A small incision technique for repairing involutional lower eyelid entropion

Purpose The objective of this paper is to describe and review our experience with Goldberg's small incision technique for use with involutional entropion. Methods Retrospective consecutive interventional case series with validated late surgical outcomes were reported. All involutional entropion cases with horizontal laxity of less than 8 mm were repaired with a small incision technique. Retractors were separated from the tarsus by blunt dissection made from three 4 mm horizontal incisions. Three 6-0 double-armed polyglactin sutures were used to tighten retractors and the orbicularis oculi muscle. The sutures were removed 3 weeks postoperatively or earlier if overcorrection continued during the first week of the postoperative period. Data were obtained for a postoperative follow-up period of at least 24 months. Results A total of thirty-seven lower eyelids from thirty-one patients with involutional entropion were included in the study. Primary operations were performed on 31 eyelids and reoperations on six eyelids. The mean follow-up time was 40 +/- 11 months. Thirty-six (97.3%) of the eyelids had no recurrence. As overcorrection was seen postoperatively in ten eyelids (27%), a number of sutures had to be removed earlier than planned. The ectropion eventually resolved, and no recurrence was seen during follow-up in these patients. Conclusions In our practice, the small incision technique has been highly effective in involutional entropion repair, with minimal complications. Although this approach does not directly address lateral canthal tendon laxity, the procedure has the advantages of being easy to learn and also that it can be combined with other procedures for tendon laxity

Combination of photodynamic therapy, intravitreal triamcinolone injection, and standard laser photocoagulation in radiation retinopathy - A case report

We report the combination of various therapy options in a 58-year-old man diagnosed with bilateral radiation retinopathy and left radiation optic neuropathy. Four mg/0.1 mL triamcinolone acetonide was injected intravitreally in both eyes followed by bilateral photodynamic treatment 2 weeks after. Bilateral panretinal photocoagulation and right focal laser treatment for residual macular edema were performed 2 months later. At 18 months, visual acuity is 20/200 in the right eye and hand motions in the left eye with no signs of active retinopathy

Pseudotumor cerebri associated with Pickwickian syndrome and obstructive sleep apnea syndrome: a case report

AIM: To report a male patient with Pickwickian syndrome and obstructive sleep apnea (OSA) who presented with pseudotumor cerebri and visual loss. METHODS: Case report. RESULES: A 54-year-old obese man with a three-month history of bilateral visual deterioration was evaluated. His visual acuity was 20/200 in OD and 20/400 in OS. Color vision was impaired only in the left eye. Funduscopy revealed bilateral disc edema and peripapillary hemorrhages together with macular exudates in OS. Physical examination and laboratory investigations were consistent with OSA and Pickwickian syndrome. Lumbar puncture demonstrated an opening pressure of 350mm H 2O and computed brain scan was normal. The diagnosis was pseudotumor cerebri in association with OSA and Pickwickian syndrome. Fundus findings and visual acuity improved with phlebotomy, blood pressure regulation, weight reduction and bi-level positive airway pressure therapy. CONCLUSION: OSA and Pickwickian syndrome should be kept in mind when facing a patient with pseudotumor cerebri

The Role of Optic Nerve Diffusion Restriction on Visual Prognosis in Methanol Poisoning

The aim of this study was to investigate the role of optic nerve diffusion status on cranio-orbital magnetic resonance imaging (MRI) in predicting visual prognosis in cases of methanol intoxication. Diffusion-weighted imaging (DWI) from 16 eyes of eight patients who were admitted to our clinic due to methanol intoxication was analysed retrospectively. The relationship between clinical and laboratory findings, treatment regimen, visual prognosis, and imaging findings was investigated. Diffusion restriction (DR) of the optic nerve on DWI was observed in seven (43%) eyes. Regardless of the clinical and laboratory characteristics and treatment regimen, visual acuity (VA) improved in eyes in which restricted diffusion regressed over the follow-up period. DWI of the optic nerve during the acute phase of methanol poisoning may provide prognostically important data. Improvement of DR during follow-up may be an indicator of an increase in VA

Efficacy of intravitreal ranibizumab injection in acute nonarteritic ischemic optic neuropathy: A long-term follow up

Background: To evaluate the effect of a single intravitreal ranibizumab injection in eyes with acute nonarteritic ischemic optic neuropathy (NAION). Subjects and Methods: In this retrospective clinical data analysis, 17 eyes of sixteen patients who experienced a visual loss with duration of 15 days or less comprised the study group. In addition to standard ophthalmic examination, retinal nerve fiber layer thickness (RNFLT) analysis with spectral domain OCT was also performed prior to 0.5 mg Ranibizumab injection, one week, one, three, six months and one year after the injection. Results: The mean time between visual loss and intravitreal injection was 7.5 days (Range, 2-15 days). Mean age of patients was 59 years (Range, 41-90 years). Male to female ratio was 6:10. After a single dose of ranibizumab injection, visual gain was noted in 14 of 17 study eyes. In two eyes, visual acuity was minimally reduced and no change was noted in the remaining eye with an initial visual acuity of hand motions. While pre-injection mean best-corrected visual acuity (BCVA) was 1.45 ±0.88 log Mar unit, post-injection mean BCVA was 1.00±0.68, 0.86 ±0.70, 0.80 ±0.71, 0.77 ±0.70, 0.77 ±0.70 log Mar unit respectively at the first week, first month, third month, sixth month and first year. In all patients, the mean RNFLT dramatically decreased after the injection during the follow- up. While pre-injection mean RNFLT was 210 ±38 μm, post-injection mean RNFLT was 162.11±40.2, 94±27, 71.23±22.5, 63 ±19 and 57 ±18 μm respectively at the first week, first month, third month, sixth month and first year. No injection related complication was noted during the follow-up period. Conclusion: Intravitreal ranibizumab injection can be a treatment modality in eyes with acute NAION. © Saatci et al

