Position of in-the-bag posterior chamber intraocular lenses relative to the limbus: Applications to Scleral Sutured Lenses
PURPOSE/OBJECTIVE:To characterize the true position of in-the-bag intraocular lenses (IOLs) relative to the limbus using ultrasound biomicroscopy (UBM) and estimate scleral sutured IOL positioning. METHODS:This prospective single center study included 70 eyes of 41 patients with in-the-bag posterior chamber IOLs. Four vertical UBM captures were performed in each eye in the superior, inferior, nasal and temporal quadrants. Post-operative biometric data were collected. The primary outcome was the vertical distance of the in-the bag IOL from the sclero-corneal limbus. Secondary outcomes included anterior shift and refractive change of a theoretical scleral sutured IOL using sclerotomies at 2.5mm and 3mm posterior to the limbus. RESULTS:A total of 265 UBM images were analyzed, including 64 superior, 69 inferior, 66 nasal and 66 temporal. The true in-the-bag IOL position measured as distance posterior to the sclero-corneal limbus was 4.23 mm Â± 0.56 mm superiorly, 4.22 Â± 0.46 mm inferiorly, 3.95 Â± 0.48 mm nasally and 3.86 Â± 0.52 mm temporally. The anterior shift of a theoretical scleral sutured IOL was 0.60mm for a 3mm sclerotomy and 0.93mm for a 2.5mm sclerotomy, resulting in a theoretical myopic shift of 0.45 D and 0.79 D respectively, assuming a 15 D IOL. Larger biometric measurements correlated to a more posterior in-the-bag position. CONCLUSIONS:True in-the-bag IOL position was found to be more posterior than estimates of scleral sutured IOLs. Additional corrections in scleral sutured IOL calculations may improve refractive outcomes.
An adult with COVID-19 kawasaki-like syndrome and ocular manifestations [Case Report]
Purpose/UNASSIGNED:The severe acute respiratory syndrome coronavirus-2 and its associated infection known as COVID-19 have resulted in a global pandemic. Ocular manifestations of COVID-19 are nonspecific and include hyperemia, chemosis, epiphora, secretions, and eyelid edema. There is a paucity in the literature regarding COVID-19 related inflammatory syndromes which may also include ocular manifestations. Observations/UNASSIGNED:In pediatric patients, conjunctivitis has been recently reported in association with a multisystem inflammatory condition related to COVID-19 that shares features with Kawasaki disease and toxic shock syndrome. We describe the clinical course of an adult patient with symptoms and signs consistent with a Kawasaki-like syndrome. Conclusions and Importance/UNASSIGNED:To our knowledge, this report may be the first case of a Kawasaki-like syndrome in an adult with COVID-19 infection.
Pseudopemphigoid: Sarcoidosis presenting as cicatricial conjunctivitis with symblepharon
Conjunctival involvement in sarcoidosis is commonly characterized by epibulbar nodules or follicular conjunctivitis. The authors describe an apparently healthy woman who developed extensive monocular cicatricial conjunctivitis with symblepharon. The array of conditions presenting with cicatricial conjunctivitis was considered, with mucous membrane pemphigoid leading the diagnostic possibilities. Conjunctival biopsy disclosed the non-infectious, non-caseating granulomas of sarcoidosis and a systemic evaluation disclosed pulmonary nodules and hilar lymphadenopathy. As the patient had no respiratory symptoms and an old history of hepatic steatosis, oral hydroxychloroquine and topical cyclosporin were chosen for therapy rather than systemic corticosteroids.
