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PURPOSE: To report an unusual case of bilateral aggressive Mooren ulcer that occurred in the setting of bilateral pterygia and showed a relentless course during pregnancy. METHODS: A 39-year-old woman of Black African ethnicity, 36-week pregnant, presented to the eye casualty with bilateral nasal corneal ulcer and associated melt around preexisting pterygia. A detailed workup including microbial evaluation, culture and sensitivity, polymerase chain reaction for herpes simplex virus, varicella zoster virus, and cytomegalovirus, inflammatory blood profile, autoimmune markers, and human leucocyte antigen (HLA) screening was undertaken. Treatment was initiated in a stepwise approach. RESULTS: Infections and systemic autoimmune and rheumatologic conditions were ruled out. A diagnosis of bilateral Mooren ulcer was made by exclusion. The peripheral blood was positive for HLA DQ2. As the condition seemed refractory to medical management (topical steroids and intravenous pulse methylprednisolone followed by oral prednisolone and topical cyclosporine), urgent bilateral conjunctival resection with multilayered amniotic membrane transplantation was performed to reduce the inflammatory stimulus and keratolysis. Stabilization of the condition warranted the need for systemic immunosuppressive agents. Using a multidisciplinary approach, in liaison with Obstetricians and Rheumatologists, the patient was planned for an earlier elective Cesarean section and commencement of oral mycophenolate mofetil postpartum, which aided in successful control of the disease. CONCLUSIONS: Mooren ulcer could follow an aggressive course during pregnancy, especially in the setting of preexisting pterygium. The complex hormonal and immunological changes during pregnancy and the delivery of inflammatory mediators directly onto the cornea by pterygium could contribute to the severity. A well-planned, stepwise, and multidisciplinary management is pivotal for the treatment of this condition.
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OBJECTIVE: To report outcomes of tacrolimus immunosuppression after penetrating keratoplasty (PK) in very young children. METHODS: Retrospective, consecutive, cohort study of children undergoing PK at a tertiary children's hospital between 2005 and 2016. Oral tacrolimus immunosuppression was given for 2 years, followed by topical tacrolimus. RESULTS: Fourteen children (20 eyes) had 24 PKs; nineteen eyes had primary PKs, five eyes had repeat PKs. Mean age at primary graft was 95 days (3.1 months) for anterior segment dysgenesis (ASD), 430 days (14.3 months) for non-ASD children. Eleven children (15 eyes) had ASD. Three children (five eyes) had non-ASD: two children (three eyes) had glaucoma-related corneal opacity and one child (two eyes) had congenital hereditary endothelial dystrophy (CHED). One-year rejection-free survival rates following primary PK was 80% for ASD (n = 15) and 100% for non-ASD (n = 4). At final review, 5/15 of primary grafts for ASD were clear. 10/15 failed after a mean of 19 months, specifically attributable to infection (n = 2), rejection (n = 2) and glaucoma (n = 2). 4/4 primary non-ASD grafts are clear at final review (mean follow-up = 77 months). All repeat grafts (n = 5), failed after a mean of 38.25 months. Considering all grafts, 15/24 (62.5%) failed: 5/15 due to infection, 2/15 due to rejection, 8/15 due to glaucoma, phthisis, perforation or vascularised with no rejection. At last review (mean = 58.1 months, range 28-84), overall cohort survival is 37.5%. Final visual acuities range between 0.86 and 2.4 LogMAR. CONCLUSION: We compare our results to published literature: 1-year graft survival was higher than previously reported, with lower failure due to rejection. Overall infection rates did not increase, however, proportionally, severe infections were higher. Overall graft survival is at least comparable to reported literature.
