Central Serous Chorioretinopathy after Rhinoplasty

We report a case of central serous chorioretinopathy after rhinoplasty for deviation of the nasal septum in a 23-year-old Caucasian man. The patient complained of deterioration of vision in the right eye 4 days after rhinoplasty. At presentation, visual acuity of the right eye was 6/9 with metamorphopsia. Fluorescein angiography revealed a focal retinal pigment epithelium leakage and optical coherence tomography an increase in macular thickness to 245 μm. The left eye was normal. One month after the operation, without any treatment, visual acuity returned to 6/6, the leakage of the retinal pigment epithelium disappeared and the macular thickness returned to 183 μm. To the best of our knowledge, central serous chorioretinopathy after rhinoplasty has not been previously reported. This case report shows a possible association between the postoperative stress and central serous chorioretinopathy. Moreover, it widens the spectrum of drugs associated with the occurrence of the disease

Corneal Clarity and Visual Outcomes after Small-Incision Lenticule Extraction and Comparison to Femtosecond Laser-Assisted In Situ Keratomileusis

Purpose. To evaluate corneal clarity and visual outcomes after small-incision lenticule extraction (SMILE) and compare them to femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Materials and Methods. Fifty-eight myopic eyes of 33 patients who underwent SMILE were compared to 58 eyes of 33 patients treated with FS-LASIK. All procedures were performed using VisuMax® femtosecond laser and MEL 80® excimer laser (Carl Zeiss Meditec AG, Germany). Pentacam™ (Oculus, Germany) was used for pre- and 3-month postoperative corneal densitometry (CD) analysis. CD was evaluated at 3 optically relevant, concentric radial zones (0–2 mm, 2–6 mm, and 0–6 mm annulus) around the corneal apex and at 3 different anatomical corneal layers (anterior, central, and posterior). Associations of postoperative CD values with the lenticule thickness and ablation depth were examined. Preoperative and postoperative corrected distance visual acuity (CDVA) values were also compared. Results. After SMILE, the total CD (all corneal layers) at 0–6 mm annulus showed no significant change compared to preoperative values (P=0.259). After FS-LASIK, the total CD was significantly reduced (P=0.033). Three-month postoperative CD showed no significant differences between the 2 groups for all examined annuli (0–2 mm: P=0.569; 2–6 mm: P=0.055; and 0–6 mm: P=0.686). Total CD after SMILE at 0–6 mm annulus displayed a weak negative association with the lenticule thickness (P=0.079, R2=0.0532) and after FS-LASIK displayed a weak negative association with the ablation depth (P=0.731, R2=0.0015). Postoperative CDVA was similar for both groups (P=0.517). Conclusion. Quantification of corneal clarity using the Scheimpflug CD showed similar results before and 3 months after SMILE. Compared to FS-LASIK, no significant differences of corneal clarity and CDVA were found 3 months postoperatively

Mutations in FRMD7, a newly identified member of the FERM family, cause X-linked idiopathic congenital nystagmus.

Idiopathic congenital nystagmus is characterized by involuntary, periodic, predominantly horizontal oscillations of both eyes. We identified 22 mutations in FRMD7 in 26 families with X-linked idiopathic congenital nystagmus. Screening of 42 singleton cases of idiopathic congenital nystagmus (28 male, 14 females) yielded three mutations (7%). We found restricted expression of FRMD7 in human embryonic brain and developing neural retina, suggesting a specific role in the control of eye movement and gaze stability

Mutations in FRMD7, a newly identified member of the FERM family, cause X-linked idiopathic congenital nystagmus

Idiopathic congenital nystagmus (ICN) is characterised by involuntary, periodic, predominantly horizontal, oscillations of both eyes. We identified 22 mutations in FRMD7 in 26 families with X-linked idiopathic congenital nystagmus. Screening of 42 ICN singleton cases (28 male, 14 females) yielded three mutations (7%). We found restricted expression of FRMD7 in human embryonic brain and developing neural retina suggesting a specific role in the control of eye movement and gaze stability

