Scleral Contact Lens to Preserve a Corneal Graft in Chronic Lagophthalmos

Facial burns involving the periorbital region may lead to cicatricial ectropion and lagophthalmos, causing severe exposure keratopathy and eventually blindness if uncorrected. In these patients, it is critical to provide aesthetic and functional surgical correction to protect the ocular surface from chronic desiccation in addition to visual rehabilitation. Conventional methods may not be sufficient to provide visual rehabilitation in complex cases. Scleral lenses can be a multipurpose alternative for these patients. Herein, we present the challenging case of a patient who developed cicatricial lagophthalmos and exposure keratopathy after facial transplantation due to gasoline burns and received a scleral contact lens for visual rehabilitation.

Bartonella Henselae Related Unilateral Anterior Uveitis and Subsequent Multifocal Retinitis in a Case Under Certolizumab Treatment

Introduction

A case of ocular bartonellosis under anti-tumour necrosis factor treatment is described.

Case description

A 29-year-old woman with psoriasis who had been on certolizumab treatment was examined with a left visual deterioration following a fever bout, malaise, and placoid erythematous rashes on her neck. As there was acute anterior uveitis in her left eye, it was recommended to stop certolizumab treatment for a possible infectious aetiology. However, her physician elected to continue the certolizumab treatment. Ten days later, the patient noticed further visual decline despite the topical steroid treatment. This time, there were scattered yellow-white small retinitis foci at the left posterior pole. Infectious agents were searched and while Bartonella henselae antibodies were negative for immunoglobulin M, the immunoglobulin G titre was 1/80. Clinical findings were improved with the systemic treatment of oral trimethoprim-sulfamethoxazole (160/800 mg twice daily for six weeks) and azithromycin (500 mg once daily for two weeks).

Discussion

Though extremely rare, ocular bartonellosis should be kept in mind in patients on anti-tumour necrosis factor treatment as rapid and accurate diagnosis may end up with an excellent visual outcome and full recovery.

LEARNING POINTS

Anti-tumour necrosis factor treatment is fraught with several ocular side effects including myositis, corneal infiltrates, scleritis, uveitis, optic neuritis, retinal vasculitis and ophthalmoplegia.When a new uveitis episode occurs in cases undergoing anti-tumour necrosis factor therapy, its cause poses a diagnostic challenge as it can have either an infectious or a non-infectious nature.Though very rare, ocular bartonellosis may also occur in immunocompromised individuals and a prompt diagnosis and appropriate treatment can lead to an excellent visual recovery.

Optical Coherence Tomography Angiography Imaging of Foveal Atrophy Secondary to Commotio Retinae in a Pediatric Patient

Optical coherence tomography-angiography (OCTA) is a fast, reliable, and non-invasive technique for the diagnosis and follow-up of patients with commotio retinae (CR). Severity of the damage to the retinal and choroidal microvasculature in OCTA imaging and the visual prognosis are directly related to the severity of trauma. There are a few published reports on OCTA in CR that shows alterations of the retinal or superficial choroidal vessels and choriocapillary plexus. OCTA imaging seems to be predictive for visual prognosis. Herein, we present a 6-year-old boy, who had blunt trauma to the right eye with a stick during outdoor playing with visual acuity reduction to 0.1 following resolution of the Berlin's edema. In our case, OCTA revealed damage to the outer layers of the retinae and choriocapillaris and resulting in permanent vision loss. OCTA is a non-invasive, rapid, and safe imaging technique that qualitatively and quantitatively analyzes blood flow from the superficial capillary plexus to the choriocapillaris, which can be predictive in the visual prognosis.