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We present a rare case of a 22-year-old female patient with floaters in her left eye and atypical orbital pain. Ophthalmic examination revealed optic disc edema with uncomplicated venous congestion (papillophlebitis). Her uncorrected visual acuity was 20/20 in both eyes and visual fields were within normal limits. Biochemical and autoimmune markers were normal, except for Factor V Leiden and methylenetetrahydrofolate reductase enzyme (MTHFR-C677T) heterozygous mutations. Ophthalmoscopic findings resolved completely after one-month treatment with oral methylprednisolone. Genetic analysis has become an integral part of papillophlebitis diagnosis and hematology consultation is essential to prevent future complications.

Purpose: To compare the Central Corneal Thickness (CCT) measurements by three different devices in normal eyes. Study Design: Cross sectional observational study. Place and Duration of Study: Dow University of Health Sciences and Dr. Ruth K.M. Pfau Civil Hospital, Karachi, from October 2020 to January 2021. Methods: 80 eyes of healthy subjects aged between 20 to 50 years were included in the study. Patients with corneal pathologies, systemic disease, history of ocular surgery or trauma, high intraocular pressure and high refractive error were excluded. Subjects underwent full ophthalmic examination. Central Corneal Thickness was measured by specular microscope (Shin-Nippon SPM-700; Rexxam Co. Ltd, Takamatsu, Japan), optical biometer (AL-Scan; Nidek, Gamagori, Japan) and corneal topographer (TMS-5; Tomey corporation, Nagoya, Japan). All data entry and analysis was done on SPSS version 23. For correlation among devices, Pearson correlation coefficient was used. Scatter plot was drawn for graphical presentation. Results: 80 eyes of 80 healthy subjects (50 males, 30 females) were recruited in the study by convenient sampling. The mean age was 37.76 ± 8.35 years. Mean Central Corneal Thickness values were 515.57 ± 31.54 µm, 510.21 ± 30.11 µm, 522.03 ± 29.78 µm with specular microscope, optical biometer and corneal topographer respectively. Measurements by these devices strongly correlate with each other using Pearson correlation coefficient (r = 0.927 to 0.966, p ≤ 0.001). Conclusion: The results of Central Corneal Thickness measurements obtained from these three devices positively correlate with each other so any of these devices can be used for its measurement. Key Words: Central Corneal Thickness (CCT), Specular microscope, Optical biometer, Corneal topographer.

Purpose: To compare the Central subfoveal choroidal thickness (CCT) in diabetic patients with and without diabetic retinopathy. Study Design: Cross sectional observational study. Place and Duration of Study: Al-Ehsan Welfare Eye Hospital, Lahore, from June 2019 to May 2020. Methods: One hundred and twenty patients with type II diabetes were included with a mean age of57±0.9. Patients were divided into two groups (60 in each group) based on presence or absence of diabetic retinopathy after ophthalmic examination. Group A comprised of patients showing signs of retinopathy and group B with no signs of diabetic retinopathy. After detailed ophthalmic examination, spectral–domain OCT was performed for the measurement of central subfoveal choroidal thickness. The differences in measurements were analyzed and measured by using SPSS version 22. Results: Out of 120 patients, 69 (57.5%) were males and 51 were females (42.5%). Mean age of patients was 58.8 ± 10 years with minimum 28 years and maximum 94 years. Central choroidal thickness in group A showed a mean value of 239 ± 41 µm with standard error of mean 3.76. While diabetic patients having no signs of diabetic retinopathy (Group B) showed mean subfoveal choroidal thickness of 240 ± 42 µm with standard error of mean 3.89. The difference in central subfoveal choroidal thickness in both groups was 1.337 which is statistically insignificant with p value of 0.250. Conclusion: Central choroidal thickness amongst diabetic patients with and without signs of retinopathy does not have any significant changes. Key Words: Choroid, Diabetic retinopathy, Optical Coherence Tomography.

Ocular problems are often associated with traumatic injury in raptors. A comprehensive evaluation, including a complete ophthalmic examination, is vital in determining the patient's overall health and suitability for release. Steps for conducting ocular examination and diagnostic testing in raptors is discussed. Additionally, common clinical findings after trauma, as well as the mechanisms by which ocular injury occurs, are outlined. An overview of medical treatments recommended for commonly diagnosed ocular diseases and the utility of ancillary diagnostic procedures is also presented.

Purpose : To assess whether a modified treatment ladder algorithm incorporating transcutaneous retrobulbar amphotericin B (TRAMB) for invasive fungal rhino-orbital sinusitis (IFROS) can reduce the risk of exenteration without compromising survival. Design : Retrospective, comparative clinical study with historical controls. Methods : Fifty consecutive patients with biopsy-proven invasive fungal sinusitis and radiographic evidence of orbital involvement were evaluated at a single tertiary institution from 1999-2020. TRAMB was incorporated as part of the treatment algorithm in 2015. Demographics, underlying immune derangement, infective organism, ophthalmic examination, surgical care, and survival were compared in a quasi-experimental pre-post format, dividing patients into a pre-2015 group and a post-2015 group. Risk of exenteration and mortality were the primary outcomes. Results : Baseline characteristics did not differ significantly between the two groups. Nearly all patients underwent a surgical intervention, which most commonly was functional endoscopic sinus surgery with debridement. TRAMB was administered to 72.7% of the post-2015 group. Exenteration was more common in the pre-2015 group (36.4% vs. 9.1%; 95% CI [5.2, 48.8]; p = 0.014), while mortality was similar (40.0% vs. 36.7%; 95% CI [-22.1, 29.3]; p = 0.816). After adjusting for potential confounders, patients treated after 2015 were found to have lower risk of exenteration (RR 0.28; 95% CI [0.08, 0.99]; p = 0.049) and similar risk of mortality (RR 1.04; 95% CI [0.50, 2.16]; p = 0.919). Conclusion : In comparison to historical controls, patients with IFROS who were treated with a modified treatment ladder algorithm incorporating TRAMB had a lower risk of disfiguring exenteration without an apparent increase in the risk of mortality.

Summary Purpose To describe en face anterior segment optical coherence tomography (EF-OCT) characteristics of pterygia and their correlation with in vivo confocal microscopy (IVCM). Patients and methods In this observational case series, we prospectively included 21 eyes of 17 subjects with pterygium. All subjects underwent detailed ophthalmic examination, anterior segment photography, an ocular surface disease index (OSDI) questionnaire, IVCM , and EF-OCT. Eyes were divided into two groups according to pterygium severity (Modified Pterygium Classification System) and OSDI score. EF-OCT images for both groups were analyzed for surface area of Fuchs Patches (FP). The IVCM activity score was based on the number of inflammatory cells, blood vessels, activated keratocytes and the appearance of the cornea/pterygium at the head of the pterygium. The correlations between EF-OCT and IVCM images were then analyzed and compared in both groups. Results EF-OCT permits clear visualization and evaluation of FPs and the border between the pterygium and the adjacent cornea. The severe pterygium group was characterized by irregular borders and larger FPs (0.13 ± 0.06 mm2 versus 0.06 ± 0.02 mm2 respectively) (P = 0.003). The mean IVCM activity score was 2.36 ± 0.81 in the severe pterygium group and 1.2 ± 0.42 in the mild pterygium group (P = 0.0013). There was a positive correlation between FP surface area and IVCM activity score. A larger FP surface area was associated with a higher activity score on IVCM. Conclusion EF-OCT allows good evaluation of pterygium extension, borders and FP surface area. EF-OCT analysis of pterygium could represent a simple, non-invasive and reproducible method to evaluate pterygium severity and activity.

A 5-year-old Mongolian mare (Equus caballus Linnaeus, 1758) was observed to have corneal opacity and excessive ocular discharge. An ophthalmic examination revealed a moving thread-like cylindrical worm in the anterior chamber of the right eye. The parasite was successfully removed surgically. The worm was observed under light microscopy and confirmed as Setaria digitata by 12S rRNA gene amplification and sequencing. Phylogenetic analysis demonstrated similarity with Setaria digitata in the National Center for Biotechnology Information (NCBI) GenBank database isolated from other Asian countries. This report is the first confirmed case of equine ocular setariasis by molecular diagnosis in China, which may indicate its presence in livestock and promote research on its epidemiology.

