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1.
J Ophthalmic Inflamm Infect ; 3(1): 10, 2013 Jan 14.
Article in English | MEDLINE | ID: mdl-23514193

ABSTRACT

Recent publications have alerted clinicians to a syndrome of uveitic transilluminating iris depigmentation associated with systemic fluoroquinolones and other antibiotics. Bilateral acute iris transillumination, which is associated with loss of the iris pigment epithelium and results in iris transillumination, differs from the previously described bilateral acute depigmentation of the iris, which is associated with atrophy of the iris stroma without transillumination. We present a case of fluoroquinolone-associated uveitis with anterior segment optical coherence tomography imaging to highlight some observations about this syndrome. We interpret pharmacokinetic data to help explain why oral, but not topical, moxifloxacin may cause fluoroquinolone-associated uveitis.

2.
Ophthalmology ; 119(12): 2650-1; author reply 2651-2, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23207030
5.
J Glaucoma ; 21(9): 608-14, 2012 Dec.
Article in English | MEDLINE | ID: mdl-21602705

ABSTRACT

PURPOSE: To investigate intraocular pressure (IOP) control and corneal graft survival rates in eyes with glaucoma drainage device (GDD) implantation and penetrating keratoplasty (PK) and 5 years of follow-up data. DESIGN: Retrospective review. METHODS: We performed a review of records of all patients who underwent both GDD placement and PK at our institution between January 1, 1988 and December 31, 2003. Twenty-eight eyes of 27 patients were studied. Glaucoma outcome was assessed by postoperative IOP, number of glaucoma medications, and need for further glaucoma surgery. Corneal grafts were assessed for clarity. RESULTS: All eyes had GDD placement in the anterior chamber. The mean pre-GDD IOP was 28.8 ± 10.3 mm Hg on a mean of 2.6 ± 0.8 glaucoma medications. At 5-year follow-up, the mean IOP was 13.0 ± 5.9 mm Hg on a mean of 0.9 ± 1.0 glaucoma medications. GDD implantation successfully controlled glaucoma in 96%, 86%, 79%, 75%, and 71% of eyes at 1, 2, 3, 4, and 5 years, respectively. Grafts remained clear in 96%, 82%, 75%, 57%, and 54% of eyes at 1, 2, 3, 4, and 5 years, respectively. Failure of glaucoma outcome or graft survival was associated with prior intraocular surgeries. CONCLUSIONS: Our data suggests that GDD placement can provide glaucoma control in a high percentage (71%) of eyes with PK even at 5 years. Furthermore, the success of PK in eyes with GDD remains reasonable (54%) at 5 years. IOP control and graft survival rates are comparable with earlier published studies with shorter follow-up or tube placement in the vitreous cavity.


Subject(s)
Corneal Diseases/surgery , Glaucoma Drainage Implants , Glaucoma/surgery , Keratoplasty, Penetrating , Adult , Aged , Aged, 80 and over , Corneal Diseases/complications , Corneal Diseases/physiopathology , Female , Follow-Up Studies , Glaucoma/complications , Glaucoma/physiopathology , Graft Survival/physiology , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome , Young Adult
8.
Eye Contact Lens ; 37(1): 36-8, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20864894

