Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Glaucoma neovascular. A propósito de un caso / Neovascular glaucoma. A case report

Se presenta un paciente masculino de 60 años de edad, con antecedentes de padecer diabetes mellitus tipo II complicada con retinopatía diabética, así como glaucoma neovascular de tórpida evolución en el ojo izquierdo. Acude a consulta de glaucoma en el Centro Oftalmológico del Hospital Universitario Clínico- Quirúrgico «Arnaldo Milián Castro» de Villa Clara por presentar visión borrosa y molestias oculares en su ojo derecho. Al examen oftalmológico de dicho ojo se observa: disminución de la visión, sangramiento activo proveniente de vaso iridiano, edema corneal, rubeosis iridiana, hipertensión ocular y al fondo de ojo retinopatía diabética; se realizan complementarios hemáticos que muestran cifras de glicemia elevada (20 mmol/l). Se plantea el diagnóstico de glaucoma neovascular del ojo derecho en el curso de una diabetes mellitus tipo II descompensada. Se le indica tratamiento médico - quirúrgico y se logra una evolución favorable.

We present a 60-year-old male patient with a history of type II diabetes mellitus complicated by diabetic retinopathy, as well as neovascular glaucoma of torpid evolution in his left eye. He came to the glaucoma consultation in the Ophthalmological Center at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara due to blurred vision and ocular discomfort in his right eye. Decreased vision, active bleeding from the iris vessel, corneal edema, iris rubeosis, ocular hypertension was observed in such eye at ophthalmological examination and diabetic retinopathy at eye fundus; blood tests were performed showing elevated glycemia figures (20 mmol /l). The diagnosis of neovascular glaucoma of the right eye is stated in the course of a decompensated type II diabetes mellitus. Medical and surgical treatment is indicated and a favourable evolution is achieved.

Unnoticed metallic foreign body in the camerular angle inducing chronic uveitis / Corpo estranho metálico não notado em ângulo camerular induzindo uveíte crônica

ABSTRACT We report the case of an eight-year-old male patient with a four-month history of unilateral anterior chronic uveitis, associated with a pigmented lesion surrounded by fibrinoid material in the inferior camerular angle and with a fibrotic lesion in the extreme periphery of the inferior retina. The patient had no history of trauma or any other clinical symptoms. Although the patient was suspected of having toxocariasis, serological tests were negative. Partial symptomatic improvement was achieved using both orally and topically administered corticosteroids. In addition, a decrease in fibrinoid material around the pigmented camerular lesion revealed it to be regular and cylindric. Computed tomography of the orbits revealed a metallic foreign body in the topography of the inferior camerular angle. The patient underwent removal of the foreign body through a corneal incision and photocoagulation around the inferior retinal traction. Excellent visual and anatomical results were obtained.(AU)

RESUMO Os autores relatam o caso de paciente do sexo masculino, 8 anos de idade, com história de uveíte crônica anterior unilateral há quatro meses, associada a lesão pigmentada envolvida por material fibrinóide em ângulo camerular inferior e a lesão fibrótica em extrema periferia de retina inferior. Não havia histórico de trauma ou outros sintomas clínicos. A hipótese de toxocaríase foi afastada diante de testes sorológicos negativos. Melhoria sintomática parcial foi alcançada com administração de corticosteróide vias oral e tópica. Ademais, redução na quantidade de material fibrinóide ao redor da lesão camerular a revelou regular e cilíndrica. Foi realizada tomografia computadorizada de órbitas, permitindo a detecção de corpo estranho metálico na topografia de ângulo camerular inferior. O paciente foi submetido a remoção do corpo estranho através de incisão corneana e a fotocoagulação ao redor da tração retiniana inferior. Excelentes resultados visual e anatômico foram obtidos.(AU)

Complicaciones posoperatorias inmediatas en pacientes diabéticos tipo 2 operados de catarata por la técnica de facochop / Immediate postoperative complications in type 2 diabetic patients undergoing phaco chop cataract surgery

