Unusual Ocular Complications of the HELLP Syndrome: Persistent Macular Elevation and Localized Tractional Retinal Detachment

We report a case of HELLP syndrome with bilateral decreased vision at 25 weeks’ gestation. Fundus examination revealed serous retinal detachment involving the macula. Systemic steroid and oral dorzolamide therapy was initiated and visual acuity improved. At 2 months, peripheral localized tractional retinal detachment was present in the left eye and argon laser photocoagulation was performed. Macular elevation did not resolve; therefore, in the right eye intravitreal triamcinolone acetonide injection was performed. Drs. Taskapili, Kocabora, and Gulkilik are from the Eye Clinic, Vakıf Gureba Training and Research Hospital, Istanbul, Turkey. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Combination of photodynamic therapy, intravitreal triamcinolone injection, and standard laser photocoagulation in radiation retinopathy

We report the combination of various therapy options in a 58-year-old man diagnosed with bilateral radiation retinopathy and left radiation optic neuropathy. Four mg/0.1 mL triamcinolone acetonide was injected intravitreally in both eyes followed by bilateral photodynamic treatment 2 weeks after. Bilateral, panretinal photocoagulation and right focal laser treatment for residual macular edema were performed 2 months later. At 18 months, visual acuity is 20/200 in the right eye and hand motions in the left eye with no signs of active retinopathy. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Effect of pterygium excision by limbal conjunctival auotografting on tear function tests

We investigated the effects of pterygium excision using the limbal conjunctival autografting technique on the tear function tests in 14 eyes of 13 patients. Since no difference was found in the Schirmer and tear break-up time tests at one and six months postoperative vs preoperative pterygium excision does not affect tear function test results during short-term follow up. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

Conjunctival–Limbal Autograft,Amniotic Membrane Transplantation,and Intraoperative Mitomycin C for Primary Pterygium

We evaluated and compared the safety and efficacy of the conjunctival–limbal autograft, amniotic membrane transplantation, and intraoperative application of mitomycin C in 94 patients undergoing primary pterygium surgery and concluded that conjunctival–limbal autografting and amniotic membrane methods were more effective and safer than intraoperative mitomycin C. Dr. Keklickci is an Assistant Professor of Ophthalmology, Dr. Cakmak is an Associate Professor of Ophthalmology, and Dr. Unlu is a Professor of Ophthalmology in the Department of Ophthalmology at Dicle University Faculty of Medicine, Diyarbakir, Turkey. Dr. Celik is a Professor of Biostatistics, Department of Biostatistics, Dicle University Faculty of Medicine, Diyarbakir, Turkey. Dr. Bilek is an Ophthalmologist, Department of Ophtalmology, Reel Medical Center, Diyarbakir, Turkey. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. Based on lower complication rate, the authors concluded that conjunctival–limbal autografting and amniotic membrane methods were more effective and safer than intraoperative mitomycin C.     

Bilateral combined cilioretinal artery and central retinal vein occlusion

A rare case with bilateral combined cilioretinal artery and central retinal vein occlusion (CRVO) is reported in a 45-year-old man. Work-up was positive only for already-present type 2 diabetes. The patient first developed ischemic-type CRVO and cilioretinal artery occlusion in his right eye, and underwent successful trabeculectomy with mitomycin-C following panretinal and grid macular photocoagulation. The fellow eye developed a nonischemic type of CRVO and cilioretinal artery occlusion 4 years after the first episode with good visual outcome. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Pseudophakic glaucoma and vision loss after clear lens extraction for high myopia

A myopic 44-year-old man was treated with bilateral clear lens extraction and posterior chamber intraocular lens implantation. A year later, the patient noted decreased vision in the right eye and was diagnosed with chronic open-angle glaucoma in both eyes. Despite medical and surgical treatment, the patient became legally blind. Pseudophakic glaucoma is a potential cause of vision loss after clear lens extraction. The authors have stated that theydo not have a significant finanical interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Chest Radiographs in Uveitis Patients

This is an article regarding a patient presented with bilateral uveitis who was subsequently found to have lung carcinoma on further investigations. We recommend doing a CXR especially in uveitis patients who have a history of smoking. Dr. Yap YC, Sharma, Raja, and Kodati are with the Department of Ophthalmology, at Watford General Hospital, Watford, Herts, United Kingdom. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. The authors present a case of bilateral uveitis in whom a chest radiograph was suggestive of a lung carcinoma and fine needle aspiration biopsy showed squamous cell carcinoma. They recommend chest radiography in uveitis patients with a history of smoking.     

