Ocular adnexal lymphoma presenting as incidental tarsal follicles.

PURPOSE: To report a case of ocular adnexal lymphoma presenting as asymptomatic follicles discovered incidentally on routine examination. OBSERVATIONS: A 43-year-old woman presented for routine annual examination and was incidentally found to have unilateral giant follicles in the left eye inferior fornix. She denied any ocular or systemic symptoms. The remainder of the examination was unremarkable, and the patient was otherwise healthy. A conjunctival biopsy revealed a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma. She underwent external beam radiation therapy, resulting in complete resolution of the follicles. CONCLUSIONS AND IMPORTANCE: Awareness of atypical presentations of conjunctival lymphoma and thorough slit lamp examinations, even on routine exams, may help expedite diagnosis and treatment.

Asymmetric Deep Stromal Keratopathy in a Patient With Multiple Myeloma.

PURPOSE: To report a case of asymmetric deep stromal keratopathy in a patient with multiple myeloma. METHODS: Case report and literature review. RESULTS: An 85-year-old woman was found to have progressive visually significant left-sided deep stromal opacity in the setting of monoclonal gammopathy. Hematologic workup resulted in a diagnosis of IgG kappa multiple myeloma. Histopathology was significant for semicrystalline deposits in the posterior stroma. The patient's visual acuity improved to 20/50 7 months after penetrating keratoplasty. A similar deep stromal lesion appeared in the right eye 2 years after initial presentation. CONCLUSIONS: We present an unusual case of paraproteinemic keratopathy with a uniquely asymmetric presentation that resulted in a diagnosis of multiple myeloma.

Characteristics and outcomes of fall-related open-globe injuries in pseudophakic patients.

AIM: We aimed to identify the characteristics and prognostic indicators of poor visual and anatomic outcome in pseudophakic patients with fall-related open-globe (OG) injuries. We used a case series design, for a total of 26 patients. METHODS: Charts of consecutive pseudophakic patients with fall-related OG injury at a single institution were reviewed. Demographics, ophthalmic history, circumstances of injury, initial best-corrected visual acuity (BCVA), examination findings, surgical interventions, and follow-up BCVA were tabulated for statistical analysis with unpaired t-tests and Fisher's exact tests. RESULTS: Nineteen patients (73%) were women. Mean (± standard deviation) age was 80.6±4.6 years (range: 61-97 years). Initial BCVA was <20/400 in 24 of 25 patients (96%). Mean ocular trauma score (OTS) was 38.54±10.95. OTS was lower (P=0.0017, P<0.0001, and P=0.0240) and wound size was larger (P=0.0440, 0.0145, and 0.0026) in patients with final BCVA <20/40, <20/400, and phthisis at final follow-up, respectively; compared to patients with BCVA ≥20/40, 20/400, and no phthisis at final follow-up, respectively. Final BCVA <20/400 was associated with 360° subconjunctival hemorrhage (SCH), retinal detachment, and proliferative vitreoretinopathy (P=0.0498, 0.0181, and 0.0310, respectively). Total hyphema, intraocular lens (IOL) damage, and IOL expulsion were associated with needing multiple surgical interventions (P=0.0345, P<0.0001, and P=0.0023, respectively). CONCLUSION: Large wound size, low OTS, 360° SCH, total hyphema, posterior injury, and IOL damage are common findings that are also prognostic of poor visual and anatomic outcome in pseudophakic patients with fall-related OG injuries. Ophthalmologists dealing primarily with geriatric populations should contribute to the discussion of fall risk.

Removal of epithelial ingrowth via central perforating wound tract 6 years post LASIK.

BACKGROUND: The purpose was to report a case of a novel approach for the removal of central interface epithelial ingrowth caused by a perforating corneal injury 6 years after laser-assisted in situ keratomileusis (LASIK). METHODS: Access to a large central area of epithelial ingrowth under a LASIK flap was achieved through the wound tract from a perforating corneal injury. Suturing of the central LASIK flap in a similar manner commonly carried out peripherally was then performed to prevent recurrent epithelial ingrowth. RESULTS: The offending epithelial ingrowth was removed with no recurrence over a 1-year follow-up. CONCLUSIONS: This is, to our knowledge, the first reported case of central epithelial ingrowth removal from a LASIK interface by a perforating injury wound tract.

Mooren's-type ulceration associated with severe hidradenitis suppurativa: a case report and literature review.

