The role of Whitnall's ligament position in the success of levator resection surgery in congenital ptosis.

PURPOSE: This study aimed to investigate the role of Whitnall's ligament position in the success of levator resection surgery in congenital ptosis. METHODS: It was an interventional case series on patients with congenital ptosis who underwent levator muscle resection in Farabi Eye Hospital (2020-2022). Patients with incomplete follow-up, a history of trauma, poor Bell's phenomenon, previous ocular and lid surgeries, poor levator function (≤ 4mm), and syndromic ptosis or systemic diseases were excluded. During the surgery, several factors, including the distance between Whitnall's ligament and the upper edge of the tarsus (W-distance), the vertical length of the tarsus (T-length), and the amount of levator muscle resection (LMR), were measured. A successful outcome was defined as the inter-eye difference of margin reflex distance-1 (MRD1) ≤ 1 and post-op MRD1 ≥ 3 OR the inter-eye difference of MRD1 ≤ 0.5 with any value of post-op MRD1 in unilateral cases and Postop-MRD1 > 3 in bilateral cases during the 3-months period. RESULTS: Thirty four eyes of 34 patients were included, and 79.4% of patients achieved successful outcomes. In univariate analysis, Preop-MRD1 and Preop-LF had meaningful negative correlations with the amount of LMR to reach the successful outcome (p < 0.05), which was only meaningful for Preop-LF in multivariable analysis (p < 0.05). Noticeably, W-distance had a significant positive correlation in univariate and multivariable linear regression (p < 0.05). CONCLUSIONS: W-distance can be considered a significant new parameter other than Preop-LF influencing the amount of levator resection needed to achieve success in levator resection surgery.

Mucormycosis, New Causative Agents, and New Susceptible Populations: Review of Cases in a Tertiary Care Hospital in Iran (2007-2021).

Background: Mucormycosis is an aggressive opportunistic fungal infection that afflicts patients with severe underlying immunosuppression, uncontrolled hyperglycemia and/or ketoacidosis, iron overload, and occasionally healthy patients who are inoculated with fungal spores through traumatic injuries. The epidemiology of mucormycosis has changed after the COVID-19 pandemic, with mucormycosis becoming the most common and the fatal coinfection. Methods: In a retrospective, cross-sectional study, 82 hospitalized patients with a definite diagnosis of mucormycosis were reported from 2007 to 2021 in a referral, tertiary care center in Tehran, Iran. Results: The number of post-COVID cases increased 4.6 times per year, with 41.5% of patients admitted during the two years of the pandemic. Mucormycosis was more common in women (57.3%), and the most common underlying diseases were diabetes (43.7%), both COVID-19 and diabetes (23.2%), cancer (11%), rheumatic diseases (7.3%), COVID-19 without other underlying diseases (6.1%), and transplantation (4.9%). Rhino-orbito-cerebral Mucormycosis (54.9%) followed by Sino-orbital infection (23.2%) was the most common presentation. There was a significant relationship between the use of immunosuppressive agents and the development of Mucormycosis (P<0.005) The average mortality was 41.5%, but this ratio decreased to 35% during the pandemic era. Conclusion: The COVID-19 pandemic caused a 4.6-fold increase in the number of mucormycosis patients, and there was a significant relationship between hyperglycemia, corticosteroid use, and mucormycosis. The death rate during the COVID-19 pandemic has decreased by 6.5%, and during the COVID period, the interval between the arrival of a patient with mucormycosis and the start of the correct treatment was significantly decreased.

Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics.

BACKGROUND: Most patients with cardiovascular disorders suffer from coronary artery diseases, which can be treated successfully using coronary artery bypass grafting (CABG). One of the unpleasant events following CABG is postoperative vision loss (POVL). Vulnerability of retinal vessels to hemodynamic changes, an expectable event following CABG, may contribute to the development of POVL, which might be associated with the changes in the choroidal and retinal structures. AIM: To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer (NFL) thickness, and progression of diabetic and hypertensive retinopathy after CABG. METHODS: In this prospective, cross-sectional study, 49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery. RESULTS: Among the study participants, 56% were male with a mean age of 62.84 years ± 10.49 years (range 33-80 years). Diabetes mellitus was observed in eight participants (32%). None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness. The mean value of the preoperative best corrected visual acuity was 0.11 ± 0.10 logMAR (range, 0-0.4), which worsened to 0.15 ± 0.08 logMAR (range, 0-0.4) after CABG (P = 0.031). No significant difference was observed between the pre- and postsurgical choroidal (P = 0.853) and macular (P = 0.507) thickness, NFL thickness in the subfoveal (P > 0.999) and peripapillary areas (P = 0.659), as well as the severity of diabetic and hypertensive retinopathy. CONCLUSION: CABG may reduce visual acuity without affecting ocular structures. Postoperative vision reduction might be attributable to molecular or cellular variations, changes in visual pathway function, or central nervous system.

