ABSTRACT
To report the clinical, confocal scan, and histopathologic features of bilateral Nocardia keratitis following photorefractive keratectomy [PRK]. A 23-year-old girl underwent simultaneous bilateral PRK for myopia. On the third postoperative day, dense central infiltrates mainly involving the anterior stroma were noticed in both eyes. Clinical and confocal scan features were consistent with a diagnosis of Nocardia keratitis and topical amikacin eye drops 2% were started. Empirical antibiotic therapy was converted into specific therapy after confirming the definite diagnosis by clinical features and confocal scan. Due to poor response to medical therapy, lamellar keratectomy was performed in both eyes which shortened the treatment course. Histopathologic examination confirmed the initial diagnosis. Familiarity with the clinical and confocal scan features of Nocardia keratitis facilitates early diagnosis, proper management and hence a rapid clinical response
ABSTRACT
To present two patients with hydatid and alveolar cysts of the orbit and to present their clinical, imaging, pathologic and therapeutic features. Two young children from rural areas were referred for progressive proptosis. Imaging showed intraorbital cysts. They were operated on with a clinical suspicion of hydatid and alveolar cysts. Pathologic evaluation confirmed the diagnoses in both instances. Clinical findings and imaging before the operation help the diagnosis of orbital echinococcosis. Knowing the nature of these lesions can prevent surgical complications. Alveolar cysts are much more invasive than hydatid cysts and their treatment is more difficult
ABSTRACT
To report the histopathological diagnoses of recipient corneal buttons in patients undergoing penetrating keratoplasty. In this observational case series, all recipient corneal specimens sent to the ophthalmic pathology laboratory of the Eye Bank of Iran between 2004 and 2007 underwent histopathologic examination. Overall, 315 corneal specimens were evaluated. Histopathologic diagnoses included keratoconus [27.0%], corneal dystrophies [23.5%], acquired corneal endothelial decompensation [13.3%], nonspecific corneal scars and degenerations [11.4%], keratitis [10.8%], mustard gas keratopathy [8.0%], combined dystrophy and keratoconus [1.6%], post-keratorefractive keratectasia [1.6%], chemical burn-induced keratopathy [1.3%] and other causes [1.6%]. In keratoconic corneas, breaks in Bowmans' layer were evident in all cases and hydrops was diagnosed in 17.6%. The most common corneal dystrophy was macular corneal dystrophy [35.0%] followed by Fuchs' endothelial dystrophy [26.25%]. In cases with keratitis, causative microorganisms were found in 35.2%. Histopathologic findings in mustard gas keratopathy included loss of keratocytes, thickening of epithelial basement membrane, foci of acute and chronic inflammation and secondary degenerative changes; the former two were the most common features. To our knowledge, this is the first report on histopathologic evaluation of recipient corneas in Iran. Keratoconus, corneal dystrophies, acquired endothelial decompensation, nonspecific corneal scars and degenerations, keratitis and mustard gas keratopathy were predominant histopathologic diagnoses. Loss of keratocytes and thickening of epithelial basement membrane were the most common histopathologic findings in mustard gas keratopathy. Breaks in Bowmans' layer were found in all keratoconic corneal buttons
ABSTRACT
To report confocal scan features of keratic precipitates [KPs] in Fuchs' heterochromic iridocyclitis [FHIC]. In this descriptive study, corneal confocal scan was performed to characterize KPs in patients with FHIC referred to Labbafinejad Medical Center from November 2005 to March 2007. Polymerase chain reaction [PCR] for Herpes Simplex virus, Herpes Zoster virus, Toxoplasma gondii, Cytomegalovirus and Rubella virus was performed on aqueous humor samples taken in 4 patients who underwent phacoemulsification. Confocal scan was performed in 40 eyes of 34 patients including 18 male and 16 female subjects with mean age of 30.7 +/- 10.5 [range 18-57] years. FHIC was bilateral in 6 and unilateral in 28 patients. The distribution of KPs was diffuse in 31 eyes and limited to the inferior cornea in 9 eyes. The morphology