Objetivo: Describir la posible presencia de complicaciones posoperatorias en pacientes diabéticos tipo 2, operados de catarata por la técnica de facochop. Métodos: Se realizó un estudio observacional, descriptivo, y longitudinal prospectivo, con 128 pacientes diabéticos (168 ojos) operados de catarata en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre septiembre del año 2017 y diciembre de 2018. Las variables clínicas y epidemiológicas objeto del estudio fueron la edad, el sexo, el color de la piel, la queratometría, la profundidad de la cámara, la longitud axial, la dureza del cristalino, la presión intraocular pre- y posoperatoria y las complicaciones posoperatorias en las primeras 72 horas. Resultados: En el estudio predominaron las mujeres (63,3 por ciento), de piel blanca (74,2 por ciento), quienes presentaron ojos biométricamente normales, con una diferencia estadísticamente significativa. La presión intraocular aumentó a las 24 horas de la cirugía. De los 128 pacientes diabéticos tipo 2 operados de catarata senil por la técnica de facochop, se pudo determinar que el promedio y la desviación estándar de la edad se ubicaron en los 69,49 ± 8,96 años, y osciló entre los 50 y 88 años. Conclusiones: Las complicaciones posoperatorias más frecuentes son el edema corneal y la uveítis. Es significativamente más probable encontrar la uveítis posquirúrgica en pacientes menores de 70 años, y el edema corneal en quienes sobrepasan esta edad(AU)

Objective: Describe the possible presence of postoperative complications in type 2 diabetic patients undergoing phaco chop cataract surgery. Methods: An observational prospective longitudinal descriptive study was conducted of 128 diabetic patients (168 eyes) undergoing cataract surgery at the Center for Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology from September 2017 to December 2018. The clinical and epidemiological variables analyzed were age, sex, skin color, keratometry, chamber depth, axial length, crystalline hardness, pre- and postoperative intraocular pressure, and postoperative complications in the first 72 hours. Results: A predominance was found of women (63.3 percent) of white skin color (74.2 percent) and biometrically normal eyes, with a statistically significant difference. Intraocular pressure rose 24 hours after surgery. Mean age and standard deviation were 69.49 ± 8.96 years, range of 50-88 years, in the 128 type 2 diabetic patients undergoing senile cataract surgery by the phaco chop technique. Conclusions: The most common postoperative complications are corneal edema and uveitis. It is significantly more probable to find postsurgical uveitis in patients aged under 70 years and corneal edema in patients aged over 70 years(AU)

Múltiplas camadas na membrana de descemet / Multiple layers on the Descemet membrane

RESUMO Relato de caso não descrito na literatura oftalmológica nacional de múltiplas camadas da membrana de Descemet. Mulher de 59 anos, pseudofácica, com diagnóstico de ceratopatia bolhosa, foi submetida à ceratoplastia penetrante em olho direito, sendo encontrado achado incomum de multiplicidade de camadas da membrana de Descemet, variáveis em forma e espessura, além de corpos ovoides com coloração de metamina de prata de Gocott-Gomori (GMS) negativa. Como a membrana de Descemet tem no seu desenvolvimento um período fetal e outro pós-natal que frequentemente é bem identificável nos cortes histológicos em adultos. No caso apresentado, em que outras camadas estão presentes, há evidência de corpos esféricos que poderiam significar que a potencialidade de produzir outras camadas pode permanecer na fase adulta mais tardia.

ABSTRACT To relate a case not described previously in the national multilateral ophthalmological literature of Descemet's membrane. A 59-year-old pseudophakic woman diagnosed with bullous keratopathy underwent penetrating keratoplasty with an unusual finding of multiple layers of Descemet's membrane, which were variable in shape and thickness. In addition, ovoid bodies with negative Gocott-Gomori (GMS) color were present. Discussion and Conclusion: As Descemet's membrane has a fetal and a postnatal period in its development, it is frequently and well identifiable in histological sections in adults. In the case presented, in which other layers are present, there is evidence of spherical bodies that could mean that the potential to produce other layers may remain into later adulthood.

