Nerve Fiber Layer Infarcts in Thiamine Deficiency.

Thiamine deficiency classically manifests as the triad of Wernicke encephalopathy: acute confusional state, ataxic gait, and ocular motor dysfunction. However, most patients do no present with this classic triad. Optic neuropathy in thiamine deficiency is a rare manifestation and is usually associated with fundus appearances of optic disc swelling or optic disc pallor. We present 2 unique cases of thiamine deficiency where the fundus demonstrated peripapillary retinal nerve fiber layer thickening without florid disc swelling or pallor.

Perspective on ophthalmic support in countries of the developing world.

There are over 300 million people living in the world today who are visually impaired and a further 45 million who are blind. The large majority (90%) of these people live in developing countries, and up to 75% of blindness are avoidable. With cataracts being the major cause of blindness and visual impairment, many ophthalmic aid programmes are aimed at alleviating the enormous burden caused by this readily treatable disease. Having said that, caution should be exercised that short surgical visits to remote rural areas that are not coordinated with local national eye care managers should be discouraged because they do little for the development of sustainable eye care programmes. With this in view, it has become imperative to design blindness prevention and ophthalmic support programmes that are workable, comprehensive, economical and sustainable.

Polypoidal choroidal vasculopathy: naked polyp.

We present an unusual case of polypoidal choroidal vasculopathy (PCV) lying above the retinal pigment epithelium (RPE) in a 60-year-old Caucasian female. PCV lesions are typically located beneath the RPE layer. However, they may rarely lie above the level of the RPE due to a discontinuity in the RPE and Bruch's membrane.

Recurrent orbitofrontal cholesterol granuloma: a case report.

Orbitofrontal cholesterol granuloma is a rare entity that has a predilection for men in their fourth or fifth decade and occurs almost exclusively within the frontal bone overlying the lacrimal fossa. Surgery by drainage and curettage is virtually curative in all cases and recurrence is very rare. We describe the case of a 77-year-old man with recurrent orbitofrontal cholesterol granuloma 11 years after surgery, presumably due to subtotal curettage. The potential use of an endoscope to aid complete removal of lesion is discussed.

Decompression of benign orbital apex lesion via medial endoscopic approach.

The use of endoscopic orbital and optic nerve decompression for traumatic optic neuropathy and dysthyroid orbitopathy have been well documented; however, reports on endoscopic decompression for benign orbital apex lesions are scarce. The records of two patients who underwent endoscopic decompression of the bony orbit for progressive visual loss were reviewed. Patient 1 had fibrous dysplasia and presented with headache and visual field defects. Patient 2 had sphenoid wing meningioma and multiple previous attempts of transcranial tumor resection and orbital decompression. Both had progressive visual deterioration and ultimately underwent transnasal endoscopic orbital decompression. Post-operatively, both patients had subjective and objective improvement in visual function and compressive symptoms. No complications from the endoscopic decompression were observed in both patients. Transnasal endoscopic approach may be a viable option for decompression of benign orbital apex lesions.

Late-onset capsular block syndrome.

We describe two patients with late-onset capsular block syndrome who presented 6 years and 4 years, respectively, after cataract surgery and were successfully treated with Nd:YAG capsulotomy.

Visual acuity recovery in traumatic optic neuropathy following endoscopic optic nerve decompression: a case report.

A 59-year-old Chinese man presented with no light perception in the left eye 1 day following functional endoscopic sinus surgery. The patient underwent endoscopic optic nerve decompression with topical and systemic application of nerve growth factor and steroids after a failed trial of high-dose intravenous corticosteroids. Visual acuity improved to 20/25 at 3 weeks and remained stable at 9 months. Reports of full visual recovery are exceedingly rare following this functional endoscopic sinus surgery complication.

Open book technique for conjunctival tumors: a surgical approach to the fornix.

Surgical management of large tumors involving the conjunctival fornix can be challenging, as exposure and clear margins may be difficult to achieve. In this case series, we report our initial experience with the open book technique in 4 patients. Through a canthotomy and cantholysis, this surgical approach provides a wide surgical field and facilitates fornix reconstruction post large tumor excision. In our series, one patient had a lateral canthus dehiscence.

Cilioretinal Artery Occlusion in Posterior Scleritis Secondary to Ankylosing Spondylitis.