A Case Series of Infectious Keratitis After Corneal Cross-linking.

PURPOSE: To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL). METHODS: This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study. RESULTS: Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty. CONCLUSIONS: This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings. [J Refract Surg. 2023;39(8):564-572.].

Outbreak of methanol-induced optic neuropathy in early COVID-19 era; effectiveness of erythropoietin and methylprednisolone therapy.

BACKGROUND: Methanol is a highly toxic, non-potable alcohol. Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol. Recently, alongside the coronavirus disease 2019 (COVID-19) pandemic, rumors circulated on social media that consuming alcohol can prevent or cure the virus, leading to a COVID-19 and methanol-induced optic neuropathy (MON) syndemic. AIM: To investigate the impact of erythropoietin (EPO) on the outcomes of patients diagnosed with MON. METHODS: In this prospective study, 105 patients presenting with acute bilateral visual loss secondary to methanol intoxication were enrolled from March to May 2020 at Farabi Eye Hospital. A comprehensive ocular examination was conducted for all participants. Recombinant human EPO and methylprednisolone were administered intravenously to all patients for three consecutive days. RESULTS: The mean age of the participants was 39.9 years (± 12.6). Ninety-four patients were male and eleven were female. The mean pre-treatment best corrected visual acuity (BCVA) improved from 2.0 ± 0.86 to 1.39 ± 0.69 logarithm of the minimum angle of resolution post-treatment (P < 0.001), with significant improvement observed in all age categories and genders (P < 0.001). Visual acuity improvement was also significant regardless of whether the patient presented before or after 72 h (P < 0.001), and the post-treatment BCVA remained significant at all monthly follow-up visits (P < 0.001). CONCLUSION: EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with MON when administrated within the first month of exposure. Public awareness efforts are necessary to prevent further outbreaks of methanol toxicity in the current COVID-19 era.

Knowledge about Prescribing Antibiotics as Prophylaxis in Patients with Open Globe Injury: A Survey in Iranian Ophthalmologists.

Objective: This study aimed to evaluate the Iranian ophthalmologists' knowledge of prescribing prophylactic antibiotics to patients with open globe injury (OGI) in Iran. Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists' knowledge about prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. The questionnaire included demographic information as well as ophthalmologists' knowledge levels. Cronbach's alpha was used to determine its validity and reliability. The obtained data were analyzed using SPSS 24.0. Results: Of 192 subjects, 111 (35 women, 76 men) were included. About 65 (58.6%) specialists and 45 (41.4%) subspecialists with different orientations completed the questionnaires. The total knowledge score was 13.04±2.96. The following are the results of ophthalmologists' responses to questions regarding the cornea/scleral injury (1.09±1.72), prophylactic antibiotics administration (2.79±1.11), the infectious agents in eye surgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as their proper dosage (2.96±2.35). There was no significant relationship between some demographic information such as sex, working hours, workplace, and the number of studied articles (p>0.05). In addition, ophthalmologists with less work experience had significantly higher levels of knowledge than those with more work experience. Conclusion: The findings indicated that the majority of ophthalmologists had a basic knowledge of prescribing prophylactic antibiotics in OGI.

Post photorefractive keratectomy (PRK) infectious keratitis; six-year experience of a tertiary eye hospital.

