Cuerpos extraños intracorneales retenidos / Retained intracorneal foreign bodies

Los cuerpos extraños constituyen la segunda forma más común de traumatismos corneales. Pueden localizarse superficiales o intracorneales. Se realiza presentación de caso de paciente con cuerpos extraños intracorneales retenidos de 34 años de evolución secundario a trauma por onda expansiva, con el objetivo de mostrar los hallazgos clínicos y resultados por pruebas diagnósticas como la microscopía confocal corneal, frente de onda corneal por topografía y microscopía especular. La presencia de cuerpos extraños intracorneales en este paciente provocó respuestas en el tejido corneal en dependencia de su composición, nivel de profundidad; evidentes a pesar de tiempo de retención. La presencia de estos induce niveles altos de aberraciones corneales que dependen del grado de afectación(AU)

Foreign bodies are the second most common form of corneal trauma. They can be superficial or intracorneal. A case of a patient was presented, with retained intracorneal foreign bodies of 34 years of secondary evolution due to blast wave trauma. The objective is to show the clinical findings and results of diagnostic tests such as corneal confocal microscopy, corneal wavefront topography and specular microscopy. The presence of intracorneal foreign bodies in this patient provoked responses in the corneal tissue depending on its composition, depth level; evident in spite of retention time. The presence of intracorneal foreign bodies induces high levels of corneal aberrations depending on the degree of involvement(AU)

Caracterización de la herida corneal en el servicio de Oftalmología del Hospital General Docente "Dr. Agostinho Neto", Guantánamo / Characterization of corneal wound in the Ophthalmology service of the Hospital General Docente "Dr. Agostinho Neto", Guantánamo / Caracterização da ferida corneana no serviço de Oftalmologia do Hospital General Docente "Dr. Agostinho Neto", Guantánamo

RESUMEN Introducción: En el Hospital General Docente "Dr. Agostinho Neto" se desconocen las características de los pacientes atendidos por herida corneal. Objetivo: Caracterizar la herida corneal en pacientes ingresados en el servicio de Oftalmología del citado hospital en el período de enero de 2014 a julio de 2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal del total de pacientes con este diagnóstico (n=35). Se estudiaron las variables: sexo, edad, procedencia, actividad que realizaba, tipo de herida, complicaciones; tipo de tratamiento y modificaciones de la agudeza visual de acuerdo al tratamiento que aplicó. Resultados: El 80,0 % de los pacientes fueron hombres, tenían entre 19 y 40 años de edad (57,0 %), procedían de áreas rurales (66,0 %) y se dedicaban a actividades laborales (60,0 %). El 91,0 % presentó una herida corneal penetrante. La catarata traumática fue la complicación más frecuente (40,0 %). El 97,0 % de los pacientes recibió tratamiento quirúrgico y sutura de la herida. Antes y después del tratamiento, el 54,0 % y el 40,0 %, respectivamente, de los pacientes presentaron agudeza visual visión cuenta dedos a percepción luminosa. Conclusiones: La herida corneal no es un problema de salud, pero sí interfiere negativamente en la calidad de vida de los perjudicados al afectar la agudeza visual.

ABSTRACT Introduction: Characteristics of the patients treated for corneal wound remain unknown at the Hospital General Docente "Dr. Agostinho Neto". Objective: To characterize the corneal wound in patients admitted to the ophthalmology service of the aforementioned hospital in the period from January 2014 to July 2019. Method: A descriptive, retrospective and longitudinal study of all patients with this diagnosis (n = 35) was carried out. The variables studied were: gender, age, origin, activity carried out at the time of injury, type of wound, complications, type of treatment and modifications of visual acuity, according to the treatment applied. Results: 80.0% of the patients were men, 57.0% were between 19 and 40 years old, 66.0% came from rural areas and 60.0% were engaged in work activities. 91.0% presented a penetrating corneal wound. Traumatic cataract was the most frequent complication (40.0%). 97.0% of the patients received surgical treatment and wound suture. Before and after treatment, 54.0% and 40.0% of the patients, respectively, presented visual acuity, counting finger vision and light perception. Conclusions: Corneal wounds are not a health problem, but it does negatively interfere with the quality of life of those affected by affecting visual acuity.

