Purtscher's like retinopathy - A rare ocular complication of acute pancreatitis.

INTRODUCTION AND IMPORTANCE: Purtscher retinopathy is the rare form of occlusive microvasculopathy, characterized by multiple retinal white areas around the optic nerve head and fovea with paravascular clearing and may be related to intraretinal hemorrhages. Acute Pancreatitis (AP) is one of the most common gastrointestinal reasons for hospital admissions globally. The complications of Acute Pancreatitis may include Purtscher's-like retinopathy, which has a low incidence rate of less than 0.24 instances per million cases. This case report highlights the value of thorough medical history taking and examination, and it apprises the consideration of ophthalmological manifestation in patients of Acute Pancreatitis. CASE PRESENTATION: A 34-year-old female came to the emergency room due to intense abdominal pain associated with nausea and vomiting, which worsened over the last 24 h. The pain was described as continuous, sharp, and cramping-like in the upper abdomen, radiating to the back. Lab tests revealed elevated serum amylase and lipase levels, indicating pancreatitis, along with slight leukocytosis. A contrast-enhanced CT scan confirmed acute pancreatitis with mild inflammation and enlargement of the pancreas. Two days after admission, the patient experienced a sudden and painless loss of central vision in both eyes. There was no history of trauma or any other significant relevant history, other than pancreatitis. The ophthalmologist's examination found reduced visual acuity (6/60 in the right eye, 3/60 in the left eye), normal corneas, and anterior chambers. DISCUSSION: Inkeles and Walsh established the first link between acute pancreatitis and Purtscher-like retinopathy when they reported three cases of the distinctive retinal appearance in individuals with acute pancreatitis in 1975. CONCLUSION: The recovery and prognosis in cases of Purtscher-like retinopathy is variable and further research is required to ascertain the usage of corticosteroids and pentoxifylline in improving the course of a patient's with Purtscher's-like retinopathy.

BOB-ACG study: Pulse methylprednisolone to prevent bilateral ophthalmologic damage in giant cell arteritis. A multicentre retrospective study with propensity score analysis.

INTRODUCTION: Giant cell arteritis (GCA) is complicated in 10 to 20% of cases by permanent visual ischemia (PVI). International guidelines advocate the use of intravenous pulse of methylprednisolone from 250 to 1000mg per day, for three days, followed by oral prednisone at 1mg/kg per day. The aim of this study is to assess whether this strategy significantly reduces the risk of early PVI of the second eye, compared with direct prednisone at 1mg/kg per day. METHODS: We conducted a multicentre retrospective observational study over the past 15 years in 13 French hospital centres. Inclusion criteria included: new case of GCA; strictly unilateral PVI, prednisone at dose greater than or equal to 0.9mg/kg per day; for the intravenous methylprednisolone (IV-MP) group, total dose between 900 and 5000mg, close follow-up and knowledge of visual status at 1 month of treatment, or earlier, in case of contralateral PVI. The groups were compared on demographic, clinical, biological, iconographic, and therapeutic parameters. Statistical analysis was optimised using propensity scores. RESULTS: One hundred and sixteen patients were included, 86 in the IV-MP group and 30 in the direct prednisone group. One patient in the direct prednisone group and 13 in the IV-MP group bilateralised, without significant difference between the two strategies (3.3% vs 15.1%). Investigation of the association between IV-MP patients and contralateral PVI through classical logistic regression, matching or stratification on propensity score did not show a significant association. Weighting on propensity score shows a significant association between IV-MP patients and contralateral PVI (OR=12.9 [3.4; 94.3]; P<0.001). Improvement in visual acuity of the initially affected eye was not significantly associated with IV-MP (visual acuity difference 0.02 vs -0.28 LogMar), even in the case of early management, i.e., within the first 48hours after the onset of PVI (n=61; visual acuity difference -0.11 vs 0.25 LogMar). Complications attributable to corticosteroid therapy in the first month were significantly more frequent in the IV-MP group (31.8 vs 10.7%; P<0.05). DISCUSSION: Our data do not support the routine use of pulse IV-MP for GCA complicated by unilateral PVI to avoid bilateral ophthalmologic damage. It might be safer to not give pulse IV-MP to selected patients with high risks of glucocorticoids pulse side effects. A prospective randomised multicentre study comparing pulse IV-MP and prednisone at 1mg/kg per day is desirable.