ABSTRACT

PURPOSE: Pseudodendritic keratitis in a contact lens wearer is generally associated with acanthamoeba keratitis. We report a case of isolated pseudodendritic fungal epithelial keratitis that occurred in an extended wear contact lens user. METHODS: A 48-year-old woman was evaluated in our clinic for a 36-hour history of left eye pain. She wore extended wear soft contact lenses and frequently rinsed her eyes with tap water. Her left cornea had a paracentral 3-mm area of epithelium with raised ridges in a pseudodendritic pattern. The underlying corneal stroma was normal. A therapeutic and diagnostic corneal scraping of the lesion was performed and sent for Gomori methenamine silver (GMS) staining. The clinical concern was for epithelial acanthamoeba keratitis. RESULTS: The GMS staining revealed septate fungal hyphae within sheets of corneal epithelium. The patient was started on frequent alternating natamycin (5%) and amphotericin B (0.15%) antifungal eyedrops and exhibited a rapid clinical response. Her keratitis completely resolved, and her vision returned to her baseline of 20/25. Corneal fungal cultures showed no growth. CONCLUSIONS: Our case is an extremely unusual presentation of fungal keratitis, which rarely presents as a pseudodendritic epithelial keratitis. There are two previous similar case reports initially misdiagnosed as acanthamoeba keratitis. Clinicians should be aware that isolated fungal epithelial keratitis can present as a distinct entity and should be considered in the differential diagnosis of pseudodendritic keratitis. The GMS staining is an excellent diagnostic test in a patient presenting with pseudodendritic keratitis because it allows rapid diagnosis of acanthamoeba and fungal infections.


Subject(s)
Contact Lenses, Extended-Wear/adverse effects , Eye Infections, Fungal/etiology , Eye Infections, Fungal/pathology , Keratitis, Dendritic/pathology , Keratitis/microbiology , Keratitis/pathology , Amphotericin B/administration & dosage , Amphotericin B/analogs & derivatives , Antifungal Agents/administration & dosage , Diagnosis, Differential , Drug Administration Schedule , Eye Infections, Fungal/drug therapy , Female , Humans , Keratitis/complications , Middle Aged , Natamycin/administration & dosage , Ophthalmic Solutions , Recovery of Function , Staining and Labeling , Vision Disorders/etiology , Vision Disorders/physiopathology
10.
J Pediatr Ophthalmol Strabismus ; 47 Online: e1-3, 2010 Sep 22.
Article in English | MEDLINE | ID: mdl-20886807

ABSTRACT

Congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome is a rare disorder characterized by birth defects of several organ systems, including the skin, viscera, musculoskeletal system, and central nervous system. The authors present the first report of CHILD syndrome with ocular manifestations in a patient with progressive bilateral optic nerve atrophy.


Subject(s)
Abnormalities, Multiple/diagnosis , Genetic Diseases, X-Linked/diagnosis , Ichthyosiform Erythroderma, Congenital/diagnosis , Limb Deformities, Congenital/diagnosis , Optic Atrophies, Hereditary/diagnosis , Child, Preschool , Female , Humans , Magnetic Resonance Imaging
11.
Ophthalmic Surg Lasers Imaging ; 41(5): 523-31, 2010.
Article in English | MEDLINE | ID: mdl-20672770

ABSTRACT

BACKGROUND AND OBJECTIVE: To examine outcomes of trabeculectomy with mitomycin C and glaucoma drainage device placement for uncontrolled glaucoma when performed by resident surgeons. PATIENTS AND METHODS: This study included any patient who underwent a trabeculectomy with mitomycin C (n = 93) or a glaucoma drainage device (n = 60) by a resident surgeon between 2001 and 2006. Outcome measures at 3, 6, and 12 months included failure of treatment, number of follow-up appointments, complications, number of medications, and need for further surgery. RESULTS: One year postoperatively, intraocular pressure averaged 12.1 ± 5.1 mm Hg in the trabeculectomy group and 13.0 ± 5.1 mm Hg in the glaucoma drainage device group (P = .31). Complications occurred in 30% of eyes with trabeculectomy and 10% of eyes with a glaucoma drainage device. CONCLUSION: During the first postoperative year, glaucoma drainage device surgery may have fewer complications and less morbidity than a trabeculectomy with mitomycin C when these surgeries are performed by resident surgeons. Final intraocular pressures were similar between the two groups.


