Neurotrophic Keratopathy in Marfan Syndrome Patient After Micropulse Transscleral Cyclophotocoagulation: A Call for Risk Stratification.

BACKGROUND Micropulse transscleral cyclophotocoagulation is a non-invasive, widely employed procedure that uses diode laser to target the ciliary body to lower the intraocular pressure. Despite its acknowledged efficacy, certain complications are recognized, with neurotrophic keratopathy being a rare yet serious consequence. This report seeks to shed light on a potential high-risk subgroup susceptible to neurotrophic keratopathy, exemplified by our patient with Marfan syndrome, a condition characterized by thin sclera. CASE REPORT Our patient, who was confirmed to have Marfan syndrome with pseudophakic glaucoma, underwent micropulse transscleral cyclophotocoagulation due to high intraocular pressure bilaterally and subsequently quickly manifested neurotrophic keratopathy in both eyes postoperatively. Swift initiation of management involved a comprehensive approach, including topical antibiotics, preservative-free lubrication, medroxyprogesterone acetate 1%, serum balanced salt solution (BSS) 50%, and the application of bandage contact lenses to expedite healing. Fortunately, the left eye demonstrated resolution within 10 days, while the right eye exhibited delayed healing, leading to subsequent scarring. CONCLUSIONS This report highlights the critical importance of recognizing populations predisposed to neurotrophic keratopathy before subjecting them to micropulse transscleral cyclophotocoagulation. Such awareness allows for the fine-tuning of procedural parameters, offering a strategic approach to mitigate the risk of neurotrophic keratopathy development. By further exploring and recognizing potential risk factors, clinicians can enhance patient outcomes and refine the safety profile of micropulse transscleral cyclophotocoagulation.

Orbital bone infarction masquerading as preseptal cellulitis in a child with sickle beta-thalassaemia.

Although several ophthalmic manifestations of sickle cell disease (SCD) are common, orbital bone infarction is rare. Orbital bones have less bone marrow creating an unlikely place to develop infarction. However, having a patient with SCD presenting with periorbital swelling should warrant imaging to rule out bone infarction. We present a case of a child with sickle beta-thalassaemia who was misdiagnosed with preseptal cellulitis in the right eye. Later upon review of the subtle signs of bone infarction in imaging, she was discovered to have orbital bone infarction.

Bell's palsy in a patient after contracting COVID-19 with signs of aberrant nerve regeneration.

Purpose: To report a 56-year-old male in Saudi Arabia who developed signs of aberrant facial nerve regeneration after recovering from Bell's palsy associated with COVID-19 infection. Observations: The patient presented, months following recovery from Bell's palsy associated with COVID-19, with symptoms of aberrant seventh nerve regeneration in the form of tearing with eating "crocodile tears" and synchronous right eyelid closure with the jaw movement. Conclusions and Importance: Case reports of Bell's palsy associated with COVID-19 are emerging, but association does not mean causation. That said, we need to report these cases to draw attention to the possible neuroinvasive propensity of this virus. It is also imperative to recognize Bell's palsy as a possible symptom of COVID-19.