Vitamin D has antiangiogenic, anti-inflammatory, and antifibrotic properties, which may play an inhibitory role on pterygium formation. Vitamin D concentration was measured in few studies, and contradictory results have been reported. There is no study investigating tear fluid concentration of vitamin D in pterygium patients.This study evaluated tear fluid and serum vitamin D concentrations of pterygium patients in comparison with healthy controls.Thirty-five (21 male, 14 female) patients with unilateral pterygium and 25 (18 male, 7 female) healthy controls were included in this case-control study. After full ophthalmic examination, blood samples were taken, and basal tear fluid was collected using glass microcapillary tubes. Tear fluid and serum vitamin D concentrations were analyzed using enzyme-linked immunosorbent assay and analyzed statistically.The mean ± standard deviation age of patients was 51.7 ± 16.7 years in the study group and 50.6 ± 18.7 years in the control group, respectively (P = .82). The mean tear fluid vitamin D concentration was statistically significantly higher than the mean serum concentration in the study groups (P.0001). The mean tear fluid (P = .76) and serum vitamin D concentrations (P = .53) did not reveal statistically significant difference between patients and controls. There was no statistically significant difference for tear fluid vitamin D concentration between pterygium eyes and fellow eyes (P = .93). The difference in concentrations was compared within the pterygium subgroups, and it was found that the mean serum vitamin D concentration trended toward lower values as the stage of pterygium increased, and the mean tear fluid vitamin D concentration trended toward higher values as the stage of pterygium increased, although these differences were not statistically significant (all, P.05).Tear fluid and serum vitamin D concentrations do not seem to have a role in pterygium pathogenesis.

Compared with normal subjects with similar shallow anterior chamber depth (ACD), patients with primary angle closure disease (PACD) had narrower angle structures measured by swept-source optical coherence tomography (SS-OCT) at 250 μm from scleral spur (very root of iris), especially along oblique and vertical axis.To examine anterior segment structures in normal subjects whose ACD was shallow on slit-lamp examination but did not meet the diagnostic criteria of PACD, and to compare them with PACD patients with similar ACD.Patients were recruited from glaucoma clinic at Zhongshan Ophthalmic Center. A total of 40 eyes from 29 PACD patients and 40 eyes from 34 normal subjects received full ophthalmic examination and CASIA SS-1000 OCT tests. PACD eyes and control eyes were 1:1 matched for ACD at 0 degree of scan. Generalized linear model that accounted for inter-eye correlation was used to compare differences between the 2 groups for intraocular pressure and SS-OCT parameters. P-values were adjusted for multiple comparisons using the Bonferroni method.The PACD and control groups had similar age, but the PACD group had a significantly higher intraocular pressure (18.4 vs. 14.0 mm Hg, P=0.005). Angle parameters, representative of angle area, such as angle recess area and trabecular iris space area measured at 250 μm along axes of 90, 135, 225, and 315 degrees were significantly smaller in PACD group than those of control group (adjusted P0.05), while most of angle parameters at 500 and 750 μm, volume parameters, and anterior chamber parameters, were similar (adjusted P0.05).In PACD patients compared with normal subjects with similar anterior chamber shallowing, OCT findings measured at the iris root 250 μm from the scleral spur, especially in the oblique and vertical axes, including angle recess area and trabecular iris space area, may match gonioscopic findings more closely and provide further insight into mechanisms of PACD.

Purpose. To evaluate the relationships between C-reactive protein (CRP) and retinal and choroidal thickness by swept-source optical coherence tomography (SS-OCT). Methods. The participants included in the prospective cross-sectional study underwent a comprehensive ophthalmic examination. Based on the CRP values, the subjects were divided into the CRP (+) group ( CRP ≥ 8.2 mg/L) and the CRP (−) group ( CRP < 8.2 mg/L). The retinal and choroidal thickness was compared between the two groups. Results. This study enrolled 43 right eyes of 43 subjects from the CRP (+) group and 86 right eyes of 86 gender- and age-match subjects from the CRP (−) group. The choroidal thickness in the CRP (+) group was thinner than that in the CRP (−) group except for the outer nasal sector of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. However, the retinal thickness only in the inner temporal sector showed a significant difference. According to Pearson’s correlation analysis, the CRP was significantly negatively correlated with the choroidal thickness in all sectors and the retinal thickness only in the inner temporal and outer nasal sectors of the ETDRS grid. Conclusion. CRP levels are associated with retinal and choroidal thickness. The data related to the retinal and choroidal thickness changes may help understand the pathogenesis of specific ocular abnormalities in patients with systemic inflammation.

Objectives. To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium. Materials and Methods. This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence. Results. In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard. Conclusion. Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.

Purpose To present the clinical manifestations and results of key diagnostic investigations in patients with Susac syndrome, with special emphasis on the principal role of fluorescein angiography (FA) of the peripheral retina. Methods A retrospective analysis of medical records (collected 2000-2019) of 20 patients (15 women and five men), aged 20 to 51 years (mean age: 31.6 years) with complete or incomplete Susac syndrome diagnosed by an ophthalmic examination and widefield fluorescein angiography (WF-FA) by Spectralis and Optos Tx200. Results Fluorescein angiography abnormalities included vascular changes in the posterior pole in 64.7% and in the peripheral retina in 82.4%. Widefield FA abnormalities in the peripheral retina alone were seen in 35.3% and in the posterior pole, but without peripheral vascular involvement, in 17.6%. Secondary leakage from veins was noted in 58.8%. Conclusion Widefield FA of the peripheral retina has a key role in cases of suspected Susac syndrome as it confirms the diagnosis and assesses disease activity. In addition to the characteristic findings, late-phase FA revealed leakage from veins which is not a typical sign. Patients experiencing migraine headaches may benefit from increasing awareness of neurologists and otologists who more promptly referred patients with suspected Susac syndrome for ophthalmologic evaluation and WF-FA of the peripheral retina.

Purpose: To evaluate ophthalmic examination results which were performed with slit-lamp biomicroscope, in patients with laboratory-confirmed SARS-CoV-2 infection. Methods: In the present study, 50 ...

Measurements of intraocular pressure (IOP) and tear production are key components of ophthalmic examination. Chimpanzees (Pan troglodytes) were anesthetized using either tiletamine-zolazepam (TZ; 2 mg/kg) combined with medetomidine (TZM; 0.02 mg/kg), or, TZ alone (6mg/kg). Tear production was lower (P = 0.03) with TZM (5.63 ± 6.22 mm/min; n = 16) than with TZ (11.13 ± 4.63 mm/min; n = 8). Mean IOP, measured using rebound tonometry in an upright body position (n = 8) was 18.74 ± 3.01 mm Hg, with no differences between right and left eyes. However, positioning chimpanzees in left lateral recumbency (n = 27) resulted in higher IOP in the dependent (left) eye (24.77 ± 4.49 mm Hg) compared to the nondependent (right) eye (22.27 ± 4.65 mm Hg) of the same animal (P < 0.0001). These data indicate medetomidine anesthesia markedly lowers tear production in chimpanzees, and that body position should be taken into consideration when performing rebound tonometry.

