Clinical spectrum of congenital corneal staphyloma: a case report.

We report the dramatic ophthalmological findings in a newborn baby consisting of a perforated right eye and a protruding buphthalmic opacified left eye. The diagnosis of congenital corneal staphyloma was suspected and was confirmed on histopathological examination of the right eye remnants, and of the left cornea after a corneoscleral keratoplasty was performed. This case report describes one clinical spectrum of Peter's anomaly.

Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review.

BACKGROUND: The enzyme hyaluronidase (HA) is an adjunctive in retrobulbar anaesthesia (RA) that is used during ophthalmic surgery to improve the efficacy and speed of nerve blocks. Although uncommon, HA has been shown to be a potential cause of allergic responses. CASE REPORTS: We describe three patients who experienced an allergic reaction to HA following ocular surgery in our department and provide an extensive overview of the literature on HA in RA. CONCLUSIONS: Although rare and mostly benign, allergy to HA should be included in the differential diagnosis when chemosis, proptosis and restriction of eye movements occur after parabulbar or retrobulbar anaesthesia. The authors feel that the beneficial effect of HA in small volumes of RA warrants its use despite this potential complication.

Two siblings with small eyes.

Posterior microphthalmos is a rare congenital bilateral eye disorder, of which the posterior segment is abnormally small. Additional features include high hypermetropia and a tendency to uveal effusion. We report two siblings who present with high hypermetropia and other features of posterior microphthalmos. Fundus examination revealed the typical crowding of the optic disc and retinal folds. We discuss clinical characteristics, pathogenesis and complications of this disorder.

A rare conjunctival Spitz nevus: a case report and literature review.

A conjunctival Spitz nevus is a very rare, benign melanocytic lesion, which can be mistaken for a malignant melanoma. We present a case of a 28-year old man, who suffered from a rapidly growing, non-pigmented mass in the left caruncular area, extending to the nasal conjunctiva. The lesion was excised and pathologic examination showed nests of large, polygonal, non-pigmented epithelioid cells, located in the stroma. The overlying epithelium showed focal erosions. At the base, there was a lymphocytic infiltrate. Immunohistochemical techniques, with stainings for S-100 protein, HMB-45 and MIB-1, were used for further investigation and showed the melanocytic origin of the lesion (S-100 staining) as well as many cells in cell cycle (MIB-1 staining). However, no mitoses were seen. The clinical image, combined with pathologic and immunohistochemical findings, provided the diagnosis of a Spitz nevus localised in the conjunctiva. Although the cutaneous location of Spitz nevi is well known, conjunctival Spitz nevi are very rare and because of their mucosal origin, some of the histological features are different.

Confocal microscopy in multiple myeloma associated crystalline keratopathy: case report.

We report on the confocal microscopical findings of both corneas of a patient presenting a multiple myeloma associated crystalline keratopathy and the response to treatment. Blurred vision was the first sign of progression of the multiple myeloma. Confocal microscopy images show needle-like structures in the epithelium and stroma of the cornea which regressed after treatment of the multiple myeloma.

Visual outcome in children with juvenile idiopathic arthritis related uveitis.

PURPOSE: To determine the incidence and characteristics of uveitis in a cohort of patients with juvenile idiopathic arthritis (JIA) as well as the nature of treatment and the risk factors for visual loss. PATIENTS AND METHODS: Retrospective review of 52 patients with JIA, screened for uveitis between 1995 and 2005. The first group, presenting with symptoms of arthritis and uveitis, was diagnosed at screening. The second group presented with symptoms of uveitis, without any rheumatological complaints at the time of diagnosis. During follow-up, reactivation of uveitis and complications were registered and treated when indicated. RESULTS: Seventeen patients had symptoms of uveitis at time of presentation or developed uveitis at follow-up. Ten of this patient group had oligo-arthritis, 16 were antinuclear antibody (ANA) positive, 16 were girls. Three patients presented with ophthalmological symptoms without rheumatological complaints. In this group, complications were more pronounced. Treatment in all patients consisted of topical corticosteroids and dilating drops at different intervals. Visual acuity was good in most patients. CONCLUSION: In this retrospective study, the risk of uveitis was higher in ANA- positive girls with oligoarthritis. To reduce severe disease at presentation, earlier diagnosis of JIA, earlier referral for slit lamp examination and universal screening of vision in childhood are necessary.

Late opacification of hydroview intraocular lenses: report of 11 cases.

PURPOSE: To report on the clinical and light microscopic analyses of Hydroview intraocular lenses (lOLs) explanted for late postoperative IOL opacification. MATERIAL AND METHODS: Retrospective study of all cases with secondary lensimplantation performed at the University Hospital Leuven during a period of one year (2003-2004) for postoperative opacification of Hydroview IOLs. Further analyses on some of the explanted IOLs included gross and light microscopic evaluation. RESULTS: Lens exchange for late-onset IOL opacification was performed in eleven eyes of eight patients. IOL opacification became apparent between 12 and 24 months after uneventful phacoemulsification and lens implantation. Visual acuity varied from < 0.05 to 0.6 before explantation. In 9 out of the 11 eyes postoperative visual acuity improved to the pre-opacification level. Light microscopic analyses showed a granular anterior lenssurface morphology composed of calcium. CONCLUSION: Late postoperative opacification of Hydroview IOLs may cause severe visual impairment, requiring explantation. Calcium is involved in the formation of these opacifications. Reporting on this type of complications is mandatory according to the Belgian and European directives for medical devices.

Surgical treatment outcomes of congenital and juvenile cataracts.

