Femtosecond laser-assisted astigmatic keratotomy versus toric IOL implantation for correcting astigmatism in cataract patients: a systematic review and meta-analysis with trial sequential analysis.

AIMS: To compare the refractive and visual outcomes of femtosecond laser-assisted astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation for correcting astigmatism in cataract patients. METHODS: Studies were retrieved from the Ovid-Medline, EMBASE, Cochrane Central Register of Controlled Trials and Scopus which compared FSAK and toric IOL for astigmatism correction in cataract patients. Outcome measures included postoperative refractive cylinder, correction index, uncorrected distance visual acuity (UDVA), the proportion of patients achieving a residual refractive cylinder of 1.00 dioptre or less, target-induced astigmatism (TIA) and surgically induced astigmatism (SIA). The trial sequential analysis (TSA) was used to collect firm evidence supporting our conclusion. RESULTS: 9 studies encompassing 590 participants were analysed. The meta-analysis revealed that toric IOLs could result in less postoperative refractive cylinder and provide better UDVA compared with FSAK. The TSA disclosed strong evidence of lower postoperative refractive cylinder in the toric IOL group compared with that of the FSAK group. FSAK showed a smaller correction index and lower mean TIA and SIA compared with toric IOLs. CONCLUSIONS: For cataract patients, both FSAK and toric IOLs are effective methods for correcting astigmatism. However, toric IOLs offer less postoperative astigmatism and result in better postoperative UDVA compared with FSAK. In vector analysis of astigmatism, toric IOLs can also produce higher TIA and SIA. Additionally, neither method is associated with severe untreatable complications. Therefore, the conclusion is that toric IOLs are the preferred choice for astigmatism correction in cataract patients and FSAK serves as a viable alternative when toric IOLs are contraindicated.

A meta-analysis of sutureless scleral-fixated intraocular lens versus retropupillary iris claw intraocular lens for the management of aphakia.

This study compared the visual outcomes and complications between sutureless scleral-fixated intraocular lens and iris claw intraocular lens implantation in aphakia without adequate capsule and/or zonule support. Studies comparing the clinical outcomes of scleral-fixated intraocular lens and iris claw intraocular lens implantation published until April 2022 were retrieved from the PubMed, EMBASE, Cochrane Library, and Google Scholar databases. The outcomes included postoperative final visual acuity, surgical time, surgery-induced astigmatism, and complications. The weighted mean difference and odds ratio were calculated. Two randomized controlled trials and five cohort studies, including 244 and 290 eyes in the scleral-fixated intraocular lens group and iris claw group, respectively, were included. Scleral-fixated intraocular lens implantation results in a better postoperative final corrected distance visual acuity compared with iris claw intraocular lens implantation; however, it is more time-consuming. Scleral-fixated intraocular lens implantation seems to have lesser incidences of surgery-induced astigmatism. Furthermore, both procedures have a similar complication rate. Therefore, based on current best evidence, these two procedures should be considered according to patient's conditions.

Investigation of corneal epithelial thickness and irregularity by optical coherence tomography after transepithelial photorefractive keratectomy.

CLINICAL RELEVANCE: Corneal epithelial healing after refractive surgery is a clinically significant issue, especially for surface ablation procedures, and this can be monitored using optical coherence tomography (OCT). BACKGROUND: The aim of this work is to investigate the corneal epithelial thickness and irregularity by OCT after transepithelial photorefractive keratectomy (t-PRK) and analyse its correlation with visual and refractive outcomes. METHODS: Patients aged ≥18 years with myopia, with or without astigmatism, who underwent t-PRK between May 2020 and August 2021 were included. All participants were subjected to complete ophthalmic examinations and OCT pachymetry at every follow-up visit. Patients were followed up at 1 week and 1, 3, and 6 months postoperatively. RESULTS: A total of 67 patients (126 eyes) were enrolled in this study. One month postoperatively, spherical equivalent refraction and visual acuity achieved preliminary stability. However, central corneal epithelial thickness (CCET) and standard deviation of the corneal epithelial thickness (SDcet) took 3-6 months to progressive recovery. Patients with higher baseline spherical equivalent refraction were associated with slower epithelial recovery. At every follow-up time point, a significant superior-inferior difference in the minimum corneal epithelial thickness area was observed. Higher stromal haze was correlated with higher spherical equivalent refraction (both baseline and residual) but had no relation with visual outcomes. There was a significant correlation between higher CCET with a better uncorrected distance visual acuity and lower corneal epithelial thickness irregularity. CONCLUSIONS: CCET and SDcet measured by OCT seem to be a good auxiliary indicator for reflecting the status of corneal wound recovery after t-PRK surgery. However, a well-designed randomised control study is needed to confirm the study results.

