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Introduction: Branch retinal vein occlusion (BRVO) is a leading cause of vision impairment globally and the second most common retinal vascular disease leading to blindness. Affecting over 20 million people worldwide, the prevalence of BRVO is expected to increase with the aging population. Branch retinal vein occlusion occurs due to the obstruction of small veins draining blood from the retina, leading to hemorrhages, fluid leakage and retinal damage. Its pathogenesis involves a complex interplay of ocular conditions and genetic predispositions. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar for articles published between January 2010 and January 2024. The search terms included "retinal vein occlusion", "BRVO" and "risk factors." After initial screening of 642 articles, non-English articles, animal studies and in vitro models were excluded. In total, 63 articles were analyzed for ocular and genetic risk factors associated with BRVO. Results: Ocular risk factors for BRVO include glaucoma, short axial length and optic disc drusen. Elevated intraocular pressure in glaucoma can compress retinal veins, while short axial length increases the likelihood of venous compression. Optic disc drusen cause vascular anomalies that heighten BRVO risk. Genetic polymorphisms affecting coagulation, endothelial function, inflammation and oxidative stress, such as MTHFR C677T and Factor V Leiden, also influence BRVO susceptibility. Familial clustering and genetic variations in inflammatory pathways further contribute to the risk. Conclusion: The significant impact of BRVO on vision health underscores the need for comprehensive strategies for early detection, prevention and treatment. Understanding the ocular and genetic risk factors is crucial for developing personalized treatment and effective public health initiatives. Ongoing research into genetic and molecular mechanisms will enhance management approaches and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of neovascular glaucoma in an 8-year-old male, secondary to a racemose hemangioma without associated intracranial arteriovenous malformation, highlighting the challenges in management and novel findings on optical coherence tomography angiography (OCTA). Observations: An 8-year-old male initially presented with pain, redness, and blurred vision in the right eye. The patient was diagnosed with secondary neovascular glaucoma due to a racemose hemangioma. Urgent interventions included intravitreal bevacizumab injection and tube shunt surgery for persistently high intraocular pressure. Pars plana vitrectomy and scatter laser photocoagulation were eventually performed to manage a tractional retinal detachment and peripheral ischemia, respectively. OCTA imaging revealed a racemose hemangioma with a unique chorioretinal anastomosis. Conclusions and Importance: We present a rare pediatric case of neovascular glaucoma secondary to a racemose hemangioma with significant peripheral ischemia and an unusual chorioretinal anastomosis. The discovery of a chorioretinal anastomosis on OCTA suggests a potentially severe variant of racemose hemangioma.

T Triwiyanto,1 Sari Luthfiyah2 1Department of Medical Electronics Technology, Poltekkes Kemenkes Surabaya, Surabaya, Indonesia; 2Department of Nursing, Poltekkes Kemenkes Surabaya, Surabaya, IndonesiaCorrespondence: T Triwiyanto, Department of Medical Electronics Technology, Poltekkes Kemenkes Surabaya, Jl. Pucang Jajar Timur No. 10, Surabaya, East Java, Indonesia, Tel +628155126883, Fax +6231-5025609, Email triwi@poltekkesdepkes-sby.ac.id; triwiyanto123@gmail.com

