathy (SMACH). A newly recognized, rare retinal disorder that remains largely underreported in the literature. Methods:Case report and review of literature. Results:We present the case of a 67-year-old asymptomatic woman with a nasal parafoveal hypopigmented lesion. Multimodal imaging, including Optical Coherence Tomography, Optical Coherence Tomography Angiography, and fluorescein angiography, revealed hyperreflective choroidal thickening, minimal subretinal fluid, and a digitiform pattern, with no signs of neovascularization. Discussion:SMACH is a rare, benign choroidal disorder whose variable clinical presentation can complicate accurate diagnosis. Understanding its non-progressive natural history is critical for differentiating it from vision-threatening pathologies, such as choroidal tumors, macular neovascularization, or pachychoroid spectrum diseases, reducing the risk of misdiagnosis and unnecessary therapeutic intervention. Conclusions:This case enhances our understanding of SMACH and underscores the value of multimodal imaging in identifying this rare condition, providing key insights into its diagnostic approach and natural course.
Background:Primary vitreoretinal lymphoma (PVRL) is a rare but aggressive subtype of extranodal diffuse large B-cell lymphoma and is closely related to primary central nervous system lymphoma (PCNSL). Its ability to masquerade as chronic posterior uveitis frequently leads to delayed diagnosis and inappropriate treatment, with significant prognostic implications. Methods:A narrative review was performed following a comprehensive search of the PubMed/MEDLINE and Cochrane Library databases, encompassing publications from 2000 through 2025 and including randomized controlled trials, observational studies, prospective and retrospective studies, and systematic reviews. The search strategy incorporated the following keywords: "primary vitreoretinal lymphoma", "intraocular lymphoma", "diagnostic vitrectomy", "MYD88 mutation", "IL-10/IL-6 ratio", "intravitreal methotrexate", "rituximab", "CNS involvement", "optical coherence tomography". Two authors independently conducted study selection and eligibility assessment. Results:Heightened clinical awareness remains pivotal for diagnosing PVRL, particularly when vitritis is partially responsive to steroids, when involvement is bilateral or asymmetric, and when subretinal pigment epithelial infiltrates are present. Multimodal imaging - including optical coherence tomography (OCT), fundus autofluorescence (FAF), and fluorescein angiography (FA) - facilitates early recognition and supports clinical suspicion. Diagnostic vitrectomy with cytology, immunohistochemistry, cytokine analysis (IL-10/IL-6 ratio), and molecular testing (IgH rearrangement, MYD88 L265P mutation) significantly increases diagnostic accuracy. Due to the strong association with central nervous system (CNS) involvement, neuroimaging is mandatory at diagnosis and during follow-up. Treatment options include intravitreal methotrexate and/or rituximab, systemic high-dose methotrexate-based chemotherapy, and radiotherapy. Emerging therapies in PVRL focus on targeted agents, including intravitreal biologics, BTK inhibitors, and personalized molecular-based treatments. The optimal strategy remains controversial and should be individualized based on CNS status and patient characteristics. Discussion:Primary vitreoretinal lymphoma remains a diagnostic challenge due to its ability to mimic chronic inflammatory eye disorders and the frequent delay in establishing a definitive diagnosis. The integration of multimodal imaging, vitreous cytology, immunohistochemistry, cytokine profiling, and molecular testing has significantly improved diagnostic accuracy. However, management remains complex because of the close association with CNS involvement and the absence of universally accepted treatment protocols. Current therapeutic approaches, including intravitreal chemotherapy, systemic methotrexate-based regimens, and targeted therapies, require individualized selection based on disease extension and patient characteristics. Future advances in molecular diagnostics and personalized treatment strategies may contribute to earlier detection, improved disease control, and better long-term outcomes. Conclusions:Prompt diagnosis, combined with a structured diagnostic approach, is essential to improving outcomes in PVRL. Close collaboration among ophthalmologists, hematologists, neurologists, and pathologists is mandatory for optimal patient management.
