Amaç:
Kombine cerrahi (KC) ve ardışık cerrahi (AC) sonuçlarımızı karşılaştırmak.
Gereç ve Yöntem:
Ocak 2009 ile Aralık 2018 tarihleri arasında KC [aynı seansta penetran keratoplasti (PK), katarakt ekstraksiyonu ve göz içi lensi (GİL) yerleştirilmesi] uygulanan 44 hastanın ve AC (PK’yi takiben ikinci seansta katarakt ekstraksiyonu ve GİL yerleştirilmesi) uygulanan 126 hastanın dosyaları retrospektif olarak değerlendirildi. En az bir yıl takip edilen hastaların birer gözü çalışmaya alındı. İki grup; endikasyonlar, düzeltilmiş uzak görme keskinliği (DUGK), refraktif sonuçlar, komplikasyonlar ve greft sağ kalımı açısından karşılaştırıldı.
Bulgular:
KC ve AC grubunda sırasıyla medyan yaş; 63 (30-79) ve 43 (18-73) yıl (p<0,001), medyan takip süresi; 51 (13-152) ve 64,5 (13-154) ay (p=0,011) idi. En sık PK endikasyonları; KC grubunda travmatik kornea skarı (%20,5) ve endotel distrofisi (%15,9), AC grubunda keratokonus (%24,6) ve stroma distrofisi (%17,5) idi. KC ve AC grubunda sırasıyla; DUGK ≥0,4 olan hastalar; %50 ve %69 (p=0,04), DUGK (0,1-0,3) olan hastalar; %45,5 ve %25,4 (p=0,04), sferik eşdeğer ≤±2,0 D olan hastalar; %54,5 ve %73 (p=0,02), ameliyat sonrası en sık komplikasyonlar; glokom %20,5 ve %15,9, (p=0,48) ve allogreft reaksiyonu %9,1 ve %23, (p=0,04) idi. KC ve AC grubunda sırasıyla, greft sağ kalım oranı birinci yılda; %95,2 ve %86,5 (p=0,10), beşinci yılda %75,9 ve %68,9 (p=0,47) olarak tespit edildi.
Sonuç:
Uzun takip süresinde iki grup greft sağ kalımı açısından benzerdi. Bu nedenle her hasta kendi içinde değerlendirilerek cerrahinin kombine mi ardışık mı yapılacağına karar verilmelidir. Daha düşük refraktif hata ve daha yüksek sonuç görme keskinliği nedeniyle özellikle genç hastalarda AC daha avantajlıdır.

Objective: To compare our combined surgery (CS) and sequential surgery (SS) results.
Materials and Methods:
Files of 44 patients who underwent CS [penetrating keratoplasty (PK), cataract extraction and intraocular lens (IOL) implantation] and 126 patients who underwent SS (cataract extraction and IOL implantation in a second session after PK) between January 2009-December 2018, were evaluated retrospectively. One eye of the patients who were followed up for at least one year were included in the study. Two groups; were compared in terms of indications, corrected distance visual acuity (CDVA), refractive results, complications, and graft survival.
Results:
Median age was 63 (30-79) and 43 (18-73) years (p<0.001), median follow-up time was 51 (13-152) and 64.5 (13-154) months (p=0.011), in the CS and SS groups, respectively. The most common PK indications were traumatic corneal scar (20.5%) and endothelial dystrophy (15.9%) in the CS group versus keratoconus (24.6%) and stroma dystrophy (17.5%) in the SS group. In the CS and SS groups patients with CDVA ≥0.4 were 50% versus 69% (p=0.04), CDVA (0.1-0.3) were 45.5% versus 25.4% (p=0.04), spherical equivalent ≤±2.0 D was 54.5% versus 73% (p=0.02), the most common postoperative complications being glaucoma, 20.5% versus 15.9%, (p=0.48) and allograft reaction, 9.1% versus 23%, (p=0.04), graft survival rate was 95.2% versus 86.5% (p=0.10) in the first year, and 75.9% versus 68.9% (p=0.47) in the fifth year, respectively.
Conclusion:
During the long follow-up time, the groups were similar in terms of graft survival. For this reason each patient must be evaluated separately whether to perform a combined or sequential surgery. Given the lower refractive error and higher expectation of final visual acuity, SS can be more advantageous especially in young patients.

