Clinical case of fungal uveitis in a patient who underwent COVID-19

Purpose. To analyze a clinical case of fungal uveitis in a patient who has undergone COVID-19. Material and methods. A patient born in 1962 was admitted to the Kaluga branch of the MNTK with complains of blurred vision. From the anamnesis: in the first half of 2020, he was treated at the Kaluga branch of the MNTK with a diagnosis of complicated cataract, highly complicated myopia, PCRD, CCRD, pigmentary glaucoma; in the autumn of 2020, he suffered a coronavirus infection complicated by severe bilateral interstitial pneumonia, he was in the intensive care unit for 2 weeks. Results. During examination of the patient, the clinical picture and data of objective methods indicated the development of bilateral uveitis in the patient. A course of anti-inflammatory therapy was prescribed, and positive dynamics were achieved. But there was a sharp deterioration on the 10th day. Concilium was held: a fungal etiology of uveitis was suspected. The anterior chamber was washed, material from the anterior chamber was taken for bacterial culture. At the 3rd day the results of bacterial culture showed the growth of Candida albicans fungi. A multistage complex medical and surgical treatment was carried out. The outcome is encouraged however, the observation time is insufficient to draw final conclusions. Conclusion. The incidence of COVID-19 remains high, so ophthalmologists should remain vigilant, collect a careful anamnesis and expect an increase of the number of patients with intraocular fungal infection. Key words: uveitis; fungal infection; COVID-19.

Refractory iatrogenic pigmentary glaucoma secondary to cosmetic laser treatment: A case report

Purpose To report a case of bilateral iatrogenic pigmentary glaucoma secondary to cosmetic iris-lightening laser treatment. Case report A 39-year-old patient presented with bilateral iatrogenic pigmentary glaucoma. She had elevated intraocular pressures (IOPs), scattered iris pitting, and intense angle pigmentation secondary to the cosmetic laser treatment she underwent 4 weeks prior to presentation. Her IOPs were refractory to maximal medical treatment and she subsequently underwent trabeculectomy. Conclusion The true scale of complications related to cosmetic laser treatments is as yet unknown. Robust clinical investigations into its safety profile, including long-term data, are required. Prospective patients should consider this with great care. Clinicians should be aware of the potential risks of this procedure, as early recognition of cosmetic laser-induced pigmentary glaucoma may avert further sequelae.

Ocular Surface Disease Signs and Symptoms of Glaucoma Patients and Their Relation to Glaucoma Medication in Finland

Purpose: To evaluate the prevalence of ocular surface disease (OSD) signs and symptoms of glaucoma patients in relation to topical glaucoma treatment and to compare them to non-glaucomatous population. Methods: A multicenter, cross-sectional study consisting of private ophthalmology clinic visits in southern Finland. Glaucoma patients had a diagnosis of primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma or treated ocular hypertension. Control patients had no prior or current use of glaucoma medication. Recorded parameters included OSD signs and symptoms, used glaucoma medications during the past 6 months, and the product name and type of used antiglaucoma drugs.Results: Glaucoma patients (n = 564) showed higher severity of OSD sign parameters excluding Schirmer’s test, as well as increased dry eye sensation compared to controls (n = 51). Beta-blockers and preservative-free prostaglandins had the smallest effect on all parameters. The increasing number of active compounds and administered eye drops per day showed an association with increasing severity of OSD signs and symptoms.Conclusion: Glaucoma patients show higher prevalence of OSD signs and dry eye sensation compared to non-glaucomatous population. The use of preserved glaucoma medication, as well as high number of active compounds and eye drops increase the severity of these parameters. There are significant differences between the types of glaucoma medication used, and therefore the selection of them is important especially in patients suffering from OSD.

Direct selective laser trabeculoplasty in open angle glaucoma study design: a multicentre, randomised, controlled, investigator-masked trial (GLAUrious)

IntroductionLaser trabeculoplasty is an effective and widely used treatment for glaucoma. A new laser technology, the Eagle direct selective laser trabeculoplasty (DSLT) device, may provide automated, fast, simple, safe and effective laser treatment for glaucoma in a broader range of clinical settings. This trial aims to test the hypothesis that translimbal DSLT is effective and not inferior to selective laser trabeculoplasty (SLT) in reducing intraocular pressure (IOP) in open angle glaucoma (OAG).Methods and analysisThis is a multicentre, randomised, controlled, investigator-masked study. The primary efficacy outcome is intergroup difference in mean change from baseline IOP measured at 6 months. Secondary outcomes include mean percentage reduction in IOP at 3, 6 and 12 months; proportion of participants with at least 20% reduction in IOP from baseline at 6 months; change in ocular hypotensive medications at 12 months and evaluation of safety. Participants were aged >= 40 years with OAG, including exfoliative or pigmentary glaucoma, or ocular hypertension with untreated or washed out IOP 22–35 mm Hg. Treatments: DSLT: 120 shots, 3 ns, 400 µm spot size, energy 1.4–1.8 mJ delivered at the limbus over 2 s. SLT: approximately 100 shots, 3 ns, 400 µm spot size administered 360 degrees at the limbus using any gonioscopy lens, energy 0.3–2.6 mJ. A sample size of 164 is sufficient to detect a non-inferiority margin of 1.95 mm Hg for change from baseline IOP.Clinical trial registration numberNCT03750201, ISRCTN14033075.

