Nowadays, lasers are used in various medical fields. Ophthalmology was the first medical specialty to utilize lasers in patient treatment and still remains the leading medical field that uses laser energy for both therapeutic and diagnostic purposes. The neodymium: yttrium-aluminum-garnet (Nd: YAG) laser is one of the most common lasers used in ophthalmology. It is a solid-state laser with a wavelength of 1064 nm that works on the principle of photodisruption. Since its introduction in ophthalmology over 40 years ago, it has found various applications, mainly for procedures where cutting or disruption of ocular tissue is required. Compared to surgical alternatives, the use of Nd: YAG lasers on ocular tissue is minimally invasive. In this review, we focus on the two most common ophthalmic applications of Nd: YAG laser - laser peripheral iridotomy and posterior capsulotomy. The history of the techniques, current trends, potential complications, and the prognosis for future use is discussed.

Tuberculosis (TB) is a global health threat, especially in HIV patients who may experience immune reconstitution inflammatory syndrome (IRIS) upon Mycobacterium tuberculosis infection. Diagnosing and defining IRIS in non-HIV patients remains challenging. A 63-year-old male with acute leukaemia underwent induction therapy with a regimen containing fludarabine. Febrile neutropenia led to further investigations, revealing non-cavitary pulmonary TB, prompting anti-tuberculosis therapy (ATT) alongside resumed leukaemia treatment with sorafenib. Persistent extra-pulmonary TB, specifically lymph node involvement, were observed and IRIS was suspected, evidenced by enlarged lymphadenopathies, scrofula, and skin lesions that developed during the 13-month course of ATT, with no recurrence after its cessation. This article explores a case of lymph node TB-associated paradoxical IRIS in a non-HIV leukaemia patient, revealing the intricate interplay between tuberculosis and haematological malignancies and emphasizing the lack of standardized diagnostic criteria and treatment consensus. Challenges in lymph node TB diagnosis and management highlight the need for tailored therapeutic approaches. The report explores the potential immunomodulatory effects of fludarabine and sorafenib, questioning their roles in TB-IRIS. This case illuminates TB-IRIS dynamics in non-HIV patients, urging further research and collaborative efforts to enhance understanding and outcomes. As medical complexities persist, personalized therapeutic approaches and advancements in TB-IRIS research are crucial.

The iris is a unique structure, with exquisite variations in colour and form. Pathological changes, specifically including iris cysts and tumours are relatively uncommon, difficult to diagnose, and yet potentially blinding or life-threatening. Based on a comprehensive literature review, with highly illustrated key case examples, this report aims to guide the clinician in filtering the differential diagnoses of iris cysts and tumours. Evaluation is in the context of key diagnostic clinical tools and management considerations. Diagnostic imaging techniques include serial anterior segment photography, ultrasound, anterior segment optical coherence tomography, and iris fluorescein angiography, however, the roles of computerised topography and magnetic resonance imaging are also considered in this review. Management includes categorisation in terms of solid iris tumours (melanocytic vs. non-melanocytic), or iris cysts (primary vs. secondary) that may be usefully differentiated by clinical assessment, avoiding more invasive interventions. Cystic lesions are generally benign, although implantation cysts in particular cause significant complications and surgical challenges. Most solid tumours are melanocytic and also typically benign. However, in larger lesions, rapid growth, symptoms and complications more likely indicate malignancy, requiring further investigation.

We report the first description of spinal cord mycobacterial spindle cell pseudotumor. A patient with newly diagnosed advanced HIV presented with recent-onset bilateral leg weakness and was found to have a hypermetabolic spinal cord mass on structural and molecular imaging. Biopsy and cultures from blood and cerebrospinal fluid confirmed spindle cell pseudotumor due to Mycobacterium avium-intracellulare. Despite control of HIV and initial reduction in pseudotumor volume on antiretrovirals and antimycobacterials (azithromycin, ethambutol, rifampin/rifabutin), he ultimately experienced progressive leg weakness due to pseudotumor re-expansion. Here, we review literature and discuss multidisciplinary diagnosis, monitoring and management challenges, including immune reconstitution inflammatory syndrome.