Amaç: Bu çalışma, Türk oftalmologlarının katarakt cerrahisinde kullandıkları teknolojik donanımlarının ve bilgi birikimlerinin uygulamalarına ne oranda yansıdığını, ne kadar güncel olduğunu göstermeye yöneliktir.
Gereç ve Yöntem: Survey Monkey uygulaması kullanılarak internet üzerinden yapılan anketle Türk Oftalmoloji Derneği üyelerinin 823’ünden 17 soruya alınan cevaplar değerlendirilmiştir. Alınan sonuçlar, katılımcıların mesleki durumlarına, çalıştıkları kurumlarına, katarakt cerrahisi ile ilgili akademik faaliyet yürütüp yürütmediklerine ve yaş gruplarına göre alt gruplarda ele alınmışlar, elde edilen veriler belirlenen ölçütlere göre yetersiz, standart ve gelişmiş yaklaşımlar olarak belirlenmiş ve karşılaştırılmışlardır.
Bulgular: Katarakt ameliyatı hazırlığı için göz içi lens (GİL) gücü hesaplamaları ve keratometrik ölçümlerde optik biyometri cihazlarının sırasıyla %77.7 ve %67.3 oranlarında kullanıldığı görüldü. GİL güç hesabı için en yaygın olarak SRK-T başta olmak üzere III. nesil formüllerin %46,2 oranında kullanıldığı, II. nesil formüllerin %21,9 oranında, IV., V. nesil ve aksiyel uzunluğa göre çoklu formül uygulamaları gibi daha güncel yaklaşımların %31,9 oranında tercih edildiği belirlendi. Katılımcıların en sıklıkla uyguladıkları ana kesi genişliği 2.8 mm. (%51,6) iken, cerrahi nedenli astigmatizma yönünden nötr kabul edilen 2,2 mm. ve daha kısa kesilerin uygulanma oranı ise %18,8 idi. Ana kesi yeri belirlerken kornea astigmatizmasını azaltmaya yönelik kesi lokasyonu yaklaşımı gösterenler %28,9, nötr yaklaşım %26,2 ve duyarsız yaklaşım gösterenler ise %44,9 olarak tanımlandı. Katılımcıların %55,6’sının hiç torik GİL, %50,7 sinin ise hiç presbiyopi düzeltici GİL uygulamadıkları görüldü. Femtosaniye lazer yardımlı katarakt cerrahisi deneyimi olan cerrah oranı %10,3 iken, ameliyat sonunda intrakameral antibiyotik uygulanma oranı %89,4 olarak saptandı.
Sonuç: Türk katarakt cerrahlarının ameliyat hazırlığı ve cerrahileri için büyük oranda yüksek teknolojiyi kullanabildikleri ancak bunun refraktif katarakt cerrahisinin çağdaş standartlarını yakalamak anlamında uygulamalara aynı oranda yansımadığı görüldü.

Objective: The aim of this study is to show, at what rate, the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected to practice and how up to date they are.
Materials and Methods: The questionnaire conducted using Survey Monkey application was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in sub-groups according to the occupational status of the participants, the institutions, whether they conducted academic activities and age groups, and the data compared as inadequate, standard and contemporary approaches according to the determined criteria.
Results: Optical biometry devices were used in 77.7% and 67.3% rates for intraocular lens (IOL) power calculations and keratometric measurements for preparation of cataract surgery, respectively. For IOL power calculation, most commonly 3rd generation formulas, especially the SRK-T, were used at a rate of 46.2%,2nd generation formulas 21.9% and 4th,5th generation formulas and multiple evaluations for different axial lengths were used at a rate of 31.9%. The most common incision width was 2.8mm (51.6%), while the percentage of 2.2mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism, was 18.8%. In choosing incision place, approaches to reduce corneal astigmatism were 28.9%, neutral approaches were 26.2% and the insensitive approaches were 44.9%. 55.6% of participants did not apply any toric IOL and 50.7% did not use any presbyopia correcting IOL. The rate of surgeons who have experience with femtosecond laser assisted cataract surgery was 10.3% and intracameral antibiotic application rate at the end of the operation was 89.4%.
Conclusion: It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rate, but this was not reflected to applications at same rate in terms of achieving contemporary standards of refractive cataract surgery.

