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Anterior segment retinoblastoma, being one of the masquerading syndromes, occasionally cause difficulties in diagnosis. We present a case consulted to our clinic with persistent unilateral hypopyon, who did not respond to the topical antibiotic and steroid treatment initiated at the external center. Upon detection of a retinal mass in the midperiphery on the dilated fundus examination performed at our center, the approach to diagnosis and treatment of the disease has changed. The eye underwent enucleation and the patient received maximal adjuvant chemotherapy upon detection of high risk factors for pathological examination. Meticulous ophthalmologic examination including dilate fundus examination is of a great importance in a 2-year of child with hypopyon and keratic precipitates for the prevention of morbidity and mortality [ABSTRACT FROM AUTHOR]

Objective: Migraine is one of the most common debilitating diseases characterized by pulsating headaches continued from a few hours to several days, accompanied by nausea, vomiting, sensitivity to light and sound. There have been claims of a relationship between migraine headaches and refractive errors and binocular vision anomalies. In this study, we aimed to evaluate optometric and ortoptic findings in patients with migraine headache and to compare with healthy subjects. Methods: This study includes 58 patients with migraine and 50 healthy subjects. Asthenopic symptoms, fotofobia, and visual symptoms of the patients were noted. Detailed ophthalmological examinations were performed containing spherical refractive error, astigmatic refractive error, spherical equivalent (SE), best-corrected visual acuity, slit lamp biomicroscopy, fundus examination. Also, ortoptic examination was performed icluding ocular motility, fusional reserves, and stereopis measurements. Results: Myopia and astigmatism were more frequent in migraine patients and near fusional convergence amlitudes were lower when compared with the control subjects (p=0.020, p=0.019, p=0.00 respectively). Conclusion: This study suggests that refractive errors and insufficiency of fusional mechanisms may make a negative contribution to migraine headache. Therefore, people who experience migraine headaches should have opthalmological examinations regularly to ensure that their refractive errors and ortoptic abnormalities are appropriately managed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate treatment outcomes in unilateral childhood cataracts. Material and methods: Records of 21 patients with unilateral congenital or juvenile cataracts who were operated in Gazi University Hospital between 2010 and 2017 were retrospectively reviewed. Anterior capsulotomy, lens aspiration, posterior capsulotomy and anterior vitrectomy were performed. Primary intraocular lens (IOL) implantation was performed in cases older than 1 year of age. Secondary IOL implantation was performed after 2 years of age in those who left aphakic. Visual acuity, intraocular pressure, refraction error, compliance with amblyopia treatment and complications were evaluated. Results: The mean follow-up was 43 (6-108) months. The mean age at the time of surgery was 5 (1-10) months for the 14 cases with congenital onset and 4 (1.5-15) years for the 7 cases with juvenile onset. Six of the 14 patients who left aphakic under one year of age underwent secondary IOL implantation at an average of 35 month. The final VA was 0.64logMAR in the congenital group and 0.19logMAR in the juvenile group (p=0.02). 28.6% of congenital cases were operated in the first 6 weeks of life. Surgery in the first 6 weeks provided better visual outcome than did late surgery (=6 weeks=0.30logMAR,> 6 weeks=0.77logMAR, p=0.012). The most common complication was deprivation-induced strabismus (29%). PCO was not seen in any of the patients. Glaucoma was observed in one case. Conclusion: Good visual results can be obtained with early surgery and effective amblyopia treatment in unilateral childhood cataracts. Families should be well informed, and amblyopia treatment and regular follow-up examinations should be started promptly. [ABSTRACT FROM AUTHOR]

Phakomatosis pigmentovascularis (PPV) is a group of diseases that defined as the coexistence of vascularized and pigmented nevi. Patients with PPV often have ophthalmic abnormalities including ocular melanocytosis, goniodysgenesis, congenital glaucoma and choroidal melanoma. In this report, ophthalmic involvements of PPV and our approach to a PPV case with congenital glaucoma and ocular melanocytosis is being discussed. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Bakirkoy is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A response from the authors' of the article "Long-term results after primary intraocular lens implantation in children operated less than 2 years of age for congenital cataract" in a 2014 issue of the journal is presented.