Exome-based investigation of the genetic basis of human pigmentary glaucoma

Background Glaucoma is a leading cause of visual disability and blindness. Release of iris pigment within the eye, pigment dispersion syndrome (PDS), can lead to one type of glaucoma known as pigmentary glaucoma. PDS has a genetic component, however, the genes involved with this condition are largely unknown. We sought to discover genes that cause PDS by testing cohorts of patients and controls for mutations using a tiered analysis of exome data. Results Our primary analysis evaluated melanosome-related genes that cause dispersion of iris pigment in mice (TYRP1, GPNMB, LYST, DCT, and MITF). We identified rare mutations, but they were not statistically enriched in PDS patients. Our secondary analyses examined PMEL (previously linked with PDS), MRAP, and 19 other genes. Four MRAP mutations were identified in PDS cases but not in controls (p = 0.016). Immunohistochemical analysis of human donor eyes revealed abundant MRAP protein in the iris, the source of pigment in PDS. However, analysis of MRAP in additional cohorts (415 cases and 1645 controls) did not support an association with PDS. We also did not confirm a link between PMEL and PDS in our cohorts due to lack of reported mutations and similar frequency of the variants in PDS patients as in control subjects. Conclusions We did not detect a statistical enrichment of mutations in melanosome-related genes in human PDS patients and we found conflicting data about the likely pathogenicity of MRAP mutations. PDS may have a complex genetic basis that is not easily unraveled with exome analyses.

Aperture photometry measurements of melanin particles in Krukenberg spindles of the cornea in pigment dispersion syndrome

BACKGROUND: Quantification of melanin pigment release in pigment dispersion syndrome as well as observations of melanin brightness changes can be valuable information in the management of this rare ocular disease. OBJECTIVES: Previous studies have focused on examining the iris pigment epithelium and aqueous humor. Therefore, the aim of this study was to examine the cornea. METHODS: A novel technique was developed for this purpose based on aperture photometry. Slit lamp digital video images of the cornea were recorded. A single frame from each video recording based on the quality was chosen for further processing and analysis. Aperture photometry was performed with AstroImageJ open source software. Aperture selection was performed automatically. Melanin particles displaying a signal-to-noise ratio above 20 were analyzed. RESULTS: A total of 16 melanin particles from the right eye of the patient participating in the study were detected and a further 9 melanin particles from the left eye. The examined area of the cornea measured 348 × 348 pixels in the image. Brightness differed by as much as 8.98 × among particles in the right eye and 2.03 × in the left eye. CONCLUSIONS: It seems feasible for this new method to be potentially used in the monitoring of patients with pigment dispersion syndrome and pigmentary glaucoma as well as in other ocular diseases.

Complex technology of laser surgery for pigmentary glaucoma

Purpose. To analyze the complex method effectiveness of pigmentary glaucoma laser surgery (YAG-laser iridectomy and a multistep SLT). Materials and methods. Laser iridectomy was performed in 14 patients (28 eyes) aged 13 to 54 years old with pigmentary glaucoma after achieving the values of the individual IOP level against the background of drug therapy. Then after 4 weeks SLT was carried out. If an exogenous pigmentation was ≥2 st., SLT repeated several times every 4-6 months. Observation period: from 4 to 15 years. Results. The glaucoma process stabilization was achieved in all cases. The level of true IOP decreased by 6.6±0.3 mm Hg (-30%, p<0.05), Becker's coefficient by 121±4.3 (-60%, p <0.001), the instillations number by 1.32±0.06 (-70%, p<0.001). The indicators increased: the average value of the total retinal photosensitivity by 381±4.3 dB (15%, p<0.001), the average threshold of the retinal photosensitivity by 2.6±0.1 dB (10%, p<0.001), the lightness of the intraocular liquid outflow by 0.08±0.013 (72%, p<0.001). Drug hypotensive therapy was canceled at 12 eyes (42.8%). Conclusion. The complex method of pigmentary glaucoma laser surgery in the form of YAG-laser iridectomy and the multistep SLT is effective and safe. It can be performed for a decrease of increased ophthalmotonus level to the individual IOP against the background of drug treatment. Key words: pigmentary glaucoma, YAG-laser iridectomy, selective laser trabeculoplasty.

Pigmentary Glaucoma After Cataract Surgery with Single-Piece Hydrophobic Intraocular Lens Implanted into the Ciliary Sulcus: Case Report

A 59 years old man presented with a history of phacoemulsification with an hydrophobic intraocular lens implant in his left eye 4 years ago. The biomicroscopy revealed pigments in the corneal endothelium (Krukenberg’s spindle), peripheral transillumination of the iris and intraocular pressure of 52 mmHg in the left eye. Gonioscopy revealed hyperpigmentation of the posterior trabeculate. Posterior segment examination and visual field revealed a cup/disc 0.9 with significant field damage in strategy 10-2. Biomicroscopic ultrasonography showed asymmetric implantation of the IOL loops in the left eye (one loop in the ciliary sulcus and the other in the capsular bag). He underwent antiglaucomatous treatment with adequate control of intraocular pressure, with no need for surgical intervention.