Objectives To describe the signalment, ophthalmic examination findings, and follow-up of dogs affected with a previously unreported retrocorneal pigmentary lesion. Materials and methods Retrospective record evaluation spanning 2009-2019. Results Retrocorneal pigmentary lesions were described in 34 patients (46 eyes). German Shepherds (n = 7), Jack Russel terriers (n = 5), and terrier crosses (n = 4) made up 16/34 (47.1%) of the cases. The mean age was 13.5 years (range 1.4-14.2 years), and 16/30 (53.3%) dogs were female. Most dogs were affected unilaterally (22/34 (64.7%)), the others bilaterally, and 5/34 (14.7%) were referred for it while the others were incidentally diagnosed. The lesions affected the ventral, peripheral, inner cornea and had a round/undulated leading edge. The number of corneal clock hours affected was known for 41/46 (89.1%) eyes and involved 1-3 clock hours in 32/41 (78.1%) eyes, 4-6 in 6/41 (14.6%), 7-9 in 2/41 (4.9%), and 10 in 1/41 (2.4%). The central cornea was affected in 9/46 (19.6%) eyes, and in 5/9 (55.6%), the median corneal clarity score was G2 (scale: G0-G4). The commonest additional findings included free-floating uveal cysts (11/34 dogs, 32.4%), cataracts (6/34 dogs, 17.6%), and primary glaucoma (5/34 dogs, 14.7%). Gonioscopy was available in 16/34 (47.1%) dogs and was normal except in primary glaucoma cases. Follow-up was documented in 13/34 (38.2%) dogs with a mean follow-up of 17 months (range: 5-26 months). Lesion progression was documented in 6/13 (46.2%) dogs. Conclusions Retrocorneal pigmentation occurs as a slowly progressive lesion of older dogs that could impact vision. Histological studies of affected eyes are warranted.

Purpose To investigate bacterial dispersion with patient face mask use during simulated intravitreal injections. Design Prospective cross-sectional study MethodsSetting Single-center Study Population Fifteen healthy subjects were recruited Intervention Each participant was instructed not to speak for 2-minutes, simulating a “no-talking” policy, while in an ophthalmic examination chair with an blood agar plate secured to the forehead and wearing various face masks (no mask, loose fitting surgical mask, tight-fitting surgical mask without tape, tight-fitting surgical mask with adhesive tape securing the superior portion of the mask, N95 mask, and cloth mask). Each scenario was then repeated while reading a 2-minute script, simulating a talking patient. Main Outcome Measures Number of colony-forming units (CFU) and microbial species. Results During the “no-talking” scenario, subjects wearing a tight-fitting surgical mask with tape developed fewer CFUs compared to subjects wearing the same mask without tape (difference, 0.93CFU; 95%CI, 0.32–1.55; P=.003). During the speech scenarios, subjects wearing a tight-fitting surgical mask with tape had significantly fewer CFUs compared to subjects without a face mask (difference, 1.07CFU; P=.001), subjects with a loose face mask (difference, 0.67; P=.034), and subjects with a tight face mask without tape (difference, 1.13; P.99) and “speech” (P=.831) scenarios. No oral flora was isolated in “no-talking” scenarios, but was isolated in 8/75 (11%) cultures in speech scenarios (P=.02). Conclusion Addition of tape to the superior portion of a patient’s face mask reduced bacterial dispersion during simulated intravitreal injections, and had no difference in bacterial dispersion compared to wearing N95 masks., Highlights • Patient face mask use may alter bacterial dispersion around the eye during intravitreal injections. • There was significantly more bacterial dispersion when wearing a tight-fitting face mask without tape compared to wearing a tight-fitting mask with tape. • There was no difference in bacterial dispersion between tight-fitting surgical masks with tape and N95 masks. • Taping the superior portion of a patient’s face mask may limit bacterial dispersion when performing intravitreal injections.

Purpose: The aim of this study was to evaluate the short-term efficacy and safety of ultrasound cycloplasty (UCP) procedure in Chinese glaucoma patients. Methods: As a single-center, prospective, noncomparative study, 23 eyes of 23 patients suffering from glaucoma with uncontrolled intraocular pressure (IOP) ≥21 mm Hg underwent a multidose UCP treatment with the activations of 6, 8, or10 sectors. Types of glaucoma include primary open-angle glaucoma (7/23), primary angle closure glaucoma (PACG) (9/23), and secondary glaucoma (SG) (7/23). A complete ophthalmic examination including intraocular pressure (IOP) measurements was performed before UCP procedure and at 1 day, 1 month, 3 months, and 6 months after the procedure. An IOP reduction of ≥20% and IOP >5 mm Hg without increasing hypotensive medication at the follow-up visit was defined as therapeutic success. The postoperative complications were also recorded and compared to baseline for safety evaluation. Results: The mean baseline IOP of 23 treated eyes was 37.2 ± 12.1 mm Hg. The IOP reduction after UCP procedure was 23, 49, 33, and 34% at 1 day, 1 month, 3 months, and 6 months, respectively. Thus, the corresponding overall therapeutic success rates reached 61% (14/23), 83% (19/23), 65% (15/23), and 61% (14/23), respectively. Baseline IOPs of 8- and 10-sector groups (37.0 ± 9.9 mm Hg and 50.1 ± 12.2 mm Hg) were significantly higher than that of 6 sector groups (30.1 ± 8.2 mm Hg). Therapeutic success rates of 6-, 8-, and 10-sector groups reached 44% (4/9), 56% (5/9), and 100% (5/5), respectively. There were the highest percentage of IOP reduction (50 and 41%) and therapeutic success rate (6/7; 86% and 7/9; 78%) in the SG group and PACG group, respectively. In addition, preoperative ocular pain symptoms of 4 patients were all disappeared within 1 week after UCP. No serious intraoperative or postoperative complications occurred. Conclusion: UCP procedure is an effective and well-tolerated treatment to reduce IOP in Chinese glaucoma patients, which offered a novel alternative for glaucoma treatment.

Purpose: To determine the frequency of myopia among children and to find out the role of smart phone usage and outdoor activities in myopia development and progression. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Ophthalmology department DHQ-UTH Gujranwala, from January 2019 to June 2019. Methods: After approval from the hospital ethical committee and informed consent from each participant, a descriptive cross-sectional study was carried out with a sample size of 250 patients. Patients of either gender between 4 – 14 years of age using smart phones for ≥ 2 hours daily and found to have refractive error were included in this study. Routine ophthalmic examination was carried out, data was recorded on proforma, and daily usage of smart phones and weekly outdoor activity in hours along with school grade, family history and previous history of using refractive glasses was also determined and documented. Data was analyzed using SPSS v.20 Results: 250 patients were included in this study, out of which 142 (56.8%) were male and 108 (43.2%) were female. Mean age was 10.1 ± 2.45 years. Mean outdoor activity was 0.95 ± 0.98 hours per week while mean daily smart phone usage was 2.89 ± 0.93 hours. Pearson correlation coefficient for daily smart phone usage and UCVA was +0.297 (0.3) which showed a positive moderate association between two variables while the value obtained for UCVA and weekly outdoor activity was – 0.51 that depicted a negative strong association. Conclusions: In conclusion, myopia occurrence is higher among smart phone users showing a moderate positive correlation while outdoor activities reduce myopia prevalence and progression depicting strong negative correlation. Key Words: Refractive Errors, Myopia, Visual acuity, Smartphone.

