Hanan Handor

Atypical Presentation of Ectopia Lentis in Homocystinuria

A 6-year-old boy presented with a history of intermittent strabismus since the age of 2 years. On examination, there was a bilateral displacement (ectopia) of the lense to the nasal and superior quadrants with a marked bilateral phacodonesis (tremulousness of the lens during eye movement) due to rupture of the zonular fibers in the inferotemporal quadrants holding the crystalline lens in place (Figure). General examination revealed a marfanoid morphotype with developmental delay, which was suggestive of a homocystinuria. This was confirmed by plasma and urine screening tests for homocysteine. The patient underwent bilateral phacophagia (surgical extraction of the lenses) and anterior vitrectomy. Iris fixated intraocular lenses were inplanted to manage the residual aphakia (absence of the crystalline lenses). Pyridoxine (vitamin B6) supplementation was started, along with a low-methionine and high-cysteine diet. Homocystinuria is an inborn error of methionine metabolism related to a deficiency of the cystathionine-bsynthetase, which converts homocysteine to cystathionine. Clinical features of this condition are related to the accumulation of the homocysteine and deficiency of cystine. The ocular manifestations are dominated by myopia and ectopia lentis. The latter is present in 90% of patients; it is an acquired and progressive abnormality. The suspensory system of the lens (zonula) contains high levels of cystine; thus, a deficiency of this component leads to an abnormal development of the zonular fibers, which alters the stability of the lens. This may lead, long-term, to a complete dislocation of the lens either to the anterior chamber or the vitreous, requiring a surgical extraction.

Cilioretinal artery and central retinal vein occlusion after sildenafil use

Its reported that sildenafil may cause non-arteritic anterior ischaemic optic neuropathy and transient changes in perception of colour hue or brightness.1 We report a case of cilioretinal artery and central retinal vein occlusion after sildenafil use. A previously healthy 40-year-old man, presented with acute visual loss of the left eye. He took one tablet of sildenafil (100 mg) for two consecutive days before the onset of symptoms. At examination the visual acuity was …

Secondary hemorrhage in traumatic hyphema

A 40-year-old man presented with 3 h history of acute painful vision loss of his right eye. He reported a blunt trauma of the same eye 7 days prior to admission. At examination his visual acuity was reduced to light perception. Slit lamp examination revealed a multilayered hyphema (collection of blood in the anterior chamber). A layer of fresh blood (empty arrows) was noted over the darker clot (white arrows) in the anterior chamber (Figure 1). The intraocular pressure (IOP) was increased (40 mmgh).

Unilateral multifocal choroidal ischemia revealing a giant cell arteritis: a case report.

Unilateral multifocal choroidal ischemia revealing a giant cell arteritis: a case report Zouheir Hafidi, Hanan Handor, Hamid Elmoussaif, Mina Laghmari, Abdelouahed Karmane, Samira Tachfouti, Rajae Daoudi Université Mohammed V Souissi, Service d’Ophtalmologie A de l’Hôpital des Spécialités, Centre Hospitalier Universitaire, Rabat, Maroc Corresponding author: Zouheir Hafidi, Université Mohammed V Souissi, Service d’Ophtalmologie A de l’Hôpital des Spécialités, Centre Hospitalier Universitaire, Rabat, Maroc

Ophthalmologists beware of adenoviruses

Epidemic keratoconjunctivitis caused by different serotypes of human adenoviruses is an explosive and highly contagious ocular surface infection. This is the case of a young ophthalmologist who presented a filamentary keratitis complicating an adenoviral keratoconjunctivitis. Filamentary keratitis is a chronic and debilitating disorder related to dry eye syndrome. Patients with filamentary keratitis report ocular discomfort ranging from mild foreign-body sensation to severe ocular pain. Filaments are composed of mucin, and degenerating and regenerating epithelial cells of the cornea. Current management of filamentary keratitis involves treating the underlying dry eye (non preserved lubricants, topical steroidal agents, and punctal plugs) and mechanical removal of filaments.

Myelinated retinal nerve fibers.

A 7-year-old girl of second degree consanguineous parents, presented with an 8 months history of intermittent exotropia of the left eye. Cycloplegic refraction was -0.25.-0.50×165o and -3.00.-0.50×20o in the right and left eyes respectively. An initial objective assessment of the visual function showed a best corrected visual acuity of 12/10 in the right eye and 6/10 in the left eye. Fundoscopy revealed superficial whitish, opaque lesion with feathered edges, hiding the optic disc and retinal vessels, and following the course of the nerve fiber layer in the left eye. We conclude to the diagnosis of myelinated retinal nerve fibers. General examination was unremarkable. The treatment of amblyopia was then undertaken, and a final corrected visual acuity of 9/10 was attained in the left eye. Myelinated retinal nerve fibers are a rare idiopathic developmental abnormality, occurring when the myelination of ganglions cells axons extend abnormally into the retina. Usually, this malformation does not affect visual acuity, unless it involves the fovea. Otherwise it can be, rarely, associated with myopia, strabismus, and amblyopia. Amblyopia treatment should be systematically considered, even if it’s reported to be refractory to the treatment in such cases.General clinical assessment must be carried out in order to exclude some systemic disorders that may be linked to this abnormality including neurofibromatosis type 1, craniofacial abnormalities, skeletal malformations, and basal cell nevus syndrome.

Hypertensive Retinopathy Associated with Preeclampsia

A 25-year-old primigravida at 36 weeks of gestation presented with a 2-week history of headache, light flashes, and blurred vision in both eyes. Her corrected visual acuity was 20/40 in the right eye and 20/50 in the left eye.