ABSTRACT
PURPOSE: To describe a case of 68-year-old male industrial chemist who received a chemical injury after a gold/amine compound exploded causing bilateral eye injuries. No apparent long-term problems were anticipated. After cataract extraction 40 years later, he developed a localized ulcerative keratitis adjacent to embedded gold in the cornea. METHODS: To describe the clinical features, management, and outcomes. RESULTS: Successful treatment with topical hydrocortisone was achieved. Subsequently, 3 further episodes of ulcerative keratitis were treated with topical steroid therapy without need for systemic immunosuppression. A systemic vasculitic/autoimmune screen was normal. DISCUSSION: Ocular chrysiasis is well recognized after systemic gold administration and is normally considered inert, but in this case exogenous gold deposition might have been a contributing factor to very localized and repeated episodes of stromal erosion in this man, many years after the original injury. To the best of our knowledge this is the first such reported case.
Subject(s)
Accidents, Occupational , Chemical Industry , Corneal Ulcer/chemically induced , Corneal Ulcer/drug therapy , Gold/adverse effects , Aged , Cataract/therapy , Cornea/drug effects , Cornea/surgery , Humans , Hydrocortisone/therapeutic use , MaleABSTRACT
PURPOSE: To determine the effect of Ultraviolet-A collagen cross-linking with hypo-osmolar and iso-osmolar riboflavin solutions on stromal collagen ultrastructure in normal and keratoconus ex vivo human corneas. METHODS: Using small-angle X-ray scattering, measurements of collagen D-periodicity, fibril diameter and interfibrillar spacing were made at 1 mm intervals across six normal post-mortem corneas (two above physiological hydration (swollen) and four below (unswollen)) and two post-transplant keratoconus corneal buttons (one swollen; one unswollen), before and after hypo-osmolar cross-linking. The same parameters were measured in three other unswollen normal corneas before and after iso-osmolar cross-linking and in three pairs of swollen normal corneas, in which only the left was cross-linked (with iso-osmolar riboflavin). RESULTS: Hypo-osmolar cross-linking resulted in an increase in corneal hydration in all corneas. In the keratoconus corneas and unswollen normal corneas, this was accompanied by an increase in collagen interfibrillar spacing (p<0.001); an increase in fibril diameter was also seen in two out of four unswollen normal corneas and one unswollen keratoconus cornea (p<0.001). Iso-osmolar cross-linking resulted in a decrease in tissue hydration in the swollen normal corneas only. Although there was no consistent treatment-induced change in hydration in the unswollen normal samples, iso-osmolar cross-linking of these corneas did result in a compaction of collagen fibrils and a reduced fibril diameter (p<0.001); these changes were not seen in the swollen normal corneas. Collagen D-periodicity was not affected by either treatment. CONCLUSION: The observed structural changes following Ultraviolet-A cross-linking with hypo-osmolar or iso-osmolar riboflavin solutions are more likely a consequence of treatment-induced changes in tissue hydration rather than cross-linking.
Subject(s)
Collagen/metabolism , Corneal Stroma/drug effects , Corneal Stroma/radiation effects , Cross-Linking Reagents/pharmacology , Keratoconus/metabolism , Riboflavin/pharmacology , Ultraviolet Rays , Aged , Aged, 80 and over , Corneal Stroma/metabolism , Humans , In Vitro Techniques , Middle AgedABSTRACT
PURPOSE: To describe a case of intraocular lens opacification resembling pseudophakic pseudoexfoliation affecting an AkreosFit intraocular lens (IOL). METHODS: Single case analysis. RESULTS: A patient had IOL opacification resembling pseudophakic pseudoexfoliation. CONCLUSIONS: An 83-year-old woman with normal tension glaucoma was noted to have pseudophakic pseudoexfoliation of an AkreosFit IOL 5 years after uncomplicated phacoemulsification with IOL.
Subject(s)
Exfoliation Syndrome/etiology , Lenses, Intraocular , Phacoemulsification , Prosthesis Failure , Pseudophakia/etiology , Aged, 80 and over , Exfoliation Syndrome/diagnosis , Female , Humans , Lens Implantation, Intraocular , Pseudophakia/diagnosisABSTRACT
PURPOSE: To evaluate changes occurring in central corneal thickness (CCT) immediately after uneventful cataract surgery. METHODS: Thirteen consecutive patients who had uneventful phacoemulsification surgery by the same experienced surgeon were prospectively evaluated for CCT measurements 1 hour preoperatively and 1 hour, 1 day, and 1 week postoperatively. The unoperated eye also had CCT measurements simultaneously on all occasions and served as a control. All patients provided informed consent. SETTING: Department of Ophthalmology, Royal Glamorgan Hospital, Llantrisant, UK RESULTS: Mean age of the patients was 69 years. Central corneal thickness was 550.34 microm preoperatively, 626.39 microm at 1 hour, 585.80 microm at 1 day, and 553.80 microm at 1 week. In the control group, CCT remained stable, within +/-2 microm of preoperative readings. CONCLUSIONS: Central corneal thickness increased by approximately 13.81% in the immediate postoperative period (at 1 hour). It remained increased by 6.44% on day 1 compared with preoperative values and gradually reduced to preoperative levels by the 1-week postoperative period (0.57% difference). Intraocular pressure (IOP) measured postoperatively in the first week may be falsely elevated to some extent because of the increased corneal thickness in the immediate postoperative period; thus, not all IOP rises have be treated in this period in healthy uncompromised eyes.