Subject(s)
Clinical Competence/statistics & numerical data , Glaucoma Drainage Implants , Glaucoma/surgery , Internship and Residency , Ophthalmology/education , Prosthesis Implantation/education , Trabeculectomy/education , Adult , Aged , Aged, 80 and over , Alkylating Agents/administration & dosage , Female , Humans , Intraocular Pressure , Male , Middle Aged , Mitomycin/administration & dosage , Treatment Outcome
12.
Clin Ophthalmol ; 4: 307-14, 2010 Apr 26.
Article in English | MEDLINE | ID: mdl-20463798

ABSTRACT

PURPOSE: To report our short-term experience with bevacizumab in neovascular age-related macular degeneration (AMD) and recommend a new treatment strategy. METHODS: Retrospective chart review of 29 consecutive patients receiving 1.25 mg of intravitreal bevacizumab for AMD and completing 12 weeks of follow up. Outcome measures were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness. Injections were repeated if no further improvement was observed. RESULTS: Twenty-nine eyes of 29 patients were included. The average BCVA improved from 20/148 at baseline to 20/106 at twelve weeks (P = 0.041). Of the 29 eyes, 25 (86.2%) had stable or improved BCVA. Average mean central macular thickness measured by OCT improved from 351 mum at baseline to 278 mum at 12 weeks (P = 0.003). Stabilization of vision and improved OCT central macular thickness were maintained for at least eight weeks following only a single injection in the majority of eyes. During the three months of follow up, only five eyes (17.2%) required repeat injections, with only three (10.3%) requiring retreatment at eight weeks and none at four weeks. No significant ocular or systemic side effects were observed. CONCLUSION: This short-term data suggests that bevacizumab appears to be a safe and effective treatment for neovascular AMD. Injections as frequent as every month do not appear to be necessary since initial treatment effect appears to be maintained for at least eight weeks in almost all of our patients.

13.
J Glaucoma ; 19(7): 499-500, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20051884

ABSTRACT

INTRODUCTION: The Trabectome is a novel surgical device used in the treatment of open angle glaucoma that removes trabecular meshwork tissue to improve aqueous access to drainage channels. Little is known about the long-term consequences of permanently unroofing Schlemm canal. Eyes that have had previous surgery in the iridocorneal angle, specifically permanent removal of trabecular meshwork tissue, may have an increased propensity for blood reflux. CASE PRESENTATION: We present a case of a patient who had intraoperative blood reflux onto peripheral iris during trabeculectomy 11 months after Trabectome surgery. DISCUSSION: Intraoperative blood reflux and resultant hyphema is strongly correlated with Trabectome surgery, but the literature does not reveal any cases of late postoperative blood reflux. In our patient, the absence of overlying angle structures, including the roof of Schlemm canal, may have allowed blood to reflux into the angle and onto peripheral iris during a sudden decrease in intraocular pressure in trabeculectomy surgery. Further studies to assess the consequences of permanent trabecular meshwork tissue removal may be warranted.


Subject(s)
Anterior Chamber/blood supply , Trabecular Meshwork/surgery , Trabeculectomy , Female , Glaucoma, Open-Angle/physiopathology , Humans , Middle Aged
14.
Retina ; 30(4): 578-85, 2010 Apr.
Article in English | MEDLINE | ID: mdl-19996826

ABSTRACT

PURPOSE: The purpose of this study was to report differentiating optical coherence tomography (OCT) findings between postacute retinal arterial occlusion (PARAO) and nonacute optic neuropathy (NAON). METHODS: A retrospective observational comparative study included 17 eyes with postacute permanent retinal arterial occlusion and 32 eyes with NAON whose assessment included a fast macular Status OCT. The macular OCT changes in the postacute phase of central retinal arterial occlusion and branch retinal arterial occlusion were, respectively, compared with those in diffuse and segmental NAON in an effort to establish differentiating features. The findings were used in the workup of four additional consecutive cases referred with suspected NAON. RESULTS: Three main features differentiating PARAO from NAON were identified on macular OCT. Complete inner retinal atrophy with loss of the normal stratification of the inner retinal layers, loss of the normal foveal depression, and marked thinning of the involved retina were characteristic findings of PARAO and were absent even in the most severe cases of NAON. The involved retina was significantly thinner in PARAO compared with that in NAON (P < 0.05). These OCT features helped establish the diagnosis of PARAO in four additional consecutive cases referred with the misdiagnosis of NAON. CONCLUSION: The extent and pattern of inner retinal atrophy differentiate PARAO from NAON and help guide the systemic workup.