Trabeculotomy is a Schlemm canal surgery to reduce the juxtacanalicular resistance between the trabecular meshwork and Schlemm channel which plays a major role in the pathophysiology of primary open angle glaucoma. To overcome the complications of standard trabeculectomy such as hypotony and late onset bleb related problems, alternative glaucoma surgeries have been performed. Among these the trabeculotomy has increasingly become popular. The effectiveness of trabeculotomy is well known in pediatric and congenital glaucomas. In recent years, the reports for suture and microcatheter 360 degree circumferential trabeculotomy increased its application for the treatment of adult glaucoma. Classically the trabeculotomy is performed ab externo however; it can also be performed ab interno, by clear corneal incision. Both ab externo and interno approaches can be performed combined with phacoemulsification. [ABSTRACT FROM AUTHOR]

Aim: To assess the clinical and genetic characteristics of children diagnosed with retinoblastoma (RB) at Gazi University Faculty of Medicine's Department of Pediatric Oncology., Methods: All cases diagnosed with RB and received treatment and follow-up in the Ophthalmology and Pediatric Oncology Department, October 2016 to May 2021 were evaluated retrospectively. The RB1 gene was analyzed by next-generation sequencing (NGS) technique in DNAs obtained from peripheral blood samples of the patients., Results: This study included 53 cases with 67 RB-affected eyes during the study period. The mean age was 24.6 (median: 18.5, range: 3-151)mo. There were 15 (22.3%) Group D eyes and 39 (58.2%) Group E eyes. The RB1 gene was sequenced by the NGS method in 19 patients. Heterozygous RB1:NM_000321.3: c.54_76del (p.Glu19AlafsTer4) variant was detected in a 15-month-old female with bilateral RB. Heterozygous RB1:NM_000321.3: c.1814+3A>T variant was detected in a 5.5-month-old male with bilateral RB. The intronic RB1:NM_000321.3: c.1332+4A>G variant was detected in patient 14, a 13-month-old male with unilateral RB. The RB1:NM_000321.3: c.575_576del (p.Lys192SerfsTer10) variant was found in an 18-month-old female with an allele frequency of 37%. These variants have not been reported in the literature and mutation databases., Conclusion: Four novel variants are described and one of them is found in two different patients. This data is crucial for assessing prognosis. It serves as a guide for estimating the long-term risk of secondary malignancy as well as the short-term risk of developing additional malignancies in the same eye and the other eye., (International Journal of Ophthalmology Press.)

