Transient Myopia Secondary to Supraciliary Effusion: Unusual Complication After an Uneventful Prolene Gonioscopy-assisted Transluminal Trabeculotomy.

PURPOSE: The purpose of this study was to report 2 cases experiencing a transient decrease in their vision due to the development of acute myopia after an uneventful prolene gonioscopy-assisted transluminal trabeculotomy (GATT) surgery. METHODS: A 52-year-old woman with primary open-angle glaucoma and an 8-year-old boy with juvenile glaucoma underwent uneventful GATT surgery. RESULTS: On the postoperative first day, both patients had mild shallow anterior chamber and intraocular pressures measured as 19 and 16 mm Hg, respectively. Both patients had myopia measured as -4.5 and -6.0 D, respectively. Fundus examination was unremarkable in the first patient, whereas it showed bilateral optic disc cupping and retinal nerve fiber layer atrophy in the second patient. In the first patient, supraciliary effusion was detected by using ultrasound biomicroscopy. Ultrasound biomicroscopy could not be performed in the second patient, but ocular ultrasonography revealed a thin layer of suprachoroidal fluid. Myopia was completely regressed, and visual acuity increased within 1 week of the follow-up in both patients. At the sixth month of the follow-up, intraocular pressures in both patients were under control without any antiglaucoma medications. CONCLUSION: Transient decrease in vision after the GATT surgery might occur secondary to supraciliary effusion leading to acute, transient myopia.

Uveal and capsular biocompatibility of a new hydrophobic acrylic microincision intraocular lens.

PURPOSE: To evaluate uveal biocompatibility and capsular bag opacification of a new hydrophobic acrylic microincision intraocular lens (IOL) in comparison with a commercially available 1-piece hydrophobic acrylic IOL. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: Eight New Zealand rabbits underwent bilateral phacoemulsification and implantation of the preloaded Nanex multiSert IOL in one eye and a commercially available preloaded lens (AcrySof IQ in UltraSert, model AU00T0) in the contralateral eye. A slitlamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes were subjected to histopathologic evaluation. RESULTS: Postoperative inflammatory reactions were similar between the test and control eyes in the 8 New Zealand rabbits. The mean postmortem central posterior capsule opacification (PCO) was 0.93 ± 0.73 in the test group and 1.19 ± 0.53 in the control group. The mean postmortem peripheral PCO was 1.75 ± 0.92 in the test group and 2.06 ± 0.77 in the control group. Central and peripheral PCO scores were not statistically different between the test and control groups (P = .41 and P = .35, respectively, 2-tailed t test: paired 2-sample for means). CONCLUSIONS: A new 1-piece hydrophobic acrylic microincision IOL incorporating an ultraviolet-ozone treatment on the posterior surface performed similarly to a commercially available 1-piece hydrophobic acrylic IOL in terms of uveal and capsular biocompatibility in the rabbit model. To our knowledge, this is the first hydrophobic acrylic microincision IOL to demonstrate similar PCO performance when compared with a conventional, commercially available IOL.

Iris and ciliary body cysts and phakic intraocular lenses.

Phakic intraocular lenses are used to correct refractive errors. The procedure is predictable and potentially reversible. The procedure is not free of complications though. The occurrence of iris cyst after implantation of a phakic intraocular lens was not described previously in the literature. We describe two cases of iris cysts in the presence of a phakic intraocular lens; the first case describes a cyst which was not present prior to the anterior chamber phakic intraocular lens implantation. The second case describes a hidden iris cyst that affected the posterior chamber phakic intraocular lens position and lead to glaucoma.

Acute uveal effusion during phacoemulsification with preoperative central serous chorioretinopathy: a case report.

BACKGROUND: We report a case of acute uveal effusion during phacoemulsification in an eye with preoperative chronic central serous chorioretinopathy (CSC). CASE PRESENTATION: A 55-year-old man with a history of chronic CSC for >18 months presented with bilateral opaque lenses. A preoperative ophthalmic examination showed suspected lenticonus and risky anatomical features, including a thick ciliary body, and anterior rotation of the ciliary process and iris root in both eyes. Optical coherence tomography (OCT) detected CSC in the left eye, but the results of fundus photography and B-scan ultrasonography were unremarkable. The anterior chamber flattened during phacoemulsification. Anterior vitrectomy was quickly performed for suspected infusion misdirection syndrome, and was followed by uneventful surgery. On postoperative day 1, fundus photography, type B ultrasound, and OCT revealed uveal exudation in the macula of the left eye. On postoperative day 50, the patient's visual acuity recovered to 20/32, and fundus photography, ultrasonography, and OCT revealed complete resolution of the uveal effusion. CONCLUSIONS: This case suggests an association between preoperative CSC and uveal effusion during surgery, because choroidal hyperperfusion and hyperpermeability were present in the patient's CSC-affected eyes.

BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION: A CASE REPORT.

PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) in the setting of metastatic ovarian cancer. METHODS: In this observational case report, a 59-year-old woman presented with bilateral worsening vision and photophobia. She had been diagnosed with metastatic ovarian cancer 5 years prior for which she received Tamoxifen. Ophthalmic examination was completed followed by fluorescein angiography and optical coherence tomography (Spectralis OCT; Heidelberg Engineering). RESULTS: The visual acuity was 20/150 in both eyes. Exam demonstrated an iris pigmented lesion in the right eye, bilateral nuclear sclerotic cataracts, multiple orange lesions in the fundus, elevated pigmented uveal melanocytic tumors with diffuse choroidal thickening and multifocal early hyperfluorescence of these lesions (giraffe-like pattern) on fluorescein angiography, and exudative retinal detachment on OCT. The patient was diagnosed with BDUMP in the setting of metastatic ovarian carcinoma. Further metastatic workup demonstrated enlarged lymphadenopathy in the right axilla and inguinal regions. The patient declined chemotherapy and was initiated on plasmapheresis. CONCLUSIONS: BDUMP is a peculiar paraneoplastic syndrome in the setting of metastatic ovarian cancer, where antigens from the retinal pigment epithelium, iris and choroidal melanocytes cross-react with ovarian tumor cell antibodies that are circulating in the serum. Plasmapheresis can decrease the concentrations of the antibodies, maintain reasonable functional vision and improve the quality of life.

Uveal cysts in domestic cats: a retrospective evaluation of thirty-six cases.

OBJECTIVE: The aim of this retrospective study was to investigate uveal cysts in domestic cats by identifying prevalence, predispositions, location, presumed etiologies, and sequelae. ANIMALS STUDIED: The clinical databases of two referral hospitals (The Animal Health Trust in the UK and Animal Eye Care in Australia) were searched to identify cats that had been diagnosed with uveal cysts, either as an incidental finding or as the reason for referral. Thirty-six cases were found. PROCEDURES: The signalment of the patients was recorded, along with any relevant previous clinical history, treatment, follow-up, and sequela. The data were compared with the unaffected feline populations examined by ophthalmologists in the two hospitals over the same 10-year time period. RESULTS: Thirty-six cats were affected, from a total examined population of 5017 (prevalence 0.72%). Twenty-one of the 36 cats were Burmese. The two centers examined 516 Burmese cats in the same time period, giving an incidence in Burmese cats of 4.1%. The mean age of affected cats at presentation was 10.25 years (SD = 4.12 years), and female cats accounted for 23 of 36 of the cases. Only 2 of 36 cats had concurrent intraocular disease. CONCLUSIONS: Uveal cysts in domestic cats are rare ophthalmic findings, and in most cases, they do not cause any clinical problems The Burmese breed is overrepresented in the data, with a relatively high prevalence of uveal cysts.

NEAR-INFRARED AUTOFLUORESCENCE IN BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION ASSOCIATED WITH ESOPHAGEAL CARCINOMA AND CHOROIDAL METASTASIS.

PURPOSE: To investigate the advantage of near-infrared autofluorescence (787 nm) for the detection of melanocytic lesions in a patient with bilateral diffuse uveal melanocytic proliferation in association with esophageal carcinoma complicated by most likely unilateral choroidal metastasis. METHODS: In this retrospective case report, a 55-year-old woman referred for the evaluation of sudden visual loss underwent normal ophthalmological evaluation and, in addition, was examined with near-infrared reflectance, near-infrared autofluorescence, fundus autofluorescence (Heidelberg Retina Angiograph II [HRA2; Heidelberg Engineering]), spectral domain optical coherence tomography (Spectralis OCT; Heidelberg Engineering), and multifocal electroretinography (RetiScan; Roland Consult). RESULTS: The patient had been diagnosed with esophageal carcinoma 3 months before the onset of visual symptoms. The visual acuity was 20/40 in the right eye and 20/20 in the left eye. Bilateral patchy melanocytic proliferation was detected on ophthalmoscopy. The extent of lesions was best detected with near-infrared reflectance and near-infrared autofluorescence, whereas fundus autofluorescence and spectral domain optical coherence tomography did not reveal alterations of the outer retina or retinal pigment epithelium in this early stage of bilateral diffuse uveal melanocytic proliferation. The right eye showed in addition to the findings on the left eye choroidal folds in the fovea and an elevated lesion inferotemporal of the fovea suspicious of a choroidal metastasis. In the B-scan ultrasonography, a homogenous lesion was seen. Spectral domain optical coherence tomography demonstrated a mild accumulation of subretinal fluid adjacent to and over the choroidal metastasis. Transretinal biopsy of this elevated lesion revealed a low differentiated carcinoma of squamous epithelium, compatible with choroidal metastasis of the esophageal carcinoma. The choroidal metastasis increased within 3 months after the first visit. The visual acuity dropped in both eyes. The patient died 6 months after her first visit. CONCLUSIONS: Bilateral diffuse uveal melanocytic proliferation can be associated with esophageal carcinoma as a systemic malignancy. Near-infrared imaging can be helpful to detect early stages of BDUMP and can help offer recently reported treatment options at an early stage of disease.

Transient Ciliochoroidal Detachment After Ab Interno Trabeculotomy for Open-Angle Glaucoma: A Prospective Anterior-Segment Optical Coherence Tomography Study.

