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We report a case of a 54-year-old female patient who underwent PAC-IOL implantation 18 years prior to presentation. The patient had a best corrected visual acuity (BCVA) 20/20 in the right eye (OD) postoperatively with normal eye exam on routine follow-up since then. The patient presented for acute onset decreased visual acuity in the right eye. BCVA was 20/60, and exam showed blunted macular reflex with no evidence of inflammation. Optical coherence tomography (OCT) showed CME. She was started on topical treatment (ketorolac 0.5%) OD four times daily. Three weeks later, the patient had a BCVA of 20/20 OD with a normal macular reflex and an OCT showing the resolution of the CME. To our knowledge, this is the first reported case of a CME 18 years post PAC-IOL implantation. The possible cause of this incidence could be related to subclinical intraocular inflammation. Ophthalmologists should be aware of the possibility of such a latent CME post-PAC-IOL implantation.

Our objective in this retrospective case series was to report 4 cases of hydrophilic intraocular lens (IOL) opacifications after repeated intravitreal bevacizumab injections. This is a retrospective analysis of all the cases of IOL opacifications presenting to a tertiary referral ophthalmic center in Beirut between January 2013 and January 2019. Four cases were included in the study, of which one was treated for vitreal hemorrhage, the other for macular edema secondary to wet age-related macular edema, and the rest for macular edema secondary to diabetic retinopathy. The mean age of the patients was 71 years with a male predominance and a mean of 5 injections. The IOL opacifications appeared approximately 24 months after first bevacizumab injection. The opacification could be explained by multiple theories such as a possible anterior or posterior segment subclinical inflammation secondary to intraocular interventions, interaction between the hydrophilic properties of the IOLs and anti-vascular endothelial growth factor injection’s content, impurities transmission during injection, or faulty IOL manufacturing.

To evaluate the progression of keratoconus in 932 eyes of 659 patients through visual, refractive and topographic data after intracorneal ring segment (ICRS) implantation.Retrospective review of 659 patients who underwent ICRS (Intacs®) implantation for keratoconus between September 1997 and November 2017. Demographics, preoperative and postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) in LogMAR, corneal topography parameters (thinnest pachymetry, Kmax), central corneal pachymetry and total follow-up time were evaluated. Statistical analysis was performed using IBM SPSS Statistics 24.0 for windows.Nine hundred and thirty-two eyes of 659 patients, with a mean age of 30.41 years (range 11-76 years), were evaluated. Mean total follow up time was 3.02 years. Forty-one eyes had a total follow up of over 10 years. Both UCVA and BCVA improved significantly after ICRS implantation (P0.01). Only 18 eyes (2.66% of eyes of patients under 35 years of age) were found to have progression of keratoconus based on postoperative topographic data (Mean age 23.00 years, 55.6% female, total follow-up 2 to 10 years) CONCLUSION: ICRS implantation showed long-term improvement and stability in visual and topographic results in a large case series of patients with keratoconus. Only a minimal rate of progression was detected in young patients. However, further prospective studies need to be conducted to better define predictability of postoperative visual outcomes and progression.

Summary We describe a case series of four eyes of four keratoconus patients with extruded intracorneal ring segments (ICRS) in whom donor corneal tissue was used to substitute for the extruded ICRS in an attempt to preserve its effect. In all patients, the extruded intracorneal ring was removed through the exposed area. Donor corneal tissue (tailored to the size and shape of the ICRS) was inserted into the empty ICRS tunnel and fixed in place using 10-0 nylon sutures. At three months follow-up, all patients had a healed graft and displayed a stable Kmax, best corrected visual acuity (BCVA) and corneal topography comparable to the preoperative values. Replacing extruded intracorneal rings with donor tissue grafts in keratoconus patients appears to be a promising technique in preserving the effect of the corneal ring and possibly in treating primary keratoconus with donor tissue segments. Refinement of the technique, longer follow-up, and a larger study population is warranted.

A 44-year-old male with no pertinent history other than poor vision for more than 25 years was examined. Best corrected visual acuity was 20/80 OD [MR: +14.25 +1.00 × 15°] and 20/200 OS [MR: +15.00 +1.50 × 175°]. Significant limitation in ocular movements and the presence of an orbital lipodermoid in the infero-temporal aspect of each eye were noted. Forced duction test was positive for the same directions of limitation indicating possible extraocular muscle fibrosis. Ophthalmoscopy was remarkable for the presence of peripheral bony spicules. Corneal topography was compatible with keratoconus (Kmax = 55.04D OD and 52.87D OS). A-scan revealed axial lengths of 16.96 mm OD and 16.32 mm OS, compatible with a diagnosis of nanophthalmos. OCT revealed diffuse macular thickening for both eyes with foveal thickness of 350 µm OD and 353 µm OS. Over the next 12 years the patient had stable visual acuity, manifest refractions and anterior segment examination. Ophthalmoscopy revealed only minimal progression of pigmentary changes. We report the first case of these simultaneous multiple findings which may refer to a possible syndromic association of congenital or early childhood onset.

Open-globe injuries with no light perception (NLP) carry a poor prognosis, and many ophthalmologists select a primary enucleation or evisceration as a result. We present a case of complete visual rehabilitation in a patient who presented with NLP after a zone III penetrating open-globe injury. We recommend patient counseling regarding decision making and management of ocular trauma with NLP, since timely intervention and close follow-ups may restore useful or complete vision even in severely traumatized eyes.

