Cataract surgery and artificial iris implantation in patient with oculocutaneous albinism: a case report.

We present a case report detailing the successful phacoemulsification surgery with artificial iris implantation for two individuals with oculocutaneous albinism. These women suffered from cataracts, resulting in reduced visual acuity and heightened photophobia due to iris pigmentary epithelium deficiency. The patients underwent phacoemulsification along with prosthetic artificial iris implantation into the posterior chamber. This intervention resulted in improved visual acuity, reduced photophobia and glare, and an overall enhanced quality of life. Our report highlights two cases of successful phacoemulsification and artificial iris implantation in patients with oculocutaneous albinism and cataracts, leading to improved visual acuity, reduced photophobia, and enhanced quality of life. Notably, there are no prior records in South American literature of cataract surgery combined with artificial iris implantation for oculocutaneous albinism patients up to the time of this publication.

Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT): A case series from a center in Brazil.

Bilateral acute depigmentation of the iris and bilateral acute iris transillumination (BAIT) are similar clinical entities. The former causes acute-onset depigmentation of the iris stroma without transillumination, whereas the latter causes depigmentation of the iris pigment epithelium with transillumination. The etiopathogenesis of these conditions is not yet fully understood, but the proposed causes include the use of systemic antibiotics (especially moxifloxacin) and viral triggers. We present a case series of five female patients with a mean age of 41 (32-45) years, all of whom suffered acute onset of bilateral pain and redness of the eyes after moxifloxacin use (oral or topical). It is important for ophthalmologists to be aware of the two forms of iris depigmentation since this case series suggests that SARS-CoV-2 or its empirical treatment with moxifloxacin may trigger iris depigmentation. If this is the case, clinicians will likely see increased incidences of bilateral acute depigmentation of the iris and bilateral acute iris transillumination during and after the COVID-19 pandemic.

Simultaneous evaluation of iris area and subfoveal choroidal thickness in Fuchs uveitis syndrome.

BACKGROUND/AIMS: To simultaneously evaluate iris area (IA) and subfoveal choroidal thickness (SFCT) in eyes with Fuchs Uveitis Syndrome (FUS). METHODS: We prospectively recruited a case series of patients with FUS at our institution, simultaneously measuring IA with anterior segment spectral domain optical coherence tomography (SD-OCT) and SFCT with enhanced depth imaging optical coherence tomography (EDI-OCT). Iris images were analyzed by ImageJ software. We tested the differences in intereye IA and SFCT with the healthy eye (HE) using the Wilcoxon test, and clinical interpretation was controlled by intraclass correlation coefficient (ICC) between two masked specialists. RESULTS: Sixteen patients with unilateral FUS were included. Six were female, and the age range was 37 to 67 (median age 48 years, IQR 41-60). ICC of 98.9%, with a lower confidence interval of 97%. Eyes with FUS had a significant thinning of the total iris median area (p < 0.002), restricted to the temporal and nasal areas compared to the HE (p < 0.01 and < 0.001, respectively). SFCT was also significantly thinner compared to the HE (p < 0.0001). A low correlation was found between iris and choroidal thinning in FUS eyes (rs = 0.21; p = 0.4). CONCLUSIONS: This study found reduced iris area and subfoveal choroidal thickness in eyes with FUS compared to the normal fellow eye.

Bilateral acute iris transillumination (BAIT) syndrome: Differential diagnosis based on clinical, OCT and UBM findings.

INTRODUCTION: Bilateral acute iris transillumination (BAIT) is a relatively new syndrome whose etiopathogenesis is still not fully understood. It is characterized by acute bilateral onset of intense pigment dispersion in the anterior chamber, iris depigmentation with severe transillumination defects, accentuated pigment deposition in the angle, and elevated intraocular pressure (IOP). In literature, the first case was of bilateral acute iris depigmentation (BADI) reported in 2004 in a 77-year-old woman. In 2019, Perone et al. published a review about BAIT syndrome. They reported a total of 79 cases have been published up that date, mainly in Europe and especially in Turkey and Belgium. The majority of reported cases were of bilateral acute iris depigmentation (BADI). BAIT syndrome might be mainly confused with acute iridocyclitis, acute primary angle-closure (APAC) and pigment dispersion syndrome (PDS). In relation to BAIT, controversies still exist regarding the etiology being the differential diagnosis of paramount importance for adequate treatment. PURPOSE: To report a case of BAIT syndrome associated to refractory glaucoma and to discuss the differential diagnosis based on clinical, OCT and UBM findings. METHODS: We present a case of BAIT syndrome in which clinical, OCT and UBM findings have pointed out the similarities and, mainly the diagnosis differences with other ocular diseases. CONCLUSIONS: BAIT syndrome with accentuated IOP rise must be differentiated of other ocular diseases. It requires urgent clinical therapy and/or surgical management as occurred in the present case for avoiding structural damage in OCT and visual field loss. OCT and UBM are critical for early recognition, differential diagnosis and management.

