ABSTRACT
This study aimed to report a case of non-resolving bilateral coarse punctate keratitis in a patient with prior bilateral penetrating keratoplasty. In view of non-response to antivirals, corneal epithelial scraping was carried out, which revealed the presence of microsporidial cysts. The infection resolved after a period of 12 days following the diagnosis, during which steroids were discontinued. Microsporidial keratitis needs to be considered in non-resolving coarse punctate keratitis and microbiologic evaluation is essential to establish the diagnosis.
Subject(s)
Corneal Transplantation , Eye Infections, Fungal , Keratitis , Microsporidiosis , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/surgery , Humans , Keratitis/diagnosis , Keratitis/drug therapy , Keratitis/etiology , Keratoplasty, Penetrating/adverse effectsABSTRACT
The COVID-19 pandemic has brought with it the huge burden of mortality and morbidity across the world and the added effects of the mandatory lockdown measures to try and control the spread. A number of aspects of healthcare including eye donation and eye collection require adequate safety precautions in place to keep both the involved healthcare workers and patients safe. This paper highlights the consensus-based guidelines by an expert panel on how to restart eye banking and eye collection services and carry out emergency corneal surgeries during this COVID-19 time. These guidelines will be applicable to all eye banks across the country and should help ophthalmologists and eye banking staff to restart eye banking while safeguarding themselves and their patients.
Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections , Disease Transmission, Infectious , Eye Banks , Pneumonia, Viral , Societies, Medical , Tissue and Organ Procurement , Humans , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , COVID-19 , Disease Transmission, Infectious/prevention & control , Eye Banks/standards , Eye Infections, Viral/epidemiology , Eye Infections, Viral/prevention & control , India/epidemiology , Ophthalmology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2ABSTRACT
Microsporidia are a rare and commonly misdiagnosed cause of corneal infection, accounting for approximately 0.4% of cases of microbial keratitis in some populations. Ocular microsporidiosis most often presents as either microsporidial keratoconjunctivitis (MKC) or microsporidial stromal keratitis (MSK). Though these two clinical entities exhibit similar symptomology, they are distinguished from one another by the time course for disease progression, findings on slit-lamp examination, and response to medical therapy. This review summarizes the current literature on the etiology and clinical presentation of microsporidial infections of the cornea and highlights ongoing developments in available diagnostic modalities and treatment regimens.
ABSTRACT
I report two patients who developed a severe necrotising inflammatory skin reaction with ulceration and hemorrhagic crusting during the first cycle of chemotherapy with 1% 5-Fluorouracil eye drops for Ocular surface squamous neoplasia. The skin reaction subsided on stoppage of the drops and the use of a steroid ointment. 5 fluorouracil therapy was terminated and the patients were shifted to interferon therapy subsequently.
Subject(s)
Antimetabolites, Antineoplastic/adverse effects , Drug Eruptions/etiology , Fluorouracil/adverse effects , Skin Diseases/chemically induced , Administration, Ophthalmic , Conjunctival Neoplasms/drug therapy , Drug Eruptions/diagnosis , Drug Substitution , Hemorrhage/chemically induced , Hemorrhage/diagnosis , Humans , Male , Middle Aged , Neoplasms, Squamous Cell/drug therapy , Ophthalmic Solutions , Skin Diseases/diagnosis , Skin Ulcer/chemically induced , Skin Ulcer/diagnosisSubject(s)
Adenovirus Infections, Human/diagnostic imaging , Cicatrix/diagnostic imaging , Corneal Diseases/diagnostic imaging , Eye Infections, Viral/diagnostic imaging , Tomography, Optical Coherence , Adenovirus Infections, Human/virology , Anterior Eye Segment , Corneal Diseases/virology , Diagnosis, Differential , Eye Infections, Viral/virology , HumansABSTRACT
Vernal keratoconjunctivitis is an ocular allergy that is common in the pediatric age group. It is often chronic, severe, and nonresponsive to the available treatment options. Management of these children is difficult and often a dilemma for the practitioner. There is a need to simplify and standardize its management. To achieve this goal, we require a grading system to judge the severity of inflammation and an algorithm to select the appropriate medications. This article provides a simple and practically useful grading system and a stepladder algorithm for systematic treatment of these patients. Use of appropriate treatment modalities can reduce treatment and disease-related complications.
Subject(s)
Algorithms , Conjunctivitis, Allergic/classification , Conjunctivitis, Allergic/drug therapy , Severity of Illness Index , Conjunctivitis, Allergic/diagnosis , Cyclosporine/therapeutic use , Drug Combinations , Humans , Immunosuppressive Agents/therapeutic use , Ophthalmic Solutions , Tacrolimus/therapeutic useABSTRACT
Prevalence of keratoconus is variable in different parts of the world. Environmental and ethnic factors and the cohort of patients selected for such studies may explain the wide variation in the reported rates. Family history, gender differences, asymmetry in the two eyes, association with ocular rubbing, and natural history of disease are discussed.
