Purpose: To evaluate the changes in tear film osmolarity and Schirmer I test after cataract surgery. Methods: This single-center, prospective study included patients with no subjective complaints about dry eye disease. Patients with the following conditions were excluded: contact lens wearers, patients with diabetes, pseudoexfoliation, pterygia, and eye drops users. The eye that had not undergone surgery was considered the control group. Tear osmolarity and Schirmer I test were evaluated before surgery and during the first postoperative month. Results: Thirty-seven patients were enrolled in the study. Before surgery, tear osmolarity was 301.2 +/- 15.09 Osm/L in the study group and 302.3 +/- 14.21 mOsm/L in the control group (P = 0.2), while Schirmer I test averaged 13.4 +/- 10.50 mm in the study group and 13.7 +/- 10.79 mm in the control group (P = 0.6). The next morning, the tear osmolarity decreased to 0.05). Conclusions: The tear osmolarity results increased to the dry eye disease level in the first postoperative week. Over the course of one month, the difference in tear osmolarity and Schirmer I test values for the study and control groups leveled off. Copyright (C) 2018, Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V.

Isolated posterior capsule rupture of the crystalline lens after blunt eye injury is a rare complication and demands a special surgical management strategy in order to achieve a good visual outcome.

Background: Primary congenital glaucoma (PCG) is a rare disease with an incidence of 1 in 12,000 to 18,000 in Europeans. The scarcity of the disease and limited access to genetic testing have hindered research, particularly within the Latvian population. Objectives: This study aims to present the preliminary results of a molecular genetic investigation into PCG in a Latvian cohort and to compare the prevalence of gene CYP1B1 variants with other European studies as well as to the general population in Latvia. Methods: Twenty probands with clinically diagnosed PCG and 36 family members enrolled in the study. Genetic testing was conducted using genomic DNA from peripheral blood using next generation sequencing (NGS) of seven selected genes: CYP1B1, FOXC1, FOXE3, PXDN, PITX2, PITX3, PAX6, and CPAMD8. Four probands had whole-genome sequencing (WGS). Results: All participants were of European ancestry, with no family history of PCG. Most probands were diagnosed in their first year of life, with a female to male ratio of 1:1.2 and with 80.0% of cases being unilateral. No CYP1B1 pathogenic variants were identified in the screened subjects. However, a heterozygous missense variant c.4357C>A (p.Pro4357Thr) in the PXDN gene was found in one proband and one of her parents that was classified as a variant of uncertain significance. Conclusions: This study represents the first genetic characterization of PCG in the Latvian population. Using NGS, we identified no pathogenic variants in the CYP1B1 gene among affected individuals. Preliminary evidence from this cohort does not support CYP1B1 variants as a predominant cause of PCG, though larger studies are needed to confirm this observation. Comprehensive genetic screening using whole-exome or whole-genome sequencing will be essential to identify the underlying genetic etiology of PCG in Latvia.

Almost every cataract surgeon has encountered a situation during the postoperative period when, even though, the primary goal – improvement of visual acuity – has been achieved, yet the patient felt frustrated because of subjective discomfort in the operated eye. Sometimes this issue is more disturbing for the patient than the hope for a perfect visual outcome. Although it has been established that the ocular surface is affected during the postoperative period, there is still no generally accepted opinion about the changes in tear osmolarity after cataract surgery despite several studies dedicated to evaluation of these changes. The present study was designed to elucidate the effect of cataract surgery on the characteristic feature of ocular surface homeostasis – tear film osmolarity in the early postoperative period. Aim. The aim of the study was to evaluate the changes in tear film osmolarity after a cataract surgery in a healthy ocular surface. Methods. For this purpose two examination groups were formed. The study group included voluntary patients undergoing cataract surgery not having any complaints about subjective symptoms typical of dry eye disease. In order to correspond to the criteria of healthy ocular surface, the study group excludes the following types of patients and conditions: contact lens wearers, patients with diabetes, pseudoexfoliation, pterygia and eye drop users. The eye that has not undergone the surgery was classified as the control group. This single–center, prospective study was held at Ophthalmology department of Pauls Stradins Clinical university hospital. All cataract surgeries were done by the same surgeon. The tear osmolarity tests were evaluated with TearLab Osmolarity System (TearLab Corporation, San Diego, CA, the USA) before surgery, in the next morning, one week and one month after the surgery. Results. No statistically significant difference was observed between the groups before operation when comparing the mean tear osmolarity – in the study group it was 296.87 mOsm/L, and in the control group it was 297.27 mOsm/L (p = 0.84). The tear osmolarity results changed significantly during early postoperative period in the study group (p < 0.001), while in non–operated eye no significant tear film osmolarity changes were observed (p = 0.86). Significant changes were recognized on the next day after the surgery – the tears became hypoosmolar (< 275 mOsm/L). One week later the tear osmolarity increased significantly, and the tears became hyperosmolar (312.64 mOsm/L). Over the course of one month, the test values for the study and control groups equalized (297.87 in the study group and 298.93 in the control group (p = 0.66)), when compared to preoperative tear osmolarity results. Conclusion. The results achieved lead towards a more detailed understanding of the changes in the ocular surface homeostasis after a cataract surgery. The obtained data indicate that tear osmolarity changes considerably during the first postoperative month after a cataract surgery. Also, there is a huge difference in measurements between operated and non–operated eye on the next day and one week after the surgery. One month after the surgery tear osmolarity returns to preoperative test results, and there is no difference determined between the eyes.

