This study evaluates the clinical outcomes of adjunctive amniotic membrane transplantation (AMT) in the surgical management of fat adherence syndrome (FAS), a rare but challenging cause of restrictive strabismus following inferior oblique surgery. This retrospective clinical series included patients diagnosed with FAS between 2016 and 2022 who presented with hypotropia, supraduction limitation, and a positive forced duction test after prior inferior oblique surgery. All patients underwent meticulous adhesiolysis, conjunctival recession, and, when indicated, inferior rectus recession, with adjunctive AMT. Surgical success was predefined as postoperative deviation ≤10 prism diopters, improved supraduction without mechanical restriction, and resolution of abnormal head posture. Seven patients (mean age: 17.7 years) met the inclusion criteria. Intraoperatively, dense adhesions involving the inferior rectus muscle, Tenon capsule, and prolapsed fat were identified and successfully released in all cases. Postoperatively, all patients demonstrated improvement in both alignment and motility, and 6 of 7 met the predefined surgical success criterion of ≤10 prism diopters. Diplopia and abnormal head posture resolved in affected patients. No cases of anterior segment ischemia, recurrent restriction, or other complications were observed during 6 to 36 months of follow-up. Adjunctive AMT may help improve postoperative healing and reduce recurrent fibrosis in patients undergoing surgery for FAS. In this retrospective series, favorable functional and cosmetic outcomes were observed following combined surgical management with AMT. Larger prospective controlled studies are required to further clarify its therapeutic contribution.

Direct chemical reprogramming provides a potentially scalable approach for generating retinal lineage-associated cells without genetic manipulation. In this study, human Tenon's capsule fibroblasts were converted into retinal progenitor-like cells using a defined small-molecule cocktail. Retinal lineage-associated features were evaluated by immunofluorescence staining, quantitative reverse-transcription PCR, Western blot analysis, and bulk RNA sequencing, showing upregulation of neural and retinal markers, including VSX2, and transcriptomic remodeling consistent with transcriptional features associated with neuronal differentiation programs. Functional responsiveness was assessed by glutamate-evoked intracellular calcium imaging, revealing glutamate-responsive intracellular calcium dynamics in induced cells but not in parental fibroblasts. For in vivo assessment, induced cells were delivered via intravitreal transplantation in Wistar rats and subretinal transplantation in Long-Evans rats. One month after transplantation, structural and functional evaluations using optical coherence tomography, electroretinography, and histological analyses showed localized alterations in retinal structure at the subretinal injection site, while no significant differences were observed in scotopic ERG responses under the present experimental conditions. In contrast, fibroblast transplantation showed more prominent structural alterations under similar conditions. Human nuclei-positive signals were detectable in a subset of eyes, exhibiting focal and heterogeneous distribution within retinal regions at the one-month endpoint. Collectively, these suggest the induction of retinal lineage-associated molecular and functional features, with short-term functional tolerability observed in vivo under the present experimental conditions.

Compressed air injuries to the globe are rare and typically associated with orbital fractures or a visible entry wound. The authors report the case of a 16-year-old male with Marfan syndrome who developed orbital emphysema strictly confined to the sub-Tenon's space following a compressed air injury, without any visible entry wound or orbital fracture. Clinical examination demonstrated a well-demarcated subconjunctival air pocket located approximately 3-4 mm posterior to the limbus, consistent with the anterior insertion of Tenon's capsule. Computed tomography confirmed a localized intraorbital air without evidence of fracture or sinus communication. A plausible mechanism is that high-pressure air entered through microscopic tissue disruption and dissected along Tenon's capsule into the sub-Tenon space. The patient was managed conservatively with spontaneous resolution. This case provides a well-documented example of localized sub-Tenon emphysema and illustrates the anatomical boundaries of the sub-Tenon space in vivo.