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Glaucoma , Queratoplastia Penetrante , Humanos , Niño , Lactante , Preescolar , Recién Nacido , Queratoplastia Penetrante/métodos , Tacrolimus/uso terapéutico , Estudios Retrospectivos , Estudios de Cohortes , Supervivencia de Injerto , Glaucoma/cirugía , Estudios de Seguimiento , Terapia de Inmunosupresión , Rechazo de InjertoRESUMEN
PURPOSE: To compare visual outcomes, complications, and vision-related quality of life (QoL) after microthin Descemet stripping automated endothelial keratoplasty (MT-DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK) for the management of corneal endothelial dysfunction in Fuchs dystrophy. METHODS: This is a prospective, double-blinded randomized controlled clinical trial. Patients with visually significant endothelial decompensation from Fuchs dystrophy were prospectively randomized to receive MT-DSAEK or DMEK surgery. The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 12 months. Secondary outcomes included refraction, keratometry, endothelial cell count, complications, and vision-related QoL at 6 and 12 months postoperatively. RESULTS: A total of 56 eyes of 56 patients were enrolled, 28 in each group. Postoperatively, LogMAR mean BSCVA in the MT-DSAEK group was 0.17 ± 0.08 and 0.11 ± 0.09 at 6 and 12 months compared with 0.09 ± 0.13 and 0.04 ± 0.13 after DMEK (P = 0.03, P = 0.002 respectively) with the DMEK cohort achieving 3.5 logarithm of the minimum angle of resolution letters better BSCVA at 1 year compared with MT-DSAEK. Complication rates were similar with 3.5% rebubbling rate in both groups, 1 primary graft failure in DMEK and a single endothelial rejection in the MT-DSAEK arm. Vision-related QoL was comparable at 6 and 12 months postoperatively, and no eyes demonstrated loss of vision from preoperative BSCVA. CONCLUSIONS: DMEK surgery resulted in significantly better BSCVA at 1, 3, 6, and 12 months postoperatively compared with MT-DSAEK. Patient satisfaction was similar with no differences reported in vision-related QoL scores, as was the complications profile between groups. Thus, our results favor DMEK as the better choice procedure for eyes with Fuchs-related corneal decompensation without ocular comorbidities.
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Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Distrofia Endotelial de Fuchs/cirugía , Anciano , Anciano de 80 o más Años , Recuento de Células , Método Doble Ciego , Endotelio Corneal , Femenino , Distrofia Endotelial de Fuchs/fisiopatología , Distrofia Endotelial de Fuchs/psicología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias , Estudios Prospectivos , Calidad de Vida/psicología , Refracción Ocular/fisiología , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
We describe a new modified technique to release the peripheral iridocorneal adhesions that formed after Descemet stripping automated endothelial keratoplasty. The usual technique of goniosynechialysis was modified and performed using endoscopic fiber-optic light and camera probe to aid visualization of the adherent iris tissue and carry out uneventful 270 degrees release of adhesions. The iris tissue was gently pulled away using micro forceps. The modified technique was conceptualized, as the view from the cornea was very poor due to recent lamellar surgery and corneal oedema secondary to poorly controlled intraocular pressure. The blocked trabecular meshwork system was successfully recanalized, which allowed an adequate control of intraocular pressure. The graft survived the insult and cornea gained complete clarity giving the patient the desired vision and improved quality of life. How to cite this article: Rana M, Shah S, Pandey P, Masood I. Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet's Stripping Automated Endothelial Keratoplasty. J Curr Glaucoma Pract 2018;12(2):90-93.
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PURPOSE: Cataract shared care schemes involving community optometrists show wide variation in practice. We report on defined key performance indicators (KPIs) which improve accountability between stakeholders. METHODS: In this prospective study over nine months at a UK public hospital, we evaluated the outcomes of consecutive direct cataract referrals from community optometrists against two KPIs agreed under a service-level agreement between the Hospital Eye Service and community optometrists: (1) 85% of patients listed for cataract listing at first consultation; and (2) 90% postoperative feedback return rate on patients discharged to community optometrists. A detailed analysis on referral triage, surgical listing and postoperative form return rate is reported in this study. RESULTS: A total of 733 direct cataract referrals were received using a designated referral form of which 86% were listed for cataract surgery. The predominant reason for not listing was a failure to reach the visual threshold set by the local clinical commissioning guidelines. Out of 569 cataract surgical episodes, 402 (71%) patients were discharged on the same day of surgery to community optometrist follow up. Completed postoperative feedback was returned from 374 patients (93%). CONCLUSION: Direct cataract referrals from accredited community optometrists led to a majority of patients receiving a definitive clinical decision during first consultation. Postoperative community follow up reduced hospital visits and allowed for convenient consultation closer to home following uncomplicated cataract surgery. A service-level agreement with an accreditation scheme measured against KPIs enhances the accountability of stakeholders involved in the cataract shared care scheme.