Seton implantasyon cerrahisi sonrası gelişen diplopinin değerlendirilmesi
AGV ve diplopi
Amaç: Ahmed glokom valv (AGV) implant cerrahisi sonrası gelişen diplopi oranını belirlemek ve değerlendirmektir.
Gereç ve Yöntem: Hastanemizde 2010-2017 yılları arasında AGV implantasyonu yapılan olguların dosyaları retrospektif olarak tarandı. Bu olgulardan AGV implantasyonu sonrası binoküler diplopi sebebi ile şaşılık birimimize refere edilen olgular çalışmaya dahil edildi. Olguların postopetatif 1. gün, 7. gün, 15. gün ve 1. ay detaylı muayeneleri dosyalarından kaydedildi. Olguların cerrahi müdahale sonrası diplopi gelişme süreleri, diplopi tipi, uzakta ve yakında diplopi varlığı kaydedildi. Olguların oküler motilite muayeneleri ve kayma ölçümleri değerlendirildi.
Bulgular: Hastanemizde 2010-2017 yılları arasında AGV implantasyonu yapılan 211 olgudan, çalışma kriterlerine uygun olan 10 olgu (%4,7) tespit edildi. On olgunun altısı erkek (%60), dördü kadın (%40) idi. Olguların yaş ortalamaları 44,5 (34-63) idi. AGV implantasyonu sonrası ortalama 14,5±12,3 (en erken 1 – en geç 30 gün) günde diplopi şikayeti geliştiği saptandı. Hastaların prizma ölçümleri ortalama 8,4±1,4 prizma diyoptri (PD) ekzoforya, 7,1±8,8 PD hipotropya olarak bulundu. Sekiz olguda sadece yakında diplopi saptanırken, 2 olguda ise hem uzakta hem yakında diplopi saptandı. Üç olgunun prizmatik gözlüklerle tedavi edildiği ve bu olguların ortalama 5,11±4,10 ayda diplopilerinin spontan düzeldiği görüldü. Yedi olgunun tedavisiz izlendiği ve bu olguların diplopi şikayetlerinin ortalama 6,11±4,40 ayda spontan düzeldiği görüldü.
Sonuç: AGV implant cerrahisi sonrası gelişen diplopilerin büyük kısmı tedavisiz düzelmekle birlikte, diplopi şikayeti nedeniyle günlük yaşamları etkilenen olgularda tedavi seçeneği olarak prizmatik gözlükler düşünülebilir.
Anahtar Kelimeler: Diplopi, şaşılık, Ahmed glokom valv

Objectives: To determine and evaluate the rate of diplopia occurring after Ahmed glaucoma valve (AGV) implantation surgery.
Materials and Methods: The records of patients who underwent AGV implantation in our hospital between the years of 2010 and 2017 were retrospectively reviewed. Patients who were referred to our strabismus department due to binocular diplopia after AGV implantation surgery were included. The detailes of postoperative 1st day, 7th day, 15th day and 1st month examinations were recorded. In the postoperative period, the onset time of diplopia complaints, diplopia type, diplopia complaints at long and close distance were noted. Ocular motility examination and slip measurements were evaluated.
Results: 10 (47%) of 211 cases who underwent AGV implantation in our hospital between the years of 2010 and 2017 were in compliance with the study inclusion criteria. Six of the ten cases were male (60%) and four were female (40%). The mean age of the patients was 44,5 (34-63) years. Complaint of diplopia was found to develop 14,5±12,3 (earliest 1 day- latest 30 days) days after AGV implantation. The prism measurements of the patients were found to be 8,4±1,4 prism diopters (PD) exotropia and 7,1±8,8 PD hypotropia. While 8 patients had diplopia only at near distance, 2 patients had diplopia both far and near. It was found that three cases were treated with prismatic glasses, and their complaints of diplopia recovered spontaneously in 5,11±4,10 months. It was observed that seven cases were followed up without treatment, and their diplopia complaints resolved spontaneously in 6,11±4,40 months.
Conclusion: Although most of the diplopia that developed after AGV implant surgery improve without treatment, prismatic glasses might be considered as the treatment option in patients whose daily lives are affected due to the complaint of diplopia.
Keywords: Diplopia, strabismus, Ahmed glaucoma valve