BACKGROUND/OBJECTIVES: As an essential development in the new century, surface ablation procedures have attracted increasing attention. There exists a concern regarding the risk of infectious keratitis. Hence, we aimed to investigate the rate and predisposing factors of infectious keratitis after photorefractive keratectomy (PRK). SUBJECTS/METHODS: This retrospective study was designed in two phases. First, the rate of post-PRK keratitis of Farabi Eye Hospital was investigated. In other words, the targeted population was the patients who developed keratitis after performing procedure at Farabi Eye Hospital. In the second phase, all the patients with the diagnosis of post-PRK keratitis were studied regardless of the centre where surgery was performed. Patients with the diagnosis of infectious keratitis between 2014 and 2020 were enrolled and following information was analyzed: demographics, presentation time after surgery, perioperative medications, culture results, risk factors, medical treatment, complications, and final visual acuity. RESULTS: The total number of PRK procedures in our centre was 24,986 (13,253 patients), in which 6 eyes of 5 patients developed keratitis. Beside these 5 patients, 24 referred patients (24 eyes) from the other centres were enrolled. Finally, a total number of 29 patients (30 eyes) were included. Our analysis revealed that manipulation of contact lens, dry eye, and blepharitis were the essential predisposing factors for keratitis development. CONCLUSION: The overall post-PRK keratitis occurrence rate of our study was 0.02%. Our observation highlighted the importance of preoperative examination and treatment of the lids and dry eye disease.

Microbiological study on foreign body and vitreous samples of patients with intraocular foreign body.

OBJECTIVE: To evaluate the relationship between the microbiological results of the vitreous humor and those of foreign body specimens in patients with intraocular foreign body (IOFB). METHODS: Seventy-one patients with an IOFB were included in this descriptive prospective case series. All patients underwent immediate IOFB removal. Vitreous sampling was performed during vitrectomy. Foreign bodies were placed directly into culture media for microbiological study. RESULTS: Thirteen (18.3%) patients developed endophthalmitis. The results of microbiological analysis of IOFB and vitreous humor specimens were negative in nine patients and positive in four. Fifty-eight (81.6%) patients with an IOFB had no evidence of endophthalmitis. Among them, seven patients showed positive microbiological results of foreign bodies with no manifestations of endophthalmitis. In five patients, a Staphylococcus epidermidis strain was observed in the culture of the IOFB specimen. Two patients had only positive smear test results of their vitreous humor specimen. CONCLUSION: A correlation appears to be present between the microbiological results of the vitreous humor and IOFB specimens in patients with clinical findings of endophthalmitis but not in patients with a pure IOFB without clinical features of endophthalmitis. This may justify early use of intravitreal and intravenous antibiotics before the development of endophthalmitis.

Electrodiagnostic signs of carpal tunnel syndrome in ocular pseudoexfoliation syndrome.

PURPOSE: To assess the occurrence and severity of electrodiagnostic signs of carpal tunnel syndrome (ED-CTS) in patients with ocular pseudoexfoliation (PEX) and compare them with normal subjects. METHOD: A cross-sectional study with comparison group was designed and 60 patients with PEX were recruited from May 2019 to February 2021, and the findings were compared with 59 healthy subjects. All patients underwent complete ophthalmologic examination and nerve conduction velocity test at the median nerve was used to assess the occurrence and severity of ED-CTS in both hands. RESULTS: The mean age of participants was 59.8 ± 4.5 years. Occurrence of ED-CTS was 38.3% in PEX patients and 20.3% in control subjects (P = 0.025). There was also a significant difference in the severityand presence of asymptomatic CTS (P < 0.05). Adjusting other variables, including; age and sex, having severe ED-CTS showed a 3.07fold higher chance in the PEX group (P = 0.005). CONCLUSION: According to our finding, it seems there is a direct association between PEX and the occurrence, as well as severity of ED-CTS.

Mycophenolate Mofetil (CellCept®) in Combination With Low Dose Prednisolone in Moderate to Severe Graves' Orbitopathy.

