Traumatic epithelial downgrowth after radial keratotomy.

A 40-year-old white man who had radial keratotomy (RK) in both eyes in 1993 experienced pain, extreme photophobia, and mild loss of uncorrected visual acuity in the right eye after being struck by a nail. The patient presented with a small, deep stromal lesion and was initially treated with a variety of antibiotic regimens without improvement in the lesion's appearance. Upon referral, confocal microscopy was performed and clearly demonstrated epithelial cells in the deep stroma and on the endothelial surface. After all medications were stopped, the mild symptoms resolved and the clinical appearance remained stable. Patients with RK incisions are at risk for traumatic epithelial downgrowth even many years after surgery. With confocal microscopy, epithelial downgrowth can be definitively diagnosed. Management of this condition remains controversial.

Solitary orbital infantile myofibroma: a case report and review of the literature.

Infantile myofibromatosis is a benign condition involving the skin, viscera, or bone that presents rarely in the orbit where rapid growth and bony destruction can mimic malignant tumors. Lesions can be solitary or scattered throughout the body. Growth in viscera such as the lungs can lead to death. Herein, we present a case of a solitary orbital myofibroma in a young child.

Optical coherence tomography measurement of nerve fiber layer thickness and the likelihood of a visual field defect.

PURPOSE: To determine if optical coherence tomography (OCT) measurements of nerve fiber layer (NFL) thickness can be used to predict the presence of visual field defects (VFD) associated with glaucoma. DESIGN: Quota-sampled, cross-sectional study. METHODS: Retrospective study of OCT NFL thickness measurements in 276 eyes of 276 subjects. All persons received OCT NFL thickness analysis; 136 eyes underwent frequency-doubling technology (FDT) perimetry; and 140 eyes underwent Swedish interactive threshold algorithm (SITA) perimetry. We defined a parameter called NFL(50), which is the NFL thickness value at which there was a 50% likelihood of a VFD with either SITA or FDT perimetry. We evaluated the use of NFL(50). RESULTS: The mean NFL thickness with (n = 68) and without (n = 68) a VFD in the FDT group was 93.2 microm +/- 22.6 and 108.4 microm +/- 14.1, respectively. The mean NFL thickness with (n = 70) and without (n = 70) a VFD in the SITA group was 78.9 microm +/- 24.8 and 103.0 microm +/- 18.0, respectively. The FDT mean NFL(50) value was 98.5 microm. The SITA mean NFL(50) value was 87.0 microm. The area under the receiver operator characteristic (AROC) curve for mean NFL was 0.73, and the positive predictive value (PPV) for FDT mean NFL(50) was 72.2%. For SITA mean NFL, the AROC was 0.79 and the PPV for NFL(50) was 77.2%. CONCLUSION: Nerve fiber layer thickness analysis using OCT may be clinically useful in identifying subjects who have visual field loss. However, the PPV suggests that OCT may need higher resolution and better reproducibility to enhance its sensitivity and specificity for population screening.