The role of funduscopy in severe thrombocytopenia: A prospective study.

PURPOSE: Platelet transfusions for patients suffering from severe thrombocytopenia are regulated by clinical bleedings and platelet counts. The aim of this study was to assess the prevalence of retinal hemorrhage in patients with hematologic and oncologic malignancies and severe thrombocytopenia, and to determine the benefit of systematic funduscopic examination in this setting. MATERIALS AND METHODS: Hospitalized patients with hematologic and oncologic malignancies having a platelet count less than 25,000 per µL underwent indirect ophthalmoscopy. The prevalence of retinal hemorrhage and its correlation with different patients' characteristics were determined. The decision to transfuse platelets or not following bedside indirect ophthalmoscopy was left at the discretion of the treating physician. RESULTS: A total of 34 severe thrombocytopenic patients were included in the study. The prevalence of retinal hemorrhage was detected in 10 patients (29.4%). No significant correlation was found between the occurrence of retinal hemorrhage and age, platelet count or thrombocytopenia etiology (P>0.05). No significant difference was found concerning the rate of transfusion between those with and without retinal hemorrhage. CONCLUSION: According to our statistical results, retinal hemorrhage is a frequent finding in severely thrombocytopenic patients. Early detection may lead to an increase in the platelet transfusion threshold from to 30,000 per µL offering additional protection against spontaneous bleedings. Funduscopy is a safe and easy exam to perform systematically in patients with severe thrombocytopenia.

Evaluation of corneal sensitivity in multiple sclerosis patients.

PURPOSE: To measure the corneal sensitivity in patients with multiple sclerosis (MS), to compare it with normal values and to study its correlation with different disease characteristics. METHODS: Corneal sensitivity of 28 MS patients was compared to corneal sensitivity of 28 age- and gender-matched normal controls. Corneal sensitivity was measured using the Cochet-Bonnet esthesiometer and was correlated to the duration, type and severity indexes of the disease. RESULTS: Corneal sensitivity was comparable between both groups (P = 0.79). No statistically significant correlation was found between corneal sensitivity and the duration of MS (P = 0.55) nor the severity indexes of MS (expanded disability status scale [EDSS] P = 0.52, global multiple sclerosis severity score [MSSS] P = 0.64). Following subgroup analysis, only the primary progressive (PPMS) form of MS had a reduced corneal sensitivity with P = 0.023, while remittent-recurrent (RRMS), secondary progressive (SPMS), and clinically isolated (CIS) forms of MS did not have any reduction in the corneal sensitivity. "ROC curve analysis" showed an area under the curve of 0.48. CONCLUSION: In the exception of PPMS subtype, MS patients have similar corneal sensitivity in comparison to controls. Cochet-Bonnet esthesiometer does not seem to be a good diagnostic tool or a disease severity marker for patients with MS.

Influence of soft contact lens material on corneal warpage: prevalence and time to resolution.

OBJECTIVE: Corneal warpage represents a reversible distortion of the corneal surface induced by soft contact lens (SCL) wear. The aim of the study is to assess the influence of SCL materials, age, wearing duration, cylindrical refraction, and spherical equivalence on the prevalence and time to resolution of corneal warpage. METHODS: This is an interventional prospective study in which SCL wearers volunteered to remove their SCLs and underwent, on each visit, a corrected distance visual acuity and anterior and posterior segment evaluation, along with keratometry measurement and corneal topography. Visits were scheduled 30 minutes after SCL removal, on day 4, day 7, and then weekly after SCL removal until warpage resolution. RESULTS: A total of 17 volunteers (34 eyes) were included, with 9 (18 eyes) in the hydrogel SCL group and 8 (16 eyes) in the silicone hydrogel SCL group. The difference in warpage prevalence between the hydrogel group (28%, 5 eyes) and silicone hydrogel group (31%, 5 eyes) was not statistically significant (p > 0.90). Duration necessary for warpage resolution ranged from 7 to 21 days with no statistically significant difference between the 2 groups (p = 0.12). CONCLUSIONS: Both types of SCL had similar corneal warpage prevalence and time to resolution, with slightly longer mean time to resolution with silicone hydrogel. All eyes had resolution of warpage by 3 weeks. It seems more cautious to wait longer than the usual 1-week interval before performing refractive surgery, especially in patients wearing SCL for long periods and regardless of the type of material.

Evaluation of allergic sensitization in Lebanese patients with allergic conjunctivitis.

