ACUTE RETINAL NECROSIS AND CONTRALATERAL CUTANEOUS ERUPTION AFTER THE SHINGLES VACCINE.

PURPOSE: To the best of our knowledge, we present a rare case report describing an occurrence of acute retinal necrosis in an otherwise healthy individual who received the shingles vaccine. METHODS: Observational case report. PATIENT: A 63-year-old healthy and immunocompetent white man presented with change of vision in the left eye after blunt trauma. A diagnosis of corneal abrasion was made. During follow-up, a detailed history discovered a progressive deterioration in vision over the past few weeks. Three months before presentation, he had received the shingles vaccine (Zostavax); 1 month before presentation, he reported an episode of varicella skin eruption on the face. RESULTS: On examination, the patient was found to have acute retinal necrosis with white satellite lesions in the fundus of the left eye. An anterior chamber paracentesis and polymerase chain reaction confirmed the diagnosis of varicella-zoster virus. CONCLUSION: Varicella-zoster virus reactivation after shingles vaccination may predispose both immunocompetent and immunocompromised individuals to herpes-zoster ophthalmicus, leading to acute retinal necrosis.

Inferior Corneal Haze and Inflammatory Endotheliopathy Related to Pars Planitis.

PURPOSE: To describe the finding of inferior corneal haze secondary to presumed inflammatory endothelio-10 pathy in a series of patients with pars planitis. METHODS: Single-center retrospective observational consecutive case-series. RESULTS: Seven patients with an established diagnosis of pars planitis are described in this case series including four females and three males. The ages ranged from 5 to 31 years at presentation. Pars planitis was bilateral in six patients and unilateral in one patient. Fundus examinations revealed vitreous opacities and pars plana exudates in all seven patients, cystoid macular edema in four patients, and peripheral retinal vasculitis in two patients. Corneal examination revealed opacification of the posterior cornea in an inferior location in 10 of the 13 eyes with pars planitis. Only one of these eyes had keratic precipitates. For a given patient, corneal involvement was more commonly seen in the more inflamed eye. In one patient with active inflammation, microcystic corneal edema was noted to predate the formation of inferior corneal endothelial opacification, suggesting that physical proximity to the site of inflammation at the inferior pars plana is the cause of this notable physical finding. CONCLUSIONS: Inferior posterior corneal haze related to inflammatory endotheliopathy may occur in eyes with pars planitis. As patients with pars planitis may be otherwise asymptomatic, this corneal finding shouldprompt a detailed funduscopic examination to rule out this form of uveitis.

A novel non-invasive retentive approach of an interim auricular prosthesis: A case report.

Auricular reconstruction is a challenging issue. It can either be performed surgically or by the use of prosthesis. Definitive auricular prosthesis can be retained by craniofacial implants. Temporary (interim) prosthesis can be retained using adhesives, engaging anatomical undercuts and using mechanical means of retention-like spectacles. This case report proposes a new mechanical means of retention for a temporary auricular prosthesis, which can be suitable for non-eyeglass wearing females or for female patients who refuse to wear eyeglass for retaining their prosthesis.

Local Anesthesia Effects on Postoperative Pain After Pediatric Oral Rehabilitation Under General Anesthesia.

Purpose: The purpose of this study was to investigate the effects of local anesthesia (LA) on postoperative pain after pediatric oral rehabilitation under general anesthesia (ORGA). Methods: Ninety-six healthy pediatric dental patients undergoing ORGA were allocated equally into two main groups. In group one, only restorative treatment was indicated; in group two, dental restoration and extraction were performed. Both groups were further divided into subgroups. In subgroup one (experimental group), but not in subgroup two (control group), LA was administered. Seven pain scores were recorded for each patient using a universal pain assessment tool (UPAT). Results: Statistical analysis revealed no significant differences in pain scores between subgroups. Conclusion: Within the limitations of this study, the use of local anesthesia in pediatric dental patients undergoing oral rehabilitation under general anesthesia had no effects on postoperative pain reduction. (Pediatr Dent 2019;41(3):181-5) Received August 8, 2018 | Last Revision February 26, 2019 | Accepted March 4, 2019.

