Persistently poor vision in dim illumination after implantation of XtraFocus small-aperture IOL (Morcher)

A 21-year-old patient presents to us with complaints of blurred vision and photophobia in the left eye, with an uncorrected visual acuity of 20/100 improving to 20/30 with pinhole and diagnostic rigid gas permeable lens trial. He had a history of trauma with subsequent cataract extraction, with residual irregular astigmatism and traumatic mydriasis. XtraFocus Pinhole intraocular lens (Morcher) was implanted in the left eye. One week postoperatively, the left eye uncorrected visual acuity improved to 20/30, uncorrected intermediate visual acuity improved to 20/40, and uncorrected near visual acuity improved to J4. The glare and photophobia resolved completely. Surprisingly, the patient complained of severely poor vision in dim illumination. His vision was limited to bare perception of objects and hand movements close to the face. He started facing difficulties in major activities such as driving at night and in dark ambient surroundings such as movie theatres, which persisted to the extent of necessitating explantation of the implant.

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Persistent troublesome floaters necessitating the explantation of XtraFocus Pinhole IOL (Morcher)

BMJ Case Reports ◽

10.1136/bcr-2018-229057 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229057 ◽

Cited By ~ 1

Author(s):

Prateek Agarwal ◽

Samuel Edward Navon

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Cataract Extraction ◽

Blurred Vision ◽

Uncorrected Visual Acuity ◽

History Of ◽

Irregular Astigmatism

A 41-year-old patient presented with blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/150, improving to 20/30 with pinhole and diagnostic rigid gas permeable lens trial. He had a history of trauma with subsequent cataract extraction with residual irregular astigmatism and traumatic mydriasis. XtraFocus Pinhole intraocular lens (Morcher) was implanted in the left eye and the vision improved to 20/40. Postoperatively, the patient experienced significant floaters which persisted to the extent of necessitating explantation of implant.

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Novel technique of explantation of rigid phakic iris-claw lens and cataract extraction by sutureless manual small-incision surgery

BMJ Case Reports ◽

10.1136/bcr-2019-233128 ◽

2019 ◽

Vol 12 (12) ◽

pp. e233128

Author(s):

Prateek Agarwal ◽

Samuel Edward Navon ◽

Neha Mithal

Keyword(s):

Visual Acuity ◽

Cataract Extraction ◽

Blurred Vision ◽

Novel Technique ◽

Small Incision ◽

Complicated Cataract ◽

Uncorrected Visual Acuity ◽

Lens Surgery ◽

Iris Claw Lens ◽

Iris Claw

A 38-year-old patient presented to us with complaints of blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/400, improving to 20/60 with pinhole. The patient underwent phakic iris-claw lens surgery 15 years ago for high myopia. On examination, there was anterior chamber rigid phakic iris-claw lens along with complicated cataract. We planned for sutureless self-sealing 6.5 mm sclerocorneal tunnel for explantation of rigid phakic iris-claw lens along with cataract extraction with irrigating vectis. There was postoperative reduction in astigmatism due to incision planned on steep axis, and visual acuity improved to 20/30 uncorrected. This technique provides significant advantages from the previously described techniques in terms of decreased postop astigmatism, no need for sutures, no issues of chamber instability and iris trauma and without the need for phacoemulsification.

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Analysis of Clinical Characteristics of 19 Patients with Endophthalmitis Caused by Liver Abscess

10.21203/rs.3.rs-319989/v1 ◽

2021 ◽

Author(s):

guangsen liu ◽

Yue Li ◽

Wei Wang ◽

Lei Gao

Keyword(s):