Posttraumatic Sphingomonas paucimobilis Endophthalmitis

A rare case of Sphingomonas paucimobilis endophthalmitis secondary to a penetrating globe injury with a retained intraocular foreign body is presented. A 30-year-old man presented with severe pain following a penetrating left eye injury. Visual acuity (VA) was 6/120. Slit-lamp examination revealed perforation of the temporal cornea and iris, hypopyon, and a fibrinous membrane covering the pupil. Ultrasonography showed dense vitreous infiltration and an orbital CT-scan confirmed the presence of a metallic foreign body in the vitreous cavity. Topical and systemic therapy were initiated. Pars-plana vitrectomy combined with phacoemulsification was performed in order to remove the foreign body; vitreous samples were acquired and Sphingomonas paucimobilis, sensitive to ceftazidime, was identified. To the best of our knowledge, this is the first report of Sphingomonas paucimobilis endophthalmitis following penetrating ocular injury. In this case, Sphingomonas paucimobilis was not resistant to antibiotics. This allowed for a good healing response following vitrectomy despite the fact that long-term retinal complications resulted in low VA

Scheimpflug Densitometry After DMEK Versus DSAEKTwo-Year Outcomes

Purpose:To compare the course of Scheimpflug corneal densitometry (CD) after Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK).Methods:Fifty-four DMEK and 25 DSAEK cases without previous corneal surgery, complicated intraoperative or postoperative course, or vision-limiting ocular comorbidities were included. Pseudophakic eyes of age-matched subjects were recruited as controls (n = 20). Scheimpflug CD of the optically relevant zones (0-2 and 2-6 mm), best-corrected visual acuity (BCVA), endothelial cell density, and central corneal thickness were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively.Results:CD of the optical zone decreased from 34.4 9.4 grayscale units (GSU) before to 19.2 +/- 2.7 GSU at 24 months after DMEK. Respectively, CD decreased from 34.0 +/- 13.4 GSU before to 21.2 +/- 2.5 GSU at 24 months after DSAEK. Mean central CD in group 3 was 18.1 +/- 1.3 GSU. Compared with DSAEK, DMEK cases showed lower central CD at 3 and 6 months (P 0.012) but not at 12 and 24 months postoperatively. DSAEK showed higher CD values throughout the postoperative period compared with healthy controls (P < 0.001). DMEK showed higher CD compared with controls at 3, 6, and 12 but not at 24 months after surgery (P = 0.152). Postoperative BCVA was significantly better after DMEK for every examination time point. No difference in endothelial cell density was found between DMEK and DSAEK at any time point.Conclusions:DMEK showed lower CD and better BCVA compared with DSAEK in the first 6 postoperative months. Notably, although CD reached similar levels in the midterm after both DMEK and DSAEK, BCVA remained significantly better after DMEK

Secondary DMEK following failed primary DMEK

Purpose To report the outcomes of secondary Descemet Membrane Endothelial Keratoplasty (DMEK) performed for failed primary DMEK. Methods The medical records of all patients undergoing secondary DMEK due to failure of primary DMEK were reviewed. Reasons for failure were sought and best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications of secondary DMEK were evaluated. Results A total of 10 cases undergoing secondary DMEK following failed primary DMEK were identified. Presumed reasons for failure included donor ECD <= 2300 cells/mm(2) (n = 4), difficulty during graft preparation (n = 2), graft detachment (n = 2), acute angle closure due to retroiridal air dislocation (n = 1), inverse graft positioning (n = 1) and phacoemulsification (n = 1). Eyes with low visual potential were not excluded from the study group. We should note that one patient (case no7) had both low ECD and graft detachment as reasons for failure and as a result he is counted twice. Median BCVA (decimal fraction) increased from 0.1 (range, 0.01; 0.3) to 0.5 (0.05; 1.0) at one month and remained stable thereafter. A BCVA of 0.5 or higher was achieved in 7 cases at the final follow-up. Mean ECD fell from 2628 +/- 284 cells/mm(2) to 1391 +/- 252cells/mm(2) at 6 months (47% reduction) and 959 +/- 225cells/mm(2) at 24 months (64% reduction) (P <= 0.028). Complications included the incomplete removal of the primary graft and mild iris bleeding, decompensation of a preexisting primary open-angle glaucoma and retroiridal air dislocation. Conclusions Apart from low donor ECD, surgical challenges, i.e., difficulty with graft preparation, inverse graft positioning, and retroiridal air dislocation, were main reasons for failure of primary DMEK. Secondary DMEK showed a good safety profile and reasonable visual outcomes