Prevalence of meibomian gland dysfunction at a tertiary centre in Taiwan.

CLINICAL RELEVANCE: Meibomian gland dysfunction and dry eye disease are closely related conditions that often coexist and can contribute to the development of each other. Understanding the similarities and differences between these diseases can assist clinicians in implementing effective treatments for both conditions in a clinical setting. BACKGROUND: Dry eye disease is a multifactorial disease of the tears and ocular surface. This study aimed to evaluate the demographic characteristics of patients with meibomian gland dysfunction in Taiwan, investigate the association between meibomian gland dysfunction and dry eye parameters, and estimate the prevalence of meibomian gland dysfunction among patients with dry eye symptoms at a tertiary referral centre. METHODS: This cross-sectional study enrolled patients aged ≥20 years who complained of dry eye symptoms and visited a tertiary centre between September 2019 and March 2020. The patients completed the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires before undergoing ocular examination. The lipid layer thickness and meiboscale scores were recorded. In addition, the study measured tear film break-up time, examined corneal staining, and evaluated the number of meibomian glands yielding liquid secretions using a slit lamp. RESULTS: The study evaluated 202 eyes of 202 patients with a mean age of 58.05 ± 13.34 years. The prevalence of meibomian gland dysfunction was 93%. Mean meiboscale score and age were negatively associated, and tear film break-up time was positively associated with the mean number of meibomian glands yielding liquid secretions. Hyperlipidaemia and smoking were the main risk factors for Meibomian gland dysfunction. CONCLUSIONS: The prevalence of meibomian gland dysfunction among patients with dry eye symptoms was extremely high at the tertiary centre, highlighting the strong relationship between Meibomian gland dysfunction and dry eye disease. Clinicians should consider meibomian gland dysfunction as a possible cause of dry eye.

Corneal topographic changes in patients with thyroid eye disease: A retrospective cross-sectional study.

PURPOSE: This study aimed to evaluate corneal topographic findings in patients with thyroid eye disease (TED) using a Galilei camera and compare their corneal topographic parameters with those of control patients. METHODS: This retrospective cross-sectional study included 52 eyes of 26 patients with TED (study group) and 40 eyes of 20 controls treated at a tertiary medical center in Taiwan between January and December 2021. All participants underwent basic ophthalmological examinations, corneal topography examination using a Galilei dual Scheimpflug camera, thyroid function examination, and orbital computed tomography. The corneal topographic parameters and cross-sectional area of the extraocular muscles were compared between the TED and control groups. RESULTS: Several corneal topographic parameters, including the Inferior-Superior Index, Keratoconus Prediction Index, Surface Asymmetry Index, Surface Regularity Index, simulated keratometry astigmatism, and anterior instantaneous astigmatism axis, differed significantly between the groups (P ≤ 0.05). The anterior instantaneous astigmatism axis was more oblique in the TED group than in the control group. A scatter plot revealed a more scattered distribution in the anterior instantaneous astigmatism axis in the TED group than in the control group. However, the corneal topographic parameters did not differ significantly among the different thyroid dysfunction groups. CONCLUSIONS: The corneas of patients with TED are suspicious and keratoconus-like, and TED can increase anterior corneal astigmatism in the oblique axis, albeit with large variations in the extent of change. These TED-related corneal changes may aid in the early diagnosis of TED, especially "silent" TED.