Smear layer removal efficiency using apple vinegar: An in vitro scanning electron microscope study.

PURPOSE: To evaluate and compare the smear layer removal efficacy using two different concentrations of apple vinegar. METHODS: 48 single-rooted human teeth with conical roots and canals were randomly divided into four groups and prepared by using a nickel-titanium rotary system (Flexmaster). The final irrigation regimens used were: Group A (negative control group) in which distilled water only was used: Group B (positive control group) in which 2.5% NaOCL was used during instrumentation and 17% EDTA as a final irrigant; Group C (experimental group) in which the 5% apple vinegar was used as a root canal irrigant during instrumentation and as a final irrigant; and Group D (experimental Group 2) in which the diluted apple vinegar was used as a root canal irrigant during instrumentation and as a final irrigant. Specimens were then examined under a scanning electron microscope and scored for smear layer removal on the coronal, middle and apical thirds. RESULTS: 5% apple vinegar was significantly more effective in smear layer removal only in the apical third (P< 0.001). However, diluted apple vinegar was comparable to 5% apple vinegar and 2.5% NaOCl and 17% EDTA, within the coronal and middle levels of the root canal (P<0.05). CLINICAL SIGNIFICANCE: 5% apple vinegar was significantly more effective in smear layer removal only in the apical third. Diluted apple vinegar demonstrated comparable results to the control groups. Thus, it is possible to use diluted apple vinegar as an irrigant after investigating its antimicrobial efficiency and the effect on sealing ability.

Applicability of Demirjian's method for dental age estimation in a group of Egyptian children.

AIMS: The aims of this study were to evaluate the applicability of Demirjian's method for dental age assessment in a group of Egyptian children in Minia city and to develop an age predictive equation suitable for the studied group. SUBJECTS AND METHODS: In this retrospective, blind, cross-sectional study, 160 dental panoramic radiographs (DPTs) were selected from 420 DPTs from healthy children aged between three and 10 years old from the archived medical files of patients attending Minia University Dental Hospital (MUDH) and evaluated to estimate dental ages. RESULTS: Age was overestimated for almost all of the studied subjects with an accuracy range from 0.18 to 1.19 years for males and from 0.08 to 0.87 years for females, with the exception of two age subgroups (9-10-year-old males and 10-11-year-old females, for which the mean difference values were -0.06 and -0.008 years, respectively). A Logistic regression was used to generate a suggested formula for dental age estimation. CONCLUSIONS: Demirjian's method may be unsuitable for Egyptian children living in Minia city. Development of a predication equation and the introduction of adaptable conversion tables to transform the maturity score into a dental age for Egyptian children may be suitable alternatives. The validity of the newly developed prediction equation must be tested among all Egyptian children.

Chronic Uveitis Following Neodymium-Doped Yttrium Aluminum Garnet Laser Peripheral Iridotomy.

PURPOSE: Assessment of a chronic uveitis entity in nonuveitic patients following neodymium-doped yttrium aluminum garnet (Nd:YAG) laser peripheral iridotomy. METHODS: A 7-year retrospective observational case series of 5 patients that developed chronic uveitis following a Nd:YAG laser peripheral iridotomy treatment. RESULTS: Five eyes of 5 nonconsecutive patients had developed chronic anterior uveitis lasting >12 weeks. Four patients were female, with a mean age of 60.3 years (range, 48 to 83 y), and a mean follow-up duration of 8 months after initiation of treatment. CONCLUSIONS: Chronic anterior uveitis should be addressed as a possible risk in patients undergoing Nd:YAG laser iridotomies. A larger prospective study would be necessary in establishing and exploring the association between these 2 entities.

A single visit feeding plate for 3 months old cleft palate infant . A case report.

Infants with cleft palate (CP) suffer from several difficulties, one of them is feeding, which prevent infant from maintaining adequate nutrition. Usage of feeding plate, special bottles and nipples has been described to overcome this problem. This article describes steps of constructing a single visit feeding plate for a CP infant. The main objective was to provide an infant with a properly functioning feeding prosthesis and to reduce parents' anxiety originated from multiple dental visits. We can conclude that our feeding plate was successfully achieving the planned objectives.

