Cataract Extraction and Intraocular Lens Implantation in Megalocornea

PURPOSE: To report a case that underwent successful centration of intraocular lens (IOL) and visual acuity improvement after cataract extraction in a megalocornic eye in our medical center. CASE SUMMARY: A 27-year-old man with bilateral megalocorneas came to our medical center. The patient had progressive loss of vision and floaters in both eyes for 3 months. His horizontal corneal diameter was approximately 14 mm in both eyes. The initial best corrected visual acuity was 0.02 in the right eye and 0.5 in the left eye. There was a white cataract and nuclear sclerotic cataract without lens luxation, respectively. The cataract was extracted from the patient's right eye after anterior continuous curvilinear capsulorrhexis (CCC), the preloaded custom IOL was inserted in the bag, and pars plana vitrectomy was performed. Two months later, after the cataract was extracted from the left eye, optic capture through a posterior capsule was attempted but converted to anterior capsule (reverse optic capture) because of the posterior CCC's radial tear, and pars plana vitrectomy performed. The IOL had a 6 mm optic and an overall length of 12.5 mm. The IOL in the right eye was decentrated inferiorly in the bag due to a large capsule diameter, but the IOL captured through the anterior capsule in the left eye had good centration. The best corrected visual acuity of both eyes improved to 0.8 without other complications.

Incidence, Molecular Characteristics and Pathogenicity of Gibberella fujikuroi Species Complex Associated with Rice Seeds from Asian Countries

Gibberella fujikuroi species complex (GFSC) was isolated from rice (Oryza sativa L.) seed samples from ten Asian countries and investigated for incidence of GFSC, molecular characteristics, and pathogenicity. Regardless of geographic origin, GFSC was detected with incidences ranging from 3% to 80%. Four species, Fusarium fujikuroi, F. concentricum, F. proliferatum, and F. verticillioides, were found to show an association with rice seeds, with F. fujikuroi being the predominant species. In phylogenetic analyses of DNA sequences, no relationship was found between species, isolates, and geographic sources of samples. Unidentified fragments of the beta-tubulin gene were observed in ten isolates of F. fujikuroi and F. verticillioides. With the exception of three isolates of F. fujikuroi, F. fujikuroi, F. proliferatum, and F. verticillioides were found to have FUM1 (the fumonisin biosynthetic gene); however, FUM1 was not found in isolates of F. concentricum. Results of pathogenicity testing showed that all isolates caused reduced germination of rice seed. In addition, F. fujikuroi and F. concentricum caused typical symptoms of bakanae, leaf elongation and chlorosis, whereas F. proliferatum and F. verticillioides only caused stunting of seedlings. These findings provide insight into the characteristics of GFSC associated with rice seeds and might be helpful in development of strategies for management of bakanae.

A Case of Unilateral Electric Cataract with Optic Neuropathy after Electric Injury

PURPOSE: Electric injury may result in cataracts, which usually occur bilaterally. In this report, we present a rare complication of such an injury presenting as a unilateral cataract with optic neuropathy. CASE SUMMARY: A 17-year-old male patient presented with gradual worsening of vision in his right eye 7 weeks after sustaining an injury from 22,900 volts of high-voltage electric current his right hand. On initial eye examination, the best corrected visual acuity (BCVA) was 20/60 in the right eye and 20/20 in the left eye. Relative afferent pupillary defect (RAPD) was noted in the right eye. Slit-lamp examination confirmed the typical anterior subcapsular lenticular opacities and funduscopy showed a slightly pale optic nerve head in the right eye. Pattern reversal visually evoked potential (P-VEP) showed a significant delay of P-100 implicit time in the right eye. After 7 months, phacoaspiration and posterior chamber intraocular lens implantation were performed in the right eye. Postoperatively, the BCVA improved to 20/30 but visual field examination showed a partial defect in the temporal area of the right eye. Cataract did not develop in the left eye during 15 months of follow-up. The electron microscopic findings showed that the number of mitochondria in the cytoplasm increased. The rough endoplasmic reticulum in the cytoplasm and microfilaments were enriched. CONCLUSIONS: Manifestation time of ocular complications after electric injuries is different. Therefore an ophthalmic examination should be performed regularly in the early recovery period of such injuries and in particular, progression of bilateral electric cataract must be checked.