Anti-Inflammatory Effects of GM1 Ganglioside on Endotoxin-Induced Uveitis in Rats.

Exogenous ganglioside GM1 has been reported to exert an immunomodulatory effect. We investigated the anti-inflammatory effect of GM1 ganglioside on endotoxin-induced uveitis (EIU) in rats and RAW 264.7 macrophages. METHODS: EIU was induced in Lewis rats by administering a subcutaneous injection of lipopolysaccharide (LPS). GM1 was injected intraperitoneally for three consecutive days prior to the LPS injection. Twenty-four hours after the LPS injection, the integrity of the blood-aqueous barrier was evaluated by determining the protein concentration and number of infiltrating cells in the aqueous humor (AqH). Immunohistochemical and Western blot analyses of the iris-ciliary body (ICB) were performed to evaluate the effect of GM1 on the LPS-induced expression of cyclooxygenase-2 (COX-2) and intercellular adhesion molecule-1 (ICAM-1). The effect of GM1 on proinflammatory mediators and signaling cascades was examined in LPS-stimulated RAW 264.7 cells using Western blotting and immunofluorescence staining to further clarify the underlying anti-inflammatory mechanism. RESULTS: GM1 significantly reduced the protein concentration and number of infiltrating cells in the AqH of rats with EIU. GM1 also decreased the LPS-induced expression of the ICAM-1 and COX-2 proteins in the ICB. In RAW 264.7 cells, GM1 inhibited the proinflammatory mediators induced by LPS, including inducible nitric oxide synthase (iNOS), COX-2, tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and interleukin-6 (IL-6), and this inhibitory effect was potentially mediated by suppressing transforming growth factor-ß-activated kinase 1 (TAK1) and reactive oxygen species (ROS)-mediated activation of nuclear factor-κB (NF-κB) and mitogen-activated protein kinases (MAPKs). CONCLUSIONS: Based on this study, GM1 may be a potential anti-inflammatory agent for ocular inflammatory diseases.

Beneficial Effects of Hypercapnic Acidosis on the Inhibition of Transforming Growth Factor ß-1-induced Corneal Fibrosis in Vitro.

PURPOSE: Corneal scarring is a common poor outcome of corneal trauma. Transforming growth factor ß-1 plays a vital role in corneal fibrosis, inducing keratocyte transformation to myofibroblasts. Other than corneal transplantation, no other curative treatment methods for corneal scarring are currently available. Hypercapnic acidosis exerts anti-inflammatory and anti-migratory effects on numerous organs; however, its effect on corneal fibroblasts remains unknown. Hence, this study aimed to evaluate the effect of hypercapnic acidosis on transforming growth factor ß-1-induced fibrosis in corneal fibroblasts and to elucidate the underlying mechanisms. MATERIALS AND METHODS: Corneal fibroblasts were obtained from human limbal tissue and cultured with or without transforming growth factor ß-1 under hypercapnic acidosis or no-hypercapnic acidosis conditions, and subjected to scratch wound, cell migration, and collagen matrix contraction assays. Furthermore, immunocytochemistry was performed to evaluate the alpha-smooth muscle actin stress fiber. Finally, western blotting was performed to assess the expression of proteins in the NF-κB and Smad pathways. RESULTS: Hypercapnic acidosis suppressed collagen gel contraction capacity in transforming growth factor ß-1-treated corneal fibroblasts and inhibited transforming growth factor ß-1-induced cell migration. Moreover, hypercapnic acidosis downregulated corneal fibrosis marker alpha-smooth muscle actin in transforming growth factor ß-1-treated corneal fibroblasts. Furthermore, hypercapnic acidosis suppressed transforming growth factor ß-1-induced fibrosis, at least partly, by inhibiting Smad2/3 phosphorylation and down-regulating p-IκB-dependent and RelB signaling transduction. CONCLUSIONS: Hypercapnic acidosis inhibits transforming growth factor ß-1-induced corneal fibroblast migration, collagen gel contraction capacity, and alpha smooth muscle actin expression, potentially through the Smad and NF-κB pathways. Therefore, hypercapnic acidosis may be a potentially useful anti-fibrotic therapy for corneal scarring.

