Digital Journal of Ophthalmology

Pickleball-related eye injuries presenting to United States emergency departments, 2010-2023

2025-10-21T08:20:54+00:00

Purpose
To characterize the epidemiology of pickleball-related eye injuries in the United States.

Methods
Data from the National Electronic Injury Surveillance System were analyzed for individuals treated in US emergency departments (ED) for pickleball-related eye injuries from 2010 through 2023.

Results
Based on a sample of 117 actual cases, there were an estimated 6,015 individuals treated in US emergency departments for pickleball-related eye injury. From 2022 to 2023, the rate of injuries increased by 37.3%. The mean age of individuals was 59.9 years. Approximately 54.7% of individuals were male. The most common mechanisms of injury were fall with facial trauma (n = 71 [60.7%]), direct impact from a pickleball paddle (n = 18 [15.4%]), and direct impact from a pickleball (n = 12 [10.3%]). The most frequently associated primary diagnoses were laceration (n = 45 [38.5%]), contusions or abrasions (n = 27 [23.1%]), blunt trauma (n = 17 [14.5), and fractures (n = 14 [12.0%]). The top two specific ocular surface or intraocular diagnoses were abrasions and iritis. Most individuals (n = 115 [98.3%]) were treated and released or examined and released without treatment.

Conclusion
Based on our analysis of a national database, the frequency of pickleball-related eye injuries treated in US EDs has increased, although most ocular injuries are clinically minor.

Evaluation of artificial language-adjusted readability on cataract surgery queries

2025-12-05T08:22:05+00:00

Purpose
To analyze accuracy and readability of answers to cataract surgery queries produced by artificial intelligence (AI) models and determine whether AI models can significantly improve readability.
Methods
Google Gemini Advanced, ChatGPT 4.0, and Microsoft Copilot Pro were prompted to answer 25 questions about cataract surgery, followed by a request to re-answer questions at a 6th-grade level. Objective readability of answers were measured with five validated reading formulas and word count. Accuracy and readability of each answer were further graded by three ophthalmologists. Comparisons were performed between original and 6th-grade versions and among the three AI models.
Results
After being prompted to answer at a 6th-grade reading level, Google Gemini Advanced and Microsoft Copilot Pro had lower average reading level than ChatGPT 4.0 (8.04 vs 8.19 vs 9.43 [P < 0.001]). Microsoft Copilot answers had higher Flesch reading ease score (75.40 vs 71.24 vs 69.46 [P < 0.007]) and lower word count (130.28 vs 180.24 vs 166.08 [P < 0.001]) among AI models. Microsoft Copilot Pro and ChatGPT 4.0 answers had greater change in reading level (−6.13 vs −5.75 vs −3.31 [P < 0.001]) and Flesch reading ease score (39.67 vs 35.98 vs 23.67 [P < 0.001]) compared with Google Gemini Advanced. Graders determined that there were no changes in accuracy before and after being prompted to answer at a 6th-grade reading level.
Conclusions
AI models can simplify reading level of responses to common cataract surgery queries while maintaining accuracy.

Bilateral Boston Keratoprosthesis for treatment of a variant of keratitis–ichthyosis–deafness syndrome

2025-04-27T15:04:01+00:00

We report the case of a 4-year-old boy diagnosed with keratitis-ichthyosis-deafness (KID) syndrome with long-term follow-up, including multiple surgical and nonsurgical treatments. Genetic testing revealed a missense GJB2 mutation (p.Asp50Asn). His ocular condition deteriorated to the point that, at 37 years of age, he required bilateral keratoprosthesis (KPro) implantation, resulting in best-corrected visual acuity of 20/25 in the right eye and 20/40 in the left eye. Our findings suggest that more advanced cases of KID syndrome may benefit from treatment options that rely less on ocular surface stability, such as KPro implantation, whereas therapies that treat the ocular surface may be preferred in early-stage disease.

