ABSTRACT
PURPOSE: To clarify the characteristic appearances of early-stage Acanthamoeba keratitis (AK) and to investigate the effects of topical steroids on those appearances. SUBJECT AND METHODS: This study involved 25 eyes of 24 patients diagnosed as early-stage AK at Kyoto Prefectural University of Medicine between October 2002 and June 2008. All patients were contact lens wearers, and 23 patients (96%) were referred from other hospitals. Clinical findings in the medical records of all patients were analyzed retrospectively. RESULTS: Radial keratoneuritis was observed in 20 of 25 eyes (80%), and pseudodendritic lesions were observed in 15 eyes (60%). Only 1 eye (4%) showed neither of these two findings. Of the 10 eyes treated with topical steroids until the first presentation at our hospital, 6 eyes manifested radial keratoneuritis and/or pseudodendritic lesions after the discontinuation of that treatment. The visual prognosis was good in both groups, with or without topical steroid treatment. CONCLUSIONS: We found that radial keratoneuritis and pseudodendritic lesions are characteristic appearances of early-stage AK, and that topical steroid treatment might mask these characteristic findings.
Subject(s)
Acanthamoeba Keratitis/pathology , Acanthamoeba/isolation & purification , Acanthamoeba Keratitis/diagnosis , Acanthamoeba Keratitis/drug therapy , Acanthamoeba Keratitis/parasitology , Acanthamoeba Keratitis/physiopathology , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Adult , Biguanides/administration & dosage , Cornea/parasitology , Female , Humans , Male , Natamycin/administration & dosage , Prognosis , Retrospective Studies , Severity of Illness Index , Vision, Ocular , Young AdultABSTRACT
PURPOSE: To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan. DESIGN: Retrospective, consecutive, multicenter case series. PARTICIPANTS: Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye. METHODS: Retrospective review of the clinical manifestations and responses to antiviral treatment. MAIN OUTCOME MEASURES: Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy. RESULTS: The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy. CONCLUSIONS: Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.
Subject(s)
Cytomegalovirus Infections/virology , Cytomegalovirus/isolation & purification , Endothelium, Corneal/virology , Eye Infections, Viral/virology , Keratitis/virology , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Administration, Topical , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , Aqueous Humor/virology , Cell Count , Cytomegalovirus/genetics , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , DNA, Viral/analysis , Endothelium, Corneal/pathology , Eye Infections, Viral/diagnosis , Eye Infections, Viral/drug therapy , Female , Ganciclovir/therapeutic use , Humans , Keratitis/diagnosis , Keratitis/drug therapy , Male , Middle Aged , Polymerase Chain Reaction , Retrospective Studies , Valacyclovir , Valine/analogs & derivatives , Valine/therapeutic useABSTRACT
PURPOSE: To evaluate the surgical outcome of retinal reattachment, the reattachment rate according to the range of detachment, and postoperative visual acuity for macular hole retinal detachment (MHRD). SUBJECTS AND METHODS: Sixty-eight eyes of 67 patients with MHRD were analyzed. The mean follow-up period was 54 months. RESULTS: Retinal reattachment occurred in 42/68 eyes (62%) after initial surgery. The reattachment rates were 6/23 eyes (26%) in the gas tamponade group, 13/19 eyes (68%) in the vitrectomy group, 23/ 26 eyes (88%) in the group that underwent removal of internal limiting membrane as adjunct to vitrectomy (ILM) group. In the additional surgery, the reattachment rates were 5/9 eyes (56%) in the gas tamponade group, 13 eyes (100%) in the vitrectomy group, 1/2 eyes (50%) in the ILM group, and 6 eyes (100%) in the macular prombe buckling group. No significant differences were seen in the detachment extent-related reattachment rate within the same surgery and the postoperative visual acuity between the groups. CONCLUSION: The results show that removal of ILM contributes to successful reattachment in the initial surgery, and that for non-reattachable eyes, macular buckling in the second surgery is the most reliable method.