Although corticosteroids are currently the first-choice drug for thyroid eye disease (TED), in 20-30% of cases, patients show poor or non-existent responses, and when the drug is withdrawn, 10-20% of patients relapse. Thus, in this study, we aimed to investigate the efficacy of the combined use of mycophenolate mofetil (CellCept®) and low dose oral prednisolone in patients with moderate to severe Graves' orbitopathy (GO). For the first time, we investigated the relationship between TED-related parameters and proptosis reduction. In a prospective, non-randomized, interventional case series, 242 patients with moderate-to-severe GO were, assigned to receive oral prednisolone (5 mg/ d) and mycophenolate mofetil (CellCept®) (one 500 mg tablet twice per day according to the therapeutic response). The patients were monitored regularly during the 3rd, 6th, 12th, and 18th month of treatment. The main outcome measures were the clinical activity score (CAS), intraocular pressure (IOP), diplopia, proptosis and visual acuity. We also assessed the relationship between the main outcomes with proptosis changes and time to improvement (months). Adverse effects were recorded during each visit. The clinical response rate increased from 67.7% on the third month to 89.2% on the sixth month, and 94.2% on the 12th month. This therapeutic response continued until the 18th month of follow-up. The CAS responses [disease inactivation (CAS <3)] improved during our study: 70.6% on the third month, 90.0% on the sixth month, and 92.5% at 12th month. These conditions continued until the 18th month of follow-up. Proptosis improvement was 52% on the third month, 71% on the sixth month, 83% on the 12th month, and 87.1% on the 18th month. Changes in IOP and visual acuity were not significant (P = 0.568 and 0.668, respectively). The patient showed significant improvement in the Gorman score. A Shorter duration of treatment was seen in patients with earlier onset of intervention, younger age, and lack of all extraocular muscle (EOM) enlargement on computed tomography (CT) scan (p < 0.05). In addition, a better response (more reduction) in proptosis was related to: younger age at disease, earlier treatment intervention (less interval from the time the diagnosis of moderate-to-severe GO was made until medication initiation), shorter treatment time (less time to improvement), less IOP, lack of EOM enlargement on CT scan, and lack of diplopia (P < 0.05). Adverse events occurred in six patients. Findings show that mycophenolate mofetil (CellCept®) plus low-dose prednisolone can be introduced as a new optimal dosing regimen in GO due to its better effect on chronic complications such as proptosis and diplopia.

Epidemiological characteristics and prognostic factors of post-traumatic endophthalmitis.

OBJECTIVE: To examine the prognostic factors and features of post-traumatic endophthalmitis. METHODS: This retrospective study enrolled adult patients (>18 years old) diagnosed with post-traumatic endophthalmitis. Their medical records were reviewed and the patient demographic characteristics, features of injury, management, outcomes and microbiology data were analysed. RESULTS: A total of 131 eyes from 131 patients were enrolled. Post-traumatic endophthalmitis was more common in male patients (122 of 131 patients: 93.1%), in those aged 30-44 years (51 of 131 patients: 38.9%), in those injured with a metallic object (86 of 131 patients; 65.6%), in those with a penetrating injury (90 of 131 patients; 68.7%) and those that were injured at work (106 of 131 patients; 80.9%). The mean ± SD time of presentation to the hospital and developing endophthalmitis was 40.60 ± 19.32 h and 5.19 ± 2.55 days, respectively. Of the cultures, 84 of 131 (64.1%) were negative and 22 of 131 (16.8%) were positive for Staphylococcus species. Patients with delayed presentation, an intraocular foreign body, traumatic cataract, retinal detachment, larger wounds, positive smears and cultures and work-related injuries had worse outcomes. CONCLUSION: Immediate presentation to an ophthalmic centre and timely diagnosis and intervention may lead to better outcomes.

Management of lenticule detachment and epithelial downgrowth after Descemet stripping automated endothelial keratoplasty: a novel technique and brief literature review.

BACKGROUND: Epithelial downgrowth is a rare complication after Descemet stripping automated endothelial keratoplasty (DSAEK), which usually leads to poor visual outcome despite multiple available options of treatment. CASE PRESENTATION: A 50-year-old man underwent DSAEK procedure due to pseudophakic bullous keratopathy. Three months later, the patient presented with gradual visual loss; slit-lamp examination revealed detachment and folding of the DSAEK lenticule, which was confirmed by anterior segment optical coherence tomography. On confocal scanning, epithelial cell sheets were detected in the interface leading to the wrinkling of the donor tissue and donor detachment. Surgical debridement and transient fixating with straight 10-0 prolene needles were performed followed by air injection into the anterior chamber. The cornea turned clear in the one-year follow-up with uncorrected-visual acuity of 20/30 and best-corrected visual acuity of 20/25. CONCLUSIONS: Early diagnosis and treatment of epithelial downgrowth may be associated with a good prognosis and prevent from more aggressive treatments such as repeat of grafting. In this case, mechanical debridement and transient fixation of lenticule by 10-0 prolene needles was performed to manage post-DSAEK epithelial downgrowth and lenticule detachment, which was successful without requiring of additional re-grafting. It seems this is a feasible technique with acceptable long-term outcomes.

Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review.

Endophthalmitis is the most serious complication of cataract surgery. A cluster of endophthalmitis is a devastating event for surgeons. Pseudomonas aeruginosa is the main causative pathogen of Gram-negative endophthalmitis, which can be suggestive of the occurrence of an outbreak.Ten patients diagnosed with endophthalmitis after cataract surgery performed by one surgeon were analyzed in this study. At presentation, five patients had obvious clinical findings of endophthalmitis with visual acuity of light perception, two patients had poor light perception/no light perception of vision complicated by concomitant keratitis, and three patients had earlier signs of infection (e.g., a lower degree of anterior chamber and vitreous cells, better presenting visual acuity, and greater visibility of the fundus). Investigations revealed that the source of infection was growth of P. aeruginosa on the phaco probe. All of the surgeries had been performed by the same contaminated probe without sterilization between surgeries. This finding emphasizes the importance of strict adherence to sterility protocols during high-risk surgeries such as intraocular surgeries. Additionally, this report aims to emphasize to surgeons that negligence of simple but vital steps of sterility for any reason, such as limitations in time or equipment, can lead to catastrophic events.

Multi modal imaging in corneal edema after corneal collagen cross-linking (CXL); a case-based literature review.

BACKGROUND: Keratoconus (KCN) is a common ectatic disorder of the cornea. Corneal collagen cross-linking (CXL) is used as an effective option to slowdown the disease progression. Although CXL is considered a safe procedure, corneal endothelial damage, especially in corneal thickness of less than 400 µm, has been reported. CASE PRESENTATION: A 25-year-old man known case of KCN was referred with complaints about blurred vision and discomfort of the right eye 3 days after performing CXL. The preoperative thinnest point was 461 µm. His presenting BCVA was CF at 1 m. Examination showed central corneal edema and stromal haziness. ASOCT demonstrated increased central corneal thickness and very deep CXL line. In the confocal scan, anterior stroma showed hyper-reflective lines without recognizable cells and nerves, the middle stroma showed rare active and edematous keratocytes and a hyper-reflective reticular pattern with elongated keratocytes and needle-like structures involving the posterior stroma indicated increased depth of CXL. To manage the patient, debridement of loosened epithelium was done. Non-preservative steroid 1% eye drop was prescribed frequently. The corneal edema was completely resolved during 2 months with no need for surgical procedure and BCVA of 20/30 in his right eye. CONCLUSION: The corneal thickness of more than 400 µm cannot guarantee the absence of corneal edema after corneal collagen cross-linking, which can pertain to several factors such as inadvertently using of higher energy as well as the incorrect observance of all guidelines, instructions, and other precautions, even by a trained surgeon.

Acute retinal necrosis caused by co-infection with multiple viruses in a natalizumab-treated patient: a case report and brief review of literature.

BACKGROUND: Acute retinal necrosis is considered a rare infectious uveitis. This condition is usually caused by varicella-zoster virus or herpes simplex virus. Acute retinal necrosis caused by co-infection with multiple viruses is extremely rare. Herein, we report a case of acute retinal necrosis caused by co-infection with herpes simplex virus (type I and II) and varicella-zoster virus (VZV) in a natalizumab-treated patient due to multiple sclerosis. CASE PRESENTATION: An adult man presented with a complaint of decreased vision of the right eye from 12 days ago. He was a known case of multiple sclerosis receiving natalizumab. Examination of the right eye revealed severe conjunctival injection, fine diffuse keratic precipitates, 3 + anterior chamber and vitreous cells, elevated intraocular pressure (26 mmHg), a blurred optic disk with hemorrhagic patches, and occlusive vasculitis plus confluent necrotizing patches in the peripheral retina compatible with diagnosis of acute retinal necrosis. He underwent anterior chamber and vitreous tap, and real-time PCR detected HSV I & II and VZV on the vitreous specimen. A second PCR showed the same result. After neurological consultation, natalizumab was discontinued and intravenous acyclovir was started followed by oral acyclovir and oral prednisolone to control the disease, which was successful. CONCLUSIONS: Although rare, multiple-viral infection should be considered in the physiopathology of acute retinal necrosis, especially in immunosuppressed patients.