Cornea opacity, uveitis with iris atrophy and lens damage following cosmetic high-intensity ultrasound of the eyelid: a case report.

BACKGROUND: High-intensity focused ultrasound (HIFU) is a cosmetic procedure that aims to tone the skin through thermal collagen coagulation. The energy is delivered in the deep layers of the skin, and because of these characteristics, the risks of severe damage to adjacent tissue and the ocular surface may be underestimated. Previous reports have demonstrated superficial corneal opacities, cataracts, increased intraocular pressure, or ocular refractive changes in different patients following HIFU. In this case, we report deep stromal opacities associated with anterior uveitis, iris atrophy and lens opacity formation following a single HIFU superior eyelid application. CASE PRESENTATION: A 47-year-old female presented to the ophthalmic emergency department complaining of pain, hyperemia and photophobia in the right eye following a HIFU application to the superior right eyelid. A slit lamp examination showed three temporal-inferior corneal infiltrates with edema and severe anterior uveitis. The patient was treated with topical corticosteroids, and six months later, there was residual corneal opacity, iris atrophy and peripherical cataract formation. No surgical procedure was needed, and the final vision was Snellen 20/20 (1.0). CONCLUSION: The risk of severe impairment to the ocular surface and ocular tissues may be underestimated. Cosmetic surgeons and ophthalmologists must be aware of the complications, and the long-term follow-up of these changes needs further investigation and discussion. Safety protocols of the HIFU intensity threshold for thermal lesions in the eye and the use of protective eye devices should be better evaluated.

Traboulsi syndrome without features of Marfan syndrome caused by a novel homozygous ASPH variant associated with a heterozygous FBN1 variant.

BACKGROUND: Traboulsi syndrome is a rare disease clinically characterized by facial dysmorphism, abnormal spontaneous filtering blebs, ectopia lentis (EL) and multiple anterior segment abnormalities. MATERIAL AND METHODS: An 18-year-old female was referred to the Emergency Service of Hospital São Geraldo (HSG) claiming decreased right eye (RE) visual acuity associated with ocular pain that was noticed approximately 2 months earlier. She underwent a complete ophthalmic and physical examination including hands, ankle, wrist and chest X-ray, abdominal ultrasound, echocardiogram and genetic analysis (whole-exome sequencing). RESULTS: The ophthalmic examination revealed a high myopia with spherical equivalent of - 9.50 D and best corrected visual acuity (BCVA) of 20/60 in RE and - 9.25 D with BCVA of 20/30 in the left eye (LE). Slit-lamp examination showed normal conjunctiva in both eyes (BE) and a superior-temporal cystic lesion in RE and nasal in LE; the flat anterior chamber in BE with the transparent crystalline lens touches the central corneal endothelium in the RE. Fundoscopy suggested glaucoma as the cup/disc ratio was 0.7, although the intraocular pressure (IOP) was 10 mmHg in BE without medication. Validation of data from whole exome demonstrated a novel splicing homozygous pathogenic variant (PV) (c.1765-1G>A) of the ASPH gene as well as a heterozygous variant of unknown significance (VUS) of the FBN1 gene (c.6832C>T). CONCLUSION: We here report a novel splice-affecting homozygous pathogenic variant in the ASPH gene that was detected in a Brazilian patient with clinical features of Traboulsi syndrome.

Scleral fixation of iris-Intraocular lens complex (Reper®) with Canabrava double-flanged technique: a case report.

