TATTOO-ASSOCIATED UVEITIS WITH CHOROIDAL GRANULOMA: A RARE PRESENTATION OF SYSTEMIC SARCOIDOSIS.

PURPOSE: The authors report a rare case of systemic sarcoidosis manifesting as bilateral granulomatous panuveitis and multiple tattoo granulomas. METHODS: Case report. RESULTS: A 30-year-old man presented with headaches, ocular pain, photophobia, and blurred vision. He was found to have significant skin inflammation, predominantly involving areas of tattoos. Fundoscopic examination revealed bilateral granulomatous panuveitis with small focal choroidal lesions. Skin biopsy demonstrated granulomatous inflammation of the dermis with tattoo pigment evident in numerous histiocytes. He was diagnosed with systemic sarcoidosis. CONCLUSION: The authors report another rare case of tattoo-associated uveitis, in which inflammation is limited to tattooed skin and the uvea. This uncommon presentation may prove informative in elucidating the pathogenesis of systemic sarcoidosis.

Does unintentional macular translocation after retinal detachment repair influence visual outcome?

BACKGROUND: To document the occurrence of postoperative macular translocation after retinal detachment repair and discuss its influence on visual outcome. DESIGN: Retrospective case series in a tertiary care setting. PARTICIPANTS: Five eyes of five patients presenting to our clinic with macula-off rhegmatogenous retinal detachment. METHODS: All patients underwent surgical repair of the retinal detachment, with regular postoperative follow-up, including macular optical coherence tomography and fundus autofluorescence. MAIN OUTCOME MEASURES: Visual acuity and subjective visual symptoms in patients with anatomically successful retinal detachment repair, in whom inadvertent macular translocation was noted. RESULTS: Our series demonstrates the presence of unintentional macular translocation after retinal detachment repair, detected by fundus autofluorescence imaging. In contrast to previous reports, we document inadvertent macular translocation in one patient after scleral buckling surgery. In each case, the retina was fully reattached postoperatively and no other complications were identified. There was variability in the symptoms and objective visual outcomes after surgery. CONCLUSIONS: Inadvertent macular translocation can occur following repair of macula-off retinal detachment, and may be a significant contributor to poorer visual outcome after retinal detachment, despite objective surgical success.

The role of mucosal flaps in external dacryocystorhinostomy.

PURPOSE: To determine whether a mucosal anastomosis fashioned at the time of external dacryocystorhinostomy (DCR) influences postoperative outcome. METHODS: The clinical records of all patients who underwent external DCR at Sydney Eye Hospital between May 2000 and August 2007 were reviewed. Data were collected in regards to surgical technique, clinical outcomes and postoperative management. Chi-square statistical analysis was done to determine the significance of the different flap techniques on surgical success. RESULTS: A total of 260 medical records were reviewed. The main outcome measure was postoperative resolution of symptoms. The mean final follow-up time was 11 months. There was no statistically significant difference in outcome between patients who had both anterior and posterior flaps sutured, compared to those who had anterior flap sutures only (73% vs 79%, p = 0.51). Patients who had no sutured flaps had an overall success rate of 89% compared to those that had at least the anterior flaps sutured together (76%); this difference was not significant (p = 0.45). CONCLUSION: There was no statistical difference in symptom outcome between patients in whom both mucosal flaps were sutured, those who had only the anterior flap sutured, or those who did not have either flap sutured at the time of surgery.

External dacryocystorhinostomy: assessing factors that influence outcome.

PURPOSE: To present the experience of external dacryocystorhinostomy (DCR) at a tertiary referral center and investigate factors that may affect clinical outcomes. METHODS: The clinical records of all patients who underwent external DCR at Sydney Eye Hospital between May 2000 and August 2007 were reviewed. Data were collected in regards to patient demographics, preoperative assessment, operative details, surgical technique, postoperative management, and clinical outcomes. This information was then analyzed, with emphasis on factors that influence surgical outcomes and success. RESULTS: A total of 338 cases were reviewed. The mean age at time of surgery was 64.82 years and the majority of patients were female (65%). Epiphora was the major preoperative symptom. Assisted local anesthesia and day stay surgery were the most common surgical settings. There was a statistically significant difference in theatre time between consultant and trainee surgeons (P < 0.00001). The mean final follow-up time was 11 months. Overall, 77.3% of patients had full resolution of symptoms and 20.8% had partial resolution. Only five patients (1.9%) had no resolution of symptoms. There was no significant difference in outcomes between consultants and trainees. Patients with anatomical nasolacrimal obstruction had significantly better outcomes compared with functional obstruction (P = 0.04). The postoperative fluorescein dye disappearance test was a good predictor of clinical success (P = 0.005). Silicone intubation for greater than 6 months was associated with better outcomes (P = 0.002). CONCLUSIONS: The results at our tertiary center are comparable to results stated in the literature. In our series, only the amount of nasolacrimal obstruction and duration of postoperative intubation influenced surgical success.

Primary cutaneous B cell lymphoma presenting as recurrent eyelid swelling.

Primary cutaneous lymphoma represents a distinct clinical entity within the spectrum of haematological malignancy. A case of primary cutaneous B cell lymphoma is reported, presenting in an 87-year-old female with a 2-year history of intermittent swelling and discolouration of the right upper and lower eyelids, in the absence of systemic symptoms. Histopathological examination of an incision biopsy revealed a lymphoid infiltrate in the dermis with immunophenotypic features of B cell lymphoma. Staging investigations confirmed the absence of systemic disease. Treatment with oral chemotherapy was undertaken with a good response. Ophthalmologists should include primary cutaneous lymphoma in the differential diagnosis of recurrent eyelid swelling.

Nocardia transvalensis resistant to amikacin: an unusual cause of microbial keratitis.

PURPOSE: To report a case of microbial keratitis caused by Nocardia transvalensis with resistance to amikacin. METHODS: Case report. RESULTS: A 51-year-old man was referred with a 10-week history of ocular pain, photophobia, redness, and blurred vision. At his initial presentation, a corneal foreign body was removed and he was diagnosed with anterior uveitis, with commencement of topical corticosteroid therapy and ofloxacin. Despite treatment, he experienced ongoing foreign body sensation and glare. At presentation to our clinic, a central epithelial defect with multiple stromal infiltrates in a wreath pattern was identified and a diagnosis of infective keratitis was made. He was initially commenced on topical amikacin, oral trimethoprim-sulfamethoxazole, and oral voriconazole. Corneal scraping confirmed Nocardia species. Microbiological culture revealed N. transvalensis as the causative organism, with resistance to several antibiotics, including amikacin. Clinically, there was only partial response of the keratitis to initial therapy. Treatment was changed to oral trimethoprim-sulfamethoxazole and topical ciprofloxacin, with eventual clinical improvement. CONCLUSIONS: This is the first reported case of N. transvalensis keratitis. In patients with Nocardia keratitis and only partial response to amikacin treatment, this isolate should be considered as it is resistant to aminoglycoside antibiotics.