Lens coloboma secondary to neglected buphthalmos

A 36-year-old male presented with progressive diminution of vision OS for 3 months. He was a known case of bilateral congenital glaucoma who underwent trabeculectomy at 6 months and 5 years of age OD and OS respectively. Best corrected visual acuity was 6/24 OD and 1/60 OS. Slit lamp examination revealed bilateral Haab striae (Figure 1a) with lens subluxation OS evident by the scalloped border of the lens with broken zonules in the superonasal quadrant and lens coloboma in the inferonasal quadrant with the absence of zonules (Figure 1b,c,d). A posterior subcapsular cataract was also noted OS. Advanced glaucomatous optic nerve cupping was noted OU. An intraocular pressure of 10 mm Hg OD and 16 mm Hg OS was noted. Biometry documented an axial length of 26.30 mm OD and 28.75 mm OS with a keratometry of 42.50D/46.50D @20˚/110˚OD and 37.75D/40.00D @ 45˚/135˚OS. Ultrasound bio-microscopy depicted increased sphericity of the lens with broken zonules OS (Figure 1e).

Accidental intralenticular sustained-release dexamethasone (Ozurdex) implantation: A case report

Intravitreal implantation of Ozurdex (Allergan Inc., Irvine, CA, USA), a sustained-release dexamethasone implant, is a common practice in ophthalmology. Inadvertent intralenticular implantation of Ozurdex is a very rare complication. Herein, we report a case of accidental intralenticular Ozurdex implantation. During the intravitreal procedure, the patient moved his head vigorously which resulted in the said complication. He was followed up periodically with monitoring of intraocular pressure (IOP), best-corrected visual acuity, lens status, fundus, and macular edema status. He developed a posterior subcapsular cataract after about 5 months of the procedure. The cataract was removed around 6 months follow-up by phacoemulsification with anterior vitrectomy and implantation of a 3-piece posterior chamber intraocular lens in the ciliary sulcus. Macular edema had resolved by 3 months of Ozurdex implantation and the patient did not require a second intravitreal dose. He was well at 3 months follow up after cataract surgery.

When the Trauma Draws a Rose: Rosette Cataract

A 40-year-old male patient referred to the ophthalmologic emergency room for complaints of diminution of vision in the left eye since three months after a trauma. Examination of the left eye showed a corrected visual acuity of 20/70. Slit-lamp examination revealed a rosette cataract (Figure 1). The patient underwent phacoemulsification with implantation of an IOL in the bag. The rosette cataract is a posterior subcapsular cataract due to a violent contusion with a closed globe. It can develop in the hours that follow, or on the contrary several years later.

Risk Factors and Types of Presenile Cataract in Patients Attending a Tertiary Care Hospital in Kerala- A Retrospective Study

Background: Cataract is a major cause of blindness worldwide with a greater prevalence in developing countries like India. Presenile cataract refers to an onset of this disease below 50 years of age. Objectives: To study the factors associated with development of presenile cataract among the total cataract patients who attended out-patient clinic of Ophthalmology department from January 2016 to July 2017 and to find out the proportion of different types of presenile cataract. Method: The study includes patients who had undergone cataract surgery in the Department of Ophthalmology Government Medical College, Ernakulam from January 2016 and June 2017. Data was retrospectively entered and analysed. Results: There were 100 (49 males and 51 females) patients between the age 30 and 50 years. Around 70 study participants had co-morbidities. The average axial length was 22.5532mm, the average haemoglobin content was 13.01 g/dL, average total count was 8590.85, average BL urea was 22.755 mg/dL, average serum creatinine concentration was 0.9611 mg/dL and average GRBS concentration was 131.43 mg/dL. Drug history of 69 patients was observed in the current study. Conclusion: The most common type of cataract seen was posterior subcapsular cataract followed by mature cataract. Diabetes mellitus was the predominant risk factor in posterior subcapsular cataract. Keywords: Presenile cataract; Risk factors; Posterior subcapsular cataract.

Relationship between the higher inflammatory cytokines level in the aqueous humor of Fuchs uveitis syndrome and the presence of cataract

Background This study aims to compare the levels of intraocular cytokines between Fuchs uveitis syndrome (FUS) eyes and the senile cataract eyes. The association between inflammatory cytokine levels and cataract severity in FUS is evaluated to find the possible mechanism of cataract in FUS eyes. Methods A retrospective study of 28 eyes with FUS was performed. Auxiliary examinations were performed, including ophthalmic examinations, laser flare-cell photometry, and levels of inflammatory cytokines in the aqueous humor were measured. The control group included 25 eyes with senile cataract. Data on the aqueous humor inflammatory cytokines were compared between the two groups. The association between the aqueous humor cytokine levels and severity of posterior subcapsular cataract was assessed. Results There were 28 eyes with FUS in 27 patients. Unilateral involvement was noted in 26 patients (96.30%). Stellate keratic precipitates (KPs) were noted in 16 eyes (57.14%). Heterochromia was observed in 21.43% of affected eyes. Posterior subcapsular cataract (PSC) was observed in 16 of the 28 eyes. Eyes with FUS had significantly higher aqueous humor (AH) cytokine levels (VEGF, bFGF, IL-6, IL-8 and IL-10) compared with the control eyes (P < 0.05). There was a statistically significant positive correlation between the severity of cataract and IL-6 and IL-8 levels in the AH (τ = 0.664 and 0.634, respectively; P = 0.001, P = 0.002, respectively). Conclusions Expression of VEGF, bFGF, IL-6, IL-8 and IL-10 in the AH of FUS patients was significantly higher than in senile cataract eyes, and the aqueous humor levels of IL-6 and IL-8 were significantly positively associated with the severity of posterior subcapsular cataract. Our results imply that an inflammation mechanism may be involved in the early development of cataract in FUS.