A gouty tophus on the eyelid is a casuistic flash in the routine biopsy flow. There has been a 12th case reported in the literature, along with an analysis of the distribution by age, sex, location, size, and symptoms. Male gender predominates (10:2) within a wide age range (26-79 years), after a several-year history of gout, affecting mainly the canthi and, in only 4 cases, the middle area of the eyelids (the upper eyelid more often), with dimensions ranging from 4 to 14 mm. The tophi can be multiple (in 2 cases). In addition to aesthetic concerns and discomfort, the tophi caused mechanical ptosis of the eyelid on two occasions. A histologically confirmed eyelid tophus may serve as an early diagnostic stigma of the disease, even in the absence of hyperuricemia. Their occurrence may be either a manifestation of disseminated skin tophi or a localized disturbance of the protective alkaline homeostasis of the eyelid tissue.
Background:Neovascular glaucoma (NVG) represents one of the most severe forms of secondary glaucoma and is characterized by an aggressive clinical course, a high risk of irreversible vision loss, and substantial variability in treatment outcomes. At the same time, the roles of systemic inflammation, ocular microcirculation, and neovascularization of the iridocorneal angle (according to the Weiss D. classification, 1978) in determining the long-term prognosis remain insufficiently investigated. Purpose:To identify clinical, microcirculatory, and systemic inflammatory predictors of long-term treatment effectiveness in secondary NVG and to compare the outcomes of surgical interventions and diode transscleral cyclophotocoagulation depending on the stage of iridocorneal angle neovascularization. Methods:A multicenter retrospective cohort study included 87 eyes with ischemic NVG secondary to proliferative diabetic retinopathy or retinal vein occlusion treated between 2018 and 2024 in Ukraine and Moldova. Patients were divided into a surgical group (n=39) and a diode transscleral cyclophotocoagulation group (n=48). Clinical parameters, systemic inflammatory indices (SII, SIRI, AISI), HbA1c, cardiovascular comorbidity, and the rheographic coefficient (RQ), a functional microcirculation marker, were analyzed. Treatment success was defined as intraocular pressure control with stabilization of visual acuity, absence of rubeosis progression, and no need for additional invasive surgery. Multivariable logistic regression and ROC analysis were performed. Results:Treatment effectiveness was strongly associated with the stage of iridocorneal angle neovascularization. In the early stages, both approaches showed high success rates, whereas in the advanced stages, surgical outcomes declined markedly. In multivariable analysis, surgery increased the odds of success more than fivefold (OR=5.4; p=0.003), whereas advanced angle stages reduced it nearly sixfold (OR=0.18; p=0.007). Higher systemic inflammation was associated with poorer prognosis (SII OR=0.76; p=0.009), whereas better microcirculation was associated with improved outcomes (RQ OR=1.42; p=0.023). The combined predictive model demonstrated good discrimination (AUC = 0.84; 95% CI, 0.74-0.92). Discussion:In the present study, long-term outcomes of neovascular glaucoma were shown to be determined by the complex interaction between the stage of iridocorneal angle neovascularization, systemic inflammation, and ocular microcirculation. Our findings indicated that the Weiss stage is a key morphological factor that modifies treatment effectiveness. In contrast, systemic inflammatory indices (SII, SIRI, AISI) reflect the underlying biological burden of disease and are associated with poorer prognosis. In contrast, higher values of the microcirculatory parameter (RQ) were significantly associated with more favorable treatment outcomes, likely reflecting preserved perfusion capacity and a lower degree of ischemic tissue damage. This observation is consistent with the concept of ischemia-driven progression in NVG. Importantly, integrating these parameters into a multivariable model demonstrated good discriminative performance (AUC = 0.84), supporting the value of a combined clinical-biological approach to risk stratification. Taken together, these results suggest that NVG should be considered not only a localized ocular disorder but also a systemically influenced condition in which the interplay among angiogenesis, inflammation, and microcirculatory dysfunction determines individual treatment response. Conclusions:Long-term outcomes in neovascular glaucoma appear to be determined by the interaction between the stage of iridocorneal angle neovascularization, systemic inflammation, and ocular microcirculation. Surgical treatment provides the greatest benefit in early disease, whereas cyclophotocoagulation remains a stable option in advanced stages. Combined clinical-biological modeling may support personalized treatment selection in NVG.
