RESUMO
IgG4-related disease is a newly recognized fibro-inflammatory condition. The purpose of this report is to present a patient with 11 years of follow-up, who revealed characteristic features of IgG4-related disease with systemic, orbital and corneal involvement and showed a favorable response to steroids and rituximab treatment.
Assuntos
Úlcera da Córnea/diagnóstico , Glucocorticoides/uso terapêutico , Imunoglobulina G/sangue , Doenças Orbitárias/diagnóstico , Pancreatite/diagnóstico , Paraproteinemias/diagnóstico , Rituximab/uso terapêutico , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Úlcera da Córnea/tratamento farmacológico , Combinação de Medicamentos , Seguimentos , Humanos , Fatores Imunológicos/uso terapêutico , Masculino , Doenças Orbitárias/tratamento farmacológico , Pancreatite/tratamento farmacológico , Paraproteinemias/tratamento farmacológico , Plasmócitos/patologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To evaluate rates of changes per year of central corneal thickness after antiglaucomatous drug administration with ß-blockers, prostaglandin analogs, and carbonic anhydrase inhibitors monotherapy and combined topical antiglaucomatous therapy, in a cohort of patients with ocular hypertension, glaucoma suspects, and patients with perimetric glaucoma as compared with normal controls. PATIENTS AND METHODS: This retrospective single-center study included 130 eyes as healthy controls, 121 eyes of ocular hypertensive patients, 105 eyes of glaucoma suspects, and 49 eyes of perimetric glaucoma patients. All patients underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography, and optical coherence pachymetry (OCP; Heidelberg Engineering). The cohort was divided into 8 groups on the basis of topical antiglaucomatous medication. Linear regression analysis was conducted to analyze the relationship between central corneal thickness and exposure to antiglaucomatous medication during the follow-up. RESULTS: Central corneal thickness did not change during the follow-up for investigated diagnostic subgroups. There was a statistically significant decrease in central corneal thickness for eyes treated with prostaglandin monotherapy (-3.1 µm/y for left eye), and a combined therapy with prostaglandins, carbonic anhydrase inhibitors, and ß-blockers (-5.8 and -3.8 µm/y for right and left eye, respectively). CONCLUSIONS: We recommend regular measurements before and during therapy with prostaglandin monotherapy and a combined therapy with prostaglandins, carbonic anhydrase inhibitors, and ß-blockers. Follow-up intraocular pressure measurements may be underestimated for eyes treated with the aforementioned treatment regimens if central corneal thickness is not measured on a regular basis.
Assuntos
Anti-Hipertensivos/efeitos adversos , Córnea/efeitos dos fármacos , Doenças da Córnea/induzido quimicamente , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Inibidores da Anidrase Carbônica/administração & dosagem , Inibidores da Anidrase Carbônica/efeitos adversos , Córnea/fisiopatologia , Doenças da Córnea/fisiopatologia , Paquimetria Corneana , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Interferometria , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/fisiopatologia , Prostaglandinas F Sintéticas/administração & dosagem , Prostaglandinas F Sintéticas/efeitos adversos , Estudos Retrospectivos , Tonometria Ocular , Testes de Campo VisualRESUMO
PURPOSE: During deep anterior lamellar keratoplasty (DALK), endothelium and Descemet's membrane are separated from the corneal stroma by intrastromal air injection ('big-bubble technique'). The aim of our study is to analyse histopathological changes in host corneal tissue caused by air insufflation in patients with keratoconus, their variability in 10 patients and their possible clinical implication. METHODS: The excised anterior corneal lamellae of 10 patients with keratoconus having undergone DALK using the 'big-bubble technique' were analysed by light and transmission electron microscopy as well as immunohistochemistry. In addition, intrastromal air accumulations were quantified morphometrically. RESULTS: Intrastromal air was detected in all examined excised lamellae (8% of stromal volume), but with large variability (SD 8.8). It was detected preferentially in the inner layer of the corneal stroma and represented there up to 39% of the stromal volume. In addition, the air was predominantly located at one periphery of the excised lamellae. Intrastromal air bubbles were larger in the inner than in the superficial stromal layer and characterized by round shape and a CD68-negative collagenous 'pseudocapsule'. We detected no air-injection-induced alterations in Bowman's layer and epithelium. CONCLUSION: Our results show that 'big-bubble DALK' causes significant intrastromal air accumulations in the cornea. Pathologists should be conscious of this phenomenon and the high topographic variability. Intrastromal air in the recipient rim may be accompanied by a decrease in mechanical stability and could contribute to postoperative suture loosening.