Prototype posterior chamber phakic IOL - 35 year follow up.

Purpose: To present a case involving a rarely seen prototype posterior chamber phakic IOL (PC-pIOL) in a highly myopic patient with bilateral cataract. Observations: A 64-year-old male presented to our clinic with poor vision in both eyes. Clinical examination revealed bilateral mature cataract, phacodonesis as well as a PC-pIOL implanted 35 years ago to address his high myopia. The visual acuity (VA) was 20/200 in the right eye and no light perception in the left eye. PC-pIOL extraction as well as 23G pars plana vitrectomy (PPV) and fragmentation surgery was scheduled for the right eye. The left eye was treated conservatively. Successful extraction of the PC-pIOL was performed while it was easy to remove. It was a bow-tie shaped lens with a collar-stud-like button in the middle which extended anteriorly into the anterior chamber through the pupil. PPV with lens fragmentation was successful and the patient was left aphakic in order to avoid the placement of a zero diopter IOL. Final best corrected VA was 20/25 one month post-surgery. Conclusions and importance: Removal of this rarely seen pIOL was performed without difficulty while excellent VA was achieved. Aphakia following complete vitrectomy represented a viable option in this case. Furthermore, we highlight the clinical manifestations associated with this IOL more than three decades after implantation.

Retinal capillary plexus in Parkinson's disease using optical coherence tomography angiography.

AIM: To evaluate the alterations of the retinal microvasculature and foveal avascular zone in patients with Parkinson's disease (PD) using optical coherence tomography angiography (OCT-A). METHODS: A retrospective study of PD patients examined in the Ophthalmology Department of the General Hospital of Athens, "Georgios Gennimatas" from March 2021 to March 2022 was conducted. Totally 44 patients with PD were included and 18 healthy controls were examined, hence a total of 124 eyes were enrolled in the study. The foveal and parafoveal superficial and deep capillary plexus vascular density (fSCP-VD, fDCP-VD, pSCP-VD, pDCP-CD) and foveal avascular zone (FAZ) were quantified with OCTA. Optical coherence tomography (OCT) was used to measure macular thickness. Our statistical analysis was conducted by using a mixed effect linear regression model. RESULTS: After adjustment for age and gender, the mean parafoveal superficial capillary plexus vascular density (pSCP-VD) and mean parafoveal deep capillary plexus vascular density (pDCP-VD) were significantly decreased in individuals with PD (P<0.001 in both) by -2.35 (95%CI -3.3, -1.45) and -7.5 (95%CI -10.4, -4.6) respectively. fSCP-VD and fDCP-VD didn't approach statistical significance. The FAZ area and perimeter were significantly decreased (P<0.001 in both) by -0.1 mm2 (95%CI -0.13, -0.07) and -0.49 mm2 (95%CI -0.66, -0.32) respectively. Circularity didn't approach statistical significance. Central retinal thickness (CRT) was significantly decreased in individuals with PD (P<0.001) by -23.1 µm (95%CI -30.2, -16) and temporal retinal thickness (TRT) was decreased (P=0.025) by -11 µm (95%CI -22, -1.5) while nasal retinal thickness (NRT) only approached statistical significance (P=0.066). CONCLUSION: The mean pSCP-VD, pDCP-VD, CRT and TRT are significantly decreased and FAZ is altered in individuals with PD. These findings can be potentially used as biomarkers for the diagnosis and evaluation of early PD.

Combining Perfluorobutylpentane (F4H5) with Glaucoma Drainage Device Implantation for Silicone Oil-Induced Glaucoma: A Pilot Study.