A 38-year-old patient who developed aphakia and aniridia secondary to trauma suffered from vision loss. To improve her vision, an iris-intraocular lens complex (Reper®) was fixed to the sclera with Canabrava's double-flanged technique. There was a satisfactory increase in the patient's visual acuity and no complications were observed during the 6-months follow-up. Canabrava technique simplifies and improves the fixation of the iris-intraocular lens complex to the sclera. It is a safe option that does not require scleral flaps or knots.

Iridologia oftalmotrópica: signo-germânica, estratégias herbais chinesas / Ophthalmotropic Iridology: Germanic sign, Chinese herbal strategies

As Fórmulas Herbais Chinesas agem por princípios farmacodinâmicos, bem como energéticos, nos cinco movimentos da Medicina Tradicional Chinesa (MTC), na qual existem vários microssistemas. Entre estes microssistemas, o olho parece ser o mais completo no que tange entender as várias síndromes da MTC, facilitando as suas estratégias fitoterápicas específicas, pois através dos meridianos principais, acessórios e/ou canais de energia, o Chi transita através do olho. O importante anatomista Poliak refere que na filogênese primeiramente surgiu o olho e somente depois o cérebro.

A new periocular dataset collected by mobile devices in unconstrained scenarios.

Recently, ocular biometrics in unconstrained environments using images obtained at visible wavelength have gained the researchers' attention, especially with images captured by mobile devices. Periocular recognition has been demonstrated to be an alternative when the iris trait is not available due to occlusions or low image resolution. However, the periocular trait does not have the high uniqueness presented in the iris trait. Thus, the use of datasets containing many subjects is essential to assess biometric systems' capacity to extract discriminating information from the periocular region. Also, to address the within-class variability caused by lighting and attributes in the periocular region, it is of paramount importance to use datasets with images of the same subject captured in distinct sessions. As the datasets available in the literature do not present all these factors, in this work, we present a new periocular dataset containing samples from 1122 subjects, acquired in 3 sessions by 196 different mobile devices. The images were captured under unconstrained environments with just a single instruction to the participants: to place their eyes on a region of interest. We also performed an extensive benchmark with several Convolutional Neural Network (CNN) architectures and models that have been employed in state-of-the-art approaches based on Multi-class Classification, Multi-task Learning, Pairwise Filters Network, and Siamese Network. The results achieved in the closed- and open-world protocol, considering the identification and verification tasks, show that this area still needs research and development.

Acquired acoria and iris pearls in leprosy: Case report.

PURPOSE: To describe a case of a patient presenting with acquired acoria and iris pearls, a rare eye manifestation and pathognomonic finding for leprosy; to reinforce clinical, histopathological, and therapeutic aspects of ocular involvement in leprosy. METHODS: Case report. CASE DESCRIPTION: A 62-year-old male presenting with acquired acoria and iris pearls in both eyes due to leprosy also had anterior uveitis and cataract. Histopathological diagnosis of iris pearls was confirmed by the presence of Hansen's bacilli. Ophthalmological examination revealed improvement of the visual acuity after iridectomy and extracapsular cataract extraction. CONCLUSIONS: To our knowledge, this is the first reported case of acquired acoria in a leprosy patient. It led to impaired vision and reversible blindness. Proper diagnosis and ophthalmological treatment of patients with these conditions are essential for the maintenance of a good quality of life.

Ophthalmological manifestations of the Schuurs-Hoeijmakers syndrome: a case report.

This is a case report of a 2-year-old male patient with cognitive delay, facial abnormalities, and microcornea in the right eye, who was referred for ophthalmological investigation. The initial ophthalmological examination revealed hypertelorism, epicanthus, nystagmus, esotropia, and microcornea in the right eye. The examination under anesthesia revealed microphthalmia in the right eye, and iris, retina, and optic nerve coloboma in both eyes. Whole exome sequencing revealed evidence of a heterozygotic pathogenic variant in PACS1. The PACS1 pathogenic variant in association with the clinical findings confirmed the diagnosis of Schuurs-Hoeijmakers syndrome. To our knowledge, this is the first report to describe microcornea and microphthalmia as additional ocular manifestations of Schuurs-Hoeijmakers syndrome.