Introduction: Les pathologies des glandes salivaires sont relativement rares, dominees par les tumeurs de la glande parotide. Elles sont caracterisees par leur polymorphisme clinique et leur grande diversite morpho-histologique. Le traitement est surtout chirurgical, la complication majeure de cette chirurgie reste la paralysie faciale pouvant etre transitoire ou permanente. Dans ce sens, l’objectif de ce travail etait de decrire les aspects epidemiologiques, cliniques, paracliniques et therapeutiques des tumeurs parotidiennes rencontrees dans le service de l’odontostomatologie de l’Hopital National de Niamey (HNN) durant la periode de l’etude. Methodologie: Il s’agissait d’une etude retrospective et descriptive portant sur les tumeurs parotidiennes rencontrees au service d’odontostomatologie de l’Hopital National de Niamey au Niger. Par ailleurs, la tumeur etait homogene dans 2 cas sur 4 et benigne egalement une fois sur 2. Resultats: 12 patients ont ete colliges sur une periode de 29 mois. La prevalence hospitaliere etait de 0,11% avec 4,97 cas par an. La tranche d’âge allait de 9 a 75 ans. Il y avait 8 hommes contre 4 femmes. La malignite a ete suspectee cliniquement devant une masse dure, fixe, douloureuse avec presence d’adenopathies satellites et associee a une paralysie faciale. La parotidectomie totale conservatrice du nerf facial a ete realisee chez 10 patients sur 12 et la chimiotherapie a ete preconisee chez 2 patients. L’examen ophtalmologique a ete realise chez tous les patients a la recherche d’une atteinte oculaire ou de la glande lacrymale. L’histologie a ete contributive dans tous les cas et les tumeurs benignes dominaient dans 50% des cas avec comme chef de fil l’adenome pleomorphe. Conclusion: Les tumeurs de la glande parotide sont rares et leur prise en charge therapeutique est essentiellement chirurgicale. Leur evolution est en general favorable. Neanmoins, l’accent devra etre mis sur la surveillance a long terme de certaines formes histologiques dont le risque de degenerescence et de recidive est eleve. Introduction: Pathologies of the salivary glands are relatively rare and are dominated by tumors of the parotid gland. They are characterized by their clinical polymorphism and their great morpho-histological diversity. The treatment is mainly surgical. The major complication of this surgery is facial paralysis which can be transient or permanent. The objective of this work is to describe the epidemiological, clinical, paraclinical, and therapeutic aspects of parotid tumors encountered in the odontostomatology department of Niamey National Hospital during the study period. Methodology: This study is a retrospective and descriptive study on parotid tumors encountered in the odontostomatology department of the Niamey National Hospital in Niger. In addition, the tumor was homogeneous in 2 out of 4 cases and also benign once in 2. Results: 12 patients were collected over a period of 29 months. The hospital prevalence was 0.11% with 4.97 cases per year. The age range was from 9 to 75 years old. There were 8 men against 4 women. The malignancy was suspected clinically before a hard, fixed, and painful mass with the presence of satellite lymphadenopathy which is associated with facial paralysis. Total conservative facial nerve parotidectomy was performed in 10 out of 12 patients, and chemotherapy was recommended in 2 patients. The ophthalmic examination was performed in all patients looking for damage to the eyes or the lacrimal gland. Histology was contributory in all cases and benign tumors dominated in 50% of cases with pleomorphic adenoma as the lead. Conclusion: Tumors of the parotid gland are rare and their therapeutic management is essentially surgical. Their development is generally favorable. However, emphasis should be placed on the long-term monitoring of certain histological forms for which the risk of degeneration and recurrence is high.

This study sought to evaluate the prevalence of dry eye and meibomian gland dysfunction (MGD) and the associated factors of severe dry eye symptoms (SDES) among garments worker of Gazipur, Bangladesh. We prospectively collected cross-sectional data for 1050 garments workers of a factory (70% response). All participants had an evaluation of the Ocular Surface Disease Index (OSDI), and a detailed ophthalmic examination including tear breakup time (TBUT), ocular surface fluorescein staining, and Schirmer&rsquo, s I test. MGD grading was based on the viscosity/color and ease of manual expression of meibum. Mean age of participants was 35.5 &plusmn, 12.1 years, 53.8% were women. The prevalence of dry eye (OSDI &gt, 12) was 64.2% (95% CI 61.2&ndash, 67.1%). OSDI was not significantly different between sex or age-groups but associated with increasing MGD grade (p &lt, 0.001), reduced TBUT (&lt, 5 s) [p &lt, 0.001], and reduced Schirmer&rsquo, s test (&lt, 5 mm) [p &lt, 0.001]. Thirty-five percent had SDES (OSDI &gt, 32). Using univariate logistic regressions, SDES was associated with older age (Odds Ratio (OR) 1.01, 95% Confidence Interval [1.005&ndash, 1.03] per year increase) and male sex (OR 1.76, 95% CI: 1.36&ndash, 2.27). When adjusted for age and sex, SDES were strongly associated with increase in MGD severity grading (OR 188, 95% CI: 91&ndash, 390). However, in multivariate regression, TBUT, but not MGD severity, became the only significant determinant of SDES (OR 13.0, 95% CI: 6.3&ndash, 27.0, for every 1 s decrease in TBUT). MGD is common in garments workers, contributing to dry eye symptoms in addition to other tear parameters. Reduced tear stability is associated with SDES.

Background The high prevalence of ocular manifestations (OMs) in patients with human immunodeficiency virus (HIV) infection and chronic diseases such as diabetes has become a global health issue. However, there is still a lack of an appropriate ophthalmic diagnostic procedure for the early detection of OMs in this population, leading to the risk of an irreversible visual impairment that substantially affects the quality of life of these patients. Methods The Guangzhou HIV Infection Study was a retrospective study that enrolled hospitalised HIV-infected patients in Guangzhou between January 2005 and December 2016, period corresponding to the highly active antiretroviral therapy (HAART) era in China. We collected data on OMs, systemic diseases, hospitalisation, and demographic characteristics. We classified the patients into 3 groups according to the ophthalmic examination mode they underwent: the non-ophthalmologist examination group (patients hospitalised in 2005–2011 who were only treated by infectious disease physicians), the on-demand ophthalmic examination group (patients hospitalised in 2012–2013 who were referred for a consultation with an ophthalmologist), and the routine ophthalmic examination group (patients hospitalised in 2014–2016 who routinely underwent standard ophthalmic examinations). Binary logistic regression models were used to investigate the factors related to OMs. Findings A total of 8,743 hospitalised HIV-infected patients were enrolled. The prevalence of detected OMs were 1.5% in the non-ophthalmologist examination group, 1.9% in the on-demand ophthalmic examination group, and 12.8% in the routine ophthalmic examination group. The odds of detection of OMs were highest in the routine ophthalmic examination group (adjusted odds ratio [aOR]=9.24, [95%CI, 6.51–13.12], compared to the non-ophthalmologist examination group). The detection of all types of OMs increased substantially, with keratitis, retinitis and vascular abnormalities increased the most (by 15.8–20.0 times). In the routine examination group, patients who were older than 50 years, males, with medical insurance, and were not resident in Guangzhou, had higher odds to have OMs. Several systemic diseases also increased the odds of OMs, with the highest odds among patients with a cytomegalovirus infection (aOR=5.59, [95%CI, 4.12–7.59]). Patients with retinitis, retinopathy and conjunctivitis had higher odds of having a CD4+ T cell counts less than 200 cells/μL compared to the patients that did not have these referred OMs. Interpretation The implementation of a routine ophthalmic examination has improved the odds of OM detection by approximately 9 times and increased the diagnosis rates of all types of OMs. Therefore, we encourage all HIV-infected patients to undergo regular ophthalmic examinations. Patients with OMs, especially retinopathy and retinitis, need to be evaluated for immune function (such as CD4+ T cell counts) and systemic diseases.

PurposeTo demonstrate the value of “smoothness index” as a novel tool for quantitative analysis of iris surface findings in unilateral Fuchs’ uveitis (FU).MethodsIn this observational study, both phakic eyes from patients with the diagnosis of unilateral FU were enrolled. All eyes underwent a complete ophthalmic examination and anterior segment optical coherence tomography(AS-OCT). The images were extracted and exported to the ImageJ software for calculating the “smoothness index (SI)”. The SI was defined as ratio of length of the straight line connecting the most peripheral and the most central points of anterior iris surface to actual length of this boundary.ResultsForty eyes from 20 patients with unilateral FU were enrolled. Mean age of patients was 40±10 years. Mean overall SI was 0.876± 0.030 in eyes with FU that was significantly more than fellow control eyes (0.841± 0.041). (p=0.005) The mean temporal and nasal SI were 0.878± 0.035 and 0.874± 0.033 in eyes with FU, compared to 0.843± 0.041 and 0.838± 0.047 in control fellow eyes, respectively. (p = 0.008 and p = 0.009, respectively)ConclusionIris “smoothness index” is a novel index to quantitatively document diffuse smoothness of iris anterior surface in eyes with FU. This index may facilitate diagnosis of subtle iris atrophic changes in these eyes, especially when heterochromia is absent.

