CMV retinitis after intravitreal triamcinolone acetonide injection in a patient with Behçet's uveitis.

We report the case of a patient with Behçet's uveitis who developed cytomegalovirus (CMV) retinitis after intravitreal triamcinolone acetonide (IVTA) injection. We reviewed the patient's chart for the purpose of this report. An IVTA injection was performed for treatment of severe panuveitis in the left eye of a 30-year-old male patient with Behçet's disease. Systemic treatment included high dose corticosteroid and azathioprine. Fourteen weeks after IVTA, extensive areas of necrotizing retinitis developed in the left eye. Polymerase chain reaction of serum and vitreous samples was positive for CMV DNA. Serum anti-CMV IgG was positive, IgM was negative, anti-HIV antibody was negative, complete blood count was normal, and CD4 count was 1,060 cells/µl. The patient responded well to intravitreal ganciclovir injection performed twice and intravenous ganciclovir treatment administered for five weeks. Local immunosuppression with IVTA may cause CMV retinitis. Awareness of this serious complication is important for correct diagnosis and treatment.

Bilateral acute depigmentation of the iris: report of 26 new cases and four-year follow-up of two patients.

PURPOSE: To report new cases of bilateral acute depigmentation of the iris (BADI), a recently described clinical entity, and to report the 4-year follow-up of 2 patients that was published previously. DESIGN: A retrospective case series. PARTICIPANTS: Twenty-six Turkish patients who were diagnosed with BADI between 2006 and 2008 and 2 patients who were reported previously. METHODS: We reviewed the patients' charts and clinical photographs. Observation procedures included clinical examination, anterior segment color photography, laser flare photometry, and pupillometry. We performed an anterior chamber tap in 2 patients for polymerase chain reaction (PCR) to demonstrate the DNA of herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) in the aqueous samples. MAIN OUTCOME MEASURES: Demographic features, presenting symptoms, laboratory findings, changes in iris stromal pigment and architecture, and time to resolution of pigment dispersion in the anterior chamber. RESULTS: Nineteen patients were female, and 7 patients were male. Mean age was 32.3+/-8.6 years. All had bilateral involvement. Twenty patients (76.9%) presented with photophobia and red eyes, and 4 patients (15.4%) presented with a recent change in eye color. Ten patients (38.5%) had flu-like symptoms preceding the onset of ocular symptoms. Diagnostic laboratory workup, viral serology, and PCR analysis of the aqueous humor were unrewarding. Diffuse depigmentation of the iris stroma from the collarette to the iris root was seen in 16 patients, and geographic areas of depigmentation were seen in 10 patients. There was heavy pigment deposition in the trabecular meshwork in all patients. Anterior chamber flare was elevated in eyes with circulating pigment. The pupil was not affected. Twenty patients received topical corticosteroids. Pigment dispersion resolved in 1 to 16 weeks (median, 9 weeks). The intraocular pressure was elevated in 8 steroid-treated eyes but was controlled with antiglaucomatous medications. In 2 patients reported previously, the depigmented iris stroma became repigmented after 4 years. CONCLUSIONS: Patients with BADI present with bilateral, symmetrical, nontransilluminating depigmentation of the iris stroma and pigment discharge into the anterior chamber. Young female persons are more commonly affected. The cause remains unknown. After 4 years, the ocular findings in 2 patients normalized.

Solitary lacrimal gland choristoma of the limbal conjunctiva.

Lacrimal gland choristoma occurs in cases with a failure in migration of any portion of the lacrimal secretory apparatus. It is a rare conjunctival tumor. The authors report the clinical and histopathologic features of a conjunctival lacrimal gland choristoma. A 34-year-old woman presented with a pinkish conjunctival mass in the left eye that had been present since birth. The lesion was removed by excisional biopsy and the histopathologic findings were consistent with conjunctival lacrimal gland choristoma. Clinically, these tumors resemble conjunctival hemangioblastoma, lymphangioma, or a lymphoid infiltrate. Its presence since birth, temporal epibulbar location, and pink solid appearance can help in the differential diagnosis.

30 years of contact lens prescribing for keratoconic patients in Turkey.

PURPOSE: To assess retrospectively the course, the rate of bilateralness, prognosis, visual acuity with contact lenses, and corneal changes of a cohort with keratoconus. METHODS: Patients applying to Istanbul Faculty of Medicine, Department of Ophthalmology, Contact Lens Division during the period 1975-2005 with the diagnosis of keratoconus were recruited. The follow-up time ranged from 1.5 years to 25 years. This cohort consisted of 273 male, 245 female patients. The patients' ages ranged from 12 years to 54 years (mean age 34.8+/-10.1 years). 518 cases' 1004 eyes were divided into four groups according to their mean keratometry values. The changes in visual acuity, keratometry values and the measurements of the used contact lenses were compared with each other, and statistical significance was sought. RESULTS: By self-report, the mean starting age of keratoconus was found to be 22.5+/-7.6 years (range 7-35 years). 59 (11.4%) of 518 patients had unilateral keratoconus occurrence. The acute hydrops rate was found to be 0.3% (5 patients). In patients with advanced keratoconus, new contact lenses were applied with steeper radius of curvature. Penetrating keratoplasty was applied to 15 eyes (1.5%). Visual acuity examination on the patients' last visit, when compared to previous examinations, was found to have decreased by 2-3 Snellen lines due to advancing keratoconus. CONCLUSION: Keratoconus has shown to be a self-limited disease and in our study, with the use of contact lenses, successful outcomes which delayed the need for surgery were achieved in 98.9% of eyes (989/1004 eyes).