Digital Journal of Ophthalmology

Recurrent acute bilateral cicatricial conjunctivitis as an adverse event of systemic adalimumab for rheumatoid arthritis

2026-03-29T19:45:11+00:00

Anti-TNF-α therapies, though known for their anti-inflammatory effects, have been associated with paradoxical inflammatory reactions, of which anterior uveitis is the most common. We report a case of recurrent bilateral cicatricial conjunctivitis linked to systemic adalimumab (ADA) treatment in a 66-year-old man with rheumatoid arthritis (RA). The patient experienced worsening bilateral red eyes, blurry vision, and discomfort following each ADA injection. Examination revealed signs of cicatricial inflammation, which responded to corticosteroids but recurred after subsequent ADA doses. Despite these ocular events, adalimumab was continued due to its effective control of systemic RA, with close ophthalmic monitoring. This case suggests a potential direct association between ADA and cicatricial conjunctivitis, a previously undescribed complication. Aggressive topical corticosteroid treatment may allow the continuation of ADA without compromising systemic disease control.

Silent sicklers and traumatic hyphema: a case to emphasize the importance of questioning the unknown

2025-01-11T16:04:33+00:00

A previously healthy 6-year-old white boy presented emergently after trauma to his right eye. On examination, intraocular pressure (IOP) was 49 mm Hg, and visual acuity was 20/50. He was diagnosed with a 3 mm layering hyphema. Despite medical therapy and lifestyle modifications, the patient’s IOP continued to rise, peaking at 77 mm Hg on day 3 after presentation. Given his elevated IOP despite the addition of new topical medications on daily follow-up, the patient was screened for sickle-cell disease to assess for an underlying pathology that could be exacerbating his elevated IOP. After testing positive for sickle cell trait, the patient was promptly taken to the operating room for anterior chamber washout. The following day, IOP normalized to 14 mm Hg, and visual acuity was 20/25. Hyphemas generally respond well to medical therapy, but patients with sickle cell hemoglobinopathy are at greater risk for permanent vision loss from pressure spikes. This case reinforces the need to collect thorough past medical and family histories and consider early sickle cell screening in all patients failing to respond to IOP-reducing medication or if hemoglobin status is unknown on initial presentation.

Complications following incisional glaucoma surgery, minimally invasive glaucoma surgery, and cycloablative procedures: a 13-year retrospective review

2026-03-30T19:45:20+00:00

Purpose
To evaluate the incidence, clinical course, and treatment outcomes of glaucoma surgery–related infections at a tertiary academic center over a 13-year time period.

Methods
Patients presenting at Duke Eye Center between January 1, 2010, and November 11, 2023, who underwent glaucoma surgery, including trabeculectomy, glaucoma drainage device (GDD) placement, GDD revision surgery, trabeculectomy bleb revision surgery, minimally invasive glaucoma surgery (MIGS), Xen gel stent implantation, and cycloablative procedures, were identified using an electronic medical record clinical database search. Diagnosis of blebitis, bleb-associated endophthalmitis, and tube malposition or tube exposure were determined using International Classification of Disease (9th and 10th editions) codes.

Results
A total of 12,115 glaucoma surgeries (in 6,684 patients) were identified during the study period. GDD implantation comprised the majority of glaucoma surgeries (33%), followed by trabeculectomy (with and without Ex-PRESS mini glaucoma shunt) (25.7%), GDD revision (8.9%), trabeculectomy bleb revision (8.6%), and transscleral cyclophotocoagulation (5.9%). There were 488 MIGS with and without phacoemulsification (4%) and 76 Xen gel stent surgeries (0.6%). Endophthalmitis was diagnosed in 18 eyes (0.96%) that underwent trabeculectomy, 11 eyes that underwent GDD implantation (0.20%), and 1 eye that underwent Xen stent implantation. Blebitis was diagnosed in 7 eyes: 5 were related to trabeculectomy (0.27%), and 2 were related to GDD placement (0.05%). The incidence of GDD malposition or erosion was 10.2%. No cases of endophthalmitis were diagnosed in patients with MIGS.

Conclusions
In our study cohort, infectious complications associated with trabeculectomy and GDD implant surgery were low; there were no cases of endophthalmitis associated with MIGS. The rate of GDD complications due to tube malposition or erosion was 10.2%.