The present case report discusses about a male patient with closed-globe traumatic cataract and isolated posterior capsule rupture. There are limited studies reporting about such type of complication. The management with phacoemulsification and combined pars plana vitrectomy with intraocular lens reverse optic capture was performed.

RECALCITRANT MULTIDRUG-RESISTANT PSEUDOMONAS KERATITIS WITH SUBSEQUENT TRIPLE PROCEDUREAuthors: Ēriks Elksnis1,2,4, Eva Elksne1,3, Olita Lūse1,2, Juris Vanags1,4, Guna Laganovska1,4Affiliations:Riga Stradins University, Riga, LatviaLatvian American Eye CenterChildren’s Clinical University Hospital, Riga, LatviaPauls Stradins Clinical University HospitalCorrespondence to: Ēriks Elksnis. ORCID 0000-0002-7899-8224Riga Stradins University, Dzirciema street 16, Riga, Latvia. LV1007.Data availability statement : We hereby transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental thereto, exclusively to the journal, in the event that such work is published by the journalConflict of interest disclosure : Authors declare no potential conflicts of interest.Ethics approval statement : All procedures performed involving this case were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Consent statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.KEY CLINICAL MESSAGERecalcitrant Pseudomona aeruginosa keratitis is a challenging case in ophthalmology and can lead to irreversible blindness if not treated properly and in time.KEYWORDS: Pseudomona aeruginosa, recalcitrant keratitis, penetrating keratoplasty.INTRODUCTIONCorneal opacity is the 5th leading cause of blindness and visual impairment, affecting approximately 6 million people worldwide; additionally, it is responsible for 1.5–2.0 million new cases of monocular blindness per year. Among all etiologies (such as infection, trauma, and inflammation), infectious keratitis (IK) is the main cause of corneal blindness, with an estimated incidence ranging from 2.5–799 per 100,000 population years (Ting et al. 2021).Pseudomonas aeruginosa (P. aeruginosa ) is a gram-negative aerobic pathogen that can cause a wide range of infections and is one of the main causative pathogens of bacterial keratitis, especially in contact lens-associated keratitis, potentially leading to sight-threatening complications if not appropriately treated (Hilliam, Kaye & Winstanley 2020).A particular characteristic of multidrug resistant Pseudomonas keratitis is its rapid progression, in which corneal destruction can be completed within 24–48 hours in some of the more virulent bacterial strains (Reynolds & Kollef 2021). Therefore, P. aeruginosa -caused keratitis is often associated with a high-cost long treatment period and poor visual outcomes (Hilliam, Kaye & Winstanley 2020).CASE PRESENTATIONA 60-year-old female presented to a tertiary medical center in May 2021 with progressive vision loss, purulent discharge, photophobia, foreign body sensation, and pain in the left eye (LE).Three weeks prior, the patient developed a foreign body sensation in her LE due to contact lenses remaining unremoved for one night. She had visited her local ophthalmologist and been prescribed topical tobramycin/dexamethasone 3 mg/mL four times daily, cyclopentolate 10 mg/mL twice daily, and dexpenthenolum once daily before bedtime. There was clinical improvement during the first 5 days of therapy; however, severe clinical worsening followed. The patient returned to the outpatient department 8 days after the first consultation, and treatment was changed to topical chloramphenicol/dexamethasone 1 mg/2 mg/mL six times daily, cyclopentolate 10 mg/mL twice daily and oral doxycycline 100 mg twice daily. Despite treatment, the symptoms worsened in the following week.On the presenting day at the tertiary medical center, the best corrected visual acuity (BCVA) was 20/25 in the right eye (RE) and hand-motion (HM) vision in the LE. The RE was unremarkable on initial examination, whereas slit-lamp examination of the LE revealed a massive amount of purulent discharge in the conjunctival fornixes and intense mixed conjunctival injection. A large epithelial defect in the cornea was present, associated with a ring-like stromal infiltrate 3.1 mm in height, which was “soupy” in appearance owing to stromal necrosis. A hypopyon 3.2 mm in height was observed (Figure 1A). Both the lids were swollen and erythematous. As the posterior segment could not be visualized, B-scan ultrasonography of the LE was performed and confirmed a flat retina with no vitritis.Corneal scrapings and cultures were obtained from LE. Cultures were acquired using a sterile cotton-tipped swab and placed in transport medium. The scrapings were placed on a glass slide and, together with the culture, forwarded to a microbiology laboratory.Topical chloramphenicol/dexamethasone was discontinued, and levofloxacin 5 mg/mL eyedrops were initially administered every hour. Additionally, cyclopentolate 10 mg/mL was administered twice daily to control pain and prevent synechia, artificial tear drops were administered to aid wound healing, and oral doxycycline 100 mg twice daily was administered to prevent keratolysis.After 12 hours, the condition worsened; discharge remained in the same amount, however, the hypopyon increased to 5.4 mm in height, with an infiltration spread 360 °around the limbus and significant corneal edema (Figure 1B).Levofloxacin was switched to moxifloxacin 5 mg/mL eye drops every hour. As a result, the amount of purulent discharge reduced, yet the central corneal infiltrate and ulcer remained unchanged, with remarkable stromal necrosis and corneal thinning in the nasal limbs (Figure 1C).On the fourth day from admission, multidrug resistantP.aeruginosa was isolated from the culture. (Table 1). Based on these results, and after consultation with an infectologist, moxifloxacin was changed to fortified piperacillin 1.5 mg/mL/tazobactam 12 mg/mL eye drops every hour.