Background A case of Epstein-Barr viral (EBV) corneal stromal keratitis during rheumatoid arthritis (RA) treatment is presented. Case presentation A 74-year-old female undergoing RA treatment was previously treated for bacterial corneal ulcer and herpetic keratitis and healed with antibiotic eye drops and topical anti-herpes ointment. At the first visit to our hospital, she presented with findings of monocular posterior interstitial keratitis with neovascularization mostly located in the inferior cornea with a corneal epithelial defect. The right eye showed no thinning of the corneal periphery and anterior uveitis. Her RA had subsided with oral steroid treatment, and infectious mononucleosis (IM) had not developed. EBV DNA could be detected in her corneal sample. After an extended but ineffective period to antibiotic treatment the corneal infiltrate responded rapidly to topical corticosteroids. Conclusion EBV can cause stromal keratitis without IM during treatment for RA.

Purpose To assess the preoperative characteristics and surgical outcomes of using micro-incision vitrectomy surgery (MIVS) to treat RRD with posterior vitreous detachment (PVD) in an older and a younger patient group. Methods This retrospective cohort study included 407 eyes from 397 patients with primary RRD with PVD who were consecutively treated in our hospital from February 2016 to February 2020. PVD was diagnosed clinically by the presence of a Weiss ring, or was diagnosed morphologically via optical coherence tomography and subsequently confirmed during surgery. The main outcome measures were preoperative RRD characteristics, best-corrected visual acuity (BCVA), and postoperative complications. Results Data were analysed from 55 eyes in the elderly group (age 70 and older), and 352 eyes in the young group (age 69 and younger). There was no significant inter-group difference in the initial reattachment rate. Preoperative characteristics indicated that elderly patients had a significantly lower rate of phakic eyes, shorter mean axial length, lower lattice incidence, and longer time spans from onset to surgery. There were no significant between-group differences in the incidence of the following complications: fibrin formation, intraocular pressure elevation, epi-retinal membrane on the macula, intraocular lens optic capture, proliferative vitreoretinopathy, and vitreous haemorrhage. While the elderly patients had significant postoperative improvements in BCVA, these improvements were significantly lower than those of the younger patients. Conclusions This study highlighted the characteristics and surgical outcomes of MIVS in elderly patients with RRD. Although the time from onset to surgery was longer, MIVS still can be performed safely to improve older patients’ postoperative BCVA.

Background To present a novel case that developed annular choroidal detachment after intravitreal anti-vascular endothelial growth factor antibody injection in a patient after immune checkpoint inhibitor treatment. Case presentation A 58-year-old Japanese man presented visual impairment in the right eye. Ophthalmological examination revealed macular edema in the right eye, which suggested the possibility of age-related macular degeneration. Following the intravitreal aflibercept injection, the annular choroidal detachment was observed in the injected eye. As hypotony or thick sclera was not observed, choroidal detachment seemed to have appeared due to enhanced inflammation by intravitreal injection. The patient had a history of stage IV paranasal cavity cancer and was treated with nivolumab, an immune checkpoint inhibitor. The immune response might have been enhanced due to the use of nivolumab so that intravitreal injection triggered inflammation. Three weeks after sub-tenon injection of triamcinolone acetonide, macular edema and choroidal detachment improved. Conclusions Intravitreal aflibercept injection caused annular choroidal detachment in our patient, presumably because the immune system was activated after nivolumab treatment. To the best of our knowledge, this is the first case report of annular choroidal detachment that developed after intravitreal injection in a patient with a history of nivolumab therapy. With the increasing use of immune checkpoint inhibitors in patients with various cancers, clinicians should be aware of these potentially associated immune-related adverse events.

Background Immune checkpoint inhibitors (ICIs) cause ICI-related adverse events (irAEs) such as dry eye and uveitis, sometimes necessitating the suspension of ICI treatment. To the best of my knowledge, this is the first prospective study on ocular irAEs. In this study, we aimed to identify early changes in ocular irAE and control conditions without suspending ICI treatment. Methods 22 participants who began ICI treatment between July 2020 and July 2021 in Keiyu Hospital, Japan (3 women and 19 men; age, 69.1 ± 7.9 years, range, 53–83 years) were prospectively evaluated. The patients underwent ocular examinations before and 1, 3, and every 2 months after the initial dose of ICI. Examinations included measurement of aqueous flare and central choroidal thickness (CCT). Results Among the 22 participants, 6 developed systemic irAEs. Of these 6 patients, one experienced ocular pain after ICI treatment, likely due to dry eye disease. We did not observe any change in CCT or aqueous flare, even in patients with systemic AEs. This result suggests that ocular irAE is dose- independent, and we cannot predict whether the patient have risks of presenting irAE by following up ocular findings. Conclusions Ocular irAEs occur dose-independently.

There is no consensus on an appropriate and sustainable practice method in vitreoretinal surgery. We found a self-made vitreoretinal surgical simulator using a silicone mold that can offer various operative maneuvers and can become a solution for such a problem. We obtained a spherical silicone mold, a mannequin head, and spray material on the net market and combined them with expired surgical instruments to complete the simulator. Simulated vitrectomy was performed by vitreoretinal experts, and the practicality was verified. They reviewed that the simulated eyeball had size and rigidity very similar to the eyeball and that the intraocular practice swing seemed to be useful for the prevention of complications. The silicone material's semitransparency and open-sky structure offered them plenty of visibility. The membrane simulated by spray glue provided them with an excellent peeling sensation. These findings suggested that this simulator is suitable for practicing the basic procedures of vitreoretinal surgery. The simple shape seems to have many possibilities, and further verification at many facilities is desirable.