Purpose. To assess intraocular pressure (IOP), lens vaulting, and anterior chamber (AC) angle width, following V4C implantable Collamer lens (ICL) procedure for myopic refractive error. Methods. A prospective case series that enrolled 54 eyes of 27 patients that were evaluated before and after V4C phakic posterior chamber Collamer lens implantation for correction of myopic refractive error. Preoperative measurement of IOP was done using Goldmann applanation tonometer and anterior chamber angle width using both Van Herick slit lamp grading system and Scheimpflug tomography imaging (Oculus Pentacam). Follow-up of the aforementioned variables was at 1, 6, and 18 months postoperatively, together with ICL vault measurements. Results. The mean baseline IOP of 11.69 ± 2.15 showed a statistically significant (P = 0.002) increase after 1 month that remained unchanged at 6 and 18 months postoperatively, with mean value of 16.07 ± 4.12, 16.07 ± 4.10, and 16.07 ± 4.13, respectively. Pentacam AC angle width showed a statistically significant decrease at 1 (P = 0.025), 6 (P = 0.016), and 18 (P = 0.010) months postoperatively, with mean preoperative value of 40.14 ± 5.49 that decreased to 25.28 ± 5.33, 25.46 ± 5.44, and 25.49 ± 5.38, at 1, 6, and 18 months, respectively. Mean ICL vault showed moderate correlation with Pentacam AC angle width at 1 (r = −0.435) and 6 (r = −0.424) months. Conclusion. V4C ICL implantation resulted in decrease in AC angle width and increase in IOP, within acceptable physiological values at all time points.

Purpose A distinct pattern of granulomatous anterior uveitis, with white anterior chamber (AC) granuloma, has been reported in certain endemic areas. The aim of this work was to compare the outcome of conservative treatment to surgical intervention for the treatment of large AC granulomas presenting with moderate–severe anterior uveitis. The secondary outcome is ultrasound biomicroscopy (UBM) characterization of AC granulomas. Methods This is a prospective randomized interventional study including 41 eyes of 39 patients with active AC granuloma ≥3 mm (flare & cells ≥ +2). Patients were randomly assigned to either conservative treatment in the form of topical prednisolone and cycloplegic drops with orbital floor (transseptal) injection of Triamcinolone acetonide (20 eyes) or surgery in the form of granuloma excision and AC wash (21 eyes). As a perioperative care, topical steroids and cycloplegic drops were given few days before surgery and tapered gradually over 6 weeks. Patients were followed up at first day, 2 weeks, 1 and 3 months. Results Thirty‐seven patients were males, and 2 were females (13.0 ± 3.5 years). After 2 weeks, disappearance/healing of granuloma was achieved in 20 eyes in the surgical group versus 2 eyes in the conservative group (p < 0.0001). This effect was maintained throughout the follow‐up period, for the surgical group and reached up to 70%, for the medical group. At every follow‐up, BCVA was better in the surgical group, but this was only statistically significant at 1 and 3 months. The granuloma appeared as a homogenous hyperreflective lesion in examined eyes (16 eyes of 15 patients). Conclusion Surgical treatment of large granulomas leads to a more complete and rapid resolution of inflammation.

BackgroundThe purpose of this study was to evaluate subthreshold diode-laser micropulse (SDM) photocoagulation as a primary and secondary line of treatment for clinically significant diabetic macular edema (CSDME).MethodsIn this prospective nonrandomized case series, 220 cases of nonischemic CSDME were managed primarily and secondarily by SDM photocoagulation on a 15% duty cycle with a mean power of 828 mW and a spot size of 75–125 μm. SDM treatment was repeated at 3–4-month intervals if residual leakage was observed. Additional intravitreal pharmacologic therapy was used according to the response. Follow-up varied from 12 to 19 (mean 14±2.8) months. Novel software designed by the authors was used to record the subvisible threshold laser applications and their parameters on the fundus image of the eye. Evaluation of the results of treatment was done using fluorescein angiography and optical coherence tomography (OCT). Primary outcome measures included changes in visual acuity and foveal thickness at OCT. Secondary outcome measures included visual loss of one or more Snellen lines and laser scars detectable on fundus biomicroscopy or fluorescein angiography.ResultsIn the primary treatment group, there was significant improvement or stabilization of visual acuity after the first 3–4 months, which was stable thereafter. Visual acuity was stable in the secondary treatment group. A corresponding reduction of macular thickness on OCT was noted during the follow-up period in both groups. Additional therapy included repeat SDM photocoagulation, intravitreal injection of triamcinolone, and pars plana vitrectomy. Laser marks seen as changes in retinal pigment epithelium on fundus biomicroscopy and fluorescein angiography were noted in 3.3% and 5.7% of cases. Our novel software could accurately record the location of all SDM-invisible applications.ConclusionMicropulse laser is an effective minimal intensity therapy that offers the clear advantage of minimizing or avoiding laser-induced visible retinal burn/scarring while reducing the foveal thickness in the management of selected cases of CSDME. Future prospective studies should include the use of SDM photocoagulation as a combined minimally invasive therapy to consolidate the prompt but temporary effects of anti-vascular endothelial growth factor or anti-inflammatory agents. Virtual localization of SDM-invisible applications using our proprietary software could be used to guide further retreatments.

