Case Report: Corneal perforation secondary to orbital cellulitis caused by Streptococcus pseudoporcinus infection.

INTRODUCTION: This report described a rare case of corneal perforation secondary to orbital cellulitis caused by Streptococcus pseudoporcinus (S. pseudoporcinus) infection. To the best of our knowledge, only six cases of S. pseudoporcinus infection have been reported. This case report suggested that S. pseudoporcinus infection was contagious and potentially life threatening. The report emphasized the value of managing infections early to avoid serious consequences. CASE DESCRIPTION: A patient with orbital cellulitis, which progressed to corneal perforation was admitted to the hospital for right facial swelling, pain, and decreased vision in his right eye. S. pseudoporcinus infection was found after bacterial culture of pus puncture. After aggressive anti-infection and surgical treatment, the infection was eliminated, and the patient was discharged. However, the patient had sustained permanent vision loss. CONCLUSIONS: This case suggested the potential risk of corneal perforation and orbital cellulitis caused by S. pseudoporcinus infection in humans. The specific biological changes and mode of action of S. pseudoporcinus are unclear and need further investigation.

Preparation of Expanded Graphite and Graphite Nanosheets for Improving Electrical Conductivity of Polyester Coating Films.

Expanded graphite and graphite nanosheets were facilely prepared by the thermal expansion of expandable graphite at 800 °C and sand milling of expanded graphite in water, respectively. When the expandable graphite precursor was prepared by the oxidation and intercalation of natural graphite (5 g) using KMnO4 (6 g) as an oxidant in a concentrated sulfuric acid solution (120 mL) at room temperature (25 °C) for 8 h, the expanded graphite with a maximum volumetric rate of 317 mL g-1 was prepared after the thermal expansion of the expandable graphite precursor at 800 °C for 60 s. The oxidation extent of natural graphite with KMnO4 is crucial for the preparation of expanded graphite. The thicknesses of graphite nanosheets decreased from 8.9 to 3.2 nm when the sand milling time of the expanded graphite in deionized water was prolonged from 6 to 24 h. The prolonging of the sand milling time not only decreased the layer number of the graphite nanosheet but also increased the d002 spacing due to the shocking and shearing forces. The addition of the expanded graphite powder and graphite nanosheets in a polyester paint efficiently improved the electrical conductivity of the resultant polyester coating films.

Establishing a Porcine Eye Model for Manual Sub-Bowman Layer Photorefractive Keratomileusis.

OBJECTIVE: To establish a porcine eye model for manual sub-Bowman layer photorefractive keratomileusis (SBPRK), which is a reformed surface ablation refractive surgery that results in preserving the corneal Bowman layer (BL). METHODS: The SBPRK group consisted of eleven eyes of 8 healthy pigs with BL flaps by mechanical technique followed by laser ablation. Regarding the remaining 5 eyes, 3 random eyes had transepithelium photorefractive keratectomy (TransPRK) (the TransPRK group), while the other 2 eyes were untreated (the blank control group). All the pigs were followed up for 8 weeks. Slit-lamp biomicroscopy and optical coherence tomography (OCT) were examined before the surgeries and at 1 week, 4 weeks, and 8 weeks after the surgeries. RESULTS: In a few days after the surgery, 3 eyes of the SBPRK group were excluded from the study because of poor healing of the corneal flaps. At the 1st postoperative week, one eye had an irregular defect of about 3 mm in the central corneal epithelium area; the cornea of the other 7 eyes had just light edema with intact epithelium just like the cornea of the TransPRK group. At the 4th week, in the SBPRK group, the cornea was slightly hazy (haze stage 1). While in the TransPRK group, the cornea was hazier (haze stage 2). At the 8th week, in the SBPRK group, both corneas were almost transparent, and the edges of the BL flaps could not be clearly seen. Meanwhile, in the TransPRK group, the corneal haze became lighter and thinner. OCT showed that, in the SBPRK group, there was high reflection in the BL layer, and it was obvious at 1 week postoperation, decreased at 4 weeks, and calmed down at 8 weeks. However, in the TransPRK group, the high reflection diffused in the anterior corneal stroma at 1 week postoperation, enhanced at 4 weeks, and weakened at 8 weeks. CONCLUSIONS: Preserving the BL while conducting surface refractive surgery may result in less haze than TransPRK. However, further study is still needed, and this technique still requires refining until it becomes a standard clinical procedure.

Management of Corneal Ectasia after LASIK with Phototherapeutic Keratectomy Combined with Photorefractive Keratectomy and Collagen Cross-Linking.