Sympathetic ophthalmia following vitreoretinal surgery

The objective is to discuss the characteristics of three patients who developed sympathetic ophthalmia following vitreoretinal surgery. The first case was a 29-year-old man who underwent placement of an encircling band, pars plana vitrectomy, foreign body removal, endolaser photocoagulation, transscleral cryotherapy, and silicone oil injection due to a retained foreign body 3 months after a corneoscleral rupture repair. He experienced visual loss in the fellow eye 2 months after the vitrectomy. An extensive exudative detachment was detected in the fellow eye. Sympathetic ophthalmia was diagnosed and systemic steroids together with azathioprine were initiated. The injured eye was enucleated as there was no useful vision. The other two cases were operated for rhegmatogenous retinal detachments. One underwent placement of an encircling band, pars plana vitrectomy, silicone oil injection, and endolaser photocoagulation with good anatomic outcome. However, 4 months later, the fellow eye experienced severe visual loss with disc swelling and hyperemia and exudative retinal detachment. Systemic steroid was sufficient to reverse the process and the visual acuity recovered. The other case underwent placement of an encircling band, subretinal fluid drainage, SF6 injection and 360° indirect laser photocoagulation. Two years later, he noted a sudden visual decrease in the fellow eye in which we detected a Harada-like extensive exudative detachment. Systemic steroid without immunosuppressive therapy rendered regression of the detachment and recovery of good visual acuity. Sympathetic ophthalmia may occur following vitreoretinal surgery either for trauma-related problems or rhegmatogenous retinal detachment. Since it may present with relatively mild anterior segment findings and mainly posterior segment involvement; any visual disturbance in the fellow eye of a patient with a history of perforating trauma or vitreoretinal surgery should be thoroughly evaluated for sympathetic ophthalmia. © 2009 Springer Science+Business Media B.V

Optic nerve sheath decompression saves sight in severe papilloedema: results from 81 eyes in 56 patients with pseudotumor cerebri

Durmaz Engin, Ceren/0000-0001-5797-6467WOS:000603423400001PubMed: 33377617Purpose To report the outcome of optic nerve sheath decompression (ONSD) for papilloedema in a teaching hospital in western Turkey. Methods The charts of 56 patients who had ONSD surgery between April 2007 and September 2019 were collated; and a total of 81 operated and 31 fellow eyes were included. Pre- and postoperative ophthalmologic examination including best-corrected visual acuity (BCVA), colour vision (CV), visual field (VF) analysis, fundoscopic examination and demographic and medical characteristics of the patients were noted and outcomes after surgery were investigated. Results of all study eyes, 49 (43.7%) eyes had BCVA 0.2 or less and 62 (55.3%) eyes had mean deviation (MD) below - 20.0 dB. 62 (55.3%) eyes had Frisen grade 4 or 5 papilloedema. Almost half of the eyes had severe vision loss. After ONSD, BCVA, CV and MD in both operated and fellow non-operated eyes improved significantly (p < 0.001, p = 0.009 and p < 0.001 for operated, p < 0.001, p = 0.007 and p < 0.001 for fellow eyes, respectively). Earlier surgery and higher cerebrospinal fluid opening pressure were related to better outcomes. None of the patients had major operative complications. Conclusion Optic nerve sheath decompression can safely improve vision not only of the operated but also of the non-operated eye, even in cases with severe vision loss from severe bilateral papilloedema. Regardless of initial VA and VF, patients may benefit from ONSD; the earlier it is done the more likely the better outcome

Intravenous Immunoglobulin Treatment for Neuromyelitis Optica and Its Spectrum Disorders

7th Congress of the Pan-Asian-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (PACTRIMS) -- NOV 06-08, 2014 -- Taipei, TAIWANWOS: 000354258600101…Pan Asian Comm Treatment & Res Multiple Sclerosi

Necrotic arachnidism of the eyelid due to Loxosceles rufescens spider bite

Tuncok, Yesim/0000-0002-4049-336XWOS: 000296498200008PubMed: 21554159A 69-year-old woman was awakened with redness and swelling of the left upper eyelid a few days before her presentation. She also noticed a dead spider on her bed. Ophthalmic examination revealed severe left periorbital hyperemia, edema and a wide necrotic area on the upper eyelid. Systemic condition of the patient was well. She was hospitalized with the diagnosis of necrotic arachnidism of the left upper eyelid. Systemic corticosteroid and antibiotic treatment was commenced. No surgical intervention was carried out. A week later, whole upper eyelid was covered with a black eschar. This black eschar shrank with time, and it detached completely within 8 weeks and the lesion healed without a disfiguring scar. Meanwhile, the offending spider was identified as Loxosceles rufescens. Although rare, eyelid may be a biting site for Loxosceles spiders and a favorable result may be obtained with conservative management