The course of retinal vasculitis.

AIMS: To determine if characteristics of retinal vasculitis correlate with ocular complications, or the response to different lines of treatment. MATERIALS AND METHODS: We performed a computerised database analysis of 56 patients evaluated for uveitis at the Casey Eye Institute from September 1985 until May 2010. All patients had non-infectious retinal vasculitis and at least 1 year of follow-up. RESULTS: Although occlusive vasculitis was rare, retinal neovascularisation occurred much more commonly in the occlusive vasculitis subgroup than among the non-occlusive vasculitis subgroup (p<0.01). Epiretinal membrane (ERM) was found more commonly in the retinal vasculitis patients who presented with cotton wool spots and intraretinal haemorrhage compared to retinal vasculitis patients who presented with sheathing noted on clinical examination (p<0.01). Smoking was significantly related to vision loss. Age at presentation below 40 years correlated with therapy beyond oral corticosteroids CONCLUSIONS: The heterogeneity of retinal vasculitis should be considered in providing prognostic information. Neovascularisation occurs more commonly in occlusive retinal vasculitis, and ERM is diagnosed more frequently in conjunction with cotton wool spots and intraretinal haemorrhage rather than just vascular sheathing. Cigarette use predicts visual loss and patients who are relatively young often receive treatment beyond oral corticosteroids.

TINU (tubulointerstitial nephritis uveitis) can be associated with chorioretinal scars.

PURPOSE: To report a case series of patients with chorioretinal lesions secondary to tubulointerstitial nephritis and uveitis (TINU). METHODS: Retrospective chart review of patients with TINU. RESULTS: We found 4 patients (3 with a possible or probable diagnosis of TINU and 1 with a definite diagnosis of TINU) and multiple chorioretinal lesions. CONCLUSION: Tubulointerstitial nephritis and uveitis usually presents with anterior uveitis, but chorioretinal lesions do occur and may facilitate the diagnosis.

Characteristics and visual outcome of patients with retinal vasculitis.

OBJECTIVE: To examine the characteristics and visual outcome in 207 patients with retinal vasculitis. METHODS: Demographic and visual outcome data were collected retrospectively from the ophthalmologic records of 207 cases (321 affected eyes). Descriptive analysis was performed on all cases and visual outcome analysis was performed for the 114 cases with visual acuity recorded at 2 or more visits. The Kaplan-Meier method and Cox regression were used to examine visual outcome and predictors for prognosis. RESULTS: Patients in our series had a roughly even distribution of sex, were predominantly non-Hispanic white (77.8%), and had bilateral disease (75.7%). The annualized mean visual acuity change for the 203 eyes (114 patients) with some follow-up was 0.01 logMAR unit per year. Although 75 eyes (36.9%) had 20/25 or better visual acuity at baseline, 33.6% of the remaining eyes experienced visual acuity improvement of at least 2 lines on the Snellen chart during follow-up and some continued to improve more than 9 years after the initial evaluation. Cox multivariate analysis demonstrated that patients who were nonwhite, had worse visual acuity at baseline, or who had an ocular infection were more likely to experience improvement by this definition. CONCLUSIONS: We believe that this is the first US case series to investigate visual outcome in patients with this diagnosis. Although many patients in our series worsened despite therapy, a subset experienced substantial improvement.

Patients with retinal vasculitis rarely suffer from systemic vasculitis.