BACKGROUND: To evaluate the efficacy of phototherapeutic keratectomy (PTK) combined with photorefractive keratectomy (PRK) and riboflavin with ultraviolet-A collagen cross-linking (CXL), performed sequentially on the same day, in the management of corneal ectasia after LASIK. METHODS: This retrospective review comprised consecutive patients with corneal ectasia after LASIK. The patients were administered PTK and PRK on the previous corneal flap, and CXL was given on the same day by the same surgeon. The main outcome measures included age, sex, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent refraction, cylinder equivalent refraction, steep and flat keratometries (K), central corneal thickness (CCT), endothelial cell count, corneal haze, and ectasia stability. Mean follow-up period was 6, 12, and 24 months. RESULTS: Sixteen eyes of twelve patients were included in the study. Twenty-four months after administration of PTK combined with PRK and CXL, a significant improvement in UDVA was observed. Mean cylinder equivalent refraction was significantly reduced at 6, 12, and 24 months postoperatively. However, no significant reduction was observed in spherical equivalent refraction. A significant reduction in the flat K and steep K values was observed. No significant change in mean CCT value was observed. Mean endothelial cell count and morphology were unchanged between preoperative and postoperative patients. In addition, no obvious corneal haze was observed. CONCLUSIONS: PTK combined with PRK and CXL on the same day is a safe and effective treatment in improving visual acuity in selected patients with corneal ectasia after LASIK.

Management of recalcitrant epithelial ingrowth after laser in situ keratomileusis: A case report.

RATIONALE: Surgically lifting and scraping, mitomycin C, fibrin glue, Nd:YAG laser, hydrogel ocular sealant, and amniotic membrane patch are the reported methods for treating epithelial ingrowth after laser in situ keratomileusis (LASIK). Here we report the management of a rare case of recalcitrant epithelial ingrowth using a combined scraping/laser ablation that occurred after LASIK. PATIENT CONCERNS: A female patient underwent uncomplicated bilateral LASIK 10 years before incurring trauma to the right eye. Approximately 2.5 years later, she presented with a complaint of blurred vision and a foreign body sensation. DIAGNOSES: The patient was diagnosed with epithelial ingrowth because of the presence of corneal melting, wrinkling, and scarring. Approximately 6 months after injury, the patient underwent corneal scraping to remove the epithelial ingrowth. Even after 2 more scraping procedures, the epithelial ingrowth recurred. Corneal densitometry was performed (Oculus Pentacam), which revealed a maximum corneal densitometry value of 87.4 gray scale units (GSUs) in the inferonasal quadrant. This reading highly elevated compared to readings from normal cornea (approximately 20 GSU). INTERVENTIONS: We used a combination scraping/laser ablation procedure to correct astigmatism and eliminate any undetected residual corneal epithelial cells. OUTCOMES: Two days following the procedure, the patient developed a mild corneal opacity in the area where the epithelial ingrowth had been located. At this time, visual acuity was 20/40, refractive error (manifest refraction) was -0.50 Diopter (D) sph, and the maximum corneal densitometry value was 79.2 GSU. After 2 months, the central cornea remained slightly blurred, but visual acuity was 20/25. No signs of recurrent epithelial ingrowth were present and the maximum corneal densitometry reading had decreased to 55.4 GSU. LESSONS: This case demonstrates that epithelial ingrowth should be treated as soon as possible after trauma and that thorough scraping combined with laser ablation is effective for treating recalcitrant epithelial ingrowth. Additionally, corneal densitometry can be used to assess epithelial ingrowth severity and treatment efficacy.

Prospective Cohort Comparison of Visual Acuity and Contrast Sensitivity Between Femto Laser In Situ Keratomileusis and Orthokeratology for Low-to-Moderate Myopia.

