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Purpose@#To describe the clinical manifestations, causative organisms, treatment, and prognostic factors of fungal keratitis based on analysis of patients over the past 20 years. @*Methods@#A total of 177 patients (177 eyes) with fungal keratitis, who were diagnosed by smears and cultures, were reviewed retrospectively. Sex, age, predisposing factors, causative organisms, clinical manifestations, treatment, and prognosis were evaluated. The patients were divided into three groups: only potassium hydroxide (KOH)-positive, only culture-positive, and KOH- and culture-positive. Logistic regression was performed to identify the factors associated with a poor clinical outcome. @*Results@#The mean age of the patients was 67.4 ± 11.3 years; 107 (60.5%) patients were men. The most common predisposing factor was ocular trauma (57.6%), especially by plants (29.4%). The most prevalent filamentous fungi were Fusarium species (31.6%, 49 isolates), and the most prevalent yeasts were Candida species (11.0%, 17 isolates). In cases of bacterial and fungal keratitis, filamentous fungus with Gram-positive bacterial infection (70.7%, 29/41) was the most common presentation. Visual improvement after treatment was common in the KOH-positive group (79.2%, 19/24), while visual deterioration after treatment was common in the culture-positive group (40.4%, 36/89). Previous ocular disease (odds ratio [OR]: 3.744, p = 0.010), hypopyon (OR: 2.941, p = 0.030), and surgical treatment (OR: 24.482, p < 0.001) were risk factors for a poor clinical outcome in the multivariate logistic regression model. @*Conclusions@#Clinical prognosis was good in the KOH-positive only group, but poor in the culture-positive group. If fungal keratitis is suspected, diagnostic KOH staining and culture tests should be performed initially. Early intensive antifungal medical treatments are necessary for patients with risk factors for poor clinical outcomes.
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Purpose@#To report a case of bilateral subepidermal calcified nodules of the upper eyelid in a child.Case summary: A 5-year-old girl with no history of trauma or systemic disease was referred for assessment of bilateral eyelid masses that had appeared 8 months prior. The masses grew slowly without pain, and were hard, elevated, and yellowish-white in color. The right eyelid mass was close to the medial canthus and measured 0.2 × 0.2 cm. The mass of the left upper eyelid was smaller (0.2 × 0.1 cm) and closer to the medial side. The clinical impression was juvenile xanthogranuloma and molluscum contagiosum. Excisional biopsy of the bilateral eyelid masses was performed. Histologic findings revealed that the lesions were composed of variable-sized multiple calcium deposits, lined by hyperplastic and hyperkeratotic epidermis or within the hyperkeratotic epidermis. The diagnosis was subepidermal calcified nodules (SCNs) for both of the bilateral eyelid masses. The patient made a complete recovery after the excision, without recurrence. @*Conclusions@#SCNs should be considered during differential diagnosis of a painless, elevated, yellowish-white eyelid lesion.
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Purpose@#To describe the clinical manifestations, causative organisms, treatment, and prognostic factors of fungal keratitis based on analysis of patients over the past 20 years. @*Methods@#A total of 177 patients (177 eyes) with fungal keratitis, who were diagnosed by smears and cultures, were reviewed retrospectively. Sex, age, predisposing factors, causative organisms, clinical manifestations, treatment, and prognosis were evaluated. The patients were divided into three groups: only potassium hydroxide (KOH)-positive, only culture-positive, and KOH- and culture-positive. Logistic regression was performed to identify the factors associated with a poor clinical outcome. @*Results@#The mean age of the patients was 67.4 ± 11.3 years; 107 (60.5%) patients were men. The most common predisposing factor was ocular trauma (57.6%), especially by plants (29.4%). The most prevalent filamentous fungi were Fusarium species (31.6%, 49 isolates), and the most prevalent yeasts were Candida species (11.0%, 17 isolates). In cases of bacterial and fungal keratitis, filamentous fungus with Gram-positive bacterial infection (70.7%, 29/41) was the most common presentation. Visual improvement after treatment was common in the KOH-positive group (79.2%, 19/24), while visual deterioration after treatment was common in the culture-positive group (40.4%, 36/89). Previous ocular disease (odds ratio [OR]: 3.744, p = 0.010), hypopyon (OR: 2.941, p = 0.030), and surgical treatment (OR: 24.482, p < 0.001) were risk factors for a poor clinical outcome in the multivariate logistic regression model. @*Conclusions@#Clinical prognosis was good in the KOH-positive only group, but poor in the culture-positive group. If fungal keratitis is suspected, diagnostic KOH staining and culture tests should be performed initially. Early intensive antifungal medical treatments are necessary for patients with risk factors for poor clinical outcomes.
