Journal of Current Ophthalmology
Volume:33 Issue: 4, Oct-Dec 2021

To summarize the recent evidence regarding different aspects of pterygium recurrence.

Human‑based studies from PubMed, Scopus, and Google Scholar were identified using the following keywords: conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management/surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, and adjuvant therapy (January 2009 to February 2021). We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence.

Dry eye disease, black race, and young age are considered definite risk factors for recurrence. However, fleshy appearance of the pterygium and preoperative size remain controversial. Surgical techniques such as excessive suturing, insufficient conjunctival graft size, thick conjunctival graft with remained Tenon tissue, and postoperative graft retraction are considered possible risk factors for recurrence. Using fibrin glue instead of sutures can further reduce recurrence rates. Although recurrence could occur even after many years, most recurrences happen in the first 3–6 months after surgery. Multiple kinds of adjuvant medications are used before, during, or after the operation including mitomycin C (MMC), 5‑fluorouracil (5‑FU), corticosteroids, and anti‑vascular endothelial growth factors(anti‑VEGFs). Multiple weekly subconjunctival 5‑FU injections are shown to be safe and effective in halting the progression of recurrent pterygium. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia.

There is yet to be a panacea in treating recurrent pterygium. Currently, there is not a globally accepted recommendation for treating recurrent pterygium with anti‑VEGFs or 5‑FU as a nonsurgical treatment. We strongly recommend using MMC as an adjunct to surgery in recurrent cases, with consideration of its specific complications. CAU is the most effective surgical treatment for recurrent pterygium, and other new surgical therapies need further investigation.

To provide a comprehensive review on different characteristics of abnormal head postures (AHPs) due to different ocular causes, its measurement, and its effect on facial appearance.

In this review article, PubMed, Scopus, and Google Scholar search engines were searched for the scientific articles and books published between 1975 and September 2020 based on the keywords of this article. The selected articles were collected, summarized, classified, evaluated, and finally concluded.

AHP can be caused by various ocular or nonocular diseases. The prevalence of ocular causes of AHP was reported to be 18%–25%. 1.1% of patients presenting to ophthalmology clinics has AHP. The first step in evaluating a patient with AHP is a correct differential diagnosis between nonocular and ocular sources by performing comprehensive eye examinations and ruling out other causes of orthopedic and neurological AHP. Ocular AHP occurs for a variety of reasons, the most important of which include nystagmus, superior oblique palsy, and Duane’s retraction syndrome. AHP may be an essential clinical sign for an underlying disease, which can only be appropriately treated by the accurate determination of the cause. Long‑standing AHP may lead to facial asymmetry and secondary muscular and skeletal changes.

In conclusion, a proper differential diagnosis between nonocular and ocular causes, knowledge of the different forms of AHP and their measurement methods, accurate diagnosis of the cause, and proper and timely treatment of ocular AHP can prevent facial asymmetry and secondary muscular and skeletal changes in the patients.

To investigate the frequency of persistent postoperative ptosis (PP) following trabeculectomy or Ahmed glaucoma valve (AGV) implantation and to analyze the associated factors.

It is a prospective observational study on glaucoma patients who underwent trabeculectomy or AGV implantation from October 2015 to June 2017 in a tertiary center. Margin reflex distance 1 and 2 (MRD1 and 2) and levator function were measured before and at least 6 months, postoperatively. Clinically significant ptosis was defined as ≥2 mm drop of MRD1.

One hundred and fourteen patients (124 eyelids) including 76 patients (87 eyelids) with trabeculectomy and 35 patients (37 eyelids) with AGV implantation were included. The mean age was 55.50 (standard deviation = 17.54) years. Most of the surgeries were performed under general anesthesia (87.9%, 109/124) between 30 and 60 min (53.2%, 66/124) by residents (39.5%, 49/124). Trabeculectomy and AGV groups did not differ in terms of pre, intra, and postoperative variables (0.1≤ P ≤0.9) except duration of surgery (P = 0.01) and sex (P = 0.04). Clinically significant persistent PP was observed in 12.9% (16/124) in total, 13.7% (12/87) in the trabeculectomy group, and 10.8% (4/37) in the AGV group (P = 0.6). Male gender (ß coefficient = 2.56, 95% confidence interval (CI) = 4.76–0.36, P = 0.02) and a higher preoperative MRD1 (ß coefficient = 1.24, 95% CI = 0.52–1.95, P = 0.001) were the only factors affecting the frequency of clinically significant PP.