PURPOSE: To describe the profile of patients with allergic conjunctivitis (AC) regarding their demographics, symptomatology and specific allergen sensitization, in a Lebanese tertiary hospital. METHODS: Cross-sectional study conducted at the Hôtel-Dieu de France hospital (Beirut, Lebanon) during a period of 18 months. Patients with seasonal or perennial AC presenting for ophthalmic consultation had measurements of total and specific IgE. A matching group of patients with AC seen at the allergist office during the same period underwent skin prick tests (SPTs). RESULTS: Forty-four patients were enrolled for blood work by their ophthalmologists. Seasonal and perennial forms were almost equivalent. In total, 56.8% had positive specific IgE, with higher prevalence in patients with seasonal AC (p = 0.002), other associated allergies particularly allergic rhinitis (p = 0.002) or a family history of allergy (p = 0.005). Ocular surface severity scales were not shown as predictors. High levels of total IgE were commonly detected in those with positive specific IgE. Thirty-eight patients were assessed with SPT, and all had a positive result for at least one allergen. Dust mites were found to be the most frequent allergens based upon both specific IgE (72%) and SPT (92%), followed by Parietaria and other pollens. CONCLUSION: In our study, dust mites mono- or co-sensitization is present in the majority of patients with AC, with odds of positivity being higher using SPT than specific IgE. The latter are found more readily in seasonal AC and in the presence of personal and family history of allergy.

Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis.

PURPOSE: To assess the efficacy of topical 1.5% azithromycin in the treatment of moderate to severe chronic blepharitis and to compare the efficacy of two different treatment modalities. METHODS: A randomized clinical trial included 67 patients with chronic anterior and/or posterior blepharitis, followed-up for 3 months. Signs and symptoms were graded according to severity. Patients were randomized into two groups: 33 patients in group I and 34 patients in group II. Group I patients were treated with topical 1.5% azithromycin twice a day for three days, and Group II patients were treated with topical 1.5% azithromycin twice a day for three days then at bedtime for the rest of the month. All patients were instructed to apply warm compresses and an eye-friendly soap twice daily. RESULTS: Patients in both groups tolerated the treatment with minimal irritation. A significant improvement in signs and symptoms was noted at the one week follow-up visit. Group II showed a more pronounced and longer-lasting improvement that persisted after three months of follow-up. CONCLUSION: Topical 1.5% azithromycin ophthalmic solution is an effective treatment option for chronic blepharitis. In moderate to severe blepharitis, a one month treatment is safe and shows better improvement than the three-day protocol with no significant relapse until three months of follow-up.

Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis / Solução oftálmica de azitromicina 1,5%: eficácia e modalidades de tratamento em blefarite crônica

PURPOSE: To assess the efficacy of topical 1.5% azithromycin in the treatment of moderate to severe chronic blepharitis and to compare the efficacy of two different treatment modalities. METHODS: A randomized clinical trial included 67 patients with chronic anterior and/or posterior blepharitis, followed-up for 3 months. Signs and symptoms were graded according to severity. Patients were randomized into two groups: 33 patients in group I and 34 patients in group II. Group I patients were treated with topical 1.5% azithromycin twice a day for three days, and Group II patients were treated with topical 1.5% azithromycin twice a day for three days then at bedtime for the rest of the month. All patients were instructed to apply warm compresses and an eye-friendly soap twice daily. RESULTS: Patients in both groups tolerated the treatment with minimal irritation. A significant improvement in signs and symptoms was noted at the one week follow-up visit. Group II showed a more pronounced and longer-lasting improvement that persisted after three months of follow-up. CONCLUSION: Topical 1.5% azithromycin ophthalmic solution is an effective treatment option for chronic blepharitis. In moderate to severe blepharitis, a one month treatment is safe and shows better improvement than the three-day protocol with no significant relapse until three months of follow-up.

OBJETIVO: Avaliar a eficácia do uso tópico de azitromicina 1,5% no tratamento de blefarite crônica moderada a grave, comparando a eficácia de duas diferentes modalidades de tratamento. MÉTODOS: Um ensaio clínico randomizado incluiu 67 pacientes com blefarite anterior e/ou posterior crônica, acompanhados por três meses. Os sinais e sintomas foram classificados de acordo com a gravidade. Os pacientes foram randomizados em dois grupos: 33 pacientes no grupo I e 34 pacientes no grupo II. Os pacientes do grupo I foram tratados com azitromicina tópica 1,5% duas vezes ao dia durante três dias, e os pacientes do grupo II foram tratados com azitromicina tópica 1,5% duas vezes ao dia durante três dias e, em seguida, ao deitar, durante o resto do mês. Todos os pacientes foram instruídos a aplicarem compressas quentes e higiene palpebral duas vezes ao dia. RESULTADOS: Os pacientes em ambos os grupos toleraram o tratamento com irritação mínima. Melhora significativa dos sinais e sintomas foi observada na visita de uma semana de acompanhamento. Grupo II mostrou uma melhora mais acentuada e mais duradoura que persistiu após três meses de acompanhamento. CONCLUSÕES: A solução de azitromicina oftálmica tópica 1,5% é uma opção eficaz de tratamento para a blefarite crônica. Em blefarite moderada a grave, o tratamento de um mês é seguro e demonstrou melhora acentuada em relação ao protocolo de três dias, sem recidiva significante até três meses de acompanhamento.

Clinical and molecular findings in three Lebanese families with Bietti crystalline dystrophy: report on a novel mutation.

