Peripapillary retinal nerve fiber layer thickness in bipolar disorder.

BACKGROUND: To compare peripapillary retinal nerve fiber layer thickness (RNFLT) between patients with bipolar disorder and a control group by optical coherence tomography (OCT). METHODS: This prospective comparative case series included 60 eyes of 30 patients with bipolar disorder and 60 eyes of 30 age-matched healthy control subjects. Using OCT, peripapillary RNFLT of the 4 quadrants and the mean of them was compared between the two groups. Variables such as age of onset, duration, smoking, psychosis, mania and depression episodes in the case group and their relationships with RNFLT were evaluated by OCT. RESULTS: Mean RNFLT was 99 ± 8 in the case group, significantly less than the 106 ± 8 mµ in the control group (p = 0.001). The inferior, superior, and nasal quadrants in the case and control groups showed significant difference in RNFLT (p < 0.001) (p = 0.040) (p = 0.005); however, the temporal quadrant was not reduced significantly, compared to the control value (p = 0.907). Moreover, the only variable showing significant relation with RNFLT was duration of bipolar disorder (p = 0.040). CONCLUSION: Reduction of peripapilary RNFLT occurs in patients with bipolar disorder, and is related to the duration of disease. RNFLT can be a beneficial value for studying neurodegenerative changes over time towards detecting the severity and duration of disorder.

A very rare case of eyelid metastasis originating from lung adenocarcinoma.

PURPOSE: To report a very rare eyelid mass confirmed to be a metastasis from lung adenocarcinoma. METHODS: A 68-year-old man had a two-month history of a large nodule in the right upper eyelid. He was a known case of lung adenocarcinoma since 2 years without a history of systemic metastasis. He underwent further investigations including orbital imaging and biopsy of the lesion. RESULTS: Biopsy and immunohistochemical evaluations of the eyelid lesion revealed a moderate to poorly differentiated adenocarcinoma, a similar histology to the lung lesion. CONCLUSIONS: Metastatic involvement of the eyelids is rarely seen; specifically, those associated with lung adenocarcinoma as the source have been reported extremely rare. Eyelid metastases present with various and non-specific clinical features, and therefore biopsy of suspicious or recurrent lesions is highly recommended to rule out such malignant processes.

Secondary Piggyback Intraocular Lens for Management of Residual Ametropia after Cataract Surgery.

PURPOSE: To investigate the indications, clinical outcomes, and complications of secondary piggyback intraocular lens (IOL) implantation for correcting residual refractive error after cataract surgery. METHODS: In this prospective interventional case series, patients who had residual refractive error after cataract surgery and were candidates for secondary piggyback IOL implantation between June 2015 and September 2018 were included. All eyes underwent secondary IOL implantation with the piggyback technique in the ciliary sulcus. The types of IOLs included Sulcoflex and three-piece foldable acrylic lenses. Patients were followed-up for at least one year. RESULTS: Eleven patients were included. Seven patients had hyperopic ametropia, and four patients had residual myopia after cataract surgery. The preoperative mean of absolute residual refractive error was 7.20 ± 7.92, which reached 0.42 ± 1.26 postoperatively (P < 0.001). The postoperative spherical equivalent was within ± 1 diopter of target refraction in all patients. The average preoperative uncorrected distance visual acuity was 1.13 ± 0.35 LogMAR, which significantly improved to 0.41 ± 0.24 LogMAR postoperatively (P = 0.008). There were no intra- or postoperative complications during the 22.4 ± 9.5 months of follow-up. CONCLUSION: Secondary piggyback IOL implantation is an effective and safe technique for the correction of residual ametropia following cataract surgery. Three-piece IOLs can be safely placed as secondary piggyback IOLs in situations where specifically designed IOLs are not available.