Postoperative blepharoptosis occurred in 12.9% of eyes after glaucoma procedures. Male gender and higher preoperative MRD1 were significantly associated with a higher frequency of postglaucoma surgery blepharoptosis.

To evaluate intraocular pressure (IOP) and corneal biomechanical changes after water‑drinking test (WDT) in glaucomatous and normal eyes using Ocular Response Analyzer (ORA).

This prospective study included 30 medically controlled, 30 surgically treated glaucoma patients and 30 normal individuals. Baseline measurements included central corneal thickness (CCT), ORA‑derived corneal hysteresis (CH), corneal resistance factor (CRF), corneal‑compensated IOP (IOPcc), and Goldmann‑correlated IOP (IOPg). Measurements were repeated 15, 30, and 60 min after drinking 1000 mL of water. Changes in ORA parameters were compared among the groups.

All groups showed a significant increase in IOPg and IOPcc at all test points. Peak IOP occurred at 15 min and decreased gradually over time but did not reach the baseline values at 60 min. The surgery group had significantly lower baseline IOPg and IOPcc (10.7 ± 3.1 and 12.8 ± 3.7 mmHg, P = 0.001 and 0.01), lower peak IOPg and IOPcc (14.4 ± 4.6 and 16.2 ± 4.6 mmHg, P = 0.003 and 0.034), and lower percent IOPg and IOPcc fluctuations (13 ± 5.6 and 15 ± 5.9, P = 0.0001 and 0.002), respectively, compared to the medical group. Baseline CH and its fluctuations were not significantly different among the groups. CH decreased to a trough corresponding to peak IOPcc. There was a significant negative correlation between IOPcc and CH (r = −0.609, P < 0.001). The medical group showed more CRF fluctuations compared to normal group.(P = 0.039).

Surgically treated glaucomatous eyes show less IOP fluctuations and lower peak IOP after WDT compared to medically controlled and normal eyes.

To evaluate the effect of opposite clear corneal incisions (OCCI) with 4 mm incisions on the steep meridian on postoperative astigmatism.

This study was performed on 64 eyes of 55 patients with keratometric astigmatism of ≥ 1 diopter (D) undergoing phacoemulsification. Patients were divided into two groups, with‑the‑rule (WTR) astigmatism and against‑the‑rule (ATR) astigmatism. Initial incisions in the WTR group were performed on the temporal side with 3.2 mm keratome and paired stab incisions were performed on the steep meridian. At the end of the surgery, stab incisions were enlarged to 4 mm. Follow‑up visits were scheduled at 1, 3, 6, and 12 months postoperatively, which included refraction and keratometry.

It was found that the mean preoperative keratometric astigmatism was 2.06 ± 0.86 D. The postoperative mean keratometric astigmatism was 1.3 ± 0.7 D after 1 month and 1.2 ± 0.7 D after 12 months. The mean astigmatism correction between the preoperative measure and that taken at 1 month was statistically significant (P = 0.001), but there was no significant change in the severity of astigmatism afterward. The mean surgically‑induced astigmatism was found to be 1.99 ± 0.9 D. The 12‑month changes of mean absolute astigmatism were: 1.06 ± 0.7 D in the WTR group, and 0.53 ± 0.7 D in the ATR group. The difference between the two groups was statistically significant (P = 0.02).

Based on our findings, we posit that paired OCCI on the steep axis, using 4 mm incisions is an effective technique to correct preoperative astigmatism.

To describe, through anterior segment optical coherence tomography (AS‑OCT) images, the different phases of epidemic keratoconjunctivitis (EKC) and show the impact of topical steroid on the course of this disease.