Purpose:To compare endothelial cell properties and central corneal thickness (CCT) between nondiabetic individuals and patients with early type 2 diabetes mellitus (T2DM) with good glycemic control. Methods:This retrospective case-control study included patients diagnosed with T2DM within the past 10 years and nondiabetic individuals. All participants underwent comprehensive ocular examination and specular microscopy to measure endothelial cell density (ECD), central corneal thickness (CCT), and coefficient of variation (CV). Intergroup differences were analyzed statistically. Results:A total of 312 eyes from 180 patients were included: 118 eyes in the diabetic group and 194 in the nondiabetic group. There were no significant differences in age (p = 0.08) or sex distribution (p = 0.49) between groups. The diabetic group had a significantly lower mean ECD compared with controls (2467.8 ± 334.5 vs. 2553.5 ± 289.2; p = 0.028) and a significantly higher CCT (558.8 ± 48.8 vs. 547.1 ± 44.6; p = 0.034). No significant difference was observed in the coefficient of variation. Discussion:These findings suggest that corneal endothelial alterations may occur early in the course of type 2 diabetes mellitus, even in patients with good glycemic control and short disease duration. The observed reduction in endothelial cell density alongside increased central corneal thickness may reflect subclinical endothelial dysfunction or early metabolic effects on corneal hydration regulation, preceding overt clinical corneal disease. Conclusions:Early T2DM is associated with reduced ECD and increased CCT compared with nondiabetic individuals, despite good glycemic control. These results indicate that diabetes may affect corneal endothelial structure and function at an early stage.
Objective:To report the early refractive, visual, and astigmatic-vector outcomes of single-step StreamLight™ transepithelial photorefractive keratectomy (Trans-PRK) on the WaveLight EX500 platform in eyes with high preoperative astigmatism (≥ 2.00 dioptres, D). Methods:Single-centre cohort study of 171 consecutive eyes of 107 patients (mean age 27.87 ± 6.56 years; 37.4% female) treated by a single surgeon. Astigmatic outcomes were analyzed by the Alpins method at the corneal plane. A subset of 57 eyes with a mean follow-up of 10.3 ± 7.4 months underwent stability sub-analysis. Results:Mean preoperative cylinder was 3.29 ± 0.81 D and mean spherical equivalent (SE) was -2.73 ± 2.56 D. At one month, mean UDVA was 0.05 ± 0.09 logMAR, mean residual cylinder was 0.65 ± 0.44 D, and mean SE was -0.22 ± 0.47 D. SE was within ±0.50 D of intended in 71.3% of eyes; cylinder was ≤ 0.50 D in 53.2%. Mean efficacy and safety indices were 1.04 ± 0.22 and 1.10 ± 0.22, respectively, with no eye losing two or more lines of CDVA. Vector analysis yielded a correction index of 1.09 ± 0.16, an index of success of 0.21 ± 0.14, and 99% of eyes within ±15° of the intended axis. Stability sub-analysis showed minimal change in SE and an unchanged cylinder between 1 month and a mean follow-up of 10.3 ± 7.4 months (SE -0.14 to -0.07 D). Discussion:Trans-PRK delivered good early visual, refractive, and astigmatic vector outcomes. Axis precision was high with a mean angle of error of -0.81 ± 5.32°, 80% of eyes within ±5°, and 99% within ±15° of the intended axis. Interpretation of vectorial results is subject to the specificity of the 1-month post-Trans-PRK central epithelial thickness (CET decreases in the first week, returns to baseline at 1 month, and progressively increases up to 6 months). Conclusions:Single-step StreamLight™ Trans-PRK on the WaveLight EX500 platform achieves favorable early refractive, visual, and vector-analytic outcomes in eyes with high preoperative astigmatism, with corneal-plane vector parameters that compare favorably with those reported in the published Trans-PRK literature.