Subject(s)
Keratoconus/epidemiology , Female , Geography , Humans , India/epidemiology , Male , Prevalence , Risk FactorsABSTRACT
The clinical and pathological features and management of a patient with recurrent intracorneal epithelial cyst are reported. A child presented with a large intracorneal cyst and underwent drainage with 96 % ethanol irrigation. Histopathology confirmed the epithelial nature of the cyst. The cyst recurred, however, and subsequently a repeat ethanol irrigation with removal of the cyst wall was done. The cyst wall was vacuumed to ensure complete removal of epithelial cells. There was no recurrence, with good visual and cosmetic recovery. Intracorneal epithelial cysts can be successfully managed with drainage, 96 % ethanol irrigation, and vacuum-assisted cyst wall excision.
Subject(s)
Anti-Infective Agents, Local/therapeutic use , Corneal Diseases/therapy , Cysts/therapy , Epithelium, Corneal/pathology , Ethanol/therapeutic use , Child , Humans , Recurrence , Therapeutic Irrigation , Treatment Outcome , VacuumABSTRACT
We report the success of oral cyclosporine therapy in a patient with severe vision-threatening vernal keratoconjunctivitis. A child presented with severe allergy which was not controlled with topical steroids, cyclosporine and mast cell stabilizers. Oral steroids were required repeatedly to suppress inflammation. Child showed a dramatic improvement and stabilization with oral cyclosporine therapy. Oral cyclosporine therapy can be tried in severe vision-threatening allergy refractory to conventional therapy.
Subject(s)
Conjunctivitis, Allergic/drug therapy , Cyclosporine/administration & dosage , Drug Resistance/drug effects , Administration, Oral , Child , Conjunctiva/pathology , Conjunctivitis, Allergic/diagnosis , Cornea/pathology , Dose-Response Relationship, Drug , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/administration & dosage , Male , Retrospective Studies , Severity of Illness IndexABSTRACT
PURPOSE: To report a case of severe corneal endothelial damage after collagen cross-linking treatment in a 37-year-old man with progressive keratoconus with a corneal thickness of more than 400 µm. METHODS: After central epithelial debridement, the left cornea was cross-linked for 25 minutes using dextran-riboflavin solution and UV-A light of 370 nm with an irradiance of 3.0 mW/cm2. One month after cross-linking treatment, the patient presented with massive corneal edema. He was treated with 1% prednisolone and carboxymethylcellulose 1% eyedrops 4 times a day for 3 months. Specular microscopy with endothelial cell counting was performed after resolution of the corneal edema 6 months after cross-linking. RESULTS: Despite intense treatment, a ring-shaped corneal scar remained, and uncorrected visual acuity was finger counting. Cell density after resolution was 1776 cells per square millimeter in the affected eye compared with 2978 cells per square millimeter in the untreated fellow eye. CONCLUSIONS: Corneal thickness is not the only factor for corneal endothelial damage after cross-linking procedure.
Subject(s)
Cornea/radiation effects , Corneal Edema/etiology , Cross-Linking Reagents/adverse effects , Photochemotherapy/adverse effects , Photosensitizing Agents/adverse effects , Ultraviolet Rays/adverse effects , Adult , Cell Count , Cornea/pathology , Humans , MaleABSTRACT
Diagnosis of corneal intraepithelial neoplasia was missed in a patient who presented with recurrent large epithelial defects with pannus. The patient was eventually diagnosed and successfully treated with topical mitomycin C. Mitomycin C may be preferable to surgery in lesions with extensive corneal involvement. Impression cytology should be used for early diagnosis in suspicious lesions.