A prospective observational study included 38 eyes(28 patients) with a presumed EKC complicated by subepithelial infiltrates(SEIs) and treated with topical fluorometholone. Slit‑lamp examinations and serial AS‑OCT were performed on days 7, 14, 30, 90, 180, and 210. The thickness of the whole cornea and thickness of the corneal epithelium were measured with AS‑OCT and correlated to the clinical findings on slit‑lamp examination in the different EKC phases.

In all patients, on day 7, the AS‑OCT showed hyperreflective dots that were limited to the epithelial layers of the cornea and slightly rising above the epithelial surface, corresponding to the confluence of the punctuations of punctate epithelial keratitis. On day 14, a hyperreflective line in the Bowman’s layer with intact epithelium was noted. On day 30, this hyperreflective band extended rapidly toward the anterior stroma, becoming thicker and more intense, corresponding to the SEI. They gradually decreased in number, intensity, and extent following treatment by topical steroids in 71.4% of the cases. Only two patients had persistent SEI. They were refractory to 3‑month treatment by steroids. In these patients, who had persistent SEI, AS‑OCT showed that the hyperreflective areas became well‑defined, plaque‑like lesions with sharp margins associated with disruption of Bowman’s layer, localized epithelial thickening, stromal thinning, and a decrease in pachymetry.

AS‑OCT can be a valuable tool that provides a range of characteristic patterns of EKC and helps in monitoring it

To simplify the fitting process, this study was designed to predict the initial power of contact lenses using the regression model based on manual Javal keratometry data and refractive errors.

In this retrospective study, 121 eyes of 69 patients with keratoconus(KCN) were fitted with a specific trial set of rigid gas permeable contact lenses based on the standard criterion of “three‑point touch” over a 7‑year period. Power of the cornea was measured using Javal keratometer. Refractive errors and over refraction of patients were diagnosed using Topcon autorefractometer (RM‑A2000) and confirmed by Heine beta 2000 retinoscope.

The results of multiple linear regression showed the following equation: power of contact lens = −14.368 (constant of the final multiple regression model), +0.475 (spherical refraction), and +0.275 (flatter corneal power).

The results of this study revealed that lens power has a significant relationship with the power of the flat corneal meridian and spherical refractive error in KCN patients. The obtained regression model can be used to shorten patients’ chair time and optometric examination for predicting the power of contact lens.

To assess the long‑term visual and refractive stability and ocular biometric changes in low to moderate myopic subjects treated by laser‑assisted subepithelial keratomileusis (LASEK).

It is a prospective, interventional study. Included were 70 eyes of 35 patients who underwent LASEK for correction of ≤6 diopters (D) myopia. The uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest refractions, and ocular biometric indices (by Lenstar‑LS900, Haag‑Streit AG, Koeniz, Switzerland) including keratometry, anterior chamber depth (ACD), aqueous depth (AD), axial length (AL), central corneal thickness (CCT), and lens thickness (LT) were assessed preoperatively and after 6 months and 8 years.

Mean preoperative spherical equivalent was −3.99 (standard deviation [SD] =1.38) D which improved to 0.02 (SD = 0.27, P < 0.001) D and −0.10 (SD = 0.31, P < 0.001) D at 6 months and 8 years, respectively. The preoperative AL was not different from postoperative measures at 6 months (P = 0.15) and 8 years (P = 0.47). The ACD and AD decreased during 8 years, while LT increased (all P ≤ 0.001). The changes of LT inversely correlated with changes of ACD (rs = −0.67, P = 0.001 at 6 months and rs = −0.87, P < 0.001 at 8 years) and AD (rs = −0.76, P < 0.001 at 6 months and rs = −0.86, P < 0.001 at 8 years). The CCT and keratometry values reduced at 6 months postoperatively (all P < 0.001) and then did not change up to 8 years (0.21 ≤ P ≤ 0.87).

The post‑LASEK myopic regression is 0.1 D over 8 years. Ocular biometric values like keratometry, CCT, ACD, AD, and LT have been changed for a long period after LASEK in low to moderate myopia except AL.

To evaluate postoperative corneal haze and corneal densitometry following three different corneal cross-linking (CXL) protocols; standard, accelerated, and trans‑epithelial (TE).