Radiation-induced optic neuropathy is an uncommon but devastating complication of radiotherapy for head and neck tumors, characterized by subacute, painless, irreversible visual loss. Nasal mucosal melanoma, although rare, carries a high risk of visual pathway toxicity due to its proximity to anterior optic structures. We report the case of a 73-year-old woman with right nasal mucosal melanoma treated with adjuvant radiotherapy (66 Gy) and anti-PD1 immunotherapy, who developed progressive bilateral vision loss. Neuro-ophthalmological examination revealed severe visual acuity reduction, bilateral mydriasis, and optic disc pallor. Optical coherence tomography showed retinal nerve fiber layer thinning. Brain MRI demonstrated contrast enhancement of the optic chiasm and prechiasmatic optic nerves. Despite intensive treatment, the patient progressed to bilateral blindness. This case underscores the importance of early recognition of radiation-induced optic neuropathy, particularly in high-risk anatomical sites and in patients receiving radiotherapy combined with immunotherapy.
Objective:Orbital wall fractures require precise reconstruction to restore orbital volume and visual function, and bio-inert titanium implants benefit substantially from osteoconductive surface modifications. This study evaluated the biocompatibility and osteogenic potential of hydroxyapatite-collagen (HAP-COL) composites used in titanium implants intended for orbital fracture repair, comparing a sprayed HAP coating with a robocasting-deposited, 3D-printed HAP-COL layer. Methods:HAp-COL hybrid powder (HAp:COL mass ratio 4:1) was prepared by hydrothermal synthesis at 100 °C and 104 Pa, followed by spray drying, and characterized by FAAS, ICP-OES, FT-IR, XRD, and SEM-EDS. Two implant configurations were tested: Sample 1 (titanium with sprayed HAp) and Sample 2 (titanium with three robocasting-deposited 3D-printed HAP-COL layers). Cytotoxicity was assessed on a normal human osteoblast cell line (NHOst, Lonza CC-2538) in accordance with ISO 10993-12, using sample extracts at stock concentration and binary dilutions (1/2, 1/4, 1/8) and quantified by MTT assay at 24 and 48 hours. Results:Both samples showed dose- and time-dependent viability profiles within the acceptable limits of ISO 10993-5. Sample 1 viability ranged from 70.62% (stock) to 89.72% (1/8) at 24 h, and from 77.28% to 93.63% at 48 h. Sample 2 consistently outperformed Sample 1, with values from 80.61% to 91.28% at 24 h and from 83.35% to 96.47% at 48 h. Discussion:Both HAP-COL application techniques proved highly biocompatible and compliant with ISO 10993-5 non-cytotoxic safety limits. However, the 3D-printed robocast layer (Sample 2) consistently outperformed the sprayed coating, exhibiting superior osteoblast viability and proliferation. This demonstrates that a layered, biomimetic robocast architecture optimizes cell survival and successfully mitigates the bio-inert properties of standard titanium. Conclusions:The 3D-printed HAP-COL coating produced by robocasting exhibited superior biocompatibility and osteoconductive behavior compared with the sprayed alternative, supporting sustained osteoblast proliferation. HAP-COL robocast layers on titanium represent promising candidates for personalized orbital wall reconstruction, although in vivo validation remains necessary.
Objective:To assess and compare higher-order aberrations (HOAs) in migraine patients versus healthy controls, and to explore potential correlations between aberrometric parameters and migraine characteristics. Methods:A cross-sectional study was conducted involving 99 migraine patients (32 episodic and 67 chronic) and 99 age- and sex-matched controls. Comprehensive ophthalmologic examinations and wavefront aberrometry (using Huvitz HRK-8000A Autorefractor/Keratometer based on a Hartmann-Shack principle) were performed on all participants. HOAs, including spherical aberration, coma, trefoil, and quadrafoil, were quantified. Statistical analyses examined differences between groups and correlations with clinical migraine data. Results:Migraine patients exhibited higher total HOAs, but the result was not statistically significant compared to controls. Coma and oblique trefoil aberrations were notably elevated in the migraine patients. Oblique trefoil was significantly higher in cases than in controls. However, no correlation was found between HOA magnitude and migraine disease duration. Statistically significant correlation was found when comparing episodic versus chronic migraine cases. Discussion:Increased higher-order aberrations, especially oblique trefoil, are linked to chronic migraine, indicating that even with normal acuity, small optical variables may cause visual disruptions. Although more long-term research is required to establish causality, these results point to a combination of ocular and neurological mechanisms. Conclusions:Migraine patients demonstrate increased higher-order ocular aberrations, which may contribute to their visual symptoms. Aberrometry may serve as a valuable tool in identifying visual triggers and customizing optical interventions for migraine management.
