The absence of adequate posterior capsule support—whether due to complicated cataract surgery, lens subluxation due to trauma or syndromes, or aphakia due to any other cause—necessitates a suitable intraocular lens (IOL), either an anterior chamber intraocular lens (ACIOL) or a scleral-fixated IOL. The absence of any systematic review in the English literature comparing ACIOL with scleral-fixated IOL prompted this study. We looked for clinical trials (randomized and controlled) comparing the outcomes of ACIOL with scleral-fixated IOLs through various search engines. The searched terms included anterior chamber intraocular lens, scleral-fixated intraocular lens, complicated cataract surgery, and secondary intraocular lens. All patients who had either an ACIOL or scleralfixated IOL were included. Risk of bias was assessed using the Cochrane Collaboration tools to ascertain the standard and quality of the trials. The outcomes studied were best-corrected visual acuity (BCVA) and intraoperative and postoperative complications. Seven trials were finally selected for analysis. There was no difference in BCVA between ACIOL and scleral-fixated IOL. There was also no difference in terms of complications, including retinal detachment, cystoid macular edema, glaucoma, uveitis, and vitreous prolapse, between the two groups. However, there was a higher chance of vitreous hemorrhage in the scleral-fixated group compared to ACIOL. Both ACIOL and scleralfixated IOLs appear to be used as safe options in current practice. Further multicenter randomized controlled trials are needed to clarify the benefits of each intervention and strengthen the validity of this review
Purpose: To present a case of epithelial downgrowth, which is a known complication of various corneal surgeries, including corneal laceration repair, cataract surgery, and corneal transplantation. Case Report: We present a 45-year-old male with progressive epithelial downgrowth after incisional astigmatism correction and phacoemulsification in his right eye with a history of penetrating keratoplasty. The preoperative best-corrected visual acuity was 20/100 with a refraction of −9.00 −6.00 × 120. The patient underwent phacoemulsification combined with an incision in steep meridian to correct the corneal astigmatism. One month post operation, a sheet-like membrane (4 × 5 mm) was observed in the paracentral zone of cornea, attached to the incisional region. Due to progression of epithelial downgrowth, the patient underwent repeat penetrating keratoplasty, and the tissue specimen was sent for histopathological examination. The pathology exam revealed an epithelial layer posterior to the deep stroma and anterior to the Descemet membrane. Conclusion: Our case highlights the possibility of epithelial downgrowth in the layer between deep stroma and Descemet membrane.
Purpose: To leverage deep learning (DL) to process optical coherence tomography (OCT) images for the detection of optic nerve head (ONH) abnormalities, particularly optic disc swelling. Methods: The study employed a dataset of 795 pre-processed OCT images, comprising 561 images with structural abnormalities and 234 images with normal ONH structures. A DL architecture, namely a 3D ResNet model, was implemented to classify the images. Results: The 3D ResNet model achieved an accuracy of 93.7%, an F1-score of 0.87, and an AUC of 0.96 on the test dataset, demonstrating high precision in distinguishing between normal and abnormal ONH structures. Conclusion: The application of 3D ResNet for classifying ONH OCT images demonstrated promising results for the automated detection of ONH swelling. This approach may support clinical decision-making by improving diagnostic accuracy and reducing reliance on manual image interpretation.
Purpose: This study evaluated the short-term anatomical and visual outcomes and complications of simultaneous intravitreal injection of bevacizumab and dexamethasone versus bevacizumab alone in patients with persistent macular edema caused by retinal vein occlusion (RVO) admitted at Labbafinejad Medical Center. Methods: This prospective interventional study was performed on 50 eyes from 50 patients with RVO-related macular edema refractory to at least three monthly bevacizumab injections. The eligibility criteria included central macular thickness (CMT) >300 μm and <10% reduction from baseline. Patients were alternately allocated to two groups: one received monthly bevacizumab (1.25 mg) alone (monotherapy group) and the other received intravitreal bevacizumab combined with dexamethasone (200 μg) for three sessions (combination group). Best-corrected visual acuity (BCVA), CMT, and intraocular pressure (IOP) were measured at baseline and 1 month after the third injection. Results: Baseline CMT was 511.4 ± 139.05 μm in the combination group, which decreased to 417.58 ± 156.72 μm 1 month after the last injection (P = 0.004), while the reduction of CMT was not significant in the monotherapy group. In comparison, combination therapy yielded a significantly greater CMT reduction than bevacizumab monotherapy (P = 0.020). BCVA improved significantly from baseline only in the combination group (P = 0.016), though the difference in visual improvement between groups was not significant (P = 0.457). In patients with central retinal vein occlusion (CRVO), CMT reduction was notably greater with combination therapy (P = 0.015) compared to branch retinal vein occlusion (BRVO). Visual and anatomical improvements were comparable between BRVO and CRVO subgroups. Combination therapy did not increase the risk of elevated IOP. Conclusion: For treatment-resistant macular edema secondary to RVO, simultaneous intravitreal bevacizumab and dexamethasone could reduce CMT and improve BCVA more effectively than bevacizumab alone, without increasing IOP. Given the cost and limited access to dexamethasone implants, adjunctive intravitreal dexamethasone solution is a viable option for persistent macular edema secondary to RVO.
Purpose: Ocular manifestations of multiple myeloma (MM) are rare but may affect all tissues of the eye. This report describes a patient with recurrent MM initially presenting with ocular hypertension due to angle closure, revealing extensive ocular, orbital, and systemic metastatic disease. Case Report: A 54-year-old female patient with previously treated MM presented with left eye pain, blurred vision, and an intraocular pressure of 38 mmHg. Examination revealed proptosis, restricted upward gaze, conjunctival injection with two salmon-patch lesions, and complete angle closure. Further findings included multiple ciliary body cysts, a massive choroidal mass, and retinal/choroidal detachments. She had pancytopenia. Magnetic resonance imaging confirmed recurrent MM with superior rectus muscle and spine infiltrations, and a large prevertebral lymph node mass. The patient responded well to antiglaucoma medications and was referred to her oncologist. Conclusion: MM can involve various ophthalmic structures. Patients with MM require regular examinations for early detection of ocular metastasis.
