Multiple Evanescent White Dot Syndrome Associated with Coronavirus Infection: A Case Report.

Coronavirus disease 2019 (COVID-19) causes ocular manifestations in approximately 11% of patients. Most patients typically develop ocular symptoms within 30 days of the onset of the first COVID-19 symptoms. The most common ocular manifestation is conjunctivitis, which affects nearly 89% of patients with eye problems. Other much less common anterior segment abnormalities caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are scleritis, episcleritis, and acute anterior uveitis. Posterior segment abnormalities caused by SARS-CoV-2 are mainly vascular, such as hemorrhages, cotton wool spots, dilated veins, and vasculitis. Herein, we report a rare manifestation of COVID-19 and multiple evanescent white dot syndrome (MEWDS) of the retina. In April 2021, a 40-year-old female patient was admitted to the Eye Clinic of Clinical Center of Montenegro (Podgorica, Montenegro). The patient's main complaint was sudden vision impairment, which occurred 14 days after a positive polymerase chain reaction (PCR) test result for SARS-CoV-2 infection. A complete eye examination was performed, followed by fundoscopy, optical coherence tomography (OCT), and fluorescein angiography (FA) tests. The results showed retinal changes associated with MEWDS. The patient underwent additional examinations to rule out common causes of multifocal retinitis, all of which were unremarkable. Therefore, it was concluded that retinitis was a complication of COVID-19. Given its non-invasive nature, fundus examination should be used as a standard screening method for retinal changes in patients with COVID-19.

Rapid fingerprinting of source and environmental microplastics using direct analysis in real time-high resolution mass spectrometry.

Microplastics are ubiquitous in the aquatic and terrestrial environment. To prevent further contamination, methods to determine their sources are needed. Techniques to quantify and characterize microplastics in the environment are still evolving for polymers and the additives and leachable substances embedded therein, which constitute the "chemical fingerprint" of an environmental microplastic. There is a critical need for analytical methods that yield such diagnostic information on environmental microplastics that enables identification of their composition and sources of pollution. This study reports on a novel approach for rapid fingerprinting of environmental microplastics and the screening of additives using Direct Analysis in Real Time (DART)-high resolution mass spectrometry. A variety of plastic samples were investigated, including virgin pre-production pellets, microbeads from personal care products, microplastics found in the aquatic environment, and synthetic fibers. The resulting mass spectra display ∼10,000 discrete peaks, corresponding to plastic additives released by thermal desorption and polymer degradation products generated by pyrolysis. These were used to characterize differences among plastic types, microplastic source materials, and environmental samples. Multivariate statistics and elemental composition analysis approaches were applied to analyze fingerprints from the mass spectra. This promising analytical approach is sensitive, (potentially) high-throughput, and can aid in the elucidation of possible sources of microplastics and perhaps eventually to the analysis of bulk environmental samples for plastics.

Acquired ectropion uveae and secondary glaucoma due to trauma: report of 3 cases.

PURPOSE: To investigate the possible association between acquired ectropion uveae and blunt trauma to the eye. We present 3 cases of acquired ectropion uveae that occurred after blunt trauma to the eye. There are no previously published data on possible association of these conditions. METHODS:: A retrospective review was conducted of patients with ectropion uveae and eye injury at University Eye Hospital over a 10-year period (2006-2016). We analyzed medical records and clinical findings. RESULTS:: Three eyes of 3 male patients with ocular trauma and ectropion uveae, ages 71, 68, and 5 years, were reviewed. The period between the eye injury and the diagnosis of ectropion uveae ranged from 10 to 36 months. All 3 eyes developed clinical evidence of secondary glaucoma with moderately to severely elevated intraocular pressure (IOP) (ranging from 29 to 48 mm Hg). Surgical treatment (trabeculectomy) was needed in 2 cases in order to control secondary glaucoma and conservative treatment was sufficient in 1 case. Mean patient follow-up was 19.3 ± 4.6 months. CONCLUSIONS:: Trauma can be considered as a cause of acquired ectropion uveae. Acquired ectropion uveae following eye trauma may be associated with significant increase in IOP. All patients in our series had secondary glaucoma and 2 of 3 required surgical treatment for IOP control.

Secondary surgical management of suprachoroidal hemorrhage during pars plana vitrectomy.