Fish-hook injury of the eyelid

A 20-year-old man had a fish-hook injury of the right upper eyelid. The hook was advanced into the subcutaneous tissue in a forward direction and was extracted from the second exit wound of the lid without cutting. We believe that the advance-without-cut method may be useful to remove fish hooks embedded in the superficial eyelid. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Adjunctive treatment with interferon alpha-2b may decrease the risk of papilloma-associated conjunctival intraepithelial neoplasm recurrence

PURPOSE: To report a case of bilateral papilloma virus-positive conjunctival intraepithelial neoplasm and the treatment results of using adjunctive interferon alpha-2b. METHODS: Case report and literature review. RESULTS: A 73-year-old man underwent subtotal excisional biopsy of the 270-degree gelatinous limbal lesion of the right eye to avoid creating a limbal deficiency and cicatricial change. Total excisional biopsy of the temporal elevated leukoplakic limbal lesion was performed on his left eye. Histology examination showed bilateral intraepithelial neoplasia, and human papilloma virus-16 and -18 were detected by polymerase chain reaction in both lesions. Two supplemental perilesional injections of interferon alpha-2b in the right eye were given, and the residual mass decreased in size gradually and completed clinical resolution 7 weeks following initial surgery. Although no recurrence was noticed in the right eye, recurrence of the conjunctival intraepithelial neoplasm lesion was noticed in the left eye. CONCLUSION: Adjunctive therapy might lower CIN recurrence rate, especially in extensive lesions, when surgical excision cannot ensure a tumor-free margin. Our bilateral case provided a good control example for the recurrence with or without adjunctive therapy.     

Unilateral optic disc edema in a patient with acute lymphocytic leukemia

A young male complained of acute left-eye visual loss. The right eye was normal. Only hand motions were seen with the left. The dilated fundus showed mild optic disk elevation, blurred margins, tortuous vessels, retinal vascular sheathing, and flame-shaped hemorrhages. Laboratory exam revealed acute lymphocytic leukemia. Following chemotherapy and radiotherapy, disk swelling and retinal changes resolved and visual acuity improved. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Phakomatous Choristoma of the Lower Eyelid: A Case Study with a Review of the Literature

We report a case of phakomatous choristoma of the lower eyelid. A 2-week-old girl was referred with a tumor of the right lower eyelid near the inner canthus, present since birth. No other abnormalities were noted. The tumor was excised, and histopathologic examination of the tumor showed phakomatous choristoma of the eyelid. This is the first report of phakomatous choristoma of the eyelid in Turkey. Dr. Keklikci is an Assistant Professor of Ophthalmology and Dr. Cakmak is an Associate Professor of Ophthalmology, and Dr. Soker is an Assistant Professor of Histology and Embryology, Dicle University Faculty of Medicine, Diyarbakir, Turkey. Dr. Cakmak is an Assistant Professor of Pediatrics, Department of Pediatrics, Harran University Faculty of Medicine, Sanlıurfa, Turkey. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. The authors report an extremely rare case of phakomatous choristoma of the lower eyelid in a 2-week-old infant.     

Amniotic membrane grafting for a conjunctival defect caused by multiple surgeries

A 74-year-old woman suffered a macular hole retinal detachment in the right eye. Though the retina was finally attached after multiple surgeries, the conjunctiva was defected and coverage of the sclera was difficult. Amniotic membrane grafting was undertaken at the end of the third vitrectomy, resulted in a rapid epithelialization. This case illustrates how amniotic membrane transplantation facilitates epithelialization after multiple vitrectomies. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Necrotizing scleritis after intraocular surgery associated with the use of polyester nonabsorbable sutures

We present 2 elderly patients who developed necrotizing scleritis after cataract extraction in which the wound was sutured with polyester. In the first case, a 73-year-old woman who had right phacoemulsification via a limbal incision developed necrotizing scleritis 8 months after surgery. The eye became progressively painful and phthisical, necessitating enucleation. Microscopic examination of the enucleated globe showed a predominantly lymphocytic infiltration of the ocular tissues with no evidence of an infectious agent. In the second case, a 78-year-old woman had bilateral extracapsular cataract extraction through a limbal incision closed with a polyester suture. The patient presented 3 years later with bilateral necrotizing sclerokeratitis. No underlying systemic vasculitis or autoimmune condition was identified in either patient. To our knowledge, the association of necrotizing scleritis after intraocular surgery and polyester fiber suture material (Mersilene) has not been described.     