Vitamin B12 Deficiency as a Cause of Neurotrophic Keratopathy.

INTRODUCTION: Neurotrophic keratitis is a rare degenerative corneal disease caused by an impairment of trigeminal corneal innervation, leading to a decrease or absence of corneal sensation. Here, we present a case of neurotrophic keratopathy caused by B12 deficiency in a 34 years old man who had a progressive decrease in visual acuity and corneal involvement since 3 months before being referred to our ophthalmology clinic. RESULT AND DISCUSSION: Based on our clinical findings and with the diagnosis of B12 deficiency we started B12 treatment for the patient. After 3 weeks the patient showed a dramatic response with corneal sensation reversal, an increase of visual acuity, improved neurotrophic keratopathy and significantly improved neurological findings. To the best of our knowledge, there is no report regarding vitamin B12 deficiency induced keratopathy and this is the first report that describes this aspect of vitamin B12 deficiency.

Protective effect of melatonin in the diabetic rat retina.

Diabetic retinopathy (DR) is one of the most common and serious microvascular complications of diabetes. The aim of this study was to evaluate the effects of melatonin (MEL) on retinal injury in diabetic rats. In this study, 21 rats were randomly divided into three groups: control, diabetic, and diabetic + MEL. Streptozotocin was used to induce diabetes at a dose of 50 mg/kg, i.p., and blood glucose was measured to choose the diabetic rats for the study. MEL (20 mg/kg) was given orally for 7 weeks in diabetic rats starting 1 week after induction of diabetes. After 8 weeks, the groups were compared in terms of mean scores of fluorescein leakage, using fluorescein angiography. Reactive oxygen species (ROS) and malondialdehyde (MDA) levels were estimated in retina using commercially available assays. Structural changes in retinas were evaluated by light microscopy. Results showed that diabetes significantly increased the mean scores of fluorescein leakage, and MDA and ROS levels compared to control group. Treatment of the diabetic rats with MEL for 7 weeks prevented the alterations induced by diabetes in comparison with the diabetic control group.Based on these findings, it can be concluded that MEL might have beneficial effects in prevention of DR.

Ophthalmologic Findings in Patients with Neuro-metabolic Disorders.

PURPOSE: We aimed to present the ophthalmic manifestations of neuro-metabolic disorders. METHODS: Patients who were diagnosed with neuro-metabolic disorders in the Neurology Department of Mofid Pediatric Hospital in Tehran, Iran, between 2004 and 2014 were included in this study. Disorders were confirmed using clinical findings, neuroimaging, laboratory data, and genomic analyses. All enrolled patients were assessed for ophthalmological abnormalities. RESULTS: A total of 213 patients with 34 different neuro-metabolic disorders were included. Ophthalmological abnormalities were observed in 33.5% of patients. Abnormal findings in the anterior segment included Kayser-Fleischer rings, congenital or secondary cataracts, and lens dislocation into the anterior chamber. Posterior segment (i.e., retina, vitreous body, and optic nerve) evaluation revealed retinitis pigmentosa, cherry-red spots, and optic atrophy. In addition, strabismus, nystagmus, and lack of fixation were noted during external examination. CONCLUSION: Ophthalmological examination and assessment is essential in patients that may exhibit neuro-metabolic disorders.

Allergic Conjunctival Granuloma Presenting the Splendore-Hoeppli Phenomenon; Report of Two Cases and Review of Literature.

To report two cases of bilateral conjunctival granuloma with histopathological features of the Splendore-Hoeppli phenomenon and review of the literature. Two female patients, one with a history of pulmonary eosinophilic infiltration and another with a history of vernal keratoconjunctivitis, presented with bilateral cream to yellow colored nodules in the superior bulbar conjunctiva. Histopathologic examination revealed characteristic features of the Splendore-Hoeppli phenomenon manifesting as zones of amorphous eosinophilic material surrounded by aggregations of epithelioid histiocytes, giant cells, eosinophils and lymphoplasmacytic infiltrates. No evidence of infectious organisms was found. Our report adds to non-infectious cases of conjunctival Splendore-Hoeppli phenomenon. Previous history of allergic disorders may have contributed to the occurrence of this entity.