Subject(s)
Optic Nerve Diseases/pathology , Retina/pathology , Retinal Artery Occlusion/pathology , Tomography, Optical Coherence/methods , Aged , Aged, 80 and over , Female , Humans , Image Processing, Computer-Assisted , Intraocular Pressure , Male , Middle Aged , Retrospective Studies , Visual Acuity
15.
Retina ; 28(5): 689-95, 2008 May.
Article in English | MEDLINE | ID: mdl-18463511

ABSTRACT

PURPOSE: To report our short-term experience with intravitreal bevacizumab treatment of retinal angiomatous proliferation (RAP) in neovascular age-related macular degeneration (AMD). METHODS: A retrospective, interventional case series was performed that included 13 patients who received intravitreal injection of bevacizumab (1.25 mg) for treatment of RAP and completed 12 weeks of follow-up. Ophthalmic assessment included determination of best-corrected Snellen visual acuity (BCVA), complete ocular examination, fluorescein angiography, and optical coherence tomography (OCT). Injections were repeated if no further improvement or worsening was observed after an initial favorable functional and/or anatomical response. Main outcome measures were BCVA and central macular thickness (CMT) measured by OCT. RESULTS: Twelve eyes (92.3%) had stable or improved BCVA, and 8 eyes (61.5%) had at least 2 lines of vision improvement. The average BCVA improved from 20/203 at baseline to 20/113 at 12 weeks (P = 0.001). Average CMT improved from 369 mum at baseline to 216 microm (P = 0.016) and 315 microm (P = 0.020) at 8 weeks and 12 weeks, respectively. Six eyes underwent fluorescein angiography at the 12-week follow-up visit; 3 (50%) of these eyes had decreased leakage compared with baseline. Both stabilization of vision and improved CMT were maintained for at least 8 weeks after a single injection in almost all eyes. No significant side effects were observed. CONCLUSION: These short-term data suggest that bevacizumab is a viable treatment option for RAP in AMD. The initial treatment effect appears to be maintained for at least 8 weeks.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Angiomatosis/drug therapy , Antibodies, Monoclonal/therapeutic use , Retinal Neovascularization/drug therapy , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Angiomatosis/physiopathology , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal, Humanized , Bevacizumab , Female , Fluorescein Angiography , Humans , Injections , Male , Retinal Neovascularization/physiopathology , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Vitreous Body
16.
Curr Eye Res ; 31(12): 1047-9, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17169843

ABSTRACT

PURPOSE: To report optical coherence tomography (OCT)-histologic correlations of two peripheral retinal lesions (PRLs) and to emphasize the feasibility of OCT imaging in fixed tissue specimens. METHODS: We studied seven formalin-fixed human eyes two of which contained two common peripheral retinal lesions. OCT scans were performed through these lesions and the vitreous base area, and the images were correlated with corresponding histologic sections. RESULTS: Two PRLs including a retinal break and pars plana cysts in addition to the pars plicata and anterior vitreous were successfully imaged. Their optical characteristics correlated well with histology. OCT findings that may help differentiate the hyaloid face and vitreous skirt were also observed. CONCLUSIONS: The correlation between OCT images and corresponding histologic sections demonstrates the feasibility of OCT imaging in fixed tissue specimens. Optical characteristics of the vitreous noted in this study may be helpful in understanding disease processes involving the vitreomacular interface.


Subject(s)
Macular Edema/diagnosis , Retina/pathology , Retinal Perforations/diagnosis , Tomography, Optical Coherence/methods , Vitreous Body/pathology , Eye Enucleation , Humans , Tissue Fixation
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