Amaç: Glokomu olmayan miyopik hastalarda retina sinir lifi tabakası kalınlıkları (RSLTK) için normal değerleri belirlemek ve renkli haritadaki değişimleri analiz etmek.
Gereç ve Yöntem: Glokomu olmayan toplam 245 göz çalışmaya alındı. Olgular miyopi derecesine göre +1.00/-1.00 D (kontrol gurubu, n=70), --1.00/-3.00 D (grup 1, n=50), -3.00/-6.00 D (grup 2, n=75) ve > -6.00 D (grup 3, n=50) olarak ayrıldı. Gruplar kendi arasında üst temporal, üst nazal, nazal, alt nazal, alt temporal, temporal ve global RSLTK (Heidelberg Spektralis, Optik Koherens Tomografi, Almanya) ve bu kadranların renk kodlamaları (yeşil: normal, sarı: sınırda incelik, kırmızı: normal sınırların dışında incelik) açısından kıyaslandı.
Sonuçlar: Tüm gruplar yaş ve cinsiyet açısından benzerdi (p>0.05). Miyopisi yüksek olan gruplarda üst ve alt temporal ve üst ve alt nazal kadranlarda RSLTK kademeli olarak daha ince idi (p<0.01). En az bir kadranda ‘sınırda incelik’ ve ‘normal limitlerin dışında incelik’ oranı miyopisi daha yüksek olan gruplarda tüm kadran ölçümlerinde daha yüksekti (p<0.05). En az bir kadranda sınırda incelik ya da normal limitlerin dışında incelik kontrol grubunda 8/70 (%11.4), grup 1’de 9/50 (%18.0), grup 2’de 21/75 (%28.0), grup 3’te 33/50 (%66.0) idi (p<0.01).
Tartışma: Miyopik hastaların RSLTK ölçümlerinde ‘sınırda incelik’ ve ‘normal limitlerin dışında incelik’ oranının yüksek olması özellikle glokom şüphesi durumunda yanlış tanı koymamak adına dikkat edilmesi gereken bir durumdur.

Objective: To determine the normal values for retinal nerve fiber layer thickness (RNFLT) in myopic patients without glaucoma and analyze the changes in their color map.
Material and Method: A total of 245 eyes without glaucoma were included in the study. According to the degree of myopia, the cases were divided into four groups: control group (+1.00/-1.00 D; n=70), Group 1 (--1.00/-3.00 D; n=50), Group 2 (-3.00/-6.00 D; n=75), and Group 3 (>-6.00 D; n=50). Intra-group comparisons were performed in terms of superotemporal, superonasal, nasal, inferonasal, inferotemporal, temporal and global RNFLT (Heidelberg Spectralis, Optic Coherence Tomography, Germany) and the color coding of these quadrants (green: within normal limits, yellow: borderline, red: outside normal limits).
Results: All groups were similar in age and gender (p>0.05). As the degree of myopia increased, RNFLT became thinner in the upper and lower temporal and upper and lower nasal quadrants (p<0.01). The rate of measurements considered as borderline and outside normal limit in at least one quadrant was higher in groups with higher myopia for all quadrants (p<0.05). This rate was found to be 8/70 (11.4%) for the control group, 9/50 (18.0%) for Group 1, 21/75 for Group 2 (28.0%), and 33/50 (66.0%) for Group 3 (p<0.01).
Discussion: The high rate of RNFLT classified as borderline or outside normal limits in myopic patients is a finding to which clinicians should pay attention in order not to make a misdiagnosis especially in cases of glaucoma suspicion.

