Occlusive Retinal Vasculitis After a Single Injection of Pegcetacoplan.

Purpose: To describe a patient with retinal vasculitis after a single intravitreal injection (IVI) of pegcetacoplan. Methods: A case and its findings were analyzed. Results: An 80-year-old woman was treated with pegcetacoplan for subfoveal geographic atrophy. Ten days later, the patient noted "purple iridescent waves" but did not immediately report it. On day 18, she presented with pain and decreased visual acuity from 20/80 (pinhole) preinjection to 20/150 postinjection. No signs of inflammation were observed, and she was treated for high intraocular pressure (30 mm Hg). On day 23, iritis was noted. The fluorescein angiogram showed severe occlusive vasculitis involving all quadrants and the macula. The vasculitis/neuroretinitis laboratory panels were negative, and no contributing systemic features were identified other than well-controlled diabetes. Conclusions: In this patient, occlusive retinal vasculitis occurred shortly after a single IVI of pegcetacoplan.

New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis.

Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.

Role of anti-TNF in Pediatric Inflammatory Choroidal Neovascularization: A Case Series.

OBJECTIVE: To highlight the safety and efficacy of Tumor Necrosis Factor inhibitors (anti-TNF) in inflammatory choroidal neovascularization (CNV) in the pediatric population. DESIGN: Retrospective case series. PARTICIPANTS: Three patients, < 16 years old with uveitic inflammatory CNV. METHODS: Patients received systemic steroids, methotrexate (MTX), intravitreal (IVT) injections of bevacizumab, and anti-TNF (infliximab or adalimumab) in case of refractory leakage. RESULTS: Five eyes of three pediatric patients (mean age 6 years old) presenting with CNV and put on anti-TNF were followed up for a minimum of 32 months. Four out of five eyes had improved vision, reduced fluid on clinical exam and macular spectral-domain optical coherence tomography (SD-OCT), and cessation of leakage on fundus fluorescein angiography (FFA) after introduction of anti-TNF agents. Two patients developed minor psoriasis treated topically. CONCLUSION: Anti-TNF agents showed efficacy and safety in a sustainable leakage control of inflammatory pediatric CNV along with improvement in vision.

Characteristics of open eye injuries in the Beirut Port explosion.

INTRODUCTION: On the 4th of August 2020 an ammonium nitrate explosion took place at the Port of Beirut in Lebanon. The aim of this study was to present the open eye injuries caused by the Beirut Port blast, and to describe their characteristics and visual outcomes at 6 months. METHODS: Patients who suffered from open globe injuries during the Beirut port explosion were recruited. Characteristics of the ocular injuries and best corrected distance visual acuity (BCVA) were recorded at presentation and at 6 months. RESULTS: All included eyes (23 eyes of 19 patients) suffered from penetrating open globe injuries secondary to glass material and were operated by globe exploration + primary repair. Four of the 19 patients suffered from bilateral injuries none of whom suffered from legal blindness. BCVA at presentation was hand motion or worse in 21 of 23 eyes (91%). Seven of 23 eyes (30%) had expulsive loss of intraocular tissue, 4 of 23 eyes (17%) had retinal detachment and 4 of 23 eyes (17%) had traumatic cataracts. Ocular trama score (OTS) had a mean +/- standard deviation (SD) of 61 +/- 12. Eleven of 23 eyes (48%) had zone 2 ocular injuries and 10 of 23 eyes (43%) had zone 3 ocular injuries. At 6 months follow-up 15 of 23 eyes (65%) had a BCVA of less than 20/200. All patients with Grade 2 OTS, zone 3 injuries, expulsive loss of intraocular tissue and retinal detachment had BCVA of less than 20/200 at 6 months. CONCLUSION: Open eye injuries secondary to explosions occur most frequently due to glass fragments. Most of the victims were indoors, near windows and less than 500m away of the explosion site at the time of the blast. The majority of victims have very low BCVA, a low OTS and a high ocular ZOI at presentation which reflects the danger of open globe injuries secondary to blasts. A high ZOI, a low OTS, the expulsive loss of intraocular tissue and retinal detachment seem to be predictors of worse VA at 6 months.

Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus.

PURPOSE: To report predictive factors of outcome of conventional epithelium-off corneal crosslinking (CXL) in the treatment of progressive keratoconus. METHODS: This is a monocentric observational retrospective study conducted at Eye and Ear International Hospital, Lebanon. All patients with progressive keratoconus who underwent CXL between January 2008 and January 2016, with minimal 3-years follow-up were included. Primary treatment outcomes were maximum keratometry (K max), best-corrected distance visual acuity (CDVA), and failure. Failure was defined as an increase of 1.00 diopters (D) or more in K max and/or an increase of 0.1 logMAR or more in CDVA and conversion to corneal transplantation. Statistical analysis was done to identify predictors of treatment success. Univariate and multivariate analyses were performed to determine the correlations between baseline parameters and outcomes, and an equation for predicting K max and CDVA was created. RESULTS: 156 eyes of 102 patients were enrolled. The mean age was 23.85 ± 6.52 years. Failure occurred in 31 eyes (19.87%). Gender and thinnest pachymetry did not have any impact on postoperative outcomes. Concerning the CDVA outcome, multivariate analysis showed that a better preoperative CDVA was associated with higher improvement in CDVA, and higher baseline K max and higher posterior mean K were associated with a worse outcome CDVA. Regarding postoperative K max, a higher baseline K max, a worse baseline CDVA, and a younger age were associated with less flattening postoperatively. CONCLUSION: CXL is a safe and effective method in treating progressive keratoconus. However, the clinical benefits can differ among patients, and in our series, a nonnegligible number of cases show a continued progression of their ectasia. Further studies to identify predictors of postoperative progression prior to the procedure could help sort out good responders to treatment.

Comparison of Efficacy and Ocular Surface Disease Index Score between Bimatoprost, Latanoprost, Travoprost, and Tafluprost in Glaucoma Patients.

AIM: The purpose of this study is to evaluate and compare the efficacy of 4 prostaglandin analogues (PGAs) and to determine the incidence of ocular surface disease in newly diagnosed, primary open-angle glaucoma (POAG) patients started on one of those 4 PGAs: bimatoprost (benzalkonium chloride, BAK, 0.3 mg/mL), latanoprost (BAK 0.2 mg/mL), travoprost (polyquad), and tafluprost (BAK-free). PATIENTS AND METHODS: In this single-center, open-label trial, 32 patients newly diagnosed with POAG were randomly started on one of the four PGAs. All patients underwent a complete ophthalmological exam at presentation and at 1, 3, and 6 months of follow-up. Dry eye disease (DED) was assessed using the original Ocular Surface Disease Index (OSDI) questionnaire, in order to evaluate the impact of the drops on the quality of life of patients. RESULTS: The mean age was 60.06 years ± 11.76. All four drugs equally and significantly reduced the intraocular pressure (IOP) with respect to the baseline IOP. There was a trend for a slightly greater reduction of IOP with bimatoprost, but the difference was not found to be statistically significant when compared to other PGAs. OSDI scores were significantly superior for travoprost (10.68 ± 5.73) compared to the other three drugs (p < 0.05). Latanoprost caused the most significant eyelash growth and iris discoloration. Conjunctival hyperemia and superficial keratitis occurrence were similar in the four groups. CONCLUSION: All prostaglandin analogues equally and significantly reduce the IOP in patients with POAG. According to the results of the OSDI score, latanoprost seems to be the least tolerated among the four drugs.