The study recruited 104 eyes (53 patients) with progressive keratoconus divided into three groups: Group I were subjected to standard CXL, Group II to TE‑CXL, and Group III to accelerated CXL (A‑CXL) (10 mW/cm2 for 9 min). Subjective and objective corneal haze measures were evaluated before and 3, 6, and 12 months post‑CXL using slit‑lamp biomicroscopy and Pentacam Sheimpflug camera.

There was a significant difference in corneal densitometry between the three groups at 3 and 6 months post‑CXL (P < 0.0001). By the 12th month, a significant statistical difference was observed only in zones (0–2 mm) and (2–6 mm) in both the anterior and the central layers. In Group I, the densitometry value of the preoperative anterior stromal layer (anterior 120 μm) was 19.42 ± 1.81. Then, it peaked at 23.12 ± 1.21 at 3 months (P < 0.0001), reached 19.82 ± 1.19 at 6 months (P = 0.007), and decreased to 19.33 ± 3.23 (P ˃ 0.05) at 12 months. In Group II, the preoperative densitometry value of the anterior layer was 19.41 ± 1.21, peaked at 19.72 ± 1.12 at 3 months (P = 0.02), reached 19.04 ± 1.18 at 6 months (P = 0.052), and increased to 19.13 ± 1.37 at 12 months (P = 0.84). In Group III, the preoperative densitometry value of the anterior stromal layer was 19.53 ± 2.23. Then, it peaked at 24.80 ± 1.08 at 3 months (P < 0.0001), decreased to 21.75 ± 1.11 at 6 months (P < 0.0001), and reached 19.77 ± 2.26 at 12 months (P = 0.047). There was no significant correlation between the visual acuity changes and the total corneal densitometry.

The TE‑CXL group showed a better and earlier recovery from the haze, while the A‑CXL group showed a delay in recovering and persistent increased corneal densitometry, mainly in the anterior 120 µ.

To evaluate the psychometric properties of the Persian version of quality of life impact of refractive correction (QIRC) questionnaire and its utility in assessment of refractive error‑related quality of life (QoL) following photorefractive keratectomy (PRK).

Patients with low‑to‑moderate myopia (−0.75 to − 6.0) were enrolled in this study. Standard alcohol‑assisted PRK was performed in all patients. The QIRC questionnaire was translated into a Persian version using the standard method. Patients completed QIRC questionnaire preoperatively and 3‑month postoperatively. A group of patients completed the questionnaire twice preoperatively. Psychometric properties were evaluated by internal consistency (Cronbach’s α), item‑total correlation, and known group construct validity. Intraclass correlation coefficient (ICC) were used to examine the repeatability.

One hundred forty‑seven patients(60 males and 87 females) with a mean age of 26.3 ± 5.5 (range, 18–39) years were enrolled. Cronbach’s α for total score was 0.923. Item‑total correlation was above 0.3 for all items. ICC was 0.978 for total score. Preoperatively, predominantly contact lens wearers showed significantly better total QIRC score than predominantly spectacle wearers (P = 0.017), which showed good known group validity. Total QIRC score significantly increased from 41.31 ± 6.69 preoperatively to 50.47 ± 7.26 postoperatively (P < 0.0001). Improvement in total QIRC score was observed both in contact lens wearers and spectacle wearers.

The Persian version of QIRC questionnaire is a valid and reliable tool. Refractive error‑related QoL assess by QIRC was significantly improved after PRK in an Iranian population.

To investigate the influence of topical cyclopentolate 1%, as an anti‑muscarinic mydriatic agent, on the peripapillary and macular microvasculature by optical coherence tomography angiography (OCT‑A) in healthy adults.

A total of 41 healthy adults without any systemic or ocular disease were enrolled for this prospective consecutive study. All patients underwent OCT‑A measurements (OptoVue Inc., Freemont, CA, USA) to assess optic disc status for radial peripapillary capillary network (whole image, inside disc, and peripapillary capillary densities), and superficial and deep capillary plexus whole, foveal, parafoveal and perifoveal densities, and foveal avascular zone (FAZ) densities. Foveal retinal thicknesses and all quadrant retinal fiber layer thicknesses were also assessed. The 4.5 mm × 4.5 mm peripapillary and 6 mm × 6 mm macular OCT‑A images were undertaken before and 30 min after instillation of topical cyclopentolate 1% to the right eyes.

