Intraocular foreign body in the anterior chamber angle misdiagnosed as herpetic stromal keratitis.

We report a case of a metallic intraocular foreign body (IOFB) retained in the anterior chamber (AC) angle that was masquerading as herpetic stromal keratitis. A 41-year-old male construction worker was referred to our ophthalmology clinic with the complaint of consistent blurred vision for 3 days in his left eye. He had no history of ocular trauma. The best-corrected visual acuity was found to be 10/10 in the right eye and 8/10 in the left eye. On slit-lamp examination of the anterior segment, the right eye was normal, while the left eye showed unilateral corneal edema and scarring, anterior lens capsule opacification, +2 cells in the AC, and the Seidel test was negative. Fundus examination was normal bilaterally. Despite there not being history of it, we still suspected ocular trauma considering the patient's occupational risk. Consequently, an orbital computed tomography imaging was performed which revealed a metallic-IOFB in the inferior iridocorneal angle. On the second follow-up day, the corneal edema regressed, and a gonioscopic examination of the affected eye was performed, showing a small foreign body embedded in the inferior iridocorneal angle of the AC. Subsequently, the IOFB was surgically removed using Barkan lens, and excellent visual results were achieved. This case emphasizes the importance of considering IOFB in the differential diagnosis of patients with unilateral corneal edema and anterior lens capsule opacification. Fur-thermore, the presence of IOFB should be definitely excluded in patients with occupational risk of ocular trauma even if there is no history of trauma. More awareness about the proper use of eye protection should be raised to circumvent penetrating ocular-trauma.

Choroidal and retinal anatomical response following treatment of carotid-ophthalmic aneurysms with flow diverter stents.

BACKGROUND: Flow diverter stents(FDSs) are recent additions to the endovascular armament for treating ophthalmic segment aneurysms(OSA). In our study we evaluated the long-term effect of FDS placement on multiple Optical Coherence Tomography(OCT) findings, best corrected visual acuity(BCVA) and intra-ocular pressure(IOP). METHODS: A prospective cohort study was conducted in 35 patients treated with a single FDS placement for OSA, between 2013 and 2018. Spectral-domain OCT was used to measure retinal nerve fiber layer thickness, ganglion cell complex thickness, subfoveal choroidal thickness(SFCT), and other stereometric parameters. Choroidal Vascularity Index(CVI) in a 1.5 mm wide subfoveal choroidal area was calculated. BCVA and IOP were also assessed. These measurements, at final follow up, were compared to the untreated fellow eye to evaluate the long-term effect of FDS placement. RESULTS: This study included 70 eyes from 35 patients (100% female) with a mean age of 54.9 ± 9.8 years and mean follow-up period of 37.3 ± 18.9 months. No ophthalmic artery occlusion was encountered. The mean CVI was significantly higher in the stented side compared to the fellow normal eye (66.90±1.95 vs 65.05±1.93, p=.001) while mean SFCT was significantly reduced (251.23±68.54 vs 288.78±78.95, p=.037). Differences in the remaining studied parameters did not reach statistical significance. The difference in BCVA between stented and fellow normal eyes was also not significant (0.057±0.213 vs 0.060±0.214, p=.977 in logMAR). CONCLUSION: Treatment with FDSs did not cause permanent visual damage. This study is the first to report a decrease in SFCT with a compensatory increase in CVI following FDS placement for OSA.