Background: Retinal vein occlusion (RVO) is a major cause of vision impairment globally. Obstruction in the retinal venous system is often due to thrombus formation at arteriovenous crossing points, leading to symptoms localized to the affected retinal area. Systemic conditions like hypertension, diabetes mellitus, dyslipidemia and heart disease are recognized risk factors for RVO, influencing the components of Virchow's triad. Objective: This work aims to provide an updated overview of systemic risk factors associated with branch retinal vein occlusion (BRVO) development and to explore management options for the prevention or modification of associated risks. Methods: Review of the literature concerning the pathogenesis and risk factors of BRVO, including diabetes mellitus, hyperlipidemia, hematologic conditions, hormonal factors, thyroid disease, and the impact of COVID-19 and related vaccines on BRVO incidence. Results: Diabetes mellitus contributes to BRVO through mechanisms like endothelial dysfunction and thrombogenesis. Hyperlipidemia -- through lipid-mediated vascular changes -- and hematologic conditions -- by predisposing to hypercoagulability -- significantly increase BRVO risk. Hormonal imbalances and thyroid diseases also influence BRVO development through their effects on vascular and hemostatic systems. Furthermore, COVID-19 has been identified as a potential risk factor for BRVO, possibly due to its prothrombotic effects. Conclusion: Branch retinal vein occlusion represents a complex interplay of systemic and local vascular factors, necessitating comprehensive management strategies. Early detection and modification of risk factors is crucial for preventing vision impairment associated with BRVO. The ongoing pandemic and its systemic implications underscore the importance of continued research into the multifactorial etiology of BRVO and optimization of management strategies to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads. Methods: Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1–69%, Type III = 70–99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group. Results: In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%). Conclusions: The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED. [ABSTRACT FROM AUTHOR]

Introduction: In chronic venous insufficiency (CVI), an increase in venous pressure causes the passage of intravascular blood cells and molecules into the surrounding tissues and induces histopathological changes in the lower extremities, leading to increased pigmentation in the legs, ulceration, and tissue loss to various degrees. This study aimed to investigate whether an increase in venous pressure in the coronary veins can lead to the aforementioned histopathological changes. Material and methods: Twenty-four New Zealand rabbits were divided into the following three groups: experimental model of coronary venous hypertension (CVH) (n = 8), sham group (n = 8), and control group (n = 8). After 21 days postoperatively, tissue samples from each group were compared for perivascular inflammation, erythrocyte extravasation, macrophage infiltration, and hemosiderin deposits by histopathological scoring under a light microscope. Matrix metalloproteinase-2 (MMP-2) activation was evaluated using immunohistochemical staining. Results: In the CVH group, hemosiderin accumulation was significantly higher than in the sham and control groups (1.0 (1.0-3.0), 0.0 (0.0-1.0), 0.0 (0.0-0.0); p < 0.001). Immunohistochemically, in the CVH group, MMP-2 levels were significantly higher than in the sham and control groups (2.0 (1.0-3.0), 0.0 (0.0-1.0), 0.0 (0.0-0.0); p < 0.001). Conclusions: This experimental study showed for the first time the histopathological and immunohistochemical changes in myocardial tissue, similar to those observed in CVI, as a result of increased coronary venous pressure due to coronary vein ligation. Further studies are needed to understand the clinical implications of these results. [ABSTRACT FROM AUTHOR]

Purpose: To determine the association of primary angle-closure disease (PACD) in patients with retinal vein occlusion (RVO) at a tertiary eye care center in North India. Methods: It is a cross-sectional, observational study. Sixty consecutive patients with retinal vein occlusion within a period of one year from a single tertiary eye care center were enrolled. Detailed history, slit-lamp examination of the anterior segment, intraocular pressure measurement by applanation tonometry, gonioscopy and fundus examination were done. Anterior chamber depth and axial length were also measured. Results: Among the 60 patients, 29 were males (48.3%) and 31 females (51.6%). Twenty-seven (45%) of them had central retinal vein occlusion (CRVO) and 33 (55%) had branch retinal vein occlusion (BRVO). Forty percent of patients with RVO had PACD. Relative risk of PACD was 1.71 times in patients with CRVO as compared to BRVO. Risk of glaucoma was 49% more in CRVO than BRVO. Probability of PACD was more in patients of RVO who had diabetes and CAD as comorbidity. Conclusion: The association between PACD and RVO is less known. PACD can be one of the risk factors for the development of RVO. A comprehensive examination and detailed angle evaluation of both of the eyes should be done in all cases of RVO, in addition to investigating for systemic risk factors. However, larger population-based studies would be required to prove it as an independent risk factor.

