ABSTRACT
Rhinosporidiosis is a granulomatous infection of mucocutaneous tissue caused by Rhinosporidium seeberi that most commonly occurs in the nasal cavity. Ocular rhinosporidiosis affects primarily the conjunctiva. Diagnosis of rhinosporidiosis is based on strong clinical suspicion and is confirmed by histopathological examination. We report a rare case of conjunctival rhinosporidiosis in an immunocompromised patient (human immunodeficiency virus) with disseminated cutaneous rhinosporidiosis. A 44-year-old male presented with a swelling in the right upper eyelid for 6 months. Excision biopsy of the ocular lesion showed multiple thick-walled, variable-sized sporangia containing endospores within the subepithelium suggestive of rhinosporidiosis. A multidrug regimen of systemic cycloserine, ketoconazole, and dapsone was administered to treat disseminated rhinosporidiosis, in addition to antiretroviral therapy. There was good response with reduction in the swellings.
Subject(s)
Conjunctiva/pathology , Conjunctival Diseases/pathology , Eye Infections, Parasitic/diagnosis , Immunocompromised Host , Rhinosporidiosis/diagnosis , Rhinosporidium/isolation & purification , Adult , Animals , Biopsy , Conjunctiva/parasitology , Conjunctival Diseases/parasitology , Diagnosis, Differential , Eye Infections, Parasitic/parasitology , Humans , MaleABSTRACT
PURPOSE: To describe a technique to manage corneal perforations between 3 and 6 mm in size using autologous Tenons tissue with cyanoacrylate glue and a bandage contact lens. METHODS: A thin layer of Tenons capsule harvested from the patient's own eye is used to seal the perforation and act as a scaffold. The Tenons patch graft is spread over the perforation and held in place by the application of cyanoacrylate glue. A bandage contact lens is then placed on the eye. RESULTS: A 6-year retrospective review of 28 patients who underwent this procedure was performed. One patient was lost to follow-up. Of the 27 patients who were followed up, 20 healed completely, with an adherent leucoma and preservation of the anterior chamber. The condition of one patient (with a perforated Pseudomonas corneal ulcer) progressively worsened despite maximum medical therapy and had to undergo evisceration. CONCLUSIONS: This procedure makes use of easily available autologous Tenons tissue in patients with corneal perforations too large to be managed with cyanoacrylate glue alone, to preserve eyeball morphology. A corneal transplant can then be done when the cornea has healed.
Subject(s)
Corneal Perforation/surgery , Ophthalmologic Surgical Procedures , Tenon Capsule/transplantation , Adult , Aged , Bandages , Enbucrilate/therapeutic use , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Tissue Adhesives/therapeutic use , Tissue and Organ Procurement , Wound HealingABSTRACT
PURPOSE: The aim of this study was to describe a case series of Papulaspora equi keratomycosis, with clinical and laboratory characteristics of an organism that has not been reported from scrapings of corneal ulcers from humans. METHODS: This is a retrospective chart review of 5 patients whose diagnostic corneal scrapings had grown P. equi on culture between 2008 and 2013. The clinical presentation, diagnostic tests, management, and the outcome of the ulcers are described. RESULTS: All patients showed characteristic features of fungal corneal ulcers on clinical examination. Only 2 of the 5 patients reported having a history of injury to their eyes. One patient showed surface pigmentation that could mimic a dematiaceous ulcer. All the patients responded to topical antifungal treatment with 5% natamycin or prepared 2% ketoconazole drops. CONCLUSIONS: Corneal ulcers may be caused by rare organisms, as in our series of patients who had P. equi keratomycosis, a hitherto unreported human pathogen. All the patients responded to treatment with conventional topical antifungal medications.
