Pituitary Apoplexy Secondary to Thrombocytopenia due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Report of a Rare Case and Literature Review.

Purpose: To report a 16-year-old female patient with pituitary apoplexy in the setting of coronavirus disease 2019 (COVID-19) infection-related thrombocytopenia in the absence of preexisting pituitary macroadenoma. Methods: The patient had been admitted because of respiratory complications of COVID-19 infection and developed thrombocytopenia, intense headache, and symptoms of cavernous sinus syndrome. Results: Urgent magnetic resonance imaging of the brain depicted a pituitary apoplexy. Conclusion: This case indicated that thrombocytopenia due to COVID-19 could be a predisposing factor for pituitary apoplexy in the absence of underlying pituitary disease.

Transient intraocular lens opacification during phacoemulsification surgery.

PURPOSE: To report an interesting case of intraoperative opacification of intraocular lens (IOL). METHODS: This study is a report of a 61-year-old male patient who suffered from nuclear sclerosis cataract and had undergone phacoemulsification surgery. During surgery, intraoperative opacification of IOL (Cristal, Cristalens), which was a foldable, 13 mm, one piece, square edge and hydrophilic acrylic IOL, occurred. This phenomenon caused a surprise and a decision to explant the IOL, but the surgeon decided to keep the IOL in place. After a day, it was completely clear. RESULTS: The surgery was completed successfully without any complications, and the IOL was completely clear the day after surgery. CONCLUSION: Acute, transient IOL opacification with unproven etiology may occur during cataract surgery.

Intravitreal Diclofenac plus Bevacizumab versus Bevacizumab alone in treatment-naive diabetic macular edema: a randomized double-blind clinical trial.

The aim of this study is to evaluate the short-term effects of a single intravitreal injection of 1.25 mg Bevacizumab combined with 300 lg/0.1 mL Diclofenac (IVB/D) versus 1.25 mg intravitreal Bevacizumab (IVB) alone in the treatment of naive diabetic macular edema (DME). In this prospective, randomized clinical trial, 80 eyes were included in the final analysis; 42 and 38 of which in the IVB and IVB/D groups, respectively. The primary outcome measure was a change in best-corrected visual acuity (BCVA) in logMAR at week 4. The secondary outcomes included changes in central macular thickness (CMT), macular volume, and potential injection-related complications. Significant improvement of BCVA was demonstrated in both study arms (mean reductions in LogMAR: -0.088 ± 0.278, -0.228 ± 0.330 for IVB and IVB/D, respectively). The difference in BCVA changes was in favor of IVB/D; however, not to a statistically significant level (P = 0.160). Significant reduction of CMT was documented in both study arms (mean reductions: 82.43 ± 160.09 and 153.26 ± 163.85 for IVB and IVB + IVD, respectively). Comparison of CMT changes between groups showed that IVB/D reduced CMT more than that of IVB (P = 0.04). Effects on macular volume corresponded to those of CMT. No injection-related complications or significant alterations in intraocular pressure were observed in any of the study arms. In treatment-naive DME, superiority of IVB/D combination therapy over IVB monotherapy may exist; especially as regards anatomical features. In our therapeutic arsenal for DME, IVD can be added as an adjunct to Bevacizumab.

Comparison of Scheimpflug and swept-source anterior segment optical coherence tomography in normal and keratoconus eyes.

PURPOSE: The purpose of the study was to assess the agreement of anterior segment optical coherence tomography with its older well-known opponent i.e., Sheimpflug imaging in evaluation of the cornea in normal and keratoconus subjects. METHODS: 107 normal and 56 keratoconus eyes were evaluated with the anterior segment optical coherence tomography followed by the Scheimpflug imaging. Parameters included axial keratometry data in both of steep and flat meridians, mean keratometry and the astigmatism values in the central 4.0 mm zone, central, thinnest and apex corneal thicknesses, Q-value in 8 mm zone and pupil diameter. Corneal topographic maps were recorded and were evaluated for anterior highest and lowest points, posterior highest and lowest points. Average values were recorded for analysis. RESULTS: All anterior cornea keratometry indices showed perfect agreement between two devices in normal corneas; while the level of agreement in keratoconus cases ranged from moderate to strong. All posterior keratometry indices also showed perfect agreement in both groups; except for flat K in normal corneas and steep K in KC ones. The amount of corneal cylinder in normal corneas had perfect agreement, and moderate to strong agreement in anterior/posterior cornea in keratoconus group. Anterior highest and lowest points showed strong and perfect agreement in normal and keratoconus cases, respectively. Posterior highest and lowest points showed strong agreement in normal cases. Thickness indices (central, thinnest, and apex thicknesses) showed perfect agreement between two devices in both normal and KC groups. Mean values of anterior and posterior highest points were statistically higher in Scheimpflug system. CONCLUSIONS: Although two imaging technologies had statistically numerical different output, it seems that they have a good agreement in most parameters.

The Persian legend of ophthalmology: Ali Asghar Khodadoust and his everlasting lines.