Scleromalacia perforans as an early manifestation of late-onset rheumatoid arthritis: a case-based review.

Rheumatoid arthritis is a chronic autoimmune disease that can affect different organs beyond the joints. Ocular involvement includes keratoconjunctivitis sicca, peripheral ulcerative keratitis (PUK), episcleritis, scleritis, anterior uveitis, and corneal impairment. The most severe form of scleritis, scleromalacia perforans, is an aggressive ophthalmic manifestation that can potentially lead to blindness, usually occurring in late stages of disease. We report a case of an elderly woman in which this severe ocular manifestation occurred early on disease onset, differing from most of the previously reported cases of scleromalacia perforans. Ocular symptoms started concomitantly with the polyarthritis and other extra-articular manifestations, including rheumatoid nodules and vasculitic skin lesions. Ocular disease progressed due to patient's loss to follow-up, requiring pulse therapy with methylprednisolone. However, despite treatment, right eye enucleation was required due to melting of the corneal patch with uveal exposition. The patient was then treated with rituximab with improvement of systemic disease. The present case reinforces that, although rare, this complication is severe and must be promptly diagnosed and aggressively treated to improve prognosis of ocular and systemic RA.

Ocular surface reconstruction of Steven Johnson syndrome / toxic epidermal necrolysis affected eye - A case report.

Introduction: Toxic epidermal necrolysis (TEN), also known as Steven Johnson syndrome (SJS), is a devastating disease. Patients develop blindness and symblepharon despite multiple reconstructive surgeries. We report a case of SJS/TEN with ocular involvement where treatment with hyperbaric oxygen therapy (HBOT) resulted in a significant improvement in the visual acuity after surgery. Case presentation: A woman with SJS/TEN with severe ocular complication (SOC) had limbal stem cell deficiency and symblepharon of the superior and inferior fornix. Pannus grew over her cornea, reducing the vision to counting finger. The symblepharon produced shortening of the fornix, causing entropion. The in-turned eyelid caused her eyelashes to rub against the cornea, causing great damage to the ocular surface. Limbal stem cell deficiency led to the loss of normal corneal morphology and invasion of the pannus onto the central visual axis, resulting in poor vision. She experienced ocular inflammation for 3 months before transfer to our hospital for admission. Ophthalmic examination showed bilateral corneal opacity with conjunctivalization, and inferior and superior fornix shortening. Symblepharon-lysis with amniotic membrane transplantation was attempted but the outcome was poor, with recurrence of superior scaring and symblepharon. She finally underwent major reconstructive surgery with allogeneic limbal stem cell transplantation with her sister as the donor, autologous minor salivary gland transplantation, and oral buccal mucosa flap transplant. HBOT was given daily post-surgery for supporting the grafts and suppressing inflammation. After 17 HBOT sessions and 3 months of autoserum drops, her left eye vision increased from the initial counting finger to 0.4 due to the successful growth of the corneal epithelium from the donor corneal limbal cell line. When a scleral contact lens which vaulted over the corneal limbal area was fitted, her vision improved to 0.8 due to redressal of high order aberration and astigmatism from the cornea scar. Conclusion: After major reconstruction of the ocular surface with multiple cell type transplants, including limbal stem cells, minor salivary gland acinar cells, and oral mucosa cells, HBOT proved useful in supporting the graft uptake and oxygenation of the donor tissues, enabling fast recovery of the grafts and cell functioning, with eventual return of the working vision of the patient.

Risk Factors for Ocular Complications and Visual Loss in Patients with Juvenile Idiopathic Arthritis-associated Uveitis at a Turkish Tertiary Ophthalmology and Pediatric Rheumatology Referral Center.

PURPOSE: To investigate the rates of ocular complications and visual loss and their risk factors in patients with juvenile idiopathic arthritis (JIA) -associated uveitis. METHODS: Medical records of 51 patients were reviewed. RESULTS: The incidence of visual loss to the 20/50 or worse was found to be 0026/ eye-year (EY) in the present study. Cataract and ocular hypertension occurred during the follow-up period and were significantly associated with visual acuity loss to 20/50 or worse (p = .008, HR 11.932, 95% CI 1.915-74.355; p = .03, HR 7.323, 95% CI 1.216-44.110, respectively). Anti-TNF therapy was initiated in 88.2% of our cases and 93.3% of them achieved uveitis inactivity. CONCLUSION: The risk of vision loss is higher in patients with JIA-associated uveitis who had complications at presentation. We attribute the lower complication rates and better visual outcomes in our study to the early and frequent use of biologic agents.

