No abstract

Body modification is the practice of deliberate alterations to the human body, such as tattoos, piercings, and scarification, to achieve self-expression or control over one's body. 1 The "body modification movement" has seen an increasingly popular practice of tattooing the eye. Typically, ink is injected into the subconjunctival space with pigmentation of the episclera and/or sclera. This has resulted in complications ranging from conjunctival edema and nodules 2 to more serious complications such as orbital cellulitis, 3 scleritis, panuveitis, 4 and secondary glaucoma. 5 Here we present 3 Canadian cases of ocular tattooing resulting in complications ranging from scleral laceration and serious corneal and anterior segment injury to endophthalmitis requiring enucleation. These cases reinforce the need for specific legislature surrounding ocular tattooing in Canadian provinces. A 39-year-old female (case 1) presented with severe left eye pain after allowing her partner (case 2) to attempt scleral tattooing at home using tattoo ink ordered from an online source (StarBrite, Somers, Conn). They did not have access to topical anaesthetics and used a 31-gauge insulin needle to perform the tattoo. She was otherwise healthy and did not take any ocular or systemic medications. On examination, her visual acuity was 6/6 in both eyes, with intraocular pressures of 18 mm Hg in the right eye and 13 mm Hg in the left eye. Slit-lamp examination revealed a shallow left anterior chamber and a Seidel-positive puncture wound temporally, where there was blue tattoo dye staining. Dilated fundoscopic examination findings were within normal limits bilaterally without any obvious evidence of intraocular penetration of tattoo dye in the left eye. To allow a complete examination and closure of the apparent wound, she was taken to the operating room. Despite an extensive exploration, a leaking scleral puncture wound was not found. The conjunctiva was closed in a watertight closure technique with 9-0 Vicryl. Postoperatively, her anterior chamber deepened, and her temporal sclera was Seidel-negative. An epithelial defect required a temporary bandage contact lens. She recovered well in the next week but was subsequently lost to follow-up. A 41-year-old male (case 2) presented with vision loss in his right eye after inadvertent globe penetration and intraocular injection of blue tattoo ink (StarBrite) during selfadministration of the dye. After watching a YouTube video, the patient attempted to tattoo his lateral right sclera. Increased force had been applied to the plunger to clear an obstruction, which resulted in the needle penetrating his eye. He injected approximately 1 mL of blue tattoo ink into his eye. On examination, his uncorrected visual acuity was light perception in the right eye and 6/6 in the left eye. Intraocular pressures were 44 and 12 mm Hg in the right and left eyes, respectively. Slit-lamp examination of the right eye revealed blue tattoo dye filling the anterior chamber (Fig. 1A) and evidence of inferotemporal needle penet...

Background Familial exudative vitreoretinopathy (FEVR) is a rare congenital disorder characterized by a lack of blood vessel growth to the periphery of the retina with secondary fibrovascular proliferation at the vascular‐avascular junction. These structurally abnormal vessels cause leakage and hemorrhage, while the fibroproliferative scarring results in retinal dragging, detachment and blindness. Mutations in the FZD4 gene represent one of the most common causes of FEVR. Methods A loss of function mutation resulting from a 10‐nucleotide insertion into exon 1 of the zebrafish fzd4 gene was generated using transcription activator‐like effector nucleases (TALENs). Structural and functional integrity of the retinal vasculature was examined by fluorescent microscopy and optokinetic responses. Results Zebrafish retinal vasculature is asymmetrically distributed along the dorsoventral axis, with active vascular remodeling on the ventral surface of the retina throughout development. fzd4 mutants exhibit disorganized ventral retinal vasculature with discernable tubular fusion by week 8 of development. Furthermore, fzd4 mutants have impaired optokinetic responses requiring increased illumination. Conclusion We have generated a visually impaired zebrafish FEVR model exhibiting abnormal retinal vasculature. These fish provide a tractable system for studying vascular biology in retinovascular disorders, and demonstrate the feasibility of using zebrafish for evaluating future FEVR genes identified in humans.

Purpose: To report a case of peripheral ulcerative keratitis secondary to atypical hemolytic uremic syndrome. Methods: We report the case of a 76-year-old man who presented with bilateral aggressive peripheral ulcerative keratitis. Clinical examinations and investigations are reported from the patients' admission. Results: The patient had an extended workup for autoimmune and infectious etiologies that all returned negative. The laboratory work in conjunction with renal biopsy and clinical symptoms were consistent with atypical hemolytic uremic syndrome. The patient was treated with systemic steroids for his peripheral ulcerative keratitis and underlying systemic disease. Corneal glueing and amniotic membrane grafting was also performed. Conclusions: To our knowledge, we report the first known case of peripheral ulcerative keratitis secondary to atypical hemolytic uremic syndrome. In cases where the standard workup is negative, this diagnosis should be considered because it can have significant systemic morbidity.