Purpose: To evaluate the efficacy of transscleral drainage of subretinal fluid (TDSRF) with and without pars plana vitrectomy (PPV), which are performed as an adjunct to ablative therapies in advanced Coats disease., Design: Retrospective, comparative case series., Patient Population: A total of 31 eyes from 31 consecutive patients with advanced Coats disease at an average age of 47.8 ± 34.2 (2-156) months at the time of the surgery, who underwent TDSRF alone or in combination with PPV., Methods: Main outcome measurements were LogMAR visual acuity values, anterior and posterior segment findings, need for further surgery, laser photocoagulation, and anti-vascular endothelial growth factor (anti-VEGF) treatment. Anatomical success was defined as the maintenance of retinal reattachment without any further surgery during follow-up., Results: Sixteen patients underwent TDSRF alone, and 15 patients underwent combined TDSRF and PPV. Mean follow-up time was 34.8 ± 32.9 months (6-128). Anatomical success rate of combined TDSRF and PPV was higher than that of TDSRF alone (93.8% vs 75%, respectively). The incidence of epiretinal membrane formation, number of laser photocoagulation procedures, and anti-VEGF treatments were statistically significantly higher in the group that underwent TDSRF alone than in those who had combined TDSRF and PPV in the long term. There was an improvement in vision in only 4 eyes (12.9%) (all >3 years old at presentation) during the follow-up., Conclusions: Combined TDSRF and PPV appears to be more effective in controlling the disease than TDSRF alone, as an adjunct to ablative procedures for the treatment of advanced Coats disease. The need for additional treatment is much less with the addition of PPV., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose : To evaluate the in vivo efficacy of rose bengal (RB)-mediated photodynamic antimicrobial therapy (PDAT) for treatment of Acanthamoeba castellanii keratitis (AK). Materials and Methods : An animal (rabbit) AK model was successfully achieved via intrastromal inoculation of a suspension of A. castellanii cells and trophozoites. Prior to RB-PDAT (pre-treatment, day-5), the severity of the induced corneal infection was graded numerically for epithelial defects, stromal edema, neovascularity, and stromal opacity/infiltration. The right eyes of rabbits (n = 18) were divided equally into three groups (n = 6/group): control (no treatment); 0.1% RB+518 nm irradiation (5.4 J/cm 2 ); and 0.2% RB+518 nm irradiation (5.4 J/cm 2 ). On post-treatment day-5, animals were euthanized, after which corneal buttons were excised and submitted for real-time polymerase chain reaction (RT-PCR) analysis. Results : Post-treatment clinical scores of the 0.1 and 0.2% RB groups indicated significant improvement compared to control group scores (pre-treatment clinical scores; 5.17 ± 0.98, 7.50 ± 0.62, and 6.17 ± 0.70 and post-treatment clinical scores; 4.50 ± 0.56, ( p = .043), 3.50 ± 0.99 ( p = .039), 6.83 ± 1.66 ( p = .34), respectively). RT-PCR analysis revealed that the mean cycle threshold (Ct) values were significantly higher in treated-group corneas compared to control-group corneas, with no significant differences between treated-groups (Mean Ct values; 34.33, 34.5, and 29.67 for 0.1 and 0.2% RB, and control groups). There was a statistically significant negative correlation between post-treatment clinical scores and Ct values ( r = -0.474, p -value 0.047). Conclusions : Our results demonstrate that RB-PDAT is effective in decreasing the parasitic load and clinical severity of AK.

Purpose: To investigate the effect of sildenafil on an experimental sodium selenite-induced cataract model in rats., Materials and Methods: Twenty-six young Wistar rats were separated into four groups. On postpartum day 10, six rats received only selenite (group 1, selenite-induced cataract), seven rats received selenite and high dose oral sildenafil (group 2, high-dose sildenafil-treated), seven rats received selenite and low dose oral sildenafil (group 3, low-dose sildenafil-treated), and six rats received only saline (group 4, controls). On postpartum day 30, cataract formation was graded and recorded using an operating microscope. The rats were sacrificed, lens tissues were isolated, and serum samples were collected. Nitrite oxide metabolites (NOx), advanced oxidative protein products (AOPP), and total sulfhydryl (TSH) levels were assessed in both serum and lenticular samples., Results: The rats treated with low-dose sildenafil showed lower levels of AOPP and NOx, and the higher levels of TSH than the rats in other experimental groups. Otherwise, the rats treated with high-dose sildenafil, similar to the selenite-induced cataract group, showed higher levels of AOPP and serum NOx than rats in the low-dose sildenafil-treated group. The rats treated with low-dose sildenafil also showed less cataract development than rats in the other experimental groups., Conclusion: Low doses (0.7 mg/kg) of oral sildenafil might show a protective effect on cataract development by lowering oxidative stress.

PRéCIS:: The present study demonstrates that the surgical success rate of circumferential trabeculotomy is 64.7% according to target intraocular pressure (IOP) ≤21 mm Hg and ≥30% reduction from baseline in patients with neonatal-onset primary congenital glaucoma (PCG), with an average follow-up of 35.1 months., Purpose: The aim of the study was to evaluate the surgical success rate and applicability of circumferential trabeculotomy compared with converted traditional trabeculotomy in patients with neonatal-onset PCG in Turkey., Patients and Methods: A retrospective study enrolled 42 eyes of 42 patients with an average age of 34.0±6.7 (14 to 59) days at the time of the surgery, who underwent 5/0 prolene suture-assisted circumferential trabeculotomy or rigid probe-assisted traditional trabeculotomy for the treatment of neonatal-onset PCG. IOP at baseline, 1st, 2nd, 3rd, 6th, 9th, 12th, 24th, and 36th months of follow-up, need of glaucoma eye drop, need of further glaucoma surgery, cup to disc ratio, axial length, corneal diameters, and presence of corneal clouding were recorded. Surgical success was defined as IOP <21 mm Hg and ≥30% reduction from baseline without any further glaucoma surgery., Results: Seventeen eyes underwent circumferential trabeculotomy and 25 eyes with a failure in completing circumferential trabeculotomy underwent traditional trabeculotomy. The applicability rate of circumferential trabeculotomy was 40.4%. The mean preoperative IOP value was 33.2±7.6 mm Hg. The average follow-up time was 35.1±21.7 (12 to 95) months. Surgical success rates of circumferential trabeculotomy at the first, second, and third year of follow-up were 70.6%, 64.7%, and 64.7%, respectively. Surgical success rates of traditional trabeculotomy at the first, second, and third year of follow-up were 60%, 48%, and 44%, respectively., Conclusions: Circumferential trabeculotomy seems to be a safer and more successful procedure than traditional trabeculotomy for the treatment of neonatal-onset PCG. Unlike the traditional procedure, the IOP-lowering effect of circumferential trabeculotomy could be maintained up to ~36 months.

