Unusual Corneal Sarcoidosis Manifestations.

AIM: To document atypical presenting forms of ocular sarcoidosis at the corneal level. METHODS: Case report. RESULTS: A 63-year-old woman presented multiple uncommon unilateral primary corneal conditions as manifestation of ocular sarcoidosis, including peripheral ulcerative keratitis, sterile corneal infiltrate (corneal granuloma), and sterile infiltrates related to a corneal foreign body, requiring medical and surgical management to control the inflammatory symptoms and to preserve the integrity of the eyeball. An excisional biopsy of a nodule in the temporal conjunctiva was performed under topical anesthesia. Histological analysis revealed a non-caseating granuloma, confirming the diagnosis of ocular sarcoidosis. CONCLUSION: When thinking of ocular involvement in patients with ocular sarcoidosis, it is essential to remember that manifestations such as peripheral ulcerative keratitis, sterile corneal infiltrate, and sterile foreign body-related infiltrates may be presentations of this disease.

Etiology and Risk Factors for Admission to the Pediatric Intensive Care Unit in Children With Encephalitis in a Developing Country.

OBJECTIVE: To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). STUDY DESIGN: Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. RESULTS: Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. CONCLUSIONS: Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.

Dengue-chikungunya coinfection outbreak in children from Cali, Colombia in 2018-2019.

OBJECTIVE: To identify the arbovirus involved in febrile cases identified in a pediatric clinic in Cali, Valle del Cauca province, Colombia, and study the clinical characteristics. METHODS: A descriptive, prospective study enrolled 345 febrile children for 12 months in a pediatric clinic. Medical record registers documenting signs and symptoms, and serum samples were analyzed to detect DENV, CHIKV, and ZIKV by reverse transcription-polymerase chain reaction and serology methods. Diagnosis at the time of admission and discharge were compared based on laboratory test results. RESULTS: All patients were diagnosed as severe dengue at admission. Molecular detection and serology tests identified 143 CHIKV-positive (41.4%), 20 DENV-positive (5.8%), and 123 DENV-CHIKV coinfection patients (35.7%). DENV or CHIKV serology test results of these double-infected patients yield poor performance to confirm patient cases. ZIKV infection was detected in 5 patients (1.4%), every time as double or triple infections. CONCLUSION: . A sustained CHIKV circulation and transmission was confirmed causing febrile illness in children and indicating that this virus spreads even during the regular DENV season, leading to double infections and altering clinical symptoms. Specific clinical tests are necessary to closely identify the arbovirus involved in causing infectious diseases that can help in better treatment and mosquito-transmitted virus surveillance.

An Unexpected Incidence of Ocular Surface Neoplasia on Pterygium Surgery. A Retrospective Clinical and Histopathological Report.

PURPOSE: To report the unexpected finding of ocular surface neoplasia (OSSN) on conjunctival tissue removed during pterygium surgery and subjected to histopathology analysis. METHODS: This is an observational, descriptive retrospective study in which all the samples removed during surgery between 1997 and 2020 with a clinical diagnosis of pterygium were sent for histopathology analysis in which an unexpected OSSN was found. RESULTS: There were 461 cases with a preoperative diagnosis of pterygium, with a mean age of 30.14 ± 10.6 years. In this group, there was an unexpected finding of OSSN in 69 cases (14.96%) of the surgical samples, with a mean age of 46 ± 8.2 years (31.86 ± 12.13). CONCLUSIONS: The unexpected coincidence of pterygium and OSSN is frequent, although varies depending on the geographical location. We recommend performing a histopathology analysis on every pterygium removed.

Current Global Bioethical Dilemmas in Corneal Transplantation.