The mean age of subjects was 38.14 ± 14.10 years. All macular, optic disc, and FAZ densities, foveal retinal thicknesses, average, and all quadrant retinal fiber layer thicknesses were statistically similar between baseline and after administration of topical cyclopentolate 1% (P > 0.05).

The current study demonstrated that pupillary dilation with topical cyclopentolate 1% seems to have no statistical effect on macular and peripapillary OCT‑A measurements of healthy adults.

To determine the incidence and risk factors for intraocular pressure (IOP) rise after the scleral buckle (SB) procedure for retinal detachment (RD).

A retrospective chart review of the medical records of patients, who underwent RD repair by SB performed by a single surgeon and had a minimum follow‑up of 6 months was carried out. The outcome measures were the incidence of IOP rise in the operated eyes and the associated risk factors.

Fifty‑two eyes of 52 patients with a median postsurgical follow‑up of 18 months(interquartile range: 6, 36, range: 6–60 months) were included. Seven eyes had encircling buckle, 23 eyes had encircling buckle and 1 quadrant segmental buckle, and 22 eyes had encircling buckle and 2 quadrant segmental buckle. IOP rise was seen in 15/52 eyes (28.85%), within 1 month of the SB surgery. Nine out of 15 eyes (60%) of patients <40 years of age had a rise in IOP as compared to 6/37 eyes (16.2%) of patients >40 years of age (P = 0.002). Patients <40 years had a significant increased risk of developing IOP rise, compared to those above 40 years of age (adjusted odds ratio: 7.246 with 95% confidence interval of 1.641–31.986, P = 0.009). None of the fellow eyes had a rise in IOP during the follow‑up period. None of the operated eyes with raised IOP progressed to glaucoma.

Elevated IOP is a common complication after the SB procedure, and age <40 years is associated with a greater risk of development of increase in the IOP. Hence, IOP monitoring after the SB surgery is of paramount importance to detect early rise during follow‑up.

To investigate possible links between thyroid dysfunction and prevalence of wet age‑related macular degeneration (AMD).

The present case–control study enrolled a total number of 90 patients with wet AMD and 90 sex‑, and age‑matched controls through a convenient sequential sampling method. Thyroid hormones were profiled in serum assay. Statistical measures were done to compare means between groups.

Our findings showed a significant difference in free T4 levels between wet AMD and control groups (P = 0.002), but the mean values of total T3 and Thyroid‑stimulating hormone levels were similar between the two groups. In addition, there were no differences in serum lipid profile between groups. Although no significant difference in the history of hypertension and hyperlipidemia between wet AMD and control groups was found, the history of smoking was higher in controls (P = 0.039).

Thyroid hormone abnormalities may be associated with wet AMD.

To analyze the macular microvascular network and the correlations between visual acuity and quantitative parameters using optical coherence tomography angiography (OCTA) in eyes with retinal vein occlusion (RVO).

We conducted a prospective cross‑sectional study including patients with unilateral RVO. We performed 4.5 mm × 4.5 mm macular OCTA angiograms for assessment of quantitative parameters in both superficial and deep capillary plexuses(SCP, DCP). Area of foveal avascular zone (FAZ), vascular density (VD), skeleton density (SD), fractal dimension (FD), vessel diameter index (VDI), and lacunarity (LAC) were analyzed.

Seventy eyes of 35 patients were enrolled. As compared to fellow eyes, OCTA analysis in eyes with RVO showed larger FAZ, lower VD, lower SD, lower FD, higher VDI, and increased LAC in both plexuses (All P < 0.05). The enlargement of FAZ in the SCP was associated with visual loss (P = 0.025, r = 0.378). In the DCP, visual acuity was negatively correlated with parafoveal VD, SD, and FD (P = 0.004, r = −0.472; P = 0.003, r = −0.482 and P = 0.036, r = −0.308, respectively). Stepwise multivariate regression analysis showed that lower SD and lower FD in the DCP remained correlated with poorer visual acuity (P = 0.04, r = −0.261 and P = 0.032, r = −0.264, respectively).

