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Objective To evaluate the safety, efficiency, short term stability, and sensory results of photorefractive keratectomy (PRK) in anisometropic in non-compliant children with correction. Methods Twelve eyes of 12 children with an age range: 6–17 years and anisometropic amblyopia who underwent PRK under general anesthesia to correct the dioptric difference between the eyes were included in this study. A complete ophthalmic assessment including refractive status, uncorrected and corrected distance visual acuity (UDVA & CDVA), and binocular vision status using the Worth 4-dot test and stereopsis were performed before and 1, 3, 6, and 12 months after PRK. Results The mean preoperative CDVA was 0.34 ± 0.24 LogMAR which showed a statistically significant improvement at 12 months (0.20 ± 0.19, p = 0.024) after surgery compared to the preoperative assessment. (p = 0.003) The mean preoperative UDVA was 0.63 ± 0.24 LogMAR that increased to 0.44 ± 0.24, 0.32 ± 0.16, 0.25 ± 0.19, and 0.25 ± 0.19 LogMAR at 1, 3, 6, and 12 months after PRK, respectively. One to three lines improvement in UDVA and CDVA was seen in 10 (83.4%) and 8 eyes (66.7%); while one line UDVA and CDVA loss was seen in one (8.3%) and one (8.3%) eye and unchanged UDVA and CDVA was seen in 1 (8.3%) and 3 eyes (25%), respectively. The mean preoperative stereoacuity was 341.9 ± 245.7 s of arc, which significantly improved to 166.6 ± 87.5 s of arc 12 months after PRK. (p = 0.012) Conclusion PRK was an effective surgical alternative to improve visual acuity and stereopsis in anisometropic children who did not cooperate with conventional methods of amblyopia therapy.

The outbreak of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) through the latest waves of the pandemic in several countries gathered attention to this rare fungal infection. This prospective observational study aims to evaluate the demographic and medical profile, clinical signs and symptoms (with a special focus on ophthalmic findings), imaging features, and the outcome of CA-ROCM patients. The collaborative study of COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis in Iran (CA-ROCM-IR) has been conducted in 8 tertiary referral ophthalmology centers among different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination, and underwent standard accepted treatment strategy based on the disease stage. The present report is the preliminary results of this project study. Two hundred seventy-four CA-ROCM patients, including 150 males (54.7%), who had a mean age of 56.8 ± 12.44 years, were enrolled. Diabetes mellitus was the most prevalent (82.8%) medical disease among the patients. Supplemental oxygen administration and corticosteroid use due to COVID-19 were present in a large proportion of the patients (68.2%, and 73.7% respectively). The most common primary complaints were facial pain (47.4%), facial swelling (38.3%), and nasal discharge (32.5%). Ptosis (58%), periorbital swelling (46%), and nasal congestion (40.5%) were common signs and symptoms among CA-ROCM patients. A majority of the patients (80.3%) were diagnosed at stage 3 or higher of ROCM and the rate of ocular involvement in whom was 92.3%. The most affected paranasal sinus was the ethmoid sinus (75.2%), followed by the maxillary sinus (70.8%). A total of 30 patients (10.9%) had expired before discharge from hospitals. Patients with a history of cigarette smoking (OR = 7.25), ICU admission (OR = 87.36), higher stage of the ROCM (OR = 4.22), receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (TRAMB) (OR = 4.20), and bilateral ocular involvement (OR = 2.94) had upper odds for death before discharge from hospital. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (OR = 0.058, P = 0.006). Also, GEE analysis showed statistically significant higher mean LogMAR visual acuity score among expired patients (3.71, 95% CI: 3.04–4.38) compared to patients who were discharged from hospitals (2.42, 95% CI: 2.16–2.68) (P

