A 25-year-old woman presented with acute bilateral blurred vision and history of headache, dizziness, and syncope for three days. Her visual acuity was 20/60 in both eyes. Fundoscopy revealed multiple bilateral peripapillary yellow-white patches like cotton wool spots, intraretinal hemorrhages and macular edema. The patient was diagnosed with Purtscher-like retinopathy based on the retinal findings and lack of trauma history. She was urgently admitted to the nephrology clinic due to thrombotic microangiopathy findings (hemoglobinemia, thrombocytopenia, and acute renal failure). After excluding thrombotic microangiopathy, the patient was diagnosed with atypical hemolytic uremic syndrome (aHUS) with the clinical and laboratory findings. Eculizumab treatment was added to hemodialysis and plasmapheresis therapy. Three months after starting treatment, retinal lesions regressed and visual acuity increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of Purtscher-like retinopathy associated with aHUS.

Objective: To compare clinical outcomes of cataract surgeries with 2.4 mm and 2.8 mm clear corneal incisions. Materials and Methods: This retrospective study comprised 2 groups of cataract surgery cases with different wound lenghts of group 1; 2.4 mm and group 2; 2.8 mm. We evaluated 80 eyes of 72 patients with 3-month follow-ups. Procedures carried out using the temporal self-sealing incision technique. Measured intraoperative parameters included phacoemulsification time, mean cumulative dissipated ultrasound energy and total volume of balanced salt solution used. Keratometric data, specular microscopy and macular thickness were measured preoperatively, and postoperative 1 and 3 months. Vector analysis calculated the surgically induced astigmatism. SPSS 15.0 were used for statistical analysis. Results: There were no significant differences in intraoperative ultrasound energy, total phacoemulsification time and volume of balanced salt solution analyzed between two groups (p>0.05). There were no statistically significant difference between two groups in macular thickness alteration and endothelial cell loss (ECL) (p>0.05). The mean surgically induced astigmatism was significantly less in group 1 in each visit (p<0.05). Conclusion: Phacoemulsification surgery through a 2.4 mm incision size appeared to be safe and less surgically induced astigmatism.

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Précis: Decreased circumpapillary vascular density (cpVD) and average retinal nerve fiber layer (RNFL) thickness were detected at different locations in eyes with preperimetric glaucoma (PPG). Although RNFL loss was more prominent in preperimetric eyes, in early glaucoma, both cpVD and RNFL thickness showed comparable diagnostic ability.Purpose: To evaluate changes in circumpapillary and macular vascular density and investigate correlations between vascular and structural parameters in PPG and early glaucoma.Method: This cross-sectional study included a total of 27 patients with PPG in 1 eye and early primary open angle glaucoma in the fellow eye, as well as a control group consisting of 27 eyes of 27 healthy volunteers. All subjects underwent optical coherence tomography angiography (OCTA) imaging. RNFL and macular ganglion cell complex measurements were obtained simultaneously with vascular parameters by AngioVue OCTA using the single-scan protocol. cpVD was examined in 8 sectors. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve.Results: In preperimetric eyes, average RNFL thickness and wholeimage vessel density had comparable diagnostic performance (area under the receiver operating characteristic curve = 0.853 and 0.753, respectively). Compared with the control group, PPG eyes had significantly lower RNFL thickness in all quadrants (P < 0.001-0.003) except for the temporal quadrant, whereas cpVD differed only in the nasal inferior and nasal superior sectors (P = 0.001 and 0.041, respectively). In early glaucoma eyes, cpVD differed significantly from controls in all sectors except for the inferotemporal, temporal inferior, and temporal superior sectors, whereas perifoveal macular vascular parameters differed in all quadrants (all P < 0.05). cpVD was strongly correlated with RNFL thickness in the superior, nasal, and temporal quadrants (r = 0.664, 0.698, and 0.649, respectively, P < 0.001) and moderately correlated in the inferior quadrant (r = 0.450, P < 0.001). Conclusion:Although RNFL involvement is valuable in the diagnosis and follow-up of PPG, the change in nasal cpVD has an important place in these patients. The role of macular vascular parameters and macular ganglion cell complex in glaucoma follow-up becomes important in early glaucoma. Longitudinal studies are needed to determine the place of OCTA in the diagnosis and follow-up of glaucoma.

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A 12-year-old girl was referred to our clinic because of unilateral conjunctivitis not responding to treatment. In the left eye, lower bulbar and tarsal conjunctiva had a polypoidal appearance due to micronodules and there was a subconjunctival nodular mass in the inferior fornix. Systemic examination was unremarkable except for a left preauricular lymphadenopathy. Excision biopsy of the subconjunctival mass revealed a granulomatous inflammation with caseation necrosis, but acid-fast bacilli (AFB) was negative. Fine needle-aspiration biopsy of the preauricular lymph node was performed. In microbiological examination, both AFB and mycobacterial culture were positive. The isolated mycobacteria strains were identified as Mycobacterium tuberculosis complex and full remission was achieved with 6 months of anti-tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological and histopathological examinations should be performed both in conjunctiva and regional lymph node.

Purpose: To present ocular findings and anterior segment–optical coherence tomography (AS-OCT) imaging findings of 2 cases of fish-eye disease (FED) involving 2 novel genetic variants of the lecithin–cholesterol acyltransferase (LCAT) gene. Methods: A case report. Results: A 46-year-old woman and 63-year-old man presented with blurred vision, burning sensation, and whitening of both eyes for 2 and 3 years, respectively. Ophthalmologic examination revealed slightly decreased visual acuity, yellowish-white diffuse corneal opacities causing corneal clouding, and dry eye disease bilaterally in both patients. AS-OCT imaging demonstrated diffuse hyperreflective corneal opacities predominantly located in the anterior stroma. On systemic examination, both patients had very low plasma high-density lipoprotein cholesterol levels. However, they did not have any systemic associations with familial LCAT deficiency or Tangier disease, which are differential diagnoses for corneal clouding and low plasma high-density lipoprotein cholesterol. Both patients were diagnosed with FED based on clinical findings. Furthermore, genetic analysis, in which novel variants of c.86A>G (p.Asn29Ser) in the first exon and c.1052A>G (p.Tyr351Cys) in the sixth exon on the LCAT gene were detected, confirmed the diagnosis. Conclusions: Although it is a rare genetic disorder, FED should be considered in the differential diagnosis of corneal clouding. Corneal lipid deposits, visible on AS-OCT are suggestive of FED, and genetic analysis can be used to confirm the clinical diagnosis. Finally, there may be a relationship between dry eye disease and LCAT enzyme deficiency disorders, which should be investigated in further studies.

Persistent corneal epithelial defects (PED) can lead to potentially destructive results. In longer lasting defects, stromal melting starts and perforation may develop. Therefore, epithelial defects should be aggressively treated. In recent years, regenerating agent (RGTA) based matrix therapy has been presented as a new therapeutic approach for the treatment of PED and neurotrophic ulcers. We report the successful application of RGTA (Cacicol20, Paris, France) for the post -keratoplasty PED resistant to 4 weeks of conventional therapy including 30% autologous serum and lastly temporary tarsorrhaphy. Cacicol20 was applied once every other day. The PED started to shrink in a week and healed completely in 4 weeks. No side effect was observed. RGTA seems to be an effective therapeutic agent for PED resistant to conventional therapy. However; randomized clinical trials are needed to be able to better assess the effectiveness and the safety of the treatment.