ABSTRACT
Central retinal vein occlusion [CRVO] occurs at the scleral outlet where the optic nerve, central retinal artery, and central retinal vein enter the eye; therefore it may be considered a "compartment syndrome" which is defined as a neurovascular compression within this confined space of scleral outlet resulting in tissue ischemia and dysfunction. Transvitreal optic neurotomy [TON] is a new surgical technique advocated for treatment of CRVO. By this procedure and providing surgical relaxation of the scleral outlet, clearing of macular edema and interaretinal hemorrhage and improved retinal blood flow may reestablish. TON may be a beneficial surgical procedure for patients with sever CRVO via decompressing the scleral outlet and by that affecting the optic nerve and the blood supply. In addition to scleral ring relaxation, other postulated mechanisms of effect in TON include development of opticociliary vessels and increased perfusion into pre-existing opticociliary vessels. Preliminary results of TON for CRVO have demonstrated encouraging results; however these results need to be reconfirmed in a randomized clinical trial
ABSTRACT
Purpose: to present 2 cases of acanthamoeba keratitis diagnosed by confocal scanning before positive results of smear and culture, and their successful treatment with combined medical therapy and corneal epithelial debridment
Patients and Windings: confocal scan was carried out in 2 contact lens wearers with a clinical diagnosis of acanthamoeba keratitis followed by corneal epithelial debridment for debulking of the corneal lesion and preparing specimens for smear and culture. Medical therapy was initiated subsequently. Wet mount preparations of the contact lens preservative fluid were also evaluated under dark field microscopy. Confocal scan in both patients revealed reflective round to oval-shaped structures 15 to 25 micro in diameter in the sub-epithelial and anterior stromal areas. Smear and culture results were positive for acanthamoeba and the motility of the trophozoites was easily observed using wet mount preparations. Both cases were treated successfully by combined medical therapy and debulking of the lesion
Conclusion: confocal scan is a very helpful, non-invasive procedure in the early diagnosis of acanthamoeba keratitis before positive results of smear and culture. Corneal epithelial debulking in the early stages of acanthamoeba keratitis is of diagnostic value and has high therapeutic importance when combined with anti-acanthamoeba medical therapy