Demarcation line evaluation of iontophoresis-assisted transepithelial corneal collagen cross-linking for keratoconus.

PURPOSE: To evaluate the visualization and depth of the demarcation line with anterior segment optical coherence tomography (AS-OCT) after iontophoresis-assisted transepithelial corneal collagen cross-linking (CXL). METHODS: This prospective, consecutive, single center, non-randomized clinical study involved 15 eyes of 12 patients with keratoconus who underwent an AS-OCT scan (Spectralis; Heidelberg Engineering, Inc., Carlsbad, CA) to search for a demarcation line and its depth at 1 month after iontophoresis-assisted transepithelial CXL. AS-OCT scan measurements were performed by two independent examiners. RESULTS: No intraoperative or postoperative complications were observed. Kappa coefficient estimation for operator agreement in demarcation line visualization (whether it was visualized) was 70.6%. The corneal stromal demarcation line was identified in 9 eyes (60%) by both examiners. Mean depth of the corneal stromal demarcation line was 246.67 ± 50.72 µm (range: 183 to 339 µm) for the first examiner and 241.89 ± 62.52 µm (range: 163 to 358 µm) for the second examiner. There were no statistically significant differences for the measurements of the paired comparisons between the two examiners (P = .61). The Pearson correlation coefficient between the measurements was 0.910. CONCLUSIONS: Iontophoresis-assisted transepithelial CXL creates a demarcation line that can be visualized with AS-OCT, which seems less easily distinguishable and shallower than in conventional CXL. However, its depth and visualization seems to be more similar to conventional CXL than transepithelial CXL.

Syphilitic Scleritis.

A 47-year-old man developed a painful right red eye for 72 hours with a 20/25 decreased visual acuity. He had no medical history. Slit-lamp examination revealed a painful nodular scleritis at the equator of the globe in the infero-temporal quadrant. There was a moderate intraocular inflammation in the anterior segment. Fundus examination revealed a grade 1 hyalitis and a focal retinitis with vasculitis and arterio-veinous occlusion toward the scleritis zone. Syphilis and HIV serology were positive and the scleritis resolved 5 days after a penicillin G medication. Syphilitic scleritis are relatively uncommon.

A rare presentation of metastatic renal clear cell carcinoma to the tongue seen on FDG PET.

Renal clear cell carcinoma has a great metastatic potential, with possibly uncommon secondary lesions, notably in the head and neck region. The role of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) in the staging or follow-up of urological malignancies is still not clearly defined. We report a case of metastatic renal cell carcinoma involving the tongue and a cervical lymph node, 3 years after initial nephrectomy. The use of combined positron emission tomography/computed tomography scan showed increased F-18 FDG activity in these 2 lesions that were then diagnosed and treated by surgery. Although the diagnostic performance of F-18 FDG PET is limited in the detection of primary disease, this imaging modality can be a very useful tool in the follow-up of renal clear cell carcinoma.