Purpose: The aim of this study is to investigate the relationship between retinal vein occlusions (RVO) and blood groups. Materials and Methods: Detailed ophthalmological examinations, systemic diseases and blood groups of patients who applied to Balıkesir University Faculty of Medicine, Ophthalmology Outpatient Clinic between February 2019 and May 2020 with retinal vein occlusion were retrospectively analyzed. The blood groups of the patients were divided into 2 groups as O and non-O. The results were compared with a normal group matched in terms of age and gender. Regression analysis was performed to determine the relationship between blood group types and vein occlusions. Results: A total of 78 people were included in the study. The mean age of 38 patients with vein occlusion was 61.8±11.3, while the mean age of 40 patients without vein occlusion was 64.0±10.3 (p=0.320). In the RVO patients group, 14 (36.8%) were female, 30 (78.9%) had non-O blood group, 20 (52.6%) had hypertension (HT), 19 (50%) had diabetes mellitus (DM). According to the results of logistic regression analysis, HT have statistically significant effect on RVO formation (OR 2.92 95% CI 1.14-7.51, p=0.025). The number of patients with non-O blood group was 30 (78.9%) in the RVO group and 25 (62.5%) patients in the control group had non-O blood group (p=0.140). Conclusion: HT is the major risk factor for RVO. Although non-0 blood group is found at a higher rate in RVO patients, it does not show a significant difference. [ABSTRACT FROM AUTHOR]

Purpose: To determine the association of primary angle-closure disease (PACD) in patients with retinal vein occlusion (RVO) at a tertiary eye care center in North India.Methods: It is a cross-sectional, observational study. Sixty consecutive patients with retinal vein occlusion within a period of one year from a single tertiary eye care center were enrolled. Detailed history, slit-lamp examination of the anterior segment, intraocular pressure measurement by applanation tonometry, gonioscopy and fundus examination were done. Anterior chamber depth and axial length were also measured.Results: Among the 60 patients, 29 were males (48.3%) and 31 females (51.6%). Twenty-seven (45%) of them had central retinal vein occlusion (CRVO) and 33 (55%) had branch retinal vein occlusion (BRVO). Forty percent of patients with RVO had PACD. Relative risk of PACD was 1.71 times in patients with CRVO as compared to BRVO. Risk of glaucoma was 49% more in CRVO than BRVO. Probability of PACD was more in patients of RVO who had diabetes and CAD as comorbidity.Conclusion: The association between PACD and RVO is less known. PACD can be one of the risk factors for the development of RVO. A comprehensive examination and detailed angle evaluation of both of the eyes should be done in all cases of RVO, in addition to investigating for systemic risk factors. However, larger population-based studies would be required to prove it as an independent risk factor. [ABSTRACT FROM AUTHOR]

Background: Facial rejuvenation and reconstruction with autologous fat injection are a common and effective procedure used worldwide. Most surgeons and patients are satisfied with the favorable outcomes. However, catastrophic complications from arterial and venous occlusion resulting in visual loss and stroke may occur. Case presentation: We herein report a case of isolated venous occlusion from fat embolism. The patient developed acute painful proptosis and blurred vision of her right eye while undergoing an esthetic autologous fat injection into her forehead. Based on her clinical manifestations and radiologic findings, the patient was diagnosed with superior ophthalmic vein occlusion. Symptomatic and supportive treatments were given. Spontaneous clinical improvement occurred without secondary complications. Therefore, the initially planned endovascular therapy with transfemoral transvenous embolectomy of the right superior ophthalmic vein was canceled. Conclusions: Facial augmentation with autologous fat injection can cause superior ophthalmic vein embolism. Surgeons should therefore perform this procedure very cautiously. Prompt ophthalmological evaluation and proper management are important for improving clinical outcomes. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Purpose: Schistosomiasis, one of the most important parasitic diseases in humans, is caused by the trematode parasites. Common manifestations include gastrointestinal and genitourinary symptoms while ophthalmologic involvement is rare. Here we report a case of retinal vein occlusion and neuroretinitis secondary to a schistosomiasisis infection. Observations: A healthy 23-year-old man presented with headache and decreased vision in his right eye. Ophthalmic examination revealed a swollen disc, engorged retinal veins with retinal hemorrhages in all quadrants and macular edema with hard exudates (‘macular star’). Fluorescein Angiography demonstrated a hot disk and an irregular pattern of filling defects along a major retinal vein. Further questioning revealed that a few months earlier, the patient had returned from an endemic area and was found seropositive for schistosomiasis. Conclusion: In this case of neuroretinitis and secondary retinal venous stasis, the presumed underlying mechanism is associated with embolization of Schistosoma eggs or deposition of immune complexes. Although ophthalmic manifestations of schistosomiasis are rare, awareness should be maintained especially among world-travelers with unusual ocular findings.