Psicoiridologia: Jung e o método Rayid / Psychoiridology: Jung and the Rayid method

Este livro procura estabelecer a relação existente entre o Método Rayid e a abordagem Junguiana, de modo facilitar a compreensão do individuo, seja para o terapeuta junguiano, como também para o Iridologista que conhece o Metódo Rayid, descrito por Denny Jonhson. Ambos, o Método Rayid e a análise junguiana têm muito em comum e as irises dão as informações necessárias para se realizar a interposição de informações, que as duas escolas fornecem para melhor se compreender o individuo, fornecendo, também, subsídios para as estratégias a serem adotadas frente ao ser humano que está sendo analisado. Esse livro trata-se de um profundo e prático facilitador para a junção destas duas abordagens.

Iridologia: olhodiagnose alemã e chinesa, estudo comparativo e integrativo / Iridology: German and Chinese ocular diagnosis, comparative and integrative study

Trata-se de uma obra inovadora, provavelmente, inédita correlacionando a Olhodiagnose da Escola Alemã de Iridologia, com a Medicina Tradicional Chinesa, possibilitando, destarte, oferecer tanto ao Iridologista quanto ao praticante da Medicina Tradicional Chinesa, um Universo maior, para melhor compreender o individuo a ser analisado, fornecendo, também, estratégias que visem equilibrar o individuo.

Severe sequelae in bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin: a case report.

BACKGROUND: Moxifloxacin is a fourth-generation fluoroquinolone used as a second-line treatment for multiple bacterial infections. Uveitis has been described as an adverse effect related to this medication. Although several case reports have been published describing uveitis and bilateral acute iris transillumination syndrome related to moxifloxacin, we present a unique case of a patient with severe sequelae associated with bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin. CASE PRESENTATION: A 45-year-old Colombian hispanic female presented bilateral conjunctival hyperemia, decreased visual acuity, blurred vision, photophobia, and ocular pain after 15 days of treatment with systemic moxifloxacin for an upper tract respiratory infection. The patient presented unilateral anterior chamber pigment dispersion, mydriatic and nonreactive pupils, extensive iris transillumination defects, and secondary glaucoma. Blood and aqueous humor tests were negative for infectious and autoimmune diseases. Moxifloxacin-induced bilateral acute iris transillumination syndrome was diagnosed. Permanent sequelae such as ocular pain, photophobia, and focus difficulty secondary to severe bilateral iridian atrophy and inability of synkinetic reflex were left. Additionally, glaucoma was diagnosed, and Ahmed valve implantation was required. CONCLUSIONS: We should be aware of the possible association between moxifloxacin and bilateral acute iris transillumination syndrome. A detailed anamnesis, adequate examination, and laboratory tests are necessary to reach an early diagnosis and treatment to avoid unnecessary therapies. Larger studies should be carried out to understand the pathophysiology, diagnosis, management, and sequelae of the disease.

Dermoscopy of the iris: identification of Lisch nodules and contribution to the diagnosis of neurofibromatosis type 1

Abstract Neurofibromatosis is a common genodermatosis, whose diagnosis often involves the participation of a dermatologist. A case of a 38-year-old female patient with four café-au-lait macules and eleven neurofibromas on clinical examination is presented. Dermoscopy allowed the identification of Lisch nodules in the iris, bilaterally. The combination of these findings allowed the diagnosis of neurofibromatosis type 1, according to NIH criteria. Lisch nodules are melanocytic hamartomas of the iris, which must be evaluated through a visual augmentation method, usually employed in ophthalmology. Alternatively, dermoscopy can be used and contribute to the early diagnosis of neurofibromatosis type 1.

Dermoscopy of the iris: identification of Lisch nodules and contribution to the diagnosis of Neurofibromatosis type 1.

Neurofibromatosis is a common genodermatosis, whose diagnosis often involves the participation of a dermatologist. A case of a 38-year-old female patient with four café-au-lait macules and eleven neurofibromas on clinical examination is presented. Dermoscopy allowed the identification of Lisch nodules in the iris, bilaterally. The combination of these findings allowed the diagnosis of neurofibromatosis type 1, according to NIH criteria. Lisch nodules are melanocytic hamartomas of the iris, which must be evaluated through a visual augmentation method, usually employed in ophthalmology. Alternatively, dermoscopy can be used and contribute to the early diagnosis of neurofibromatosis type 1.

Acute angle closure triggered by oral benzodiazepines.