Objective:To describe an atypical presentation of ocular leptospirosis in a pediatric patient without systemic symptoms, highlighting its diagnostic challenges and therapeutic approach. Case Presentation:A 9-year-old previously healthy girl presented with unilateral papillitis and vitritis, progressing to 360º retinal vasculitis as the sole manifestation of subclinical leptospirosis. Serology was positive for Leptospira spp. (IgM and IgG), although PCR testing in aqueous humor and urine was negative. The condition was interpreted as a post-infectious immune-mediated response. Treatment included systemic corticosteroids, intravenous ceftriaxone, and intravitreal triamcinolone, resulting in complete anatomical and visual recovery. Discussion:Ocular leptospirosis can appear as an isolated manifestation in the immune phase of infection, even in the absence of general symptoms or epidemiological evidence. Pediatric cases are rare and often underdiagnosed due to the negative microbiological tests in late stages. This case also highlights the importance of considering environmental exposures, such as flooding, as potential risk factors. Conclusion:This case underlines the need to include leptospirosis in the differential diagnosis of posterior uveitis and papillitis of unknown origin in children. Early multidisciplinary management and appropriate immunomodulatory treatment can prevent permanent visual sequelae.
Objective:This study aims to assess the surgical and visual outcomes of a sutured intraocular lens (IOL) fixation approach performed without creating a scleral flap or tunnel in aphakic eyes without posterior capsule support. Methods:In this retrospective study, we evaluated aphakic patients who underwent surgery using the ab externo scleral fixation technique that involved tying IOL fixation sutures on the sclera and placing the suture ends under the Tenon's capsule without opening the scleral flap. Preoperative and postoperative visual acuity, refraction values, intraocular lens centralization, and operation-related complications were analyzed. Results:In the study involving 38 patients with an average follow-up period of 8.2 months, the best-corrected visual acuity (BCVA) improved from an average of 1.00 logMAR to 0.10 logMAR. Spherical equivalent refraction decreased from +10.03 D to +0.96 D. Intraocular lens decentration was observed in 7.9% of cases. No intraoperative complications were observed, while 5.2% of patients experienced postoperative corneal edema and 2.6% experienced macular edema. Discussion:The results of this study demonstrate that the ab externo scleral fixation technique without a scleral flap or groove is a safe and effective approach for secondary IOL implantation in aphakic eyes. The significant improvement in BCVA (from 1.00 to 0.10 logMAR) and the substantial reduction in spherical equivalent refraction confirm the technique's optical efficacy. The low rates of intraoperative and postoperative complications, along with satisfactory IOL centration in 92% of cases, support the safety profile of this method. By positioning the suture ends beneath Tenon's capsule rather than creating a scleral flap or tunnel, this technique reduces operative complexity. It minimizes the risk of suture exposure and conjunctival erosion, while maintaining reliable IOL fixation. Conclusions:Due to its short surgical length, low complication rate, and satisfactory visual results, this simplified sutured IOL fixing technique without a scleral flap or tunnel is safe and effective. Suture exposure is reduced, and the procedure is less invasive, with the suture ends under Tenon's capsule. Larger, comparable, and prospective research is needed to assess the method's long-term effects.