RESUMO Introdução: No Hospital General Docente "Dr. Agostinho Neto", não se conhecem as características dos pacientes tratados por ferida corneana. Objetivo: Caracterizar a ferida corneana em pacientes internados no serviço de Oftalmologia do referido hospital no período de janeiro de 2014 a julho de 2019. Método: Foi realizado um estudo descritivo, retrospectivo e longitudinal de todos os pacientes com esse diagnóstico (n=35). As variáveis estudadas foram: sexo, idade, procedência, atividade realizada, tipo de ferida, complicações; tipo de tratamento e modificações da acuidade visual de acordo com o tratamento aplicado. Resultados: 80,0% dos pacientes eram homens, tinham entre 19 e 40 anos (57,0%), procediam da zona rural (66,0%) e exerciam atividades laborais (60,0%). 91,0% apresentavam ferida penetrante na córnea. Catarata traumática foi a complicação mais frequente (40,0%). 97,0% dos pacientes receberam tratamento cirúrgico e sutura da ferida. Antes e após o tratamento, 54,0% e 40,0%, respectivamente, dos pacientes apresentavam acuidade visual, visão de contagem de dedos e percepção luminosa. Conclusões: A ferida corneana não é um problema de saúde, mas interfere negativamente a qualidade de vida das pessoas feridas, afetando a acuidade visual.

Etiological causes and epidemiological characteristics of patients with occupational corneal foreign bodies: A prospective study in a hospital-based setting in India

Purpose: Corneal foreign bodies (CFBs) due to occupational exposure have been largely ignored in Indian literature, especially nonmetal workers. Our study looks at a broad range of occupations and settings that contribute to CFB in our local Indian population. The study objective was to determine the occupations, level of education and demographics of patients presenting with CFB acquired during occupational work. Methods: Prospective hospital-based study at a tertiary eye hospital in Gurgaon, Haryana, India, within duration of 9 months. Patients presenting with CFB were asked a set of questions relating to their occupation, level of education, understanding of the potential complications of CFB, and demographics. Results: A total of 83 patients were included in the study. CFB were attributed only to males. 66% of patients were in the age group of 14--29 years. 30% of patients were in the age group 30--44 years and 4% of patients were between 45 and 60 years old. The metal work industry was responsible for 47% of presentations. The construction industry was responsible for 27% of presentations. Electricians and carpenters combined were responsible for 10% of presentations and 17% of presentations occurred in other sectors. Conclusion: CFB occur across a number of occupations in the construction industry, not just metallic workers. Among a population that is generally poorly educated and have nominal understanding of the impact that CFB can have on vision, occupational hazard education is necessary to address this problem.

A Removed Chestnut Thorn after Corneal Incision

PURPOSE: To report the surgical technique to remove a chestnut thorn through a corneal incision. CASE SUMMARY: A 54-year-old female visited our clinic complaining of a sudden foreign body sensation and conjunctival injection in her left eye after picking chestnuts 4 days prior to her visit. Visual acuity of both eyes was 1.0 and the intraocular pressures were within normal limits. Slit lamp examination revealed that a chestnut thorn had deeply penetrated the left corneal stroma and a small number of inflammatory cells were observed in the anterior chamber. There was no corneal defect stained with fluorescein and the Seidel test was negative. A corneal foreign body comprised of a chestnut thorn and its remnants was diagnosed and emergency surgery was performed. A partial corneal incision was made along the foreign body and the exposed foreign body was easily and completely removed. The patient was treated with topical antibiotics after surgery and no complication was observed during a follow-up period of 3 months. CONCLUSIONS: In the case of a corneal foreign body comprised of a chestnut thorn, the foreign body with its remnants were easily removed by performing a partial corneal incision.