OCTA provides quantitative parameters to analyze retinal microvasculature in eyes with RVO. These OCTA biomarkers could be used to predict the impact of macular ischemia and capillary dropout on visual acuity in RVO.

To study the potential of dark‑field scanning laser ophthalmoscopy (DF‑SLO) for the prediction of central serous chorioretinopathy (CSC) responsiveness to laser therapy.

Fifty‑two eyes of 52 patients (44 males and 8 females, mean age of 45.4 ± 8.8 years) newly diagnosed with CSC were included in this prospective cohort study. At baseline, all patients received multimodal imaging including DF‑SLO and then were observed until resolution of subretinal fluid or, in nonresolving cases, treated with laser therapy. At the end of the follow‑up, each case was categorized as either self‑resolving, resolving after laser treatment, or nonresolving after laser treatment. Presence of granular retinal pigment epithelium (RPE) changes and lucency of RPE/choroid complex at the leak on DF‑SLO images were used by two masked graders to identify cases nonresolving after laser treatment.

Using DF‑SLO images, the masked grader correctly classified 45 of 52 (86.5%) CSC cases. Kappa value for the classification by two graders was 0.95 (95% confidential interval [CI] 0.85–1.0). The area under the receiver operating curve, sensitivity, and specificity of DF‑SLO in identifying nonresolving after laser treatment cases were 0.92 (95% CI: 0.79–0.98), 86.7% (95% CI: 59.5%–98.3%), and 96.6% (95% CI: 82.2%–99.2%), respectively.

DF‑SLO may be a useful technique in prognostication of response to laser treatment in newly diagnosed CSC.

To report our 5‑year experience in treating retinoblastoma (RB) with intra‑arterial chemotherapy (IAC) as a primary or secondary therapy, without adjuvant intravitreal chemotherapy.

A retrospective study was conducted on 70 eyes with intraocular RB that were treated with primary or secondary IAC from December 2010‑2015. Demographic characteristics, clinical features, tumor control, and treatment complications were compared and reported.

Thirty-seven eyes had received IAC as a secondary therapy after failed/incomplete response to systemic chemotherapy, and 33 eyes had received IAC as a primary treatment. The mean age of patients was 25 ± 8.9 months, and the patients were followed for a mean of 24.5 ± 16.26 months. Overall, enucleation rates were significantly higher in advanced tumors (Group D and E) in both groups (both P < 0.05). The main reason for enucleation in this study group was being unresponsive to treatment (27.4%), with 76% of latter patients having vitreous seeds at the time of enucleation. Enucleation rates did not differ significantly between patients receiving primary (18/33, 54%) or secondary IAC (18/37, 48%) (P = 0.06). In addition, recurrence and complication rates did not differ significantly between eyes receiving IAC as their primary or secondary treatment (P > 0.05).

In primary and secondary treatment of RB with IAC, the main findings that are globe salvage, recurrence, and complication rates were comparable when no adjuvant intravitreal chemotherapy was used.

To determine the clinical characteristics and surgical outcomes of medial rectus(MR) advancement with or without lateral rectus (LR) recession in patients with consecutive exotropia.

This interventional case series was performed on patients with consecutive exotropia of more than 15 prism diopters (PD) at least 6 months after the esotropia surgery. All patients were operated using either unilateral or bilateral MR muscle advancement with or without simultaneous LR recession. Ocular deviation at far and near distances, adduction limitation, and exoshift were investigated at the follow‑ups of 1 week, as well as 1, 3, and 6 months after the surgery. Operation was considered successful when the postoperative far deviation was <10 PD.

Thirty patients were evaluated. The mean amount of MR advancement was 5.69 ± 1.33 mm with the mean dose response of 4.7 ± 3.3 and 4.55 ± 4.01 PD at 3 and 6‑month follow‑ups, respectively. Success rate was reduced from 93% at week 1 to 73% at month 6 due to postoperative exodrift, especially during the first 3 months. Preoperative exotropia was the only contributing factor in our study.

MR advancement was an effective surgical method for consecutive exotropia correction, especially in cases with MR underaction. Bilateral MR advancement and/or LR recession are suggested in cases with higher preoperative exodeviation. The presence of postoperative exodrift indicates longer follow‑ups for patients.