Isolated ocular relapse in pediatric acute lymphoblastic leukemia: a case report

2025-06-09T16:01:57+00:00

A 5-year-old girl, previously in complete remission from common B-cell acute lymphoblastic leukemia (B-ALL), presented at the University Hospital of Leuven with a unilateral, painless red left eye. Over several weeks, the clinical picture evolved from common conjunctivitis into a painful red eye with iris heterochromia and increased iris vascularization unresponsive to topical and oral antibiotics. No signs of leukemic relapse were detected on comprehensive systemic work-up, including bone marrow and lumbar puncture. Aqueous sampling at this time could not confirm the clinical suspicion of isolated ocular relapse of ALL. Oral prednisolone was initiated, with good clinical response. After discontinuation of steroids, the affected eye developed a hypopyon-like mass in the anterior chamber. Urgent anterior chamber washout was performed. Cytology now confirmed the presence of a leukemic infiltrate, indicating an isolated ocular relapse of common B-ALL. Not only because this was the fourth relapse, but primarily because this patient had already undergone extensive prior treatments, including an allogeneic stem cell transplant just 6 months earlier, there were no systemic therapeutic options available. Palliative radiotherapy to the left orbit was therefore initiated. Two months later, the girl presented with similar symptoms in the right eye, which was also treated with radiotherapy.

Extensive orbital invasion by conjunctival squamous cell carcinoma in an anophthalmic socket: a case report

2025-05-16T09:23:37+00:00

We report the case of a 75-year-old man with conjunctival squamous cell carcinoma in his anophthalmic socket that had resulted from enucleation at age 5. He had a 6-week history of a palpable, right orbital mass and periocular pain. Examination revealed a right inferolateral orbital mass and keratinization of the inferior fornix. Magnetic resonance imaging revealed an extensive mass in the inferolateral orbit. Biopsy showed squamous cell carcinoma. The patient underwent exenteration with temporalis flap reconstruction followed by adjunctive radiotherapy. A metastasis to the right parotid was excised at 6 months. This case illustrates the potential for extensive orbital invasion and perineural spread by ocular surface squamous neoplasia in an anophthalmic socket despite minimal conjunctival signs.

Intraocular inflammation and presumed retinal vasculitis following initial pegcetacoplan intravitreal injection

2025-06-29T16:29:49+00:00

We report a case of presumed retinal vasculitis and precipitous complete vision loss following a single intravitreal injection of pegcetacoplan. A 76-year-old woman received intravitreal pegcetacoplan in the right eye for geographic atrophy. Visual acuity was 20/50 right eye. Ten days after the injection, she experienced initial signs of subjective vision loss. On day 11, she presented with elevated intraocular pressure and visual acuity of hand motions, worsening to no light perception (NLP) by day 12. Anterior chamber and vitreous fluid taps for Gram stain and culture were negative. On day 22, the patient had diffuse retinal hemorrhages along a retinal vascular distribution. At day 83, visual acuity remained NLP. This patient developed presumed occlusive retinal vasculitis, progressing from visual acuity of 20/50 to NLP within 2 days of initial subjective vision loss and 12 days of a single intravitreal pegcetacoplan injection.

Proliferative diabetic retinopathy

2024-12-30T15:30:32+00:00

This fluorescein angiography image demonstrates advanced proliferative diabetic retinopathy (PDR) in a patient with poorly controlled type 1 diabetes mellitus. The image highlights extensive neovascularization originating from the optic disc, vessel infiltration of the macula, and diffuse neovascularization peripherally. Abundant neovascular nets, fluorescein leakage from these webs of thin, irregular, vessels are consistent with pathological angiogenesis. Additionally, 360° capillary nonperfusion is evident, contributing to retinal ischemia and the drive for neovascularization. The image also shows intraretinal microvascular abnormalities, vessel looping, and venous beading (yellow arrows). The pathophysiology of PDR involves chronic hyperglycemia-induced damage to retinal capillaries, leading to hypoxia-driven upregulation of vascular endothelial growth factor.