A Case of Hallermann-Streiff Syndrome

PURPOSE: We report a case of Hallermann-Streiff syndrome with 360 degrees posterior synechiae, small pupils and aphakia. METHODS: A five-year-old female presented with decreasing visual acuity of both eyes. Visual acuity was not checkable due to mental retardation. Microcornea, microphthalmia, nystagmus and esotropia were found, and a fundus examination was not available due to 360 degrees posterior synechiae and small pupils. She had developmental delays, bird-like face and hypotrichosis. A pediatric physician was consulted who diagnosed her with Hallermann-Streiff syndrome. Refraction and fundus examinations were impossible due to her small pupils, so synechiolysis was done. RESULTS: After synechiolysis and pupil dilatation in right eye with iris retractors, continuous curvilinear capsulorhexis (CCC) was attempted. However, the anterior capsule was unusually fragile and fibrtic. Therefore, the CCC failed. In addition, the crystalline lens and the zonule were not found. The posterior capsule was fragile similar to the anterior capsule. Complete posterior CCC (PCCC) was impossible. We could not find any formed vitreous in the vitreous cavity during anterior vitrectomy. We diagnosed the condition as aphakia with only two layers of membranes. Two weeks later, synechiolysis in the left eye was done. The left eye was also diagnosed with aphakia, and only synechiolysis was performed. CONCLUSIONS: The possibility of aphakia must be always considered in cases of Hallermann-Streiff syndrome.

A Case of Hallermann-Streiff Syndrome

PURPOSE: We report a case of Hallermann-Streiff syndrome with 360 degrees posterior synechiae, small pupils and aphakia. METHODS: A five-year-old female presented with decreasing visual acuity of both eyes. Visual acuity was not checkable due to mental retardation. Microcornea, microphthalmia, nystagmus and esotropia were found, and a fundus examination was not available due to 360 degrees posterior synechiae and small pupils. She had developmental delays, bird-like face and hypotrichosis. A pediatric physician was consulted who diagnosed her with Hallermann-Streiff syndrome. Refraction and fundus examinations were impossible due to her small pupils, so synechiolysis was done. RESULTS: After synechiolysis and pupil dilatation in right eye with iris retractors, continuous curvilinear capsulorhexis (CCC) was attempted. However, the anterior capsule was unusually fragile and fibrtic. Therefore, the CCC failed. In addition, the crystalline lens and the zonule were not found. The posterior capsule was fragile similar to the anterior capsule. Complete posterior CCC (PCCC) was impossible. We could not find any formed vitreous in the vitreous cavity during anterior vitrectomy. We diagnosed the condition as aphakia with only two layers of membranes. Two weeks later, synechiolysis in the left eye was done. The left eye was also diagnosed with aphakia, and only synechiolysis was performed. CONCLUSIONS: The possibility of aphakia must be always considered in cases of Hallermann-Streiff syndrome.

Postoperative Refractive Changes after Optic Capturing

PURPOSE: To present postoperative refractive changes in patients with optic capturing. METHODS: This retrospective review was comprised of 81 eyes of 69 presenile and senile cataract patients who had undergone cataract surgeries, and 20 eyes of 11 pediatric cataract patients who had undergone irrigation and aspiration of the cataract, posterior continuous curvilinear capsulorhexis (PCCC) and optic capturing. Presenile and senile cataract patients were divided into three groups: Group I: Phacoemulsification with posterior chamber lens implantation (Phaco with PCL), 37 eyes; Group II: Phaco with PCL and PCCC, 22 eyes; Group III: Phaco with PCL, PCCC and optic capturing, 22 eyes. Preoperative target refractive error and postoperative refractive errors were compared postoperatively. RESULTS: Hyperopic shiftings were noticed in Groups I and II, but were not statistically significanct. However, statistically significant hyperopic shifting was found in Group III. In pediatric populations, we found no statistically significant refractive changes. CONCLUSIONS: PCCC alone does not cause refractive change postoperatively. When performing optic capturing, postoperative hyperopic shifting must be considered.