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Background: Descemet's membrane detachment is a possible complication after cataract surgery and has been reported to happen in 0.5% of cases after cataract surgery. Case Presentation: A 77-year-old male patient underwent right eye cataract surgery and presented 2 weeks after surgery with decreased visual acuity (CF) in the operated right eye. There was generalized cornea edema and the Descemet's membrane (DM) was noticed to be detached at 80% of the corneal surface. At 12 days postoperatively, a descemetopexy with intracameral air bubble was performed following the principles of endothelial keratoplasty. On follow-up, the visual acuity in the right eye was 6/7.5 with complete corneal clarity at 2 months. Conclusion: Early recognition and surgical intervention of a DM detachment at cataract surgery are likely to enable resolution without the need for a transplant. If suspected or identified at the end of surgery, anterior chamber air insertion is recommended. It is important to note that separated DM can mimic a retained anterior capsule flap. Care must be taken when considering removal of any clear membranes at the end of cataract surgery. [ABSTRACT FROM AUTHOR]

Sarcoid-like granulomas are a rare adverse effect of TNF-α inhibitors that are becoming increasingly reported in the literature. A retrospective study in France estimated this adverse effect to occur in 0.04% patients. We report an important reversible cause that is more commonly being seen. A 70 year old lady presented with multiple lesions on her lids in the ophthalmology clinic. Histology confirmed that they were sarcoid-like granulomas. The patient had been started on etanercept (anti-TNF agent) a few months prior for rheumatoid arthritis. Investigations were undertaken to rule out differentials such as autoimmune conditions and infective causes like tuberculosis. After ruling out an active inflammatory disease and an autoimmune cause, etanercept induced granulomas were considered. Etanercept was stopped. This resulted in the resolution of granulomas over the course of a few months. Etanercept induced granulomas resolve when the anti-TNF agent is discontinued; however, some patients may require treatment with steroids. As this case demonstrates, ophthalmologists should be aware that anti-TNF agents can cause non-caseating granulomas, which can be cutaneous or pulmonary. This can help to result in more prompt diagnoses and appropriate treatment. [ABSTRACT FROM AUTHOR]

Objective: To report a case of recalcitrant fungal keratitis successfully managed with topical caspofungin acetate in North India.Methods: Case report and literature review.Results: An 18-year-old male patient presented with complaints of redness, watering, pain and diminution of vision in the right eye and was referred to our centre as a case of corneal ulcer. The patient was examined and found to have a near total epithelial defect, with corneal infiltrates approximately 8x8 mm. A provisional diagnosis of polymicrobial keratitis was made based on corneal scraping suggestive of and confocal scan revealing fungal hyphae. The patient failed to respond to topical voriconazole 1%, natamycin 5% and moxifloxacin hydrochloride 0.5% with oral voriconazole. In view of the poor response to these drugs, the patient was subsequently administered topical caspofungin 0.5% in place of natamycin and continued on topical and oral voriconazole, in addition to topical moxifloxacin and cycloplegics, which finally led to healing with minimal scarring. The patient attained a best corrected visual acuity (BCVA) of 6/12.Conclusion: Topical caspofungin may be used as a useful and effective alternative in cases of recalcitrant fungal keratitis. It may result in healing with minimal scarring.