PURPOSE: To analyze some of the bioethical dilemmas that may arise during the process required for corneal transplantation. METHODS: We conducted a narrative review based on the available literature and the experience of cornea specialists from 3 different countries. RESULTS: Bioethical dilemmas related to informed consent for organ and tissue donation, allocation of corneal tissues, transplant tourism, corneal tissue exportation and importation, and for-profit eye banking were analyzed and discussed. CONCLUSIONS: Around the world, the number of required corneal transplants exceeds the number of donated corneas that are available and suitable for transplantation. This shortage of corneal tissue has led to the emergence of practices that may put the 4 basic principles of bioethics at risk: autonomy, beneficence, nonmaleficence, and justice. Therefore, it has been necessary to create ethical guidelines such as the Barcelona Principles and the World Health Organization Principles of Transplantation that attempt to regulate these practices.

Long-term Results of Corneal Wedge Resection for High Postkeratoplasty Astigmatism.

PURPOSE: To present the results of corneal wedge resection in postkeratoplasty astigmatism, performed by the same surgeon using the same nomogram over a 25-year period. METHODS: This is a retrospective observational study. The sample was obtained from the medical records of all patients who underwent penetrating or deep lamellar keratoplasty, performed by a single surgeon from 1993 to 2018. All surgeries were performed using a diamond knife, on the flat meridian, involving the keratoplasty scar and closed with five 10-0 nylon sutures. RESULTS: A total of 39 eyes were included. The keratometry measured cylinder improved from 7.99 ± 0.25 to 2.5 ± 0.3 D at 12 months and remained stable thereafter (a mean follow-up of 76.3 months). Best spectacle corrected visual acuity increased from 0.35 ± 0.01 to 0.57 ± 0.02 at 12 months and remained stable thereafter. There was a coupling ratio of 0.08 ± 0.03 D at 12 months. There were no corneal graft rejections or loss of best spectacle corrected visual acuity on this series. CONCLUSIONS: Corneal wedge resection is a valuable resource for the management of high postkeratoplasty astigmatism. It is a safe and reproducible procedure, with stable results at 12 months and thereafter.

Comparison of 4 techniques for limbal-conjunctival autograft fixation in primary pterygium surgery.

PURPOSE: To compare 4 limbal-conjunctival autograft fixation techniques-conventional suture, commercial fibrin glue, autologous fibrin glue, and cautery-in primary nasal pterygium surgery. METHODS: This is a retrospective and descriptive study. The postoperative patient discomfort, graft edema, ocular inflammation, and other complications of 4 limbal-conjunctival autograft fixation techniques in primary nasal pterygium surgery were evaluated. RESULTS: Postoperative patient discomfort was significantly lower with the sutureless techniques (p<0.001), with fixation with cautery having the lowest rate of discomfort. Graft edema and ocular inflammation during the early postoperative period were significantly higher when fibrin glue techniques were used (p<0.001). The recurrence rate did not show a statistically significant difference (p = 0.682) among the 4 groups. CONCLUSION: In primary nasal pterygium surgery, limbal-conjunctival autograft fixation using cautery is the technique with the lowest postoperative discomfort rate and without a statistically significant increase in recurrence rate when compared to conventional suture and fibrin glue techniques.

Effects of Desolvating Agent Types, Ratios, and Temperature on Size and Nanostructure of Nanoparticles from α-Lactalbumin and Ovalbumin.

In this study, we compare the preparation of ovalbumin (OVA) and α-lactalbumin (α-LA) nanoparticles using different desolvating agents (ethanol, acetone, and methanol) and water: desolvating agent volume ratios (1:3, 1:4, 1:5, 1:10, and 1:20). Also the effects of protein solution temperature (25, 50, and 80 ℃) on the size of nanoparticles and the stability of crosslinked nanoparticles for 30 d were studied. OVA and α-LA were shown to be good candidates for nanoparticulation and nanoparticles in the range of 60 to 230 nm were obtained. The comparison between the 2 proteins offers guidance to optimize OVA and α-LA nanoparticle fabrication and to efficiently obtain nanoparticles with desired characteristics. The particle sizes of OVA nanoparticles were found to be in the range of 60 to 160 nm, and the particle sizes of α-LA were between 150 and 230 nm. The sizes varied with different desolvating agents: for OVA, ethanol, and methanol both produced nanoparticles smaller than 100 nm; for α-LA, methanol produced the smallest nanoparticles. Water: desolvating agent ratios, in the studied range, did not show a significant effect on the particle sizes for both OVA and α-LA nanoparticles. The size and morphology of the nanoparticles were found to change when the protein solutions were heated up to 50 and 80 ℃ and cooled down before nanoparticulation and most nanoparticles had a smaller diameter.

