Ophthalmic findings and parameters in Western tiger salamanders (Ambystoma mavortium) from northern Colorado.

OBJECTIVE: The aim of this study was to document ophthalmic examination findings and provide reference values for ocular examinations and diagnostics in clinically normal Western tiger salamanders (Ambystoma mavortium) and to evaluate the mydriatic effect of a topical rocuronium bromide and identify any adverse effects. ANIMALS STUDIED: Sixteen Western tiger salamanders. PROCEDURE: A complete ophthalmic examination, including intraocular pressure via rebound tonometry [iCare® TonoVet (dog-setting) or iCare® TonoVet Plus (dog-setting)], and fluorescein and Rose Bengal stains, was performed. Ocular surface flora culture swabs were collected for microbiology in four salamanders. Rocuronium bromide (50 µL; 0.01 mg) was administered into each eye in three salamanders. Pupil size and constriction ability were evaluated up to 60 min following administration of rocuronium bromide. Distant visual examination and Doppler heart rate were used to monitor for potential adverse effects of rocuronium bromide. RESULTS: Observed ocular abnormalities included lipid keratopathy/keratitis (19%; 3/16), parasitic ophthalmitis (19%; 3/16), and cataracts (6.3%; 1/16). A significant difference was found between tonometry with iCare® TonoVet (11.5 ± 2.7 mmHg) versus TonoVet Plus (15.4 ± 3.7 mmHg) (p = .025). Fluorescein and Rose Bengal stains were negative in all salamanders. Ocular surface microbiology revealed a high incidence of contamination from environmental flora, with the most common isolate being unidentified as Gram-negative nonfermenters (75%; 3/4). No significant change in pupil size or constriction ability was observed with rocuronium bromide. CONCLUSION: This is the first study to document ocular examination findings and diagnostics in captive and wild urodeles and may serve as a reference for clinical assessment and future studies of the Western tiger salamander.

Disseminated idiopathic lipid keratopathy in a normolipemic cat.

OBJECTIVE: To report a case of idiopathic lipid keratopathy in a normolipemic cat. ANIMAL STUDIED: A 10-year-old neutered female European domestic cat. RESULTS: A cat was evaluated for bilateral white corneal deposits. Slit-lamp examination revealed multiple, well-defined, round, stromal, cream-colored deposits of different sizes associated with generalized superficial corneal vascularization. Blood lipids were normal, and no history of travel to tropical locations or ocular trauma was present. Topical betamethasone/gentamicin 0.1% suspension q 12 hours did not result in any improvement of clinical appearance after one week. Tomography following the initial therapy revealed dense, hyperreflective deposits with posterior shadowing in the anterior and mid stroma of both corneas. A four-week course of itraconazole 0.01% ophthalmic cream was prescribed q 12 hours with no improvement. Four months after the initial examination, a diagnostic superficial keratectomy and amniotic membrane implantation were performed. Histopathological analysis showed membrane bound vacuoles with infiltration of foamy macrophages suggesting a diagnosis of primary lipidosis. The post-surgical period was unremarkable, and ten days later, the patient was re-examined. Opacification from a corneal leukoma was observed in the excision site with mild fibrotic tissue. Two months post-keratectomy, no further changes were detected in the cornea, and the patient was managed only with topical lubricant. CONCLUSIONS: To our knowledge, this is the first report of idiopathic corneal lipidosis in a cat and may be considered as a differential diagnosis of corneal disease in felines.

Multimodal ocular imaging of known and novel corneal stromal disorders in dogs.

BACKGROUND: Imaging features obtained with Fourier-domain optical coherence tomography (FD-OCT) and in vivo confocal microscopy (IVCM) for corneal stromal disorders have been sparsely reported in dogs. This case report is a compilation of imaging features for three cases of different stromal disorders of the canine cornea which have not yet been reported elsewhere. CASE PRESENTATION: Lipid deposition in case 1 appeared as needle-shaped hyperreflective lines along the collagen lamellae, which correlated histologically with lipid clefts. In case 2, glycosaminoglycan accumulation by mucopolysaccharidosis type 1 caused diffuse stromal hyperreflectivity and depletion of keratocytes on IVCM and was associated with secondary corneal degeneration presumed to be calcium deposition. In case 3, posterior corneal stromal opacities in the absence of ocular inflammation were identified. Hyperreflective particles were scattered in the middle and posterior corneal stroma on FD-OCT. With IVCM, hyperreflective deposits were identified within keratocytes and the number of enlarged keratocytes containing hyperreflective deposits increased towards the posterior stroma. The bilateral, non-inflammatory nature and unique appearance with IVCM is most consistent with a posterior stromal dystrophy reminiscent of pre-Descemet corneal dystrophy described in humans. CONCLUSIONS: In vivo multimodal corneal imaging facilitated instantaneous microstructural analysis and may be valuable in the differential diagnosis of corneal stromal disorders in veterinary clinical practice. The non-specific nature of imaging findings occurs in some conditions such as mucopolysaccharidosis, thus in vivo corneal imaging should be complemented with other gold standard methods of definitive diagnosis.