Purpose: Measurement of optic nerve sheath diameter (ONSD) with ocular ultrasonography (USG) is a noninvasive technique that can be readily used to determine clues of increased intracranial pressure. In this study, we aimed to determine the role of optic nerve sheath diameter measurements in the diagnosis and follow-up of pediatric patients with idiopathic intracranial hypertension (IIH)., Methods: Eight patients with a diagnosis of IIH with a median age of 11.7 (range 4.5-17) years were examined prospectively. During follow-up, orbital ultrasonography (USG) was performed immediately prior to lumbar puncture (LP) and at 24 h, at 1 week, and between 1 and 18 months after LP. Cranial MRI examinations and automated visual field assessments were performed at baseline and at 3 months, and both measurements were compared with each other., Results: The mean cerebrospinal fluid opening pressure (37.75 ± 12.64 cm H 2 O) and the mean ONSD (5.94 ± 0.46 mm) were correlated. The median follow-up was 16 (range, 12-18 months), and ONSD regressed gradually consistent with clinical and radiologic improvement during follow-up., Conclusions: To the best of our knowledge, this is the first prospective pilot study performed on pediatric patients with IIH using orbital USG for ONSD measurements. Despite the small sample size, the present study indicated that orbital USG may be used as a promising noninvasive tool to diagnose increased intracranial pressure and for monitoring treatment efficacy in this special patient population.

Background/aim: To compare the clinical use, image quality and viewing angle of a commonly used contact wide angle viewing (WAV) system (Advanced Visual Instruments (AVI) Panoramic Imaging Systems, NY, USA) with a commonly used noncontact WAV system (Leica RUV800, Leica Microsystems, Switzerland)., Materials and Methods: Images of 42 consecutively operated eyes were obtained with both systems at the same surgical stages and were compared for image quality using the Imatest Master 4.5.13 (Imatest LLC, Boulder, USA) software. The viewing angles of the images were calculated using the optic disc sizes measured from the OCT and infrared fundus images. The 68-degree AVI lens was compared with the 90-dioptre (D) Leica RUV800 lens, while the 130-degree AVI lens was compared with the 132-D Leica RUV800 lens. The surgical assistants were asked to grade the difficulty of holding the lens in place from 1 to 10, 1 being the easiest and 10 being the most difficult., Results: The contact system provided wider viewing angles with higher quality compared to the noncontact system both under fluid and air media. The difference was clinically significant in eyes with impaired corneal clarity, very high myopia, or small pupil. The difficulty of holding the lens in place ranged from 4 to 7, and decreased gradually with practice., Conclusions: Both WAV systems provided high image quality and adequate viewing angles in most cases. However, the contact system appeared to provide a superior image quality and/or a wider viewing angle in more challenging situations. The difficulty of holding the contact lens in place was found to be moderate., Competing Interests: The authors report no conflict of interest, or any financial interest in any of the materials and methods used or described, (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objectives: To evaluate the long-term results of intravitreal dexamethasone implant (DEX) for noninfectious uveitis., Materials and Methods: The study included 62 eyes of 44 patients treated with DEX implant due to noninfectious uveitis and followed up for at least a year. Best-corrected visual acuity (BCVA), central foveal thickness, intraocular pressure (IOP), vitreous haze score, indications, immunomodulatory therapy and steroid usage before/after injection, number of injections, and adverse events were analyzed retrospectively., Results: Average follow-up was 20 months (range 12-64 months). The female/male ratio was 29/15. Mean age was 50 years (range 22-75 years). The most frequent uveitis etiologies were idiopathic (25 patients, 40.3%) and Behçet’s uveitis. (17 patients, 27.4%) The most common indication for DEX injection was cystoid macular edema together with resistant vitreous haze (26 eyes, 41.9%). Twenty-two eyes (30%) received more than one DEX injection. Mean BCVA was improved from 0.55 logMAR at baseline to 0.38, 0.32, and 0.35 after 1, 3, and 6 months, respectively (p<0.001 for each). Mean CFT was decreased from 386 μm at baseline to 288, 311, and 302 μm after 1, 3, and 6 months, respectively (p<0.001 for each). Mean IOP did not change significantly during follow-up. Five eyes (8%) received topical anti-glaucoma medication (IOP ≥25 mmHg). Eighteen (46%) of 39 phakic eyes underwent cataract surgery during follow-up. Similar efficacy of the DEX implant was observed in eyes that received multiple injections. Systemic immunomodulatory therapy did not change significantly during follow-up., Conclusion: Intravitreal DEX injection does not alter systemic immunomodulatory therapy, but may facilitate the management of noninfectious uveitis by suppressing local intraocular inflammation. Multiple injections yielded comparable visual and anatomical outcomes to single injections. Follow-up for ocular hypertension and cataract formation are important, especially in eyes receiving multiple injections.