Horseshoe tears in the retina after traumatic posterior vitreous detachment

2024-12-31T15:23:16+00:00

A 70-year-old man with no known past ocular history presented to the Brooklyn Veterans Affairs Hospital after a fall from standing height with the chief complaint of flashing lights in his vision. Ultrawide-field Optomap imaging of the patient’s right eye demonstrated three large horseshoe retinal tears extending from 2:00 to 5:00 at the ora serrata. Persistent vitreous attachment to the peripheral retina, combined with the traumatic fall mechanism, produced the characteristic tear pattern. The contiguous inferior tears illustrate vitreous avulsion associated with traumatic retinal injury. These tears are a significant risk factor for rhegmatogenous retinal detachment due to liquefied vitreous accessing the subretinal space through the breaks. Horseshoe tears in the retina often result from posterior vitreous detachment, particularly in patients with risk factors such as myopia, trauma, and lattice degeneration. Timely identification of these tears is critical to preventing retinal detachment. Management may involve laser retinopexy to barricade the tear and prevent progression.

A quadruple fundal coloboma

2024-09-18T11:55:08+00:00

An 18-year-old girl presented at Guru Nanak Eye Center with a complaint of blurred vision in her left eye since childhood. On examination, her eye was found to have a complete typical iris coloboma (A) with visible inferior lens equator and absent zonules (B). Fundus examination revealed a normal optic disc surrounded by peripapillary atrophy enclosing a chorioretinal coloboma (C, black arrow) at its inferior border and a combination of Ida Mann type (5, 6, 7) chorioretinal colobomas (C, white arrows) connected by bridging retinal tissue. The occurrence of fundal coloboma is postulated to be due to failure of posterior closure of embryonic fissure in the optic cup. This defect usually gives rise to an isolated fundal coloboma and very rarely to multiple discrete fundal colobomas as shown here.

Moniliform blepharosis in lipoid proteinosis

2024-10-10T16:38:31+00:00

A 16-year-old girl presented at Aravind Eye Hospital, Chennai, Tamil Nadu, India, with a complaint of recurrent irritation in both eyes for the previous 2 years. On examination, she had characteristic beaded papules along both eyelid margins suggestive of moniliform blepharosis. Incisional biopsy revealed irregular acanthosis, deposition of eosinophilic material in the dermis (black arrow) and pinkish material around blood vessels and adnexa , confirming the diagnosis of lipoid proteinosis. Lipoid proteinosis is an autosomal recessive inherited disease caused by a homozygous or compound heterozygous loss-of-function mutation in the extracellular matrix protein 1 (ECM1) gene, located on chromosome 1q21, which encodes for glycoproteins essential for basement membrane and extracellular matrix structure integrity, skin adhesion, and protein-protein interactions. Moniliform blepharosis, characterized by beaded papules along the eyelid margins, is a pathognomonic finding present in about 50% of cases. The patient was managed by radiofrequency ablation of papules and topical lubricants.

Conjunctival ulcers: a rare feature of ocular herpes simplex virus infection

2024-10-26T14:16:36+00:00

A healthy 22-year-old woman presented at Unidade Local de Saúde de Gaia e Espinho with a persistently painful and red left eye of about 5 days’ duration. Prior treatment with dexamethasone+levofloxacin drops from an outside provider had been ineffective. On examination, conjunctival hyperemia and ulcers were observed, in the perilimbal, bulbar, and tarsal conjunctiva, which stained positively with fluorescein under a cobalt-blue filter. No corneal changes were present. Polymerase chain reaction testing was positive for herpes simplex virus type 1 (HSV1). The patient was started on topical ganciclovir (5 times daily) and oral valacyclovir 500 mg (3 times daily), with resolution of the pain and ulcers within 5 days. Herpes simplex infection manifesting as conjunctival ulcers is rare, with fewer than 20 reported cases.