Amaç: Yaş tip yaşa bağlı maküla dejenerasyonu (YBMD) nedeniyle intravitreal anti- vasküler endotelyal büyüme faktör (anti-VEGF) enjeksiyonundan sonra enfeksiyöz olmayan intraoküler inflamasyon (İOİ) gelişen olguların fonksiyonel ve anatomik sonuçlarının değerlendirilmesi amaçlandı.
Materyal ve Metod: Ocak 2015- Mart 2019 tarihleri arasında yaş tip YBMD tanısıyla anti-VEGF uygulanan hastalar retrospektif olarak tarandı. Anti-VEGF enjeksiyon sonrası İOİ gelişen olguların enjeksiyon öncesi ve sonrası rutin oftalmolojik muayeneleri ile santral maküla kalınlığı, inflamasyon süresi ve takip süreleri kaydedildi.
Bulgular: Toplam 12.652 anti-VEGF (4.796 aflibercept, 7.856 ranibizumab) enjeksiyonu yapılan 1.966 hastadan 13 gözde (11 göz aflibercept sonrası, 2 göz ranibizumab sonrası) enfeksiyöz olmayan İOİ saptandı. İOİ ortalama 7. enjeksiyondan sonra (2-12 enjeksiyon) gelişti. Tüm gözlerde ön kamara reaksiyonu (Tindal: +1/+3) ve vitritis (Grade 1-3) birlikte mevcuttu. Hastaların hiçbirinde ağrı, hipopiyon ve fibrin reaksiyon izlenmedi. Hastalarda görme keskinliği ortalama 28,3 günde başlangıç seviyesine geri döndü. Vitritis ise ortalama 40 gün devam etti. Tüm hastalarda topikal steroid tedavisi ile düzelme sağlandı. 11 gözde aynı anti-VEGF ajan ile enjeksiyona devam edildi ve hiçbir olguda inflamasyon tekrarlamadı.
Sonuç: İntravitreal anti-VEGF enjeksiyonu sonrası enfeksiyöz olmayan İOİ tipik olarak ağrı, konjonktival hiperemi, hipopyon ve fibrin reaksiyon olmadan ortaya çıkmakta ve topikal steroid tedavisine iyi cevap vermektedir. Görme keskinliği, intraoküler inflamasyonun şiddeti ile orantılı olarak haftalar içerisinde başlangıç seviyesine geri dönmektedir.

Purpose: To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD).
Methods: Medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness (CMT), duration of inflammation and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded.
Results: Non-infectious intraocular inflammation was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1.966 patients who received a total of 12.652 anti-VEGF (4.796 aflibercept and 7.856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall: + 1/ + 3) and vitritis (Grade 1-3). None of the patients had pain, hypopyon and fibrin reaction. Visual acuity progressed to baseline levels within 28,3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes injection was continued with the same anti-VEGF agent. No recurrence of IOI was observed in any patients.
Conclusion: Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, fibrin, and responds well to topical steroid therapy. The visual acuity returns to baseline levels within weeks according to the severity of inflammation.

Amaç: Submakular hemoraji (SMH) tanılı hastalarda, vitrektomi ile kombine subretinal doku plazminojen aktivatörü (tPA) ve anti-vasküler endotelyal büyüme faktörü (anti-VEGF) eşliğinde %5 C3F8 gaz tamponad cerrahisinin fonksiyonel ve morfolojik sonuçları yanısıra preoperative prognostic faktörleri değerlendirmek.
Materyal-Metod: Retrospektif çalışmamıza, yaşa bağlı makula dejenerasyonuna (YBMD) sekonder SMH tanılı 30 hasta (16 kadın, 14 erkek) dahil edildi. Preoperatif SMH kalınlığı ve alanı, elipsoid zonun durumu yanı sıra postoperatif optic koherens tomografide (OKT) subfoveal hemoraji miktarındaki azalma ve fundus fotoğrafları değerlendirildi. Ayrıca görme keskinliği (GK), hemorajinin süresi ve ek intravitreal anti-VEGF enjeksiyon ihtiyacı kaydedildi.
Bulgular: Hastaların ortalama yaşı 73.33±8.23 idi. Ortalama GK logMAR 2.11±0.84’ten postoperatif 1. ayda logMAR 1.32±0.91, 2. ayda 0.94±0.66, 3. ayda 1.13±0.84 ve 6. ayda 1.00±0.70’e yükseldi. Hemorajinin süresi ile postoperatif 2.ay (p=0.005), 3. ay (p=0.019) ve 6. ay (p=0.012) GK’leri arasında anlamlı negative korelasyon mevcuttu. Postoperatif total hemoraji rezolüsyonu elde edilen grupta SMH süresi subtotal rezolüsyon grubuna kıyasla anlamlı olarak kısaydı (p<0.001). Elipsoid zon bütünlüğü korunmuş olgularda ortalama SMH alanı daha küçük idi.
Sonuç: Vitrektomi ile kombine subretinal tPA ve anti-VEGF enjeksiyonu eşliğinde %5 C3F8 gaz tamponad cerrahisi, neovasküler YBMD olgularında hemorajinin yeterince yer değiştirmesi sonucu görme keskinliğinde anlamlı artış sağlayabilmektedir. Ayrıca cerrahinin zamanlaması sonuç GK’ni etkileyen en önemli faktör gibi görünmektedir.