COVID-19 Vaccine-Related Vogt-Koyanagi-Harada Disease Complicated by Central Serous Chorioretinopathy during Treatment Course: Case Report and Literature Review.

With the promotion of mass COVID-19 vaccination in the elimination of the SARS-CoV-2 pandemic, new side effects, including ocular complications, are emerging. In this study, we report on a 62-year-old Chinese man who developed Vogt-Koyanagi-Harada (VKH) disease six days after his third dose of an inactivated COVID-19 vaccine, with a preceding severe headache and tinnitus. His medical history included tuberculosis 20 years prior and hypertension. Systemic prednisone was administered, resulting in completely relieved inflammation and improved visual acuity. Another three and a half months later, the visual acuity of his right eye slightly decreased due to complicated central serous chorioretinopathy (CSC) disease. By gradually replacing prednisone with cyclosporine within 2 months, the subretinal fluid was completely absorbed at the last visit. Steroid-related CSC during the treatment course of VKH disease after COVID-19 vaccination has never been reported before. By reviewing relative literature, we discuss the mechanism of CSC onset in our case and the potential therapeutic strategies. Complicated CSC may develop in the eyes with vaccine-related VKH after steroid treatment. Ophthalmologists should be aware of this condition, carefully distinguish complicated CSC with inflammation relapse, and adjust the medication in a timely manner.

Uveítis, complicación ocular de enfermedades reumatológicas / Uveitis, ocular complication of rheumatologic diseases

Las espondiloartropatías constituyen una de las causas más frecuentes de uveítis anteriores. Las uveítis asociadas a espondiloartropatías se encuadran dentro del grupo de las uveítis relacionadas con el antígeno de histocompatibilidad HLA-B27. El objetivo de este estudio es presentar una revisión de las uveítis asociadas a las espondiloartropatías seronegativas (espondilitis anquilosante, artropatía psoriásica, artritis reactiva o síndrome de Reiter y enfermedad inflamatoria intestinal), así como la afectación ocular en el contexto de la artritis reumatoide del adulto y la artritis idiopática juvenil. Las manifestaciones oculares, que incluyen epiescleritis, escleritis, queratitis ulcerosa periférica y enfermedad del ojo seco, se pueden encontrar hasta en el 39 por ciento de los pacientes con artritis reumatoide. La uveítis anterior aguda unilateral recidivante es la más frecuente en las espondiloartropatías, y puede ser la forma de inicio de una espondiloartropatía no diagnosticada previamente. La colaboración entre oftalmólogos y reumatólogos o internistas es fundamental para el correcto manejo y tratamiento de estos pacientes(AU)

Spondyloarthropathies are one of the most frequent causes of anterior uveitis. Uveitis associated with spondyloarthropathies fall within the group of uveitis related to the histocompatibility antigen HLA-B27. To present a review of uveitis associated with seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthropathy, reactive arthritis or Reiter's syndrome and inflammatory bowel disease), as well as ocular involvement in the context of adult rheumatoid arthritis and arthritis Juvenile idiopathic. Ocular manifestations, including episcleritis, scleritis, peripheral ulcerative keratitis, and dry eye disease, can be found in up to 39 percent of rheumatoid arthritis patients. Recurrent unilateral acute anterior uveitis is the most frequent in spondyloarthropathies, and can be the initiation of a previously undiagnosed spondyloarthropathy. Collaboration between ophthalmologists and rheumatologists or internists is essential for the correct management and treatment of these patients(AU)

A new injury severity scale for ocular complications following cosmetic filler injection.

