Crystalline-like keratopathy after intravenous immunoglobulin therapy with incomplete kawasaki disease: case report and literature review.

A 7-year-old girl had presented with high body temperature and joint pain which continued for 3 days. Because of the prolonged history of unexplained fever, rash, bilateral nonpurulent conjunctival injection, oropharyngeal erythema, strawberry tongue, and extreme of age, incomplete Kawasaki disease was considered and started on an intravenous immunoglobulin infusion. Six days after this treatment, patient was referred to eye clinic with decreased vision and photophobia. Visual acuity was reduced to 20/40 in both eyes. Slit-lamp examination revealed bilateral diffuse corneal punctate epitheliopathy and anterior stromal haze. Corneal epitheliopathy seemed like crystal deposits. One day after presentation, mild anterior uveitis was added to clinical picture. All ocular findings disappeared in one week with topical steroid and unpreserved artificial tear drops. We present a case who was diagnosed as incomplete Kawasaki disease along with bilateral diffuse crystalline-like keratopathy. We supposed that unusual ocular presentation may be associated with intravenous immunoglobulin treatment.

A rare devastating complication of LASIK: bilateral fungal keratitis.

Purpose. To report an unusual case of severe bilateral fungal keratitis following laser in situ keratomileusis (LASIK). Method. A 48-year-old man developed bilateral diffuse corneal infiltration two weeks after LASIK. The corneal scrapings revealed fungal filaments but cultures were negative. Results. The corneal ulceration was improved on the left eye whereas spontaneous perforation occurred and finally evisceration was needed on the right eye despite topical and systemic antifungal treatment. Conclusions. Fungal keratitis, especially with bilateral involvement, is a very rare and serious complication of LASIK surgery. Clinical suspicion is crucial because most of fungal keratitis are misdiagnosed as bacterial keratitis and can lead serious visual results, even eye loss.

Severe acute corneal hydrops in a patient with Down syndrome and persistent eye rubbing.

We report a case of severe acute corneal hydrops in an 11-year-old boy with keratoconus associated with Down syndrome and vigorous eye rubbing. Complete resolution of the corneal edema and a central corneal scar was seen in the 8th week of final follow-up. Eye-rubbing may play a role in the pathogenesis of acute hydrops, and conventional therapy can be successful in its management, even in severe cases.

Management of severe allergic conjunctivitis with topical cyclosporin a 0.05% eyedrops.

PURPOSE: To evaluate the efficacy of topical cyclosporin A 0.05% in the management of severe allergic conjunctivitis. METHODS: Seven patients with severe allergic conjunctivitis who were not responding to topical steroids, antihistamines, and mast cell stabilizers were given topical cyclosporin A 0.05%. All patients had an active disease when they were included in the study. Signs and symptoms were recorded before and after treatment. RESULTS: Seven patients, 6 boys and 1 girl, 6-14 years old, 6 with vernal keratoconjunctivitis and 1 with atopic keratoconjunctivitis, were enrolled in the study. Treatment with topical cyclosporin A 0.05% decreased the severity of symptoms and clinical signs significantly after 6 months (P < 0.05, Wilcoxon signed rank test). In addition, the need for steroids was reduced or even stopped. The patients experienced no side effects during the follow-up periods (mean, 14.0 +/- 2.1 months; range, 8-18 months). CONCLUSIONS: Topical cyclosporin A is an effective treatment in the management of severe allergic conjunctivitis with a benefit as a steroid-sparing agent.

Visual acuity and corneal topographic changes related with pterygium surgery.

PURPOSE: Applied pre- and postoperative corneal topography outcomes with visual acuities were evaluated to determine the surgical results in pterygium therapy. METHODS: The study group consisted of 30 eyes of 26 patients with primary and recurrent pterygium. Mean patient age was 52.26+/-11.50 years (range: 27 to 68 years). Pre- and postoperative visual acuity and comeal topography were evaluated for each case. Statistical analysis was performed using the repeated-measure test. RESULTS: The mean uncorrected visual acuity was 0.41+/-0.30 preoperatively and 0.63+/-0.26 postoperatively (P<.001). The mean best spectacle-corrected visual acuity was 0.59+/-0.28 preoperatively and 0.84+/-0.22 postoperatively (P<.001). Surface regularity index ranged from 1.96+/-1.08 preoperatively to 1.09+/-0.76 postoperatively (P<.001). The mean surface asymmetry index was 3.05+/-2.85 preoperatively and 1.39+/-1.70 postoperatively (P=.003). The mean topographic astigmatism was 4.65+/-3.02 preoperatively and 2.33+/-2.26 postoperatively (P=.003). CONCLUSIONS: Examination of the topographic records reveals pterygium-associated corneal flattening in the horizontal meridian along the line of the pterygium. The improvement in topographic pattern and best spectacle-corrected visual acuity can be used as one indicator of the success of pterygium surgery.

Surgical management of scleral defects.

