AimTo assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts.MethodsThis was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes of 101 subjects with grade 3‒4+ nuclear cataracts were randomised to torsional phacoemulsification alone (controls) or torsional phacoemulsification with adjunctive endocapsular nuclear fragmentation using a manual microinterventional nitinol filament loop device (miLOOP group). Outcome measures were phacoemulsification efficiency as measured by ultrasound energy (cumulative dispersed energy (CDE) units) and fluidics requirements (total irrigation fluid used) as well as incidence of intraoperative and postoperative complications.ResultsOnly high-grade advanced cataracts were enrolled with more than 85% of eyes with baseline best corrected visual acuity (BCVA) of 20/200 or worse in either group. Mean CDE was 53% higher in controls (32.8±24.9 vs 21.4±13.1 with miLOOP assistance) (p=0.004). Endothelial cell loss after surgery was low and similar between groups (7‒8%, p=0.561) One-month BCVA averaged 20/27 Snellen in miLOOP eyes and 20/24 in controls. No direct complications were caused by the miLOOP. In two cases, capsular tears occurred during IOL implantation and in all remaining cases during phacoemulsification, with none occurring during the miLOOP nucleus disassembly part of the procedure.ConclusionsMicrointerventional endocapsular fragmentation with the manual, disposable miLOOP device achieved consistent, ultrasound-free, full-thickness nucleus disassembly and significantly improved overall phaco efficiency in advanced cataracts.Trial registration numberNCT02843594

Purpose To report our case report with sustained‐release dexamethasone 0.7 mg intravitreal implant (Ozurdex®; Allergan, Inc., Irvine, CA) in retinal vein occlusion with macular edema. Methods A 67‐years old female patient with recent retinal vein occlusion with macular edema treated with sustained‐release dexamethasone 0.7 mg intravitreal implant was performed. On initial examination, the right best‐corrected visual acuity (BCVA) was 0,3. Right fundoscopy revealed dilatation and tortuosity of the retinal veins and retinal hemorrhage in the superior quadrant of the retina. The fluorescein retinal angiography showed a delay of filling time and spectral domain optical coherence tomography (Spectralis SD‐OCT; Heidelberg Engineering, Heidelberg, Germany) showed macular edema. Results The patient was treated with two intravitreal ranibizumab injections but two moths later the visual acuity was 0,2 and then we treated with sustained‐release dexamethasone 0.7 mg intravitreal implant and six moths later the right BCVA was improved to 0.7. Funduscopy and optical coherence tomography confirmed reduction of edema and tolerability of the implant was assessed. Conclusion The dexamethasone drug delivery system is one of the most recent additions to the armamentarium against macular edema, and is intriguing for its potency, dose consistency, potential for extended duration of action, and favorable safety profile. In patients with macular edema in retinal vein occlusion, sustained‐release dexamethasone 0.7 mg intravitreal implant may be an effective treatment option to control macular edema

Purpose Ectopia lentis is a patology with lens dislocation presumably secondary to zonular fiber weakness. Ectopia lentis can occur in isolation, in association with other ocular disorders or as part of systemic disorder. Marfan´s syndrome and homocystinuria are the most frequent cause of heritable ectopia lentis. Marfan syndrome (MFS) is a hereditary connective tissue disorder. Studies of MFS have established the critical contribution of fibrillin‐1 deficiency to disease progression through altered cell‐matrix interactions and dysregulated TGF‐β signalling. Methods We report four eyes of 4 children aged from 2 years to 4 years with ectopia lentis Both cases showed bilateral and symmetric lens dislocation with low visual acuity. One of the children was diagnosed of Marfan syndrome. Results We practised Twenty three gauge two port pars plana lensectomy without intraocular lenses. Conclusion Pars plana lensectomy is a safe, effective procedure for the management of ectopia lentis. Earlier surgery is indicated to prevent amblyopia and improve visual acuity. Marfan syndrome, homocystinuria, trauma and simple ectopia lentis are the most common caused of pediatric lens subluxation. Ectopia lentis in children continues to be a diagnostic and therapeutic challenge for ophthalmologists. The convencional surgical management of congenital subluxated lenses infrequently associated with a high incidence of complications leading to poor visual prognosis. Surgical intervention is necessary when lens subluxation causes a significant refractive error resulting in amblyopia.

Purpose Ranibizumab is a recombinant, humanized, monoclonal antibody antigen‐binding fragment that neutralizes all biologically active forms of vascular endothelial growth factor (VEGF), and is effectively used in the treatment of neovascular age‐related macular degeneration (AMD). Ocular and systemic side effects may be encountered after its intravitreal injection. We report the importance of provide information for patients about the alarm signs and when to seek urgent attention from their doctor. Methods Prospective, interventional, single case report. A 79‐year‐old male patient controlled to our department for exudative AMD since 1997. The process started in the right eye (RE), which had been treated by argon laser photocoagulation. Twelve years later, visual acuity in his left eye (LE) decreased to 5/10 and ophthalmoscopy showed a subretinal macular haemorrhage corresponding with an occult choroidal neovascular membrane in fluorescein angiography image. In this time, we decided to proceed with intravitreal ranibizumab treatment in the LE. Results Two days following de second injection, the patient is referred to our department for ocular pain with severe episcleral inflammation, located at the injection site. Not visual loss was documented. A good response to topical steroids was obtained, and so, one month later, the third injection is performed with no complications. Conclusion Intravitreal ranibizumab therapy is associated with various complications, the most of which are related with the injection procedure. However ranibizumab´s benefits are greater than its risks, for the treatment of exudative AMD.

Purpose Ocular metastases are becoming less and less rare. Choroidal metastases are recognized as the most common intraocular malignancy. Most ocular tumors metastasize from systemic origins in breast carcinoma in females, and bronchial carcinoma in males Methods CASE REPORT A 44 years‐old woman with an history of breast adenocarcinoma three years ago, who complained of visual disturbance of the left eye. On initial examination, the left best‐corrected visual acuity (BCVA) was 0,3. Left fundoscopy revealed several elevated yellowish masses with peripapillary serous retinal detachment. The fluorescein retinal angiography showed a choroidal lesion highly suggestive of choroidal metastasis Results The patient was treated with subtenon triamcinolone intection. Five moths later the left BCVA was improved to 0.8. Funduscopy and optical coherence tomography confirmed reduction of edema Conclusion CONCLUSIONS Subtenon triamcinolone inyection reduced subretinal edema. Optical coherence tomography (OCT) is useful in the follow‐up of choroidal metastasis after treatment. However, some limitations result from the choroidal location of the metastasis.