BACKGROUND: Cosmetic filler injection can cause a variety of eye complications; however, there is currently no good way to evaluate injury severity and prognosis. By analyzing the injury manifestations of severe ocular complications following cosmetic filler injection and their prognosis, we propose a new injury severity scale. METHODS: Twenty-two eyes of 22 patients experiencing ocular complications following cosmetic filler injection were followed for 6 months to observe injury characteristics, manifestations and prognosis. Best corrected visual acuity (BCVA), intraocular pressure (IOP), split lamp microscopy, fundus photography, optical coherence tomography (OCT), and fundus fluorescein angiography were examined at the onset and follow-up visits. RESULTS: According to the immediate BCVA at the time of injury (with the presence or absence of brain infarction), a new injury severity scale was proposed, namely, Grades 1-4. Grade 1 (4 patients) and Grade 2 (2 patients) tended to have no atrophy of the globe. Grade 3 (12 patients) and Grade 4 (4 patients) were more likely to develop atrophy of the globe (4/12 patients and 2/4 patients, respectively) at the last follow-up. Grade 3 and Grade 4 were more likely to be complicated with ophthalmoplegia and ptosis (7/16 patients). CONCLUSIONS: The new injury severity scale we proposed can determine the prognosis of different ocular complications following cosmetic filler injection. Accordingly, we can inform injured patients regarding the possibility of phthisis bulbi and the extent of improvement of visual impairment, ophthalmoplegia, ptosis and stroke.

Ocular Complications of Pediatric Inflammatory Bowel Disease: A Case Series From a Pediatric Tertiary Medical Center.

Background. Ocular extraintestinal manifestations (O-EIMs) are one of the most well-known EIMs in patients with inflammatory bowel disease (IBD). This study aimed to identify the frequency of O-EIMs in children with IBD, referred to Mofid Children's Hospital, Tehran, Iran, during 2014 to 2019. Methods. Children with IBD, younger than the age of 18 years, who were referred to an ophthalmologist, were included in this study. Results. Ninety-six patients with IBD were examined. Four patients had ocular manifestation of IBD. Two patients had complications due to treatment of IBD. The mean age of the patients was 11.25 ± 4.17 years (range: 5.5-17 years). The O-EIMs included 3 (50.0%) cases of anterior uveitis, 1 (16.7%) case of episcleritis, and 2 (33.3%) cases of posterior subcapsular cataract. Conclusion. O-EIMs are important in children with IBD. Therefore, it is recommended that annual screening for ocular complications be performed in all children with IBD.

Disminución de la agudeza visual tras un procedimiento odontológico: A propósito de un caso / Unilateral visual impairment after a dental procedure: Case report

El uso de anestésicos locales para la realización de procedimientos odontológicos es una práctica ampliamente extendida que puede causar efectos adversos. Sin embargo, muy infrecuentemente puede causar complicaciones oculares como diplopía, ptosis, visión borrosa, miosis, disminución de la agudeza visual o amaurosis. Presentamos un caso de un paciente varón de 26 años que se presentó a la consulta por una disminución de la agudeza visual en su ojo derecho 48h después de una intervención odontológica del lado ipsilateral, logrando una recuperación de la misma en los 6 meses posteriores, sin tratamiento alguno. Diferentes teorías que justifiquen la aparición de complicaciones oculares como consecuencia de esta clase de procedimientos han sido propuestas en la literatura. En nuestro caso, una inyección intravenosa inadvertida habría sido la causa posible del hecho (AU)

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause (AU)

Unilateral visual impairment after a dental procedure: Case report.

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause.

Toxic keratopathy related to antiseptics in nonocular surgery.

Antiseptics, especially those containing ethanol, are toxic to the ocular surface. Here, we report a 5-year-old girl with antiseptic-related eye injury following an uneventful bilateral tonsillectomy under general anesthesia. Before surgery, her eyes were protected and disinfection of perioral skin with ethanol-containing chlorhexidine followed. Whitening of the lower half of her right ocular surface was found after the surgery, and this indicated severe chemical burn. Prompt irrigation with normal saline, instillation of topical medication, and application of amniotic membrane containing device were performed, which led to a satisfactory result. Toxic eye injury could happen in head and neck surgeries under general anesthesia. Causes of ocular injury include improper eye protection, head positions leading to accumulation of excessive antiseptics, and improper usage of ethanol-containing antiseptics for skin preparation. The use of ethanol-free antiseptic solutions in the peri-ocular region and proper protection of eyes may reduce the risk of severe ocular surface injury in nonocular surgeries.

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan.