PURPOSE: To report a case of bilateral Mooren's-type corneal ulcers associated with severe hidradenitis suppurativa. DESIGN: Case report and literature review. METHODS: Detailed clinical course including presentation, medical, and surgical treatment. RESULTS: A 47-year-old African American male with severe hidradenitis suppurativa presented with bilateral Mooren's-type corneal ulcers. His systemic workup was unrevealing. Progression led to bilateral corneal perforations. Systemic immunosuppression and surgical intervention were needed to control his disease. CONCLUSIONS: Severe hidradenitis suppurativa should be considered as a risk factor for Mooren's-type corneal ulcer.

Efficacy and safety of voriconazole as an additive in Optisol GS: a preservation medium for corneal donor tissue.

PURPOSE: To assess the endothelial toxicity and the microbiological efficacy of voriconazole (100 microg/mL) as an antimicrobial additive to Optisol GS. METHODS: A total of 533 donor rims were studied. One half of each donor rim was placed in standard Optisol GS and the other half rim in Optisol GS fortified with voriconazole (100 microg/mL). All rims were refrigerated for 24 hours at 3 degrees C and placed in thioglycolate broth and incubated at 37 degrees C for 7 days. A pair of donor buttons not used in transplantation was stored for 2 days in each solution and examined for endothelial changes with electron microscopy (EM). A second pair of cornea buttons was examined for toxicity by endothelial staining with 0.3% trypan blue and 0.2% alizarin red. RESULTS: Seven of 533 corneal rim cultures were positive for fungal organisms in the Optisol GS group. No rims were positive for fungal growth in the voriconazole-fortified Optisol GS medium. The difference was statistically significant (P = 0.015; Fisher exact test). There was no difference in the cellular morphology of the button stored in voriconazole fortified Optisol GS compared with Optisol GS using EM. In the bioassay, the percentage of nonviable cells in the voriconazole-fortified medium compared with the control medium was nonsignificant (P < 0.05, Student t test). CONCLUSIONS: Voriconazole seems to be safe as a fortifying agent for cornea storage medium. It significantly reduces the rate of positive fungal rim cultures and shows no signs of endothelial cytotoxicity as viewed by EM and by a bioassay of trypan blue and alizarin red.

Efficacy and safety of moxifloxacin as an additive in Optisol-GS a preservation medium for corneal donor tissue.

PURPOSE: To assess the endothelial toxicity and the microbiological efficacy of moxifloxacin (250 microg/mL) as an additive to Optisol-GS. METHODS: Five hundred nine donor rims were studied. One half of each donor rim was placed in standard Optisol-GS and the other half of the rim in Optisol-GS fortified with moxifloxacin (250 microg/mL). All rims were refrigerated for 24 hours at 3 degrees C and placed in thioglycolate broth and incubated at 37 degrees C for 7 days. One pair of donor buttons not used in transplantation stored in each solution was examined for endothelial changes by using electron microscopy (EM). A second pair of cornea buttons was examined for toxicity by endothelial staining with 0.3% trypan blue and 0.2% alizarin red. All endothelial cells that stained (nonviable cells) and nonstained cells (viable cells) were counted, and the ratio of nonviable cells was calculated. RESULTS: The rate of culture-positive donor rims in the Optisol-GS group was 11.9% (61/509) and in the moxifloxacin-fortified Optisol-GS media was 2.5% (13/509). The difference was statistically significant (P < 0.01; chi test). There was no difference in the cellular morphology of the button stored in moxifloxacin-fortified Optisol-GS compared with Optisol-GS using EM. In the bioassay, the rate of nonviable cells in the moxifloxacin-fortified media compared with the control media was nonsignificant (P > 0.05). CONCLUSION: Moxifloxacin (250 microg/mL) seems to be safe as an additive agent for cornea storage media. It significantly reduces the rate of positive rim cultures and shows no signs of endothelial cytotoxicity as viewed by EM and by a bioassay of trypan blue and alizarin red.

Laboratory model of tissue adhesive (2-octyl cyanoacrylate) in sealing clear corneal cataract wounds.