Edema de Berlín secundario a Traumatismo ocular cerrado / Berlin Edema secondary to closed eye trauma / Edema de Berlim secundário a trauma ocular fechado

INTRODUCCIÓN: el trauma ocular es una de las causas que difieren entre áreas urbanas de un país a otro y entre diferentes clases demográficas o socioeconómicas. OBJETIVO: Demostrar la evolución y características clínicas del edema de Berlín secundario a trauma ocular cerrado. MATERIALES Y MÉTODOS: se realizó un estudio de caso observacional en un paciente masculino de 11 años que presentó una AVMC 20/20 en OD y cuenta dedos 50 cm en OI posterior a trauma ocular cerrado contuso con objeto romo. Desde el inicio desarrolló una conmoción retiniana asociada a edema de Berlín en OI. Con seguimiento desde 11 de diciembre de 2019 al 27 de enero de 2020. Las variables fueron: agudeza visual mejor corregida, retinografía, tomografía de coherencia óptica de dominio espectral macular. RESULTADOS: se indicó metilprednisolona 500 mg endovenoso diario por 3 días; prednisona 30 mg oral disminuyendo gradualmente durante 10 días; acetato de prednisolona 1% tópico cada 2 horas, moxifloxacina 0,5% cada 6 horas, ciclopentolato 1% cada 8 horas. 7 semanas después, no hubo mejoría clínica a pesar de medicación, manteniéndose en observación médica con AVMC OD 20/20 y OI cuenta dedos 2 metros. DISCUSIÓN: edema de Berlín (commotio retinae) una afección común causada por una lesión contusa en el ojo, suele ser autolimitante y no existe un tratamiento como tal. CONCLUSIÓN: el trauma ocular cerrado contuso con compromiso retiniano puede causar daño macular como el edema de Berlín, como éste caso que puede condicionar el pronóstico visual a pesar de que mayormente es favorable.

INTRODUCTION: ocular trauma is one of the causes that differ between urban areas from one country to another and between different demographic or socioeconomic classes. OBJECTIVE: to demonstrate the evolution and clinical characteristics of Berlin edema secondary to closed ocular trauma. MATERIALS AND METHODS: an observational case study was conducted in an 11-year-old male patient who presented a 20/20 BCVA in RE and 50 cm finger count in LE after blunt ocular trauma with blunt object. From the beginning, she developed a retinal concussion associated with Berlin edema in LE. With follow-up from December 11, 2019 to January 27, 2020. Variables were included: best-corrected visual acuity, retinographies, and macular spectral domain optical coherence tomography. RESULTS: methylprednisolone 500 mg intravenous daily for 3 days was indicated; prednisone 30 mg oral gradually decreasing over 10 days; 1% prednisolone acetate topical every 2 hours, moxifloxacin 0.5% every 6 hours, cyclopentolate 1% every 8 hours. 7 weeks later, there was no clinical improvement despite medication, and he was kept under medical observation with BCVA RE 20/20 and LE with a 2-meter finger count. DISCUSSION: Berlin edema (commotio retinae), a common condition caused by a blunt injury to the eye, is usually self-limiting and there is no treatment as such. CONCLUSION: blunt ocular trauma with retinal involvement can cause macular damage such as Berlin edema, as in this case, which can condition the visual prognosis even though it is mostly favorable.