Benzodiazepines are psychoactive drugs that are prescribed worldwide with limited information on their ocular side effects. Acute angle closure glaucoma is an adverse event with a high risk of blinding, especially in the elderly. We report two patients under 45 years old who presented with bilateral acute angle closure secondary to use of two long half-life benzodiazepines (clonazepam and alprazolam). In addition to suspending the use of these medications and administering ocular hypotensive drugs, both patients were successfully treated with bilateral peripheral laser iridotomy. To the best of our knowledge, this is the first report of bilateral acute angle closure secondary to the use of clonazepam and alprazolam.

Pigment dispersion syndrome and its implications for glaucoma.

Pigment dispersion syndrome (PDS) represents a clinical spectrum of a relatively common and usually underdiagnosed phenomenon produced by spontaneous pigment dispersion from the iris into the anterior segment. PDS is often bilateral, has no gender predisposition, and presents at a young age, particularly in myopes. Although most patients experiencing an episode of pigment dispersion are asymptomatic, extreme photophobia, ocular pain, redness, and blurred vision may occur. Other characteristic signs are iridolenticular contact, concave iris configuration, 360° peripheral iris transillumination, and pigment deposition on the anterior chamber angle or the corneal endothelium (Krukenberg spindle). Early PDS diagnosis is crucial to detect patients with pigment-related ocular hypertension (POHT) that can eventually lead to pigmentary glaucoma (PG). The latter represents a sight-threatening condition in which mechanical, environmental, and genetic factors contribute to optic nerve damage. In this review, we update the pathogenic mechanisms involved in the clinical spectrum of the disease. We describe its clinical presentation, ophthalmologic manifestations, and complications, including the factors influencing the development of POHT and PG. Because PDS has variable clinical presentations that lead to misdiagnoses, we emphasize the differential diagnosis and the actual therapeutic strategies according to disease status.

Quiste de iris. A propósito de un caso / Iris cysts. About a case

Introducción: Los quistes de iris son lesiones benignas encapsuladas de contenido líquido que se pueden localizar en el epitelio pigmentario del iris o en su estroma, se clasifican de acuerdo con su etiología en primarios cuando no tienen una causa conocida y secundarios cuando se forman como consecuencia de traumatismos, fármacos, tumores malignos, uveítis, parásitos o trastornos sistémicos.Los síntomas incluyen obstrucción del eje visual, visión borrosa e incluso descompensación corneal, el diagnóstico se realiza mediante la observación directa a través de la lámpara de hendidura y con estudios de imagen como la ultrasonografía, una vez establecido el diagnóstico su tratamiento sigue siendo controversial e incluyen iridectomía, drenaje del conteni-do quístico, uso de láser argón y YAG láser.Presentación del caso: Paciente femenina de 28 años con antecedente de traumatismo ocular derecho, posteriormente presenta lesión quística en iris, valorada mediante biomicroscopía y estudios de imagen (ultrabiomicroscopía), confirmando el diagnóstico de quiste de iris, para lo cual se realiza drenaje quirúrgico con evolución favorable. Conclusión: Los quistes de iris son lesiones poco frecuentes que podrían comprometer el campo visual dependiendo de su localización y tamaño por lo que el drenaje quirúrgico del contenido quístico iridiano es una opción terapéutica eficaz.

Introduction: Iris cysts are benign encapsulated lesions of liquid content that can be located in the pigment epithelium of the iris or in its stroma, they are classified according to their etio-logy as primary when they do not have a known cause and secondary when they form as a consequence from trauma, drugs, malignant tumors, uveitis, parasites or systemic disorders.Symptoms include visual axis obstruction, blurred vision and even corneal decompensation. The diagnosis is made by direct observation through the slit lamp and with imaging studies such as ultrasonography. Once the diagnosis is established, its treatment remains contro-versial and include iridectomy, drainage of cystic contents, use of argon laser and YAG laser.Case presentation: A 28-year-old female patient with a history of right ocular trauma, subse-quently presenting a cystic lesion in the iris, assessed by biomicroscopy and imaging studies (ultrabiomicroscopy) confirming the diagnosis of iris cyst, for which surgical drainage was performed with a favorable evolution.Conclusion: Iris cysts are rare lesions that could compromise the visual field depending on their location and size, which is why surgical drainage of the iris cyst content is an effective therapeutic option.