PurposeTo evaluate the safety and efficacy of yellow laser photocoagulation for deep conjunctival nevi.MethodologyThis prospective interventional case series included patients with clinically stable conjunctival nevi for ≥6 months. Treatment was performed using the Iridex yellow laser (577 nm) under topical anesthesia, with a 200-micron spot, 80 ms exposure, and 300-600 mW power. The lesion was removed with sterile cotton buds post-laser, and topical steroids were prescribed for one week. Follow-up was at day 1, week 1, month 1, and month 3, assessing ocular surface health and lesion resolution. Examinations included Schirmer Test 1, Oxford corneal staining, Ocular Surface Disease Index (OSDI), tear meniscus height, and non-invasive keratograph break-up time (NIKBUT).ResultsThe study included 10 eyes from 9 patients. Mean age was 30 years (range: 6-63), with a 1:1 sex ratio. Anterior segment OCT confirmed subepithelial lesions in all, with intralesional cysts in 60%. Mean nevus diameter was 4.2 mm (range: 2-11), and 70% showed severe pigmentation. Laser treatment was completed in one session for 90% of eyes; one required a second due to large size. No significant changes were observed in ocular surface parameters. At a mean follow-up of 10.5 months (range: 3-17), 85% (6/7) of eyes had complete resolution when the laser was fully applied. No recurrence occurred. One patient developed conjunctival scarring from inadvertent Tenon's capsule application.ConclusionYellow laser photocoagulation is a safe, effective, minimally invasive outpatient treatment for conjunctival nevi, including deeply pigmented cases. It yields excellent cosmetic outcomes with minimal side effects, supporting its role as a potential standard of care.

PURPOSE: To characterize the clinicopathologic features of extraocular silicone oil (SO) migration in the ocular adnexae, including the conjunctiva, eyelid, and orbit (CEO). METHODS: Retrospective, single-institution case series. The Florida Lions Ocular Pathology Laboratory database at the Bascom Palmer Eye Institute was searched for surgical specimens diagnosed with “silicone oil” involving the ocular adnexae from 1997 to 2023. Clinical and histopathologic features were reviewed. All specimens were stained with hematoxylin-eosin, and immunohistochemical stains for histiocytes CD68 (M1, pro-inflammatory) and CD163 (M2, anti-inflammatory). RESULTS: 25 specimens met inclusion criteria. Affected sites included the conjunctiva (76%), orbit (12%), eyelid (8%), and Tenon’s capsule (4%). Histopathology revealed clear dropout spaces consistent with SO surrounded by histiocytes in all cases. CD68 and CD163 both highlighted histiocytes, with CD163 demonstrating significantly higher immunohistochemical staining (p < 0.0001). The average time from SO placement to presentation was 451.1 days (Range: 14 − 1,220 days). SO migration was clinically suspected in 17 cases, presenting with conjunctival injection, irritation, cysts, or eyelid swelling. Imaging (anterior segment OCT, CT) aided diagnosis. CONCLUSION: Diagnosis of silicone oil migration in the ocular adnexae is important to avoid misdiagnosis. The presence of M2 histiocytes (anti-inflammatory) is consistent with the high immunotolerance of these lesions.

A 46-year-old woman noticed blurred vision in her right eye two weeks after receiving the fourth dose of a COVID-19 vaccine and visited a local eye clinic. Then, the patient was referred to our hospital to investigate the cause of decreased vision in the right eye. At the initial visit to our hospital, the best-corrected visual acuity (BCVA) in the right eye was 0.7 in decimal units and 1.5 in the left eye, respectively. Intraocular pressure was 17 mmHg in both eyes. Abnormal findings were observed only in the right eye; the left eye was completely normal. Therefore, all abnormal findings described below are related to the right eye. Anterior segment examination revealed inflammatory cells in the anterior chamber. The lenses in both eyes were almost clear, and the right eye showed vitreous cells and vitreous opacity. Fundus examination revealed multiple small white exudative spots. Optical coherence tomography (OCT) demonstrated disruption of the ellipsoid zone (EZ) and hyper-reflective lesions beneath the retina. Fluorescein angiography (FA) showed hyperfluorescence consistent with staining at the sites of exudative lesions, while indocyanine green angiography (ICGA) revealed corresponding hypofluorescent spots due to blocked fluorescence. Full-field electroretinography (ERG) showed reduced amplitudes of both a- and b-waves. Goldman perimetry identified a central scotoma in the right eye. Based on these findings, the patient was diagnosed with multiple evanescent white dot syndrome (MEWDS) in the right eye. Topical betamethasone sodium phosphate and fradiomycin sulfate were initiated six times a day for the right eye at the first visit. The day after the initial visit, the BCVA in the right eye rapidly declined to 0.01 in decimal units, prompting the initiation of oral prednisolone at 30 mg/day. Eight days later, a sub-Tenon's capsule injection of triamcinolone acetonide (20 mg/0.5 ml) was administered. The symptoms gradually improved thereafter, and the hyper-reflective subretinal lesions observed on OCT disappeared. Oral steroid therapy was tapered, and the visual acuity (VA) improved to 1.0 in decimal units four months later. A case of MEWDS occurring after COVID-19 vaccination showed favorable recovery with oral steroid therapy and sub-Tenon's injection.