INTRODUÇÃO: o trauma ocular é uma das causas que difere entre áreas urbanas de um país para outro e entre diferentes classes demográficas ou socioeconômicas. OBJETIVO: demonstrar a evolução e as características clínicas do edema de Berlim secundário a trauma ocular fechado. MATERIAIS E MÉTODOS: foi realizado um estudo de caso observacional em um paciente do sexo masculino, 11 anos, que apresentou BCVA 20/20 em OD e contagem de dedos de 50 cm em OE após trauma ocular fechado contuso com objeto contuso. Desde o início, ela desenvolveu uma concussão retina associada ao edema de Berlim em LE. Com acompanhamento de 11 de dezembro de 2019 a 27 de janeiro de 2020. As variáveis foram: melhor acuidade visual corrigida, retinografias e tomografia de coerência óptica de domínio espectral macular. RESULTADOS: foi indicada metilprednisolona 500 mg intravenosa ao dia por 3 dias; prednisona 30 mg oral diminuindo gradualmente ao longo de 10 dias; Acetato de prednisolona 1% tópico a cada 2 horas, moxifloxacina 0,5% a cada 6 horas, ciclopentolato 1% a cada 8 horas. 7 semanas depois, não houve melhora clínica apesar da medicação, e ela foi mantida em observação médica com AVMC OD 20/20 e LE com uma contagem de 2 metros nos dedos. DISCUSSÃO: o edema de Berlim (commotio retinae), uma condição comum causada por uma lesão contusa no olho, geralmente é autolimitado e não há tratamento como tal. CONCLUSÃO: o trauma ocular fechado com envolvimento retiniano pode causar danos maculares como o edema de Berlim, como neste caso, que pode condicionar o prognóstico visual, embora seja na maioria favorável.

Descemets membrane endothelial keratoplasty for acute corneal hydrops: a case report / Ceratoplastia endotelial com membrana de descemet para hidrópsia corneana aguda: relato de caso

ABSTRACT Here, we describe the result of a Descemet's membrane endothelial keratoplasty for acute corneal hydrops in a 45-year-old female with keratoconus, who presented with severe visual loss in her OS. The patient's best-corrected visual acuity was 20/80 in the right eye and hand motion in the OS. Slit-lamp examination revealed an extensive tear of the Descemet's membrane and stromal corneal edema in the OS. We opted for Descemet membrane endothelial keratoplasty. Twelve months postoperatively, the patient had a best-corrected visual acuity of 20/50 in the OS.

RESUMO Trata-se de uma paciente do sexo feminino, de 45 anos, portadora de ceratocone, submetida a uma ceratoplastia endotelial com membrana Descemet após apresentar um quadro de perda de visão severa devido a uma hidrópsia corneana aguda no olho esquerdo. Inicialmente, a acuidade visual corrigida da paciente era de 20/80 no olho direito e de movimento de mãos no olho esquerdo. Após exame de biomicroscopia que detectou uma extensa rotura da membrana de Descemet e edema estromal, optamos por tratar esse caso com o ceratoplastia endotelial com membrana Descemet. Doze meses após o procedimento cirúrgico, percebeu-se uma melhora do edema corneano, não havia sinais de rejeição do botão óptico e a acuidade visual corrigida da paciente era de 20/50 no olho afetado.

Parámetros endoteliares y edema corneal poscirugía de catarata en pacientes con córnea guttata / Endothelial parameters and corneal edema in cornea guttata patients undergoing cataract surgery

RESUMEN Objetivo: Relacionar la severidad del edema corneal poscirugía de catarata en pacientes con córnea guttata, considerados sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, con los parámetros de la microscopia endotelial. Métodos: Se realizó un estudio descriptivo, prospectivo de 42 pacientes con córnea guttata, considerados sin riesgo o bajo riesgo de edema posquirúrgico según la densidad celular, quienes fueron sometidos a la cirugía de catarata por el mismo cirujano en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde abril del año 2016 a diciembre de 2017. Se determinó la severidad del edema corneal y se relacionó con el grado de córnea guttata, así como con los parámetros de la microscopia endotelial. Resultados: El 52,4 por ciento fueron mayores de 70 años y el 64,3 por ciento mujeres. No hubo edema en el 54,8 por ciento en las primeras 24 horas, y fue en el 26,2 por ciento leve y en el 19,0 por ciento mínimo, donde predominó la córnea guttata grado 3 y presentaban un bajo riesgo prequirúrgico. Sin embargo, no hubo diferencias en relación con el polimegatismo y el pleomorfismo. Conclusiones: La severidad del edema corneal en pacientes con córnea guttata posfacoemulsificación a los siete días no se asocia con el polimegatismo, ni con el polimorfismo prequirúrgico, pero sí con el conteo endotelial prequirúrgico(AU)