We report a case series of 8 toric intraocular lenses (IOLs) noted to have paracentral inherent opacities after implantation in uneventful phacoemulsification cataract surgery. Defective areas had a microbubble appearance embedded paracentrally in the lens material. All patients were followed up at 1 day, 1 week, and 3 months postoperatively; uncorrected distance visual acuity was unaffected in all cases. None of the 8 patients reported symptoms of increased glare or significant visual distortion postoperatively. It is likely that the defective areas were induced by the manufacturing process and less likely that they were the result of instrument manipulation or ophthalmic viscosurgical device use. To our knowledge, this is the first report of defective toric IOLs with no effects on visual acuity.

We present a case of intracorneal inlay implantation (Kamra) to treat severe disabling glare secondary to traumatic mydriasis in a 33-year-old patient. During the 3-month follow-up, the patient showed significant improvement of symptoms with complete resolution of glare. This conforms to the objective assessment through amelioration of the point-spread function evaluation. Uncorrected visual acuity for distance and for near was 20/20 at 2.5 months. To our knowledge, this is the first report of intracorneal inlay implantation to treat extensive glare and photophobia secondary to traumatic mydriasis. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Objective Case series of haptic migration in patients with angle-supported phakic anterior chamber intraocular lens (PAC-IOL: Phakic6H) through the superior peripheral iridectomy (PI). Methods Charts of 23 patients (35 eyes) with at least 6 months’ postoperative follow-up were retrospectively reviewed. Evaluation included preoperative and postoperative cycloplegic and manifest refractions, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp examination, fundoscopy, corneal topography, and biometry. Results Mean UCVA was 1.67 ± 0.30 (1.17–2.00) for all 35 eyes preoperatively and 0.35 ± 0.25 (0.00–1.00) postoperatively (p Conclusions Angle-supported PAC-IOL implantation resulted in significant improvement in both UCVA and BCVA. However, there is a 23% incidence of haptic migration in our series with no sequelae on BCVA or harmful effect on the intraocular structures. This IOL movement may be explained by changes in aqueous dynamics at the level of the PI leading to migration of the haptic into the area of least resistance. Objectif Etudier des cas de migration de l’haptique dans le site de l’iridectomie peripherique (IP) superieure apres l’implantation de lentilles intraoculaires phaques (LIOP) a support angulaire dans la chambre anterieure (Phakic 6H®). Methodes On a examine retrospectivement les dossiers de 23 patients (35 yeux) ayant fait l’objet d’au moins 6 mois de suivi postoperatoire. Elements evalues: refraction sous cycloplegie et refraction manifeste preoperatoires et postoperatoires, acuite visuelle non corrigee (AVNC), meilleure acuite visuelle corrigee (MAVC), examen a la lampe a fente, fondoscopie, topographie corneenne et biometrie. Resultats L’AVNC moyenne etait de 1,67 ±0,30 (1,17-2,00) avant l’intervention et de 0,35 ±0,25 (0,00-1,00) apres l’intervention (P Conclusions L’implantation de LIOP a support angulaire dans la chambre anterieure a donne lieu a une amelioration significative de l’AVNC et de la MAVC. Cependant, il y a eu parmi les cas etudies une incidence de 23 % de migration de l’haptique, sans sequelles pour la MAVC ni effet nocif sur les structures intraoculaires. Le deplacement des LIO pourrait decouler de variations de la dynamique aqueuse au niveau de l’IP, entrainant une migration de l’haptique vers l’endroit ou la resistance est la moindre.

Purpose: To evaluate the ability of Ocular Response Analyzer (ORA) to differentiate between normal and abnormal corneas as compared to Sirius corneal topography. Methods: This retrospective study included 302 eyes of 151 patients. All patients underwent evaluation with ORA and Sirius corneal topography. Parameters included disease classification results on both instruments (device software classification), Surface asymmetry index (SAI) on Sirius, Corneal Hysteresis (CH), Corneal Resistant Factor (CRF), Keratoconus Match Index (KMI), Goldmann-correlated intraocular pressure (IOPg), Corneal compensated intraocular pressure (IOPcc) and waveform score (WS) on ORA. Results: On Sirius, 198 eyes (65.6%) were classified as normal. On ORA, 121 eyes (40.1%) were documented as normal. Overall, 105 eyes (34.8%) were classified as normal and 88 eyes (29.1%) with non-normal classification on both Sirius and ORA. Of the 198 eyes classified as normal on Sirius, 53% were classified as normal, 39% as suspect and 8% as mild keratoconus on ORA (47% non-normal). Of the 121 eyes classified as normal on ORA, 87% were classified as normal, 6% as suspect, and 2% as keratoconus compatible on Sirius (13% non-normal). Four percent of the eyes classified as keratoconus compatible on Sirius were classified as normal on ORA. There was a significant difference when comparing normal and non-normal classifications between ORA and Sirius (p < 0.001) with poor agreement (Kappa=0.32). When including only normal and Keratoconus eyes in the analysis, good agreement was found between the two machines (Kappa=0.75). Conclusion: According to our results there seems to be a significant difference between ORA and Sirius in their ability to differentiate between normal and non-normal eyes. As such, we recommend that these devices not to be used interchangeably for assessing patients prior to refractive surgery. Keywords: Cornea; Corneal biomechanics; Keratoconus; Ocular response analyzer; Sirius corneal topo