Bupivacaine (BUP) is an anesthetic from the family of aminoacyl anesthetics and has the highest myotoxicity among other groups of anesthetics. Intramuscular injection of BUP first causes acute libriform lysis and subsequently with the regeneration process, stronger myofibrils are formed within 3-4 weeks. Satellite cells, which are actually myogenic stem cells, are preserved in the early stage and during the destruction of muscle fibers. In fact, these cells are responsible for the subsequent regeneration of fibers. BUP is one of the few medicines that is able to increase muscle strength. In animal studies on rabbits, a decrease has been observed in the diameter of the global layer in the first week and an increase in type-I myosin occurs after 60 days, especially in the global muscle layer. There are numerous studies according to BUP injection for the non-surgical management of horizontal strabismus. To intensify the effects of the injection, botulinum toxin injection can also be used simultaneously in the antagonist muscles. In general, although the rate of improvement in strabismus varied among different studies, BUP injection alone corrects about 5-8 prism diopters. Together with botulinum toxin, BUP corrects about 15 prism diopters. The stability of this improvement is up to 10 years after injection. No significant difference has been observed in response rate between patients with esotropia and exotropia. Unlike the large molecule of botulinum toxin, which spreads slowly to its site of action, the BUP molecule is small and must be in direct contact with myofibrils before absorption into the bloodstream to exert its effect. Therefore, the injection volume should be about 3 cc with a concentration of 0.75 g per deciliter. Although BUP is promising non-surgical strabismus management, especially in small angle and residual horizontal strabismus, however, it has its own limitations. The need for direct infusion of a relatively large volume of BUP may be one of its major drawbacks that limits its usage in an office method.

Reports of isolated anomalies of the medial rectus (MR) muscle in literature are sparse. It has been identified as a subtype of congenital cranial dysinnervation disorder that affects the normal development of brainstem motor neurons. Herein, we report a 37-year-old male presented with large-angle exotropia since the birth of right eye with palpebral fissure widening. On examination of ocular movements, there was -6 limitation of adduction. There was no limitation in other ocular movements. In the preoperative CT scan, all extraocular muscles were present. He underwent surgery in right eye. Intraoperatively in the site of medial rectus, we found an empty sheath without muscle fibers indicating medial rectus hypoplasia. The width of muscle insertion was normal. Surgery consisted of lateral rectus muscle recession 10 mm in hang-back method and vertical muscle transposition procedure, by a modification of Nishida technique, in which the vector of superior and inferior recti was transposed medially by inserting non-absorbable sutures at nasal margins of muscles secured to sclera 8 mm posterior to medial rectus site without tenotomy or splitting. The deviation was decreased to less than 10 PD exotropia in primary position. The adduction was improved from -6 to -4. The palpebral fissure asymmetry was also corrected. Here, we also reviewed clinical features of all cases of medial rectus hypoplasia/aplasia in the literature and discussed surgical approaches. For vertical rectus transposition and horizontal muscle weakening, this technique has the advantages of being simpler and less traumatic to ocular tissues and unlike the traditional transposition procedures, there is no need for tenotomy and splitting.

Purpose: To evaluate the ectasia risk score system in cancelled laser in situ keratomileusis (LASIK) candidates at an academic hospital. Methods: LASIK candidates who had been cancelled by a surgeon considering the patient age, preoperative central corneal thickness, residual stromal bed thickness, or preoperative manifest refraction spherical equivalent were retrospectively reviewed, and their Randleman ectasia risk score system score was calculated. Results: The mean ectasia score of 194 eyes (97 patients) was 4.5 ± 2.67; 40 (20.6%), 46 (23.7%), and 108 (55.7%) eyes were classified as low-, moderate-, and high-risk eyes, respectively. The topography was abnormal in 69% of the patients. The mean manifest refraction spherical equivalent, central corneal thickness, and estimated residual stromal bed thickness were 4 (+0.50 to –15.50) diopters, 520 (439 to 608) µm, and 312.38 (61.5 to 424.12) µm, respectively. The main cause of cancellation in low- and moderate-risk patients (86 eyes) was the presence of unstable refractive error in the past year. Conclusion: Although promising, some other criteria, such as stable refraction, should be added to this scoring system to achieve greater practicality since a main cause of cancelling LASIK candidates in this study was the presence of unstable refraction.

Purpose: To evaluate the outcome of single long scleral tunnel technique for the prevention of conjunctival erosions caused by the Ahmed glaucoma valve. Methods: This study was a retrospective case series that included 30 eyes of 30 patients who underwent glaucoma valve implantation surgery by the single long scleral tunnel technique. Results: The mean age of patients at the time of surgery was 52 ± 21.6 years (range: 10–90 years). The mean visual acuity was 1.5 ± 0.81 logMAR preoperatively. The intraocular pressure was 40.7 ± 9.18 mm Hg (range: 25–58) before surgery that decreased significantly to 19.7 ± 3.1 mm Hg (range: 14–25; p Conclusion: Single long scleral technique was efficacious with no occurrence of tube exposure in relatively long period of follow-up. In this method, there is no need to harvest any additional material, and in situations with limited access to patch grafts, it is performable with the minimal facilities.