Introduction: The pandemic of COVID-19 has been caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Apart from respiratory malfunction, COVID-19 causes a system-wide thromboembolic state, leading to serious cardiovascular, cerebrovascular and peripheral vascular manifestations. However, our knowledge regarding retinal manifestations due to systemic COVID-19 is minimal. This systematic review has comprehensively summarized all retinal manifestations secondary to COVID-19 disease recorded till date since the beginning of the pandemic. Methods: All studies published till November 27, 2020, which have reported retinal manifestations in COVID-19 patients were systematically reviewed using the PRISMA statement. Results: We included 15 articles: 11 case reports and four cross-sectional case series. The most commonly reported manifestations which did not affect visual acuity were retinal hemorrhages and cotton wool spots. The most common vision threatening manifestation was retinal vein occlusion with associated macular edema. Rarely, patients may also present with retinal arterial occlusions and ocular inflammation. These manifestations may occur from as soon as within a week after the onset of COVID-19 symptoms to more than 6 weeks after. Conclusion: Mostly causing milder disease, COVID-19 may however lead to severe life-threatening thromboembolic complications, and systemic antithrombotic therapy has been suggested as a prophylactic and therapeutic management strategy for patients affected with serious systemic disease. However, both sick and apparently healthy patients may suffer from various retinal complications which may lead to loss of vision as well. No consensus regarding management of retinal complications with anticoagulants or anti-inflammatory medications have been proposed; however, they may be tackled on individual basis. [ABSTRACT FROM AUTHOR]

Introduction In chronic venous insufficiency (CVI), an increase in venous pressure causes the passage of intravascular blood cells and molecules into the surrounding tissues and induces histopathological changes in the lower extremities, leading to increased pigmentation in the legs, ulceration, and tissue loss to various degrees. This study aimed to investigate whether an increase in venous pressure in the coronary veins can lead to the aforementioned histopathological changes. Material and methods Twenty-four New Zealand rabbits were divided into the following three groups: experimental model of coronary venous hypertension (CVH) (n = 8), sham group (n = 8), and control group (n = 8). After 21 days postoperatively, tissue samples from each group were compared for perivascular inflammation, erythrocyte extravasation, macrophage infiltration, and hemosiderin deposits by histopathological scoring under a light microscope. Matrix metalloproteinase-2 (MMP-2) activation was evaluated using immunohistochemical staining. Results In the CVH group, hemosiderin accumulation was significantly higher than in the sham and control groups (1.0 (1.0–3.0), 0.0 (0.0–1.0), 0.0 (0.0–0.0); p < 0.001). Immunohistochemically, in the CVH group, MMP-2 levels were significantly higher than in the sham and control groups (2.0 (1.0–3.0), 0.0 (0.0–1.0), 0.0 (0.0–0.0); p < 0.001). Conclusions This experimental study showed for the first time the histopathological and immunohistochemical changes in myocardial tissue, similar to those observed in CVI, as a result of increased coronary venous pressure due to coronary vein ligation. Further studies are needed to understand the clinical implications of these results.

AIM: To observe the clinical efficacy of anti-VEGF combined with laser in treatment of retinal vein occlusion with macular edema.METHODS: Totally 62 patients with retinal vein occlusion complicated with macular edema were diagnosed in the Ophthalmology Department of our hospital during 2017-03/09 were randomly divided into three groups. Group A was treated by retinal laser alone, and groups B and C were treated with intravitreal injection of conbercept and rezuzumab respectively before retinal laser a follow-up of 6mo was conducted to observe the clinical efficacy of three groups.RESULTS: After treatment, the retinal thickness(CMT)in macular center of the three groups was significantly lower than that before treatment, and the CMT of groups B and C were lower than that of group A(PP>0.05). At 6mo after treatment, the total effective rate of the three groups was 44%, 86% and 86%, respectively(PPCONCLUSION: Vitreous injection of conbercept or ranibizumab combined with retinal laser in treatment of retinal vein occlusion with macular edema can effectively reduce macular edema and improve vision. Conbercept or ranibizumab has similar effects.