PURPOSE: To evaluate the results of surgical management of scleral defects using fascia lata, cornea, and sclera as graft materials. METHODS: The scleral defects of 8 patients were repaired surgically. Six had previous intraocular surgery, 1 had eye trauma, and the other had both intraocular surgery and trauma. Corneoscleral grafts were used in 3 eyes, scleral grafts in 4, and fascia lata was used in 1 eye. RESULTS: In 7 patients, we achieved the desired cosmetic and tectonic success. During the follow-up period, a recurrent defect was seen in 1 patient, and a second operation was required. CONCLUSIONS: Surgical techniques using fascia lata, corneal, and scleral grafts are effective for scleral defects.

Aromatic monoterpenoid glycosides from Cruciata taurica.

Two new aromatic monoterpenoid glycosides, cruciaside A (2,5-O-beta-D-diglucopyranosyl-3-hydroxy-p-cymene) (1) and cruciaside B (5-O-beta-D-glucopyranosyl-2,3-dihydroxy-p-cymene) (2), were isolated from aerial parts of Cruciata taurica. The structures of the new compounds were determined by spectral and chemical methods. The new compounds seem to be promising as taxonomic markers for C. taurica.

Preoperative brush and impression cytology in ocular surface squamous neoplasms.

OBJECTIVE: Preoperative cytologic diagnoses of ocular surface squamous neoplasms were evaluated and compared with histologic diagnoses. STUDY DESIGN: Impression cytology (Millipore filter paper) and brush cytology were applied to 32 patients who had conjunctival neoplasms. Papanicolaou-stained cytologic preparations and hematoxylin and eosin-stained histologic sections were examined by light microscopy. RESULTS: The brush technique was used on 27 patients; impression cytology was applied in 5 cases. Cytologic and histologic diagnoses were concordant in 26 cases. Squamous cell carcinoma or carcinoma in situ was diagnosed in 18 and dysplasia in 4 cases. Squamous metaplasia and normal-appearing conjunctival epithelial cells were diagnosed cytologically in four cases; of those histologic diagnoses, one was pterygium and three, conjunctival nevus. Four cases revealed discrepancies between the cytologic and histologic preparations. There was one false positive result, and one case was subconjunctival invasion of basal cell carcinoma of the eyelid. CONCLUSION: Impression and brush cytology are fast, cost-effective, reliable and noninvasive diagnostic tools for ocular surface squamous neoplasms. However, the brush technique has several advantages over impression cytology.

A new pregnane glycoside and a furostanol glycoside from Digitalis cariensis.

Chemical investigation of the aerial parts of Digitalis cariensis Boiss. ex Jaub. & Spach resulted in the isolation of a new pregnane glycoside, cariensisoside (1) and a furostanol glycoside, uttroside A (2), along with the two known phenylethanoid glycosides, lugrandoside (3) and maxoside (4). On the basis of spectral (UV, IR, NMR, MS) and chemical methods, compounds 1 and 2 were identified as digifologenin-3-O-beta-glucopyranosyl-(1-->4)-beta-oleandropyranoside and 3-O-(beta-lycotetraosyl)-26-O-(beta-glucopyranosyl)-(25R)-22 alpha-methoxy-5-furostane-3 beta,26-diol, respectively.

Iridoid and phenylethanoid glycosides from Phlomis tuberosa L.

A new iridoid glucoside, 8-O-acetylshanzhiside (1), was isolated from the aerial parts of Phlomis tuberosa, together with two known iridoid glucosides, shanzhiside methyl ester and lamalbide. The known phenylethanoid glycosides acteoside and forsythoside B were also obtained and characterized. The structure of 1 was determined by means of 1D- and 2D-NMR spectroscopic evidence.

Iridoid and phenylethanoid glycosides from Phlomis longifolia var. longifolia.

From the aerial parts of Phlomis longifolia var. longifolia four iridoid glucosides, shanzhiside methyl ester (1), 5-deoxypulchelloside I (2), lamalbide (3), phlomiol (4) and three phenylethanoid glycosides, verbascoside (5), forsythoside B (6), leucosceptoside A (7) along with the caffeic acid ester, chlorogenic acid (8) were isolated. The structures of the isolated compounds were established by spectroscopic (UV, IR, 1D- and 2D-NMR, FABMS) and chemical evidence. The structure elucidation of the iridoid compounds 2 and 3 are discussed in detail.

An iridoid glucoside from Euphrasia pectinata.

A new iridoid glucoside, 5beta,6beta-dihydroxyboschnaloside (1), was isolated from the aerial parts of Euphrasia pectinata. Five known iridoid glucosides, 6beta-hydroxyboschnaloside (2), aucubin, euphroside, plantarenaloside, and geniposidic acid, and two known phenylethanoid glycosides, verbascoside (= acteoside) and leucosceptoside A, were also obtained and characterized. The structure of compound 1 was established by spectroscopic evidence.

Brush technique in ocular surface cytology.

New techniques are being searched for the evaluation of cellular morphology and population of ocular surface. Impression cytology is one of the most preferred techniques in ocular surface sampling in dry eye, keratitis, and conjunctivitis. We evaluated and compared the efficacy of impression and brush cytology in 63 patients. All of the samples collected by the brush technique were sufficient for diagnosis: 88% of the slides revealed abundant cells and 12% adequate number of cells. In 21% of the samples observed by impression cytology the cell number was inadequate for diagnosis. In 58% of them the cells were abundant and in 21% few cells were observed. This study proved the value of brush cytology in collecting ocular surface cells.