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Catarata/diagnóstico , Servicios de Salud Comunitaria/normas , Optometristas/normas , Optometría/normas , Indicadores de Calidad de la Atención de Salud , Derivación y Consulta/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reino UnidoRESUMEN
Serratia liquefaciens is a rarely encountered gram-negative organism in ophthalmology practice. The only reported ocular infections are from contamination of contact lenses. The authors report the first case of a patient who developed orbital cellulitis secondary to severe S. liquefaciens microbial keratitis.
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Lentes de Contacto/microbiología , Infecciones Bacterianas del Ojo/etiología , Queratitis/etiología , Celulitis Orbitaria/etiología , Infecciones por Serratia/etiología , Serratia liquefaciens/aislamiento & purificación , Anciano , Biopsia , Lentes de Contacto/efectos adversos , Córnea/microbiología , Córnea/patología , Contaminación de Equipos , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Humanos , Queratitis/diagnóstico , Queratitis/microbiología , Masculino , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/microbiología , Infecciones por Serratia/diagnóstico , Infecciones por Serratia/microbiología , Tomografía Computarizada por Rayos XRESUMEN
The purpose of this study was to evaluate the effects of vital dyes on human Descemet's membranes (DMs) and endothelia. DMs of 25 human cadaveric corneas with research consent were treated with dyes routinely used in Descemet membrane endothelial keratoplasty (DMEK), 0.05% Trypan blue (TB) or a combination of 0.15% Trypan blue, 0.025% Brilliant blue and 4% Polyethylene glycol (commercial name Membrane Blue Dual; MB). The effects of these two dyes on (i) endothelial cell viability, (ii) DM mechanical properties as assessed by atomic force microscopy, and iii) qualitative DM dye retention were tested for two varying exposure times (one or four minutes). No significant differences in cell toxicity were observed between treatments with TB and MB at the two different exposure times (P = 0.21). Further, both dyes led to a significant increase in DM stiffness: exposure to TB and MB for one minute increased the apparent elastic modulus of the DM by 11.2% (P = 8*10-3) and 17.7%, respectively (P = 4*10-6). A four-minute exposure led to an increase of 8.6% for TB (P = 0.004) and 13.6% for MB (P = 0.03). Finally, at 25 minutes, the dye retention of the DM was considerably better for MB compared to TB. Taken together, a one-minute exposure to MB was found to improve DM visibility compared to TB, with a significant increase in DM stiffness and without detrimental effects on endothelial cell viability. The use of MB could therefore improve (i) visibility of the DM scroll, and (ii) intraoperative unfolding, enhancing the probability of successful DMEK surgery.
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Colorantes/farmacología , Lámina Limitante Posterior/efectos de los fármacos , Elasticidad/efectos de los fármacos , Endotelio Corneal/efectos de los fármacos , Adulto , Anciano , Bencenosulfonatos/farmacología , Cadáver , Supervivencia Celular/efectos de los fármacos , Córnea/efectos de los fármacos , Córnea/patología , Córnea/cirugía , Lámina Limitante Posterior/patología , Lámina Limitante Posterior/fisiología , Queratoplastia Endotelial de la Lámina Limitante Posterior/efectos adversos , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Módulo de Elasticidad/efectos de los fármacos , Endotelio Corneal/patología , Endotelio Corneal/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polietilenglicoles/farmacología , Resultado del Tratamiento , Azul de Tripano/farmacologíaRESUMEN
A 49-year-old diabetic man presented with a 2-day history of a painful right eye associated with a purulent discharge. Prior to becoming symptomatic, he reported that someone spat at him, resulting in direct contact between the saliva and his affected eye. Gram stain revealed numerous leucocytes with Gram-negative diplococci, and culture yielded Neisseria meningitidis (serogroup C). There was no evidence of any systemic infection, and blood cultures were negative for any growth. He was treated for primary meningococcal conjunctivitis (PMC) with intensive topical antibiotic eyedrops as well as systemic antibiotics. One week after commencing treatment he remained systemically well and his symptoms had fully resolved.