Objectives: Our aim was to perform a perfluorobutylpentane (F4H5) washout in conjunction with glaucoma drainage device (GDD) placement in patients with silicone oil (SO)-induced glaucoma. In this report we present our preliminary results concerning the effectiveness in clearing the SO and the safety of the procedure. Materials and Methods: Eight patients who previously underwent pars plana vitrectomy with SO tamponade due to retinal detachment were selected. Removal of SO was performed on average 10 months after initial surgery. All patients developed glaucoma with evidence of SO remnants in the anterior chamber (AC) and angle. Removal of the remaining SO with F4H5 washout was performed in all cases with concomitant insertion of a GDD to treat the refractory glaucoma. Intraocular pressure (IOP), SO remnants, endothelial cell count, and need for glaucoma medications were evaluated up to 12 months after the surgical procedure. Results: All patients had uneventful surgery with no major complications 12 months postoperatively. A marked reduction of SO remnants in the AC and angle was observed in all cases after surgery. There was a 60.9% decrease in mean IOP 12 months postoperatively (p<0.05) and the need for glaucoma medication was lower in all patients (mean topical medicines: 4 preoperatively vs. 0.75±0.89 postoperatively; p<0.05). Endothelial cell density showed no significant change (mean 2012±129 cells/mm2 preoperatively vs. 1985±134 cells/mm2 postoperatively; p>0.05), and there were no signs of corneal edema. Conclusion: F4H5 is an effective emulsifier for removing SO remnants and may be safely used in conjunction with GDD placement in order to control IOP in eyes with silicone oil-induced glaucoma.

Posterior Scleritis in a Patient with Psoriasis Masquerading as Acute Angle Closure Glaucoma.

Posterior scleritis is a relatively uncommon form of scleral inflammation of the posterior segment of the eye. Clinical manifestations include ocular pain, headache, pain with ocular movements, and loss of vision. A rare presentation of the disease is acute angle closure crisis (AACC) with elevated intraocular pressure (IOP) secondary to anterior displacement of the ciliary body. Various systemic diseases have been described to co-exist with posterior scleritis; however, psoriasis has not been associated with posterior scleritis. Here, we present a case of posterior scleritis which initially presented as AACC in a patient with pre-existing psoriasis. A 50-year-old male with a history of psoriasis under treatment presented to the emergency department with intense sudden ocular pain and loss of vision on the left eye as well as headache and nausea. A thorough medical and ocular history was taken, and a detailed examination of the anterior and posterior segment was completed including visual acuity and IOP. Initial diagnosis of AACC was made, and appropriate actions were taken with partial resolution of his symptoms. However, upon further work-up including ultrasound (B-scan) of the left eye a final diagnosis of posterior scleritis was made. The patient was treated with steroids and nonsteroidal anti-inflammatory drugs which dramatically improved his condition. Photographic evidence of initial presentation and post-treatment condition was obtained and presented in this report. Posterior scleritis is a potentially vision-threatening condition which is usually challenging to diagnose. In this report, we highlight the challenges one might come into when dealing with different manifestations of the same disease, increasing awareness. This case of posterior scleritis presenting as AACC in a patient with a history of psoriasis enhances what we already know from the literature as well as provides some new insights in the clinical manifestations of posterior scleritis in the setting of psoriasis without arthritis.

Overactivation of plasmacytoid dendritic cells inhibits antiviral T-cell responses: a model for HIV immunopathogenesis.

A delicate balance between immunostimulatory and immunosuppressive signals mediated by dendritic cells (DCs) and other antigen-presenting cells (APCs) regulates the strength and efficacy of antiviral T-cell responses. HIV is a potent activator of plasmacytoid DCs (pDCs), and chronic pDC activation by HIV promotes the pathogenesis of AIDS. Cholesterol is pivotal in maintaining HIV envelope integrity and allowing HIV-cell interaction. By depleting envelope-associated cholesterol to different degrees, we generated virions with reduced ability to activate pDCs. We found that APC activation was dissociated from the induction of type I IFN-α/ß and indoleamine-2,3-dioxygenase (IDO)-mediated immunosuppression in vitro. Extensive cholesterol withdrawal, resulting in partial protein and RNA loss from the virions, rendered HIV a more powerful recall immunogen for stimulating memory CD8 T-cell responses in HIV-exposed, uninfected individuals. These enhanced responses were dependent on the inability of cholesterol-depleted HIV to induce IFN-α/ß.