Initial outcomes of mitomycin intravascular chemoembolization (MICE) for corneal neovascularization.

PURPOSE: To report on the preliminary outcomes of mitomycin C (MMC) intravascular chemoembolization (MICE) for corneal neovascularization (NV). METHODS: This is a retrospective case series of three consecutive eyes that underwent MICE for progressive corneal NV with sight threatening lipid keratopathy. A 1.0 cc syringe was partially filled with MMC (0.4 mg/mL) and attached to a 33-gauge needle used to cannulate the vessels. The MMC (0.01-0.05 ml) was injected with enough retrograde hydrostatic force to fill efferent and afferent vessels. Follow-up ranged from 4 months to 1 year. RESULTS: Three eyes of three patients aged 59, 73 and 33 years were included. There were no intraoperative or postoperative complications associated with the MICE procedure. Patient 1 presented with progressive corneal NV and lipid keratopathy secondary to herpes zoster ophthalmicus (HZO) and a best-corrected spectacle visual acuity (BSCVA) of 20/100 Snellen. At one-year post-MICE, there was no recurrence (BSCVA was 20/20 Snellen). Patient 2 presented with idiopathic lipid keratopathy (BSCVA 20/50 Snellen). At four months post-MICE, there were no signs of recurrence (BSCVA 20/20 Snellen). Patient 3 presented with corneal NV and lipid keratopathy secondary to HZO (BSCVA 20/30 Snellen). At four months following two MICE treatments, resolution of the lipid keratopathy was noted (BSCVA 20/20 Snellen). CONCLUSIONS: Preliminary findings suggest that MICE may be an additional modality for treating progressive corneal NV with lipid keratopathy. Larger comparative studies with longer follow-up are warranted.

OPHTHALMIC EXAMINATION FINDINGS AND INTRAOCULAR PRESSURE MEASUREMENTS IN SIX SPECIES OF ANURA.

A complete ophthalmic exam, including intraocular pressure (IOP) measurement, is key to diagnosing ocular diseases such as uveitis and glaucoma in frogs. We performed complete ophthalmic anterior segment examinations and IOP rebound tonometry measurements using two different settings (other "p" and canine "d") for six anuran species. The objectives were to describe common ocular abnormalities found in these species, to compare IOP values between different tonometer settings, and to compare IOPs between species. Examinations revealed abnormalities including cataracts (11/98 total eyes), lenticular sclerosis (10/98) and lipid keratopathy (9/98). IOP was measured with the TonoVet® and the ranges (oculus uterque, OU mm Hg other "p" setting, canine "d" setting) were giant waxy monkey tree frogs (Phyllomedusa bicolor) (3.5-7.6; 6.5-11.7; n = 5), mission golden-eyed tree frogs (Trachycephalus resinifictrix) (7.0-9.7, 13.2-15.7; n = 6), boreal toads (Bufo boreas boreas) (0.8-5.5, 5.7-10.5; n = 13), Mexican giant tree frogs (Pachymedusa dacnicolor) (3.8-5.0, 8.3-11.8; n = 3), Lake Titicaca frogs (Telmatobius culeus) (8.8-10.5, 14.0-17.2; n = 8), and mossy tree frogs (Theloderma corticale) (9.7-11.0, 15.7-17.0; n = 5). The TonoVet canine "d" setting IOP measurements were statistically higher (P = 0.01) than the other "p" setting measurements for all species except the giant waxy monkey tree frogs. IOP was significantly lower for giant waxy monkey tree frog eyes with cataracts (P < 0.05) with the other "p" setting. IOP did not statistically differ in eyes with lenticular sclerosis. IOP can be measured by rebound tonometer in anurans, but more research is needed for species-specific references using consistent settings.

Case report of interstitial keratitis in pregnancy.