Purpose To describe a case of bilateral choroidal neovascularization in a patient with beta-thalassemia major and an interventional therapeutic attempt. Method Retrospective case report. Result A known case of beta-thalassemia major presented with gradual vision loss. Fundoscopy revealed bilateral macular edema accompanied by intraretinal hemorrhages. Optical coherence tomography and fluorescein angiography were compatible with the diagnosis of choroidal neovascularization. No signs of angioid streaks or other related abnormalities were noticed in examination and imaging. The patient was treated with intravitreal bevacizumab, and visual acuity improved within 6 months of follow-up. Conclusion Bilateral choroidal neovascularization can be a presenting pathology in patients with beta-thalassemia major. Anti-vascular endothelial growth factor is a promising treatment option.

Subperiosteal hematoma of the orbit is a rare complication that may occur in different situations. The most common cause is blunt trauma to the head region. The victims are usually young boys and the common site is usually orbital roof. There is no uniform approach in the literature in the management of subperiosteal hematoma. Conservative management has been recommended in cases with intact visual function. If conservative management is planned, complete resorption of hematoma may last several months, and the patients must tolerate diplopia and varying degrees of proptosis in this relatively long period of time. In this study, four boys (12-15 years) were referred to our clinic with a provisional diagnosis of subperiosteal hematoma after blunt trauma no more than 10 days after initial trauma. Although in our patients, no one had compressive optic neuropathy, they underwent hematoma aspiration and nearly 7 ml dark blood was drained. All procedures were performed in an office-based setting without local anesthesia or sedation and the patients tolerated the procedure comfortably and the procedure was uneventful. When there is no indication for orbitotomy in cases of subperiosteal hematoma, early office-based needle aspiration in comparison to follow-up or administration of steroid, is a viable approach because of its feasibility, an office-based treatment that obviates the need for general anesthesia and yields immediate recovery.

Orbital floor fractures alone or in conjunction with other facial skeletal fractures are the most commonly encountered midfacial fractures. The technological advances in 3-dimensional (3D) printing allow the physical prototyping of 3D models, so creates an accurate representation of the patient's specific anatomy. A 56-year-old Caucasian man with severe hypoglobus and enophthalmos with an extensive blowout fracture was scheduled for reconstruction. First, 3D physical models were created based on the computed tomography scan datasets from patient. Then, this model was used as templates for preoperative trimming the implant. Surgical reconstruction with the aid of pre-shaped, customized prosthesis based on 3D anatomical model resulted in significant esthetic and clinical improvement. It is possible to build anatomical models on the basis of computed tomography scan datasets. It is relatively inexpensive and can be used in the repair of complex orbital floor fractures.

Purpose: To evaluate the histopathologic changes in the conjunctiva of patients with conjunctivochalasis (CCh) compared to age-matched controls. Methods: This cross-sectional, controlled study included 27 eyes of 27 patients with CCh and 16 eyes of 16 age-matched controls. A biopsy of the bulbar conjunctiva was performed along the temporal lower lid margin before cataract surgery in both groups. Histopathologic evaluation of the specimens was done with light microscopy using staining with hematoxylin/eosin, periodic acid Schiff, and van Gieson elastic stain. Various histopathologic features of the conjunctival epithelium and stroma were compared between the two groups. Results: The mean age of patients was 62.4 ± 6.9 years in the CCh group and 65.1 ± 6.3 years in the control group ( P = 0.54). No significant differences were noted between the two groups in terms of conjunctival epithelial changes including papillomatosis, epithelial clefts, epithelial goblet cells, or infiltration of inflammatory cells. Mean thickness of the conjunctival stroma was 0.21 ± 0.08 mm in the CCh group and 0.26 ± 0.21 mm in the control group ( P = 0.10). For the conjunctival stroma, there were no significant differences between the two groups in terms of elastosis, fibrosis, lymphangiectasia, or infiltration of inflammatory cells. Conclusion: No noticeable differences were found in the histopathologic features by light microscopy between eyes with CCh and those of age-matched controls. Therefore, the primary pathology of CCh may not be within the conjunctiva itself. Instead, loose attachment of the conjunctiva to the underlying tissue may be the reason for the redundant folds in the bulbar conjunctiva.