of KPs included: globular, 34 eyes [85%]; infiltrating, 31 eyes [77.5%]; dendritiform, 31 eyes [77.5%]; stippled, 27 eyes [67.5%]; and cruciform, 25 eyes [62.5%]. None of the cases demonstrated smooth-rounded KPs. PCR of aqueous specimens was negative for the above-mentioned infectious agents in 4 eyes who had infiltrating and dendritiform KPs on confocal scan. Confocal features of KPs in FHIC are diverse and include globular, infiltrating and dendritiform, stippled and cruciform. Presence of infiltrating and dendritfrom KPs in FHIC may be suggestive of a possible infectious etiology, however the results of PCR were negative in the limited numbers of such patients in our series
ABSTRACT
To evaluate stem cell deficiency using impression cytology [IC] in patients with chronic and delayed-onset mustard gas keratopathy [MGK]. A consecutive series of patients with MGK underwent IC Thirty-five eyes of 18 patients [all male] with mustard gas keratopathy were included in this observational case series. Presence of goblet cells on the corneal side of specimens was considered to indicate stem cell deficiency. Corneal involvement was graded as mild, moderate and severe. Relation between IC findings and clinical grading was evaluated. There was limbal stem cell deficiency in at least one quadrant of the cornea in all 35 eyes [100% of cases]. No differences was found between impression cytology findings [positive versus negative for corneal goblet cells] among different quadrants [p= 0.378]. Clinical grading was the same between nasal and temporal quadrants [P=0.266] and between superior and inferior quadrants [P= 0.263]. Combining the superior and inferior quadrants [vertical zone] and also the nasal and temporal quadrants [horizontal zone] together, clinical grading was more severe in horizontal versus vertical zones [p< 0.001]. There was no correlation between stem cell deficiency and clinical corneal severity [p=0.893]. Varying degrees of stem cell deficiency was demonstrated in all patients with chronic or delayed-onset MGK using IC Clinical corneal manifestations are more severe in nasal and temporal quadrants. We found no correlation between stem cell deficiency and clinical manifestations. Other factors such as perilimbal conjunctival ischemia might play a role
ABSTRACT
To evaluate the safety of different doses of intravitreal bevacizumab in rabbit eyes. Twelve eyes of 6 rabbits underwent intravitreal injection of 5, 7.5 and 10 mg of bevacizumab. In each rabbit, one eye was considered for bevacizumab injection and the fellow eye served for either placebo injection or observation. All eyes were examined before and I, 2, 3, 7, 14 and 28 days after intravitreal injections. Electroretinography [ERG] was performed before and 14 days after the injections. 28 days after the injections, all eyes were enucleated and examined with light and electron microscopy. In the clinical examination, significant vitritis was observed in one of the 10 mg injected eyes from first post-injection which was eliminated by the 7th day. Cataract was seen in the same eye. Post-injection ERGs showed no significant changes. Increase in Muller-like cells was observed in the histological examination in the injected eyes. Intravitreal injection of 5 and 7.5 mg doses of bevacizumab was safe in rabbit eyes; however, the 10 mg dose was associated with intraocular inflammation
ABSTRACT
To determine the indications for penetrating keratoplasty [PK] in Iran over an 11-year period. All eye bank records of patients who underwent PK from 1994 to 2004 at ophthalmologic centers throughout Iran were reviewed. During this 11-year period, a total of 19,668 cases were operated. The most common indication for penetrating keratoplasty was keratoconus [34.5%], followed by corneal opacity and scar [18.7%], pseudophakic bullous keratopathy [9.2%], corneal dystrophies [6.5%], aphakic bullous keratopahty [6.1%], and regraft [5.3%]. There was an increasing trend in rates of keratoconus and pseudophakic bullous keratopathy and a decreasing trend in aphakic bullous keratopathy during this period. [P<0.001] No significant change of trend was noted in the corneal opacity and scar, regraft, and corneal dystrophy groups. Keratoconus is the most common indication for penetrating keratoplasty in Iran