Lyme disease atypically presenting with a singular symptom: Unilateral chorioretinitis.

BACKGROUND: Lyme disease, caused by Borrelia burgdorferi, is a spirochetal disease. Lyme disease-related ocular findings may also provide important clues. Ocular involvement is most commonly seen as uveitis, chorioretinitis, conjunctivitis, keratitis, episcleritis, papillitis, panuveitis, ischemic optic neuropathy, papilledema, and retinal vasculitis. CASE: A 27-year-old male patient was admitted with a history of fatigue, malaise, and sudden loss of vision in his left eye for 3 days. The best visual acuity was found 20/20 in the right eye and 20/400 in the left eye. Fluorescein fundus angiography showed no pathological findings in the right eye; but hyperfluorescence that was compatible with choroiditis foci was seen in the left eye. Optical coherence tomography (OCT) showed choroidal thickening in the left eye compared to the right eye. Lyme IgM antibody was found to be positive, explaining choroiditis etiology, while IgG values were found to be negative. Western blot verification test was positive. The patient was treated with 2 × 100 mg doxycycline (21 days) with a diagnosis of Lyme disease, prednol 1 mg/kg/day (10 days) for choroiditis. Omeprazole tablets were given 1 × 1 during the period of cortisone intake. On the third day of treatment, visual acuity increased to 20/200 and continued to increase until reaching 20/20 in the second week. CONCLUSIONS: Lyme disease is rare, but must be kept in mind when investigating the etiology of chorioretinitis and retinal vasculitis. The patient reported here is, to our knowledge, the second case reported in literature that shows atypical clinic for Lyme disease with unilateral chorioretinitis without Erythema chronicum migrans (ECM).

The influence of dead spaces and the designs of injectors on the amount of drug dose in intra-vitreal injection.

AIM: To evaluate the dead spaces resulting from different designs of the insulin injectors used for intravitreal injections and the amounts of drug doses. METHODS: In the study, five different brands of sterile insulin injectors of 1 mL were used for the test. The weight of the injectors was determined before and after filling the injectors with 0.05 and 0.1 mL distilled water. The weight of the injectors was measured with and without the needle after the water within the injectors had been taken out and weight differences were measured. The difference between the intended amount of fluid to be thrown out and the weight of the fluid remaining in the injector was calculated as percent error. RESULTS: After throwing out 0.05 mL distilled water from the injector, weights of the Beybi®, Traf®, Becton Dickinson®, Ayset®, and Setojet® brands of injectors with 30 G needle were detected to increase the mean 0.0220 ± 0.006 g, 0.0208 ± 0.008 g, 0.0355 ± 0.016 g, 0.0219 ± 0.017 g, and 0.0150 ± 0.007 g, respectively compared to the weights of the dry injectors. The 0.1 mL injector group was found to be mean 0.0350 ± 0.014 g, 0.0264 ± 0.008 g, 0.0405 ± 0.015 g, 0.0272 ± 0.013 g, and 0.0245 ± 0.014 g, respectively. The maximum increase due to the dead spaces in the injectors was found in the Becton Dickinson® injector, both in the 0.05 mL and the 0.1 mL groups (p < 0.000). CONCLUSION: The injector designs may affect the dose of IVI required to be given. More correct amounts of drugs may be administered via the intra-vitreal route through designs that reduce the dead spaces at the end part of the injector and between the inner wall and the plunger.

In-vitro dewetting properties of planned replacement and daily disposable silicone hydrogel contact lenses.

