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Purpose@#To report a rare case of acute red eye in a contact lens user.Case summary: An 18-year-old female presented with decreased visual acuity and ocular pain in the right eye for 4 days. The patient had used contact lenses for > 8 hours a day, even while sleeping at night, for the past 3 months. Corneal epithelial edema and punctate stromal infiltration along with diffuse conjunctival hyperemia and corneal limbal injection in the right eye were observed in slit lamp examination. The uncorrected and corrected visual acuities of the right eye were 0.02 (20/1000) and 0.16 (20/125), respectively. The right eye had an intraocular pressure of 10 mmHg, and the left eye was within normal range. The patient stopped wearing contact lenses and was prescribed steroid and antibiotic eye drops and artificial tears. The corrected visual acuity increased to 0.5 (20/40) on the first day of treatment and to 1.0 (20/20) after 2 months. The cornea and conjunctiva also returned to the normal appearance. @*Conclusions@#It is important to differentiate contact lens-induced acute red eye from microbial keratitis. Discontinuation of contact lens use and education are required to prevent acute red eye caused by contact lens use.
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Purpose@#We report a rare case of allergic contact dermatitis after the use of a non-preservative 0.5% moxifloxacin ophthalmic solution.Case summary: A 60-year-old male presented with bacterial corneal ulceration of the right eye. He was treated with 50 mg/mL of fortified cefazolin and 14 mg/mL of tobramycin that were tapered as the corneal lesion improved after 1 month, and 0.5% moxifloxacin application was started. After 2 weeks of moxifloxacin treatment, the patient developed conjunctival injection, lid swelling, redness, and itching in the right eye. An allergic reaction was suspected and moxifloxacin administration was immediately stopped. The symptoms improved after the administration of oral antihistamines, 0.5% loteprednol eye drops, and steroid combination ointment. @*Conclusions@#Patients treated with 0.5% topical moxifloxacin should be monitored for allergic contact dermatitis, even if preservative-free eye drops are used.
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Purpose@#To report a rare, sterile, peripheral, corneal infiltrative event after laser in situ keratomileusis (LASIK).Case summary: A 29-year-old male presented with left-eye conjunctival injection and peripheral corneal infiltration 3 days after LASIK. A whitish, oval, peripheral infiltration around the corneal flap was apparent from 6-to-10 o’clock in the limbus. Slit lamp examination revealed conjunctival injection and mild corneal edema but neither a corneal epithelial defect nor an inflammatory reaction of the anterior chamber. Intensive cycloplegic, steroid ointment, steroid drops, antibiotic drops, and artificial tear therapies were prescribed under the impression of a sterile, peripheral, corneal infiltrative event. After 1 month, the symptoms and corneal opacity resolved without any complications. @*Conclusions@#A sterile, peripheral, corneal infiltrative event, namely, an oval infiltration of the periphery of the cornea without pain or epithelial damage can develop after LASIK but responds well to steroid eye drops.
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Purpose@#To report the clinical efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser iris cystotomy in iris cysts. @*Methods@#We examined three eyes with primary iris cysts diagnosed by ultrasound biomicroscopy that had fewer cornea endothelial cells or reduced visual acuity due to an occluded visual axis. Nd:YAG laser cystotomy was done. The logarithm of the minimum angle of resolution (logMAR) visual acuity, intraocular pressure (IOP), and specular microscopy test at baseline and last follow-up were reviewed. @*Results@#The average patient age was 54.0 ± 5.3 years; the mean follow-up was 11.7 ± 2.1 months. The baseline and final logMAR visual acuity were 0.23 ± 0.25 and 0.16 ± 0.15, respectively. Visual acuity improved, although not significantly (p = 0.317). The baseline and final IOP were 14.7 ± 2.3 and 13.7 ± 0.6 mmHg, respectively (p = 0.276). The corneal endothelial cell density (p = 0.109), hexagonality (p > 0.999), and coefficient of variation (p = 0.285) were not significantly different after treatment. There were no serious complications or recurrence. @*Conclusions@#After Nd:YAG laser cystotomy, the cell density and morphology of corneal endothelial cells changed little. It can be considered an effective treatment when there is a decrease in corneal endothelial cells or occlusion of the visual axis.
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Purpose@#We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. @*Conclusions@#Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.
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Purpose@#We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. @*Methods@#We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. @*Results@#The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. @*Conclusions@#Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.