Idiopathic isolated optic nerve head swelling a presentation of two cases

Optic nerve head swelling is caused by either ocular or systemic diseases of inflammatory, infective, infiltrative, compressive, or ischemic origin. Uncommonly, an isolated optic nerve head swelling without the above underlying mechanisms might also occur. Two patients presented with unilateral, isolated optic nerve head swelling. A detailed oculoneurological examination and a series of investigations failed to indicate any pathology. No probable cause for optic nerve head swelling in these patients was determined by the authors. the authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or privider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

Surgical treatment of retinal detachment due to macular hole in high myopia

The use of vitrectomy combined with the adjunct of 18% C₃F₈ or silicone oil is a safe and effective method in treating retinal detachment due to macular hole in high myopia. Preoperative careful examination of ocular fundus, appropria te surgical design, and better surgical expertise are basic factors in treating this disease. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label product, which includes unlabeled, unapproved, or investigative products or devices.     

Spontaneous Extrusion of Subconjunctival Cysticercosis

We report on a case of subconjunctival cysticercosis in a patient who presented with redness on the medial side, fever, and pain and swelling on the inside of the right eye. There was no diplopia, restriction of ocular movements in any gaze or diminution of vision. Cyst excision was scheduled and oral albendazole was administered. However, the cyst extruded spontaneously prior to surgery. Dr. Reddy is a Senior Resident, Dr. Raj is a Resident, and Dr. Maurya is a Reader and Former Head, Institute of Medical Sciences, Banaras Hindu University. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. The authors report on a case of subconjunctival cysticercosis in a patient who presented with redness on the medial side, fever, and pain and swelling on the inside of the right eye. Spontaneous extrusion occurred following treatment with oral albendazole and steroids.     

Cultivated limbal and oral mucosal epithelial transplantation

Stem cells located at the limbus are the ultimate source for regeneration of the corneal epithelium in normal and traumatized states. When limbal stem cells are dysfunctional or deficient, limbal stem cell deficiency (LSCD) develops. Its surgical management depends on laterality and severity of corneal-limbal involvement. Conventional methods of stem cell transplantation are conjunctival-limbal autograft (CLAU), conjunctival-limbal allograft (CLAL), and kerato-limbal allograft (KLAL) surgeries. Cultivated limbal epithelial transplantation (CLET) and cultivated oral mucosal epithelial transplantation (COMET) on a carrier such as amniotic membrane are current surgical alternatives. These new surgical procedures are effective in stabilizing the ocular surface. The theoretical advantage of ex-vivo expansions over conventional methods is that only a small limbal or mucosal biopsy is needed, thus minimizing the risk to the donor eye; there is also a lower risk of rejection. They can be used in cases with unilateral or bilateral total stem cell deficiency. In the unilateral cases, the source for CLET is a healthy fellow eye and in bilateral cases the source can be living-related or cadaveric eyes. The oral explants do not have limbal stem cells, but they seem to be a source of limbal stem cell equivalents that are able to generate cornea-like epithelium under the proper culture conditions. The main advantage of COMET is that patients with bilateral LSCD can be treated with grafts derived from their own autologous oral mucosal cells. The long-term outcomes of COMET have to be elucidated.     

Cultivated Limbal and Oral Mucosal Epithelial Transplantation

Stem cells located at the limbus are the ultimate source for regeneration of the corneal epithelium in normal and traumatized states. When limbal stem cells are dysfunctional or deficient, limbal stem cell deficiency (LSCD) develops. Its surgical management depends on laterality and severity of corneal-limbal involvement. Conventional methods of stem cell transplantation are conjunctival-limbal autograft (CLAU), conjunctival-limbal allograft (CLAL), and kerato-limbal allograft (KLAL) surgeries. Cultivated limbal epithelial transplantation (CLET) and cultivated oral mucosal epithelial transplantation (COMET) on a carrier such as amniotic membrane are current surgical alternatives. These new surgical procedures are effective in stabilizing the ocular surface. The theoretical advantage of ex-vivo expansions over conventional methods is that only a small limbal or mucosal biopsy is needed, thus minimizing the risk to the donor eye; there is also a lower risk of rejection. They can be used in cases with unilateral or bilateral total stem cell deficiency. In the unilateral cases, the source for CLET is a healthy fellow eye and in bilateral cases the source can be living-related or cadaveric eyes. The oral explants do not have limbal stem cells, but they seem to be a source of limbal stem cell equivalents that are able to generate cornea-like epithelium under the proper culture conditions. The main advantage of COMET is that patients with bilateral LSCD can be treated with grafts derived from their own autologous oral mucosal cells. The long-term outcomes of COMET have to be elucidated.     

Comprehensive classification of pediatric cataracts

A comprehensive classification of pediatric cataracts with extensive bibliography is presented. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Endogenous endophthalmitis treated with systemic ciprofloxacin and linezolid

Endogenous endophthalmitis is a serious sight-threatening condition. The role of intravitreal antibiotics is controversial. We present a case of endogenous endophthalmitis successfully treated with a combination of systemic ciprofloxacin and linezolid. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.