INTRODUCTION: Suprachoroidal hemorrhage (SCH) is one of the most feared and devastating complications of intraocular surgery. Intraoperative SCH is defined as sudden hemorrhagic swelling of the choroid which develops at time of intraocular surgery, and is associated with expulsion of some or all of the intraocular contents. CASE REPORT: A 56-year-old man was admitted to our Clinic with bullose retinal detachment in the left eye. Intraoperatively, during the substitution of perfluorocarbone liquid (PFCL) with silicone oil, which is very rare situation, a sudden loss of red reflex happened and SCH was recognized as the cause. No attempt was made to drain the suprachoroidal blood. After 3 weeks the patient was scheduled for pars plana vitrectomy. Initial drainage of liqufied blood was made through a sclerotomy port during pars plana inferotemporally. Massive epiretinal proliferation with funnel shaped retinal detachment was solved during vitrectomy and internal tampo- nade with silicone oil was done. Postoperative visual aquity was 2/60 on the third postoperative day. CONCLUSION: Although suprachoroidal hemorrhage is one of most feared and devastating complications ofintraocular surgery, it might have relatively good prognosis with proper preoperative, intraoperative and postoperative management

Retinal detachment in the eye with the choroidal coloboma.

INTRODUCTION: Choroidal coloboma is a congenital defect caused by an inadequate closure of embryonic fissure. About 40% of the eyes with the choroidal coloboma (CHC) develop the retinal detachment (RD). It is extremely difficult to manage these cases due to the lack of pigmentation at the site of choroidal coloboma. OUTLINE OF CASES: This is a case series of five patients with CHC and RD who were successfully operated using one of two different surgical techniques: pars plana vitrectomy (PPV)+silicone oil internal tamponade and/or scleral buckle with encircling band with laser photocoagulation (SB+EB+LPC) around the coloboma. The purpose of this paper is to present how to successfully handle patients with CHC, who have concurrent retinal detachment in the same eye and to compare two different techniques and indications for the predominant use of one of them in a specific case. CONCLUSION: Both surgical techniques can be applied with equal success in the operation of retinal detachment in eyes with the chorioidal coloboma. Which one will be used depends only of the posterior segment of eye findings. We use scleral buckling in cases with RD accompanied by CHC when the peripheral break is evident and there are no breaks in the coloboma itself. We also perform, 2-3 days after surgery, laser burns around the coloboma, which is our modification of this technique. In all other cases it is indicated to perform PPV+silicon oil internal tamponade.

Morphometric characteristics of optic disc in patients with myopia and primary open-angle glaucoma.

BACKGROUND/AIM: Primary open-angle glaucoma is a multifactorial and progressive neuropathy, characterised by the acquired loss of ganglion cells of the retina and their axons. One of the risk factors for primary open-angle glaucoma is myopia over 5 diopters (D). The aim of our work was to investigate two groups of patients with primary open-angle glaucoma and myopia by using confocal scanning laser ophthalmoscopy, and to find out if the size of refractive error influences optic disk morfometric characteristics. METHODS: One hundred eyes of one hundred patients with primary open-angle glaucoma and myopia were involved in our study. All the patients were classified into two groups, the first one with myopia < 5 D, and the second one with myopia > or = 5 D. The Heidelberg retina tomograph is a technique we used in our study. We analized morfometric parameters of patients optic discs, with the aim to find a correlation between the parameters in each group separeatly, and also to find differences between the same parameters from both groups. RESULTS: There were significant differences in disc area, cup area, rim area and mean RNFL thickness between the two groups. The size of damage of neuroretinal rim in the group with high myopia was 27%, and in the group with lower myopia 14%. The most frequently damaged segment of neuroretinal rim in the patients with high myopia was nasal segment and in the patients with low myopia infero-temporal one. The least frequently damaged segment of neuroretinal rim in both groups was temporal one. CONCLUSION: Optic discs of glaucomatous patients with high myopia have bigger diameter, also bigger and more irregularly distributed damaged zone of neuroretinal rim, and also thinner retinal nerve fiber layer compared to glaucomatous patients with lower myopia.

Natural evolution of experimental vitreous hemorrhage and effects of corticosteroids on its course.