Atypical presentation of peripheral posterior lenticonus and role of multi-modal ocular imaging in its diagnosis and management

A 6-year-old systemically healthy child presented with visual acuity of 1/60, N18 oculusdextrus (OD), and 6/18, N6 oculus sinister (OS). Slit-lamp biomicroscopy revealed suspicious bilateral inferotemporal pigmented ciliary body (CB) tumour, protruding posterior capsule and temporal posterior subcapsular cataract oculus uterque. Anterior segment optical coherence tomography, ultrasonography, ultrasonic biomicroscopy and Scheimpflug imaging revealed protruding posterior capsule and cortex abutting but not arising from CB suggestive of peripheral pigmented posterior lenticonus with hypermetropia (axial length 20.27 mm OD and 19.97 mm OS). Aberrometry revealed high internal aberrations and low Dysfunctional Lens Index (DLI). Lens aspiration with intraocular lens implantation in the bag OD and contact lens correction OS were undertaken. The child had a postoperative visual gain of 3/60, N18 with improved aberrometric profile OD, and was advised amblyopia therapy. Rarely posterior lenticonus can mimic a CB mass. Multi-modal ocular imaging can aid in its diagnosis and management. DLI may serve as a useful indicator of surgery in such cases.

Relationship Between the Higher Inflammatory Cytokines Level in the Aqueous Humor of Fuchs Uveitis Syndrome and the Presence of Cataract

Background This study aims to compare the levels of intraocular cytokines between Fuchs uveitis syndrome (FUS) eyes and the senile cataract eyes. The association between inflammatory cytokine levels and cataract severity in FUS is evaluated to find the possible mechanism of cataract in FUS eyes.Methods A retrospective study of 28 eyes with FUS was performed. Auxiliary examinations were performed, including ophthalmic examinations, laser flare-cell photometry, and levels of inflammatory cytokines in the aqueous humor were measured. The control group included 25 eyes with senile cataract. Data on the aqueous humor inflammatory cytokines were compared between the two groups. The association between the aqueous humor cytokine levels and severity of posterior subcapsular cataract was assessed.Results There were 28 eyes with FUS in 27 patients. Unilateral involvement was noted in 26 patients (96.30%). Stellate keratic precipitates (KPs) were noted in 16 eyes (57.14%). Heterochromia was observed in 21.43% of affected eyes. Posterior subcapsular cataract (PSC) was observed in 16 of the 28 eyes. Eyes with FUS had significantly higher aqueous humor (AH) cytokine levels (VEGF, bFGF, IL-6, IL-8 and IL-10) compared with the control eyes (P<0.05). There was a statistically significant positive correlation between the severity of cataract and IL-6 and IL-8 levels in the AH (τ = 0.664 and 0.634, respectively; P = 0.001, P = 0.002, respectively).Conclusions Expression of VEGF, bFGF, IL-6, IL-8 and IL-10 in the AH of FUS patients was significantly higher than in senile cataract eyes, and the aqueous humor levels of IL-6 and IL-8 were significantly positively associated with the severity of posterior subcapsular cataract. Our results imply that an inflammation mechanism may be involved in the early development of cataract in FUS.

Relationship Between the Levels of Inflammatory Cytokines in the Aqueous Humor and Cataract in Fuchs Uveitis Syndrome-A Case Control Study

Background This study aims to compare the levels of intraocular cytokines between Fuchs uveitis syndrome (FUS) eyes and the senile cataract eyes. The association between inflammatory cytokine levels and cataract severity in FUS is evaluated to find the possible mechanism of cataract in FUS eyes.Methods A retrospective study of 28 eyes with FUS was performed. Auxiliary examinations were performed, including ophthalmic examinations, laser flare-cell photometry, and levels of inflammatory cytokines in the aqueous humor were measured. The control group included 25 eyes with senile cataract. Data on the aqueous humor inflammatory cytokines were compared between the two groups. The association between the aqueous humor cytokine levels and severity of posterior subcapsular cataract was assessed.Results There were 28 eyes with FUS in 27 patients. Unilateral involvement was noted in 26 patients (96.30%). Stellate keratic precipitates (KPs) were noted in 16 eyes (57.14%). Heterochromia was observed in 21.43% of affected eyes. Posterior subcapsular cataract (PSC) was observed in 16 of the 28 eyes. Eyes with FUS had significantly higher aqueous humor (AH) cytokine levels (VEGF, bFGF, IL-6, IL-8 and IL-10) compared with the control eyes (P<0.05). There was a statistically significant positive correlation between the severity of cataract and IL-6 and IL-8 levels in the AH (τ = 0.664 and 0.634, respectively; P = 0.001, P = 0.002, respectively).Conclusions Expression of VEGF, bFGF, IL-6, IL-8 and IL-10 in the AH of FUS patients was significantly higher than in senile cataract eyes, and the aqueous humor levels of IL-6 and IL-8 were significantly positively associated with the severity of posterior subcapsular cataract. Our results imply that an inflammation mechanism may be involved in the early development of cataract in FUS.