Down gaze palsy due to periaqueductal lesion diagnosed by magnetic resonance imaging.

Selective paralysis of downward gaze is known to be rare. There are 6 cases reported in the literature based on neuropathologic and anatomical studies. We report a 60-year-old diabetic and hypertensive patient with isolated down gaze palsy. Computed tomography failed to show the lesion in the periaqueductal region, and the diagnosis was made by Magnetic resonance imaging. The case presented is the only one still surviving.

Ocular involvement in childhood leukemias.

Ocular involvement was detected in 36 of 84 children suffering from acute leukemia. The major manifestation of leukemic ophthalmology was retinal hemorrhage. Neither platelet counts nor hematocrit values correlated with the occurrence of hemorrhages. As the eye is a pharmacologic sanctuary, it is emphasized that full ophthalmologic evaluation of leukemic patients is a critical part of their follow-up and will guide the choice of therapeutic regimen.

Circulating corneal epithelium antibodies and immune complexes in immunologic eye disorders.

We investigated the incidence of circulating corneal epithelial antibodies and the serum levels of immune complexes in patients with immunologic disorders associated with the eye. Fifty patients with autoimmune diseases, 29 of whom had Behcet disease, were included in our study. Twenty healthy subjects were used as controls. Twenty-four patients (48%) had detectable levels of circulating antibodies against the corneal epithelium compared with two (10%) of the control subjects. Patient age had a negative effect on the induction of antibodies, whereas there were neither positive nor negative associations of antibody positivity rates with factors such as gender, the duration of the illness, the activity of the disease, the occurrence rate of the attacks, immune suppressant therapy, and the levels of circulating immune complexes. This study clearly demonstrated the high incidence of corneal antibodies in certain diseases of immunologic origin, including Behcet disease. Further investigations should be done to reveal clues about the presumed effects of local and systemic factors on the production of anticorneal antibodies.

Aetiological distribution of uveitis patients in Southern Turkey.

A prospective study was conducted involving 363 patients seen in the UveaImmunology Clinic of the Department of Ophthalmology, Çukurova University Medical Faculty, to determine the aetiological distribution of uveitis in this region. The results of the study were compared with previous studies carried out on different populations, and the significance of geographical, cultural and genetic factors in the occurrence of uveitis was discussed. In the authors' study group an aetiological diagnosis was established in 68.3% of the patients, whereas 115 cases (31.7%) were diagnosed as idiopathic uveitis. 203 cases (55.9%) were found to be associated with systemic diseases and 45 patients (12.4%), who had a well established clinical uveitis without a recognizable systemic disorder were diagnosed as having primary ocular syndromes. Although the aetiological distribution of the patients in our study group was found to be similar to that of other populations living in different regions in Turkey, it was completely different from the results of studies performed on populations living in different geographical areas of the world, who have different cultural and genetic characteristics. In the authors' study an associated condition was found in a high percentage of the patients, the most frequent of which was Behçet's disease (32.5%).

The association between HLA B5 and ocular involvement in Behçet's disease in southern Turkey.

HLA B5 plays an important role in the aetiology of Behçet's disease. The frequency of HLA B5 differs between racial groups and geographical regions. Ocular involvement, which could lead to serious complications, is a very important feature of Behçet's disease. Various racial groups having different genetic properties live in the Cukurova region, located in southern Turkey. To investigate the role of HLA B5 in Behçet's disease in Cukurova region, HLA B5 antigens were investigated by lymphocytotoxicity assay in 65 patients and 200 healthy controls. A significantly higher frequency was found in the patient group. Neither ocular involvement, nor the type of uveitis showed any correlation with HLA B5, but it was found that patients presenting with frequent ocular attacks had significantly higher HLA B5 positivity than the patients with rare attacks. This observation suggests that HLA B5 would be a negative factor in visual prognosis in Behçet's disease.

Two phenylpropanoid glycosides from Leonurus glaucescens.

Two new phenylpropanoid glycosides, leonosides A and B, and two known glycosides lavandulifolioside and verbascoside, were isolated from the aerial parts of Leonurus glaucescens. On the basis of chemical and spectral evidence, leonosides A and B were shown to be beta-(3,4-dihydroxyphenyl)-ethyl-O-alpha-L-arabinopyranosyl-(1---- 2)-alpha-L- rhamnopyranosyl-(1----3)-4-O-feruloyl-beta-D-glucopyranoside and beta-(3-hydroxy, 4-methoxyphenyl)-ethyl-O-alpha-L-arabinopyranosyl-(1----2)- alpha-L-rhamnopyranosyl-(1----3)-4-O-feruloyl-beta-D-glucopyranosi de, respectively.

Granuloma pyogenicum originating from the caruncle.

This paper describes, to our knowledge, the first reported granuloma pyogenicum originating from the caruncle, and reviews the clinical and pathological findings associated with the disease.