Ophthalmology journal article processing charges for publications in a post-COVID world

2024-06-16T10:30:20+00:00

Purpose
The period 2002-2021 saw an annual growth rate of 51.46% in listings of open access (OA) journals in the Directory of Open Access Journals (DOAJ), with a steeper rate of growth corresponding with the onset of COVID-19. The introduction of OA and hybrid models, which give authors traditional subscription and OA options, may have led to increased article processing charges (APCs). This study aimed to analyze the APCs for ophthalmology journal articles after the COVID pandemic and analyze changes in publication modality and cost.

Methods
APC, frequency of publication, and impact factor (IF) were analyzed for 83 MEDLINE-indexed ophthalmology journals. Data were stratified based on publication modality (OA, hybrid, or traditional), and geodistribution, intermodality, and correlation between APC and IF were compared.

Results
Average APC for OA, hybrid, and traditional journals was $1,310.49, $3,550.71, and $7.18, respectively (P < 0.001). Univariate analysis demonstrated a statistically significant impact of hybrid mode (P < 0.001), traditional mode (P = 0.046), and IF >1 (P < 0.001). Multivariate analysis demonstrated a statistically significant effect of the modality of publication on journal APC. Intermodality analysis showed significantly higher APC for hybrid journals than OA or traditional journals, without statistically significant differences in frequency of publication or IF.

Conclusions
Ophthalmology journals are experiencing a subject-wide transition from traditional publication to hybrid modality. Since the COVID pandemic, APCs across all publication modes have increased, and there has been a transition from the traditional publishing model to a more lucrative hybrid model.

Electric shock–induced cataract

2024-11-10T05:59:14+00:00

A 44-year-old man presented at All India Institute of Medical Sciences, Mangalagiri, with a chief complaint of decreased vision in his left eye. Eight years earlier, he had experienced an electrical shock injury to his left hand from a home appliance, and since then he had been experiencing gradually decreasing vision in his left eye. He had no other systemic complaints. On examination, his best-corrected visual acuity was 6/6 (−1.50 DS) in the right eye and 6/18 (−1.75 DS) in the left eye. Intraocular pressure was normal in both eyes. Slit lamp examination revealed an anterior subcapsular cataract in the left eye, with a placoid appearance. This cataract, likely induced by the electric shock, had changed over the 8 years since the injury and appeared similar to anterior subcapsular cataract caused by blunt trauma. The posterior segment of both eyes appeared normal, and there were no abnormalities in the fellow eye. The patient underwent phacoemulsification cataract surgery with posterior chamber intraocular lens implantation, resulting in postoperative visual acuity of 6/6 in the left eye.

Bilateral Bartonella neuroretinitis in an 11-year-old girl without a history of cat scratches

2024-12-24T00:06:42+00:00

An 11-year-old girl presented at Bayindir Kavaklidere Hospital with a 15-day history of progressive bilateral eye redness and vision loss. She reported that over the previous week, her vision had deteriorated significantly. Visual acuities on presentation were 20/200 in the left eye and 20/100 in the right eye. Ophthalmic examination revealed bilateral conjunctival hyperemia, with 4+ cells in the right eye and 3+ cells in the left in the anterior chamber. Intraocular pressure was 15 mm Hg in the right eye and 13 mm Hg in the left eye. Fundus examination demonstrated optic disc hyperemia and swelling bilaterally, accompanied by macular star formation, more pronounced in the right eye (A, arrow), consistent with bilateral neuroretinitis. Optical coherence tomography revealed flattening of foveal contour, central marked retinal thickening, and macular subretinal fluid. The patient reported contact with cats but denied scratches. Serological testing confirmed Bartonella infection, diagnosing Bartonella neuroretinitis. Following consultation with pediatric specialists, she was treated with doxycycline 100 mg twice daily for 12 weeks, along with a single 600 mg dose of rifampin. Additionally, she received a tapering regimen of oral prednisolone, starting at 20 mg daily, tapered to 10 mg over 12 weeks. Topical prednisolone eye drops were administered starting with 8 drops per day and tapered as inflammation subsided. At her 12 weeks’ follow-up, her visual acuity had significantly improved to 20/20 in the right eye and 20/25 in the left eye. The optic disc hyperemia and edema had significantly decreased.