Foreign body episcleral suture granulomas mimicking nodular anterior scleritis.

Scleritis is an idiopathic condition that may sometimes be associated with systemic immunological like disorders rheumatoid arthritis, Wegener's granulomatosis and systemic lupus erythematosus. A variety of foreign material has been reported to result in granuloma formation in various parts of the body. We report a case of inflamed episcleral granulomas mimicking severe nodular anterior scleritis in a healthy Caucasian woman who underwent strabismus surgery in her childhood. Foreign body reaction on the episcleral/scleral surface is rare. It is extremely unusual for a non-absorbable suture that was used for childhood strabismus surgery to incite an acute inflammatory episode mimicking nodular anterior scleritis as in our case. As the strabismus surgery was performed 37 years prior to her presentation with anterior scleritis, we were unable to obtain any details of this surgical procedure. We presume that a non-absorbable suture like braided polyester or prolene may have been used.

A Rare Case of Mixed Infectious Keratitis Caused by Pseudomonas koreensis and Aspergillus fumigatus.

We report the clinical and microbiological features of contact lens-related mixed infectious keratitis caused by a spore-forming filamentous fungus and a rare gram-negative bacterial infection. A 66-year-old Caucasian female presented with right eye (OD) pain after sleeping in her 2-weekly contact lenses for 3 days. On presentation, corrected distance visual acuity was 0.46 LogMAR OD and 0.20 in the left eye. Slit lamp biomicroscopy revealed a 1.9 mm by 1.9 mm area of dense stromal infiltrate with epithelial defect. Corneal scrapes grew Aspergillus fumigatus and Pseudomonas koreensis, and culture-directed microbial therapy with oral and topical voriconazole and topical fortified gentamicin along with regular debridement resulted in slow resolution of the infection, leaving a dense stromal scar in the visual axis requiring penetrating keratoplasty. Mixed infectious keratitis caused by filamentous fungi and gram-negative bacteria is rare. Pseudomonas koreensis infection has not been previously reported as a cause of infectious keratitis in humans. In our experience, these mixed infections require prolonged systemic and topical therapy and the secondary scarring may require surgical intervention for vision rehabilitation.

Posterior Segment Visualization in Eyes With Small-Aperture Intraocular Lens.

PURPOSE: To evaluate the posterior segment visualization in patients with small-aperture intraocular lens (IOL) implantation. METHODS: In this prospective, comparative case series, 15 patients who had unilateral implantation of the small-aperture IOL in their non-dominant eyes were recruited. Their fellow eyes were pseudophakic with a monofocal IOL in 14 patients and phakic in 1 patient. All underwent bilateral posterior segment clinical investigations including fundus photography, threshold perimetry, and optical coherence tomography of the posterior pole including optic nerve head. The results from these investigations were graded by a clinician masked to the laterality and type of IOL. Patient 11 developed postoperative endophthalmitis 4 weeks following cataract surgery with implantation of a small-aperture IOL and underwent pars plana vitrectomy. The intraoperative view of the posterior segment was subjectively evaluated by the retinal surgeon. RESULTS: All 15 patients had successful image captures with all clinical investigative tools with no differences in image quality detected between the images obtained from the monofocal pseudophakic and small-aperture IOL eyes. The small-aperture IOL did not subjectively obstruct the intraoperative view for the retinal surgeon during pars plana vitrectomy. CONCLUSIONS: Standard posterior segment investigations including non-mydriatic fundus photography, optical coherence tomography, and automated perimetry can be safely and effectively performed in eyes with small-aperture IOLs. There is no difference in the image quality. [J Refract Surg. 2019;35(8):538-542.].

Limbal Stem Cell Deficiency Secondary to Diffuse Non-necrotizing Anterior Scleritis: A Clinicopathological Report.

PURPOSE: To report a case of limbal stem cell deficiency (LSCD) secondary to diffuse non-necrotizing anterior scleritis (DNNAS). METHOD: Interventional case report with clinicopathologic correlation. A 69-year-old white woman with known Crohn disease presented with DNNAS. The acute inflammatory phase was treated with topical and systemic steroids. After DNNAS, she developed secondary LSCD with loss of limbal palisades of Vogt and conjunctivalization of the corneal surface and corneal haze. She underwent superficial keratectomy combined with autologous limbal stem cell grafting from the fellow eye. The keratectomy specimen was sent for pathological examination. RESULTS: There were no intraoperative or post-operative complications. Histopathology and immunohistochemistry showed a cytokeratin 19-positive and cytokeratin 3- and cytokeratin 12 negative epithelium in keeping with a conjunctival phenotype on the corneal surface. CONCLUSIONS: LSCD can be a rare complication of DNNAS. After control of ocular surface inflammation, autologous limbal stem cell grafting and amniotic membrane transplantation can be effective in normalizing the ocular surface.