Opportunistic infections have significantly decreased in individuals living with human immunodeficiency virus and receiving antiretroviral therapy. However, in approximately 10%-25% of patients, severe skin reactions during immune reconstruction are constantly increasing. This may manifest as either an exacerbation of a chronic disease or the development of a new disorder, referred to as immune reconstitution inflammatory syndrome. This review focuses on the current knowledge regarding the dermatological symptoms of immune reconstitution inflammatory syndrome observed in recent years. These symptoms encompass various pathogens, neoplasms, and certain autoimmune diseases. In addition to the most common skin reactions, attention is directed towards conditions not previously described in any review, such as psoriasis.

This systematic review aimed to clarify the relationship between the location of laser peripheral iridotomy (LPI), a common procedure to prevent or treat angle-closure glaucoma, and the incidence of post-procedure visual disturbances known as dysphotopsias. Understanding this relationship is crucial due to the high frequency of LPIs performed and the significant impact dysphotopsia can have on vision and quality of life. Articles investigating the relationship between LPI location and dysphotopsia in at least five patients were identified via a literature search of OVID MEDLINE (1946-November 19, 2022) and EMBASE (1946-November 19, 2022). Non-comparative and non-English studies were excluded. Studies did not require a control group to be included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and Cochrane Risk of Bias 2 (RoB2) tool were used to appraise included studies. Our review included three studies encompassing 1756 eyes from 878 patients. The location of LPI was grouped into superior (604 patients, 889 eyes), inferior (150 patients, 150 eyes), and nasal/temporal (443 patients, 717 eyes). The analysis showed no significant difference in the incidence of any new dysphotopsia types among the location groups post-LPI. Overall, the incidence of lines, ghost images, and blurring significantly increased after LPI, while halos and glare significantly decreased. In conclusion, the current literature suggests that the location of LPI has no significant relationship to the types and rates of dysphotopsia experienced thereafter. While there is a 2-3% risk of linear dysphotopsia after LPI regardless of location, LPI may also resolve pre-existing halos and glare.
摘要: 周边虹膜激光切开术 (LPI) 是预防或治疗闭角型青光眼的一种常见手术, 本综述旨在阐明周边虹膜激光切开术 (LPI) 选择的位置与术后视力障碍发生率之间的关系。由于 LPI 手术的高频率以及视力障碍对视力和生活质量的重要影响, 对其了解至关重要。通过对 OVID MEDLINE (1946 年至 2022 年 11 月 19 日) 和 EMBASE (1946 年至 2022 年 11 月 19 日) 数据库进行文献检索, 发现至少有五名患者的 LPI 位置与视力障碍之间关系的研究文章。非比较型研究和非英文研究被排除在外。纳入研究无需对照组。采用推荐、评估、发展和评价分级 (GRADE) 系统和 Cochrane Risk of Bias 2 (RoB2) 工具对纳入的研究质量进行评估。本综述包括三项研究, 涉及 878 名患者的1756只眼睛。LPI 的位置分为上侧 (604名患者, 889只眼) 、下侧 (150名患者, 150只眼) 和鼻/颞侧 (443名患者, 717只眼) 。分析结果表明, LPI 后各位置组的新发生的视力障碍类型发生率无明显差异。总体而言, LPI后线性视力障碍、黑影和视物模糊的发生率明显增加, 而光晕和眩光则明显减少。总之, 目前文献表明, LPI位置与术后出现的视力障碍类型和发生率没有相关性。无论在哪个位置, LPI后都有 2%-3% 的线性视力障碍风险, 但LPI 也可以解决之前存在的光晕和眩光问题。.