Visual Acuity ◽

Liver Abscess ◽

Diagnosis And Treatment ◽

Endogenous Endophthalmitis ◽

Klebsiella Pneumonia ◽

Microbial Culture ◽

Poor Vision ◽

Ocular Symptoms ◽

History Of ◽

First Time

Abstract Objective: To analyze the clinical features, treatment, and prognosis of endophthalmitis caused by a liver abscess.Methods: All cases of endogenous endophthalmitis caused by a liver abscess in our hospital in the past 7 years were analyzed retrospectively. The data collected included age, sex, history of diabetes, initial and final vision, pathogen, course of the disease, treatment, and prognosis.Results: 21 eyes of 19 patients were complicated with liver abscess. The average age was 55.9 ±9.8 years old, including 10 males (52.6%) and 9 females (44.4%), 13 patients complicated with diabetes (71.4%), 14 patients (66.7%) first went to the ophthalmology department for diagnosis and treatment and 5 with hepatobiliary surgery (33.3%). 14 patients had a fever before onset, with an average fever time of 5.8 days. Before treatment, the duration of ocular symptoms was 7.71 ±6.68 days, 5.71 ±1.25 days for patients who go to ophthalmology for diagnosis and treatment for the first time, and 12.2 ±3.58 days for patients who go to other departments. After treatment, the average visual acuity of 21 eyes was 0.013, and the average best-corrected visual acuity was 0.79. In the 21 eyes, vitreous fluid culture was positive in 7 eyes (33.3%), all of which were Klebsiella pneumonia. Among the 14 patients with fever during hospitalization, 5 cases were positive for blood microbial culture, all of which were Klebsiella pneumonia. After vitrectomy, the average visual acuity was improved by 4.90 ±2.47 letters and that of patients without vitrectomy was-0.25±0.16letters. The visual acuity of patients who underwent postoperative visual was significantly better than that of patients without postoperative visual (P＜0.096). The visual acuity of patients without vitrectomy was significantly higher than that of patients without vitrectomy (P ＜0.01). 3 eyes (33.3%) of 9 eyes in the IVI group were removed because of uncontrolled inflammation, and 1 eye of 12 eyes in the PPV group was removed because of inflammation recurrence.Conclusion: The prognosis of endogenous endophthalmitis caused by liver abscess is generally poor, but early treatment can save part of the vision. The first visit non-ophthalmology department will delay the early diagnosis of the disease. Diabetes is an important risk factor for endogenous endophthalmitis and poor vision in patients with liver abscess. Klebsiella pneumonia is the main pathogen of intraocular infection. Vitrectomy combined with vitreous injection of antibiotics can improve the prognosis. A systematic and thorough treatment of a liver abscess is of great significance to prevent the recurrence of endophthalmitis in a liver abscess.

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Novel technique of fixing intracorneal rings segments after migration

BMJ Case Reports ◽

10.1136/bcr-2019-233312 ◽

2020 ◽

Vol 13 (1) ◽

pp. e233312

Author(s):

Prateek Agarwal ◽

Praveen Subudhi ◽

Neha Mithal

Keyword(s):

Visual Acuity ◽

Corneal Stroma ◽

Stable Position ◽

Novel Technique ◽

Nylon Suture ◽

Uncorrected Visual Acuity ◽

History Of ◽

And Migration

A 38-year-old patient with a history of non-progressive keratoconus in the left eye presented to us with an uncorrected visual acuity of 20/400, which improved to 20/60 with pinhole. We planned for intracorneal rings segment in the left eye. Postoperatively uncorrected visual acuity improved to 20/30. The patient presented 2 weeks later with severely decreased vision to 20/100 and migration of intracorneal rings were noted with both the rings riding side by side. The patient gave history of vigorous eye rubbing. The rings were repositioned with the help of Sinskey hooks and superior ring was anchored with 10-nylon suture passed through the ring hole to the corneal stroma. Two more sutures were placed radial to the circumference of inferior ring to prevent its migration. The sutures were removed after 1 month and the patient was followed up with stable position of the rings for the next 6 months . The uncorrected visual acuity improved to 20/40.

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Achondroplasia Associated with Bilateral Keratoconus

Case Reports in Ophthalmological Medicine ◽

10.1155/2012/573045 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ammar M. Al Mahmood ◽

Hind M. Al Katan ◽

Ghada Y. Al Bin Ali ◽

Samar A. Al-Swailem

Keyword(s):

Visual Acuity ◽

Rare Case ◽

Penetrating Keratoplasty ◽

Slit Lamp ◽

Poor Vision ◽

The Past ◽

Uncorrected Visual Acuity ◽

Hard Contact ◽

Slit Lamp Biomicroscopy ◽

Contact Lens Fitting

We report a rare case of bilateral keratoconus in association with achondroplasia. A 26-year-old male, with a known case of achondroplasia, complained of bilateral gradual deterioration in vision for the past few years. Slit lamp biomicroscopy showed bilateral central corneal protrusion and stromal thinning at the apex consistent with keratoconus. a trial of hard contact lens fitting failed to improve VA in the left eye (LE). Right eye (RE) improved to 20/25. The patient underwent penetrating keratoplasty (PKP) in his LE. Twenty-seven months postoperatively, uncorrected visual acuity (UCVA) was 20/30. Ophthalmologists should be aware that patients with achondroplasia who complain of poor vision should be suspected of having keratoconus once other more common conditions are ruled out.

