Late intraocular Lens dislocation following scleral depression: a case report.

BACKGROUND: The case describes a rare entity. Most cases of IOL dislocation are associated with surgical trauma or preexisting zonulopathy. This patient presents IOL dislocation following routine exam, suggesting the need of careful evaluation of zonular integrity on pseudopahkic patients. METHODS: Patient is a 65 year old who presented with sudden loss of vision and pain following retinal examination using scleral depression. Patient was diagnosed with late intraocular lens dislocation, which was subsequently for proper repositioning of IOL. CONCLUSION: Pseduophakic eyes should be approached with caution when scleral indentation is attempted due to the possibility of zonular dehiscence and subsequent intraocular lens dislocation.

Head and Neck Region Dermatological Ultraviolet-Related Cancers are Associated with Exfoliation Syndrome in a Clinic-Based Population.

OBJECTIVE: We assessed the relationship between ultraviolet (UV)-associated dermatological carcinomas (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) and exfoliation syndrome (XFS) or exfoliation glaucoma (XFG). DESIGN: Case-control study. PARTICIPANTS: Between 2019 and 2021, 321 participants and control subjects (XFS or XFG = 98; primary open-angle glaucoma [POAG] = 117; controls = 106; ages 50-90 years) were recruited. METHODS: A cross-sectional survey assessing medical history, maximum known intraocular pressure, cup-to-disc ratio, Humphrey visual field 24-2, the propensity to tan or burn in early life, history of BCC or SCC, and XFS or XFG diagnosis. The multivariable models adjusted for age, sex, medical history, eye color, hair color, and likeliness of tanning versus burning at a young age. MAIN OUTCOME MEASURES: History of diagnosed XFS or XFG. RESULTS: Any history of BCC or SCC in the head and neck region was associated with a 2-fold higher risk of having XFS or XFG versus having POAG or being a control subject (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.04-3.89) in a multivariable-adjusted analysis. We observed a dose-response association in which the chance of having XFS or XFG increased by 67% per head and neck BCC or SCC occurrence (OR, 1.67; 95% CI, 1.09-2.56). When we excluded POAG participants, head and neck BCC or SCC was associated with a 2.8-fold higher risk of XFS or XFG (OR, 2.80; 95% CI, 1.12-7.02), and each additional occurrence had a 2-fold higher risk of XFS or XFG (OR, 1.97; 95% CI, 1.09-3.58). The association between head and neck region BCC or SCC and POAG compared with the control subjects was null (OR, 1.42; 95% CI, 0.58-3.48). With BCC or SCC located anywhere on the body, there was a nonsignificantly higher risk of having XFS or XFG compared with having POAG or being a control subject (OR, 1.65; 95% CI, 0.88-3.09). CONCLUSIONS: Head and neck region BCCs or SCCs are associated with a higher risk of having XFS or XFG. These findings support prior evidence that head and neck UV exposure may be a risk factor for XFS.

Imaging implanted keratoprostheses with anterior-segment optical coherence tomography and ultrasound biomicroscopy.

PURPOSE: To describe the anterior ocular segment findings of eyes with implanted Boston type 1 keratoprostheses (KPro) in vivo by using anterior-segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). METHODS: A retrospective, comparative study was made of patients with implanted KPros who were examined with AS-OCT (AC Cornea OCT) and UBM (OTI Scan 35-50 MHz Ultrasound). RESULTS: One pseudophakic and 1 aphakic eye were included in the study. Cross-sectional AS-OCT adequately imaged the components of the KPro (front plate with stem, back plate, and titanium ring), the corneal graft, and host cornea. The angles could be seen as open, filled with debris, or closed. Coronal AS-OCT showed en face views of each KPro part. Retrokeratoprosthetic membranes were depicted to be thick opacities covering the rear optical surface of the stem. UBM, on the other hand, imaged the KPro front plate as a muffin-shaped space at the apical center, with the corneal graft appearing wispy and the host cornea grainy. The back plate, titanium ring, and angles could not be resolved. Glaucoma tubes and posterior-chamber intraocular lens (PCIOL) haptics were imaged below the iris plane. CONCLUSIONS: Cross-sectional AS-OCT adequately imaged the components of the assembled KPro in vivo, as well as its interaction with surrounding anterior-segment structures. It allowed visualization of the anterior chamber, iris, and angle, essential in the postoperative care of these patients. Coronal AS-OCT showed graphic en face images of the KPro device and suspected retrokeratoprosthetic membranes. UBM, on the other hand, adequately imaged glaucoma tube shunts and PCIOL haptics beneath the iris plane.

Bilateral keratectasia after unilateral laser in situ keratomileusis: a retrospective diagnosis of ectatic corneal disorder.

We present a case of iatrogenic keratectasia in the left eye after laser in situ keratomileusis (LASIK) with 14 microm of stromal ablation. Preoperative evaluation did not show significant evidence of keratoconus or forme fruste keratoconus in either eye. Twenty months postoperatively, in addition to postoperative ectasia in the left eye, the right eye developed mild changes in manifest refraction and on corneal topography. A retrospective diagnosis of ectatic corneal disorder was made in a patient who had no obvious findings of corneal pathology prior to LASIK.

Evaluation of the stability of Boston type I keratoprosthesis-donor cornea interface using anterior segment optical coherence tomography.

PURPOSE: To evaluate the anatomic stability of an implanted Boston type I keratoprosthesis (KPro)-donor cornea interface and assess the presence or absence of a potential space (gap) between the KPro front plate and donor cornea using anterior segment optical coherence tomography (AS-OCT). The presence of a gap would raise concerns of a possible pathway for the exchange of extraocular fluid with the anterior chamber. METHODS: Fifteen eyes implanted with a Boston type I KPro were studied by the noncontact technique of AS-OCT (AC Cornea OCT prototype; OTI, Canada). All the KPro devices had been implanted at least 4 weeks before the study (mean: 7 months, range: 1-22 months). Eight eyes had aphakic Kpros, and the other 7 had pseudophakic implants. Anesthetized eyes were imaged before and during pressure application using sterile cotton-tip applicators. Pressure was applied for 10 seconds on the nasal or temporal side of the eye. Images were analyzed for any possible changes in the KPro-donor cornea interface during the application of pressure. RESULTS: Of 15 eyes, 10 had the threaded front plate model with a T-shaped silhouette and corrugated sides, whereas 5 had the threadless type with a T-shaped silhouette and smooth sides on cross-sectional optical coherence tomography. Of the 15 eyes, 2 revealed a gap between the front plate and the surface of the donor cornea. The rest revealed no gaps. With pressure, none of the eyes, including the 2 with gaps, demonstrated any change in the KPro-donor cornea interface during dynamic imaging (eg, gaping or evidence of fluid escape along the KPro-donor cornea borders). In all eyes, the position of the titanium locking ring was visible and verified to be in an adequate position. CONCLUSIONS: The implanted KPro-donor cornea interface seems to be stable dynamically using AS-OCT. A gap that has been documented with this imaging tool showed neither gaping nor escape of anterior chamber fluid during dynamic cross-sectional imaging. Further studies will be needed to assess the cause of these gaps and to determine if they are possibly related to the hydration status of the cornea, suture tension on the donor cornea, or other factors that remain to be determined.