INTRODUCTION: The course and prognosis of vitreous hemorrhage (VH) are difficult to predict in spite of so far published experimental and clinical studies. OBJECTIVE: The goal of this study was to follow the course and evaluate prognosis of vitreous hemorrhage. METHODS: The experiment was performed on 19 Chinchilla rabbits (Oryctolagus cuniculus), both males and females (38 eyes), weighing 2500-3000 g, which were treated with autologous blood (B) from marginal ear vein--the first group, and the second group was treated with both blood and corticosteroids (B+CS). The course of vitreous hemorrhage was examined. RESULTS: Our results have shown that the cellular reaction to vitreous hemorrhage is different, compared to hemorrhage in other types of tissue, which is due to absence of an early polymorphonuclear cellular reaction. Number of cells within vitreous body is very low. CONCLUSION: Vitreous hemorrhage has unusual course followed by a small number of cells (mostly polymorphonuclear cells). This is most important fact why VH is cleared very slowly (about 6 to 9 weeks). CS has moderate influence on the acceleration ofVH absorption.

Effects of Different Amounts of Supplemental Selenium and Vitamin E on the Incidence of Retained Placenta, Selenium, Malondialdehyde, and Thyronines Status in Cows Treated with Prostaglandin F2α for the Induction of Parturition.

The incidence of retained placenta (RP) in cows increases in cases of parturition induced by prostaglandin F2α . We analyzed the effects of different doses of supplemental selenium and vitamin E on the incidence of RP, blood selenium, plasma thyronines, and malondialdehyde concentration. Thirty-three clinically healthy, multiparous Holstein-Frisian cows were assigned to 3 groups and supplemented with a single intramuscular injection of sodium selenite (SS) and tocopherol acetate (TAc) between days 250 to 255 of gestation: control-unsupplemented; group A-10 mg SS + 400 mg TAc; group B-20 mg SS + 800 mg TAc. Parturition was induced using PGF2α not before day 275 of gestation. The RP incidence was reduced from 66.7% in the control to 38.2 and 30.8% in groups A and B, respectively. Blood selenium and glutathione peroxidase activity in treated groups were significantly higher compared to control, with no significant difference between groups A and B. Plasma malondialdehyde in group B was significantly lower than that in control and group A, while thyronines levels were not affected. Comparison of RP and non-RP cows, independently of supplement treatment, revealed higher blood selenium and glutathione peroxidase activity and lower MDA and thyroxine in non-RP animals, while triiodothyronine level did not differ.

Unusual eye injuries.

PURPOSE: The analysis of ten unusual eye injuries, and the discussion of appropriate preventive measures. CASE OUTLINE: Ten patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, in the period from January 2000. to December 2009. were presented. Following data were taken in account: sex and age of the patient, injured eye, the mechanism of injury, type of the injury, applied treatment and final visual acuity. The circumstances of the eye injuring of ten patients were described. The eye injuries in all cases occurred in a bizarre way and they were severe enough to require hospital admission. The surgery was necessary in seven patients. Three injured eyes resulted in blindness, and two additional had subnormal vision. CONCLUSION: In three quarters of discussed cases injuries can be avoided. It is necessary to implement protective measures constantly and consistently and to think about the possible consequences of certain activities. Particular attention should be paid on safety of children. The iatrogenic injuries require special consideration.

Ocular injuries caused by airsoft guns - ten-year experience.

INTRODUCTION: The study describes ocular injuries caused by airsoft guns pellets, type of these injuries and their incidence in different age groups. METHODS: This is a retrospective review of medical charts of patients who were hospitalized due to airsoft guns ocular injuries in ten-year period (from 2000 to 2009). Patient's age, gender, duration of hospitalization, type of treatment and initial and final visual acuity were analyzed. RESULTS: Overall 92 patients with ocular injuries caused by airsoft gun pellets were hospitalized in ten-year period. In all patients only one eye was injured and there were 72 (78.3%) male patients. Injuries involved ocular adnexa, anterior and posterior segment of the eye. On initial examination 41 (44.6%) patients were presented with subconjunctival hemorrhages, 42 (45.6%) with corneal abrasion, 42 (45.6%) patients had corneal edema, 6 (6.5%) had traumatic mydriasis, 90 (97.8%) patients exhibited hyphema, 10 (10.9%) iridodialysis, in 27 (29.3%) patients high intraocular pressure (IOP) was measured, one patient had subluxation of intraocular lens (IOL) and one patient had traumatic cataract. Posterior segment findings included vitreous hemorrhage in 3 (3.3%) patients, retinal hemorrhage in 15 (16.3%) patients, retinal edema in 35 (38.0%) patients and one patient had globe rupture. Average duration of hospitalization was 5.7 days (range from 1 to 18 days). Three patients (3.3%) required eye surgery, eight patients (8.7%) had anterior chamber washout while rest of the patients were conservatively managed. Visual acuity at hospital release was significantly improved comparing to initial visual acuity, ranging from counting fingers at 1 meter to 20/60 in 7 (8.6%) patients, from 20/50 to 20/30 in 13 (16.0%) patients and from 20/25 to 20/20 in 61 (75.3%) patients. In 11 patients testing the visual acuity was not possible because of their young age. CONCLUSION: Injuries attributed to airsoft guns were confined mostly to anterior segment. There was also high percentage of severe posterior segment trauma requiring hospital admission. The most important factors in preventing such injuries are restricting access to airsoft guns, especially to minors, as well as mandatory use of protective equipment such as protective eyeglasses.