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Conjuntiva/microbiología , Conjuntivitis Bacteriana/microbiología , Infecciones Bacterianas del Ojo/microbiología , Infecciones Meningocócicas/transmisión , Neisseria meningitidis/aislamiento & purificación , Saliva/microbiología , Antibacterianos/administración & dosificación , Conjuntiva/diagnóstico por imagen , Conjuntivitis Bacteriana/diagnóstico , Conjuntivitis Bacteriana/tratamiento farmacológico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Humanos , Masculino , Infecciones Meningocócicas/tratamiento farmacológico , Infecciones Meningocócicas/microbiología , Persona de Mediana Edad , Soluciones OftálmicasRESUMEN
OBJECTIVE: Diffuse lamellar keratitis is a fairly uncommon complication of laser in situ keratomileusis (LASIK) that usually occurs within 1 week of surgery. It is described as an inflammatory reaction in the lamellar interface characterized by a diffuse, white granular lamellar keratitis. Progression of the keratitis can result in scarring and significant visual loss. We report a case of bilateral diffuse lamellar keratitis (DLK) of delayed onset and look at confocal microscopic features of corneal interface. CASE REPORT: A 35-year-old male patient was referred with visual concerns and red eye. The patient had undergone LASIK procedure for high myopia 3 months previously. A detailed examination revealed a clinical presentation of DLK. A thorough account of the past revealed no pertinent medical history or risk factors for delayed-onset DLK after LASIK. The patient was put on topical antibiotics (ofloxacin, Exocin 3 mg/mL) and topical steroids (prednisolone acetate 1%, Pred Forte). Because of poor response to treatment, an interface washout was carried out and treatment with Pred Forte was continued. This helped in resolution of the condition in both eyes with residual faint, diffuse, corneal haze. Confocal microscopy was carried out before and after interface washout to assess features of DLK at cellular level after a delayed onset. CONCLUSIONS: The presence of inflammatory cells along with interface debris was noted in our case, which is unusual in stage 3 DLK with a delayed presentation as reported in literature. Although it is difficult to confirm without histology the type of inflammatory response seen, it is advocated that delayed presentation should also be treated quite intensively with steroids and any progression should be dealt with lifting up of the flaps to carry out interface washout.
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Queratitis/patología , Microscopía Confocal , Adulto , Humanos , Queratitis/etiología , Queratomileusis por Láser In Situ/efectos adversos , Masculino , Complicaciones Posoperatorias/patologíaRESUMEN
We report a rare and atypical skin adnexal tumour of the eyelid. We highlight this condition for clinicians who treat periocular neoplasia.
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Neoplasias de los Párpados/diagnóstico , Neoplasias de Anexos y Apéndices de Piel/diagnóstico , Anciano , Biopsia , Diagnóstico Diferencial , Neoplasias de los Párpados/patología , Femenino , Humanos , Neoplasias de Anexos y Apéndices de Piel/patologíaRESUMEN
PURPOSE: We present the case of a young woman with optic disc drusen and peripheral vasculitis. METHODS: Diagnosis was based on fundoscopic, optical coherence tomography as well as fluorescein angiography (FA) findings. RESULTS: An asymptomatic 34-year-old female patient with no systemic pathology was referred to our hospital from her optician for retinal findings. Fundoscopy revealed mild disc swelling that could be attributed to the presence of optic disc drusen in both eyes. There was fundoscopic evidence of periphlebitis in the periphery confirmed by FA findings. CONCLUSIONS: In our case, the unique feature was the presence of optic disc drusen and retinal periphlebitis. The patient's disc configuration may have contributed to a predisposition for vasculitis in addition to vessel tortuosity.
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Oftalmopatías/diagnóstico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Pérdida Auditiva Sensorineural/diagnóstico , Oftalmología/estadística & datos numéricos , Niño , Preescolar , Femenino , Investigación sobre Servicios de Salud , Humanos , Lactante , Recién Nacido , Masculino , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Reino Unido , Pruebas de VisiónRESUMEN
We report the first case of endogenous aspergillus endophthalmitis in an immunocompetent person with systemic aortic root aspergillus endocarditis.