Study of fatigue crack initiation and propagation mechanisms in an advanced Ni-based superalloy: effects of microstructures and oxidation

Low Solvus, High Refractory (LSHR) alloy is a latest generation of turbine disc alloy which contains relatively high Co and Cr levels compared with incumbent alloys, this provides a low solvus temperature for enhanced high temperature processing versatility, and the alloy is designed to operate at higher temperatures to achieve higher thrust-to-weight ratio and higher fuel efficiency. Understanding the fatigue performance of the LSHR alloy along with the coupled influences of deformation and oxidation damage is important for both its practical application and in further development of turbine disc alloys.Short crack tests have been conducted on coarse grained (CG) and fine grained (FG) LSHR alloys by uninterrupted and interrupted three-point bending with a replication procedure at room temperature, 650 and 725 oC in air and vacuum under a sine waveform (20Hz) and/or 1-1-1-1 trapezoidal waveform to investigate fatigue crack initiation and early propagation. The results show that fatigue lives in the LSHR alloy are shortened by high temperature, high oxygen partial pressure and low frequency loading waveforms which are associated with more intergranular fracture mechanisms. At room temperature, where the effect of oxidation is absent, twin boundary (TB) cracking in relatively large grains dominates the crack initiation process along with occasional crack initiation due to slip band cracking. Activation of the primary slip systems parallel to the TB at matrix and twin and high resolved shear stress associated with high Schmid factor (SF) are required for TB crack initiation. Cracks preferentially propagate along slip bands associated with high SF slip systems after initiation. But cracks also propagate along slip bands associated with slip systems with lower SF if the inclination angle between the slip band ahead of the crack tip and the crack segment of the crack tip is small enough to enable a steady transition (or non-deflected growth) of cracks across the grain boundary (GB).At elevated temperatures (i.e. 650 and 725 oC), fatigue crack initiation and early short crack propagation behaviour are closely related to coupled deformation-oxidation damages. Plentiful crack initiation mainly occurs at GBs and/or ?/?? interfaces (in the FG variant) with bulged Ni/Co-rich oxides and Cr/Ti/Al oxide intrusion due to oxide cracking. Cracks subsequently propagate along oxidised GBs at the surface and exhibit significant crack coalescence in the final stages of fatigue life. In terms of crack propagation in the depth direction, this is a consequence of the competing effects between mechanically-driven and oxidation-assisted crack propagation, and exhibits transgranular or intergranular or mixed inter-transgranular propagation.Formation of bulged Ni/Co-rich oxides and Cr/Ti/Al oxide intrusion along grain boundaries is accompanied by dissolution of ?? precipitates, and is closely related to the strain localisation which is associated with grain orientation and applied stress. The boundaries of high/low SF grains are preferential sites for bulged Ni/Co-rich oxides and Cr/Ti/Al oxide intrusion formation. Strain-assisted formation of internal GB Cr/Ti/Al oxide intrusion can facilitate coupled formation of GB bulged Ni/Co-rich oxides by providing abundant Ni and Co. Apart from the significant oxidation at grain boundaries and ?/?? interfaces, uniform surface oxide scale along with internal Al oxide particles form within grains and primary ??.Studies of long fatigue crack growth (FCG) behaviour in LSHR alloy at 650 and 725 oC in air and vacuum under trapezoidal waveforms of 1-1-1-1 and 1-20-1-1 indicate that a CG structure possesses better FCG resistance due to the enhanced slip reversibility promoted by planar slip as well as the reduction in grain boundary area. The fatigue performance of the LSHR alloy is significantly degraded by the synergistic oxidation effect brought about by high temperature, high oxygen partial pressure and dwell at the peak load, associated with increasingly intergranular fracture features and secondary grain boundary cracking. Secondary cracks are observed to be blocked or deflected around primary ??, carbides and borides, and their occurrence closely relates to the roughness of the fracture surface, FCG rate and grain boundary oxidation. The apparent activation energy analysis provides a further insight into the underlying mechanism of the FCG under dwell-fatigue testing conditions, and confirms that oxidation fatigue is the dominant process contributing to the intergranular failure process. At high enough crack growth rates and at lower temperatures, mechanically-driven fatigue crack growth processes can outstrip crack-tip oxidation processes