Mitomycin C for the prevention of corneal haze in photorefractive keratectomy: a meta-analysis and trial sequential analysis.

PURPOSE: To evaluate the anti-haze effect and visual outcome after intraoperative mitomycin C (MMC) use during photorefractive keratectomy (PRK) in myopia or myopic astigmatism patients. METHODS: We searched in PubMed, EMBASE, Cochrane Library and Google Scholar comprehensively to obtain studies comparing the clinical effects after PRK with and without MMC published until February 2020. Meta-analysis of primary outcome (corneal haze rate) and secondary outcomes [predictability, efficacy, safety and corneal endothelial cell density (ECD)] were conducted. We used trial sequential analysis (TSA) in an effort to collect firm evidence supporting our conclusion. RESULTS: Of the included 11 randomized controlled trials, five cohort and one case-control studies, 3536 eyes (2232 and 1304 in the MMC and control groups, respectively) were enrolled for meta-analysis. The TSA disclosed strong evidence of decline in corneal haze rate in the MMC group compared with that of the control group. In the subgroup analysis of duration, MMC seemed to reduce corneal haze rate in early-onset and late-onset haze. Predictability of refraction and visual acuity were greater in the MMC groups, not significantly though. The proportion of patients losing at least two lines of best corrected visual acuity postoperatively in the MMC groups was lower than that in the control groups. The corneal postoperative ECD showed no significant difference between the MMC and control groups. CONCLUSION: Our meta-analysis revealed that MMC is an important anti-haze agent in PRK for reducing both early- and late-onset haze and can also help improving predictability of refraction and subjective postoperative visual acuity.

The impact of diabetes mellitus medication on the incidence of endogenous endophthalmitis.

PURPOSE: This study aimed to evaluate the relationship between diabetic mellitus (DM) treatment and the incidence rate of endogenous endophthalmitis (EE). DESIGN: This study used a matched cohort design. We utilized the Longitudinal Health Insurance Database to identify outpatients and inpatients who were diagnosed with DM and treated with medication from 2000 to 2010. METHODS: Several factors and different DM medications were also investigated. The influence of DM medication on the incidence of EE was examined by using Cox proportional hazards regression models, and the hazard ratios and 95% confidence intervals were determined. RESULTS: The cumulative incidence of EE was lower in DM patients treated with medication than in subjects in the control group (P = 0.002). The adjusted hazard ratio (AHR) was 0.47-fold lower in the treatment group than in the control group (P = 0.004). With respect to DM medication, single-agent therapy with insulin, metformin, gliclazide, glimepiride, or repaglinide and combination therapy with glimepiride/metformin or repaglinide/metformin were associated with decreased AHRs (0.257-0.544, all P<0.05). CONCLUSIONS: Diabetic patients treated with medication had lower AHRs than those in the control group. Further stratification indicated that liver abscess, liver disease DM patients who were treated with medication had a lower risk of developing EE. Several specific DM medications may decrease the incidence of EE.

Ethnic disparity in prevalence and associated risk factors of myopia in adolescents.