The authors describe the case of a 25-year-old male who presented with a cilioretinal artery occlusion secondary to posterior scleritis. The patient had a history of juvenile spondyloarthritis that evolved into ankylosing spondylitis. Cilioretinal artery occlusion is a rare complication of posterior scleritis, having only been described once previously in the literature. This is the first reported case of a cilioretinal artery occlusion in posterior scleritis that was associated with an underlying systemic disease. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:102-106.].

Circumscribed choroidal haemangioma: Indocyanine green angiography features on scanning laser ophthalmoscopy versus traditional digital fundus photography.

BACKGROUND AND OBJECTIVE: Circumscribed choroidal haemangioma (CCH) has several characteristic clinical and angiographic features. We aimed to compare indocyanine green angiography (ICG) findings of CCH captured on a traditional digital camera system (DCS) to newer scanning laser ophthalmoscopy (SLO) platforms. STUDY DESIGN/MATERIALS AND METHODS: A total of 35 patients over a 10-year period diagnosed with CCH using ICG were included (18 imaged with DCS and 17 with SLO). RESULTS: On early ICG frames, intrinsic vessels were apparent in two-thirds (12/18; 67%) of the DCS group compared with all of eyes in the SLO group (p = 0.020). In addition, at maximal hyperfluorescence, most eyes imaged with DCS had a feathery appearance (16/18; 89%) compared with those in the SLO group which all (17/17; 100%) displayed a granular appearance (p < 0.001). The presence of hot spots at maximal hyperfluorescence was also more common in the SLO group (12/17; 71%) versus the DCS group (0/18; 0%) (p < 0.001). Finally, intrinsic vessels and vascular loops could be identified throughout the entire duration of the ICG in 100% of the SLO cases (17/17) versus only 11% (2/18) of DCS cases (p < 0.001). CONCLUSIONS: The visualization of intrinsic vessels, vascular loops, and "hot spots" in CCH is significantly enhanced with SLO compared with DCS. Many characteristic mid-late angiographic findings of CCH are more optimally visualized on SLO which may negate the need for late frames (>30 min) without compromising diagnostic accuracy.

Extramedullary plasmacytoma arising from the lacrimal gland.

An 80-year-old man presented with an 8-week history of painless swelling in the right lacrimal gland region with infero-medial dystopia of the globe. The lesion was excised and histology confirmed an orbital plasmacytoma. Multiple myeloma screening was negative and a solitary extramedullary plasmacytoma arising from the lacrimal gland was diagnosed. The patient was subsequently treated with radiotherapy.

Two Cases of Giant Melanocytoma (Hyperpigmented Magnocellular Nevus).

Melanocytoma or hyperpigmented magnocellular nevus is a variant of melanocytic nevus that is most commonly seen in the optic nerve, but has also been reported to occur in the iris, ciliary body, choroid, sclera, and conjunctiva. We present two cases of giant uveal melanocytoma with histopathology. The first case occurred in a 10-year-old girl who presented with decreased vision in the right eye and a mushroom-shaped pigmented choroidal lesion measuring 15.5 mm in apical height. The lesion was abutting the lens but not causing a cataract. This was diagnosed as a choroidal melanocytoma on open scleral window biopsy. The second case was in a 68-year-old lady, referred for a left nasal pigmented choroidal lesion measuring 8 mm in apical height and having a mushroom configuration. The lesion grew to 8.6 mm in height and was complicated by a vitreous hemorrhage and rhegmatogenous retinal detachment and was treated with iodine-125 plaque brachytherapy. Subsequently, the treated eye became a painful phthisical eye and was enucleated. Histopathology confirmed melanocytoma with extrascleral extension but without malignant transformation. Features of melanocytoma and other very large cases reported in the literature are discussed.

Immune privilege: failure of immunotherapy in controlling metastatic cutaneous melanoma to the eye.

This report concerns a 49-year-old female with cutaneous malignant melanoma and systemic metastases. These resolved following combination immunotherapy with ipilimumab and nivolumab. She subsequently experienced unilateral floaters, an increase in iris pigmentation and pigmentary glaucoma. The eye progressively lost vision and became painful due to iris neovascularization. The clinical diagnosis was of cutaneous melanoma metastatic to the vitreous, ciliary body and iris. Enucleation was performed for symptom control, with histopathology confirming the clinical diagnosis. The immune privilege of the eye may preclude ocular metastasis control with immunotherapy. Ocular symptoms in such patients merit referral to an ophthalmologist.

Age-related change in contrast sensitivity among Australian male adults: Florey Adult Male Ageing Study.