Fuchs' superficial marginal keratitis managed with circumferential marginal corneoscleral lamellar patch graft.

PURPOSE: To report a case of Fuchs' superficial marginal keratitis managed with circumferential marginal corneoscleral lamellar patch graft. METHODS: Interventional case report. RESULTS: A 34-year-old man presented with several years' history of ill-defined symptoms of binocular ocular irritation associated with vision loss, mostly in the left eye. A superior marginal corneal thinning was found at biomicroscopy of the left eye, with 2 finely vascularized descemetoceles, and a gray epithelial demarcation line without lipid infiltrates. The right eye was clinically normal. Anterior segment optical coherence tomography demonstrated an important corneal thinning from the 7 o'clock to 3 o'clock positions, without scleral involvement. A circumferential marginal corneoscleral lamellar patch graft was done involving 3 mm of sclera and 3 mm of cornea. CONCLUSIONS: Fuchs' superficial marginal keratitis is a rare entity, mostly affecting young adults. It should be considered part of a spectrum of corneal thinning disorders, together with Terrien's marginal degeneration. Definitive treatment with a marginal corneoscleral lamellar patch graft with or without conjunctival autograft is suggested.

Management of primary pterygia using free conjunctival and limbal-conjunctival autografts without antimetabolites.

PURPOSE: To report the incidence of recurrence after primary pterygium surgery using either a free conjunctival or limbal-conjunctival autograft without antimetabolites. METHODS: One hundred eleven eyes of 90 patients underwent pterygium resection; a free conjunctival autograft was used in 88 surgeries and a free limbal-conjunctival autograft in 24; the latter technique was reserved for dark-skinned patients, under age 30, and with a history of recurrent pterygium in the contralateral eye. RESULTS: Mean age was 42.5 years (range, 23-75), and 50% of the patients were male. Mean follow-up was 9 months (range, 3-12). There were 2 recurrences (1.8%), both observed in the third postoperative month. CONCLUSIONS: With a good surgical technique, the incidence of recurrence after primary pterygium surgery is very low, making the use of antimetabolites unnecessary.

Symptomatic management of postoperative bullous keratopathy with nonpreserved human amniotic membrane.

PURPOSE: To report the results of the management of painfully symptomatic postoperative bullous keratopathy (PBK) by performing a nonpreserved human amniotic membrane (NP-AMT) transplantation in nine eyes with poor visual potential. METHODS: A prospective, comparative, nonrandomized management of symptomatic PBK was done by performing a complete corneal de-epithelialization followed by a NP-AMT transplantation (NP-AMT group) or no NP-AMT transplantation (control group). We evaluated time for re-epithelialization, patient's symptoms, and appearance of new bullae. RESULTS: In the NP-AMT group, mean follow-up time was 40 weeks. Mean re-epithelialization time was 11.2 days. Symptoms of PBK resolved completely in eight patients (88%), who were asymptomatic and showing very quiet eyes from postoperative day 1, and resolved partially in one patient in whom we observed barely symptomatic bullae at the peripheral NP-AMT border (sixth postoperative week) and an asymptomatic one at the corneal center under the NP-AMT (seventh postoperative week). In the control group, mean follow-up time was 18 weeks; there were recurrences of symptomatic bullae in four of five patients at a mean time of 6.3 days. CONCLUSIONS: NP-AMT is a good alternative for the management of painful PBK in eyes with poor visual potential; NP-AMT is widely available, the technique is easy to perform, and it has good results from both the symptomatic and esthetic standpoint.