Multiple different procedures have been proposed to address complete sixth nerve palsy with severe abduction limitation. In this study, we report a modification of the Hummelsheim's procedure. It is in fact muscle pulley transposition that obviates the need for tenotomy or muscle splitting. For the first time, Muraki and Nishida proposed this technique.Patients with large angle esotropia and abduction limitation of minus four or greater were enrolled. The surgery involved insertion of a polyester monofilament fiber suture through the temporal muscular margin of each vertical rectus muscle at approximately one-third of the width from the edge at 10 mm behind the muscle insertion. We tried to insert sutures away from the vessels of vertical muscles. Then, the vertical muscles were transposed without any tenotomy or splitting and the sutures were secured to the sclera 16 mm from the limbus in supratemporal and infratemporal quadrants. In all of the patients, this transposition was combined with medial rectus recession.A total of 10 patients were included; all of them had an esotropia with profound abduction deficit (-4 or more). The mean age of patients was 44.2 ± 9.2 years (mean ± standard deviation) (range: 28-57). The mean preoperative deviation was 49.5 ± 9 PD prism diopters (PD) (range: 40-65 PD). The mean preoperative abduction limitation was -4.8 ± 0.8. The patients were followed for at least 6 months. Postoperative deviation ranged from orthotropia to 12 PD of esotropia and all the patients obtained abduction at least beyond the midline. No vertical ductional disturbances or deviations were developed. The adduction was not compromised in any patient. Anterior segment ischemia did not occur in any patients.This procedure is comparable to traditional procedures with the advantages of no need to tenotomy or splitting and can be a good alternative to conventional Hummelsheim's procedure.

Purpose: Acanthamoeba keratitis (AK) is a sight-threatening corneal infection with a rapidly increased incidence since 1990s along with the growing popularity of contact lenses. In this study we aimed to study patients with AK and its associated risk factors in Farabi Eye Hospital of Tehran, focusing on those with more severe corneal involvement. Methods: Patients with clinical or laboratory diagnosis of AK at the cornea clinic of Farabi Eye Hospital during April 2009 to March 2010 were studied regarding their demographics, and clinical characteristics, corneal infection risk factors, and suboptimal hygiene practices. Linear regression analysis was applied to determine factors affecting the stage of corneal involvement at presentation. Results: Twenty five patients (4 males and 21 females) with 27 involved eyes were identified during the one year study. Cosmetic contact lenses accounted for the most common potential risk factor of AK (85.2%). Most of the patients (92.6%) reported a history of antibacterial treatment before the presentation. Only four patients (16%) did not report any suboptimal hygiene practice. In the linear regression model only the first visual acuity (VA) at presentation, and the duration of symptoms were independently associated with the stage of disease. Conclusion: The high number of patients presented with AK in our study suggests a possible outbreak of the disease in Tehran, which is highly associated with cosmetic contact lenses.

Duane's retraction syndrome (DRS) is characterized by limitations in horizontal eye movements, globe retraction, and palpebral fissure narrowing on attempted adduction. This disorder is caused by a disturbance in innervation originating in the brain stem and represents

AIM: To evaluate demographic variables and visual outcomes, among patients with ocular injuries involving the posterior segment, managed with pars plana vitrectomy. METHODS: The records of patients were studied retrospectively from March to September 2010, to determine the age, gender, place of occurrence of trauma, visual acuity, anatomical site, nature of injury, wound length, the presence of an afferent pupillary defect, and the timing of vitrectomy. The Ocular Trauma Score was measured. The minimum follow-up from presentation was 6mo. RESULTS: Ninety patients (77 males, 13 females), with a mean age of 32.7±15.8y were included over the 6-month period. The majority of cases occurred in the workplace (47 patients), followed by home (14 patients). The mean visual acuity (logMAR) of patients significantly improved from 2.36±0.72 preoperatively to 1.50±1.14 postoperatively. Twenty-three patients had preoperative vision better than 2.0 logMAR, the postoperative visual acuity was significantly better among these patients than patients with worse than 2.0 logMAR (P7d) was not significantly different (P=0.66). Postoperative visual acuity was not significantly different between patients with injury in Zone I and II (P=0.64), but patients with injury in Zone III had significantly poorer visual acuity (P=0.02). Patients with relative afferent pupillary defect had significantly poorer postoperative visual acuity (P=0.02). Preoperative visual acuity, the difference of preoperative and postoperative visual acuity, and postoperative visual acuity were significantly different between groups with different ocular trauma scores (P