PURPOSE: To compare the visual acuity and contrast sensitivity (CS) after femto laser in situ keratomileusis (fLASIK) and orthokeratology (OK) in patients with low-to-moderate myopia. METHODS: A total of 68 patients were enrolled in this prospective cohort study. Of these, 40 eyes from 40 patients with low-to-moderate myopia underwent fLASIK and 28 eyes from 28 patients underwent OK. In addition to uncorrected distance visual acuity and corrected distance visual acuity, photopic and mesopic CS (with CSV-1000E) were tested before treatment and at 1, 3, and 6 months after treatment. RESULTS: The preoperative refraction and CS were not significantly different between the groups (P>0.05). Postoperative visual acuity and refraction were similar (P>0.05). The photopic CS of the fLASIK group was better than that of the OK group (P<0.01). The fLASIK mesopic CS was better than the OK at 3 c/d (P=0.023). In the fLASIK group, only the photopic CS of postoperative 12 c/d decreased at 1 month and 3 months (P<0.01) and 18 c/d decreased at 1 month (P=0.002); whereas in the OK group, all the postoperative photopic CS values decreased at 1 month (all P<0.01) and 3 months (P<0.05) and increased to the normal level at 6 months (P>0.05). While as to the mesopic CS, in the fLASIK group, the 3 c/d, 6 c/d, and 18 c/d decreased at 1 month (P<0.05) and in the OK group, the 3 c/d decreased at 1 month and 3 months (P<0.05) and the 6 c/d decreased at 3 months (P=0.041), and the 12 c/d and 18 c/d decreased at 1 month (P<0.01). CONCLUSIONS: These results show that fLASIK provides better visual quality than OK for patients with low-to-moderate myopia.

Outcomes of corneal crosslinking for central and paracentral keratoconus.

BACKGROUND: The aim of the study was to compare the therapy of corneal collagen crosslinking (CXL) for central and paracentral keratoconus. METHODS: 64 eyes of 43 central keratoconus patients whose highest power of the cornea located in the central 3 mm zone and 24 eyes of 16 paracentral keratoconus patients whose highest power located out of the central 3 mm zone received standard corneal CXL were included. Maximum keratometry (Kmax) and astigmatism according to topography, uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA) were studied preoperatively and 2 years postoperatively. RESULTS: Central group: Preoperative UDVA and CDVA were 0.9 ±â€Š0.4 and 0.5 ±â€Š0.4 logMAR, respectively. At 2 years, UDVA and CDVA significantly improved to 0.8 ±â€Š0.4 and 0.4 ±â€Š0.3 logMAR(P < 0.01). Preoperative Kmax and astigmatism were 61.5 ±â€Š14.7 diopter (D) and 4.0 ±â€Š2.9 D, respectively. At 2 years, Kmax and astigmatism significantly decreased to 57.0 ±â€Š10.4 and 3.0 ±â€Š2.2 D (P < 0.01). Paracentral group: preoperative UDVA and CDVA were 0.8 ±â€Š0.7 and 0.2 ±â€Š0.4 logMAR, respectively. At 2 years, UDVA significantly improved to 0.4 ±â€Š0.4 logMAR(P < 0.01), whereas CDVA remained 0.2 ±â€Š0.3 logMAR(P > 0.05). Preoperative Kmax and astigmatism were 50.3 ±â€Š5.3 and 2.4 ±â€Š1.7 D, respectively. At 2 years, Kmax significantly decreased to 48.8 ±â€Š4.6 (P < 0.01), whereas astigmatism remained 2.2 ±â€Š1.8 D (P > 0.05). CONCLUSION: This study indicated that CXL was more effective for central keratoconus than paracentral keratoconus.

[Clinical analysis of 17 cases of pneumatic compression therapy in infants with Kasabach-Merritt phenomenon].

OBJECTIVE: To summarize the efficacy and safety of employing pneumatic compression therapy in infants with Kasabach-Merritt phenomenon (KMP). METHODS: Seventeen patients with KMP (11 males, 6 females) were treated with pneumatic compression therapy from October 1997 to May 2008. And their clinical characteristics, course of treatment and clinical and laboratory data were retrospectively analyzed. Among 17 patients, 8 cases were located in trunk, 5 in lower extremities and 4 in upper extremities. The diameters of lesions exceeded 8 cm in all patients. The platelet count was all < 100 x 10(9)/L while hemoglobin < 110 g/L and fibrinogen < 2.0 g/L. The self-designed device for pneumatic compression hemangioma therapy was employed (Patent No: ZL97232266. 3). Biopsy and exairesis were performed from the local lesions with KMP in order to determine the pathological features. RESULTS: Two patients were cured after pneumatic compression therapy for 4 and 6 months respectively, and their lesions disappeared, blood parameters became normal and remained relapse-free after a 5/11-year follow-up. Eleven patients were effective after pneumatic compression therapy for 4 - 6 months, and improvement was demonstrated after 6 - 24 months follow-up without any treatment. Two patients showed improvement after pneumatic compression therapy for 6 months after a follow-up for 5 months or 2 years without progression. After a 6-month pneumatic compression therapy, 2 ineffective patients underwent surgical resection. There were 14 cases of kaposiform hemangioendothelioma (KHE) and 3 cases of tufted hemangioma (TA). CONCLUSION: Pneumatic compression therapy has definite curative effects for KMP lesions in extremities and trunk and its side effects are fewer.