Unilateral Congenital Lacrimal Fistula with Renal Agenesis and Pelvic Kidney: A Case Report and Review of the Literature.

A 12-year-old boy presented to the clinic of ophthalmology because of watering and discharge from his left lower eyelid. The inspection examination revealed an orifice that was associated with congenital lacrimal fistula (CLF). He underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings. Systemic evaluation revealed multiple renal anomalies: right renal agenesis and left ectopic pelvic kidney. This case is unique because this is the first reported case of CLF accompanied with ectopic pelvic kidney in the literature.

Effectiveness of posaconazole in recalcitrant fungal keratitis resistant to conventional antifungal drugs.

Purpose. To present the success of posaconazole in two cases with recalcitrant fugal keratitis that were resistant to conventional antifungal drugs. Method. We presented two cases that were treated with posaconazole after the failure of fluconazole or voriconazole, amphotericin B, and natamycin therapy. Case 1 was a 62-year-old man with a history of ocular trauma. He had been using topical fluorometholone and tobramycin. His best corrected visual acuity (BCVA) was hand motion. He had 5.0 × 4.5 mm area of deep corneal ulcer with stromal infiltration. Case 2 was a 14-year-old contact lens user. He had been using topical moxifloxacin, tobramycin, and cyclopentolate. His BCVA was 20/200. He had a 4.0 × 3.0 mm area of pericentral corneal ulcer with deep corneal stromal infiltration and 2 mm hypopyon. Results. Both patients initially received systemic and topical fluconazole or voriconazole and amphotericin B and topical natamycin that were all ineffective. But the response of posaconazole was significant. After posaconazole, progressive improvement was seen in clinical appearance. BCVA improved to 20/100 in case 1 and 20/40 in case 2. Conclusion. Posaconazole might be an effective treatment option for recalcitrant fusarium keratitis and/or endophthalmitis resistant to conventional antifungal drugs.

Dynamic MR dacryocystography in patients with epiphora.

OBJECTIVE: The purpose of this study was to investigate the diagnostic value of dynamic MRI dacryocystography (dMR-DCG) for the assessment of nasolacrimal drainage system (NLDS). METHODS: The study population consisted of 35 patients with a history of epiphora. Each patient underwent bilateral dMR-DCG and conventional dacryocystography (DCG) to assess the NLDS. Two radiologists, who were unaware of the clinical data, evaluated the images separately for the level of obstruction at the nasolacrimal passage and the presence or absence of lacrimal sac dilatation. The findings from the dMRI-DCG and DCG images were compared. DCG was considered to be the gold standard imaging technique. RESULTS: dMRI-DCG had a sensitivity of 90.5% and a specificity of 89.3% to detect nasolacrimal passage. In 24 out of 70 NLDS that were assessed, there was 100% agreement between the dMRI-DCG and DCG images in the detection of the obstructed level in the nasolacrimal pathway. The lacrimal sac dilatation finding detected by DCG was not observed by dMRI-DCG in only two patients, in whom there was a prior history of dacryocystorhinostomy (DCR) operation. These findings suggest that dMRI-DCG has 94.3% sensitivity and 100% specificity for the diagnosis of lacrimal sac dilatation. CONCLUSION: dMRI-DCG is an easily performed, minimally invasive imaging technique to identify the presence or absence of obstruction and its level, and lacrimal sac dilatation in the evaluation of NLDS. dMRI-DCG does not require the use of contrast material and ionizing radiation and provides functional information by depicting dynamic behaviour. Thus, dMRI-DCG could be useful as a reliable diagnostic imaging technique in many patients prior to surgery.

Diagnostic significance of impression cytology in allergic rhinoconjunctivitis.

Impression Cytology (IC) is a noninvasive and easily repeated technique for investigating many pathologies of the conjunctiva such as dry eye, drug toxicities, and melanoma. In addition to skin tests and determination of serum IgE levels, the presence of eosinophilia in the nasal mucosa and the conjunctiva is an important diagnostic factor in allergic rhinoconjunctivitis. Eosinophilia can classically be shown by the nasal smear technique as well as IC. The nasal smear is a difficult test to carry out and does not always give adequate results. With this in mind, we collected cells from the nasal mucosa and superior palpebral conjunctiva from 27 patients with allergic rhinoconjunctivitis (17 female, 10 male) using 5 x 5 mm, 0.22 micron pore-sized cellulose acetate paper. The specimens were fixed in 95% alcohol and were then stained with hematoxylin eosin and periodic acid-Schiff stain for examination by light microscopy. Taking the free and intraepithelial eosinophilia into consideration, the specimens were grouped. Of all patients, 92.6% and 85.2% had nasal and conjunctival eosinophilia, whereas 44.4% and 25.9% had nasal and conjunctival mononuclear cells, respectively. Our study has shown that IC is a very reliable and practical technique that offers a valuable alternative test for investigating both the intraepithelial and free eosinophilia in allergic rhinoconjunctivitis and other pathologies that cause cytologic changes.

Tear LTC4 levels in patients with subclinical contact lens related giant papillary conjunctivitis.

We determined the tear levels of LTC4 in contact lens wearers who had minimal irritative symptoms and signs suggesting subclinical conjunctival abnormalities and the possible development of giant papillary conjunctivitis (GPC). We examined 25 patients wearing rigid gas permeable lenses. Ten of the contact lens wearers had minimal irritative symptoms and nonspecific papillary hypertrophy, and 15 patients had no symptoms. We included eight controls chosen from the same age group who were not contact lens wearers and who had normal conjunctiva. Tear samples were examined through the ELISA technique. Elevated levels of LTC4 were found in the tears of symptomatic patients (525.50 +/- 202 pg/mL) compared with tears of asymptomatic contact lens wearers (52.6 +/- 10.2 pg/mL) and the control group (75 +/- 8.4 pg/mL) (P < 0.001). Two patients in the first group developed GPC in the course of their follow-up. The results of this study indicate that detecting tear LTC4 levels in contact lens wearers can give useful information regarding the presence of contact lens related subclinical inflammation and subclinical GPC.