IMPORTANCE: Although trabeculotomy is a glaucoma surgical procedure for modest intraocular pressure (IOP) reduction, some eyes exhibit very low IOP during the early postoperative period. To our knowledge, the reason and its effect have not been investigated. OBJECTIVES: To investigate ciliochoroidal detachment (CCD) immediately after ab interno trabeculotomy and evaluate its effect on IOP immediately after surgery. DESIGN, SETTING, AND PARTICIPANTS: This prospective, observational, case series was conducted at Kyoto University Hospital, Kyoto, Japan. Patients with open-angle glaucoma who underwent ab interno trabeculotomy using a microsurgical device by a single surgeon between July 1, 2014, and May 31, 2015, were included. Thirty-seven consecutive patients were enrolled, 33 of whom were included in the analysis. The dates of the analysis were August 1 to August 15, 2015. INTERVENTION: Imaging of CCD using anterior-segment optical coherence tomography (AS-OCT). MAIN OUTCOMES AND MEASURES: The incidence of CCD immediately after ab interno trabeculotomy and its effect on IOP in the early postoperative period. RESULTS: The study cohort comprised 33 patients. Their mean (SD) age was 69.4 (13.2) years, and 19 (58%) were male. At postoperative day 3, CCD was detected in 14 of 33 eyes (42%) (CCD group) using AS-OCT. The CCD group had shorter axial length (mean [SD], 23.66 [1.67] vs 25.16 [1.59] mm) and thinner central corneal thickness (mean [SD], 505.9 [35.8] vs 533.9 [39.1] µm) than the non-CCD group. Only 5 eyes had CCD at postoperative day 10, and 4 of these eyes had CCD at 1 month after surgery. The postoperative IOPs at all follow-up periods were lower in the CCD group than in the non-CCD group, but the difference in the postoperative IOPs between the groups decreased as time passed. The mean (SD) IOPs for the CCD group vs the non-CCD group were 9.1 (3.0) vs 14.2 (5.8) mm Hg at day 1, 8.4 (2.4) vs 13.4 (5.0) mm Hg at day 3, 11.0 (3.0) vs 15.5 (6.3) mm Hg at day 10, 13.4 (2.4) vs 15.5 (3.3) mm Hg at 1 month, and 13.9 (3.4) vs 15.5 (4.0) mm Hg at 3 months. In several eyes in the CCD group, the AS-OCT images revealed a connection between the CCD and the anterior chamber via the trabeculotomy site. CONCLUSIONS AND RELEVANCE: Ciliochoroidal detachment after ab interno trabeculotomy was not rare and was associated with low IOP immediately after surgery. Postoperative CCD may be partially attributed to the transient increase in uveoscleral aqueous outflow via the trabeculotomy site.

Plateau Iris in Primary Angle Closure Glaucoma: An Ultrasound Biomicroscopy Study.

PURPOSE: To determine prevalence and anterior segment morphology of plateau iris in patients with primary angle closure glaucoma (PACG) after laser peripheral iridotomy using ultrasound biomicroscopy (UBM). METHODS: In this prospective study, 262 PACG patients and 144 normal controls underwent UBM examination. Plateau iris in a quadrant was defined by the presence of anteriorly directed ciliary process, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact in the same quadrant. At least 2 quadrants had to fulfill these UBM criteria. RESULTS: UBM analysis showed plateau iris in 83/262 (31.68%, 95% confidence interval: 26.7%-37.9%) PACG eyes, it was common in female individuals (61.44%), and patients were significantly younger than PACG patients (P=0.006). Plateau iris was found in superior quadrant in 19/83 (22.89%) eyes, inferior quadrant in 19/83 (22.89%) eyes, nasal quadrant in 21/83 (25.3%) eyes, and temporal quadrant in 24/83 (28.91%) eyes. In plateau iris patients, the central anterior chamber depth was shallower, the anterior chamber angle, the scleral-iris angle, and the sclera-ciliary process angle were significantly narrower, and the trabecular ciliary process distance and the iris ciliary process distance were significantly shorter in patients than in PACG subjects. CONCLUSIONS: Patients with plateau iris had significantly shallow central ACD when compared with those with pupillary block and normal eyes. After laser peripheral iridotomy, about a third of PACG eyes had plateau iris. This is clinically important because these patients can develop synechial angle closure and should be followed up closely.

Inadvertent cyclodialysis cleft and annular ciliochoroidal detachment after hyperopic phakic intraocular lens implantation and prophylactic surgical iridectomy.

UNLABELLED: We present the case of a 26-year-old man with severe early hypotony after implantation of the Implantable Collamer Lens phakic intraocular lens (pIOL) in the left eye for hyperopia. To our knowledge, this is the first documented case of cyclodialysis cleft and secondary annular ciliochoroidal detachment after implantation of a pIOL, presumably provoked by a straightforward prophylactic surgical iridectomy. The initial diagnosis was determined using swept-source Fourier-domain anterior segment optical coherence tomography as gonioscopy and ultrasound biomicroscopy did not reveal the cleft. Conservative treatment was not effective. Argon laser photocoagulation resolved the problem. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.