Sudden transient loss of vision after an acute bout of alcohol consumption in patients with chronic alcoholism is rare. The underlying mechanism is a transient depression of the endothelial pump due to ethanol toxicity following a large amount of alcohol consumption in chronic alcoholic patients. Here, we report a rare case of a 60-year-old male patient who came to the outpatient department with complaints of sudden loss of vision associated with redness following a large amount of alcohol consumption. The case was managed by prompt diagnosis and topical and oral corticosteroid therapy. This is a rare case of acute toxic endotheliitis due to ethanol toxicity with only a few cases reported in the past.

Proper hydration and the clarity of the cornea are maintained through the crucial function of the corneal endothelium. Inflammation of the corneal endothelium, known as endotheliitis, can disrupt endothelial function, resulting in alterations to vision. Corneal endotheliitis is characterised by corneal oedema, the presence of keratic precipitates, inflammation within the anterior chamber, and occasionally, limbal injection, neovascularisation, and the concurrent or overlapping presence of uveitis. The aetiology of this condition is diverse, predominantly viral, but it may also be drug-induced, result from bacterial or fungal infections, be associated with systemic diseases and procedures, or remain idiopathic with no identifiable cause. To date, no standardised protocol for the treatment of this ocular disease exists, and in severe cases, corneal transplantation may be required. A 31-year-old male was transferred to our hospital for the management of corneal endothelial decompensation resulting from corneal endotheliitis. Hormonal therapy and antiviral medications proved ineffective, rendering the patient a candidate for corneal transplantation. As a final measure, treatment with the ROCK inhibitor netarsudil was initiated. The patient demonstrated significant improvement in symptoms, and the inflammation was successfully managed after nine months. In this study, a novel approach employing ROCK inhibitor therapy was utilised for the treatment of corneal endotheliitis, leading to marked recovery during patient follow-up. This case report represents the inaugural application of the ROCK inhibitor netarsudil in managing corneal endothelial decompensation attributed to corneal endotheliitis. These findings suggest that this method warrants consideration as a potential novel treatment option for similar conditions.

UNASSIGNED: We describe a case of reticular bullous corneal epithelial edema associated with the use of netarsudil ophthalmic solution (0.02%) for elevated intraocular pressure.
UNASSIGNED: A 74-year-old man with a complex ocular medical history, including Fuchs dystrophy and primary open-angle glaucoma, developed progressively worsening loss of vision 3 weeks following the initiation of topical netarsudil for increased intraocular pressure. Visual acuity in the left eye was counting fingers at 3 feet and intraocular pressure in the left eye was 7 mm Hg. A characteristic \"honeycomb\" pattern epitheliopathy was seen on ocular examination.
UNASSIGNED: Reticular bullous epithelial corneal edema is an uncommon finding associated with netarsudil use, which can be overlooked in favor of corneal edema associated with Fuchs dystrophy. This is especially relevant given Fuchs dystrophy itself is a predisposing risk factor for netarsudil-induced reticular bullous corneal epithelial edema. Improvement of both the corneal edema and visual acuity should be expected after discontinuing netarsudil and undergoing superficial keratectomy.

OBJECTIVE: The objective of the study was to describe the optical coherence tomographic features of a cat with acute corneal hydrops.
METHODS: A 4-year-old castrated male domestic shorthaired showing conjunctival redness, ocular discharge, and intermittent squinting of both eyes with asymmetrical disease onset.
METHODS: Complete ophthalmic examination and optical coherence tomography were performed.
RESULTS: On slit-lamp biomicroscopic examination, severe intrastromal fluid pockets with profound bullae were observed in the dorsomedial region in both eyes. A diagnosis of feline acute corneal hydrops was made in both eyes. Optical coherence tomography revealed profound stromal lamellar separation representing heterogeneous reflective areas, and fluid pockets and bullae of variable size were concomitant to Descemet\'s membrane detachment demonstrated by a well-defined homogeneous hyporeflective area. Upon reevaluation 30 days during healing process for both eyes, the thickened epithelia and the thinning pan-stromal areas were identified as homogeneously hyper-reflective epithelia and as heterogeneous hyper-reflectivity, respectively. A thickened posterior corneal surface was shown as heterogeneous with patchy hyper-reflectivity. Additionally, Descemet\'s membrane detachment in the initial presentation had two distinct forms suspicious of Descemet\'s membrane rupture in each eye: a break with rolled ends and a break with flat ends.
CONCLUSIONS: To the author\'s knowledge, this study represents the first documentation of in vivo detection of Descemet\'s membrane detachment and presumed rupture in a cat experiencing acute corneal hydrops. These observations strongly indicate that Descemet\'s membrane detachment/rupture acts as a most likely risk factor in the onset of acute corneal hydrops in cats.