To evaluate the role of monocanalicular intubation (MCI) in congenital nasolacrimal duct obstruction (CNLDO) in children older than 5 years of age.

A retrospective case series study was done on children over 5 years of age diagnosed with CNLDO who underwent MCI. Success rates were evaluated subjectively by asking their parents about persistent symptoms and objectively using the dye disappearance test in clinical examination.

A total of 43 eyes of 37 patients with a mean age of 7.42 ± 2.33 (range, 5–15 years of age) were included. The success rate was 60.46%, and the rate of secondary surgical intervention was 25% of all cases (61.11% of failed cases).

Primary MCI maintains a reasonable success rate in incomplete complicated CNLDO regardless of age.

To describe a case where prophylactic use of nonsteroidal anti‑inflammatory drugs (NSAID) eye drops lead to recurrent corneal melt with loss of vision and a brief literature review.

This is a case report of an 84‑year‑old diabetic female with chronic dry eye, operated by two different surgeons on each eye at different time intervals. She received topical NSAID prophylaxis after the second surgery only, which led to blindness due to recurrent corneal melt and chronic choroidal effusions. We also present a brief literature review.

This lady presented with corneal melt and perforation 5 days following the use of topical NSAIDs prophylaxis after a routine cataract surgery in the second eye. Unfortunately, all efforts to save her vision and eye were unsuccessful as she developed repeated complications in spite of corneal gluing, amniotic membrane, penetrating keratoplasty, and tarsorrhaphy. She also had chronic choroidal effusions. She ended up with an opaque cornea and a subtotal tarsorrhaphy, with no other option to improve her vision as she did not qualify for sedation or general anesthesia due to her poor systemic health.

Although it is a common practice for diabetic patients to have topical NSAIDs prophylaxis in combination with steroid eye drops to reduce the risk of cystoid macular edema after cataract surgery, the elderly diabetic patients with concomitant dry eyes should be considered high risk for corneal melt and should be closely monitored. This case highlights the rare but serious complication of topical NSAIDs prophylaxis in the vulnerable cornea, which warrants careful consideration.

To report the closure of a recalcitrant macular hole (MH) following the development of choroidal neovascularization.

A 67‑year‑old female patient in this case report was diagnosed with a MH and operated twice, but anatomical closure of MH could not be achieved. The patient was followed up without further treatment, as she rejected any additional procedure.

Six months later, a lesion consistent with choroidal neovascularization appeared in the central macula, and the recalcitrant MH closed spontaneously. The MH defect remained closed in the following years.

Besides being a new example of the presence of choroidal neovascularization after MH surgery, the most important aspect of this case report is to report the closure of a recalcitrant MH following the development of choroidal neovascularization.

To report a case of macular edema and an epiretinal membrane in an isolated astrocytic hamartoma treated surgically.

Case report.

We describe the case of a 37‑year‑old woman whose first symptoms were blurred vision and metamorphopsia. Optical coherence tomography revealed macular edema together with an epiretinal membrane secondary to an isolated retinal astrocytic hamartoma. We performed a pars plana vitrectomy (PPV) with membrane peeling. Both visual and structural outcomes were satisfactory. Complete resolution of symptoms was obtained, and visual acuity was preserved after a 7‑month follow‑up.

Although rare, epiretinal membrane may be present in isolated retinal astrocytic hamartomas, PPV and epiretinal membrane peeling may be a good treatment option in glial tumors with macular edema associated with an epiretinal membrane.

To report a rare case of orbital angioleiomyoma (ALM) and its management.

A 22‑year‑old woman presented with slowly progressive painless axial proptosis. Computed tomography and magnetic resonance imaging demonstrated a well‑defined intraconal mass that was isointense in T1 and hyperintense in T2 weighted images, heterogeneously enhanced by gadolinium.

The tumor, despite having significant adhesions to surrounding tissues and noticeable hemorrhage, was excised completely via the lateral orbitotomy approach. Histopathologic analysis of the specimen was consistent with an orbital ALM. The patient recovered from the operation uneventfully.

ALM must be considered in the differential diagnoses of orbital tumors