Purpose: To evaluate the functional and morphological outcomes of vitrectomy in combination with intravitreal 5% C3F8 tamponade and subretinal injections of tissue plasminogen activator (tPA) and anti–vascular endothelial growth factor (anti-VEGF) in patients with submacular hemorrhage (SMH) in addition to investigating the preoperative prognostic factors.
Methods: In this resrospective study, 30 patients (16 females, 14 males) diagnosed with SMH secondary to neovascular age related macular degeneration (AMD) were included. Preoperative thickness and area of SMH, status of the ellipsoid zone, postoperative reduction in the amount of subfoveal blood on on optical coherence tomography (OCT) and fundus photographs are assessed. Furthermore visual acuity (VA), duration of the hemorrhage and the need for additional intravitreal anti-VEGF injections were recorded.
Results: The mean age of patients was 73.33±8.23 years. Mean VA improved from logMAR 2.11±0.84 at baseline to logMAR 1.32±0.91, 0.94±0.66, 1.13±0.84 and 1.00±0.70 at postoperative month 1,2,3 and 6 respectively. A significant negative correlation was found between the duration of the hemorrhage and postoperative VA at month 2 (p=0.005), month 3 (p=0.019) and month 6 (p=0.012). The mean duration of the SMH prior to surgery was significantly shorter in patients who achieved total resolution of the hemorrhage compared with the subtotal resolution group (p<0.001). The mean SMH area was smaller in the patients with continuous ellipsoid zone.
Conclusion: Vitrectomy, submacular tPA and anti-VEGF injections with a concurrent C3F8 tamponade appears to provide adequate displacement of the hemorrhage resulting in significant improvement of the VA in patients with hemorrhagic neovascular AMD. Furthermore, timing of the surgery appears to be the most important factor determining the final VA.

Alerjik konjonktivit, hem çocukları hem de yetişkinleri etkileyen ve yaşam kalitelerinde önemli ölçüde bozulmaya ve bazen geri döndürülemez görme hasarına neden olan artan prevalans hastalıklarıdır. Hastalığın çeşitli formları vardır, bazıları mevsimsel ve çok yıllık alerjik konjonktivit, dev papiller konjonktivit ve temas alerjik blefarokonjonktivit gibi alerjene bağlı; ve diğerleri her zaman vernal keratokonjonktivit ve atopik keratokonjonktivit gibi alerjen maruziyeti ile açıklanmaz. Klinik seyrini, özelliklerini ve ayırıcı tanısını gözden geçiriyoruz ve patofizyolojileri ve tedavilerindeki son gelişmeleri vurguluyoruz.

Allergic conjunctivitis are diseases of increasing prevalence that affect both children and adults and cause significant deterioration of their quality of life and sometimes irreversible visual damage. There are various forms of the disease, some are allergen-induced such as seasonal and perennial allergic conjunctivitis, giant papillary conjunctivitis and contact allergic blepharoconjunctivitis; and others are not always explained by allergen exposure such as vernal keratoconjunctivitis and atopic keratoconjunctivitis. We review their clinical course, characteristics and differential diagnosis, and we emphasize the recent advances in their pathophysiology and treatment.

A 61-year-old man presented corneal perforation of 1.0 mm in diameter in his right eye caused by a metallic foreign body fragment. We used “one-bite-mini-keratoplasty” technique that applies a host-graft-host cornea patch with a single suture to stop aqueous humor leakage. Postoperatively, the graft was completely epithelialized. The suture was removed and the use of soft contact lens was discontinued. Postoperative best-corrected visual acuity (BCVA) recovered to 180/200 and corneal astigmatism was 0.6 diopters. The postoperative course was unremarkable, but corneal perforation recurred because of an ocular bruise due to patient’s carelessness during the 17-month follow-up. He was reoperated using the same technique. His BCVA was 160/200 and corneal astigmatism was 1.1 diopters after reoperation. This surgical technique was performed twice for corneal perforation, but optimal visual function can be maintained even after 2 years. For paracentral corneal perforations, our simple technique may reduce astigmatism and maintain high visual function.