Infectious Crystalline Keratopathy Caused by Alternaria

PURPOSE: To report a case of infectious crystalline keratopathy caused by Alternaria in the corneal center. CASE SUMMARY: A 66-year-old male visited our clinic with right ocular pain and visual loss after corneal trauma caused by a foreign body hitting his right eye while performing farm work 1 month prior to his visit. The patient had no history of corneal surgery and long-term use of topical corticosteroid. A corneal epithelial defect and whitish snowflake margin infiltration around the corneal stroma were observed in the corneal center, but there was an absence of conjunctival injection and anterior segment inflammation. Cultures and a biopsy of the corneal scrapings revealed Alternaria species fungus. The patient was treated with 1% topical voriconazole and 0.5% moxifloxacin, together with oral voriconazole (400 mg/day). After 2 months of treatment, the disease was completely cured, with a minute corneal opacity. CONCLUSIONS: We successfully treated a rare case of infectious crystalline keratopathy caused by Alternaria, which has not been previously reported in the Republic of Korea.

Factores de riesgo en pacientes con sospecha de úlcera corneal micótica en Pinar del Río / Risk factors found in patients with possible diagnosis of mycotic corneal ulcer in Pinar del Río province

OBJETIVOS: Identificar los principales factores de riesgo en pacientes con sospecha de úlcera corneal micótica en la provincia Pinar del Río. MÉTODOS: Se realizó una investigación observacional, analítica de tipo caso-control. La información fue obtenida a través de la revisión de historias clínicas de los pacientes que ingresaron en el Servicio de Oftalmología del Hospital Clinicoquirúrgico "Abel Santamaría Cuadrado" con impresión diagnóstica de úlcera corneal micótica en el periodo comprendido entre el 1 de enero de 2004 y el 30 de noviembre de 2007. Se emplearon como variables edad, sexo, ocupación, tipo de lugar de residencia, antecedente reciente de trauma corneal con materia vegetal, trauma corneal, uso de lentes de contacto, uso de esteroides tópicos, enfermedades sistémicas inmunosupresoras, cirugía ocular previa y enfermedades crónicas de la superficie ocular. Se emplearon medidas de frecuencia y asociación. RESULTADOS: Se determinó que la ocupación, el tipo de lugar de residencia y el antecedente de trauma corneal con materia vegetal constituyen posibles factores de riesgo de la úlcera corneal micótica en esa provincia. La frecuencia de la úlcera corneal micótica fue de un 27 por ciento con respecto al total de pacientes ingresados con diagnóstico de úlcera corneal. El sexo más afectado fue el masculino y el grupo etario el de 38 a 57 años. CONCLUSIONES: El antecedente de trauma corneal con materia vegetal, el lugar de residencia rural y las actividades laborales relacionadas con la manipulación directa de plantas constituyeron factores de riesgo de úlcera corneal micótica en los pacientes estudiados. La frecuencia de la úlcera corneal micótica en el estudio se correspondió con el patrón observado en países con clima cálido y húmedo, especialmente cerca del ecuador. La úlcera corneal micótica es más común en hombres en edades laboralmente activas.

OBJECTIVE: To identify the main risk factors in patients suspected of mycotic corneal ulcer in Pinar del Río province. METHODS: An observational and analytical case-control study was conducted. Data were collected from the medical histories of those patients with possible diagnosis of mycotic corneal ulcer, who had been admitted at the Ophthalmology Service of "Abel Santamaría Cuadrado" clinical and surgical hospital from January 1st, 2004 to November 30th, 2007. The variables such as age, sex, occupation, kind of residence place, recent history of corneal trauma caused by vegetable matter, corneal trauma, use of contact lenses, use of topical steroids, immunosuppressive systemic diseases, previous eye surgery and and ocular surface chronic illness were all used . The frequency and association measures were also used. RESULTS: It was determined that occupation, kind of residence place and recent history of corneal trauma with vegetable matter are possible risk factors of mycotic corneal ulcer in the province. The frequency of mycotic corneal ulcer was 27 percent of the total number of patients admitted and diagnosed with that disease. Males were the most affected and the 38-57 y age group as well. CONCLUSIONS: The recent history of corneal trauma caused by the vegetable material, rural place of residence and direct handling of plants at work were those risk factors in the studied patients. The frequency of mycotic corneal ulcer in this study matched that of the pattern seen in those countries with warm and humid climate, particularly near the Equator. Mycotic corneal ulcer is more common in men at working age.