Purpose To report ocular side effects after inadvertent intracameral injection of a high dose of cefuroxime. Methods Nineteen eyes of 19 patients were seen in our eye department 1 week after the referring surgeon had injected an erroneous dose of intracameral cefuroxime (12.5 mg/0.1 mL in 14 patients, Group A, and 10 mg/0.1 mL in 5 patients, Group B) at the end of a cataract surgery. A complete ophthalmic examination was performed postoperatively. Results Eight patients (42.10%) exhibited ocular side effects. One patient (Group A) developed a noninfectious panuveitis. One case (Group B) had a serous macular detachment. Five patients (4 from Group A and 1 from Group B) showed a disruption of the ellipsoid layer with temporary/permanent drop in visual acuity. One patient presented with color alteration (Group A), but electrodiagnostic studies did not reveal any significant alterations. Conclusion Anterior and posterior inflammation has been described after intracameral injection of high dose of cefuroxime. In this study, 10 mg to 12.5 mg of intracameral cefuroxime is shown to be, principally, toxic to the retina with transient or permanent retinal changes on optical coherence tomography which correlate with visual outcomes postoperatively. Protocols to avoid dilution errors should be available in theaters during cataract surgery where such commercial preparations are not available.

Background: glaucoma is the most common cause of irreversible blindness. Primary open angle glaucoma (POAG) is the most commonly diagnosed form. Pattern electroretinogram emerged as a promising tool for diagnosing of early glaucoma. Aim of the work: the present study aimed to assess the role of pattern electroretinogram in differentiating between patients with early glaucoma and normal controls. Methodology: this study included 25 early glaucoma patients and 25 normal controls. They were undergone into careful history taking, complete ophthalmic examination and investigations by using PERG, SD- OCT and perimetry. Results: regarding the comparison we found reduction in amplitude of P50 and N95 between early glaucoma patients and normal controls.

For several reasons, cerebral visual impairment (CVI) is emerging as a major cause of visual impairment among children in the developing world and we are seeing an increasing number of such children in our clinics. Owing to lack of early training about CVI and it being a habilitation orientated subject, we need to become equipped to optimally help the affected children. In this paper we have explained our pragmatic approach in addressing children who present with low functioning CVI. Initially we explain briefly, how vision is processed in the brain. We then present what should be specifically looked for in these children in regular clinics as a part of their comprehensive ophthalmic examination. We discuss the process of functional vision evaluation that we follow with the help of videos to explain the procedures, examples of how to convey the conclusions to the family, and how to use our findings to develop intervention guidelines for the child. We explain the difference between passive vision stimulation and vision intervention, provide some common interventions that may be applicable to many children and suggest how to infuse interventions in daily routines of children so that they become relevant and meaningful leading to effective learning experiences.

Objective: To find out the association of seeking ophthalmic assessment in children with parental history of refractive errors. Methods: After the approval of ethical review board, an analytical cross-sectional study was conducted in eight high schools of public and private sector at Lahore during the period of seven months from August 2017 to March 2018. Multistage random sampling technique was opted and 2000 study subjects were recruited including 50% boys and 50% girls. Informed consent was obtained and data was collected on a structured questionnaire. The data was organized, entered in version 23 of IBM SPSS and analyzed by the use of statistical tools. Results: Age of the respondents ranged between nine to 18 years with a mean of 13.40 ± 1.82 SD. Parental history of wearing spectacles was present in 21.3% of the fathers and 28.6% of the mothers. Moreover, 72.4% of the participants never visited eye care professional. Among private schools, an association was found between the visit of boys to eye care professional and maternal positive history of wearing spectacles (p-value 0.019). A significant association was found between the positive paternal history of wearing spectacles and visit of the female strudy subjects to an eye care professional (p-value 0.001). In public schools, there was an association between visit of children to eye care services and positive history of mothers about the use of spectacles (p-value 0.018). Conclusions: This study concludes that positive maternal history of wearing spectacles is associated with the ophthalmic examination of children in both public and private school.

Background: In systemic sclerosis (SSc) patients, dry eye syndrome (DES) is the most frequent ocular feature. The aim of this study was to investigate ocular DES-related SSc patients and to establish any correlation with the severity of the disease. Methods: Retrospectively, data from 60 patients with SSc underwent ophthalmic examination, where non-invasive film tear break-up time (NIF-TBUT), tear film lipid layer thickness (LLT), anesthetic-free Schirmer test I, tear osmolarity measurement (TearLab System), and modified Rodnan skin score (mRSS) data were collected. The visual analog scale (VAS) and Symptom Assessment in Dry Eye (SANDE) methods were utilized. The results were correlated with mRSS and the duration of SSc. Results: Severe DES occurred in 84% of cases, and was more severe in women. The eyelids were involved in 86.6%, secondary to meibomian gland disease (MGD). A direct correlation was found between the tear osmolarity (mean 328.51 &plusmn, 23.8 SD) and skin score (mRSS) (r = 0.79, p &lt, 0.01). Significantly reduced NIF-TBUT, LLT, and Schirmer test I values were observed in the case of severe skin involvement. Conclusions: SSc patients show lipid tear dysfunction related to the severity and duration of the disease due to inflammation and the subsequent atrophy of the meibomian glands.

A 74-year-old woman with Carney complex (CNC) and complaints of poor vision was found, on ophthalmic examination, to have a pigmented tumor involving the peripheral choroid and ciliary body in her right eye. The eye was enucleated and showed a ciliochoroidal melanoma with marked pleomorphism. The tumor did not recur or metastasize after almost 10 years of follow-up, and the patient died of unrelated causes. Molecular studies revealed a complex genome with multiple whole-chromosome losses including monosomy of chromosomes 1, 2 (including loss of CNC2at 2p16), 14, 17 (including loss of a copy of PRAKA1 at 17q24.2), 18, 19, 21, 22, and X. No monosomy 3 was observed. This is only the second case of uveal melanoma in a patient with CNC, raising the possibility that this might represent a rare component of this syndrome.

Objective To report on the anatomical changes at the macula in patients with commotio retinae (CR) and not accompanied by any other types of traumatic maculopathy. Design Retrospective, observational case series. Participants In this study, individuals with history of blunt ocular trauma and having CR involving the macula without any other type of traumatic maculopathy were included. Methods Participants were evaluated with ophthalmic examination, visual acuity testing, and spectral domain optical coherence tomography (OCT) at presentation and further follow-up visits. Results On colour fundus photography, grey-white retinal discolouration was identified in all 16 patients and 1 patient had accompanying inferior vitreous hemorrhage. On OCT imaging, hyper-reflectivity of the ellipsoid zone (EZ) with disappearance of the thin hyporeflective optical space was noted in all 16 patients at presentation. One patient showed focal hyporeflective micro-elevation of the EZ (MEEZ) at presentation. Final follow-up visit ranged from 6 to 54 days (mean 19.5 days). Complete resolution of CR was noted in 14 eyes at the final visit. Focal hyporeflective MEEZ was noted in 11 eyes at the final follow-up visit. The number of eyes with irregular ellipsoid layer was 5 at the final follow-up visit. Conclusions In eyes with CR involving the macula, 2 new OCT features were identified, namely, irregular ellipsoid layer and focal hyporeflective MEEZ. These OCT findings did not affect the vision. Further studies with histological evidence would be required in future to establish the pathogenesis of CR involving the macula.