Purpose: To evaluate the effects of clinical features associated with enucleation in eyes with Coats disease., Methods: The medical records of all patients with Coats disease at the Ocular Oncology, Wills Eye Hospital from November 1, 1973, to July 31, 2018, were reviewed retrospectively. The clinical features pertaining to need for ultimate enucleation and time to enucleation were compared., Results: The records of 351 eyes were reviewed, of which 259 had follow-up at our center and 32 (12%) were managed with enucleation. Reasons for enucleation included neovascular glaucoma (n = 24 [75%]), possible tumor (6 [19%]), and phthisis bulbi (2 [6%]). Compared to nonenucleated eyes, enucleated eyes had more extensive clock hour involvement of telangiectasia (P < 0.001), light bulb aneurysms (P < 0.001), exudation (P < 0.001), and subretinal fluid (P < 0.001). On adjusted analysis by binomial logistic regression, variables predictive of enucleation included presence of iris neovascularization (P = 0.01), ultrasonographic retinal detachment (P = 0.004), open-funnel retinal detachment (P = 0.04), closed-funnel retinal detachment (P = 0.01), ultrasonographic elevation of subretinal fluid by millimeters (P = 0.001), and angiographic extent of light bulb aneurysms by clock hours (P = 0.02). By Kaplan-Meier analysis of 4-year cumulative risk of enucleation, risk factors for enucleation included presence of iris neovascularization (hazard ratio [HR] 31.0; P < 0.001), ultrasonographic retinal detachment (HR 56.2; P < 0.001), open-funnel retinal detachment (HR 2.7; P = 0.01), and closed-funnel retinal detachment (HR 4.5; P < 0.001)., Conclusions: Clinical features that predict risk of and time to enucleation in eyes with Coats disease include iris neovascularization, ultrasonographic presence and millimeter-elevation of retinal detachment, and angiographic extent of light bulb aneurysms., (Copyright © 2019 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to investigate factors predictive of subretinal fluid (SRF) resolution in Coats disease., Design: Retrospective cohort study., Methods: Institutional review board-approved review of patients diagnosed with Coats disease demonstrating SRF (stage 3-5) at a single center from November 1973 to July 2018 with comparison of eyes that had resolution of SRF to those in which SRF persisted., Results: There were 177 cases (154 males, 87%) of Coats disease diagnosed at a mean age of 8 years. After a mean follow-up of 62 months, SRF resolved in 110 (62%) and persisted in 67 (38%) eyes. Comparison (resolved SRF vs persistent SRF) revealed classification as stage 3A [63 (57%) vs 20 (29%)], stage 3B [47 (43%) vs 40 (60%)], or stage 4 [0 (0%) vs 7 (11%)] (P < 0.001). Eyes with resolved SRF presented with fewer clock hours of telangiectasia (mean: 5 vs 7 clock hours, P < 0.001), light bulb aneurysms (mean: 5 vs 7 clock hours, P < 0.001), exudation (mean: 7 vs 10 clock hours, P < 0.001), and extent of SRF (mean: 7 vs 10 clock hours, P < 0.001). Factors predictive of SRF resolution included absence of iris neovascularization on fluorescein angiography [odds ratio 0.05 (95% confidence interval 0.01-0.60), P = 0.02], and less elevated SRF by ultrasonography [odds ratio 0.84 (95% confidence interval 0.76-0.95), P = 0.004). For every 1-mm decrease in SRF, likelihood of SRF resolution increased by 16%., Conclusions: Resolution of SRF was achieved in the majority of eyes (62%) with stage 3 to 5 Coats disease. Predictors of SRF resolution included lack of neovascularization on fluorescein angiography and less elevation of SRF by ultrasonography.

