Oman Journal of Ophthalmology最新文献

Despite the advantages of self-sealing wounds in microincisional vitrectomy surgery (MIVS), wound leak can occur, leading to hypotony and increased risk of choroidal detachment and endophthalmitis. Inappropriate wound construction is the major cause of wound leaks, apart from failure to detect and manage wound leaks. Few techniques of wound construction have been described to prevent wound leaks and enhance appropriate closure, but wound leaks can still happen. It is challenging to address it due to compromised visibility because of the oozing of blood or vitreous substitute and swelling of the conjunctiva and tenons. The use of an inverted surgical contact lens to detect port leakage has been documented. Still, it fails to address the issue of passing the suture to close the sclerotomy. Our approach addresses both issues. It has been reported that more than one-third of ports in MIVS require suturing. In our technique, we start suturing the port at the conclusion of surgery while withdrawing the cannula itself. We did 30 consecutive cases of MIVS for various indications where suturing the ports was done with this new technique. The mean postoperative intraocular pressure on day one was 18.82 ± 12.24 mmHg. Our technique ensures proper identification of the port and facilitation of suturing of the port, especially in cases where we decide to suture the sclerotomy in anticipation of a leak.

An interesting and unusual case of a 42-year-old Indian male with unilateral chorioretinitis, optic disc inflammation, and positive syphilis serology is presented, highlighting the need for a high index of suspicion in diagnosing this "great masquerader" with diverse manifestations.

A 59-year-old diabetic woman presented with acute dacryocystitis in her left eye and visual acuity of finger counting at two feet and was initially treated with topical and systemic antibiotics. However, her condition deteriorated, leading to left orbital cellulitis and a significant reduction in vision, with no perception of light. Prompt drainage of the lacrimal abscess was performed, and she was administered parenteral antibiotics. The patient showed clinical improvement and subsequently underwent external dacryocystorhinostomy after the acute infection had subsided. Unfortunately, her visual acuity did not improve significantly, with only a positive perception of light. Magnetic resonance imaging during the acute phase revealed optic nerve enhancement and focal signal changes, which persisted even after the infection had resolved. Acute dacryocystitis rarely advances to orbital cellulitis, which can result in vision loss, with only a few documented cases in literature. It is crucial to closely monitor such patients and promptly intervene with imaging and parenteral antibiotics, along with abscess drainage if indicated.

Background: The aim of the study was to assess the midterm efficacy and safety of the iStent glaucoma device in patients with open-angle glaucoma (OAG).

Materials and methods: We conducted a retrospective case series of all patients implanted with iStent inject® in OAG. Primary outcomes included intraocular pressure (IOP) and the reduction of antiglaucoma medications. Safety outcomes comprised adverse complications, additional surgeries, and postoperative best-corrected visual acuity (BCVA).

Results: Eight eyes from eight patients were included in this series. The mean age was 56.3 ± 17.5 years. Six eyes had primary OAG and two eyes had secondary OAG. The majority of eyes (75%) had mild-to-moderate glaucoma. Five eyes underwent combined surgery, whereas the remaining three eyes underwent a standalone procedure. The mean baseline IOP was 22.9 ± 8.2 mmHg, and the mean IOP at 2 years after the procedure was 13.6 ± 2.8 mmHg. There was a 44.5% (10.2 ± 2.5 mmHg; P = 0.002) IOP reduction over 2 years. There was also a reduction in medication burden from a baseline mean of 3.4 ± 0.7 to 2.0 ± 1.2 (P = 0.17). There was no documented intraoperative adverse complication, whereas one patient required trabeculectomy post iStent for IOP control.

Conclusion: iStent inject implantation safely reduced IOP and medication burden up to 24 months postoperative.

Fundus fluorescein angiography (FFA) is considered the gold standard for identifying focal leaks in central serous chorioretinopathy (CSCR). However, there are situations where FFA cannot be performed, and alternative noninvasive investigations are required to pinpoint area of focal leaks. We present a case of a 36-year-old female patient with bilateral steroid induced acute CSCR with three distinct fluorescein-free signs converging in the same area indicating presence of focal leak.

This case report describes a patient with acute posterior multifocal placoid pigment epitheliopathy, presumed to be the initial manifestation of systemic lupus erythematosus (SLE), who responded to oral immunotherapy. The clinical, hematological, serological, and imaging examinations were carried out on the 28-year-old female who presented with bilateral multifocal central creamy lesions. The imaging modalities' findings and the overall visual improvement led us to diagnose acute posterior multifocal placoid pigmented epitheliopathy. This is the second time SLE has been presented as acute posterior multifocal placoid pigmented epitheliopathy, and before declaring it is idiopathic, we must investigate it thoroughly.

A 60-year-old woman suffering from polypoidal choroidal vasculopathy (PCV) was treated with photodynamic therapy (PDT). The treatment spot was small (850 µm) and was targeted only against the lesion and not the surrounding vascular network. Three days later, she complained of severe visual impairment and the clinical examination set the diagnosis of PDT-induced acute exudative maculopathy (PAEM). Further examinations 3 days later demonstrated on the one hand that subretinal fluid had regressed, but on the other hand, it was identified that PDT possibly resulted in the activation of two other previously quiescent PCV lesions. No other treatment was applied, and the patient's clinical status was monitored. A new evaluation after 6 weeks, revealed the complete resolution of the exudative phenomena and the significant improvement of vision. Three years later, the condition remains stable. Our report is the first in the literature to describe a case of PAEM following PDT with a small target spot (850 µm), while no other report has demonstrated that PCV-associated PAEM may resolve spontaneously without any treatment. Moreover, the application of PDT was accompanied by the activation of two previously inactive PCV lesions, an adverse effect that has not been previously described.

To describe the management of post-traumatic Descemet's membrane detachment and intraoperative corneal rupture in a known case of Ehlers-Danlos Syndrome (EDS). A 7-year-old child, a known case of EDS, presented with Descemet's membrane tear in the right eye for which intracameral sulfur hexafluoride (SF₆) and descemetopexy were done. Intraoperative spontaneous rupture of the cornea was noted during descemetopexy which was managed using cyanoacrylate glue and bandage contact lens. We successfully used cyanoacrylate tissue adhesive glue for sealing of corneal rupture suggesting that it can be considered a treatment option for such cases where there is a lack of tissue strength for suturing.