UNASSIGNED: To describe features of a syphilitic vascularized iris mass on multimodal imaging and its resolution after penicillin treatment.
UNASSIGNED: Observational case report and literature review of syphilitic iris masses.
UNASSIGNED: A 43-year-old woman presented with a unilateral vascularized tan iris mass in the setting of bilateral panuveitis that occurred along with bilateral papillitis, cystoid macular edema and retinal vasculitis. Laboratory work-up confirmed a diagnosis of syphilis. Ultrasound biomicroscopy (UBM) of the iris mass showed parapupillary hyperechoic full-thickness iris stromal thickening with small intrinsic circular lumens without cyst or ciliary body extension, while the anterior segment optical coherence tomography (AS-OCT) demonstrated a hyperreflective mass with deep iris extension and partial hyporeflective rim. Following treatment, the mass fully resolved without residual sequela. A review of literature identified 11 additional cases of syphilitic iris masses in the English literature from 1915 to present. Their presentations and clinical courses were reviewed herein.
UNASSIGNED: This report characterizes a syphilitic iris mass on slit-lamp photography, iris fluorescein angiography, UBM and AS-OCT; depicts key characteristics of syphilitic iris masses; and highlights the need for close inspection of the iris mass as an uncommon sign of ocular syphilis.

Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by five years and in 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are denoted by a letter (ABCDEF) guide: A for age ≤40 years old at presentation (hazard ratio [HR] = 3, P = .01), B for blood (hyphema) (HR = 9, P < .0004), C for clock hour of tumor inferiorly (tumor location) (HR = 9, P = .03), D for diffuse flat tumor configuration (HR = 14, P = .02), E for ectropion uveae (HR = 4, P = .002), and F for feathery ill-defined margins (HR = 3, P = .02). At diagnosis, iris melanoma has a mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). We provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis, with the hope that clinicians will be more comfortable in understanding this rare malignant condition.

UNASSIGNED: It is well established that starting antiretroviral therapy (ART) increases a patient\'s life expectancy among HIV-positive individuals. Considering the HIV pandemic, the major concern is initiation of ARTs to the large segment of HIV infected population, not adverse events from immune restoration. The prevalence of HIV-associated immune reconstitution inflammatory syndrome (IRIS) is poorly estimated due to Africa\'s underdeveloped infrastructure, particularly in Eastern Africa. Therefore, this study compiled data regarding the magnitude and associated factors of IRIS in the context of Eastern Africa.
UNASSIGNED: The electronic databases such as Google Scholar, PubMed, Web of Science, and free Google access were searched till 5 June 2021, and the search was lastly updated on 30 June 2022 for studies of interest. The pooled prevalence, and associated factors with a 95% confidence interval were estimated using the random effects model. The I2 and Egger\'s tests were used for heterogeneity and publication bias assessment, respectively.
UNASSIGNED: The development of HIV-associated IRIS in Eastern Africa was estimated to be 18.18% (95% CI 13.30-23.06) in the current review. The two most common predictors of IRIS associated with Eastern Africa were the lower pre-ART CD4 T-cell count of 50 cells/μl and the low baseline body mass index level. Therefore, attention should be focused on the early detection and care of HIV-associated IRIS to reduce the morbidity and death caused by IRIS.

OBJECTIVE: The current review will discuss the pathophysiology, work-up and clinical relevance of the ocular phenotype in Williams-Beuren syndrome in detail.
RESULTS: Few case reports, case series and retrospective studies reported the ophthalmic features in Williams-Beuren syndrome, focusing on specific aspects of the ocular involvement. Recently, novel retinal findings have been described in association with the disease.
CONCLUSIONS: Numerous ocular features have been described in Williams-Beuren syndrome. Some of them, such as the stellate pattern of the iris or the retinal arteriolar tortuosity may be helpful for the diagnosis but have no significant clinical implications; others, such as strabismus and refractive errors require early treatment to reduce the risk of irreversible visual impairment. Finally, some features, such as a broad foveal pit and thinner retina still have unknown significance and require further longitudinal and multimodal studies.