Purpose: To report anatomical and functional results of vitreoretinal surgery in our case series of late cicatricial retinopathy of prematurity (ROP) patients with subtotal retinal detachment., Methods: This is a retrospective, consecutive case series. Eleven eyes of 10 patients presented with partial tractional retinal detachment secondary to late cicatricial ROP (cicatricial stage 4B) who underwent vitreoretinal surgery were retrospectively reviewed. Anatomical and functional outcomes were evaluated., Results: The mean gestational age at birth was 28.6 (26-32) weeks. The mean age at surgery was 79 (4-213) months. Patients were followed up for 21.7 (6-40) months. Six eyes (55%) had lens-sparing vitrectomy and five eyes (45%) had lensectomy + vitrectomy. Anatomical success was achieved in 10 eyes (91%). Improvement in visual acuity was noted in nine eyes (82%)., Conclusion: Eye grows but fibrotic tissue does not grow with age, and during this period retinal traction may get worse. Relieving these tractions may lead to good anatomical and visual outcomes in selected late cicatricial ROP cases., Competing Interests: None

Purpose: To assess features and outcomes of Coats disease over 5-decades., Methods: Retrospective review of Coats disease patients at a single center. Features and outcomes were compared based on decade of presentation., Results: There were 351 patients with Coats disease. The presenting median age (6 years), male sex (84%), and unilaterality (100%) did not change per decade. Coats disease classification did not change per decade with Stage 1 (1%), Stage 2 (21%), Stage 3 (68%), Stage 4 (6%), and Stage 5 (1%). Clinical features that changed per decade (1970s vs. 1980s vs. 1990s vs. 2000s vs. 2010s) included 1980s features of more eyes with exudation in all 4 quadrants (22% vs. 58% vs. 44% vs. 33% vs. 27, P = 0.01) and total exudative retinal detachment (33% vs. 53% vs. 39% vs. 27% vs. 21%, P < 0.001). Imaging features that changed per decade included 2010s greater fluorescein angiographic extent of retinal non-perfusion in mean clock hours (4 vs. 4 vs. 3 vs. 5 vs. 6, P = 0.003), and 1980s greater mean height of retinal detachment ultrasonographically (5 vs. 12 vs. 5 vs. 5 vs. 4 mm, P < 0.001). Treatment features that changed per decade included 1980s greater primary enucleation (11% vs. 16% vs. 3% vs. 4% vs. 1%, P = 0.001), and 2010s greater use of laser photocoagulation (55% vs. 33% vs. 38% vs. 40% vs. 72%, P < 0.001), sub-Tenon corticosteroid (0% vs. 4% vs. 5% vs. 8% vs. 29%, P < 0.001), and intravitreal anti-VEGF) (0% vs. 4% vs. 2% vs. 13% vs. 18%, P = 0.003). Outcomes that changed per decade included 2010s findings of more complete resolution of subretinal fluid (64% vs. 59% vs. 38% vs. 58% vs. 72%, P = 0.01) and less need for primary/secondary enucleation (17% vs. 27% vs. 14% vs. 13% vs. 6%, P = 0.04)., Conclusion: Eyes with Coats disease in the 1980s demonstrated more advanced findings, often requiring enucleation. Over the decades, greater use of laser photocoagulation and injections has led to improved disease resolution with greater globe salvage., Competing Interests: None