Chorioretinal lacunae aid in the diagnosis of Aicardi syndrome

2024-07-04T11:32:18+00:00

A 2-month-old girl, born at 38 weeks’ gestation via cesarean section, was referred to Dr. R. P. Centre, AIIMS, New Delhi, with a diagnosis of retinal detachment in the left eye. On examination, the child showed no response to bright light in each eye. Pupillary reaction was sluggish in each eye. Fundus examination revealed chorioretinal lacunae involving the posterior pole in right eye and retinal detachment in the left eye. Further inquiry elicited a history of neonatal intensive care unit admission and seizures at birth. The child was referred to a pediatrician, and magnetic resonance imaging showed agenesis of the corpus callosum. The baby was diagnosed with Aicardi syndrome, having the classic triad of infantile spams, corpus callosum agenesis, and chorioretinal lacunae. The parents were counseled regarding the guarded visual prognosis, need for regular follow-up, and the role of early visual rehabilitation and multidisciplinary care.

Pseudoexfoliative material on an intraocular lens

2024-10-15T19:38:51+00:00

An 84-year-old woman with a prior history of bilateral cataract surgery with intraocular lens (IOL) implantation and neodymium:YAG capsulotomy presented at the Bascom Palmer Eye Institute for routine ophthalmological examination. She was previously diagnosed with pseudoexfoliation glaucoma. On presentation, best-corrected visual acuity in the right eye was 20/30; in the left eye, 20/25. Intraocular pressure was 13 mm Hg in the right eye and 14 mm Hg in the left eye on latanoprost eye drops in both eyes. Slit lamp examination revealed pseudoexfoliation material on the anterior surface of the IOL in multiple linear patterns in the right eye on oblique illumination (A) and retroillumination (B). This case underscores the importance of anterior segment examination where the deposits on the IOL may be an important sign for diagnosis of pseudoexofliation syndrome in pseudophakic patients.

Bull’s eye maculopathy in a young patient with systemic lupus erythematosus

2024-06-15T01:33:49+00:00

A 19-year-old woman diagnosed with systemic lupus erythematosus and treated with hydroxychloroquine therapy 200 mg/day for 6 years (cumulative dose approximately 438 g) presented at Ibn Sina University Hospital for her routine ophthalmological examination. There was no history of childhood overdose. Visual acuity was 20/40 in each eye. Funduscopic examination revealed atrophic bull’s eye maculopathy, with concentric rings of hypopigmentation and hyperpigmentation surrounding the fovea in the right eye and left eye. Optical coherence tomography showed decreased retinal thickness (foveal thickness, 191 μm), and atrophy of the outer retinal layers with interruption of the ellipsoid line. Hydroxychloroquine was discontinued after the diagnosis of retinal toxicity. At the 12-month follow-up, visual acuity remained stable, and no further progression of retinal changes was observed.

Persistent pupillary membrane type 2

2024-09-05T07:47:01+00:00

A 31-year-old woman presented AIIMS Mangalagiri with bilateral, type 2 persistent pupillary membrane (PPM) that originated from the inferotemporal region of the collarette of the iris in the right eye and the lateral half of the collarette of the iris in the left eye. Both PPMs were adherent to the lens capsule. Her best-corrected visual acuity was 6/9 in the right eye and 6/18 in the left eye. Intraocular pressure was normal in each eye. After dilation, there was a radial opacity in the lens seen at 5 o'clock in the right eye and a similar opacity was seen at 7 o’clock in the left eye.

Cilium incarnatum internum

2024-10-28T04:34:08+00:00

A 53-year-old man presented at Zhongshan Ophthalmic Center with irritation of the left eye of 2 weeks’ duration. He had a history of dry eye for the previous 8 years and had been using artificial tears. Eversion of the upper eyelid revealed a fine eyelash lying on the margin of eyelid, with the tip toward the eye. The hair follicle was located on the anterior lip of the eyelid margin, but the eyelash was limited by the epidermis and grew beneath it, leading to an inward growth. Trichiasis, where the eyelashes grow toward the eye rather than away from it, is mainly caused by infection, inflammation, congenital defects, or trauma, and leads to irritation, photophobia, and tearing. This tiny eyelash can easily be overlooked, leading to long-term irritation and unnecessary regimen of lubrication. When a patient complains of recurring eye foreign body sensation, everted eyelid examination is essential. In this patient, the trichiatic lash was removed, and irritation was immediately relieved.