Purpose: Over the last decade, there has been tremendous progress in the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To understand whether this has resulted in better ophthalmic outcomes, we aimed to study the incidence of severe ocular complications (SOCs) in the acute and chronic stage among SJS/TEN patients, major causative medications, and therapeutic effect of medical and surgical treatment. Methods: Using electronic medical records review of patients of Chang Gung Memorial Hospital Linkou Branch from 2010 to 2020, 119 patients (236 eyes) received ophthalmic consultation during the acute stage and were retrospectively studied. Sotozono's grading score systems for acute and chronic SJS/TEN were employed for accessing correlation between acute and chronic presentations, the therapeutic effect of systemic etanercept treatment, and outcome of early amniotic membrane transplantation (AMT) performed in patients with severe acute SOCs. Results: There were 46 male and 73 female patients with a mean age of 45.6 ± 22.7 years old (2-90 years), and follow-up time of 408.3 ± 351.0 (116-1,336) days. The numbers of patients with SJS, overlap syndrome, and TEN were 87, 9, and 23, respectively. In total, 109 eyes (55 patients) had acute SOCs, which comprised 46.2% of patients who underwent ophthalmic examination. Antiepileptics were the most common category of culprit drugs causing SOCs in the acute stage. At the end of follow-up, there were 14 eyes (9 patients) with chronic SOCs (5.9%), and non-steroidal anti-inflammatory drugs and cold medicine were the most common causative medications that were associated with severe chronic sequela. The correlation between Sotozono's acute and chronic grading score showed a positive relationship [Spearman's rank correlation coefficient (r) = 0.52, p < 0.001]. The average chronic grading scores in patients receiving systemic corticosteroid combined with etanercept treatment were significantly lower than those receiving corticosteroid only, Finally, the average chronic grading scores in patients receiving AMT <7 days after onset were significantly lower than those performed beyond 7 days. Conclusion: Our study implies that acute manifestation can be an indicator for chronic sequelae. Additional early etanercept treatment and early AMT showed beneficial effect in reducing chronic ocular sequela.

Retrospective analysis of adverse events with dupilumab reported to the United States Food and Drug Administration.

BACKGROUND: Atopic dermatitis (AD) is one of the most common inflammatory skin diseases and has aesthetic, physical, and emotional-social sequelae when left untreated. OBJECTIVE: To classify the most common adverse reactions associated with dupilumab treatment in patients with AD. METHODS: The United States Food and Drug Administration Adverse Event Reporting (FAERS) database was analyzed for common adverse reactions associated with dupilumab, topical pimecrolimus, and topical tacrolimus. Phase III clinical trial data were used to compare the rate of herpes infections between the treatment group and placebo group. RESULTS: The most common adverse reaction associated with dupilumab was ocular complications. Herpes infections were extremely rare in the patients with AD being treated with dupilumab. LIMITATIONS: Prescribing information for dupilumab, topical pimecrolimus, and topical tacrolimus is not available. Adverse effects are reported by patients, health care providers, and pharmaceutical companies, they have not been corroborated. CONCLUSIONS: Ocular complications are the most common complication associated with dupilumab. The rate of herpes infection is low in patients being treated with dupilumab, topical pimecrolimus, and topical tacrolimus. There is no significant difference for the rate of herpes infection between, placebo, dupilumab, topical pimecrolimus, and the topical tacrolimus treatment group, suggesting that dupilumab does not affect herpes infection rates.

Pharmacological Effects of Saffron and its Constituents in Ocular Disorders from in vitro Studies to Clinical Trials: A Systematic Review.

INTRODUCTION: Some medicinal plants have shown promising therapeutic potential for the management of the diseases. We aimed to systematically review the literature wherein the therapeutic effects of saffron have been studied on eye disorders. METHODS: A systematic literature search was performed in PubMed, Scopus, Web of Science, Google scholar and other databases using eye disorders and saffron as key terms. No strict inclusion criteria were defined, and almost all clinical studies, as well as in vivo and in vitro studies were included. The reported data in each study were extracted and then qualitatively described. RESULTS: Finally, 78 articles were found but only 29 relevant articles were included. Nine articles were clinical trials and 20 articles were studies conducted on cellular and molecular aspects of saffron on eye disorders. According to the included studies, crocin prevented the pro-inflammatory response in retinal cells and decreased glucose levels in diabetic mice. Also, crocetin prevented retinal degeneration and saffron protected photoreceptors from light-induced damage in retinal cells. Saffron also improved visual function in age-related macular edema and decreased intraocular pressure in patients with glaucoma. In addition, it was shown that crocin can improve best corrected visual acuity and decrease central macular thickness in patients with diabetic maculopathy. CONCLUSION: The results of this review indicated that saffron and its main ingredients such as crocin could be a potential candidate for the treatment of ocular disease especially eye inflammation; however, further clinical studies are needed to confirm such efficiency.

