Comparison of Spectral-Domain and Time-Domain Optical Coherence Tomography in Solar Retinopathy

The purpose of this article is to compare spectral-domain (SD) and time-domain (TD) optical coherence tomography (OCT) findings in patients with solar retinopathy. Complete ocular examinations and OCT were performed in two patients presenting with acute solar retinopathy soon after observation of an eclipse. Both patients were evaluated with SD-OCT and TD-OCT at the same time. SD-OCT demonstrated characteristic defects at the level of the inner and outer segment junction of the photoreceptors in all the affected eyes and decreased reflectiveness of the retinal pigment epithelium layer. TD-OCT images showed unremarkable findings in two eyes with deteriorated visual acuity. SD-OCT improves diagnosis and assessment of the degree and nature of foveal damage in patients with solar retinopathy and may be an important tool for use in identifying foveal damage not detected by TD-OCT. SD-OCT may be preferable to TD-OCT for confirmation or assessment of the degree of foveal damage in patients with solar retinopathy.

The effect of subconjunctival bevacizumab on corneal neovascularization, inflammation and re-epithelization in a rabbit model

PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects.

Bilateral macular hole secondary to remote lightning strike.

We report a case of a 16-year-old girl, who was struck by lightning, and experienced blurred vision in the right eye (RE) immediately following the episode. She reported for ophthalmic evaluation two months later. Examination revealed relative afferent pupillary defect in the RE. Posterior subcapsular cataract was noted in both eyes. Fundus examination revealed macular holes and multiple areas of RPE hyperpigmentation in the periphery in both eyes. Fundus fluorescein angiography showed increased choroidal transmission with early fluorescence and late fading in the foveal region and retinal pigment epithelium (RPE) stippling in the periphery in both eyes. This is the first case report of such nature in India to the best of our knowledge.

The Effect of In Vivo Grown Corneal Epithelium Transplantation on Persistent Epithelial Defects with Limbal Stem Cell Deficiency

We report our experience with corneal epithelium, grown in vivo, transplantation in three patients with persistent epithelial defect (PED). The three patients had ocular surface disease unresponsive to standard treatments and were therefore chosen for transplantation. They underwent transplantation of epithelial sheets, grown in vivo, to the most affected eye. In vivo cultivation was carried out in the cornea of a living related donor. After epithelialization was completed, the epithelium grown on an amniotic membrane was harvested gently; it was then transplanted into the patient's eye after debridement of fibrovascular tissue. The cultivated epithelium was completely epithelialized by 2 weeks; it was well-differentiated with well-formed hemidesmosome. On immunohistochemical staining, p63, connexin 43, and Integrin beta4 were expressed in the cells on the epithelial sheet. The PED was covered completely and maintained for 4 weeks in all cases. However, corneal erosion recurred after 5 weeks in two cases. This novel technique demonstrates the corneal epithelial cells can be expanded in vivo successfully on denuded amniotic membrane of a healthy cornea and harvested safely. A corneal epithelial sheet, grown in vivo, can be transplanted to treat eye with a severe ocular surface disease, such as total limbal deficiency.

Severe post thermal burn cicatricial ectropion with corneal ulceration: an illustrative case.

Management of postburn cicatricial ectroption of the upper lid is always a challenge for the oculoplastic surgeon, as they are often associated with exposure keratitis and ulceration. Traditionally, split thickness grafts have been described for upper lid reconstruction and tarsorrhaphies have been discouraged. We present a case of corneal ulceration associated with postburn cicatricial ectropion presenting 10 years following the initial trauma. The patient underwent full thickness skin grafting and tarsorrhaphy to release the ectropion with resolution of corneal ulceration. We believe that full thickness skin grafts and tarsorrhaphy are effective in correcting upper lid cicatricial ectropion, without functional compromise.