ABSTRACT
Purpose@#To report a case of bilateral subepidermal calcified nodules of the upper eyelid in a child.Case summary: A 5-year-old girl with no history of trauma or systemic disease was referred for assessment of bilateral eyelid masses that had appeared 8 months prior. The masses grew slowly without pain, and were hard, elevated, and yellowish-white in color. The right eyelid mass was close to the medial canthus and measured 0.2 × 0.2 cm. The mass of the left upper eyelid was smaller (0.2 × 0.1 cm) and closer to the medial side. The clinical impression was juvenile xanthogranuloma and molluscum contagiosum. Excisional biopsy of the bilateral eyelid masses was performed. Histologic findings revealed that the lesions were composed of variable-sized multiple calcium deposits, lined by hyperplastic and hyperkeratotic epidermis or within the hyperkeratotic epidermis. The diagnosis was subepidermal calcified nodules (SCNs) for both of the bilateral eyelid masses. The patient made a complete recovery after the excision, without recurrence. @*Conclusions@#SCNs should be considered during differential diagnosis of a painless, elevated, yellowish-white eyelid lesion.
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PURPOSE@#To report the clinical characteristics and prevalence of Charles Bonnet syndrome (CBS) in patients with retinal diseases in the Republic of Korea.@*METHODS@#Patients with deterioration of visual acuity or visual field or episodes of complex visual hallucination (cVH) with retinal diseases between March 2019 and June 2019 at the retinal outpatient clinic of the Chonbuk National University Hospital were selected to answer standardized questions to determine whether they had symptoms of CBS.@*RESULTS@#The selected 303 patients from the total of 2,916 patients were comprised of 163 males (53.8%) and 140 females (46.2%). The mean age of the patients was 66.0 ± 15.1 years. six patients (2.4%) of 245 with no response to initial question in 301 with best-corrected visual acuity less than finger counting and two patients with experience of cVH were diagnosed with CBS. Most patients had seen a wide variety of hallucinations, including objects, people, and scenery, with negative emotions, for > 1 year. The hallucinations were experienced daily with the same frequency. Negative feelings such as fear and worry improved when they received appropriate patient education about the hallucinations.@*CONCLUSIONS@#The prevalence of CBS in the Republic of Korea is higher than previously reported. We found that relatively young patients with visual impairment could experience cVH from CBS. CBS patients experienced negative emotions for long periods due to the hallucinations which decreased their quality of life. CBS should be considered during the differential diagnosis of cVH in patients with visual impairment due to ophthalmic diseases. We should also provide appropriate patient education to assist them in understanding more fully the clinical characteristics of CBS.
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PURPOSE: To report a case of recurrent myxomatous corneal degeneration after pterygectomy. CASE SUMMARY: A 65-year-old man with a history of abdominal keloid was referred to our hospital for assessment of a well-circumscribed, gelatinous, whitish corneal mass on the nasal corneal area of the left eye that appeared one month prior. The patient had undergone pterygectomy on his left eye 2 years ago. The patient experienced mild foreign body sensation. The other anterior segment and fundus examination of the left eye were both normal. We diagnosed the case as keloid and we performed excisional biopsy of the corneal mass. Histologic findings revealed proliferation of myxoid-appearing material in the anterior corneal stroma. On immunohistochemical examination, sections were stained positive for actin and calretinin, and negative for S-100. We diagnosed the tumor as myxomatous corneal degeneration. After six months, a recurrent mass was found on the previously excised site. Re-excisional biopsy and topical interferon α-2b treatment were then performed in response. After re-excision, there was no recurrence or complications during one year follow-up. CONCLUSIONS: Myxomatous corneal degeneration should be considered during differential diagnosis of an elevated, whitish, gelatinous lesion of the cornea with previous history of trauma or operation, such as pterygectomy. An interferon α-2b topical treatment is useful for recurrent corneal myomatous degeneration.