Very High-Frequency Ultrasonography Signs in Bilateral Acute Choroidal Effusion Associated with Systemic Sulphonamide Medications: 2 Cases.

Sulphonamides are commonly used in medicine for several purposes; however, they can lead to significant adverse effects, including idiosyncratic reactions and choroidal detachment corresponding to a forward rotation of the iris-lens diaphragm; this could also evolve into acute transient myopia with possible acute angle closure glaucoma. The risk of such reactions to sulphonamides is approximately 3%. In our communication, we have reported on 2 cases involving patients who suffered choroidal detachments after starting sulphonamide treatments and who were diagnosed with the help of ultrasound biomicroscopy. Patient 1 was an 87-year-old male with bilateral pseudophakia who developed an acute change in vision in both eyes after he started taking chlorthalidone, a classic thiazide diuretic antihypertensive that is characterized by having a sulpha-based group. Patient 2 was a 42-year-old female who developed dramatic visual loss after beginning a new treatment (topiramate) for weight loss. We were able to successfully detect the choroidal detachments in these patients with ultrasound biomicroscopy, which aided us in quickly diagnosing the condition. Subsequently, the drugs were immediately discontinued, and appropriate treatment was administered resulting in the full recovery of both patients.

Donor age and gestational age influence on growth factor levels in human amniotic membrane.

PURPOSE: Amniotic membrane (AM) is used as a biomaterial for reconstruction in ocular surface surgery. This study investigated the influence of interdonor variations and processing and preservation procedures applied to the AM on growth factors and protein levels. METHODS: Samples of human AM from thirteen donors were analysed. Collected donor data were age, parity and gestational age. Total protein amount was measured in extracts of intact AM nonpreserved, lyophilized and cryopreserved, at -80°C and in liquid nitrogen. An enzyme-linked immunosorbent assay (ELISA) was used to assay growth factors protein levels for epidermal growth factor, basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), keratinocyte growth factor (KGF), transforming growth factor beta1 (TFG-ß(1) ) and nerve growth factor (NGF). Univariate and multivariate statistical analyses were used to study the influence of the preservation method applied and interdonor variations on growth factors levels. RESULTS: We detected important variations in growth factors and protein concentrations between samples from different donors. Total protein amount, bFGF, HGF, KGF and TGF-ß(1) showed lower levels in samples from donors with higher gestational ages and donor ages, for all groups. CONCLUSION: The variability in the biochemical composition of AM from different donors is considerable, and it is related with donor factors as donor age and gestational age. As AM biochemical composition has a role in its therapeutic effects, these variations could affect the clinical results of amniotic membrane transplantation and must be taken into account in donor selection processes.

Palpebro-orbital myiasis in a patient with basal cell carcinoma.

PURPOSE: We report a patient with basal cell carcinoma presenting with severe myiasis in a large ulcer involving the upper and lower eyelid. METHODS: Myiasis is an infestation of vertebrate animals by larvae of certain fly species. About 70 larvae were removed manually. A biopsy of the tissue underneath demonstrated a basal cell carcinoma. The myiasis was produced by the fly Lucilia sericata, currently used for treating chronic nonhealing ulcers. Because of the stage of the carcinoma, an orbital exenteration was carried out. RESULTS: The patient died 2 days later because of cardiopulmonary failure not related to the myiasis. CONCLUSIONS: We present a case of a severe orbital myiasis focusing on its management and life-threatening nature.

Effects of lyophilization on human amniotic membrane.

PURPOSE: This study aimed to evaluate the effects of lyophilization and cryopreservation on human amniotic membrane (HAM) in terms of histological characteristics and growth factor levels. METHODS: Non-preserved, lyophilized and cryopreserved HAM samples from 13 placentas were investigated. The morphological characteristics of HAM were evaluated using light and electron microscopy. Immunohistochemical methods were also applied to assess the distribution of collagen IV in the basement membrane. Total protein amounts were measured in extracts of intact amniotic membrane from non-preserved, lyophilized and cryopreserved samples. An enzyme-linked immunosorbent assay (ELISA) was used to assay growth factor protein levels for epidermal growth factor, fibroblast growth factor basic, hepatocyte growth factor, keratinocyte growth factor, transforming growth factor-beta1 and nerve growth factor. RESULTS: Histological examination of lyophilized and cryopreserved human amniotic membrane showed similar results. Immunohistochemistry showed presence of collagen IV throughout the basement membrane, both in cryopreserved and lyophilized samples. Total protein amount was higher in cryopreserved samples, without statistical significance. Growth factors ELISA did not show statistically significant differences except for fibroblast growth factor basic, with higher levels in cryopreserved amniotic membrane. CONCLUSIONS: Lyophilization maintains the histological structure of HAM, but seems to cause greater reductions in total protein amount and growth factor concentration than cryopreservation.

Bilateral ocular involvement in encephalocraniocutaneous lipomatosis.

We report a case of encephalocraniocutaneous lipomatosis (ECCL), a rare congenital neurocutaneous syndrome, with cutaneous, ocular and neurologic malformations. The key features of ECCL are epibulbar choristomas, nevus psiloliparus, and intracranial lipomas. A full-term newborn presented at birth bilateral conjunctival tumours, right facial papulonodular lesions and an alopecic lesion consistent with lipoma on the right frontoparietal area. Brain imaging studies showed arachnoid cyst, enlarged lateral ventricle, cortical dysplasia, lipoma and leptomeningeal angiomatosis in the right hemisphere. The results were consistent with ECCL. Since ocular and skin involvement is a hallmark of the condition, children with epibulbar congenital lesions and skin lesions suggestive for ECCL should undergo a brain imaging study.

Pterygium surgery: conjunctival autograft using a fibrin adhesive.

PURPOSE: To evaluate the efficiency and safety of using a fibrin adhesive (Tissucol Duo, Baxter AG, Vienna, Austria) to avoid the need for sutures during conjunctival autograft surgery for primary pterygium. METHODS: Twenty patients (20 eyes) with primary nasal pterygium were subjected to conjunctival autograft surgery. The free conjunctival graft placed over the bare sclera was fixed to the surrounding conjunctiva and cornea using the fibrin glue. An occlusive patch was applied. The outcome of surgery and any possible complications were periodically assessed. RESULTS: Mean patient age was 54.9 years (28-75 years). The mean follow-up time was 26.05 +/- 3.15 (SD) weeks. The time of surgery was 15 to 20 minutes. During the postoperative course, none of the patients felt pain, and only 5/20 (25%) had the mild sensation of the presence of a foreign body. In 18/20 (90%) patients, the conjunctival autograft was observed to be correctly positioned and fixed in all the follow-up exams. No sutures were used during or after surgery. There were no cases of regrowth of the pterygium. CONCLUSION: Our findings demonstrate the safety and efficiency of Tissucol Duo as a conjunctival adhesive for pterygium autograft surgery as treatment of primary pterygium. Because of its fast and easy application, this product considerably reduces the time of surgery. Its use also avoids complications derived from sutures and diminishes the sensation of a foreign body in the eye following surgery.