ABSTRACT
Purpose@#We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. @*Conclusions@#Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.
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Purpose@#We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. @*Methods@#We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. @*Results@#The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. @*Conclusions@#Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.
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PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.
Subject(s)
Humans , Male , Middle Aged , Acyclovir , Anterior Chamber , Ganciclovir , Hand , Herpesvirus 3, Human , Intravitreal Injections , Light Coagulation , Polymerase Chain Reaction , Retina , Retinal Detachment , Retinal Hemorrhage , Retinal Necrosis Syndrome, Acute , Retinal Vessels , Retinaldehyde , Retinitis , Silicon , Silicones , Visual Acuity , VitrectomyABSTRACT
Purpose@#To report a rare case of corneal perforation treated with a multilayer collagen sheet graft transplantation after amniotic membrane graft failure to prevent corneal perforation in a fungal corneal ulcer.Case summary: A 64-year-old woman with a past history of rheumatoid arthritis 1 year prior was transferred to our hospital due to unresponsive treatment of a corneal ulcer. Although the corneal ulcer of the right eye was treated with antibiotics for 10 days, loss of the corneal epithelial layer and corneal stromal infiltration were observed on examination. A culture test was conducted on the corneal ulcer that identified the pathogen as the Paecilomyces strain. Corneal perforation occurred 1 month after undergoing an amniotic membrane graft to prevent this outcome. A multilayer collagen sheet graft (Aongen®; Pharos Tech Medical, Seoul, Korea) was applied at the perforated corneal ulcer site without a donor cornea. One year after this operation, visual acuity has not been restored; however, corneal perforation of the ulcer site has not progressed. @*Conclusions@#If there is no donor cornea, partial corneal transplantation using a multilayer collagen sheet graft is thought to be a therapeutic method to treat corneal perforation in cases involving impacted corneal perforation or corneal perforation that occurs in corneal disease.
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Purpose@#To report a rare case of corneal perforation treated with a multilayer collagen sheet graft transplantation after amniotic membrane graft failure to prevent corneal perforation in a fungal corneal ulcer.Case summary: A 64-year-old woman with a past history of rheumatoid arthritis 1 year prior was transferred to our hospital due to unresponsive treatment of a corneal ulcer. Although the corneal ulcer of the right eye was treated with antibiotics for 10 days, loss of the corneal epithelial layer and corneal stromal infiltration were observed on examination. A culture test was conducted on the corneal ulcer that identified the pathogen as the Paecilomyces strain. Corneal perforation occurred 1 month after undergoing an amniotic membrane graft to prevent this outcome. A multilayer collagen sheet graft (Aongen®; Pharos Tech Medical, Seoul, Korea) was applied at the perforated corneal ulcer site without a donor cornea. One year after this operation, visual acuity has not been restored; however, corneal perforation of the ulcer site has not progressed. @*Conclusions@#If there is no donor cornea, partial corneal transplantation using a multilayer collagen sheet graft is thought to be a therapeutic method to treat corneal perforation in cases involving impacted corneal perforation or corneal perforation that occurs in corneal disease.
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PURPOSE@#To evaluate the clinical features of ocular ischemic syndrome in Koreans.@*METHODS@#The medical records of patients who were presumed to have ocular ischemic syndrome by ophthalmic examination, and confirmed by carotid artery imaging, were retrospectively reviewed from 2010 to 2017.@*RESULTS@#A total of 22 patients and 27 eyes were included in the study. Twenty patients were male. The average age was 64.2 years. Fifteen patients had hypertension and fifteen patients had diabetes mellitus. Twenty-one patients presented with acute visual impairment at the initial visit. The average best-corrected visual acuity (BCVA) was a LogMAR of 0.89 ± 0.65, with an average IOP of 16.1 ± 6.9 mmHg. Elevated IOP > 21 mmHg was noted in five eyes (18.5%). Iris neovascularization was the most common (13 eyes, 48.1%) feature in the anterior segment. Retinal hemorrhage was the most common feature in the fundus examination (23 eyes, 85.2%). The average central submacular thickness was 255.0 µm, and there was no macular edema except for one case with vitreomacular traction syndrome on optical coherent tomography.@*CONCLUSIONS@#A total of 90.9% of patients with ocular ischemic syndrome were males > 50 years of age. Most patients presented with acute visual impairment. There was no macular edema on optical coherent tomography of all eyes.