Purpose: To report an unusual case of interstitial keratitis and lipid keratopathy in a pregnant woman with unknown etiology and atypical clinical course. Observations: A 15 weeks pregnant 32-year-old female daily soft contact lens wearer presented with 1 month of right eye redness and intermittent blurry vision. Slit lamp examination revealed sectoral interstitial keratitis with stromal neovascularization and opacification. No underlying ocular or systemic etiology was identified. The corneal changes were unresponsive to treatment with topical steroids and progressed over the ensuing months of her pregnancy. On continued follow up, the cornea demonstrated spontaneous partial regression of the opacification in the post-partum period. Conclusions and importance: This case illustrates a possible rare manifestation of pregnancy physiology in the cornea. It also emphasizes the utility of close follow-up and conservative management in pregnant patients with idiopathic interstitial keratitis not only to avoid intervention during pregnancy but also because of the possibility of spontaneous improvement or resolution of the corneal changes.

Clinical demographic characteristics and ocular Co-morbidities associated with Secondary lipid keratopathy at a tertiary care center.

OBJECTIVE: To describe the demographics and clinical profile of Secondary Lipid Keratopathy in patients presenting to a multi-tier ophthalmology hospital network in India. METHODS: This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of Secondary Lipid Keratopathy in at least one eye were included as cases. The data were collected using an electronic medical record system. RESULTS: Overall, 389 (0.01%) patients were diagnosed with Secondary Lipid Keratopathy. Majority were males (53.5%) and had a unilateral affliction (82.8%). The most common age group at presentation was during the sixth decade of life with 76 (19.5%) patients. The overall prevalence was higher in patients from a lower socio-economic status (0.02%) presenting from the rural geography (0.01%) and in individuals related to agriculture work/ manual labor (0.02%). Of the 456 eyes, mild or no visual impairment (<20/70) was noted in 194 (42.5%) eyes followed by moderate visual impairment (>20/70 to 20/200) in 81 (17.8%) eyes. At presentation, the mean visual acuity was 0.96 ± 1.07 log MAR units. The most associated corneal condition was non-HSV corneal scar (36.8%), followed by spheroidal degeneration (19.7%) and HSV keratitis in (18.6%). CONCLUSION: Secondary lipid keratopathy more commonly affected males presenting during the sixth decade of life. Most (42.5%) of the eyes had mild or no visual impairment. Corneal scar (non-HSV) was the most associated corneal condition in both unilateral and bilateral cases. HSV keratitis was the commonest corneal condition in those between 20 and 40 years, followed by those above 40 years.

Bilateral lipid keratopathy with rheumatic fever in siblings.

PURPOSE: To report two unusual cases of lipid keratopathy in siblings with rheumatic fever and positive anti-phospholipid antibodies. METHODS: Clinical and histopathological examination along with complete systemic work-up was done after taking appropriate consent from the patients. A serum lipid profile showed elevated cholesterol and low-density lipoproteins. Systemic history revealed both the siblings were on treatment for rheumatic fever. A complete blood profile showed positive anti-phospholipid antibodies in one of them. RESULTS: Penetrating keratoplasty was performed in both cases one year apart. Histopathological examination showed lipid filled macrophages distributed throughout the corneal stroma. No episode of recurrence was noted in the follow-up period of three years. CONCLUSION: These two cases highlight the importance of a thorough family history and a full systemic work-up in a patient with bilateral symmetrical lipid keratopathy. The co-existence of rheumatic fever and anti-phospholipid syndrome has been studied in literature but, their presence along with lipid keratopathy has not been previously described. It requires further research whether they have an association or it was just an incidental finding.

Lipid Keratopathy: Histopathology, Major Differential Diagnoses and The Importance of Clinical Correlation.

Lipid keratopathy (LK) is a rare ophthalmological condition characterized by a progressive reduction in visual acuity caused by corneal opacification due to central lipid accumulation. LK is characterized by lipid deposits, cholesterol clefts, and neovascularization (NV) leading to disruption in corneal optical quality. LK classification includes a primary and secondary form which depend on pre-existing corneal or systemic disorders and the evidence of NV. Secondary LK is typically associated with a prior occurrence of herpetic infection, such as herpes zoster keratitis. Patients with LK usually present with progressive vision loss and dense cream-colored corneal opacification. Treatment modalities include conservative and surgical approaches focused on corneal NV elimination. When evaluating corneal lipidosis, it is crucial to consider a range of differential diagnoses, including corneal arcus, Schnyder corneal dystrophy, and other corneal deposit conditions. We report a case of a 62-year-old male with herpes zoster keratitis complicated with LK. He presented with painless progressive vision loss and corneal scarring, which raised suspicion about LK diagnosis. This paper emphasizes the importance of correlating clinical and histological findings for accurate LK diagnosis.