PURPOSE: To describe the age-related change in contrast sensitivity seen in 35- to 80-year-old men in an Australian population. METHODS: The Florey Adelaide Male Ageing Study (FAMAS) is a prospective population-based study of men aged 35-80 years randomly selected from the north-west suburbs of Adelaide. We conducted a nested ophthalmic substudy of these men. Contrast sensitivity (CS) was measured at four spatial frequencies (3, 6, 12 and 18 cycles/degree [cpd]) using the Vectorvision CSV-1000 contrast sensitivity test chart (Vectorvision, Dayton, OH, USA), and results were statistically analysed relative to age and cataract type. RESULTS: There were 2650 eligible subjects in the FAMAS and 1195 participated (45.1%); 472 of those participated in the ophthalmic substudy. A statistically significant decrease in contrast sensitivity was seen with advancing age at each spatial frequency tested [Generalized estimating equations (GEE) multiple linear regression: p ≤ 0.01]. The decline with age was greatest in the highest spatial frequency (18 cpd) and least in the lowest spatial frequency (3 cpd). Posterior subcapsular cataract caused the greatest reduction in contrast sensitivity at all spatial frequencies, while nuclear cataract caused significant reduction only in the intermediate (12 cpd) and high (18 cpd) spatial frequencies. Cortical cataract failed to reach statistical significance in contrast sensitivity reduction at all spatial frequencies tested. CONCLUSION: Contrast sensitivity declines with age in all spatial frequencies tested with a greater decline occurring in the higher spatial frequencies. Age and cataracts are independently associated with contrast sensitivity decline, and posterior subcapsular cataracts caused the greatest reduction at all spatial frequencies.

Prevalence of and risk factors for primary open-angle glaucoma in central Sri Lanka: the Kandy eye study.

PURPOSE: To report the prevalence and risk factors associated with primary open-angle glaucoma (POAG) in the Kandy district of central Sri Lanka. METHODS: A cross-sectional, population-based ophthalmic survey of the inhabitants >or= 40 years of age from villages in the Kandy District, Sri Lanka was conducted. Selection was randomized using a cluster sampling process; 1721 eligible participants were identified, 1375 participated in the study and sufficient examination data to diagnose glaucoma in at least one eye was obtained in 1244 participants. A detailed ophthalmic history and examination including ocular biometry was made of each participant. Primary open-angle glaucoma was classified into three levels according to diagnostic evidence. RESULTS: The overall prevalence of POAG was 2.3% (95% CI 1.5-3.2). In the univariate analyses, increasing age (P = 0.001), intraocular pressure (IOP) (P < 0.001), myopia (P < 0.001) and axial length (P = 0.003) were significantly associated with POAG. In the multivariate analysis, age (P = 0.001), mean IOP (P < 0.001) and mean axial length (P = 0.008) were significant risk factors of POAG. CONCLUSIONS: The prevalence of POAG in the population aged >or=40 years in central Sri Lanka was 2.3%. POAG in this population was independently associated with increasing age, IOP and axial length.

A survey of visual impairment and blindness in children attending four schools for the blind in Cambodia.

PURPOSE: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending four schools for the blind in Cambodia and to provide spectacles, low vision aids, orientation and mobility training and ophthalmic treatment. METHODS: Children < 16 years of age were recruited from all 4 schools for the blind in Cambodia. Causes of visual impairment and blindness were determined and categorized using World Health Organization methods. RESULTS: Of the 95 children examined, 54.7% were blind (BL) and 10.5% were severely visually impaired (SVI). The major anatomical site of BL/SVI was the lens in 27.4%, cornea in 25.8%, retina in 21% and whole globe in 17.7%. The major underlying etiologies of BL/SVI were hereditary factors (mainly cataract and retinal dystrophies) in 45.2%, undetermined/unknown (mainly microphthalmia and anterior segment dysgenesis) in 38.7% and childhood factors in 11.3%. Avoidable causes of BL/SVI accounted for 50% of the cases; 12.9% of the total were preventable with measles being the commonest cause (8.1% of the total); 37.1% were treatable with cataracts and glaucoma being the commonest causes (22.6% and 4.8% respectively). More than 35% of children required an optical device and 27.4% had potential for visual improvement with intervention. CONCLUSION: Half of the BL/SVI causes were potentially avoidable. The data support the need for increased coverage of measles immunization. There is also a need to develop specialized pediatric ophthalmic services for the management of surgically remediable conditions, to provide optometric, low vision and orientation and mobility services. Genetic risk counseling services also may be considered.