BACKGROUND: Lamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as Descemet Membrane Endothelial Keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management.
METHODS: An 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24 h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber. She underwent re-DMEK with preservation of the original graft after 24 h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble. 24 h after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9.
CONCLUSIONS: The discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues.

UNASSIGNED: To describe a case of bilateral interface fluid formation 2 years after laser-assisted in situ keratomileusis (LASIK) surgery caused by the side effect of amantadine.
UNASSIGNED: A 47-year-old male patient with a history of Parkinson\'s disease treated with amantadine who had uneventful LASIK surgery in both eyes 2 years ago, presented with a decline in vision over the past 6 weeks. Results: Best corrected vision was 20/200 and 20/400 in the right and left eye respectively. Intraocular pressures were measured within the normal range. Biomicroscopic exam showed bilateral corneal edema. Anterior segment optical coherence tomography (AS-OCT) revealed fluid accumulation within the LASIK flap interface in both corneas. The patient\'s corneal edema and fluid in the interface began to gradually resolve, and vision improved 2 weeks after discontinuing amantadine.
UNASSIGNED: Although there is no previous report, it is possible that amantadine may cause interface fluid formation in patients with LASIK surgery.

OBJECTIVE: The aim of this study was to describe the efficacy of Descemet membrane endothelial keratoplasty (DMEK) in patients with corneal endothelial decompensation secondary to a forceps-induced corneal birth injury.
METHODS: This was a retrospective, noncomparative, interventional case series. Four eyes of 4 patients (1 female and 3 males; mean age, 64.0 ± 4.7 years) with corneal endothelial decompensation due to forceps-induced corneal birth injury were included. DMEK was performed in all cases, using a combined technique, including the use of intraoperative optical coherence tomography, vital staining of Descemet membrane of both host and donor, removal of scarred Descemet membrane with side-port forceps and vitreous cutter to smoothen the posterior corneal surface, epithelial peeling, and illumination for visualization. The examination included preoperative and postoperative ophthalmologic examinations: best-corrected visual acuity (converted to logarithm of the minimum angle of resolution [logMAR]), intraocular pressure, endothelial cell density (ECD), and central corneal thickness.
RESULTS: No postoperative complications were noted, and corneal transparency was maintained during follow-up (mean follow-up period, 32.0 ± 27.0 months; range, 3-71 months). The mean best-corrected visual acuity was 0.52 ± 0.35 logMAR preoperatively and 0.15 ± 0.09 logMAR at the last visit. The mean postoperative ECD was 1632 ± 631 cells/mm 2 (mean ECD at baseline, 3167 cells/mm 2 ). Central corneal thickness decreased from 640 ± 67 μm preoperatively to 576 ± 58 μm postoperatively.
CONCLUSIONS: This study suggests that DMEK can be performed uneventfully in eyes with a forceps-induced corneal birth injury. The combination of surgical techniques may be an effective approach for DMEK.