Radiofrequency diathermy as a treatment of lipid keratopathy in a radial keratotomy incision.

Purpose: We report a case of lipid keratopathy in a radial keratotomy incision that was successfully managed with radiofrequency diathermy of the neovascular pedicle responsible for the lipid deposition. Observations: No perioperative or postoperative complications were noted. Following the procedure, the lesion showed significant decrease in lipid deposits and opacification along with disappearance of the neovascular pedicle. Conclusions and importance: Radiofrequency diathermy of neovascular pedicle may represent an effective and safe alternative treatment option for treating lipid keratopathy. This is a first ever report of lipid keratopathy inside a radial keratotomy incision that was successfully managed by radiofrequency diathermy.

Lipid Keratopathy: A Review of Pathophysiology, Differential Diagnosis, and Management.

Lipid keratopathy is a disease in which fat deposits accumulate in the cornea, leading to opacification and decrease of visual acuity. This condition can be idiopathic without signs of previous corneal disease or secondary to ocular or systemic diseases. Lipid keratopathy is usually associated with abnormal vascularization of the cornea, and the lipid classically deposits adjacent to these vessels. Treatment of this condition usually aims to eliminate or prevent abnormal vessel formation, and several modalities have been described. In this review we summarize the etiology, pathophysiology, and clinical presentation of lipid keratopathy and describe current and emerging treatment regimens.

Corneal Neovascularization with Associated Lipid Keratopathy in a Patient with Obstructive Sleep Apnea-Hypopnea Syndrome Using a Continuous Positive Airway Pressure Machine.

OBJECTIVE: To report a case of corneal neovascularization with secondary lipid keratopathy in a patient treated with continuous positive airway pressure (CPAP) for obstructive sleep apnea-hypopnea syndrome (OSAHS). CASE REPORT: A 49-year-old male had been diagnosed with obstructive sleep apnea syndrome 10 years ago and has been treated with the application of a CPAP machine during night sleep ever since. For the past year, the patient had been complaining for ocular irritation and excessive tearing of the left eye on awakening. Slit-lamp biomicroscopy revealed the presence of neovascularization and lipid exudation in the inferior third of the cornea of the left eye. Ocular patching during night sleep resulted in recession of the reported symptoms and shrinkage of the neovascularization, while the area of lipid exudation ceased to enlarge. CONCLUSION: To the best of our knowledge, this is the first report of corneal neovascularization in a patient using a CPAP machine for OSAHS.

Massive lipid keratopathy after Elizabethkingia meningosepticum keratitis.

PURPOSE: To report the occurrence of massive lipid deposition in the cornea after Elizabethkingia meningoseptica keratitis. METHODS: A 52-year-old female presented to the ophthalmology outpatient department of the Hong Kong Eye Hospital in January 2012 with complaints of pain, redness, watering and blurred vision in her left eye for 6 days. Past records showed that the patient underwent radiotherapy for mucoepidermoid carcinoma of the maxillary antrum which was later complicated by radiotherpay associated dry eye syndrome in her left eye. At the time of presentation, her best-corrected visual acuity was 0.7 OD and hand motions close to face OS. Slit lamp examination of the left eye showed a small infiltrate 1.4mm×1.2mm in size with an overlying epithelial defect. Elizabethkingia meningosepticum was isolated on broth. Good clinical response was observed with hourly 5% vancomycin eye drops. RESULTS: At the end of 8 weeks, slit lamp examination of the left eye revealed a corneal scar with mild lipid deposition at the site of previous corneal infiltrate. The lipid deposits increased tremendously over the next 4 weeks. The final visual acuity in the right eye dropped down to perception of light. The patient refused any further surgical intervention and is on regular follow-up in our clinic. CONCLUSIONS: Our case report highlights the occurrence of post-keratitis lipid keratopathy with E. meningosepticum.

Treatment of herpes zoster related corneal neovascularisation and lipid keratopathy by photodynamic therapy.

Traditionally, photodynamic therapy (PDT) has been used to treat choroidal neovascularisation. More recently, its use in corneal neovascularisation has provided promising clinical results. The major advantage of PDT is that it is minimally invasive, resulting in closure of the neovascular network without damaging the surrounding healthy tissue. This report describes the positive results of PDT, clinically and microstructurally, as imaged by in vivo confocal microscopy, for treating corneal neovascularisation with lipid keratopathy, secondary to herpes zoster infection.