Primary Low Grade Follicular Lymphoma of the Conjunctivae Mimicking Nodular Anterior Scleritis: A Case Report.

Conjunctival lymphomas are rare entities and may present with non-specific ocular signs that resemble inflammation. They may mimic common ocular pathologies, leading to a delay in diagnosis and treatment. The treatment options of conjunctival lymphomas should be tailored to individuals due to their indolent nature compared to other adnexal lymphomas. Herein, the authors report a case of a primary follicular conjunctival lymphoma in a patient who presented with signs and symptoms of nodular anterior scleritis. The final histology of the conjunctiva lesion revealed primary follicular lymphoma. The patient was managed conservatively with active surveillance.

Corneal Cell Morphology in Keratoconus: A Confocal Microscopic Observation.

PURPOSE: To evaluate corneal cell morphology in patients with keratoconus using an in vivo slit scanning confocal microscope. METHODS: A cross-sectional study was conducted to evaluate the corneal cell morphology of 47 keratoconus patients and 32 healthy eyes without any ocular disease. New keratoconus patients with different disease severities and without any other ocular co-morbidity were recruited from the ophthalmology department of a public hospital in Malaysia from June 2013 to May 2014. Corneal cell morphology was evaluated using an in vivo slit-scanning confocal microscope. Qualitative and quantitative data were analysed using a grading scale and the Nidek Advanced Visual Information System software, respectively. RESULTS: The corneal cell morphology of patients with keratoconus was significantly different from that of healthy eyes except in endothelial cell density (P = 0.072). In the keratoconus group, increased level of stromal haze, alterations such as the elongation of keratocyte nuclei and clustering of cells at the anterior stroma, and dark bands in the posterior stroma were observed with increased severity of the disease. The mean anterior and posterior stromal keratocyte densities and cell areas among the different stages of keratoconus were significantly different (P < 0.001 and P = 0.044, respectively). However, the changes observed in the endothelium were not significantly different (P > 0.05) among the three stages of keratoconus. CONCLUSION: Confocal microscopy observation showed significant changes in corneal cell morphology in keratoconic cornea from normal healthy cornea. Analysis also showed significant changes in different severities of keratoconus. Understanding the corneal cell morphology changes in keratoconus may help in the long-term monitoring and management of keratoconus.

Effects of contact lens wearing on keratoconus: a confocal microscopy observation.

AIM: To evaluate the corneal cell morphology of new keratoconus patients wearing two different types of rigid gas-permeable (RGP) contact lenses for 1y. METHODS: Thirty nine eyes of 39 new keratoconus patients were selected and randomly fitted with two types of RGP contact lenses. Group 1 had 21 eyes with regular rigid gas-permeable (RRGP) contact lens and rest 18 eyes were in group 2 with specially designed rigid gas-permeable (SRGP) contact lens. Corneal cell morphology was evaluated using a slit scanning confocal microscope at no-lens wear and after 1y of contact lens wearing. RESULTS: After 1y of contact lens wearing in group 1, the mean anterior and posterior stromal keratocyte density were significantly less (P=0.006 and P=0.001, respectively) compared to no-lens wear. The mean cell area of anterior and posterior stromal keratocyte were also significantly different (P=0.005 and P=0.001) from no-lens wear. The anterior and posterior stromal haze increased by 18.74% and 23.81%, respectively after 1y of contact lens wearing. Whereas in group 2, statistically significant changes were observed only in cell density & area of anterior stroma (P=0.001 and P=0.001, respectively) after 1y. While, level of anterior and posterior stromal haze increased by 16.67% and 11.11% after 1y of contact lens wearing. Polymegathism and pleomorphism also increased after 1y of contact lens wearing in both the contact lens groups. CONCLUSION: Confocal microscopy observation shows the significant alterations in corneal cell morphology of keratoconic corneas wearing contact lenses especially in group 1. The type of contact lens must be carefully selected to minimize changes in corneal cell morphology.

Microbial keratitis in West and East Malaysia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the epidemiological and etiological factors of microbial keratitis seen in tertiary hospitals in West and East Malaysia.METHODS:A total of 207 patients were enrolled.Patients referred for microbial keratitis to Sungai Buloh Hospital and Kuala Lumpur Hospital in West Malaysia and Queen Elizabeth Hospital and Kuching General Hospital in East Malaysia were recruited.Risk factors were documented.Corneal scrapings for microscopy and culture were performed.RESULTS:The most common risk factor in West Malaysia was organic trauma (28.5％) followed by non organic trauma (18.3％);27.7％ of trauma cases was work related with 34.2％ involving male foreign workers.The most common risk factor in East Malaysia was contact lens wear (32.9％).Pseudomonas aeruginosa was the most common organism isolated in both places.The most common fungal pathogen in West Malaysia was Fusarium spp representing 60％ of all positive fungal cultures.CONCLUSION:In West Malaysia organic trauma was the most common risk factor seen in public hospitals here whereas,contact lens wear was the most common risk factor in East Malaysia (P＜ 0.05).Fungal keratitis was more commonly seen in West Malaysia.

Anterior segment characteristics of keratoconus eyes in a sample of Asian population.

PURPOSE: To assess changes in anterior segment parameters of keratoconus eyes at different stages of the disease in a sample of the Asian population. METHODS: Files of 32 patients (48 eyes) diagnosed as clinical keratoconus were assessed and the following parameters noted: central corneal thickness (CCT), thinnest corneal thickness (TCT), location of thinnest pachymetry, anterior chamber depth (ACD) at the centre from posterior corneal surface, ACD at 1, 2 and 3mm inferior-paracentral, ACD at thinnest pachymetry, anterior chamber volume (ACV) and anterior chamber angle (ACA). For analysis, keratoconus eyes were classified into 3 subgroups according to mean keratometry readings (mild: K≤47.0D, moderate: 47.0

Non-syndromic young girl with epibulbar choristomas: the never end battle / 国际眼科杂志(Guoji Yanke Zazhi)

Choriostomas represent the most common epibulbar lesions in the pediatric age group. Generally, they are on the surface and do not involve the deeper layer of cornea or sclera. Epibulbar dermoids frequently cause amblyopia and cosmetic problems due to high astigmatism and the presence of the tumor. Surgery is the only option for epibulbar dermoids. Lamellar or penetrating keratoplasty has been advocated depending on the site and the depth of the epibulbar dermoids. However, the outcome is not always promising due to accompanying amblyopia and high incidence of vascularization of the grafts. In the present article we report a case of epibulbar choriostomas in the right eye of a 5-year-old, non-syndromic girl who underwent right limbal dermoid excision with lamellar keratoplasty.Postoperatively she was improved cosmetically, however the astigmatism and the vision remained the same. Therefore the amblyopic therapy should be emphasized postoperatively.