Purpose To investigate the accuracy of echography with a 20-MHz probe for evaluation of posterior lens capsule in traumatic cataract before surgery. Design Prospective interventional case series. Methods This study consisted of 43 eyes with traumatic cataract that were scheduled to undergo surgery. In all cases, cataract was dense enough to prevent visualization of the posterior lens capsule. Echography was performed using a 20-MHz probe to detect rupture of the posterior lens capsule. All patients subsequently underwent cataract extraction and intraoperative findings of the posterior lens capsule were compared with the preoperative echographic findings. Results This study included 43 eyes of 43 patients (38 men and 5 women) with a mean age of 35.6 ± 15.3 years (range, 4-68 years). The trauma was either blunt (4 eyes) or sharp (39 eyes); there was closed globe injury in 2 eyes and open globe injury in 41 eyes. By 20-MHz echography, posterior border of the crsytalline lens was clearly visualized in all 43 eyes. By 20-MHz echographic imaging, rupture of the posterior lens capsule was identified in 17 eyes (39.5%). During cataract surgery, it was noted that 14 eyes (32.6%) had rupture of the posterior lens capsule. Sensitivity, specificity, positive predictive value, and negative predictive value were 93%, 86%, 76%, and 96%, respectively, for 20-MHz echography to detect rupture of the posterior lens capsule. Also, the positive likelihood ratio, negative likelihood ratio, and odds ratio were 6.7, 0.08, and 81, respectively. Conclusion Echography with 20-MHz probe is an accurate imaging modality for detection of posterior lens capsule rupture in traumatic cataract preoperatively. This technique helps ophthalmologists have an appropriate surgical plan before operating.

1. Lee SH, Chang JH. Medial rectus muscle anchoring in complete oculomotor nerve palsy. J AAPOS 2015;19:465–8. 2. Ahmed R, Coats DK, Yen MT. Periosteal flap fixation of the globe for surgical treatment of severe restrictive strabismus: a report of eight cases with outcomes. Binocul Vis Strabolog Q 2011;26:230–5. 3. TseDT, Shriver EM,Krantz KB, Tse JD, CapoH,MckeownCA. The use of titanium T-plate as platform for globe alignment in severe paralytic and restrictive strabismus. Am J Ophthalmol 2010;150:404–11.

Purpose To evaluate changes in corneal endothelial cell counts after pterygium surgery with application of mitomycin C (MMC) either on the perilimbal sclera or in the subconjunctival space. Design Prospective, randomized interventional study. Methods Fifty-six eyes of 56 patients with primary pterygium underwent excision followed by removal of subconjunctival fibrovascular tissue, 0.02% MMC application, and amniotic membrane transplantation. These were stratified randomly into 2 groups. In 1 group (n = 28), MMC was applied on the perilimbal bare sclera (sclera group), and in other group (n = 28), MMC was applied under conjunctiva, where subconjunctival fibrovascular tissue was removed (subconjunctiva group). Based on severity of pterygium fleshiness, MMC was used for 1, 3, or 5 minutes in 8, 13, and 7 eyes, respectively, in the sclera group and in 9, 13, and 6 eyes, respectively, in the subconjunctiva group. Central corneal endothelial cell counts were evaluated before and during 6 months of follow-up after surgery. Results Mean preoperative endothelial cell count was 2810 ± 278 cells/mm 2 in the sclera group and 2857 ± 332 cells/mm 2 in the subconjunctiva group. Mean endothelial cell losses in sclera and subconjunctiva groups were 9.7% and 9.0% at 1 week, 6.5% and 6.5% at 1 month, 4.0% and 5.0% at 3 months, and 3.4% and 4.8% at 6 months, respectively, with no statistically significant difference between the 2 groups. Longer durations of MMC application were associated with significantly greater endothelial losses in both groups. Conclusions Regardless of application location, MMC use during pterygium surgery can cause a significant decrease in central endothelial cell count.