AIM: To compare the in-vitro videokeratoscopic surface dewetting properties of new-generation silicone hydrogel (SiH) planned replacement contact lenses (CL) with those of daily disposable CLs. METHOD: A chrome coated cornea model was used for the in-vitro evaluation of surface dewetting. Pre-lens and post-lens film layers were formed by instilling a normal preservative-free normal saline solution (PFNs) (0.9 %) before and after the placement of the CL on the model cornea. The tests were carried out on fanfilcon A, lotrafilcon B, samfilcon A, and senofilcon A lenses, as well as such daily disposable lenses as delefilcon, nesofilcon A and senofilcon one day. Using videokeratoscopic methods, images were obtained at 30-second intervals up to 180 s in the lens and control groups and were analyzed by the ImajeJ® program. RESULTS: The mean measured area of the keratoscopic rings was largest in the fanfilcon group (67.56 mm2), followed by 61.53 mm2 in the lotrafilcon A group and 64.60 mm2 in the samfilcon group, while the smallest area was measured in the senofilcon A group, at 56.90 mm2. The area was measured as 64.33, 63.09 and 68.39 mm2 for the delefilcon, nesofilcon and Senofilcon one day CLs, respectively. The dewetting patterns and properties differed in the CL groups (p < 0.05), while no significant differences were found between the measured areas of the planned replacement and daily disposable CL groups (p > 0.05). DISCUSSION: Videokeratoscopy using in-vitro cornea models has been identified as a reproducible and reliable method for the analysis of the surface dewetting of CLs. The dewetting characteristics of CL groups have been found to differ from each other, despite all being produced from SiH materials. The surface wetting coating has been shown to affect CL dewetting performance.

Rare Presentation of Severely Limited Granulomatosis With Polyangiitis Manifesting With Orbital Wall Destruction: Literature Review and Case Report.

Necrosis resulting from mechanical local factors can be seen in patients with granulomatosis with polyangiitis (GPA) even in remission. GPA can cause serious morbidity even when limited. An ocular prosthesis that increases inflammation and damages local circulation should be used very carefully in such patients. In this article, we report a 68-year-old male patient who was diagnosed with localized GPA 11 years ago and referred to our clinic with the complaint of displacement of an ocular prosthesis inside the nose and epistaxis. Four years ago, the left eye was enucleated because of pain and vision loss. Two months after the enucleation, the patient began to use an ocular prosthesis. Orbital medial wall destruction developed while the patient was receiving maintenance therapy that consisted of cyclophosphamide (150 mg/day) plus prednisolone (32 mg). When the ocular prosthesis was displaced in the nasal cavity, the prosthesis was first removed and the patient was clinically stabilized. Later, orbital wall reconstruction was performed at another center.

Videokeratoscopic assessment of silicone hydrogel contact lens wettability using a new in-vitro method.

PURPOSE: The aim of the study was to assess the surface wettability of new-generation silicone hydrogel (SiH) contact lenses (CLs) videokeratoscopically using a new in-vitro method under office conditions. METHOD: Videokeratoscopic methodology was used to compare time-dependent CL wettability on an in-vitro cornea model. The model cornea was a polished chrome surface coating a Teflon form. It was prepared with a base curve of 8.7 mm and a diameter of 15 mm. Laboratory temperature and humidity were controlled. Before and after placing CLs on the on the model cornea, Bausch + Lomb Biotrue® multi-purpose solution (MPS) was dropped to simulate the pre-lens and post-lens film layer. Fanfilcon A, Senofilcon A, Samfilcon A, and Lotrafilcon B CLs with -3.00D were used, and images were taken with the videokeratoscopic method for testing. In the control group, the same procedure was performed without placing CLs. The images of CLs at 0, 60, 90, 120, 150, and 180 s were taken. Distortions and gaps seen in rings were recorded. The areas in rings were calculated in pixels using ImageJ. RESULTS: When CLs were examined, statistical differences were found among average pixel values (p < 0,001). The average pixel value was 131877.4 in the Samfilcon group, 116125.5 in the Senofilcon group, 137893.2 in the Fanfilcon group, 125578.3 in the Lotrafilcon group, and 124984.6 in the control group. No difference was found between the average values of the Lotrafilcon group and the control group. Differences were found between the average values of all other groups. DISCUSSION: The results obtained showed that videokeratoscopy was an effective method for in-vitro testing of CL wettability. It was found that SiH lenses displayed different performance under office conditions depending on materials and technologies used for wetting the lens surface. It was shown that lens surface wettability could be measured with a repeatable and new method when the factors affecting surface wetness and image quality were ruled out.