To explore the feasibility of using Saccadic Vector Optokinetic Perimetry (SVOP) to differentiate glaucomatous and healthy eyes. A prospective case–control study was performed using a convenience sample recruited from a single university glaucoma clinic and a group of healthy controls. SVOP and standard automated perimetry (SAP) was performed with testing order randomised. The reference standard was a diagnosis of glaucoma based a comprehensive ophthalmic examination and abnormality on standard automated perimetry (SAP). The index test was SVOP. 31 patients with glaucoma and 24 healthy subjects were included. Mean SAP mean deviation (MD) in those with glaucoma was − 8.7 ± 7.4 dB, with mean SAP and SVOP sensitivities of 23.3 ± 0.9 dB and 22.1 ± 4.3 dB respectively. Participants with glaucoma were significantly older. On average, SAP sensitivity was 1.2 ± 1.4 dB higher than SVOP (95% limits of agreement = − 1.6 to 4.0 dB). SVOP sensitivity had good ability to differentiate healthy and glaucomatous eyes with a 95% CI for area under the curve (AUC) of 0.84 to 0.96, similar to the performance of SAP sensitivity (95% CI 0.86 to 0.97, P = 0.60). For 80% specificity, SVOP had a 95% CI sensitivity of 75.7% to 94.8% compared to 77.8% to 96.0% for SAP. SVOP took considerably longer to perform (514 ± 54 s compared to 267 ± 76 s for SAP). Eye tracking perimetry may be useful for detection of glaucoma but further studies are needed to evaluate SVOP within its intended sphere of use, using an appropriate design and independent reference standard.

Purpose: To compare the safety and efficacy of Accelerated Corneal Cross Linking (AXL) protocols ,9mW/cm2 for 10 min with 18mW/cm2 for 5 min in terms of refractive and topographic keratometric indices in patients with progressive keratoconus over 3, 6, 12 and 18 months follow-up. Study Design: Quasi experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Nov 2016 to Jun 2018. Material and Methods: Sixty eyes, 30 in each group, of 55 consecutive patients diagnosed with progressive keratoconus were enrolled through convenience sampling and were subjected to AXL with irradiance protocols of 18 watt/cm2 for 5 minutes in group 1 and 9mwatt/cm2 for 10 minutes in group 2. All patients underwent a comprehensive ophthalmic examination at baseline and postoperative follow up visits at 3, 6, 12 and 18 months. Primary outcome parameter was disease stability defined as increase in maximum keratometry over baseline K max of no more than 1 diopter at 1 year after AXL. Statistical analysis of data was performed with IBM SPSS software (version 20.0 SPSS). P value of < 0.05 was considered as statistically significant. Results: Disease stability was 96 % in each group. At the final time point of 18 months, group 2 (AXL 9mmwatt/cm2 for 10 min) was superior as compared to group 1 (AXL 18mmwatt/cm2 for 5 min) in terms of flattening of steep and sim K (p = 0.007, 0.023 respectively). Conclusion: The two AXL protocols are safe and appear to show comparable efficacy in disease stability. They can be used alternatively in the treatment of progressive keratoconus.

Objective To report ophthalmic examination, biometry, phenol red thread test (PRTT), intraocular pressure (IOP), and histologic findings from a private collection of inland bearded dragons (Pogona vitticeps). Animals studied Fourteen inland bearded dragons. Procedures Complete ophthalmic examinations were performed on all animals, including slit-lamp biomicroscopy, indirect ophthalmoscopy, fluorescein stain, phenol red thread test, and rebound tonometry. B-mode ultrasonography was used to measure anterior chamber depth, axial lens thickness, vitreal chamber depth, and axial globe length. Horizontal corneal diameter was estimated using ImageJ software. Histologic assessment was obtained for one of the bearded dragons that died following the study period. Results The median PRTT value was 7.27 mm/15 seconds. Mean IOP was 6.29 ± 1.60 mm Hg and 2.14 ± 1.37 mm Hg using the dog and undefined calibration settings, respectively. Median axial globe length was 11.75 mm. Mean anterior chamber depth and mean lens thickness were 2.06 ± 0.35 mm and 3.38 ± 0.45 mm, respectively. Median vitreal chamber depth was 6.79 mm. Mean horizontal corneal diameter was 5.138 ± 0.346 mm. Two distinct ocular phenotypes were observed, with two of the bearded dragons having corneal globosa, deep anterior chambers, and tufts of iridal vessels and fibrillar material extending into the anterior chamber. Conclusions The ultrasound biometry, PRTT, and rebound tonometry results may serve as a guideline for ophthalmic parameters in healthy bearded dragons. Examination and testing of greater numbers of animals are necessary to establish true reference ranges and determine if the observed ocular phenotypes represent normal variants or pathologic changes.

Purpose. To investigate longitudinal changes in peripheral anterior chamber depth (pACD) of eyes with angle closure after laser iridotomy (LI) and factors related to prognosis. Design. Retrospective cohort study. Methods. Eyes with primary angle closure (PAC), acute PAC, or chronic angle closure glaucoma (CACG) that underwent LI (LI group) and eyes that underwent phacoemulsification and intraocular lens insertion (PEA + IOL group) were employed. Longitudinal changes in pACD were evaluated with a scanning peripheral anterior chamber depth analyzer (SPAC) in addition to routine ophthalmic examination. Results. Forty-eight eyes of LI groups (69.8 ± 8.5 years) and 21 eyes of PEA + IOL group (65.6 ± 12.7 years) were enrolled. Mean follow-up times of LI group and PEA + IOL group were 43.4 ± 12.7 months and 36.5 ± 2.5 months, respectively. LI significantly increased pACD as indicated by the SPAC grade change from 3.8 ± 1.1 to 4.6 ± 1.2 (p<0.001). However, SPAC grade was gradually reduced and reached the pre-LI level by the third year of follow up. PEA + IOL also significantly increased SPAC grade from 6.7 ± 1.6 to 8.7 ± 2.0 (p<0.001), but no time-related change was observed. Twenty-three cases of LI group presented with deterioration of glaucoma control. The type of angle closure, plateau iris configuration, peripheral anterior synechia, and glaucomatous visual field defects were significantly associated with prognosis of glaucoma after LI. Conclusions. Peripheral ACD is temporarily deepened by LI, but returns to the pre-LI level in approximately three years. The type of angle closure and some factors may be related to glaucoma prognosis after LI.

Background: To describe a case of corneal toxicity associated with the use of the epidermal growth factor receptor (EGFR) inhibitor ABT-414 in the treatment of glioblastoma multiforme. Case Presentation: Case report of a 56-year-old male with glioblastoma multiforme who developed mild painless blurred vision after systemic treatment with the investigational EGFR inhibitor ABT-414. The patient had best corrected visual acuity of 20/60 right eye and 20/50 left eye. Ophthalmic examination revealed corneal toxicity with whorl-like opacities in the inferior interpalpebral cornea. The patient was treated with topical fluoromethalone and lifitegrast, and his ocular symptoms as well as the corneal findings improved. Conclusions: The systemic use of EGFR inhibitor ABT-414 may be associated with corneal toxicity and the effects are reversible with treatment.

We report a novel finding on spectral domain optical coherence tomography in patients with choroideremia, which we describe as scleral pits (SCPs).Cross-sectional observational case series of 36 patients with choroideremia, who underwent ophthalmic examination and multimodal imaging, including optical coherence tomography of the macula. Optical coherence tomography images were reviewed for SCP, which were defined as discrete tracts of hyporeflectivity that traverse the sclera with or without the involvement of Bruch membrane, retinal pigment epithelium, and retina. Unpaired two-tailed t-test with Welch correction was used for statistical analysis.Of the 36 patients, 19 had SCP in at least one eye. Scleral pits were confined to areas of advanced chorioretinal degeneration and never involved the foveola. Type 1 SCP affected only the sclera, whereas Type 2 SCP also involved the Bruch membrane and the retinal pigment epithelium. Type 3 SCP additionally had a full-thickness retinal defect. Patients with SCP were significantly older (51 ± 2 vs. 33 ± 4 years; P0.05) and had lower best-corrected visual acuity (20/160 vs. 20/30 or 0.9 ± 0.2 vs. 0.2 ± 0.07 logarithm of the minimum angle of resolution; P0.05) than patients without SCP. Patients with SCP had a greater myopic refractive error compared with patients without SCP (-2.6 ± 0.5 vs. -0.3 ± 0.5D; P0.05), but there was no significant correlation between the number of SCPs with refraction. Short posterior ciliary arteries were observed to enter the eye through one Type 3 SCP.Scleral pits are, to the best of our knowledge, a novel optical coherence tomography finding in advanced choroideremia that likely represents the abnormal juxtaposition of penetrating short posterior ciliary arteries with the retina.