CONCLUSIONS: Some patients show poor visual outcomes after Descemet stripping automated endothelial keratoplasty. In such cases, secondary Descemet membrane endothelial keratoplasty can be performed to achieve complete visual recovery. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the follow-up of posterior lamellar keratoplasty outcomes and complications.
OBJECTIVE: This study aimed to report the clinical outcome of secondary Descemet membrane endothelial keratoplasty for managing poor visual results in a patient with graft failure after a previous Descemet stripping automated endothelial keratoplasty, highlighting the importance of AS-OCT in the follow-up of endothelial keratoplasty.
METHODS: A 38-year-old woman with high myopia underwent Descemet stripping automated endothelial keratoplasty for bullous keratopathy after explantation of an angle-supported phakic intraocular lens. Two years after keratoplasty, the patient experienced poor visual acuity (counting fingers), and significant corneal edema was observed on clinical examination hindering visualization of the anterior chamber structures. Anterior segment optical coherence tomography showed a failed and thickened graft adhering well to the recipient cornea in an anterior chamber without other comorbidities. Therefore, the graft was removed and replaced with a Descemet membrane endothelial keratoplasty graft without any complications. One year later, the clinical outcome was evaluated by comparing the pre-operative and post-operative best-corrected visual acuity, biomicroscopy findings, endothelial cell density, and corneal central thickness.
CONCLUSIONS: Anterior segment optical coherence tomography is an important tool when deciding on the surgical technique to be applied and for the post-surgical monitoring of endothelial corneal grafts. This case demonstrates the successful management of Descemet stripping automated endothelial keratoplasty graft failure with Descemet membrane endothelial keratoplasty graft, highlighting the importance of AS-OCT in detecting complications such as graft dislocation and primary graft failure. In addition, corneal thickness measured using AS-OCT serves as a critical predictor of graft failure, as observed in this case.

UNASSIGNED: To present a case of irreversible corneal edema after 10 years of amantadine use. A literature review was carried out to describe the clinical characteristics and outcomes of amantadine-induced corneal edema.
UNASSIGNED: A 36-year-old woman presented with a 6-week history of gradually progressive bilateral painless visual loss with visual acuity (VA) of 20/350 and 20/300 in the right and left eye, respectively. Examination showed bilateral diffuse central corneal edema with multiple Descemet membrane folds without endothelial guttata, keratic precipitates or intraocular inflammation. This did not respond to hypertonic saline drops and empirical treatment for presumed herpetic endotheliitis with oral acyclovir. Medication review revealed the use of amantadine 100mg daily for the past 10 years, prescribed by her neurologist for fatigue. Despite discontinuing amantadine, corneal edema was irreversible due to a markedly reduced endothelial cell count of 625 (right) and 680 cells/mm2 (left).
UNASSIGNED: This case highlights the need to consider amantadine as a cause of unexplained bilateral non-guttae corneal edema. A literature review of 33 case reports revealed broadly similar features of amantadine-induced corneal edema; whilst most cases had favorable outcomes with median VA 20/25 (interquartile range IQR 20/20-20/30) and complete resolution of corneal edema within 30 days (IQR 14-35) of amantadine discontinuation, most experienced low endothelial cell density 759 cells/mm2 (IQR 621-1078). Taken together, screening specular microscopy ought to be considered for those in whom amantadine is likely required long-term.

UNASSIGNED: Brown-McLean Syndrome (BMS) was first documented by Brown and McLean in 1969. To date, BMS is typically described in primarily cataract-related complications, and it is inextricably associated with long-term aphakia. Our purpose is to report a case that describes a unique association of BMS in the presence of patent peripheral iridectomy.
UNASSIGNED: A 35-year-old male known case of congenital glaucoma who has a history of bilateral trabeculectomy, presented to our clinic with a long history of mild progressive blurriness of vision for years. Upon examination, the patient was bilaterally phakic, with bilateral 360-degree of peripheral corneal edema sparing the center of the cornea with endothelial pigmentation and bilateral patent peripheral iridectomy in an otherwise stable ophthalmic examination. His uncorrected visual acuity was 20/20 in the right eye and 20/30 in the left eye with normal intraocular pressure. Our plan was to prescribe topical medications and schedule him for regular follow-up. At the last follow-up, our patient reported no improvement in his vision, and there were no signs of clinical improvement.
UNASSIGNED: This case of BMS demonstrates the importance of the potential of such a disease to develop, albeit rarely, in phakic patients who are undergoing intraocular surgery. The preventive role of PI is also questionable.
UNASSIGNED: Ophthalmology, Pediatrics, Transplantation.