We report a unique case of venous stasis retinopathy secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis with significant optic disc edema, tortuous and dilated retinal venules, and retinal hemorrhages. In a patient with significant vision loss and signs of venous stasis retinopathy, optic neuritis should be considered as the underlying diagnosis. Purpose: To report a case of a 38-year-old woman with venous stasis retinopathy secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis. Methods: Observational case report. Results: We report a unique case of venous stasis retinopathy secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis with significant optic disc edema, tortuous and dilated retinal venules, and retinal hemorrhages, which resolved promptly with high-dose corticosteroids. The retinal changes were likely secondary to severe inflammation of the optic nerve and optic nerve sheath, which exhibited significant postcontrast enhancement on magnetic resonance imaging. Despite aggressive treatment with high-dose corticosteroids and plasmapheresis, the patient had a significant generalized visual field defect at 6 months. Conclusion: Venous stasis retinopathy may be secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis due to reduced venous outflow from significant optic nerve edema. This may be a poor prognostic factor and a marker for more severe optic nerve inflammation. [ABSTRACT FROM AUTHOR]

Emine Dogan,1 Ozkan Sever,2 Burcin Köklü Çakir,1 Erkan Celik1 1Department of Ophthalmology, Sakarya University Medical Education and Research Hospital, Sakarya, Turkey; 2Department of Ophthalmology, Namik Kemal University School of Medicine, Namik Kemal University, Tekirdag, Turkey Purpose: The aim of this study was to evaluate the effect of initial intravitreal ranibizumab injection on visual acuity (VA) and central macular thickness (CMT) for the treatment of macular edema (ME) with and without serous retinal detachment (SRD) secondary to branch retinal vein occlusion (BRVO). Materials and methods: Fifty-two BRVO eyes, treated with intravitreal ranibizumab injection for ME with and without SRD, were retrospectively reviewed. Patients were divided into two groups according to spectral domain optical coherence tomography (SD-OCT). The efficacy of intravitreal ranibizumab injection at first month was assessed by analyzing the change in best-corrected VA and reduction in CMT with SD-OCT. Results: There were 21 patients with SRD and 31 patients with only CME (no-SRD). CMT was significantly greater in the SRD group than in the CME group (451±62.2 µm vs 383.5±37.2 µm, respectively, P

Objective: To date, conflicting evidence has been reported regarding the energy settings to use during endovenous laser ablation (EVLA). In the present study, we evaluated the outcomes of EVLA of the great saphenous veins (GSVs) using different power settings with the same linear endovenous energy density (LEED) of ∼70 J/cm. Methods: We performed a single-center, randomized, controlled noninferiority trial with a blinded outcome assessment of patients with varicose veins of the GSV who underwent EVLA with a wavelength of 1470 nm and a radial fiber. The patients were randomly assigned to three groups according to the energy setting: group 1, 5 W power and an automatic fiber traction speed of 0.7 mm/s (LEED, 71.4 J/cm); group 2, 7 W and 1.0 mm/s (LEED, 70 J/cm); and group 3, 10 W and 1.5 mm/s (LEED, 66.7 J/cm). The primary outcome was the rate of GSV occlusion at 6 months. The secondary outcomes were pain intensity along the target vein the next day and at 1 week and 2 months after EVLA, the necessity for analgesics, and the occurrence of significant complications. Results: From February 2017 to June 2020, 245 lower extremities of 203 patients were enrolled. Groups 1, 2, and 3 included 83, 79, and 83 limbs, respectively. At 6 months of follow-up, 214 lower extremities were examined with duplex ultrasound. GSV occlusion was observed in 72 of 72 limbs (100%; 95% confidence interval [CI], 100%-100%) in group 1 and 70 of 71 limbs (98.6%; 95% CI, 97%-100%) in groups 2 and 3 (P <.05 for noninferiority). No difference was found in the pain level, necessity for analgesics, or rate of any other complications. [ABSTRACT FROM AUTHOR]