The results of observation of patients who underwent vision eximerlaser correction by the LASEK method regarding medium degree of hyperopia were analyzed.Purpose:to investigate the severity of the «dry eye» syndrome and corneal subepithelial fibroplasia in patients after laser correction of hyperopia by the LASEK method, and their prevention by reducing the preservative action on the eye surface.Patients and methods.The study included 40 patients (76 eyes), aged 21–46 years (32.98 ± 1.79) who underwent LASEK surgery for moderate hyperopia (4.03 ± 0.38 D). Patients were divided into two groups: 1) control group (20 patients, 37 eyes) — postoperative therapy included the corneoprotector “Stilavit®” and the preparation of hyaluronic acid “Oksial®”, containing preservatives; 2) the study group (20 patients, 39 eyes) — postoperative therapy included the corneoprotector “Hilozar-comod®” and the artificial tear preparation “Hilo-comod®”, which did not contain reservatives. Ophthalmic examination included, in addition to standard diagnostic methods, the Norn test, the Schirmer test, the staining of the eye surface with lissamine green. In addition, a questionnaire was conducted on a modified OSDI questionnaire; there a section characterizing the quality of vision (section B) was removed.Results.The analysis of the obtained data showed that in the study group there was less pronounced “dry eye” syndrome at 3,6,12 months after the operation. The maximum difference in the indicators of the “dry eye” syndrome between the groups was at 3 and 6 months of the postoperative period. When evaluating corneal subepithelial fibroplasia, maximum attention was paid to the frequency and the intensity index. It was shown a significant difference in the intensity of the haze between the study group and the control group by 26.1 % at 3 months, by 62.2 % at 6 months and by 65.3 % 12 months after the operation. Conclusion.Nonconservative therapy with sodium hyaluronate and dexapanthenol in the early postoperative period and only sodium hydrolurate allows to reduce the severity of the dry eye syndrome after laser correction of hypermetropia and, as a result, to reduce the intensity of haze development by 65.3 %, and its frequency on 11,5 %.

Objective: To find an association with Vitamin D levels and Diabetic retinopathy (DR). Methods: In a prospective clinical study, 412 Type 2 DM patients were evaluated for their ophthalmic findings. All patients underwent complete ophthalmic examination including detailed history, best corrected visual acuity, slit lamp examination, indirect ophthalmoloscopy and +90D lens biomicroscopy. All relevant blood investigation for evaluation of glycemic status including Vitamin D was done on first presentation. Results: Among the 412 patients that were examined, thepercentage of patients with HbA1C 8.0 was 54%. Among 222 patients with >5 years duration of DM, 95(43%) had HbA1C >8.0. Among 96 patients with 5-10 years duration of DM, 67 (70%) had HbA1C .8.0. Among 94 patients with>10 years duration of DM, 59(63%) had HbA1C >8.0, with a significant P value of 30, 13% had levels between 20-30 and 80% had

Jennifer S Fogt, Lisa A Jones-Jordan, Joseph T Barr The Ohio State University College of Optometry, Columbus, OH, USA Introduction: New designs of eye wash stations have been developed in which the direction of water flow from the fountain has been reversed, with two water streams originating nasally in both eyes and flowing toward the temporal side of each eye. No study has been done to determine the ideal direction of water flow coming from the eye wash in relation to the eye. Materials and methods: Ophthalmic eye examinations were conducted before and after the use of two eye wash stations with opposite water flow directionality. Fluorescein was instilled in both eyes before using an eye wash to measure the effectiveness of the water flow. Subjects were surveyed upon their experiences using the eye washes. Conclusion: Ophthalmic examination found no significant difference in the efficacy of the eye washes with nasal-to-temporal water flow when compared to temporal-to-nasal water flow direction. Keywords: eye wash, ocular burn, cornea, water flow

Case report The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. Discussion Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications.

PURPOSE To investigate the relationship between choroidal thicknesses (CT), central foveal thicknesses, multifocal electroretinography (mf-ERG) responses, and best-corrected visual acuity levels in patients with Stargardt disease (STGD). METHODS A total of 30 eyes of 30 patients with STGD, and 30 age- and sex-matched healthy controls were included in the study. All participants underwent detailed ophthalmic examination including best-corrected visual acuity and spectral domain optical coherence tomography measurements, and also patients with STGD were performed mf-ERG. RESULTS The mean subfoveal CT values were 271.95 ± 85.57 μm in patients with STGD and 355.73 ± 87.41 μm in the control group (P < 0.001). The mean central foveal thickness values were 223.56 ± 61.38 μm in patients with STGD and 272.46 ± 27.52 μm in the control group (P < 0.001). The mean central and paracentral mf-ERG responses (45.71 ± 26.60 and 16.47 ± 10.75 Nv/deg respectively) in patients with STGD were significantly lower from the normal ranges (66.6-130.8 Nv/deg and 30.9-77.7 Nv/deg, respectively; P < 0.001 for both). There was a statistically significant correlation between subfoveal CT and best-corrected visual acuity levels (P = 0.012, r = -0.452), and between parafoveal CT and inner retinal thickness and paracentral mf-ERG responses (P = 0.043, r = +0.372 and P = 0.049, r = +0.363, respectively). Paracentral mf-ERG responses were also correlated with outer retinal thickness values (P = 0.005, r = +0.503). CONCLUSION Patients with STGD have a thinner CT, which may be responsible for some of the clinical findings. The pathophysiological significance of these findings needs further study.

Background: Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive disease where deficiency of sterol 27-hydroxylase leads to reduced production of CDCA. In such cases, life expectancy is only 4–6 decades, with progressive neurologic dysfunction such as dementia and spinal cord paresis, unless the condition is diagnosed early and treated appropriately. Herein, we aim to raise awareness regarding the importance of ophthalmic examination in evaluating of xanthoma. Clinical Cases: Case 1: In a 58-year-old man with no neurological symptoms; bilateral cataracts were detected during the initial diagnostic process. This patient had two siblings with xanthoma; one died from cerebral infarction and the other from biliary tract cancer. Another sibling had premature acute cardiovascular disease without xanthomas. Baseline lipid profiles were nearly within the normal range, while lipoprotein A was approximately 2.5 times higher than the normal. CTX was confirmed by the detection of a homozygous mutation in the CYP27A1 gene and high plasma cholestanol level (8.5 mg/L; reference range 0.0–5.0 mg/L). He has been taking oral CDCA (250 mg, three times daily). Case 2: In a 24-year-old man with no neurological symptoms or intellectual disability, premature bilateral cataracts were detected 1 year prior to diagnosis of CTX. None of his family members had xanthoma or premature cardiovascular disease. Lipid profile showed a similar pattern to that of Case 1; CTX was confirmed by the detection of a homozygous mutation in the CYP27A1 gene and high plasma cholestanol level (21.33 mg/L). One year after starting CDCA (250 mg, three times daily), cholestanol levels dropped to 7.34 mg/L. They were measured annually and identified as 5.08 mg/L, 4.2 mg/L, 4.7 mg/L, and 3.8 mg/L at 24, 38, 61, and 72 months, respectively. It took approximately 2 years for the normalization of his cholestanol level. There were no recurrences of xanthoma or progression of complications in target organs after 6 years of treatment. Conclusion: Early diagnosis improves the outcomes of CTX, allowing proper treatment. Bilateral cataracts caused by cholestanol buildup on the crystalline lens due to CTX usually occur within the first three decades of life. This manifestation does not occur in patients with xanthoma, familial hypercholesterolemia, or sitosterolemia. Taken together, this report suggests that premature bilateral cataracts are a specific marker that can accelerate early diagnosis of CTX. References: (1) Duell PB et al. Diagnosis, Treatment and Clinical Outcomes in 43 Cases with CTX. Journal of Clinical Lipidology. 2018;12:1169 (2) Salen G, Steiner RD. Epidemiology, diagnosis, and treatment of CTX. J Inherit Metab Dis 2017: 40:771

An approximately 2-year-old female Doberman Pinscher was referred for the evaluation of bilateral, chronic proliferative conjunctivitis. Ophthalmic examination revealed bilateral thick, opaque pseudomembranes originating from the conjunctivae that prevented visualization of the cornea and interior structures of the eye. Histopathological findings of biopsies of the pseudomembranes were consistent with ligneous conjunctivitis. Serum plasminogen activity levels were within the normal range. Treatment with topical and systemic anti-inflammatory and immunosuppressive drugs did not improve the conjunctival lesions. The pseudomembranes were surgically excised, and the conjunctival surfaces were reconstructed with amniotic membrane. At final re-examination two years postsurgery, there was no evidence of recurrence of the pseudomembranes. To the authors' knowledge, this is the first reported case of the successful treatment of canine ligneous conjunctivitis with amniotic membrane transplantation.