Clinical Aspect and Prognosis of Alternaria Keratitis

PURPOSE: To investigate the risk factor, clinical manifestations, treatment results, and prognosis in Alternaria keratitis. METHODS: Thirteen eyes of 13 patients who were diagnosed as Alternaria species by corneal smear and culture were included. The past history, visual acuity, location and size of ulceration, hypopyon, treatment results, and prognosis were analyzed retrospectively. RESULTS: Nine (69.2%) were women, and 4 were men. The mean age was 65.23+/-8.70 years. Eleven eyes (84.6%) had previous history of corneal traumas by soil or plant material. In 7 eyes (53.8%), the lesions were located at the corneal center. The average size of ulceration was 13.90+/-21.80 mm2. Four eyes (30.8%) had hypopyon. The initial visual acuity was less than 0.1 in 10 eyes (76.9%). The final visual acuity improved more than 2 lines in 10 eyes (76.9%) and more than 1 line in 12 eyes (92.3%), and did not change in 1 eye (7.7%). The treatment success was achieved in 12 eyes (92.3%). CONCLUSIONS: Early diagnosis and specific antifungal treatments of Alternaria keratitis can lead to a good prognosis.

Epidemiology of Staphylococcus epidermidis Keratitis

PURPOSES: Staphylococcus epidermidis is a causative agent of bacterial keratitis and the authors performed an epidemiologic study to identify the risk factors, clinical features and treatment results. METHODS: Epidemiologic study on Staphylococcus epidermidis keratitis, which were confirmed by cultures in 6 university hospitals, was performed prospectively under the identical protocol. RESULTS: Seventeen cases of Staphylococcus epidermidis keratitis were diagnosed by culture with corneal scraping and comprised 4.1% of 401 cases of confirmed bacterial keratitis. Male patients were affected more than female patients and the highest prevalent age was in the seventies. Most of their occupation was farming. The most prevalent season was fall and it mostly occurred after corneal trauma. CONCLUSIONS: Staphylococcus epidermidis keratitis usually occurred in a relatively old age group followed by corneal trauma. Its prevention along with early and proper antimicrobial therapy based on sensitivity results is important.

Epidemiologic study of Alternaria Keratitis

PURPOSE: Alternaria spp. is opportunistic fungus and the most prevalent cause of asthma and allergic disease. Keratitis caused by the fungus Alternariaspp. is quite rare. The authors performed an epidemiological study to identify the risk factor and to evaluate clinical manifestations, methods and results of treatment in Alternaria keratitis. METHODS: Epidemiological study of Alternaria keratitis was performed prospectively under the identical protocol from April 1995 to May 2000 in 5 hospitals. RESULTS: Seven cases of Alternaria keratitis were identified by culture with corneal scraping or corneal biopsy. They were 8.5% of the 82 cases of fungal keratitis. Of the 7 patients, 5 were men (71.4%). All patients were over 50 years and 5 of them (71.4%) were farmers. In terms of trauma history, 6 out of 7 patients had previous history of corneal traumas, and most of these corneal traumas were vegetable matter-related. CONCLUSIONS: The most common (83.3%) predisposing factor for Alternaria keratitis was vegetable matter-related corneal trauma. The prompt referral for diagnostic studies and specific antifungal management, or surgical therapy might be helpful to reduce the incidence rate of complication of keratomycoses.