A Case of Photic Retinal Injury Associated with Exposure to Plasma Arc Welding

PURPOSE: To report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions. METHODS: We describe a case report of a 37-year-old male, working in the steel industry, who presented with central scotoma in both eyes. RESULTS: On his first visit, one day after performing plasma arc welding with protective gear at work, his best corrected vision was 0.7 for both eyes. Ophthalmic examination of the fundus showed a round yellow lesion with an approximate size of 300 micrometers superonasal to the fovea of both eyes. On his next visit, one month later, his vision had recovered to 1.0, his symptoms had improved, and the ophthalmoscopic examination of the fundus revealed that the round yellow spots had disappeared from both eyes. CONCLUSIONS: To our knowledge, this is the first report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions have not previously been reported. For these reasons, we report this case.

Pedicled scalp island flap for successful one stage aesthetic eyebrow reconstruction

The use of scalp flap based on frontal branch of superficial temporal artery is one of the famous known methods of eyebrow reconstruction. But to achieve aesthetic eyebrow appearance it is important not only to have viable scalp flap but also normal width, length together with and more importantly the direction of the hairs and lastly the density of hairs. This study included 18 patients, six patients were males and 12 were females with age ranging from 13 to 50 years. The treated patients had unilateral partial or complete brow loss. Management was done for all patients by following some technical considerations to have aesthetic eyebrow shape. during using the scalp island flap based on one of the branches of superficial temporal artery. All cases were done as one stage operation with satisfactory appearance and survival rate [100%]. There was minimal swelling due to the subcutaneous pedicle in the temporal region which needed between 2-3 weeks to subside in all cases. One case of the post-burn alopecia of eye brows suffered partial flap congestion, which improved by conservative measures. The results were satisfactory as regard the eyebrow measurement [width and length], hair direction, but the hair density was higher than the normal density which was clearly noted in partial cases or unilateral reconstruction. And the hair growth also was noted to be faster than normal [they needed frequent shortening]. Scalp island superficial temporal artery flap is an excellent solution for aesthetic eye brow reconstruction. Perfect match with the undamaged eyebrow in partial loss or unilateral cases can be achieved by following some pre-operative and intraoperative important technical considerations

Management of periocular post burn scarring in the epileptics

To assess the clinical presentation and management of patients with epilepsy presenting with periocular post burn scarring. Design: Prospective and descriptive study. Place and Duration of Study: Department of Ophthalmology, Jinnah Postgraduate Medical Centre, Karachi from September 1999 to September 2002. Subjects and This study included 23 patients who had epilepsy and presented with periocular post-burn scarring to the eye department for management. All patients had contractures of their lids with variable amounts of corneal scarring and damaged to the eye ball. The surgical procedure performed consisted of release of contracture, horizontal lid shortening and application of free skin graft. There were 18 [78.26%] female and 5 [21.73%] male patients. The age range was from 18 to 45 years with a mean of 28 years. In 17 [73.91%] patients, lid contracture was released to cover their eyeballs. In 6[26.08%] patients the eyeball was lost due to late presentation. There should be a high index of suspicion in facial burns for ophthalmic damage and early referral to an ophthalmologist should be made to prevent complications. Early release of contracture with application of full or partial thickness skin grafts is advisable

Avances en causticaciones / Advances in chemical burns

El entendimiento en profundidad de los diferentes mecanismos de daño, defensa y reparación que toman lugar en una causticación ocular, ha permitido tratar en mejor forma a estos pacientes. En la etapa aguda, la medida más importante continúa siendo la irrigación profusa del ojo en el mismo lugar del accidente. Lisis de adherencias, antibióticos, corticoides, hipotensores y citrato de sodio deben emplearse. En la etapa subaguda nuestro norte será promover la epitelización (lente de contacto blanda terapéutica, tarsorrafía) y, evitar y tratar la ulceración. En la etapa tardía deberemos tratar las complicaciones y uno de los procedimientos empleados es la rehabilitación de la superficie ocular, con el transplante de células epiteliales sanas; puede hacerse tan precozmente como cuatro semanas despúes de la causticación, siempre que la isquemia limbar haya pasado y el limbo se encuentre vascularizado