Objective:To describe a rare case of bilateral ocular ischemia as the initial presentation of Takayasu arteritis and highlight the role of early recognition and treatment in preventing irreversible vision loss. Methods:A woman in her 50s presented with a gradual, progressive diminution of vision, initially in the left eye and later involving the right. Comprehensive ophthalmic evaluation, systemic examination, fundus fluorescein angiography, and CT angiography of the head and neck were performed. Laboratory investigations, including ESR, CRP, and ANA, were obtained. The American College of Rheumatology (ACR) criteria were applied to support the diagnosis. Results:The patient demonstrated severe ocular ischemic features, including attenuated retinal vessels, disc neovascularization, and intumescent cataract in the left eye. Systemic examination revealed feeble brachial and radial pulses with a significant inter-arm blood pressure difference. CT angiography showed narrowing of the right common carotid artery and non-opacification of both subclavian arteries. Laboratory findings revealed elevated ESR and CRP, with a positive ANA. Based on clinical, radiologic, and laboratory features, a diagnosis of bilateral ocular ischemia secondary to Takayasu arteritis was made. The patient was treated with oral corticosteroids (60 mg/day, tapered) and azathioprine. At 4 weeks, visual acuity improved to 6/36 in the right eye, while no improvement was noted in the left eye. Discussion:Our case highlights bilateral ocular ischemia as an uncommon but vision-threatening manifestation of Takayasu arteritis. Ocular findings such as retinal vascular attenuation, disc neovascularization, delayed choroidal filling, and peripheral capillary non-perfusion may precede the diagnosis of systemic vasculitis. Recognition of associated systemic signs, including pulse deficits and inter-arm blood pressure discrepancies, facilitated timely diagnosis. Prompt initiation of corticosteroid and immunosuppressive therapy led to visual improvement in the right eye, underscoring the importance of early diagnosis and multidisciplinary management to prevent irreversible visual loss and systemic vascular complications. Conclusion:Bilateral ocular ischemia may be the first manifestation of Takayasu arteritis. This case underscores the importance of a high index of suspicion in patients with unexplained ischemic ocular features. Early systemic evaluation and prompt initiation of immunosuppressive therapy are essential to preserve vision and prevent further vascular complications.
Objectives:The magnitude and axis of surgically induced astigmatism depend on the sclera-corneal tunnel dimensions. Often, the incision depth is subjective, and standardization is rarely emphasized. This study attempts to evaluate a fixed scleral incision depth of 350 µm at 1-week post-op. The aim is to determine the SIA vector and centroid using the Pythagorean theorem and keratometric measurements. Materials and methods:This study was conducted from January to July 2025 and recruited 42 patients at a tertiary health institution. All patients received scleral incisions to a depth of 350 µm after preoperative auto-keratometry measurements. Preoperative astigmatism was classified into WTR, ATR, and oblique types. Results:The overall mean age was 67.14 (± 9.23) years, with 27 (64.29%) males and 15 (35.71%) females. A positive correlation (r = 0.93, 0.69) was found for pre- and post-operative keratometry. T-test for pre- and post-operative vertical keratometry revealed statistical significance (p < 0.0009). The mean SIA magnitude and axis were 2.05 (± 1.75) D and 77.94º (± 59.68º), respectively. The Wilcoxon signed-rank test showed statistical significance for SIA magnitude (p=0.0003). The centroid was at 22.3º. A 28.57% conversion rate from ATR to WTR was observed, with 71.43% remaining unchanged postoperatively. High prediction accuracy was observed for preoperative horizontal and vertical keratometry (R2 values of 0.93 and 0.74, respectively). Discussion:This work adds a unique dimension to the literature by explicitly linking a fixed tunnel depth to the SIA vector and keratometric prediction. These results provide a platform for future research exploring scleral incision depth as a determinant of astigmatic outcomes. Conclusions:This study finds a statistically significant difference in vertical keratometry with moderate SIA magnitude. Astigmatic axis transition was unchanged in most patients, likely due to a standardized scleral incision depth. Centroid demonstrated a minimal SIA magnitude on horizontal keratometry. An excellent postoperative keratometry prediction was determined.