OBJECTIVES: Systemic vasculitis is often mistakenly assumed to be a common cause of retinal vasculitis. We sought to determine the relationship between retinal vasculitis and systemic vasculitis. METHODS: A selected review was performed on 1390 charts of patients attending the uveitis clinic at the Oregon Health and Science University between 1985 and 2010. Included in the review were all patients with diagnoses commonly associated with retinal vasculitis and all patients who were diagnosed with a systemic vasculitis. Retinal vasculitis was identified by perivascular exudates, intraretinal hemorrhage, or cotton wool spots as seen on clinical examination or by vascular occlusion or leakage as identified by fluorescein angiogram. RESULTS: Two hundred seven or 14.9% of patients with uveitis had retinal vasculitis as a component of the intraocular inflammation. Thirty-five patients had retinal vasculitis that was primary, ie, not associated with a systemic disease, and the dominant manifestation of the uveitis. Fourteen of the patients with retinal vasculitis had Behcet's disease. Only 11 of the 1390 patients with uveitis had a systemic vasculitis. Of these 11, four had retinal vasculitis including 1 secondary to a cytomegalovirus retinitis. Thus, systemic vasculitis was directly responsible for 1.4% or 3 of 207 cases of retinal vasculitis. Nonvasculitic systemic diseases such as sarcoidosis (n = 13), syndromes confined to the eye such as pars planitis (n = 36), and intraocular infections (n = 29) were far more common causes of retinal vasculitis. CONCLUSIONS: Retinal vasculitis is a relatively common feature of uveitis. Patients with retinal vasculitis, however, rarely suffer from 1 of the classical systemic vasculitides.

Comparative study of intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) in the treatment of neovascular age-related macular degeneration.

AIMS: To compare the safety and efficacy of 2 anti-vascular-endothelial-growth-factor agents - bevacizumab (Avastin) versus ranibizumab (Lucentis) - in the treatment of patients with neovascular age-related macular degeneration (AMD). METHODS: Retrospective analysis of patients who received intravitreal injections of bevacizumab or ranibizumab for neovascular AMD. Primary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) assessed by Spectral Domain scanning laser ophthalmoscope-optical coherence tomography (SD-OCT). A secondary outcome measure was the report of any adverse events in the 2 groups. RESULTS: The number of injections in the bevacizumab group was 184 (average of 4.7 per eye) compared to 187 in the ranibizumab group (average of 5.5 per eye). The mean logMAR equivalent of BCVA at 1 month after the injection improved by 0.18 in the bevacizumab group (p = 0.009) and by 0.13 in the ranibizumab group (p = 0.004). The average SD-OCT CFT decreased from 325 + or - 72 to 300 + or - 69 microm in the bevacizumab group (p = 0.016) and from 307 + or - 57 to 289 + or - 56 microm in the ranibizumab group (p = 0.017). In the bevacizumab group, there was 1 event of lower extremity pain (0.54%) and 1 event of increased arterial blood pressure (0.54%). In the ranibizumab group, there were 2 events of transiently increased intraocular pressure (1.1%) and 1 event (0.53%) of intraocular inflammation following injection. CONCLUSIONS: Bevacizumab and ranibizumab treatments resulted in similar gains in visual acuity and reduction in macular thickness, documented each month following injection. Intravitreal bevacizumab appears to be as safe and effective as intravitreal ranibizumab in the treatment of exudative AMD.

Seronegative spondyloarthropathies and the eye.

PURPOSE OF REVIEW: Ocular inflammation is a common and important manifestation of disease in patients with seronegative spondyloarthropathy. RECENT FINDINGS: Anterior uveitis is among the most common manifestations of eye disease in patients with seronegative spondyloarthropathies. Additionally, a strong correlation exists among such affected patients and the presence of the HLA-B27 gene. Steroid treatment is often effective for uveitis associated with spondyloarthropathies. Patients with ocular inflammation that is chronic in nature or uncontrolled by steroid treatment have shown good response to immunosuppressive agents known to be effective for articular inflammation, such as methotrexate. Recent studies have shown the possible benefits of tumor necrosis factor-alpha inhibitors, such as infliximab and etanercept. SUMMARY: Uveitis, a leading cause of blindness, is among the most common eye manifestations in patients affected by seronegative spondyloarthropathies. Evidence suggests both genetic and environmental factors in its pathogenesis. Immunomodulator treatments, including the recently popular biologics, may be effective in the control of chronic uveitis in patients with spondyloarthropathy. Ocular surgery is often needed in these patients, and appropriate cautions are required in order to achieve successful vision rehabilitation.