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Refractive Lens Exchange with Multifocal Intraocular Lens for Treatment of Chronic Intermittent Spasm of the Near Reflex

Case Reports in Ophthalmology ◽

10.1159/000481705 ◽

2017 ◽

Vol 8 (3) ◽

pp. 539-544 ◽

Cited By ~ 2

Author(s):

Guy Sallet

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Spontaneous Recovery ◽

Multifocal Intraocular Lens ◽

Refractive Lens Exchange ◽

Final Treatment ◽

Uncorrected Visual Acuity ◽

Refractive Lens ◽

Near Visual Acuity ◽

Near Reflex

We report the case of an emmetropic 32-year-old female with decreased uncorrected visual acuity and diplopia due to intermittent episodes of spasm of the near reflex. Neurologic, general, and ophthalmic examination could not find an organic cause. Attempts at spontaneous recovery, psychogenic therapy, and cycloplegic therapy were unsuccessful and the symptoms persisted for almost 5 years, leading to psychogenic distress. Final treatment with refractive lens exchange and implantation of a toric trifocal intraocular lens resolved the spasm of the near reflex, resulting in an uncorrected distance and near visual acuity of 20/20.

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Xtra focus pinhole IOL (Morchers GMBH) a novel approach to tackle irregular astigmatism and large pupillary defects with a single step surgery

BMJ Case Reports ◽

10.1136/bcr-2018-228902 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228902 ◽

Cited By ~ 1

Author(s):

Prateek Agarwal ◽

Samuel Edward Navon

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Intraocular Lens ◽

Visual Outcome ◽

Single Step ◽

Novel Approach ◽

Uncorrected Distance Visual Acuity ◽

Uncorrected Visual Acuity ◽

Corneal Scar ◽

History Of

A 69-year-old patient presented to us with traumatic mydriasis with irregular pupil measuring 7 mm, with superior loss of iris tissue and large inferior peripheral iridotomy and pseudophakia. The patient had history of blunt trauma 3 years ago in a fire cracker injury. He was operated elsewhere primarily after the trauma for cataract surgery with intraocular lens implantation and had suboptimal visual outcome with glare and photophobia. He presented to us with irregular pupil and inferior iridectomy with pseudophakia. The uncorrected visual acuity was 20/150 improving to 20/50 with glasses. He had a history of cataract surgery with intraocular lens (IOL) implantation done elsewhere several years back. The patient was not a diabetic or hypertensive. There was a para central corneal scar causing irregular corneal astigmatism. Extra focus pinhole IOL was implanted in sulcus having a pinhole aperture 1.36 mm. Preoperative total corneal higher-order aberrations were 3.3 µ and total corneal coma was 0.97 µ. Postoperatively uncorrected distance visual acuity improved to 20/40 intermediate uncorrected visual acuity improved to 20/30 and uncorrected near visual acuity was J3.

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Bilateral idiopathic choroidal folds

Orvosi Hetilap ◽

10.1556/oh.2014.29938 ◽

2014 ◽

Vol 155 (27) ◽

pp. 1083-1086

Author(s):

Milán Tamás Pluzsik ◽

Miklós Schneider

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Fluorescein Angiography ◽

Fundus Photography ◽

Fundus Examination ◽

Optical Coherence ◽

Blurred Vision ◽

History Of ◽

Choroidal Folds

Choroidal folds present as parallel bright and dark lines, which may be detected with funduscopy. Optical coherence tomography, red free fundus photography, autofluorescence and fluorescein angiography may be also helpful to establish the diagnosis. The authors present the case of a 70-year-old male who was evaluated because of a 1-month history of blurred vision on his right eye. Dilated fundus examination revealed choroidal folds in both eyes, which failed to affect visual acuity. No neurogical pathologies were found. There was no change in the patient condition durind a follow-up period of 6 months. The authors note that choroidal folds are often not recognized because they are usually asymptomatic. There are several possible causes which should be considered. The diagnosis of idiopathic choroidal folds is based on the exclusion of other pathologies. Observation of the patient’s visual acuity and monitoring for fundus changes are needed. Orv. Hetil., 2014, 155(27), 1083–1086.

