Periocular hematoma secondary to subperiosteal injury by a short needle

Bleeding and intraorbital hematoma is one of the most common complications of needle block for ophthalmic local anesthesia. We describe an unusual presentation of hematoma that originated in the subperiosteal space and extended to the subconjunctival and periocular area after a peribulbar block for phacoemulsification in a 55-year-old lady. It required an urgent surgical evacuation in order to reduce the intraocular pressure and save the eye. Detailed management to improve the outcome is discussed

The ophthalmic phenotype of IFT140-related ciliopathy ranges from isolated to syndromic congenital retinal dystrophy

Background Conorenal syndrome is a systemic skeletal ciliopathy characterised by skeletal and renal findings and caused by biallelic mutations in the gene intraflagellar transport 140 Chlamydomonas homologue (IFT140). Most studies have focused on syndromic features and are by non-ophthalmologists. We highlight the ophthalmic phenotype. Methods Retrospective consecutive case series (2010-2014). Results Twelve subjects with confirmed homozygous mutations were identified (11 consanguineous families; 7 boys; assessed at age 10 months to 20 years, average and median age 6.5 and 4 years). All were homozygous for the same IFT140 mutation (c.1990G>A; p. Glu664Lys) except one who was homozygous for c.1541_1542delinsAA. All had poor vision and nystagmus since birth, with visual acuity after 5 years old of hand motions or light perception. In early childhood, nine were noted to stare at lights, four were noted to have a happy demeanour, high hyperopia was typical, and electroretinography was non-recordable. Fundus appearance was grossly normal before the age of 1 year but thereafter appeared dystrophic. Eight children had developmental delay, two had short stubby fingers, and one had renal disease, but four had no evident extraocular disease, including one aged 18 years who also had two older affected siblings in their twenties who remained non-syndromic and were excelling academically. Conclusions Recessive IFT140 mutations cause a severe congenital retinal dystrophy with high hyperopia and often early photophilia. Developmental delay is common but not universal and not all patients have obvious extraocular findings. The c.1990G>A mutation represents a founder effect or mutational hotspot on the Arabian Peninsula

Spectrum of MRI findings in 58 patients with methanol intoxication: Long-term visual and neurological correlation

Purpose: To describe MRI and DWI spectrum of brain and optic pathway changes in cases who survived acute methanol poisoning and explore whether there is correlation between imaging features and long-term visual and neurological sequelae. Materials and methods: We retrospectively reviewed the conventional MRI and DWI of 58 consecutive patients with methanol poisoning. All patients were examined in the chronic phase. Results: Optic nerve enhancement and atrophy were detected in 33 cases (56.9%). Degree of optic nerve atrophy correlated well with cupping and time lag since initial exposure to methanol. Bilateral putamen necrosis was present in 45 cases (77.6%), 19 showed asymmetrical involvement, and caudate was involved in 6 cases. Asymmetrical necrosis and caudate involvement were correlated with higher grade of neurological deficit. Twenty-one cases (36.2%) showed combination of bilateral putamen necrosis and optic nerve enhancement. Subcortical white matter high SI was detected in 25 patients (43.1%). DWI clearly depicted putamen necrosis with non-restricted pattern. Conclusion: Spectrum of residual MRI Findings in patients who survived methanol poisoning included bilateral optic nerve atrophy and enhancement, bilateral putamen and caudate necrosis as well as subcortical white matter high SI at T2WI. Diffusion WI did not have additional value in chronic stage

Chronic Orbital Inflammation Associated to Hydroxyapatite Implants in Anophthalmic Sockets

Purpose: We report 6 patients who received a hydroxyapatite (HA) orbital implant in the socket and developed chronic orbital inflammation unresponsive to conventional medical therapy. Case Reports: We assisted 6 cases (4 males, 2 females) who received an HA orbital implant in the socket between 2015 and 2016 at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and developed chronic orbital inflammation with chronic discharge, redness, and pain (onset from weeks to over 2 decades after surgery). Computed tomography evaluation indicated inflammation in the orbital tissues, and histological examination showed a foreign body granulomatous reaction mainly localized around and blanching the HA implant. The condition was unresponsive to usual medical treatment and was resolved immediately after implant removal. Conclusions: Chronic inflammation can occur decades after placement of an HA implant in the orbit and can be successfully treated with implant removal