Bilateral peripheral ulcerative keratitis in a patient with known Sézary syndrome.

Purpose: To report a case of bilateral peripheral ulcerative keratitis (PUK) in a patient with underlying Sézary syndrome. Observations: A 58-year-old male presented with bilateral corneal ulceration with stromal thinning and was diagnosed with PUK. He was actively being treated for Sézary syndrome, a cutaneous T-cell lymphoma. He had no lagophthalmos or other adnexal abnormalities that would lead to ocular surface breakdown. A systemic autoimmune and infectious workup for PUK was unremarkable. His keratitis resolved after treatment with oral prednisone. Conclusions and importance: We describe a previously undocumented association of PUK with Sézary syndrome in a patient without adnexal disease.

Late-onset diffuse lamellar keratitis following laser in situ keratomileusis.

OBJECTIVE: To analyze 12 cases of late-onset diffuse lamellar keratitis (DLK) following uncomplicated LASIK and propose a method of management. DESIGN: Retrospective observational case series, literature review. PARTICIPANTS: Patients who developed late-onset DLK following LASIK. METHODS: Retrospective chart review of all patients with late-onset DLK from January 2014 to August 2015. Data collected included demographic information, probable cause of DLK, stage of DLK, baseline examination, treatment, clinical course, outcomes, complications, and last follow-up examination. Review of relevant literature included searching for all prior cases and case series relating to "diffuse lamellar keratitis," "late-onset DLK," "Secondary Sands," and "delayed-onset DLK" by searching PubMed with these search terms. RESULTS: Twelve eyes of 11 patients presented with late-onset DLK following LASIK. Onset ranged from 8 months to 17 years following LASIK. Stage of DLK ranged from stage I to III, and all patients responded well to aggressive corticosteroids without lifting of the LASIK flap. Final visual acuity for stage I/II and III eyes did not demonstrate a significant difference (p = 0.218). DLK resolved by a mean of 4.86 weeks for all eyes. CONCLUSION: Late-onset DLK can present at any time following LASIK with a wide range of inciting factors causing a nonspecific (and likely immune-related) inflammatory reaction. Based on our findings, aggressive oral and topical corticosteroids should be tried before lifting the LASIK flap as long as infection is not suspected or inciting debris is not seen in the flap because the vast majority resolve with such therapy.

Globe Rupture of a Post-LASIK Keratectasia Eye From Blunt Trauma.

PURPOSE: To report a case of globe rupture in a patient with post-laser in situ keratomileusis (LASIK) ectasia after blunt trauma. METHODS: Observational case report. RESULTS: A 42-year-old man with a history of post-LASIK ectasia sustained paracentral corneal rupture secondary to blunt trauma from a fist to his left eye (OS). Slit-lamp examination revealed rupture in the posterior stroma (inferior paracentral) of the OS with an overlying intact LASIK flap; however, the inferior edges of the LASIK flap were Seidel positive. The anterior chamber was flat. Although he was initially managed with cyanoacrylate glue and a bandage contact lens, the patient eventually required tectonic penetrating keratoplasty. The postoperative course was unremarkable, and over 1 year later, the visual acuity OS was 20/25 with -7.50 + 2.00 × 0.50. CONCLUSIONS: Globe rupture from blunt trauma has not been shown to be more common in patients with a history of LASIK. Although blunt trauma to the post-LASIK globe would generally incur a similar risk of rupture to that of the normal eye, keratectasia after LASIK may predispose the globe to rupture.

Treatment of chronic nonhealing neurotrophic corneal epithelial defects with thymosin beta4.

Neurotrophic corneal defects are difficult to heal and all too often lead to scarring and vision loss. Medical management is often of limited success. We describe the results of nine patients (ages 37-84) with chronic nonhealing neurotrophic corneal epithelial defects who were treated with thymosin beta 4 (Tbeta4) sterile eye drops for 28 or 49 days with a follow-up period of 30 days. Those with geographic defects (six patients) showed dramatic healing without clinically significant neovascularization. Stromal thinning was observed in one patient. Three patients with punctate epithelial defects did not have a demonstrable change in their clinical findings. Reduced ocular irritation was reported by all patients soon after treatment initiation. Results from these compassionate use cases indicate that Tbeta4 may provide a novel, topical approach to wound healing in chronic nonhealing neurotrophic corneal ulcers.

Comparison of deep lamellar endothelial keratoplasty and penetrating keratoplasty in patients with Fuchs endothelial dystrophy.

PURPOSE: To evaluate and compare 1-year postoperative visual acuity, refractive results, endothelial cell density (ECD), and complications in a consecutive group of patients who underwent deep lamellar endothelial keratoplasty (DLEK) with those who underwent penetrating keratoplasty (PK) performed by 1 surgeon. METHODS: We prospectively analyzed results of 20 consecutive patients with Fuchs dystrophy and pseudophakia who underwent small-incision DLEK surgery and retrospectively compared these results with those of 23 consecutive patients with Fuchs dystrophy and pseudophakia who underwent standard PK surgery during the same period. Main outcome measurements were best spectacle-corrected visual acuity (BSCVA); refractive, keratometric, and topographic astigmatism; topographic irregular astigmatism; absolute change in spherical equivalent; and ECD. Postoperative complications in the 2 groups were also analyzed. RESULTS: Preoperative BSCVA was significantly better in the DLEK group than the PK group (P = 0.013). Postoperative BSCVA was significantly better in the DLEK group than the PK group at 6 months (P = 0.025) and similar in each group at 12 months. Twelve-month postoperative refractive, keratometric, and topographic astigmatism was significantly less in the DLEK group than the PK group (P < 0.001). Surface asymmetry index and change in keratometric spherical equivalent was significantly less in the DLEK group than the PK group at 12 months postoperatively (P < 0.001). Preoperative ECD was significantly higher in the DLEK group (3072 +/- 307 cells/mm) than the PK group (2779 +/- 413 cells/mm). Twelve-month postoperative ECD was similar in the DLEK group (1293 +/- 469 cells/mm) compared with the PK group (1303 +/- 454 cells/mm; P = 0.949, not significant). Twelve-month percent endothelial cell loss was higher than reported in previous studies but was similar in the DLEK group (57.9%) compared with the PK group (53.1%). Twelve months postoperatively, all grafts were clear in the DLEK and PK groups. CONCLUSIONS: DLEK surgery resulted in more rapid vision recovery, significantly less regular and irregular astigmatism, and less change in spherical equivalent than PK surgery. Endothelial cell loss was significant in both groups but was not significantly different in the DLEK group from the PK group. DLEK surgery has significant advantages over PK surgery, but long-term ECD and graft survival in DLEK surgery should be studied.

Treatment of ligneous conjunctivitis with topical plasmin and topical plasminogen.

PURPOSE: To describe treatment of a child with recalcitrant ligneous conjunctivitis secondary to a systemic plasminogen deficiency. DESIGN: Interventional case report. METHODS: A seven-year-old boy developed severe unilateral membranous conjunctivitis recalcitrant to surgical debridement and treatment with topical prednisone, topical cyclosporine, and oral prednisone. Systemic evaluation revealed a severe plasminogen deficiency. RESULTS: Treatment with surgical debridement and topical plasmin was ineffective and resulted in prompt recurrence of dense conjunctival membranes. Treatment with topical plasminogen resulted in dramatic improvement and complete resolution of the membranes. CONCLUSIONS: Ligneous conjunctivitis is secondary to a systemic plasminogen deficiency. Treatment with topical plasminogen resulted in prompt resolution of the membranes. Treatment with topical plasmin was ineffective.