Abstract Background Tubercular vasculitis is an important manifestation of ocular tuberculosis and this report highlights the mimicking nature of the disease with frosted branch angiitis. Results A patient presented with a severe form of retinal vasculitis in both eyes and a branch retinal vein occlusion in the left eye. He had a positive tuberculin skin test (TST) and a raised erythrocyte sedimentation rate (ESR) and serum angiotensin-converting enzyme (ACE) levels. Radiological investigations revealed a sub-pleural nodule and mediastinal lymph nodes, which on histopathological evaluation confirmed a granulomatous etiology. Conclusion Retinal vasculitis secondary to tubercular etiology may mimic a viral vasculitis; however, a clinical suspicion with a timely diagnosis and management helps in preventing loss of vision and the eye.

Purpose: To investigate the effect of Ozurdex (dexamethasone intravitreal implant) on multifocal electroretinography (mfERG) findings during the treatment of macular edema secondary to the central retinal vein occlusion (CRVO). Methods: Fifteen eyes of 15 patients who were treated with Ozurdex implant due to CRVO-related macular edema were included in this study. Best corrected visual acuity (BCVA), central macular thickness (CMT), and mfERG evaluations were performed for all patients before injection of Ozurdex. After the injection, BCVA and CMT were measured at months 3 and 6 and mfERG test was performed at month 6 for all patients. Results: Pre-implantation mfERG P wave amplitude values of r1, r2, r3, r4 and r5 were 57.8 ± 14.8, 25.1 ± 10.6, 17.2 ± 7.3, 12.0 ± 5.0 and 7.1 ± 3.6 nV/deg2, respectively. They increased to 72.9 ± 33.2, 31.2 ± 9.3, 22.6 ± 7.6, 15.6 ± 7.1 and 10.9 ± 5.7 nV/deg2, respectively, at month 6. However, these increases were not statistically significant (all P > 0.05). Pre-implantation mfERG r1, r2, r3, r4 and r5 P wave implicit times were 40.1 ± 10.9, 39.4 ± 3, 38.4 ± 3.4, 38.2 ± 3.1 and 39.3 ± 2.2 ms, respectively and these values were measured as 38.9 ± 8.2, 38.4 ± 4.7, 37 ± 3.8, 37.5 ± 4.6 and 37.7 ± 4.7 ms at 6 months. Although there were reductions in P wave implicit times in all rings, they were not statistically significant (all P > 0.05). Conclusion: In this prospective study, we found that the Ozurdex implant had no effect on mfERG findings 6 months after insertion for treatment of CRVO-related macular edema.

Abstract Background Cryptococcal meningoencephalitis (CM) causes cerebral infarction, typically, lacunar infarction in the basal ganglia. However, massive cerebral infarction leading to death is rare and its pathophysiology is unclear. We report a case of CM causing massive cerebellar infarction, which led to cerebral herniation and death. Case presentation A 56-year-old man who suffered from dizziness and gait disturbance for one month was admitted to our hospital and subsequently diagnosed with a cerebellar infarction. He had a past medical history of hepatitis type B virus infection and hepatic failure. Although the findings on magnetic resonance imaging (MRI) imitated an arterial infarction of the posterior inferior cerebellar artery, an accompanying irregular peripheral edema was observed. The ischemic lesion progressed, subsequently exerting a mass effect and leading to impaired consciousness. External and internal decompression surgeries were performed. Cryptococcus neoformans was confirmed in the surgical specimen, and the patient was diagnosed with CM. In addition, venule congestion in the parenchyma was observed with extensive fibrosis and compressed veins in the subarachnoid space. The patient died 26 days after admission. Autopsy revealed that pathological changes were localized in the cerebellum. Conclusion C. neoformans can induce extensive fibrosis of the subarachnoid space, which may compress small veins mechanically inducing venule congestion and massive cerebral infarction. In such cases, the clinical course can be severe and even rapidly fatal. An atypical pattern of infarction on MRI should alert clinicians to the possibility of C. neoformans infection.