PURPOSE: Bietti crystalline dystrophy (BCD) is a rare autosomal recessive disorder caused by mutation of the cytochrome P450, family 4, subfamily V, polypeptide 2 (CYP4V2) gene and characterized by retinal pigmentary abnormalities and scattered deposits of crystals in the retina and the marginal cornea. The aim of this study was to investigate the spectrum of mutations in CYP4V2 in Lebanese families, and to characterize the phenotype of patients affected with BCD. METHODS: Nine patients from three unrelated Lebanese families were clinically and molecularly investigated. Detailed characterization of the patients' phenotype was performed with comprehensive ophthalmic examination, color vision study, fundus photography, visual field testing, retinal fluorescein angiography, electroretinography, and electrooculography. One family was followed for 12 years. The 11 exons of the CYP4V2 gene were sequenced. RESULTS: Symptoms consisting of night blindness, loss of paracentral visual field, and disturbed color vision were apparent during the third decade of life. Ophthalmoscopy revealed posterior pole crystalline deposits and areas of retinal pigment epithelium atrophy. Fluorescein angiography disclosed geographic areas of the pigment epithelium layer and choriocapillaris atrophy in the posterior pole and fundus periphery. The most striking findings were those of normal electroretinographic responses in some patients and clinical heterogeneity. Two mutations in CYP4V2 were found: p.I111T (c.332T>C) in exon 3 in two families and the novel p.V458M (c.1372G>A) mutation in exon 9 in one family. CONCLUSIONS: These patients are affected with Bietti crystalline dystrophy without corneal involvement. Variation in disease severity and electroretinographic responses suggests that environmental or additional genetic factors influence the course of the retinal disease. The CYP4V2 p.I111T (c.332T>C) mutant allele may be especially prevalent among patients with BCD in Lebanon, resulting from a single founder.

A newly recognized autosomal recessive syndrome with short stature and oculo-skeletal involvement.

This report describes a young girl and her cousin presenting with postnatal short stature, strabismus, photophobia, retinitis pigmentosa, short neck, rhizomelic shortening of the long bones, short and slightly bowed humeri with prominent deltoid tuberosities, short and wide ribs and clavicles, dorso-lumbar scoliosis, biconcave vertebral bodies of the thoraco-lumbar spine, and narrowed lumbar canal. In addition, in the girl there were amelogenesis imperfecta of the hypomaturation type, and the radiographs showed short distal ulnae, sloping epiphyses of the radii, short femoral necks, and slightly flat uncovered femoral heads. The children's parents are first cousins. Differential diagnoses are discussed and the possibility of a newly recognized oculo-skeletal syndrome is raised.

[Amniotic membrane utilization in ophthalmological surgical procedures]. / Utilisation de la membrane amniotique en ophtalmologie.

The amniotic membrane, which is the innermost layer of the fetal membranes, is composed of a single layer of epithelial cells that lie on a basement membrane, and of a non-vascular collagenous stroma. These three components give the amniotic membrane its beneficial properties. The first therapeutic application of the amniotic membrane was in 1910, when it was used in skin transplantation. Thereafter, it was used in surgical procedures related to the abdomen, genitourinary tract and to the head and neck. In ophthalmology, De Roth, in 1940, was the first to use the amniotic membrane for conjunctival reconstruction. However, it was only in 1995 that publications on the subject started appearing again, when Tseng and many others began using the amniotic membrane again in the treatment of ocular surface (cornea and conjunctiva) diseases. In cases of total stem cell deficiency, amniotic membrane transplantation has been shown to be very useful when used in conjunction with limbal autografts or allografts. At this stage, however, further studies are needed to elucidate the real potential of the amniotic membrane in the treatment of different ocular surface (and other) disorders, and its exact mechanism(s) of action. This will help establish the applications of such treatment in medicine, in general, and in ophthalmology, in particular.

Ocular findings in ichthyosis follicularis-alopecia-photophobia (IFAP) syndrome.

PURPOSE: To report the ocular findings in two siblings with IFAP and their mother and to review the natural course of the keratopathy of this disease. METHODS: Clinical ophthalmological examination of all patients and fundus photography of the carrier mother were performed. RESULTS: Both affected male children had severe photophobia, total superficial and deep corneal vascularization, and reduction of vision to counting fingers.The mother had tortuous retinal vessels. CONCLUSIONS: Males with IFAP have an inexorable progression of corneal vascularization and loss of vision. Retinal vascular tortuosity may be another clinical sign of carrier status in females.

Ichthyosis follicularis, alopecia, and photophobia (IFAP) syndrome: report of a new family with additional features and review.

Two brothers with ichthyosis follicularis, noncicatricial universal alopecia, photophobia, hyerkeratotic psoriasis-like lesions, nails dystrophy, inguineal herniae, cryptorchidism, short stature, seizures, and psychomotor developmental delay are described. These features correspond to the ichthyosis follicularis, alopecia, photophobia (IFAP) syndrome. The youngest brother had in addition a bilateral absence of 4th fingers and camptodactyly, features never reported in patients with IFAP syndromes.