We present a case of a 29 year-old male night watchman complaining of sudden decreased vision, redness and tearing of the left eye. On anamnesis, trauma was denied and personal past history was relevant for right eye enucleation due to an “eye injury” eight years prior. At presentation visual acuity was 20/200, intraocular pressure (IOP) of 10mmHg. Slit lamp examination revealed a 1mm inferonasal corneal wound and a localized lens opacity associated with extrusion and posterior extension of cortical material in the same quadrant. Echography confirmed posterior lens capsular bag puncture with hyperechogenic material in the anterior vitreous. Intraocular foreign body was ruled out. Topical anti-inflammatory and cycloplegic treatment was initiated with partial visual recovery, intraocular pressure rise, moderate anterior chamber inflammatory reaction and an emergent posterior subcapsular cataract. A pars plana vitrectomy and lensectomy were performed. After surgery and recovery, best-corrected visual acuity with contact lens achieved 20/15. Patient was followed for six years, on which he returned six more times with a variety of new findings, such as new corneal leukoma, leaking corneal wounds, hypotony, choroidal folds and choroidal detachments, every time with full visual acuity recovery.

Some cases of ocular injury and self-mutilation have been described in the context of psychiatric disorders including psychotic symptoms obsessive-compulsive spectrum, corporal dysmorphic, affective disorders post-traumatic stress, factitious disorder, borderline personality and substance abuse. Self-inflicted injuries were suspected due to substance abuse even though the patient denied the probable self-induced nature of the wounds. Referral to a psychiatrist was insisted in several occasions without success.

Patients that present with self-enucleation are related to psychiatric diseases mainly in the schizophrenic spectrum. Complications that can be life-threatening may arise, therefore psychiatric referral is mandatory.

An 88-year-old lady was brought to the hospital immediately after noticed by her neighbours that she was bleeding from her right eye. On examination, her right eye was pthisical with maggots’ infestation of her right orbit. Over a hundred live maggots were extracted using forceps. Computed Tomography scan revealed the infestation was confined to the right orbit. Patient underwent an exenteration of the right orbit under general anaesthesia. The species of the maggots were identified by entomologist as Chrysomya Bezziana, which is an aggressive living-tissue-eating-larvae. In this case report, it is concluded that orbital myiasis caused by Chrysomya Bezziana poses a very real risk of intracranial invasion as they feed on living tissues. Adjacent tissue destruction can be very rapid and definitive treatment involves urgent removal of its larvae via surgical debridement. To our knowledge, we are reporting the first case of orbital myiasis from a patient in Malaysia. Therefore, our case report may be helpful in the management of similar case of orbital myiasis.

Introduction: Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland or Fishman syndrome, is an extremely rare congenital neurocutaneous disorder that characteristically involves ectomesodermal tissues, such as the central nervous system, eyes, and skin. Aetiology of the disease remains unknown.
Case report: We present a case of a 3-year-old boy who presented with cystic right eye swelling since birth. Physical examination showed alopecia on right side of the scalp, ipsilateral ocular cyst and micropththalmia with a contralateral limbal dermoid. The computed tomography scan of the brain revealed severe atrophy of the right cerebral hemisphere with an expansion of the cerebrospinal fluid space and dilatation of the lateral ventricle suggesting ex-vacuo hydrocephalus. Right orbital cyst continuous with the globe and calcification of the posterior aspect of both globes were also present. Histopathologic findings of the excised orbital cyst revealed an eyeball covered by fatty tissue, cut surface showed calcification of the cyst wall and presence of corneal opacity. Microscopy showed cornea-sclera wall composed of normal cartilage communicating with sandwich bony trabeculae with a focus of marrow cells, consistent with choristoma. The constellation of these findings conforms to Moog’s revised diagnostic criteria for ECCL proposed in 2009.
Conclusion: We present a rare case of ECCL associated with bilateral eye involvement and orbital cyst from Sub-Saharan Africa. The disorder is easily recognizable at birth, however, neuroimaging is essential for appropriate diagnosis and management and to exclude or confirm other unusual associated abnormalities. Parents of a child with this abnormality should be reassured that the syndrome is not transmittable to the offspring and that the risk of recurrence in siblings is virtually absent.