BACKGROUND/PURPOSE: To examine ethnic disparity in prevalence and associated factors of myopia in adolescents using the Unites States National Health and Nutrition Examination Survey (NHANES) dataset. METHODS: Participants who were aged 12-19 years were included from NHANES (1999-2008). Logistic regression analyses were applied to identify risk factors associated with myopia after stratification by race. RESULTS: A total of 9,960 participants were included in the prevalence analysis, and 6,571 in the risk factor analysis. Other race (excluded Mexican American, other Hispanic, non-Hispanic white, non-Hispanic black) participants had the highest frequency of myopia (42.77%). Multivariate analyses of the whole population suggested that the odds of myopia were significantly lower in participants with household smokers (odds ratio [OR] = 0.79, 95% confidence interval [CI]: 0.66-0.97), and significantly greater in Mexican American race (OR = 1.28, 95% CI: 1.01-1.62), other Hispanic (OR = 1.79, 95% CI: 1.10-2.92) and in participants with senior high school graduate education (OR = 1.79, 95% CI: 1.01-3.18), watched 2 hours of television daily (OR = 1.27, 95% CI: 1.02-1.59), used the computer for 1 hour daily (OR = 1.276, 95% CI: 1.02-1.57). When examined by race/ethnicity, 1 hour of computer use increased the odds of myopia in the non-Hispanic White group, in Mexican Americans a higher family poverty income ratio and 2 hours of television time was associated with myopia, and in the Other Hispanic group, a higher family poverty income ratio was associated with myopia, while males and those with a higher sugar had a lower risk of myopia. CONCLUSION: Risk factors for myopia vary with race/ethnicity.

Bilateral proliferative retinopathy and ischemic optic neuropathy in a patient with atypical hemolytic-uremic syndrome: A case report.

RATIONALE: To report a rare case of severe atypical hemolytic-uremic syndrome (HUS) in a patient who presented with vitreous hemorrhage and tractional retinal detachment (TRD) in both eyes. To our knowledge, this is the first reported case of atypical HUS complicated with bilateral TRD in the literature. PATIENT CONCERNS: A 20-year-old man with atypical HUS demonstrated bilateral visual acuity of hand motion at 30 cm. DIAGNOSES: Dilated fundus examination revealed diffuse intraretinal hemorrhage with vascular engorgement, neovascularization of the disc, and neovascularization elsewhere bilaterally. Fluorescein angiography revealed bilateral proliferative retinopathy, retinal hemorrhage, and a large nonperfusion area with extensive neovascularization. Intravitreal antivascular endothelial growth factor (ranibizumab) injection was administered in both eyes, but his ophthalmic condition did not improve, and TRD developed bilaterally. Therefore atypical HUS complicated with bilateral TRD was diagnosed. INTERVENTIONS: Pars plana vitrectomy was performed with panretinal photocoagulation and silicone oil tamponade in the right eye. OUTCOMES: After the pars plana vitrectomy of right eye, the retina was well-attached after surgery, but visual acuity remained poor. Visual evoked potential examination showed poor waveforms bilaterally, which suggested ischemic optic neuropathy. LESSONS: Atypical HUS can cause systemic thrombotic microangiopathy, resulting in ischemic retinal changes. These ischemic retinal changes can then cause hypoxia, which triggers production of angiogenic factors and subsequently causes retinal vascular hyperpermeability, retinal and vitreous neovascularization, fibrovascular proliferation, vitreous hemorrhage, and TRD, in a manner similar to that of other ischemia-induced proliferative retinopathies. Despite successful surgery in the right eye, our patient's visual acuity did not improve, possibly because of severe and generalized ischemia of intraocular tissue, which resulted in ischemic optic neuropathy.

Agreement of post-LASIK corneal power and corneal thickness measurements by pentacam and GALILEI corneal tomography systems.

