Bilateral Serous Macular Detachment After Attempted Suicide with Pregabalin

A 24-year-old female presented with bilateral vision loss following attempted suicide with pregabalin. Her best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/50 in the left eye. The bilateral visual disturbance was associated with serous macular detachment. Fundus examination of both eyes showed foveal serous retinal detachment, which was confirmed by optical coherence tomography. Topical nepafenac 0.1% eye drops were started as single drop every 8 hours for 4 weeks. One month later, the serous macular detachment had regressed and BCVA increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of bilateral serous macular detachment presumably caused by pregabalin intoxication

Visual Impairment Secondary to Unilateral Isolated Epicapsular Star

We aimed to report a rarely observed case of unilateral epicapsular star and the visual impairment developed secondary to it. A 8-year-old girl presented with a complaint of blurred vision in the right eye; best-corrected visual acuity was 0.7 in the right eye and 1.0 in the left eye. Near visual acuity was J1 in the right eye and J1+ in the left eye. The patient had no systemic disease and no clinical findings such as ocular inflammation, trauma, or history of use of topical and systemic drug. On biomicroscopic examination, no pigment deposition was observed in the cornea of both eyes and anterior chamber was normal. The anterior capsule of the lens in the right eye demonstrated dense pigment depositions centrally which were obscuring the pupillary axis. Iris translumination defect was not seen. Gonioscopy was performed and no pigment deposition was seen in the iridocorneal angle. Fundus examination revealed no pathology in the vitreous, posterior pole, and peripheral retina. In the absence of signs of intraocular inflammation and other causes of primary or secondary pigment dispersion, it is likely that the pigmented cells were implanted on the lens surface in utero from the developing iris pigment epithelium. In such cases, visual impairment should be detected in early period, and the strict follow-up is of utmost importance. (Turk J Ophthalmol 2014; 44: 493-5

Yüksek doz oral fluoksetin alımı sonrası gelişen oküler herpes simpleks virus aktivasyonu

A 51-year-old man with high intraocular pressure on the left eye was referred to our clinic. A laser iridotomy was performed with full anti-glaucoma medication prior to the referral. There was a fixed dilated irregular pupil of the left eye, accompanied with mild corneal edema, a paracentral stromal corneal haze, patchy iris atrophy, fine keratic precipitates, trace amounts of cells and pigments in the anterior chamber and a patent iridotomy. Medical history was revealed a previous herpetic episode 7 years ago and fluoxetine use for major depression for 2 years which he overdosed 5 days before his ocular symptoms have started. Ocular herpes simplex virus activation associated with high dose fluoxetine was suspected. Fluoxetine was discontinued. Oral acyclovir, topical steroids and anti-glaucoma medication has been prescribed. A week later, on his control visit, the intraocular pressure was normalized and clinical findings have subsided. Fluoxetine, a selective serotonin re-uptake inhibitor, and some other anti-depressants, has been proved to suppress cellular immunity. Herpes simplex virus activation after surreptitious self-administration of high dose fluoxetine in this case is much more probable than coincidence. This is the first reported case of ocular herpes activation related to fluoxetine use.Yüksek Doz Oral Fluoksetin Alımı Sonrası Gelişen Oküler Herpes Simpleks Virus AktivasyonuElli bir yaşında erkek hasta, kliniğimize yüksek göz içi basıncı nedeniyle refere edilmiş. Öncesinde hastaya tam antiglokomatöz tedavi ve lazer iridotomi uygulanmış. Hastanın sol gözünde fikse dilate düzensiz pupilla ve eşlik eden hafif kornea ödemi, parasantral stromal korneal bulanıklık, yama şeklinde iris atrofisi, keratik presipitatlar, ön kamarada eser miktarda hücre ve pigment kümeleri ve açık iridotomi izlendi. Medikal öyküsünde 7 yıl önce geçirilmiş herpetik atak öyküsü belirlendi ve major depresyon nedeniyle 2 yıldır fluoksetin kullanan hastanın göz yakınmalarının başlamasından 5 gün öncesinde ilacı yüksek dozda aldığı belirlendi. Oküler herpes simpleks virus aktivasyonunun yüksek doz fluoksetin alımından olabileceğinden şüphelenildi. Fluoksetin kesildi. Oral asiklovir, topikal steroid ve anti-glokomatöz tedavi başlandı. Bir hafta sonra, hastanın kontrol muayenesinde göz içi basıncının normale geldiği ve klinik bulguların yatışmış olduğu izlendi. Fluoksetin, selektif serotonin geri alım inhibitörü olup, bazı diğer antidepresan ilaçlar gibi, hücresel immüniteyi baskıladığı kanıtlanmıştır. Bu olguda olduğu gibi hastanın gizlice yüksek doz fluoksetin alımı sonrası gelişen herpes simpleks virus aktivasyonu tesadüf olmasından daha olasıdır. Fluoksetin kullanımıyla ilişkili oküler herpes aktivasyonu olgusu ilk kez rapor edilmektedir