ABSTRACT Objective: Determine the relationship between the severity of corneal edema in cornea guttata patients undergoing cataract surgery considered to be at no risk or low risk for postsurgical edema in terms of cell density, and endothelial microscopy parameters. Methods: A descriptive prospective study was conducted of 42 cornea guttata patients considered to be at no risk or low risk for postsurgical edema in terms of cell density, who underwent cataract surgery performed by the same surgeon at Ramón Pando Ferrer Cuban Institute of Ophthalmology from April 2016 to December 2017. Corneal edema severity was determined and related to cornea guttata grade and endothelial microscopy parameters. Results: Of the patients studied, 52.4 percent were aged over 70 years and 64.3 percent were women. Edema was not observed in 54.8 percent in the first 24 hours, whereas it was mild in 26.2 percent and minimum in 19.0 percent. Grade 3 cornea guttata and low presurgical risk prevailed. However, no differences were found in relation to polymegethism and pleomorphism. Conclusions: At seven days, corneal edema severity in cornea guttata patients undergoing phacoemulsification is not associated to polymegethism or presurgical polymorphism, but it as associated to the presurgical endothelial count(AU)

Facoemulsificación y edema corneal en pacientes con córnea guttata / Phacoemulsification and corneal edema in cornea guttata patients

RESUMEN Objetivo: Relacionar la severidad del edema corneal posfacoemulsificación en pacientes con córnea guttata, sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, con la dureza del cristalino y los parámetros facodinámicos. Métodos: Se realizó un estudio descriptivo, prospectivo, de 42 pacientes con córnea guttata, sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, sometidos a facoemulsificación por el mismo cirujano en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde abril del año 2016 a abril de 2017. Se relacionó la severidad del edema corneal con la dureza del cristalino y los parámetros facodinámicos. Resultados: Predominaron los pacientes con 70 años o más (52,4 por ciento) y el sexo femenino (64,3 por ciento). A las 24 horas de operados, el edema corneal estuvo ausente en el 54,8 por ciento y se presentó leve (26,2 por ciento) o mínimo (19,0 por ciento). A los 7 días, el 71,4 por ciento tenía la córnea transparente. Fue más frecuente en la periferia y en la zona paracentral temporal (36,8 por ciento). Aquellos con dureza de cristalino NO2 NC2 no presentaron edema corneal. A los 7 días solo el 11,9 por ciento mantenía edema leve, asociado a cristalinos NO4 NC4 o superior. El edema corneal se presentó asociado al grupo en el que se usó un poder de ultrasonido entre 10 y 20 (36,0 por ciento). Conclusiones: La mayoría de los pacientes con córnea guttata, considerados sin riesgo o bajo riesgo de edema posquirúrgico según la densidad celular, no presentan edema posfacoemulsificación(AU)

ABSTRACT Objective: Determine the relationship between the severity of corneal edema in cornea guttata patients undergoing phacoemulsification considered to be at no risk or low risk for postsurgical edema in terms of cell density, and crystalline lens hardness and phacodynamic parameters. Methods: A descriptive prospective study was conducted of 42 cornea guttata patients considered to be at no risk or low risk for postsurgical edema in terms of cell density, who underwent phacoemulsification performed by the same surgeon at Ramón Pando Ferrer Cuban Institute of Ophthalmology from April 2016 to April 2017. Corneal edema severity was related to crystalline lens hardness and phacodynamic parameters. Results: A predominance was found of patients aged 70 years and over (52.4 percent) and the female sex (64.3 percent). Twenty-four hours after surgery corneal edema was not observed in 54.8 percent and where it was present it was either mild (26.2 percent) or minimum (19.0 percent). At 7 days 71.4 percent of the patients had a transparent cornea. It was more common on the periphery and in the temporal paracentral area (36.8 percent). Patients with NO2 NC2 crystalline lens hardness did not have corneal edema. At 7 days only 11.9 percent had mild edema associated to NO4 NC4 or higher crystalline lenses. Corneal edema was associated to the group in which an ultrasound power level between 10 and 20 (36.0 percent) was used. Conclusions: Most cornea guttata patients considered to be at no risk or low risk for postsurgical edema in terms of cell density do not develop postphacoemulsification edema(AU)

