Lately Diagnosed Acanthamoeba Keratitis Manifesting as an Intrastromal Corneal Abscess: A Case Report.

ABSTRACT: A 42-year-old female contact lens wearer presented to a local emergency department with a 3-day history of decreased vision and ocular discomfort in her right eye. She was started on topical fluorometholone and oral acyclovir with initial diagnosis of herpes simplex keratitis. After 3 weeks of worsening symptoms, she was diagnosed with bacterial corneal ulcer and treated with levofloxacin eye drops every 2 hr. After 14 days of no improvement, she was referred to our clinic for further workup. Slitlamp examination demonstrated a solitary dense 3×3-mm infiltration involving anterior and central corneal stroma. The overlying epithelium was intact, and there was no subepithelial infiltration, radial perineuritis, keratic precipitates, or anterior chamber reaction. Corneal sensation was normal. Confocal microscopy and corneal biopsy were definitive for Acanthamoeba infection. The patient received polyhexamethylene biguanide 0.02% every 2 hr and oral ketoconazole 200 mg twice a day, which resulted in improvement in her signs and symptoms within 10 days. The medications were gradually tapered off over 5 months per clinical response. At the 9-month follow-up visit, the best-corrected visual acuity was 5/10 with a superficial central stromal scar at slitlamp examination. Acanthamoeba infection should be considered in contact lens wearers who present with intrastromal corneal abscess.

Pars plana lensectomy and iris-claw Artisan intraocular lens implantation in patients with Marfan syndrome.

RATIONAL: The rationale of this study was to evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw Artisan intraocular lens (IOL) implantation in patients with subluxated crystalline lenses secondary to Marfan syndrome. MATERIALS AND METHODS: In this retrospective case series, we evaluate the records of 21 eyes of 15 patients with Marfan syndrome and moderate-to-severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw Artisan IOL at referral hospital from September 2015 to October 2019. RESULTS: Twenty-one eyes of 15 patients (10 males and five females) with a mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P < 0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder of 0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment 2 months after surgery. CONCLUSIONS: Pars plana lensectomy and iris-claw Artisan IOL implantation seem to be a useful, impressive, and safe procedure with a low rate of complications in Marfan patients with moderate-to-severe crystalline lens subluxation. Visual acuity was significantly improved with acceptable anatomical and refractive outcomes.

Outcomes of combined phacoemulsification/intraocular lens implantation and silicon oil removal.

PURPOSE: To evaluate the outcomes and complications of simultaneous silicon oil removal (SOR) and phacoemulsification and intra ocular lens implantation. METHODS: In this retrospective non-comparative case series, the visual, refractive and anatomical outcomes of patients who underwent combined phacoemulsification/silicone oil removal (5700 centistokes) surgery between 2017 and 2019 in a single center were evaluated. RESULTS: Forty-four eyes of 44 patients (eighteen males) were included. The mean age of the patients was 51.45 ± 11.59 years. The primary pathology was tractional retinal detachment (TRD) secondary to diabetic retinopathy in 36 eyes and rhegmatogenous retinal detachment (RRD) in 8 eyes. The median time period between silicone oil tamponade and removal was 9 months. There was no statistically significant difference between best corrected visual acuity (-0.14 ± 0.69 LogMAR, p= 0.19) and intraocular pressure (p= 0.26) before and after the surgery. Mean post-operative spherical equivalent (SE) at last visit was 0.36 ± 1.64 which was different from the target refraction (- 0.5D). After cataract/SOR surgery, one eye (2.3%) developed retinal re-detachment in RRD patient. Vitreous hemorrhage occurred in nine eyes (20.5%) which all had TRD as the primary pathology. CONCLUSION: Combined phacoemulsification, silicone oil and IOL implantation removal surgery seems to be a safe and useful procedure with high success rate and acceptable visual, refractive and anatomical outcomes.

Effective Combination Therapy with Human Amniotic Membrane Mesenchymal Stem Cells and Low-Level Laser Therapy in Wound Healing in Animal Models.

Introduction: Many studies have recognized the importance of new methods in wound healing. This study aims to investigate the healing effects of allograft extra embryonic mesenchymal stem cells (MSCs) with and without low-level diode laser irradiation when grafted into full-thickness skin defects in diabetic animal models. Methods: In this experimental study, in order to make the rats diabetic, we used an intra-peritoneal injection of streptozotocin. Human amniotic membrane derived mesenchymal stem cells (hAMSCs) were irradiated with a low-level diode laser. Two full-thickness excisions were made on the backs of the rats. Next, the rats were divided into the following groups: group 1: low-level laser (LLL) irradiated hAMSCs and group 2: hAMSCs alone transplanted into skin wound. Histopathologic, ultrasound and elasticity evaluations were performed 7, 14 and 21 days after grafting. Results: In the evaluated rats, epithelial formation was on day 7 and increased until day 14. On days 7, 14 and 21, the percentage of epithelial formation in the irradiated cell group was significantly higher than that in the cell group, so that, on day 21, the epithelium in this group completely covered the wound surface while in the control group the wound surface was still not completely covered. In terms of angiogenesis, on day 7, the irradiated cells were significantly lower than the cells. Also, the formation of collagen in the cellular hydrogel group could confirm the effectiveness of amniotic MSCs in collagen production and thus accelerate the wound healing process. In comparison with hAMSCs alone, irradiated hAMSCs increased the thickness and elasticity of the skin. Conclusion: Low-power laser along with MSCs can be effective in improving chronic wound condition in the animal model.