Actuality. Regional hemodynamics сcontravention is one of the key factors in the development of retinal vein occlusion. The available methods estimating the ocular component of oculoorbital blood flow include opthalmoplethysmography and opthalmorheography. The value of opthalmosphygmography is in question due to the dependence of the results obtained from the orbital component of eye hemodynamics. Assessment of the vascular bed in the fluorescein angiography also gives an indirect assessment of ocular blood flow. The objective is to estimate hemodynamics indices and informativity of used methods in young and middle-aged patients with retinal vein occlusion. Materials and methods. The study included 30 patients with retinal vein occlusion. In all patients, routine ophthalmic examination was performed and ocular blood flow was additionally estimated using ophthalmoplethysmography, ophthalmorheography, ophthalmosphygmography, and fluorescein angiography. Results. Insignificant decrease of ocular blood flow indices was found on the eye with RVO in young and middle-aged patients with retinal vein occlusion. High values of factors weight of opthalmoplethysmography and opthalmorheography was found, which were significantly exceed the contribution of ocular pulse amplitude of pressure. Conclusions. There was a tendency to decrease all hemodynamic parameters on the eye with RVO in young and middle-aged patients with retinal vein occlusion. The received high values of factors weights reflect the comparable informativity of opthalmoplethysmography and opthalmorheography. The researchers are more informative, which results were less affected by the blood flow in the orbital tissues.

Background Different enhancement procedures have been suggested for reduction of residual refractive errors after SMILE. The aim of this study is to evaluate an improved cap-preserving technique for enhancement after SMILE (Re-SMILE). Methods A retrospective case series was conducted at Eye subspecialty center, Cairo, Egypt on 9 eyes with myopia or myopic astigmatism (spherical equivalent – 8.0 and − 12.0D). undergoing SMILE procedure and needed second interference. This was either because the more myopic meridian was more than − 10.0 D and therefore planned to have two-steps procedure (six eyes) or because of under correction needing enhancement (three eyes). Assessment after the primary SMILE procedure was conducted at 1 day, 1 week, 1 month and 3 months postoperatively. Assessment after Re-SMILE was conducted at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperatively. The assessments included full ophthalmic examination, objective and subjective refraction, and rotating Scheimpflug camera imaging. Results Preoperatively, the mean refractive spherical equivalent (MRSE) values were: − 9.36 ± 0. 89. After primary SMILE it was − 2.18 ± 0.71. After Re-SMILE it was − 0.13 ± 0.68. MRSE was significantly improved after both procedures (P

This prospective clinical study compared the corneal astigmatism before and after pterygium excision surgery with conjunctival autograft transplantation. The study included 37 eyes of 37 patients diagnosed with pterygium. All participants underwent pterygium excision with conjunctival autograft transplantation and were examined preoperatively and on the first and third month post-intervention. Comprehensive ophthalmic examination was done and measurements included: pterygium size, uncorrected and best corrected visual acuity and corneal astigmatism. Preoperative and postoperative values were compared using the nonparametric Wilcoxon signed-ranks test. The mean pterygium horizontal length was 2.18 mm (range 1–4 mm). A statistically significant correlation was observed between the pterygium length and preoperative astigmatism. The mean corneal astigmatism preoperatively was 1.26 ± 1.18 D and decreased to 0.84 ± 0.73 D three months after the intervention (p

Purpose The pediatric ophthalmic examination is often considered a challenge to ophthalmologists at any level of training. New tools need to be developed and tested to enhance resident and fellow training in pediatric ophthalmology. To our knowledge, this pilot project introduces the first educational rubric designed specifically for a pediatric ophthalmic examination. Methods Preliminary surveys were completed by 11 ophthalmic residents, of all three postgraduate years (PGY), to gauge comfort level with the pediatric ophthalmic examination. A one-page Pediatric Examination Assessment Rubric (PEAR) was developed and reviewed by 13 content experts (12 pediatric ophthalmologists and a lead developer of the Ophthalmic Clinical Exercise Examination [OCEX] tool) at eight academic institutions. A total of five educators from three academic institutions used the rubric to evaluate a total of six residents during a new strabismus evaluation. Postevaluation surveys were completed by both the five educators and the six residents. Results Preliminary surveys showed that only 18.2% of residents felt their pediatric examination skills were good. Residents noted higher levels of frustration and less comfort with the pediatric examination when compared with an adult examination. Thirteen experts' comments were incorporated into the rubric to establish content validity. Postevaluation surveys showed that 60% of faculty and 100% of residents found the rubric to be very effective in providing feedback. Conclusion In this pilot project, we established the need for more concrete educational tools in pediatric ophthalmology, created an educational tool, established content validity, and demonstrated feasibility. The PEAR helps residents identify skills to target for improvement based on the quality of their pediatric ophthalmic examinations. At three academic institutions, the PEAR was shown to be easy to use and a useful tool for training residents to perform the pediatric ophthalmic examination.

Purpose: To estimate the prevalence, features, and associations of primary angle closure disease (PACD) in rural and urban populations from West Bengal in eastern India. Methods: This was a population-based cross-sectional study with two arms, rural and urban. The rural study area consisted of 28 contiguous villages from 13 gram panchayats in Balagarh Police Station, with rural base hospital at Dhobapara, Balagarh Police Station, in the village Kuliapara of Hooghly district. A tertiary eye hospital in central Kolkata was the urban study center. Individuals residing in the study area aged 40 years and above were included in this study using multistage random cluster sampling. All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. Data collected were analyzed using SPSS 13. Multiple logistic regressions were used to analyze risk factors for PACD. Results: A total of 7,408 and 7,248 subjects aged 40 years or older were enumerated from Hooghly district and Kolkata city, respectively. PACD was detected in 1.9% subjects in rural arm and 1.54% subjects in the urban arm (P < 0.001). In rural arm, 0.3% had PACS, 0.56% had PAC, and 1.03% had PACG. In urban arm, 0.22% had PACS, 0.35% had PAC, and 0.97% had PACG. Conclusion: The study concludes that higher age, higher CCT, and shorter axial length/presence of hyperopia are important independent predictors of ACD. ACD is more common in eastern India than previous estimates.

Purpose: To report the association of optic nerve head (ONH) drusen with Best vitelliform macular dystrophy (BVMD). Methods: Chart review. Patients: Five patients from 3 families. Results: Multimodal imaging and ophthalmic examination demonstrated findings consistent with ONH drusen, in association with BVMD, in 5 patients. Conclusion: We report the association of BVMD with ONH drusen in 5 patients. This combination has previously been reported only once. We recommend that patients with a diagnosis of BVMD undergo autofluorescence and ultrasound imaging of the optic nerve to help facilitate this diagnosis, as some ONH drusen can be buried.

The review highlights common ophthalmic emergencies seen in the hospitalized geriatric patient. It describes key features of the ophthalmic examination, early identification, and treatment of ophthalmic emergencies, including transient monocular loss of vision with risk of future ischemic complicati