Actualización terapéutica de la queratopatía bullosa pseudoafáquica / Therapeutic update on pseudophakic bullous keratopathy

RESUMEN La queratopatía bullosa pseudoafáquica o edema corneal crónico pseudoafáquico del paciente operado por cataratas con implante de lente intraocular es un proceso en el que la córnea se edematiza y pierde su función óptica, con síntomas dolorosos e irritativos de lagrimeo, ojo rojo, probabilidad de inflamación y ulceración corneal por infección secundaria. Se observan en esta afección multicausal dos grupos de pacientes. En uno de ellos el daño estructural corneal y ocular ha sido excesivo y no existe expectativa de mejora visual. El otro grupo aún conserva la potencialidad de recuperación de la agudeza visual. En el intento de solucionar esta afección se han empleado diversos tratamientos con fundamentos diferentes y resultados acordes con el desarrollo técnico y científico en que fueron aplicados. Es propósito de esta actualización describir y adecuar las posibilidades que los oftalmólogos puedan aplicar como terapéutica en sus respectivos niveles de actuación(AU)

ABSTRACT Pseudophakic bullous keratopathy or chronic pseudophakic corneal edema in patients undergoing cataract surgery with intraocular lens implantation is a process in which the cornea edematizes and loses optical function, with painful and irritating lacrimation symptoms, red eye, probable inflammation and corneal ulceration due to secondary infection. Sufferers of this multicausal condition are divided into two groups: In one of them structural corneal and ocular damage has been extreme and no visual improvement is expected, whereas in the other visual acuity recovery is still possible. In an attempt to heal this condition various treatments have been used with different rationales and results according to the scientific and technological development of the setting where they were applied. The present update is aimed at describing and adjusting the possible therapies that ophthalmologists may use in their respective fields of activity(AU)

Epstein-Barr Virus-related Corneal Endotheliitis Accompanied with Secondary Glaucoma

PURPOSE: To report a case of Epstein-Barr virus-related corneal endotheliitis accompanied by secondary glaucoma.CASE SUMMARY: A 73-year-old male presented with blurred vision in his right eye. In the ophthalmic evaluation, there were dispersed keratic precipitates overlying corneal edema. The anterior chamber showed trace ~1+ graded inflammation and an endothelial density decrease. His best-corrected visual acuity and intraocular pressure in the right eye were 0.2 and 34 mmHg, respectively. Paracentesis was performed on the anterior chamber of the right eye to confirm the diagnosis under the suspicion of corneal endotheliitis with trabeculectomy for the intraocular pressure control. Epstein-Barr virus was confirmed using a multiplex polymerase chain reaction (PCR), and oral and eye drops of Acyclovir were used to treat the patient. There was no evidence of a recurrence over 2 years and his intraocular pressure was 12 mmHg and best-corrected visual acuity was maintained at 0.5.CONCLUSIONS: A case of Epstein-Barr virus-related corneal endotheliitis was diagnosed using PCR of the aqueous humor. The patient was treated with an oral antiviral agent and eyedrops without a recurrence.

Manual Preparation of Donor Lenticule Using Artificial Anterior Chamber for Descemet's Membrane Stripping Endothelial Keratoplasty

PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.