Purpose: To evaluate the outcomes of combined intravitreal ranibizumab (IVR) and posterior subtenon triamcinolone acetonide (STTA) injection for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Nineteen eyes of 19 patients with BRVO and cystoid ME were examined in this retrospective study. Nine eyes were treated with IVR and STTA, and afterwards with pro re nata (PRN) IVR (combined group) and 10 eyes received PRN IVR (control group). The outcome measures were: changes in the central macular thickness (CMT), best corrected visual acuity (BCVA), intraocular pressure (IOP), and number of injections. Results: The mean initial CMT was 541±103µm in the combined and 475±57 µm in the control group (p=0.14). The median baseline BCVA was 1.0 (0.60-1.15) LogMAR in the combined group and 0.75 (0.47-1.07) LogMAR in the control group (p=0.5). In both groups, CMT was significantly reduced and BCVA was significantly improved at the 1st and 3rd months and at the 1st year. In the first 3 months, the combined group received a single dose, whereas the control group was treated with a median number of 2.5 (2-3) injections (p< 0.001). Nevertheless, the number of additional injections after the 1st injection wasn't significant between the groups [combined group: median 3 (1.5-3), control group: median 3 (1.75-4] p=0.34). No IOP elevations or other injection-related complications were encountered. Conclusions: Combined IVR and STTA therapy seems to be comparable to IVR monotherapy in improving both CMT and BCVA in BRVO, with similar additional injection numbers. [ABSTRACT FROM AUTHOR]

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Purpose: To report the therapeutic efficacy of an accidentally injected intralenticular sustained-release dexamethasone implant in a patient with macular edema secondary to branch retinal vein occlusion and shortly discuss the management strategy of this rare complication. Methods: Complete ophthalmological examination and optical coherence tomography imaging were performed at each visit. Results: The implant accidentally caused a posterior capsular tear during the procedure and was injected into the crystalline lens because of an involuntary head movement of the patient. Since the anterior segment was normal, and the resultant cataract and implant itself did not obscure the visual axis, the decision was made to observe the patient with intralenticular implant, preserve the therapeutic effect and avoid reinjection. The macular edema resolved within time, while visual acuity did not show significant improvement due to an increase in lens opacification. The patient underwent phacoemulsification surgery at 7 months after the injection with implantation of posterior chamber IOL into the capsular bag. Conclusion: Inadvertent injection of sustained-release intravitreal dexamethasone implant into the crystalline lens is an uncommon but possible complication that is mostly caused by surgeon inexperience, improper technique and uncontrolled head movement during the procedure. Once this complication occurs, early phacoemulsification and repositioning of the implant into the vitreous is the frequently preferred management strategy. However, remarkable decrease in macular edema and visual acuity improvement can also be achieved without an immediate surgical intervention.