Dupilumab-Associated Blepharoconjunctivitis with Giant Papillae [Case Report]
Purpose/UNASSIGNED:To describe a case of severe dupilumab-associated blepharoconjunctivitis with giant papillae treated with high potency corticosteroid eyedrops, without discontinuing or reducing dupilumab therapy. Case Report/UNASSIGNED:A 22-year-old Latin American female with a long history of severe atopic dermatitis (AD) with no ocular involvement presented 20 weeks after starting treatment with dupilumab injections with blurry vision, multiple chalazia, eyelid swelling and severe conjunctival injection in both eyes. She also reports having a hordeolum 2 months prior and severely dry eyes starting 2 weeks prior. Slit-lamp examination revealed severe conjunctivitis with macroscopically visible giant papillae in the right lower tarsal conjunctiva. The diagnosis of severe dupilumab-associated blepharoconjunctivitis was made and difluprednate 0.05% eyedrops two times a day for 7 days was initiated. Given the severity of her AD and her marked skin improvement with dupilumab, it was decided to continue dupilumab without reducing the dose. At 2-day follow-up, conjunctival injection had markedly improved, and at 2-month follow-up, her examination was unremarkable. Currently, our patient only uses dexamethasone 0.1% drops few times a week as per needed for occasional eye irritation. Conclusion/UNASSIGNED:As dupilumab injections begin to claim a rightful place in medicine, the ophthalmic community may start encountering dupilumab-associated ocular surface disease all more often and potentially play an important role in identifying, characterizing and treating the adverse ocular effects from this novel medication.
Ocular Manifestations of Rheumatoid Arthritis: Implications of Recent Clinical Trials
While rheumatoid arthritis (RA) typically presents with synovitis of the small and medium joints of the hands, ocular manifestations of the disease are generally overlooked and largely underdiagnosed. These complications usually present in longstanding RA population and occasionally represents the first manifestation of the disease and generally affect the anterior chamber of the eye, leading to keratoconjunctivitis sicca, episcleritis, scleritis, peripheral ulcerative keratitis and anterior uveitis. In this review, we present the current understanding of the pathophysiologic mechanisms for ocular disease in RA, including the role of oxidative stress, cytokine imbalance, chronic inflammation, vascular permeability, immune complex deposition and the role of T-cells as well as the contribution of tear hyperosmolarity among other factors. We also discuss the clinical presentation and diagnosis of each of the ocular disease entities highlighting the latest strategies in the management of this serious disorders that could potentially lead to blindness and the implications of recently completed and ongoing clinical trials in the field. While RA disease control is the cornerstone in the management of RA-associated ocular manifestations, early recognition of ocular pathology with prompt referral to ophthalmology is of paramount importance in order to prevent blindness and improve the quality of life in this patient population.
Evaluation of the Effect of Cycloplegia on Anterior Chamber Depth in Cataract Patients Using Optical Low-Coherence Reflectometry
PURPOSE: The study was performed to study the effect of cycloplegia on anterior chamber depth (ACD) in cataract eyes. One instrument (Lenstar) was used for all measurements. METHODS: Anterior chamber depth calculations were taken with the Lenstar in cataract eyes with a mean age of 71.9+/-8.8 years before instilling cycloplegic drops. Two drops of Tropicamide were then instilled in each eye and measurements were retaken between 30 to 45 min later. RESULTS: Cycloplegia with a mild agent used routinely in this practice location showed a statically significant effect on increasing ACD by 0.0647+/-0.01 in the OD and 0.0758+/-0.02 in the OS. CONCLUSIONS: Anterior chamber depth can be important in the final refractive result postcataract surgery. The results of a change in effective lens position would be most significant in higher intraocular lens powers.
Descemet's Membrane Dehiscence Resulting From Misdirected Viscoelastic During Anterior Chamber Reformation
We report a case of Descemet's membrane detachment after inadvertent intrastromal injection of hyaluronic acid. Surgical removal was attempted with minimal but slow improvement. Near-complete resolution occurred with subsequent conservative management within 6 weeks.
Assessment of mentorship needs during ophthalmology residency [Meeting Abstract]
Purpose: Mentorship during various stages of medical training has been demonstrated to improve satisfaction in training and also to shape career goals. There are few studies evaluating formal mentorship programs within ophthalmology residency. We aim to evaluate the mentorship needs of ophthalmology residents, which may provide the framework to establish a formal mentorship program.