This is a brief celebratory overview of the fruitful life and scientific endeavors of Professor Ali Asghar Khodadoust (b.1935), a world renowned ophthalmologist, Persian icon of modern ophthalmology and an international pioneer of eye research. The global reputation of Dr. Khodadoust is rooted in his extensive studies on corneal diseases and transplantation biology. As a result of his truly deserved world renown, several famous American ophthalmologists have recognized him as the world's best corneal graft surgeon. Due to his exceptionally impressive achievements in this field, a clinical finding has been named in his honor, the "Khodadoust rejection line", a sign indicative of a chronic focal transplant reaction.

Preventive effect of vitamin D3 supplementation on conversion of optic neuritis to clinically definite multiple sclerosis: a double blind, randomized, placebo-controlled pilot clinical trial.

Multiple sclerosis (MS) presents with optic neuritis (ON) in 20 % of cases and 50 % of ON patients develop MS within 15 years. In this study, we evaluated the preventive effects of vitamin D3 administration on the conversion of ON to MS (primary outcome) and on the MRI lesions (secondary outcome) of ON patients with low serum 25 (OH) D levels. Thirty ON patients (15 in each of 2 groups, aged 20-40 years) with serum 25 (OH) D levels of less than 30 ng/ml were enrolled in a double blind, randomized, parallel-group trial. The treatment group (cases) received 50,000 IU of vitamin D3 weekly for 12 months and the control group (controls) received a placebo weekly for 12 months. Finally, the subsequent relapse rate and changes in MRI plaques were compared between the two groups. Risk reduction was 68.4 % for the primary outcome in the treatment group (relative risk = 0.316, p = 0.007). After 12 months, patients in the treatment group had a significantly lower incidence rate of cortical, juxtacortical, corpus callosal, new T2, new gadolinium-enhancing lesions and black holes. The mean number of total plaques showed a marginally significant decrease in the group receiving vitamin D3 supplementation as compared with the placebo group (p = 0.092). Administration of vitamin D3 supplements to ON patients with low serum vitamin 25 (OH) D levels may delay the onset of a second clinical attack and the subsequent conversion to MS.

Anti-aquaporin-4 IgG in Patients Presenting with Unilateral Optic Neuritis: A Cohort Study.

BACKGROUND: Optic neuritis (ON) can be the first presentation of multiple sclerosis (MS) or neuromyelitis optica (NMO). Anti-aquaporin-4 IgG (AQP4 IgG) is a highly specific and moderately sensitive biomarker for NMO. This study was designed to assess the rate of seropositivity for AQP4 IgG, and the short-term outcome of patients presenting with single isolated ON (SION). METHODS: A cohort of 41 consecutive patients experiencing severe (< 20 / 200) SION (not fulfilling the diagnostic criteria for MS or NMO), was prospectively recruited. Blood sampling was carried out immediately after the diagnosis of ON, and AQP4 IgG was tested qualitatively, using an indirect immunofluorescence kit. After clinical and paraclinical investigations, all the patients were followed up for a short-term period of at least 18 months. RESULTS: The seroprevalence among the initial ON patients was 9.7% (4 / 41). The short-term conversion rate to MS and NMO was estimated to be about 7.3 and 4.9%, respectively. The conversion rate to NMO in initially seropositive patients was greater than that for the whole cohort [2 / 4 (50%) vs. 2 / 41 (4.9%); P = 0.035; Odds ratio: 19.5, 95% confidence interval: 1.73 to 219.50]. CONCLUSION: AQP4 IgG seropositive SION patients were more likely to develop NMO in comparison to the total SION population. Further studies, with a longer follow-up period and larger sample sizes are warranted to assess the clinical and prognostic value of assessing AQP4 IgG in SION.

Urbach-wiethe syndrome and the ophthalmologist: review of the literature and introduction of the first instance of bilateral uveitis.

Patients suffering from Urbach-Wiethe syndrome (UWS), also known as lipoid proteinosis or hyalinosis cutis et mucosae, may have an ophthalmologist involved in the diagnosis and management of their disease. Along with moniliform blepharosis as a pathognomonic feature of the disease, an ophthalmologist may encounter other manifestations of UWS in any part of the eye such as cornea; conjunctiva; sclera; trabecular meshwork; iris/pupil; lens and zonular fibers; retina; nasolacrimal duct. This paper provides a review on the pathogenesis and the diverse ocular manifestations seen in UWS patients. Uncommon complications are discussed in this paper (glaucoma; dry eye and epiphora; complications of lens, retina, cornea; iris/pupil and conjunctiva). Moreover, a 27-year-old male UWS patient is described with bilateral diffuse anterior stromal iris atrophy, diffuse keratic precipitates; posterior subcapsular cataract; 1 + vitreous cell in anterior vitreous examination. This case was thought to be the first instance of bilateral uveitis associated with UWS. Overall, ophthalmologists may encounter diverse ocular complications accompanying this syndrome. They should be familiar with well-established ophthalmologic manifestations leading them to cooperate with other specialists in diagnosis and management of the disease.