To report a case of impending central retinal vein occlusion (iCRVO) in a COVID-19 patient. A 54 years old woman with COVID-19 related pneumonia presented to our emergency department complaining of scotomas and decreased vision in her right eye. Funduscopic examination and multimodal imaging revealed rare retinal hemorrhages, retinal whitening, and fern-like hypo-autofluorescent appearance typical of iCRVO. She had no risk factors other than a transient hyper-coagulability status likely related to the ongoing infection. Systemic treatment with steroids normalized her inflammatory and coagulation status and the occlusion completely resolved. Retinal circulation should be considered as a potential site for thromboembolic complications from COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Ozurdex® is a sterile, sustained-release implant of dexamethasone. The device dissolves within the vitreous body and releases dexamethasone. Here we present a clinical case that demonstrates the sustained therapeutic efficacy of Ozurdex® when accidentally injected into the crystalline lens.Methods: Case report.Results: Sixty-three-year-old male in which we decided to prescribe the intravitreal injection of a dexamethasone implant (Ozurdex®) in the left eye because of macular oedema after branch retinal vein occlusion. Best-corrected visual acuity (BCVA) was 0.4. At 15 days post-implantation, the slit-lamp examination revealed the dexamethasone implant was located in the crystalline lens. Given there was no inflammation in the anterior pole, no cataracts had developed, the intraocular pressure (IOP) was normal and the macular oedema had been resolved, we decided to assess the efficacy and safety of the dexamethasone implant located in the crystalline lens. The BCVA improved until 14 months post-accidental injection. At 18 months post-Ozurdex® injection the BCVA worsened until 0.05 because of the cataract evolution. Phacoemulsification and intraocular lens placement in sulcus was performed.Conclusion: Once the complication has occurred, most authors advocate the early withdrawal of the implanted Ozurdex® device by means of crystalline phacoemulsification and then repositioning it in the vitreous body. However, as long as there are no signs of inflammation in the anterior pole, the IOP is within normal limits, the device does not affect the visual axis and there is no cataract development, we can evaluate the potential therapeutic effect of Ozurdex® in this non-indicated, abnormal location. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of serous retinal detachment (SRD) on the outcome of intravitreal ranibizumab (IVR) injecton in macular edema due to branch retinal vein occlusion (BRVO). Material and Methods: Eighteen eyes with cystoid macular edema (CME) and SRD (study group) and 18 eyes with only CME (control group) that received PRN IVR injections during 6 months were evaluated retrospectively. Outcome measures were changes in central macular thickness (CMT) and best corrected visual acuity (BCVA), injection numbers and the the ellipsoid zone (EZ) status. Results: Mean initial CMT in the study and control groups were 521±119 μm and 462±98 μm, respectively. Mean BCVA in the study and control groups were 0.93±0.46 and 0.73 ±0.53 LogMAR, respectively. The baseline CMT and BCVA weren't significantly different between the groups. The mean injection number was 2.88±0.83 in the study and 1.88±0.96 in the control group during the 6 months (p=0.003). At the last visit, the mean decrease in CMT and the improvement in BCVA wasn't significantly different between the groups. Conclusion: The presence of SRD doesn't seem to effect the IVR therapy in BRVO negatively, conserning the change in CMT and BCVA. Eyes with SRD received more IVR injections compared to eyes with only CME. When whole patients were evaluated disruption of the ellipsoid zone rate was equal in both groups and was correlated with poorer BCVA and increased injection number . [ABSTRACT FROM AUTHOR]

A 62-year-old woman presented with a one month history of a hard, nonmobile subcutaneous mass along the right nasojugal fold. Hematological studies showed elevated serum immunoglobulin G4 levels. Histopathological examination of the biopsy sample disclosed immunoglobulin G4-positive lymphoplasmacytic infiltration with a storiform fibrosis, vein occlusion, and epithelioid granulomas with necrosis. Systemic review corresponded to a sarcoidosis. Without treatment, the eyelid mass did not recur six months after the excisional biopsy. [ABSTRACT FROM AUTHOR]

Purpose: To review the clinical applications and diagnostic value of the retinal function imager (RFI), briefly compare RFI to other optical imaging devices, and to describe recent developments. Methods: The search words “Retinal Functional Imager,” “optical imaging,” “retina angiography,” “avascular zone,” “foveal avascular zone,” and other closely related terms were used in PubMed to review current literature involving the RFI. Results: The functions of the RFI were utilized in over 44 microvascular studies, which reported that the microvasculature may alter in velocity, morphology, and oximetry when affected by a number of ocular, neurological, or systemic diseases. Recently developed automatic algorithms for noninvasive angiography of large retinal regions, segmenting vessels, measuring blood flow, blood velocity, vessel diameter, and oximetry may enhance the clinical applications of the RFI. Conclusion: The RFI has been used to characterize the retinal microvasculature under various conditions of all prevalent retinal diseases in addition to some central nerve system (CNS) and systemic diseases. Applying the RFI in research and clinical settings should help earlier diagnosis, support disease prevention, and improve treatment management. [ABSTRACT FROM PUBLISHER]