BACKGROUND: Post-LASIK corneal conditions cannot be accurately measured by traditional optometric approaches. Therefore, we aimed to analyze the agreement of two rotating Scheimpflug cameras in corneal assessment. METHODS: Fifty otherwise healthy volunteers who had undergone LASIK were recruited in this study. The values of mean and central total corneal power (TCP), including TCP1, TCP2, and TCP-IOL, were measured by GALILEI Scheimpflug camera. The values of total corneal refractive power (TCRP) readings at both 2 mm ring and 3 and 4 mm zones were detected by Pentacam Scheimpflug camera. Central corneal thickness (CCT) and thinnest corneal thickness (TCT) were quantified by GALILEI and Pentacam respectively. Paired t-tests and Bland-Altman analyses were used to evaluate statistical differences between measurement results obtained by GALILEI and by Pentacam. RESULTS: Among these 50 subjects, the mean and central TCP1 values (37.31 ± 2.61 and 37.27 ± 2.64) derived from GALILEI measurements were consistent with the TCRP values (37.08 ± 2.76, 37.11 ± 2.74, and 37.19 ± 2.68; p > 0.05) determined by Pentacam at the 2 mm ring apex, 3 mm zone apex, and 4 mm zone apex. There were no statistically significant differences in central corneal thickness (CCT) values measured by the two cameras (463.64 ± 55.67 µm for GALILEI and 470.69 ± 44.04 µm for Pentacam, respectively; p > 0.05). However, the limits of agreement were wide when comparing mean TCP1 (-1.4 to 1.8 D, -1.4 to 1.8 D, and -1.3 to 1.6 D), central TCP1 (-1.2 to 1.6 D, -1.2 to 1.6 D, and -1.2 to 1.4 D) and CCT (-77.2-63.0 µm). CONCLUSION: Corneal power and corneal thickness are disparate post-LASIK evaluation parameters when comparing the utility of GALILEI with that of Pentacam.

Iatrogenic Posterior Lens Capsule Rupture and Subsequent Complications due to Nd:YAG Laser Vitreolysis for Vitreous Floaters: A Case Report.

Nd:YAG laser vitreolysis has been used as a noninvasive approach to treat visually significant vitreous strands and floaters. However, severe vision-threatening complications may occur. The authors describe a rare case of a 60-year-old woman who had suffered rupture of the posterior lens capsule with subsequent cataract formation 1 week post-Nd:YAG laser vitreolysis in the right eye. The authors performed phacoemulsification, pars plana vitrectomy, and intraocular lens implantation at the ciliary sulcus. At 1 month post-surgery, the patient's visual acuity had not recovered well and optical coherence tomography showed epiretinal membrane (ERM) formation. Thus, she underwent secondary pars plana vitrectomy for ERM removal. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e214-e217.].

Epidemiology and Mortality-Related Prognostic Factors in Endophthalmitis.

Purpose: Endophthalmitis describes any intraocular inflammation that involves both the posterior and anterior segments and is divided into endogenous and exogenous types according to its pathogenesis. The incidence of endophthalmitis and its risk factors have been extensively evaluated. However, few studies have explored the mortality rate in patients diagnosed with endophthalmitis. Methods: We obtained data entered into the National Health Insurance Research Database (NHIRD) from 2000 to 2013. The data collected included all discharge diagnoses of endophthalmitis in inpatients. Baseline characteristics, comorbidities, and prognostic factors were evaluated. Results: This study identified 7764 patients who were diagnosed with endophthalmitis in Taiwan from 2000 to 2013. The mortality rate was 0.97% (75/7764), and the mean age was 63.57 ± 15.72 years. Epidemiological characteristics were compared as "with or without" for different systemic comorbidities, and the results indicated that the adjusted odds ratio (AOR) was significantly higher in cases comorbid with renal disease (AOR 2.864, P = 0.001), septicemia (AOR 8.886, P < 0.001), pneumonia (AOR 2.072, P = 0.030), and tumors (AOR 7.437, P < 0.001). However, comorbidity with diabetes mellitus (DM) lowered the AOR by 0.500-fold (P = 0.026). There was no significant difference in ORs between patients comorbid with hypertension, depression, anxiety, hyperlipidemia, thyrotoxicosis, liver disease, or injury (all P > 0.05). Conclusions: Among inpatients with endophthalmitis, predictors of mortality include renal disease, septicemia, pneumonia, neoplasia, a greater burden of comorbidity (especially catastrophic illness), longer hospital stays (more than 11 days), and higher medical costs. Interestingly, DM decreased the OR for inpatient mortality.

Positron emission tomography/computed tomography scan of Vogt-Koyanagi-Harada syndrome with associated autoimmune thyroid disease: A case report and literature review.