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Surgical Management of Glaucoma Secondary to Bilateral Acute Iris Transillumination: A Role for Gonioscopy-assisted Transluminal Trabeculotomy

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i1.8258 ◽

2021 ◽

Author(s):

Stephanie Wey ◽

Jason Flamendorf ◽

Sapna Sinha ◽

Daniel Lee

Keyword(s):

Surgical Intervention ◽

Cataract Extraction ◽

Glaucoma Surgery ◽

Visual Field Defects ◽

Blurred Vision ◽

Upper Respiratory Infection ◽

Keratic Precipitates ◽

Healthy Female ◽

History Of ◽

Upper Respiratory

Purpose: We report a case of bilateral acute iris transillumination (BAIT) in a young woman associated with ocular hypertension which eventually progressed to glaucoma that was treated with gonioscopy-assisted transluminal trabeculectomy (GATT). Case Report: A 37-year-old otherwise healthy female presented with intermittently red and inflamed eyes and blurred vision. She was treated with oral moxifloxacin months prior to presentation. Iris transillumination defects, a pigmented anterior chamber reaction, the absence of keratic precipitates, and a history of upper respiratory infection treated with an oral fluoroquinolone prompted the diagnosis of BAIT. Intraocular pressure (IOP) remained uncontrolled on multiple glaucoma medications. Following the development of new visual field defects, indicating progression to glaucoma, GATT with cataract extraction was performed. Conclusion: Although surgical intervention is rare with BAIT, our case demonstrates that GATT may be used effectively in those patients needing better IOP control before considering incisional glaucoma surgery.

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Instillation Anesthesia in Refractive Surgery in Children

Ophthalmology in Russia ◽

10.18008/1816-5095-2018-2s-82-88 ◽

2018 ◽

Vol 15 (2S) ◽

pp. 82-88

Author(s):

A. G. Shchuko ◽

L. C. Khlebnikova ◽

I. G. Oleshenko ◽

T. N. Iureva ◽

O. V. Pisarevskaya ◽

...

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Refractive Surgery ◽

Surgical Intervention ◽

Functional Result ◽

Topical Anesthesia ◽

Comfort Level ◽

Uncorrected Visual Acuity ◽

Reactive Anxiety ◽

History Of

Purpose: to evaluate the safety and clinical efficacy of the Femto-LASIK refractive surgery performed under local (topical) anesthesia in children and adolescents with anisometropic and refractive amblyopia against a background of mixed astigmatism, medium and high hypermetropia with hypermetropic astigmatism.Patients and methods: 28 children (28 eyes) aged from 7 to 16 years (av. age — 13.6 ± 2.1 years old) were operated under local anesthesia by the FemtoLASIK method. The degree of anisometropy was from 3.25 to 5.21 (average — 4.27 ± 0.53 D). Uncorrected visual acuity averaged 0.21 ± 0.07, corrected one — 0.41 ± 0.1. Psychological history of patients and readiness for operative treatment of the disease were found out during the diagnostic examination. Based on the Spielberger-Khanin technique, the level of personal and reactive anxiety was determined, allowing identifying patients for surgical intervention under topical anesthesia. The surgeon assessed the comfort of the operation. During the first postoperative examination, the developed questionnaire was used to assess the comfort level of the patient during surgical treatment.Results. During the surgical intervention and in the postoperative period there were no complications. The behavior of all patients during the operation can be considered adequate. The duration of the operation slightly exceeded the duration of FemtoLASIC in adults. Uncorrected visual acuity in the first day after the operation averaged 0.39 ± 0.08, in 6 months — 0.61 ± 0.1, which is 80% higher than the baseline indices. After 6 months, the equivalent of anisometropia was 0.69 ± 0.12 D, that is, the refraction of the operated eye approached the value of the paired eye. In 60.8% of patients, the sensations during the operation corresponded to the level of “comfortable”. The surgeon’s assessment of the conditions for performing operations as ‘satisfactory” was noted in 92.9%.Conclusion. The use of topical anesthesia in refractive surgery in children with an initially low level of anxiety is an effective, safe and predictable method of anesthesia, allowing to conduct surgery in comfortable conditions for both the patient and the surgeon, with a high functional result.

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