PURPOSE: To evaluate the efficacy of intralesional bevacizumab injection in decreasing size of pterygium. METHODS: Seventeen patients with pterygium (14 with primary and 3 with recurrent pterygium) received intralesional injections of bevacizumab (2.5 mg/0.1 mL). Digital photographs were analyzed by image analysis software to determine the change of corneal involvement as a percentage of the total corneal surface. RESULTS: The mean age of the patients was 45.5 ± 15.8 years. The mean percentage size of lesions before injection was 17.2% ± 4.3% of corneal surface. The mean percentage size of lesions 1 week, 1 month, and 3 months after injection was 15.1% ± 4.3%, 13.4% ± 4.0%, and 14.1% ± 4.4% of corneal surface, respectively. The mean percentage decrease of lesion size was 3.97% ± 3.84%. There were statistically significant differences between percentage of lesion size before and 1 week (P < 0.001), 1 month (P < 0.001), and 3 months (P < 0.001) after injection of bevacizumab. There were neither postinjection ocular complications such as rise of intraocular pressure nor systemic adverse events. Visual acuity did not change after injection of bevacizumab. Despite statistically significant decrease in pterygium size, this decrease does not seem to be clinically significant. CONCLUSIONS: Intralesional bevacizumab injection is fairly effective in reducing the size of pterygium and is well tolerated; however, this effect is not clinically significant.

Introduction Progressive night blindness and constriction of the visual fields are features of Bietti crystalline corneoretinal dystrophy, but here we report a case with the most probable diagnosis of Bietti crystalline dystrophy and good central visual acuity and severely decreased electroretinogram. Case presentation The patient was a 28-year-old woman with complaint of decreased vision without night blindness. Her both eyes visual acuity were 20/25 with plano refraction. Fundus examination showed intraretinal crystals distributed in the posterior pole and also midperiphery. Fullfield electroretinogram showed decreased scotopic a and b-wave amplitudes. Conclusion In our patient central foveal region was relatively intact; and this can explain subnormal visual acuity. Although visual acuity was nearly spared, electroretinogram was extremely affected.

Ineffective esophageal motility (IEM) is a frequent finding in patients with gastroesophageal reflux disease (GERD). It is responsible for delayed acid clearance as it affects esophageal emptying and saliva transport. Since erosive GERD is a more severe disease than nonerosive GERD, it may be associated with IEM, which delays esophageal clearance. Objective : We investigated the role of IEM in patients with erosive and nonerosive GERD.We enrolled 100 patients with heartburn and a primary diagnosis of GERD referred to the GI motility department of RCGLD of Shahid Beheshti University between January 2002 and January 2005. Based on endoscopic findings, the patients were classified into two groups of erosive GERD and nonerosive GERD. Manometry and 24-hour ambulatory pH-metry was performed in all patients.Seventy-seven patients completed the study: 31 (40.3%) with erosive GERD and 46 (59.7%) with nonerosive GERD. IEM was present in 38.7% of patients with erosive GERD and in 28.3% of those with nonerosive GERD (p=0.18). A low lower esophageal sphincter pressure was present in 45.2% of patients with erosive GERD, and in 45.7% of those with nonerosive GERD (p=0.97). Abnormal acid reflux was present in 32.3% and 41.3% of patients with erosive and nonerosive GERD, respectively (p=0.42).There was no difference in the prevalence of IEM between patients with erosive and nonerosive GERD. IEM could be an integral part of GERD and may not always be associated with mucosal injury.

Anterior megalophthalmos, a rare hereditary disorder, is macrocornea (horizontal corneal diameter more than 13 mm) in association with enlarged lens-iris diaphragm and ciliary ring. One of the major challenging issues in the cataract surgery of these patients is preventing intraocular lens (IOL) malposition, because of probable large capsular bag. Several approaches have been selected by previous surgeons, such as, custom-made anterior chamber IOLs. In this study, we show a normal capsular bag diameter despite ciliary ring enlargement, with application of ultrasound biomicroscopy (UMB). We suggest that in cases of anterior megalophthalmos without phacodonesis, UBM could measure the actual size of the capsular bag and obviate the need for further procedures.

A 27-year-old woman was referred by the neurologist for ophthalmic examination. She had a history of headache, visual loss in her right eye, four-limb paresthesia, and behavioral changes over the previous 10 months. The patient complained of tinnitus and hearing loss for two weeks. The patient was initially diagnosed with multiple sclerosis, but auditory and retinal involvement (small branch retinal artery occlusion in fluorescein angiography) raised the possibility of Susac's syndrome.