Secondary Piggyback Intraocular Lens for Management of Residual Ametropia after Cataract Surgery.

PURPOSE: To investigate the indications, clinical outcomes, and complications of secondary piggyback intraocular lens (IOL) implantation for correcting residual refractive error after cataract surgery. METHODS: In this prospective interventional case series, patients who had residual refractive error after cataract surgery and were candidates for secondary piggyback IOL implantation between June 2015 and September 2018 were included. All eyes underwent secondary IOL implantation with the piggyback technique in the ciliary sulcus. The types of IOLs included Sulcoflex and three-piece foldable acrylic lenses. Patients were followed-up for at least one year. RESULTS: Eleven patients were included. Seven patients had hyperopic ametropia, and four patients had residual myopia after cataract surgery. The preoperative mean of absolute residual refractive error was 7.20 ± 7.92, which reached 0.42 ± 1.26 postoperatively (P < 0.001). The postoperative spherical equivalent was within ± 1 diopter of target refraction in all patients. The average preoperative uncorrected distance visual acuity was 1.13 ± 0.35 LogMAR, which significantly improved to 0.41 ± 0.24 LogMAR postoperatively (P = 0.008). There were no intra- or postoperative complications during the 22.4 ± 9.5 months of follow-up. CONCLUSION: Secondary piggyback IOL implantation is an effective and safe technique for the correction of residual ametropia following cataract surgery. Three-piece IOLs can be safely placed as secondary piggyback IOLs in situations where specifically designed IOLs are not available.

Characterization of In Vivo Biomechanical Properties in Macular Corneal Dystrophy.

PURPOSE: To measure and compare corneal biomechanics in patients with macular corneal dystrophy (MCD), versus those who underwent penetrating keratoplasty (PK) for MCD, versus normal subjects. DESIGN: Cross-sectional study. METHODS: This study enrolled 24 eyes with MCD, 25 eyes that underwent PK in patients with preoperative diagnosis of MCD, and 28 normal eyes. The ocular response analyzer was used to measure corneal biomechanical properties, including corneal resistance factor (CRF) and corneal hysteresis (CH). Intraocular pressure (IOP) was measured using a Goldmann applanation tonometer, and central corneal thickness (CCT) was measured using an ultrasonic pachymeter. The CCT, CRF, CH, and IOP were compared among the study group. RESULTS: CCT was significantly lower in the MCD group (423 ± 47 mµ) than in the PK group (541 ± 31 mµ; P < .001) and the controls (540 ± 26 mµ; P < .001). Meanwhile, CCT was comparable between the PK and control groups (P = .98). CRF did not differ between the MCD (8.34 ± 2.12 mm Hg) and the PK (8.66 ± 1.66 mm Hg) groups (P = .89); however, both of these groups had lower CRF values than the control (9.76 ± 1.83 mm Hg, P = .02) group. No significant differences were observed among the 3 groups in CH (P = .13). IOP values did not differ between the MCD (11.25 ± 1.69 mm Hg) and PK (12.0 ± 2.67 mm Hg) groups (P = .95); however, the IOP values for both of these groups differed significantly from those of the controls (13.46 ± 2.17 mm Hg; P = .006). CONCLUSIONS: CRF was significantly reduced in MCD and did not return to normal values even after PK. The reduced corneal rigidity could result in underestimating IOP in patients with MCD and in those undergoing PK for this stromal dystrophy.

Peripheral Hypertrophic Subepithelial Opacities of Corneal Grafts After Deep Anterior Lamellar Keratoplasty.

PURPOSE: To investigate possible underlying etiologies of the development of peripheral graft hypertrophic subepithelial opacities (PGHSO) and to evaluate the effects of these opacities on visual outcomes after deep anterior lamellar keratoplasty (DALK). METHODS: This prospective, interventional case series enrolled 29 eyes with keratoconus that underwent DALK and developed PGHSO (group 1). The control group consisted of 32 eyes with keratoconus that underwent DALK during the same period and had a clear graft at the final examination (group 2). Possible underlying risk factors for the development of PGHSO were investigated, and postoperative refractive and topographic outcomes were compared between the 2 study groups. RESULTS: Eyes of group 1 had well-defined elevated peripheral subepithelial opacities of the corneal graft, originating from the donor-recipient junction. The central 4-mm area of the graft was clear in all eyes of this group. Compared with the controls, group 1 had flatter grafts at postoperative month 1 and a longer time interval from surgery to initial suture removal. The 2 study groups were comparable in other investigated factors, including the severity of keratoconus, surgical technique, duration of topical steroid use, and donor quality. No significant differences were observed between the case and control groups in postoperative visual acuity and graft surface regularity. CONCLUSIONS: Graft flattening during the early postoperative period and prolonged time interval from surgery to initial suture removal might be factors predisposing to the development of PGHSO. This complication did not affect postoperative visual outcomes when the central 4-mm area of the graft remained clear.