Facoanafilaxia por cristalino mergulhado na Síndrome de Marfan / Phacoanaphylactic by dislocation of the lens in the Marfan Syndrome

Resumo A síndrome de Marfan é uma doença de herança autossômica dominante e que afeta o tecido conjuntivo com manifestações fenotípicas que envolvem os sistemas esquelético, cardiovascular e ocular. As principais manifestações oculares são a subluxação do cristalino, a miopia e o descolamento da retina. O objetivo deste artigo foi relatar a conduta clínico-cirúrgica de um paciente portador da síndrome de Marfan com cristalino luxado para a cavidade vítrea e que evoluiu com severa reação facoanafilática caracterizada por um glaucoma secundário severo e descompensação corneana.

Abstract Marfan syndrome is an autosomal dominant inheritance disease that affects connective tissue with phenotypic manifestations involving the skeletal, cardiovascular and ocular systems. The main ocular manifestations are the subluxation of the lens, myopia and retinal detachment. The aim of this article was to report the clinical and surgical management of a patient with Marfan syndrome with luxated lens for the vitreous cavity and who developed a severe phacoanaphylactic reaction characterized by severe secondary glaucoma and corneal decompensation.

Two Cases of Unusual Presentation of Postoperative Endophthalmitis Caused by Streptococcus dysgalactiae Subspecies Equisimilis

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.

Radial Keratoneuritis in Aeromonas Keratitis

PURPOSE: We report a case of Aeromonas keratitis presenting as radial keratoneuritis. CASE SUMMARY: A 33-year-old woman with a history of cleaning her contact lenses with tap water presented with decreased visual acuity for 1 day in the left eye. The patient showed diffuse corneal edema, stromal infiltration, and radial keratoneuritis, which were thought to be pathognomonic for Aeromonas keratitis. Based on the patient's clinical findings and past history, a diagnosis of Aeromonas keratitis was made and she was prescribed topical fortified cefazolin (50 mg/mL, 5%), tobramycin (3 mg/mL), and 0.02% chlorhexidine per hour. Culture results from the contact lens and contact lens solution confirmed infection by Aeromonas hydrophilia. Polymerase chain reaction results for Aeromonas were negative. After 8 days of treatment, the uncorrected visual acuity was 0.7/0.3 with improvement in her corneal findings. CONCLUSIONS: Radial keratoneuritis is not always pathognomic for Aeromonas keratitis and can be present in Aeromonas keratitis. Therefore, ophthalmologists should be cautious when interpreting this clinical sign.

Corneal Ulcer Caused by Corynebacterium macginleyi

PURPOSE: To report a case of a Corynebacterium macginleyi-infected corneal ulcer of a patient who had been treated for conjunctivitis for more than 3 months. CASE SUMMARY: A 72-year-old female was transferred from a private ophthalmic clinic for evaluation of herpetic keratitis with progressive corneal edema and infiltration in the left eye. She had a history of conjunctival hyperemia and eyeball pain in her left eye 3 months prior to her visit. She was treated with levofloxacin eye drops and acyclovir ointment (Herpesid®, Samil, Co., Ltd. Seoul, Korea). On slit lamp examination, 5.4 × 4.0 mm corneal epithelial defects and stromal infiltrations were observed in the upper to central cornea, and endothelial keratic precipitates were found. Gram positive bacteria were detected on Gram staining and Corynebacterium macginleyi was identified on bacterial cultures from the conjunctiva and cornea. She was treated with topical vancomycin eye drops. After 3 months of treatment, the corneal ulcer was completely resolved, leaving mild superficial opacity on the cornea. CONCLUSIONS: While Corynebacterium macginleyi, normal flora of the conjunctiva, is considered a major causative agent for conjunctivitis and blepharitis, Corynebacterium macginleyi should also be considered a possible cause of slowly progressive keratitis in patients with chronic conjunctivitis.