Simultaneous injuries to both eyes in traffic accidents.

BACKGROUND: In traffic accidents, eye injuries occur as isolated or with polytrauma. They may involve just one eye, but simultaneous injuries to both eyes do happen occasionally. The aim of our paper was to reveal the risk factors, in an effort to reduce the number of such accidents and to prevent bilateral ocular damage. METHODS: All patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, due to traffic accidents with bilateral eye injuries in a period of 9 years from the beginning of 2000 to the end of 2008 were analyzed. RESULTS: In this 9-year period, a total of 36 patients were hospitalized and treated for bilateral ocular injury (72 eyes). There were 23 males among them, the male-female ratio being 1.8:1. Mean age was 33.9 years. The occupations of injured persons were the following: the most common were workers--15, followed by clerks--seven, while less common were pupils, students, pensioners and housewives-three of each of them, and farmers--two. Front-seat passengers were the most common among the injured--20 (55.6%), then drivers--15 (41.7%), with only one passenger from the back seat on the right side (2.7%). As many as 33 (91.7%) of them failed to fasten their seat belts, while 18 (50.0%) were drunk. Penetrating bulbar injuries or eyeball ruptures were predominant--66.7%, while blunt injuries were found in only two (2.8%) eyes in one single person; but in 22 cases (30.5%) there was adnexal damage, too. Visual acuity at discharge and subsequent controls was as follows: amaurosis in 21 (29.2%), less than 0.3 in nine (5.6%), 0.4 and better in 42 (58.1%), and normal visual acuity of 1.0 in 28 patients (38.3%). CONCLUSION: The major risk factors for getting bilateral eye injuries in traffic accidents proved to be: sitting in the front car seats, not fastening the seat belt and alcohol intoxication. Prevention of these risk factors would result in a decrease in such a large number of bilateral eye injuries.

[Problems in diagnosis and extraction of foreign bodies from the orbit associated with pain]. / Problem dijagnostike i ekstrakcije stranog tela u orbiti pracenog bolovima.

The aim of this study was to present the troubles and significance of a proper diagnosis of a foreign body which caused a double perforation of the eyeball and was retained in the orbit. Another reason for this case report was the intensive pain associated with the existing foreign body in the orbit. A male, 54 years old, had a perforating wound of the eyeball caused by a metal foreign body, which stayed in the orbit close to the scleral wall. X-ray and echographic examinations of the orbit were not conclusive regarding the question whether this foreign body was situated within or outside the eyeball. Only CT imaging showed that foreign body produced a double perforation of the eyeball and was externally close to the sclera. Foreign body was extracted by transconjunctival anterior orbitotomy through the inferior fornix, using the electromagnetic probe. Since the first day of injury and up to the eighth day, the patient had intensive deep orbital pain, which was alleviated only partially by analgetics. It could not be explained by secondary glaucoma because IOP was normal or by an inflammatory process, or in any other way. Only the extraction of foreign body from the orbit led to the complete relief of pain. We believe that the pain was caused by compression of foreign body to some of scleral sensory nerves. X-ray and echographic examinations of the orbit are not always a reliable proof in the proper evaluation whether foreign body is within or outside the eyeball in the orbit. Precise diagnosis can be made only by CT imaging. The pain in the orbit may be caused by compression of foreign body to sensory nerves.