Subject(s)
Antibiotics, Antineoplastic/administration & dosage , Carcinoma in Situ/drug therapy , Corneal Diseases/drug therapy , Eye Neoplasms/drug therapy , Mitomycin/administration & dosage , Administration, Topical , Carcinoma in Situ/pathology , Corneal Diseases/pathology , Diagnosis, Differential , Drug Administration Schedule , Eye Neoplasms/pathology , Female , Humans , Limbus Corneae/pathology , Middle Aged , Stem Cells/pathology , Treatment OutcomeABSTRACT
PURPOSE: We report a case of acute corneal melt with perforation in a patient with keratoconus after collagen crosslinking treatment and the use of topical diclofenac and proparacaine eyedrops. METHODS: The authors present a case report with clinicopathologic correlation. RESULTS: A patient diagnosed with keratoconus underwent corneal collagen crosslinking followed by postoperative use of ofloxacin, dexamethasone, diclofenac, and proparacaine eyedrops. He presented 1 week later with corneal melt and perforation and was treated initially with tissue glue and bandage contact lens application followed by a penetrating keratoplasty on Day 12. The graft was clear at 1 month. A histologic examination revealed corneal perforation with surrounding stromal loss and inflammatory infiltrates. CONCLUSION: Use of diclofenac sodium and proparacaine eyedrops after surgery was possibly responsible for the corneal melt in our patient. Patients who have undergone crosslinking treatment should be observed closely until the corneal epithelium heals completely.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Collagen/metabolism , Corneal Diseases/chemically induced , Diclofenac/adverse effects , Keratoconus/drug therapy , Photochemotherapy , Corneal Diseases/surgery , Corneal Perforation/chemically induced , Corneal Perforation/surgery , Corneal Stroma/metabolism , Humans , Keratoconus/metabolism , Keratoplasty, Penetrating , Male , Photosensitizing Agents , Tissue Adhesives/administration & dosage , Ultraviolet Rays , Young AdultABSTRACT
Scleral ulceration after ocular surgery is a rare but serious complication. Determination of the underlying systemic and local causes is critical for treatment. An unusual case of ischemic scleral ulceration after vitreoretinal surgery in a diabetic patient is reported. Patient was successfully treated with a pedicle conjunctival graft.
Subject(s)
Retinal Detachment/surgery , Scleral Diseases/etiology , Ulcer/etiology , Vitrectomy/adverse effects , Adult , Humans , Ischemia/etiology , Male , Reoperation , Sclera/blood supply , Scleral Diseases/pathology , Scleral Diseases/surgery , Surgical Flaps , Ulcer/pathology , Ulcer/surgeryABSTRACT
Late onset of corneal edema after cataract surgery is an unusual complication. We report a case of corneal edema presenting one month after cataract surgery. During implantation of the foldable lens, one haptic of the intraocular lens fractured at the optic haptic junction. This caused lens decentration, necessitating an intraocular lens exchange ten days later. The patient was recovering well but presented again two weeks later with a drop in vision due to corneal edema. A retained haptic of the intraocular lens was seen in the inferior anterior chamber angle. After surgical removal of the retained haptic the corneal edema fully resolved. Retained intraocular lens fragments can cause corneal endothelial damage, which may be reversible with an early diagnosis and intervention.
Subject(s)
Corneal Edema/etiology , Eye Foreign Bodies/complications , Intraoperative Complications , Lenses, Intraocular/adverse effects , Phacoemulsification , Prosthesis Failure , Aged , Device Removal , Eye Foreign Bodies/surgery , Humans , Lens Implantation, Intraocular , Male , ReoperationABSTRACT
Viscoexpression method of nucleus delivery in manual small incision cataract surgery is described in this article. The practical modifications to the conventional technique in special situations are presented. Intraoperative and postoperative problems likely to be encountered and the steps to avoid them and tackle them effectively are discussed.
Subject(s)
Cataract Extraction/methods , Lens Nucleus, Crystalline/surgery , Microsurgery/methods , Viscoelastic Substances/therapeutic use , HumansABSTRACT
This section provides guidelines on medical therapy of patients with infectious keratitis. In addition to initial empirical therapy, preferred medications, once the organisms responsible are isolated, are discussed. Atypical mycobacterial keratitis following lasik is described. General guidelines for supportive therapy and follow-up, of these patients are presented. Clinical response to treatment and indications for intervention are discussed. Possible causes and approach to cases refractory to medical therapy are discussed.
Subject(s)
Corneal Ulcer/drug therapy , Eye Infections/drug therapy , Anti-Infective Agents/therapeutic use , Corneal Ulcer/microbiology , Eye Infections/microbiology , Humans , Practice Guidelines as TopicABSTRACT
We report a case of surgically induced necrotizing scleritis following pterygium surgery with the bare sclera technique, without the use of adjunctive irradiation or mitomycin C. The patient was successfully treated with systemic immunosuppression.
Subject(s)
Ophthalmologic Surgical Procedures/adverse effects , Pterygium/surgery , Scleritis/etiology , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/therapeutic use , Middle Aged , Postoperative Complications , Scleritis/drug therapyABSTRACT
Infection of a self-sealing tunnel incision is a rare but vision-threatening complication of cataract surgery. We describe two cases of side port infection following an uneventful phacoemulsification. Nocardia was isolated in one case. Both the cases were worsening on medical treatment and were successfully treated by therapeutic keratoplasty.