RATIONALE: Vogt-Koyanagi-Harada (VKH) syndrome is a rare disease and could be associated with autoimmune thyroid disease (AITD). This report was aimed to investigate the utility of F-fludeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) for the diagnosis of VKH syndrome with AITD and to perform a literature review on the association between the 2 diseases. PATIENT CONCERNS: A 55-year-old woman without the history of ocular trauma suffered from chronic headache. She was presented with painful blurred vision of both eyes with headache for 2 weeks. Ophthalmic evaluations revealed panuveitis, exudative retinal detachment, and papilloedema in both eyes. The clinical symptoms and presentations are compatible with the diagnosis of VKH syndrome. Other examinations for intraocular infection, malignancy, and lupus choroidopathy were of negative results. The result of contrast-enhanced computed tomography (CT) of the brain was normal. Due to the history of cancer in the patient's families, a F-FDG PET/CT whole-body scan was performed. The result indicated a focal of 2-fluoro-2-deoxy-D-glucose (FDG) uptake at the right upper lobe of the thyroid. Therefore, the patient's thyroid function was examined and the result indicated euthyroidism with detectable thyroid peroxidase/thyroglobulin antibodies. DIAGNOSES: VKH syndrome with associated AITD. INTERVENTIONS: Treatment with intravenous pulse systemic methylprednisolone (1000 mg daily) was prescribed for 3 days and then shifted gradually to tapered oral steroid medication. OUTCOMES: Symptoms of papillitis and serous retinal detachment of VKH syndrome was relieved after steroid treatment LESSONS:: F-fludeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) can be used for the effective diagnosis of VKH syndrome with AITD.

Amelioration of acute orbital compartment syndrome following transvenous embolization for an indirect carotid-cavernous fistula: A case report.

RATIONALE: Orbital compartment syndrome (OCS) is a rare occurrence after transvenous embolization of indirect carotid-cavernous fistula (CCF). A lateral canthotomy and cantholysis are the most commonly performed surgical interventions. In our case, as the acute OCS occurred immediately after an uneventful transvenous embolization, an orbital floor orbitectomy was performed. PATIENT CONCERNS: Here, we present a rare case of a 59-year-old patient who required a transvenous embolization of an indirect CCF and subsequently immediately developed an acute OCS. DIAGNOSES: An indirect CCF was revealed using brain magnetic resonance angiography and a transvenous embolization of the fistula was performed using coils. Post-embolization angiograms revealed an occlusion of the CCF. INTERVENTIONS: After the development of a relative afferent pupillary defect and acute OCS, we performed a lateral canthotomy, superior and inferior cantholysis, and an orbital floor orbitectomy. Subsequently, visual acuity and intraocular pressure improved. LESSONS: Our case is the first report of acute OCS occurring after transvenous embolization of a CCF that required further orbital floor decompression to prevent permanent visual loss. Moreover, our case demonstrates that acute OCS may rapidly develop after transvenous embolization due to superior ophthalmic venous (SOV) thrombosis and that an early intervention may reduce the risk of visual impairment.

Relenza-Induced Acute Myopia Change.

PURPOSE: To report a case of a patient with a notable side effect to Relenza, an anti-influenza virus medication, who also developed acute transient myopia. CASE REPORT: A 31-year-old woman was diagnosed as having seasonal influenza and treated with Relenza. However, an allergic reaction and blurred vision caused by a transient myopic change were noted after she received Relenza treatment. Relenza-induced acute transient myopia had never been reported. The possible mechanisms include (1) ciliary spasm, (2) lens edema, (3) ciliary body and/or choroidal effusion. Fortunately, the drug-induced myopic change mostly resolved spontaneously after discontinuation of the drug and had a benign course. CONCLUSIONS: Patients suspected of having drug-induced myopia should be examined by an internist for a systemic allergic reaction and referred to an optometrist or an ophthalmologist for further special examinations such as A-scan, B-scan, and ultrasound biomicroscopy. Optometrists and ophthalmologists should keep in mind and be aware of the possible ocular side effect (myopic change) of Relenza and warn patients of this potential condition.