PURPOSE: To determine the efficacy of a tissue adhesive (2-octyl cyanoacrylate with parabens; Liquid Bandage, Johnson & Johnson, Skillman, New Jersey) in sealing clear corneal cataract wounds. DESIGN: Laboratory investigation. METHODS: Seven human donor globes were prepared for Miyake video microscopy. A 3.0-mm clear corneal incision was created. A transscleral cannula was inserted and connected to a bottle of saline. The bottle height was varied to alter intraocular pressure. Droplets of India ink were placed on the wound. Main outcome measure was any influx of India ink into the anterior chamber as viewed through the Miyake system with intraocular pressure (IOP) fluctuation or with manual pressure. If India ink was present in the eye, it was irrigated out, and the experiment was repeated with IOP fluctuation and manual pressure after the application of 2-octyl cyanoacrylate to the wound. RESULTS: One eye demonstrated the presence of India ink inside the eye on IOP reduction to <5 mm Hg. Three eyes demonstrated the presence of India ink inside the eye with manual pressure. Three eyes did not leak with manual pressure or IOP variation. All seven eyes without glue leaked with exaggerated manual pressure at the wound edge. Of the seven eyes with tissue adhesive, none demonstrated influx of India ink with IOP variation or manual wound manipulation. CONCLUSIONS: Our laboratory model demonstrates that 2-octyl cyanoacrylate prevents the influx of ocular surface fluid independent of IOP and manual wound manipulation. Further investigations in clinical models are necessary to determine the future use of this adhesive barrier substance.

Liquid bandage (2-octyl cyanoacrylate) as a temporary wound barrier in clear corneal cataract surgery.

PURPOSE: To determine the feasibility and side effect profile of 2-octyl cyanoacrylate with parabens (Liquid Bandage) as an adjunct wound sealant and barrier against the inflow of ocular surface fluid after clear corneal cataract surgery. DESIGN: Prospective interventional case series. PARTICIPANTS: Fifty-one eyes of 51 patients undergoing clear corneal cataract surgery. METHODS: Fifty-one eyes of 51 patients who underwent cataract surgery by one surgeon (RSK) were enrolled. A 2.75-mm clear corneal, triplanar, temporal incision was used in each case, followed by routine phacoemulsification. At the conclusion of each case, the wound was dried with a cellulose sponge. A modified microsponge with 1 to 2 drops of 2-octyl cyanoacrylate with parabens was then applied in a smooth layer to the wound. All wounds were rechecked for leakage with a cellulose sponge applied at the wound lip. The following criteria were evaluated on the first 2 postoperative visits: (1) visual acuity; (2) patient complaints; (3) wound integrity; (4) presence of tissue adhesive; and (5) any adverse events, including abnormal increase in local tissue reaction to the adhesive. MAIN OUTCOME MEASURES: Side effect profile and clinical course of 2-octyl cyanoacrylate with parabens applied to clear corneal wounds. RESULTS: All 51 eyes demonstrated intraoperative watertight wound closure after the application of 2-octyl cyanoacrylate with parabens. Forty-five eyes (88%) had tissue adhesive still completely covering the wound on postoperative day 1. Two eyes (4%) had tissue adhesive over portions of their wound, and 4 eyes (8%) had no adhesive noted on their wound. All wounds were watertight on all postoperative visits. Thirty-one of 51 patients (61%) complained of mild transient foreign body sensation on postoperative day 1. Twenty-six patients (51%) had trace diffuse bulbar conjunctival hyperemia. Five patients had trace focal conjunctival hyperemia adjacent to the wound. Nine patients (18%) had remnants of the adhesive remaining on the second postoperative visit. CONCLUSIONS: Our study demonstrates the ease of use and applicability and low side effect profile of 2-octyl cyanoacrylate with parabens as a temporary wound barrier in clear corneal cataract surgery.

High-frequency ultrasound of anterior segment retinoblastoma.

PURPOSE: To evaluate anterior segment retinoblastoma with high-frequency ultrasound. DESIGN: Interventional case report. METHODS: An 11-year-old boy with a total retinal detachment and multiple white anterior chamber nodules was examined with high-frequency ultrasound before enucleation of the globe. RESULTS: Multiple solid and cystic nodular tumors were found in the anterior chamber angle. With high-frequency ultrasound, tumor was discovered posterior to the iris, over the ciliary processes, and on the lens capsule. No calcifications were noted. Other findings included angle closure related to iris neovascularization and uveal thickening. CONCLUSION: High-frequency ultrasound can be used to evaluate retinoblastoma extension into the anterior segment. These images may be used for comparison in future cases of retinoblastoma with anterior chamber invasion.