Objectives: To report big-bubble deep anterior lamellar keratoplasty (DALK) in patients with keratoconus with corneal stromal scar, and to investigate factors that can influence intraoperative Descemet membrane (DM) perforation., Methods: A retrospective study included patients with keratoconus with central stromal scar that underwent DALK using the big-bubble technique. Best spectacle-corrected visual acuity (BSCVA), keratometry, minimum corneal thickness (MCT), stromal scar depth, and endothelial cell density (ECD) were recorded. Receiver operating characteristic (ROC) curves were analyzed to predict an intraoperative perforation related to stromal scar., Results: Thirty-eight eyes of 38 patients with keratoconus (mean age: 30.0±9.2 years) were included in this study. Thirty-four eyes had successful DALK; in four eyes, the procedure was converted to penetrating keratoplasty because of DM macroperforations. Successful big-bubble formation was achieved in 24 of 38 (63.2%) eyes, whereas in 10 eyes, manual dissection was used to complete the DALK. Mean preoperative and postoperative second year BSCVA were 1.3 (±0.4) and 0.5 (±0.2) logarithm of the minimum angle of resolution (P<0.001), keratometry values were 65.5±7.4 and 42.8±7.8 diopters (P<0.001), and ECD were 2,740±359 and 2,279±452 cells/mm (P<0.001), respectively. Using ROC analysis, the area under curve value to predict DM perforation was found to be 0.792 (scar/MCT ratio, P=0.04) and the best cutoff point for scar depth/MCT ratio was 53%., Conclusion: Big-bubble DALK is effective in patients with keratoconus with stromal scars. Scar depth/MCT ratio seems to predict the DM perforation.

Importance: Metastatic tumors of the retina are rare, simulate retinitis, and are associated with poor patient survival., Objective: To describe the clinical features and outcomes of patients with retinal metastasis from systemic cancer., Design, Setting, and Participants: Retrospective case series of 8 patients with retinal metastasis from cutaneous melanoma (n = 4), breast cancer (n =2), esophageal cancer (n =1), and lung cancer (n = 1). At presentation, the mean patient age was 62 years and all were white., Intervention: Treatment included plaque radiotherapy (n = 1) for localized disease or enucleation (n =3) for extensive tumor hemorrhage (n = 1), total retinal detachment (n = 1), or pain (n = 1). For 4 preterminal patients, observation was preferred., Main Outcomes and Measures: Clinical features and systemic outcomes., Results: The mean interval from primary cancer diagnosis to retinal metastasis was 63 months. Initial misdiagnosis as retinitis (n = 5), hemangioma (n = 1), choroidal neovascular membrane (n = 1), or nerve fiber layer infarction (n = 1) for a mean interval of 5 months was recorded. Visual acuity in the affected eye was 20/40 to 20/60 (n = 5) or 20/400 to light perception (n = 3). The tumors were unilateral (n = 7), involved the macula (n = 3), and had a mean distance to the foveola of 6 mm. In one case, dense vitreous blood precluded fundus visualization. The mean tumor basal dimension was 7.4 mm, and the mean thickness was 2.3 mm. The tumors appeared white (n = 2), yellow (n = 4), or brown (n = 1); were located in the inner retina (n = 6) or full-thickness retina (n = 1); and had vitreous seeds (n = 3), vitreous hemorrhage (n = 2), retinal hemorrhage (n = 4), subretinal fluid (n = 4), and/or intraretinal exudation (n = 1). Fluorescein angiography disclosed early retinal hypofluorescence and late hyperfluorescence with staining. Fine-needle aspiration biopsy confirmed the diagnoses (n = 4). Metastasis-related death occurred in 5 patients within 1 month in each case. Of the remaining 3 patients, 2 were alive at 4 and 17 months and 1 was too sick to return., Conclusions and Relevance: Retinal metastases resemble retinitis, often with delay in diagnosis and poor life prognosis.