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Purpose: To evaluate the effect of night shifts on the biomechanical properties of the cornea using Scheimpflug camera-based imaging (Corvis and Pentacam). Methods: Thirty-four participants from the medical staff who had at least six night shifts per month as a case group and fifty-two participants as a control group participated in the study. The biomechanical characteristics of the cornea using the Corvis device and the topographical characteristics of the cornea using the Pentacam device were investigated in the participants. Results: The main indices of corneal biomechanics including Corvis Biomechanical Index (0.17 ± 0.18 vs. 0.15 ± 0.14; P = 0.66 [adjusted] and 0.66 [unadjusted]) and Tomographic and Biomechanical Index (0.16 ± 0.19 vs. 0.14 ± 0.19; P = 0.78 [adjusted] and 0.63 [unadjusted]) were not significantly different between case and control groups. Conclusion: Our study showed that night shifts do not independently affect corneal biomechanical indices.

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BACKGROUND: Epithelial downgrowth is a rare complication after Descemet stripping automated endothelial keratoplasty (DSAEK), which usually leads to poor visual outcome despite multiple available options of treatment. CASE PRESENTATION: A 50-year-old man underwent DSAEK procedure due to pseudophakic bullous keratopathy. Three months later, the patient presented with gradual visual loss; slit-lamp examination revealed detachment and folding of the DSAEK lenticule, which was confirmed by anterior segment optical coherence tomography. On confocal scanning, epithelial cell sheets were detected in the interface leading to the wrinkling of the donor tissue and donor detachment. Surgical debridement and transient fixating with straight 10-0 prolene needles were performed followed by air injection into the anterior chamber. The cornea turned clear in the one-year follow-up with uncorrected-visual acuity of 20/30 and best-corrected visual acuity of 20/25. CONCLUSIONS: Early diagnosis and treatment of epithelial downgrowth may be associated with a good prognosis and prevent from more aggressive treatments such as repeat of grafting. In this case, mechanical debridement and transient fixation of lenticule by 10-0 prolene needles was performed to manage post-DSAEK epithelial downgrowth and lenticule detachment, which was successful without requiring of additional re-grafting. It seems this is a feasible technique with acceptable long-term outcomes.

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BACKGROUND: Acute retinal necrosis is considered a rare infectious uveitis. This condition is usually caused by varicella-zoster virus or herpes simplex virus. Acute retinal necrosis caused by co-infection with multiple viruses is extremely rare. Herein, we report a case of acute retinal necrosis caused by co-infection with herpes simplex virus (type I and II) and varicella-zoster virus (VZV) in a natalizumab-treated patient due to multiple sclerosis. CASE PRESENTATION: An adult man presented with a complaint of decreased vision of the right eye from 12 days ago. He was a known case of multiple sclerosis receiving natalizumab. Examination of the right eye revealed severe conjunctival injection, fine diffuse keratic precipitates, 3 + anterior chamber and vitreous cells, elevated intraocular pressure (26 mmHg), a blurred optic disk with hemorrhagic patches, and occlusive vasculitis plus confluent necrotizing patches in the peripheral retina compatible with diagnosis of acute retinal necrosis. He underwent anterior chamber and vitreous tap, and real-time PCR detected HSV I & II and VZV on the vitreous specimen. A second PCR showed the same result. After neurological consultation, natalizumab was discontinued and intravenous acyclovir was started followed by oral acyclovir and oral prednisolone to control the disease, which was successful. CONCLUSIONS: Although rare, multiple-viral infection should be considered in the physiopathology of acute retinal necrosis, especially in immunosuppressed patients.

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