Lens-Related Ocular Emergencies (LROE) in Dogs: Treatment and Visual Outcome

Background Lens-related emergencies need immediate medical intervention to reduce complications, minimize pain, and improve chances of retaining vision. The present study aimed to demonstrate the common lens-related ocular emergencies in dogs and evaluate the short-term outcomes after treatment of these cases. Sixty dogs (90 eyes) of different breeds were presented with unilateral (30 eyes, OD = 18, OS = 12) and bilateral (60 eyes) ocular abnormalities related to crystalline lens injury. Clinical, ultrasonographic, and laboratory examinations were achieved. Different treatment protocols were conducted after complete ophthalmic examination and the associated clinical outcomes were evaluated. Results Mean (± SD) age of dogs at initial evaluation was 3.65 (± 2.4) years (range, 1˗12 years). Lens luxation and subluxation were diagnosed in 45 eyes (25 with anterior lens luxation, 15 with subluxation, and 5 with posterior lens luxation). Lens-induced anterior uveitis without glaucoma (n = 25 eyes), uveitic glaucoma (n = 15 eyes), and lens capsule disruption (n = 5 eyes) were also diagnosed. The vision was lost in all 5 eyes with posterior lens luxation (100%), 18/25 eyes with anterior lens luxation (72%), and 5/15 eyes with lens subluxation (33.3%). Vision impairment was also identified in 10/25 eyes (40%) with unresponsive lens-induced anterior uveitis and in 5/5 eyes (100%) with traumatic rupture of the anterior lens capsule. Conclusion Crystalline lens injury can cause a wide variety of ocular emergencies that may result in blindness. Early diagnosis and appropriate treatment are crucial for handling lens-related emergencies in dogs.

Spherophakia and Ectopia Lentis in a Sturge-Weber Patient: A Case Report

Sturge-Weber syndrome (SWS) is a rare, sporadic neurocutaneous disorder, primarily characterized by port-wine stain (PWS) over the ophthalmic division of the trigeminal nerve (V1) territory (hallmark feature) and glaucoma (in 30–60% of cases). Other ocular manifestations include episcleral involvement of the PWS, choroidal vascular malformations, and iris heterochromia. Two previous reports also associated ectopia lentis concomitantly among these cases. However, here we report spherophakia as a novel ophthalmological finding in SWS. A 56-year-old female previously diagnosed with SWS presented to the outpatient clinic complaining of right-sided decreased visual acuity and pain after a fall. Phenotypically, the patient had a PWS around V1 territory and involvement of both eyelids. Previous relevant ocular history included retinal detachment without macular involvement, ocular hypertension, and phacodonesis. The slit-lamp examination showed anterior lens luxation and elevated intraocular pressure (IOP) of 40 mm Hg by tonometry. Prior to the surgical approach, the patient received hypotensive treatment for elevated IOP. After intracapsular lens extraction, measurements were consistent with spherophakia. Postoperatively, the patient underwent optical coherence tomography (OCT). There was cystic macular edema (CME) by OCT and a detached posterior hyaloid membrane. The patient fully recovered with topical treatment of bromfenac for CME. To the best of our knowledge, this is the first report of concomitant anterior lens luxation and spherophakia (novel association) in a SWS patient. Our findings supplement the differential ocular diagnoses in SWS and should be considered in the routine ocular exam, specifically of the anterior segment. CME occurred similar to otherwise healthy eyes. However, in this case, topical anti-inflammatory medications had a good response and were well-tolerated.

Marfan Syndrome, A Review

Marfan syndrome is named after the French pediatrician Antoine Bernard-Jean Marfan who described in 1896 a girl with arachnodactyly and long limbs1. The patient also had congenital contractures of the elbows and would not fulfill the current criteria for Marfan syndrome. She probably was suffering from a condition that we now call contractural arachnodactyly, caused by mutations in the FBN2 gene.The clinical features of Marfan syndrome affect many systems of the body. The most obvious are the skeletal features, long limbs, tall stature, long thin fingers (arachnodactyly or spider fingers). The skeletal features can be scored objectively as: arm span more than 1.05 x body length; wrist sign (thumb and index finger can encircle the wrist of the other hand with at least one digit overlap) and thumb sign (when making a fist around the thumb, one digit of the thumb sticks out). The main neurological symptom is dural ectasias. The most severe symptoms are cardiovascular: mitralis valve prolapse, aortic dilatation and thoracic aortic aneurysms and dissections, which may lead to sudden death5. However, I noticed in discussions with patients that they often consider the ocular symptoms, severe myopia and lens luxation, the worst for themselves, because the latter may lead to blindness.