Unilateral visual impairment after a dental procedure: Case report. / Disminución de la agudeza visual tras un procedimiento odontológico: A propósito de un caso.

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause.

Using flowchart for ophthalmic consultations in hospitalized patients with COVID-19.

Ocular complications of coronavirus disease 2019 (COVID-19) do not essentially cause serious visual loss. However, due to the characteristics of this disease, delays in diagnosis and treatment in hospitalized patients may leave them with serious visual impairment. If conjunctivitis is suspected, ophthalmological follow-up is needless because it is expected spontaneous healing. Diplopia is often complicated for extra-ocular neurological findings and need neurological consults. Ophthalmologists should be consulted for ocular surface disease, high intraocular pressure, and ocular inflammation that may cause visual loss if patients complain of blurred vision, visual loss, and ocular pain. The problem is unconscious patients with risk of developing high intraocular pressure or keratitis. An ophthalmologist should be consulted as soon as possible if eye redness or pupil abnormalities appear in these patients. We developed a flowchart for ophthalmic consultations in hospitalized patients with COVID-19, for facilities where an ophthalmologist is not always present, and for third or fourth waves or, a pandemic of another infectious disease.

Management Strategies of Ocular Abnormalities in Patients with Marfan Syndrome: Current Perspective.

Marfan syndrome is an autosomal dominant genetic connective tissue disorder that results from mutations in the fibrillin-1 gene located on chromosome band 15q15-21. Fibrillin, a glycoprotein, is widely expressed throughout the body and contributes to the elasticity and force-bearing capacity of connective tissue. In the eye, fibrillin is a key constituent of the ciliary zonules, which suspend the crystalline lens in place. The zonular defect leads to ectopia lentis, which is a hallmark of Marfan ocular abnormalities and occurs in 60% to 80% of cases. Other less common ocular features of Marfan syndrome are increased axial length, astigmatism, and flat cornea. Visual function in Marfan syndrome could be affected in several ways: ectopia lentis, refractive error, amblyopia, retinal detachment, cataract, and glaucoma. Management of a subluxated lens starts with the correction of refractive error with eyeglasses in mild cases. In more severe cases, especially when the lens bisects the pupil, complete correction of refractive error is impossible without removing the subluxated lens. The best method for visual rehabilitation after lens extraction is still debated. Aphakic Artisan lens implantation at the time of subluxated lens removal results in good visual outcomes with an acceptable safety profile. Studies with longer term follow-up and larger sample populations are needed to evaluate the safety of this procedure in patients with Marfan syndrome.

Clinical Features and Prognosis of Uveitis in a Turkish Patient Population with Ankylosing Spondylitis: Incidence and Management of Ocular Complications.

Purpose: To investigate clinical features, visual prognosis, and ocular complications in patients with ankylosing spondylitis (AS)-associated anterior uveitis (AU). Methods: Data of 211 eyes of 145 patients with AU associated with AS were reviewed retrospectively. Results: Mean follow-up time was 6.31 ± 6.33 years. Men were younger than women at AS diagnosis (p = 0.035). The mean number of uveitis flares was highest during the first quarter of the year and lowest during the third quarter (p = 0.017). Immunosuppressive agent use was higher in women than men (p = 0.052). Ocular complications developed in 120 eyes (56.9%), and the complication rate was 0.146/eye year. Males developed cystoid macular edema more frequently than females (p = 0.05). Glaucoma was observed more often in early-onset disease (age at AS onset <45 years) than late-onset disease (p = 0.028). Conclusions: Visual prognosis of AU in patients with AS was good, although more than half of the eyes developed ocular complications (56.9%).