Bilateral prepapillary vascular loops in a pediatric patient

2025-08-28T21:18:32+00:00

Prepapillary vascular loops are a congenital vascular anomaly in which irregular vessels emerge from the optic disc and project into the vitreous cavity. The “loops” are unusually elongated and may display elevation, coiling, and even a corkscrew or figure-eight appearance. This abnormal vascular morphogenesis is most commonly arterial in origin; however, venous or arteriovenous involvement is also possible. Bilateral presentation is rare. Peripapillary loops are typically asymptomatic and discovered incidentally on routine fundus examination. The figure shows color fundus photography and optical coherence tomography of bilateral prepapillary vascular loops in a 12-year-old healthy boy who presented for a standard ophthalmologic evaluation. Potential complications of prepapillary vascular loops include vitreous hemorrhage, amaurosis fugax, subretinal hemorrhage, or retinal artery/vein occlusion. Clinical management is generally conservative, because the condition is benign and rarely progresses. Additional diagnoses to consider include neovascularization of the disc and vascular collaterals. Prepapillary vascular loops are distinguished from these entities by their congenital, nonprogressive nature, distinct vascular morphology, and clinical presentation.

Macular telangiectasia type 2 complicated with choroidal neovascularization

2024-10-28T05:48:45+00:00

A 50-year-old man presented at Ulucanlar Eye Training and Research Hospital with decreased vision in his right eye. On examination, his best-corrected visual acuity was 20/70 in the right eye and 20/25 in the left eye. Fundus examination revealed parafoveal loss of transparency, right angle venules, and telangiectatic vessels, more prominent temporally in the macula of each eye, in addition to a dirty, grayish retinal neovascular membrane with retinal hemorrhages temporal to the fovea of the right eye. There were also retinal pigment epithelium (RPE) atrophic changes, RPE hyperplasia, and yellowish crystalline deposits in the macula of the left eye. Fundus fluorescein angiography of the right eye showed staining of the temporal parafoveal capillaries and presence of juxtafoveal choroidal neovascularization. Optical coherence tomography angiography of the right eye revealed the telangiectatic vessels in the superficial and deep retinal plexus, neovascular membrane composed of loops, peripheral anastomoses, surrounded by a hypointense halo in the outer retina and choriocapillaris slabs in addition to subretinal hyperreflective material with intraretinal fluid on the B-scan.

Anterior suprachoroidal hemorrhage abutting anterior chamber intraocular lens

2024-05-29T08:33:25+00:00

An 88-year-old man presented at the Mayo Clinic Department of Ophthalmology with a large suprachoroidal hemorrhage following a complicated lens exchange with anterior chamber intraocular lens (ACIOL) placement. The choroidal hemorrhages were appositional and abutting the ACIOL, painless, with a formed anterior chamber. The patient was hypermetropic and had an intraocular pressure of 23 mm Hg, which was controlled with dorzolamide/timolol drops at the time of presentation. He was managed conservatively with topical therapy for 17 days (prednisolone acetate 1% 6 times daily and atropine 0.01% twice daily), followed by choroidal drainage surgery with warfarin cessation (which he was using for atrial fibrillation). Postoperatively, he refracted to 20/80 while retaining his ACIOL and successfully resumed warfarin without hematologic complications at the 1-year postoperative visit with complete resolution of the choroidal hemorrhages.

Spontaneously dislocated lens with ring-shaped pigmentation

2024-11-01T20:21:53+00:00

A 78-year-old man presented at Aravind Eye Hospital, Puducherry, with a 2-year history of poor vision in the left eye. He had no history of trauma or cataract surgery. On examination, best-corrected visual acuity in the left eye was 2/60. Slit-lamp examination showed a nondilating pupil measuring 2 mm diameter, with aphakia in the pupillary plane. B-scan ultrasound was suggestive of a spontaneously dislocated lens. During pars plana vitrectomy, spontaneously reattached retina was noted, with atrophy, and the lens with a near mature nucleus, outlined by a pigmentary ring, was located at the demarcation line.