Background Hydroxychloroquine is a widely used medication for various clinical conditions mainly rheumatological and dermatological autoimmune diseases e.g. systemic lupus erythematosus, rheumatoid arthritis and psoriasis. While it is considered a safe medication, it is well-established that it can cause retinal toxicity i.e. HCQ maculopathy. Guidelines for HCQ retinal toxicity screening include factors like body weight, daily dose, duration, systemic diseases and retinal diseases. In this case study, we report a specific association between CRAO as a retinal disease and early onset HCQ maculopathy in a SLE patient. Case presentation A 42-year-old Caucasian female SLE patient presented with a complaint of gradual progressive painless diminution of vision in the left eye that started 16 months earlier. Clinical evaluation of the patient revealed a history of sudden profound painless diminution of vision in the same eye 18 months earlier after which the patient experienced only partial improvement of vision. That episode of sudden diminution of vision was attributed to left CRAO, complicating SLE-related thrombophilia, confirmed by fundus fluorescein angiography. Based on that diagnosis, the patient had been prescribed HCQ. At the time of presentation, fundus examination revealed left bull's eye maculopathy and right normal fundus. Therefore, a diagnosis of HCQ maculopathy in the left eye was made after exclusion of other causes of unilateral bull's eye maculopathy. Conclusion Our case study is the first to report an association between CRAO as a specific retinal disease and early onset of HCQ maculopathy in a SLE patient. The unilateral bull's eye presentation which occurred in the eye with CRAO after only 16 months of HCQ treatment highly suggests that CRAO is probably the cause of such unusually early maculopathy. This case report highlights the importance of retinal diseases as risk factors for HCQ maculopathy. It also points out the lack of specific evidence concerning the association between specific retinal diseases and HCQ maculopathy.

Purpose The purpose of this study was to correlate between the axial length of the globe and the insertion site of horizontal extraocular muscles using swept-source anterior segment optical coherence tomography (SS-ASOCT), with posing an equation to calculate the muscle insertion site from the axial length. Methods The study design was observational and cross-sectional. It was performed on 157 eyes of 157 healthy subjects. The distance of the medial rectus (MR) and the lateral rectus (LR) insertion sites from the limbus were measured using SS-ASOCT. The insertion sites’ distances were correlated to the axial length (hypermetropes < 22.5 mm, myopes > 24.5). Correlation between numerical variables was done by Pearson’s correlation coefficient and confirmed by linear regression analysis and scatter diagrams. Results The mean MR insertion site was 5.47 ± 0.19 mm in hypermetropes versus 5.68 ± 0.23 mm in myopes, whereas the mean LR insertion site was 6.81± 0.23 mm in hyperopes versus 7.08 ± 0.16 mm in myopes. The axial length showed a moderate positive, but significant, correlation to the insertional position for the medial and lateral rectus muscles (MR: r =0.417, p<0.001; LR: r =0.410, p<0.001). Conclusion Comparing the horizontal extraocular muscle insertion site to axial length using SS-ASOCT showed a significant positive correlation. The model equation for MR insertion: MR (mm) = 4.522 + 0.045 (AXL in mm) with an R = 0.437, R 2 = 0.191, F=12.071, P<0.001. The model equation for LR insertion: LR (mm) = 5.72 + 0.048 (AXL in mm) with an R = 0.438, R 2 = 0.192, F=12.116, P<0.001.