Method(s): An online cross-sectional survey was distributed in May 2017 to all residents (n=20) in the New York University School of Medicine ophthalmology residency program to evaluate their perspectives on mentorship. The questionnaire consisted of multiple choice and Likert-type questions.
Result(s): The response rate was 100% (20/20 of surveyed residents), of which 7 were PGY- 2, 6 were PGY-3, and 7 were PGY-4. Seventy-five percent (15/20) of residents reported that mentorship was "very important" during residency. Approximately two-thirds of residents (13/20) had participated in a formal mentorship program prior to residency. Eighty percent (16/20) of residents reported that two mentors were an ideal number, while 20% preferred three mentors. Sixty percent (12/20) of residents had already identified an informal mentor during residency. Respondents replied that "accessibility" was the most important quality in a mentor followed by "willingness to write a letter of recommendation". Gender, age, and academic ranking were the least frequently selected as important qualities in a mentor. The most common reason for pursuing a mentor was "seeking career guidance", followed by "obtaining a letter of recommendation" and "seeking someone as an advocate or confidant". The least commonly selected reason for seeking a mentor was "improvement of clinical skills".
Conclusion(s): Ophthalmology residents view mentorship as an important part of their training. Residents prioritize accessibility and career guidance as important aspects of mentorship and many are seeking a faculty member who may contribute a reference letter in the future. The results of this survey have contributed to the development of a formalized residency mentorship program, and help guide mentorship objectives and practice
Gout Keratitis: A Case of Peripheral Ulcerative Keratitis Secondary to Gout With a Review of the Literature
PURPOSE/OBJECTIVE:To report a case of peripheral ulcerative keratitis secondary to gout. METHODS:A 41-year-old man with a history of severe gout disease presented with pain and redness of the right eye. Physical examination revealed 2 areas of peripheral corneal thinning with overlying epithelial defects. Adjacent to these areas, reflective crystals were identified in the corneal stroma. Anterior segment optical coherence tomography demonstrated stromal corneal deposits. RESULTS:Systemic workup was negative aside from an elevated serum uric acid level. The patient was administered oral prednisone, allopurinol, and colchicine. At his 2-month follow-up visit, the patient was asymptomatic and his corneal thinning had significantly improved. CONCLUSIONS:Gout is the most common type of inflammatory arthritis in adults with rising incidence and prevalence. Ocular findings in gout are common, but patients are usually asymptomatic. Monosodium urate crystal deposition has been reported to occur in various parts of the eye, with and without ocular inflammation. Crystal deposition in the cornea is extremely rare and may be a cause of peripheral ulcerative keratitis.
A case of hypertrophic herpes simplex virus affecting the eyelid and cornea masquerading as IgG4-related disease
Purpose/UNASSIGNED:To report a case of hypertrophic herpes simplex virus (HSV) of the eyelid and cornea masquerading as IgG4-related disease. Observations/UNASSIGNED:A 37-year old African American female with a past medical history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and a recent history of treated genital herpes, presented with an ulcerative lesion of the left upper and lower eyelids, and severe ocular inflammation with symblepharon. Initially, eyelid biopsy revealed findings consistent with IgG4-related disease, and the patient was treated with high dose oral prednisone. After one week of therapy, there was no improvement in the patient's symptoms, and she subsequently developed a corneal epithelial defect which progressed to chronic ulceration. Repeat biopsy and corneal cultures revealed herpes simplex virus type 2. The patient was treated with high dose acyclovir, and the lid lesion improved. The conjunctival inflammation and corneal epithelial defect resolved but symblepharon restricting her eye movement remained. She also developed corneal vascularization and opacification causing severe vision loss. Conclusions and importance/UNASSIGNED:Chronic hypertrophic herpes simplex virus infection is a rare condition reported in patients with HIV. While there have been few reports of hypertrophic HSV affecting the eyelid, this is the first reported case of hypertrophic HSV affecting the eye, resulting in severe vision loss.