Bilateral punctate keratitis and hurricane keratopathy following apremilast therapy.

Purpose: To report a unique case of bilateral punctate keratitis consistent with hurricane keratopathy during apremilast therapy. Observations: A 49-year-old female presented with severe, painful, bilateral, punctate keratitis following five months of apremilast therapy. The past ocular history was noncontributory. The past medical history included psoriasis refractory to topical corticosteroids. The patient subsequently received systemic apremilast therapy and noted improvement in her psoriatic rash. Five months later the patient presented to an outside eye care provider complaining of three weeks of progressive photophobia associated with pain and redness in both eyes. On examination, the patient had decreased visual acuity with diffuse conjunctival injection and punctate epithelial erosions in a whorl-like pattern in both eyes. The remainder of the ophthalmic exam was unremarkable. The patient was started on topical moxifloxacin drops, erythromycin ointment, and preservative free artificial tears, but did not improve. Apremilast was then discontinued and topical prednisolone was added once per day. Ten weeks after discontinuation of apremilast and topical steroid therapy, the patient had recovered normal vision with an intact and normal corneal epithelium. Conclusions and Importance: This is the first case report of cornea epithelial keratitis resembling hurricane keratopathy associated with apremilast treatment and should be recognized as a possible side effect of therapy with this class of drug.

Methamphetamine-Induced Keratitis Case Series.

ABSTRACT: Methamphetamine-induced keratitis is a recognized but not widely studied cause of corneal stromalysis and infections. These 2 cases describe the presentation and clinical course of keratitis in patients with preceding methamphetamine use.

Analysis of Compensatory Corneal Epithelial Thickness Changes in Keratoconus Using Corneal Tomography.

PURPOSE: To determine patterns of epithelial remodeling in keratoconus and to assess changes in these patterns as the disease progresses. METHODS: This is a prospective case series. Patients with keratoconus undergoing corneal collagen crosslinking underwent Scheimpflug imaging before and after epithelial debridement. Analysis was performed to determine maps of epithelial thickness and change in keratometry. Maps were analyzed for patterns, and map SD was quantified. Measures were compared across the patients as grouped by the severity of disease. RESULTS: The study comprised 38 eyes from 30 patients. Patients were stratified using the Amsler-Krumeich classification of keratoconus severity, with 17, 14, and 7 patients in the stage I, stage II, and stage III groups, respectively. A pattern of central epithelial thinning (to approximately 20 µm) with an annulus of epithelial thickening (to approximately 30-40 µm) was demonstrated. Changes were more pronounced in the later stages of the disease, with the average central thickness decreasing from 23 µm in stage I to 18 µm in stage III. Central corneal steepening of 1.5 to 1.9 diopters and peripheral flattening of 1.4 to 2.0 diopters after epithelial debridement were demonstrated. Analysis of map SD revealed a significant difference between stage III patients and patients at earlier stages of disease. CONCLUSIONS: The "doughnut pattern" of epithelial remodeling in keratoconus is supported by Scheimpflug imaging. This pattern is demonstrated to partially compensate for central corneal steepening seen in keratoconus.

The Association Between Keratoconus and Mitral Valve Prolapse: A Meta-Analysis.

OBJECTIVE: The debate pertaining to the association between Keratoconus (KC) and Mitral Valve Prolapse (MVP) continues to occur among physicians. The results of cross-sectional studies attempting to present the co-existing prevalence of these two diseases remain indeterminate. We compiled the first meta-analysis to determine the pattern of prevalence between the two diseases. METHODS: Two separate literature searches for cross-sectional studies were performed for this metaanalysis. The first search encompassed finding literature comparing the prevalence of KC between patients with MVP and a control group. The second search pertained to finding studies comparing the prevalence of MVP patients with KC and a control group. RESULTS: Six studies reported the prevalence of MVP in patients with KC and a control group. The prevalence was 41.6% in patients with KC and 11.5% in patients without KC (OR = 7.06 [95% CI = 2.41-20.64]). There was a significant heterogeneity among the studies (I2 = 84%). Two studies showed the prevalence of KC in patients with MVP and a control group. The prevalence was 17.0% in patients with KC and 2.9% in the control group (OR = 5.07 [95% CI = 1.08-23.83]). There was no heterogeneity within the analysis (I2 = 0%). CONCLUSION: There is a statistically significant co-existing prevalence between MVP and KC. Patients with KC are more likely to present with MVP, and patients with MVP are more likely to present with KC.

Ocular Pseudoexfoliation Syndrome Linkage to Cardiovascular Disease.

PURPOSE OF REVIEW: Pseudoexfoliation syndrome (PEX) is a common cause of open-angle glaucoma that is characterized by stress-induced elastic microfibrillopathy related to an accumulation of matrix metalloproteinases. The accumulation of matrix metalloproteinases increases deposition of protein substance within ocular structures and other organs including the heart. Many studies have associated the presence of cardiovascular disease with pseudoexfoliation syndrome, but much debate exists between studies in terms of significant relationships. The following meta-analysis aims to relate pseudoexfoliation syndrome with certain cardiovascular events and disorders. A thorough literature review was performed to acquire information concerning PEX patients with certain cardiovascular disorders. Diseases considered included myocardial infarction, ischemic heart disease, angina, congestive heart failure, cardiomyopathy, aortic aneurysm, hypertension, and homocystinuria. Patients without evidence of pseudoexfoliation disease were the controls of our study. Multiple forest plots were created to compile and analyze collected data for statistical comparison. RECENT FINDINGS: From a literature review, 18 studies were selected for our analysis. Cardiovascular disorders that had a statistically significant association (within a 95 % confidence interval) with PEX included ischemic heart disease, aortic aneurysms, and homocystinuria. The association between ischemic heart disease and PEX was statistically significant (p = 0.045). Myocardial infarction, chronic ischemic heart disease, angina, and hypertension did not show a correlation of relationship with the presence of pseudoexfoliation. Patients with PEX are prone to present with ischemic heart disease in addition to abdominal aortic aneurysms and homocystinuria. Patients that present with PEX should be screened for these detrimental cardiovascular disorders.