Corneal Stromal Edema during Lidocaine Injection for Blepharoplasty

PURPOSE: To report a case of corneal edema caused by an iatrogenic lidocaine injection into the corneal stroma created while performing a local anesthetic (lidocaine) injection into the eyelid for a blepharoplasty procedure. CASE SUMMARY: A 15-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection in the upper blepharon for a blepharoplasty procedure. At the first clinical visit, visual acuity was hand motion and an accurate anterior chamber examination was difficult because of corneal edema. The Seidel test was negative. On corneal optical coherence tomography, the corneal thickness was 1,580 µm without any sign of Descemet's membrane detachment. We prescribed 5% NaCl four times a day and prednisolone acetate eight times a day. On the next day after injury, the corneal edema was significantly improved (central corneal thickness: 660 µm), and Descemet's membrane detachment was still not observed. One week after injury, the naïve visual acuity was 20/20, the central corneal thickness was 560 µm, and the endothelial cell count was 3,260 cells/cm². Three weeks after injury, the corneal edema was fully resolved and only slight temporal corneal haziness remained. After 2 months, the cornea was clear without any subjective discomfort. CONCLUSIONS: Corneal edema without Descemet's membrane detachment can be resolved spontaneously without aggressive treatment such as gas or air injection. However, endothelial cell count and corneal opacity need to be monitored on follow up exam. This clinical experience suggests that severe corneal edema in anterior stromal layer could be spontaneously resolved without severe complication.

Anterior Uveitis Caused by Listeria Monocytogenes Infection

PURPOSE: To report a case of anterior uveitis secondary to Listeria monocytogenes infection. CASE SUMMARY: A 57-year-old male presented to our clinic with ocular pain and decreased vision in the right eye for 2 days. The patient had a history of liver transplantation 2 years prior and used immunosuppressive agents. Listeria monocytogenes was identified in blood cultures 1 month before his visit. At presentation, best-corrected visual acuity (BCVA) of the right eye was counting fingers at 20 cm and the intraocular pressure (IOP) was 50 mmHg. Conjunctival hyperemia, corneal edema, keratic precipitates, and cells in the anterior chamber were observed in the right eye. The patient was diagnosed as anterior uveitis in the right eye. Conventional uveitis treatment was initiated but clinical features did not improve and black hypopyon appeared. The possibility of anterior uveitis caused by Listeria monocytogenes infection was considered. An anterior chamber tap and culture were conducted to identify pathogens. Anterior chamber antibiotic injections and systemic antibiotic injections were performed. One week after injection, the BCVA of the right eye improved to 0.4 and the IOP decreased to 14 mmHg. One month after injection, the BCVA of the right eye improved to 1.0 and the IOP decreased to 16 mmHg. No inflammation of the anterior chamber was observed. CONCLUSIONS: When nonspecific uveitis occurs in immunosuppressed patients, cultures and appropriate antibiotics should be considered because of the possibility of infection.

Goniodysgenesis-associated glaucoma in a Jindo dog / 대한수의학회지

A 10-year-old intact female Jindo dog was presented with a 1-week history of conjunctival redness and ocular discharge in the left eye. There was an absence of menace response, dazzle reflex, and direct pupillary light reflex. Slit-lamp biomicroscopy revealed corneal edema, ciliary flush, and aqueous flare. Intraocular pressure was 68 mmHg. Based on the information available, a diagnosis of glaucoma and uveitis was made. Subsequent histopathologic examination showed the glaucoma was produced by the effects of goniodysgenesis, posterior synechia, and pigment dispersion in the trabecular meshwork. This is the first report of primary glaucoma caused by goniodysgenesis in Jindo dogs.

Corneoconjunctival manifestations of lymphoma in three dogs

An 8-year-old Shih Tzu, a 5-year-old Maltese, and a 10-year-old Maltese presented with conjunctival hyperemia and peripheral corneal edema. Severe conjunctival thickening with varying degrees of corneal extension was observed. Cytological examination showed many large lymphocytes with malignant changes in the conjunctiva which was consistent with findings in fine-needle aspiration samples taken from regional lymph nodes. They were diagnosed as having Stage V multicentric lymphoma. When conjunctival thickening is observed in canine patients with multicentric lymphoma, conjunctival metastasis with infiltration of neoplastic lymphoid cells should be included in the differential diagnosis.