To the Editor, Coronavirus disease 2019 (COVID-19) is a novel worldwide pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Children and adolescents generally present with mild symptoms. Nevertheless, 0.14% of them can develop a lifethreatening complication, the multisystem inflammatory syndrome in children (MIS-C). 1 This rare but serious condition can lead to multiorgan failure. To date, ocular reports associated with MIS-C are scarce. We report a case of bilateral intermediate uveitis in a healthy teenager with MIS-C secondary to COVID-19 infection.A 14-year-old male, the healthy adolescent was admitted for high-grade fever, vomiting, and rash for 3 days. Initial nasopharyngeal swab for COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) was positive and dengue serology was negative.On Day 3 of admission, his condition deteriorated with presumed septic shock, myocarditis with pericardial effusion, pleural effusion, and transaminitis. His lowest blood pressure was 87/48 mmHg with a heart rate of 147 bpm and the highest temperature was 40.4°C. He was transferred to the intensive care unit and a comprehensive workup was performed. Notable markedly elevated laboratory investigations were inflammatory markers like C-reactive protein of 10.83 mg/dl and procalcitonin of 16.14 ng/ml. Other elevated levels include D-dimer level (10.13 µg/ml), ferritin (916.23 µg/L), troponin (176 µg/L), and lactate dehydrogenase (336 µ/L). Infective screenings like blood, urine, and stool cultures were negative. Computed tomography angiogram of the thorax showed minimal pericardial effusion and bilateral pleural effusion with no evidence of coronary artery aneurysm or pulmonary thrombosis. The diagnosis was revised to MIS-C secondary to COVID-19 infection. He required inotrope support for 3 days and received two doses of intravenous immunoglobulin 1 g/kg; subcutaneous enoxaparin 40 mg od for 7 days and intravenous dexamethasone 0.2 mg/kg for 5 days followed by oral dexamethasone tapered within a month. Intravenous ceftriaxone 1 g bd for 7 days and intravenous azithromycin 250 mg od for 5 days were given as prophylaxis.
Ocular pyogenic granuloma is a benign tumor seen after ocular insult secondary to ocular surgeries, trauma or infection. Although benign, intervention is sometimes necessary. Previous authors have reported pyogenic granuloma formation following oculoplastic surgeries. We report a pyogenic granuloma after an Ahmed glaucoma valve implantation. A 65-year-old gentleman presented with right eye redness associated with pain and swelling ~2 months after Ahmed glaucoma valve implantation. Examination found a sessile growth on the tube extruding puss with signs of endophthalmitis. The glaucoma drainage device was explanted and culture results grew Staphylococcus aureus. This article discusses the formation of pyogenic granuloma on a glaucoma drainage device and its management.
Retinitis pigmentosa is one of the risk factors for intraocular lens dislocation post cataract surgery which can lead to many complications. A 64-year-old Chinese female with bilateral pseudophakia and retinitis pigmentosa was referred for the continuation of care in 2009 with baseline visual acuity of hand movement bilaterally due to the retinitis pigmentosa. The cataract surgeries with posterior chamber intraocular lens (PCIOL) implantation in her early 50s were uneventful.In 2011, her right eye PCIOL dislocated anteriorly into the anterior chamber spontaneously and touched the cornea. It was complicated with bullous keratopathy and corneal decompensation. Intraocular pressure (IOP) was normal. PCIOL explantation, anterior vitrectomy and surgical peripheral iridotomy were performed. However, the cornea remained decompensated postoperatively.Her left eye was stable until 2019 when she developed acute angle closure secondary to complete anterior dislocation of PCIOL with pupillary block glaucoma. She underwent left eye PCIOL explantation, anterior vitrectomy and surgical peripheral iridotomy when IOP was optimised medically. Finally, both eyes were left aphakic due to poor prognosis with light perception (PL) vision, IOP was stable on single topical antiglaucoma and bilateral decompensated corneas were maintained with topical hypertonic saline. This case highlights the different serious sequelae of bilateral eyes in an unfortunate retinitis pigmentosa patient.
Background: To evaluate the satisfaction of surgeons and trainees with three-dimensional (3D) ophthalmic surgery during a demonstration compared to traditional surgery Methods: This validated questionnaire-based study was conducted over 1-month during which Ngenuity 3D surgery was demonstrated. All surgeons and trainees exposed were recruited to complete a questionnaire comprising visualization, physical, ease of use, teaching and learning, and overall satisfaction. Results: All 7 surgeons and 33 postgraduate students responded. Surgeons reported no significant difference except overall (P = 0.047, paired t-test). Postgraduate trainees reported significantly better experience with 3D for illumination (P = 0.008), manoeuvrability (P = 0.01), glare (P = 0.037), eye strain (P = 0.008), neck and upper back strain (P = 0.000), lower back pain (P = 0.019), communication (P = 0.002), comfortable environment (P = 0.001), sharing of knowledge (P = 0.000), and overall (P = 0.009). Conclusions: During early experience, surgeons and trainees reported better satisfaction with 3D overall. Trainees had better satisfaction with 3D in various subcomponents of visualization, physical, ease of use, and education.
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