Comparison of Different Types of Complications in the Phacoemulsification Surgery Learning Curve According to Number of Operations Performed

Objectives: To compare the differences in intraoperative complications rates by the number of resident-performed sequential phacoemulsification surgeries. Materials and Methods: Preoperative and postoperative ophthalmological examination records and intraoperative data of 180 eyes of 140 patients who underwent cataract surgery by two residents between November 2009 and February 2012 were analyzed retrospectively. The data of 180 eyes were separated into 3 groups based on the number of operations performed: Group A (first 1-60 eyes), group B (61- 120 eyes) and group C (last 121-180 eyes). The number of direct supervisor interventions and the rates of different types of complications were compared between the three groups. Results: The number of direct supervisor interventions was 45, 35 and 19 in group A, B and C, respectively. The number of complications anterior to the iris plane was 3, 4 and 12 in group A, B and C, respectively. The difference in the rate of complications between group B and C was statistically significant (p=0.029). The number of complications posterior to the iris plane was 6, 14 and 3 in group A, B and C, respectively. The difference in the rate of complications between the groups was statistically significant (p=0.042, p=0.004). Conclusion: This study provides insight into which types of complications might arise during the phacoemulsification training period. The trends in the rates of different complication types in clinics may be analyzed, and this analysis may be used to improve and modify phacoemulsification training programmes according to the needs of residents

Four Cases of Pediatric Photokeratitis Present to the Emergency Department After Watching the Same Theater Show

We report four consecutive cases of photokeratitis that presented to the emergency department, interestingly after having watched the same theatre performance in the same school. The patients’ ages (3 male, 1 female) ranged from 9 to 13 years. All patients presented with similar complaints consisting of pain, tearing, foreign body sensation, photophobia and blurred vision in both eyes. Patients reported watching a theatre performance in the same school approximately 4 hours before symptom onset. On slit-lamp examination, conjunctival injection and corneal punctate epithelial erosions were observed in the interpalpebral zone in both eyes. On fundus examination, no pathology was observed in the vitreous, posterior pole or peripheral retina. All cases were treated with topical antibiotics and lubricant eye drops. Corneas were clear two days later in the control visit. In this case report, exposure to ultraviolet light from high-power lamps used in the theatre was proposed as a possible cause of corneal epithelial cell damage and subsequent photokeratitis. (Turk J Ophthalmol 2015; 45: 226-228

Isolated Anterior Lens Capsule Rupture Secondary to Blunt Trauma: Pathophysiology and Treatment

A 25-year-old man suffered an isolated lens anterior capsular tear and mature cataract formation following blunt injury to his right eye. One week after the trauma, best-corrected visual acuity (BCVA) in the right eye was hand motion. B-scan ultrasonography showed that the lens posterior capsule was intact; no vitreous foreign body or retinal pathology were observed. Orbital computed tomography revealed narrowed anterior chamber and increased lens material volume and lens reflectivity in the injured right eye. The globe was intact and no bone fractures were observed. The cataractous lens material was removed by phacoemulsification and a foldable, acrylic, posterior chamber intraocular lens was implanted in the bag. Postoperative BCVA in the right eye was 20/20