PURPOSE: Evaluation of visual outcome after lens aspiration with or without intraocular lens implantation for isolated congenital and juvenile cataract in children aged 6 years and younger. MATERIAL AND METHODS: Retrospective review of 48 children with isolated congenital and juvenile cataract who were surgically treated between January 1993 and December 2002 and had a minimal follow-up of 12 months. RESULTS: In the group of children with unilateral cataract, 33% (3 out of 9 children) of aphakic children and 45.5% (5 out of 11 children) of pseudophakic children attained a final best corrected visual acuity of 20/200 and 20/60 respectively. In the group of children with bilateral involvement, 35% (6 out of 17 children) of aphakic children have a final best corrected visual acuity of 20/30 and 63.7% (7 out of 11 children) of pseudophakic children have a final best corrected visual acuity of 20/25 or more. CONCLUSION: The results of this study emphasize the need for early surgery and good organisation of postsurgical care in patients with pediatric cataract to optimise visual outcome. Furthermore patients with isolated unilateral congenital cataract surgically treated at an average age of 15 months without primary lens implantation and with variable and low compliance have suboptimal results. The effect of early surgery with primary lens implantation on the long term visual outcome in pediatric cataract needs to be further evaluated.

External ophthalmomyiasis: a case report.

Many dipteran flies can cause ophthalmomyiasis, a potentially severe and vision threatening disease. We report a case of ophthalomyiasis caused by Oestrus ovis. Larvae of Oestrus ovis are confined to the surface of the eye and cause external ophthalmomyiasis. The presentation is similar to a viral conjunctivitis, with tearing, itching, hyperaemia and foreign body sensation. The disease is self-limiting and removal of the larvae is the most effective therapy. Identification of the species is important to estimate the risk of penetration of the globe.

Corneal opacifications in a low high density lipoprotein syndrome: suspicion of fish eye disease: a case report.

A 49 year old patient with progressive massive bilateral corneal opacifications associated with a HDL (high-density-lipoprotein) deficiency is described. The opacifications started at the age of twenty and progressed slowly. They were found diffusely over the cornea, though more in the corneal periphery. A penetrating keratoplasty at the right eye was performed. The diagnosis of Fish Eye Disease was put forward on the basis of the ophthalmological, clinical, biochemical and pathological appearance. After 2 year follow-up, the graft was clear. The final distance and near vision of the right eye was 8/10 and Snellen 1 respectively.

Fungal keratitis caused by Pseudallescheria boydii (Scedosporium apiospermum).

Keratitis is rarely caused by fungi. Filamentous fungal keratitis is often preceded by corneal trauma and occurs mostly in previously healthy individuals. We studied a case of posttraumatic keratitis caused by Pseudallescheria Boydii, which belongs to the group of filamentous fungi.

Sudden development of bilateral cataract in a child with Dubowitz syndrome: a case report.

The Dubowitz syndrome is a rare, autosomal recessive disorder including intrauterine growth retardation, craniofacial abnormalities, mental retardation and eczematous skin eruption. Ocular problems occur in about 20%: strabismus, blefarophimosis, ptosis, telecanthus and epicanthal folds being the most frequent ones. We present a three years old girl, diagnosed with Dubowitz syndrome, with sudden visual loss due to bilateral cataract.

Invasive squamous cell carcinoma of the conjunctiva.

A 75-year-old man, known with Morbus Kahler, was referred with a history of uveitis and hypopyon at the left eye. The uveitis did not respond to any steroid treatment. It was complicated with high intraocular pressure. Anterior chamber punction showed atypical cells of epithelial origin. Several weeks prior to this presentation an atypical pterygium of the same eye was biopsied. Histopathologic examination at that time showed mild atypical actinic changes. The biopsy specimen was reviewed in our laboratory and revealed an invasive squamous cell carcinoma originating from the bulbar conjunctiva. The eye was eventually enucleated. Histologic examination of the enucleated eye showed invasion of the cornea, sclera, trabeculum, anterior chamber angle and choroid by a muco-epidermoid squamous cell carcinoma.

Limbal transplantation after chemical injuries of the eye.

PURPOSE: To illustrate the benefit of limbal stem cell transplantation in three eyes with severe ocular surface failure due to chemical burns. METHODS: In two patients with monocular corneal scarring and vascularization after chronic chemical burns, a limbal tissue autograft was transferred from the unaffected fellow eye. A complete superficial keratectomy was performed on the host eye. One patient with bilateral ocular surface disorder received an eccentrically trephined corneolimbal allograft. To prevent immunologic rejection of the transplanted limbus, this patient was treated with systemic Ciclosporin A. RESULTS: Postoperatively the limbal autografts grew a normal epithelium on the recipient eye with less vascularization and scarring. Our two patients reported a significant reduction in symptoms (redness, pain, photophobia) and an improved visual acuity. The corneolimbal allograft has remained clear for five months postoperatively. CONCLUSION: In strictly unilateral conditions of limbal deficiency, transplantation of healthy limbal tissue from the normal fellow eye may result in a stable ocular surface and a quiet and comfortable eye. Transplantation of an eccentrically trephined corneolimbal allograft under systemic Ciclosporin A cover may be an option in the rehabilitation of patients with severe bilateral stem cell deficiencies.

Modified phacotrabeculectomy with Crozafon punch.

We retrospectively evaluated the results of combined phacoemulsification and trabeculectomy by analyzing 22 consecutive operations. A "Crozafon punch" was used to perform the trabeculectomy through the sclerocorneal tunnel. The mean follow-up period was 6 months. Visual acuity of 0.5 or better was achieved in 18 eyes (82%). Intraocular pressure control was achieved in 18 eyes without medication, 4 eyes required a beta-blocking agent. The complication rate was low.

Prospective HLA-DR matching in penetrating keratoplasty.

This prospective study examines whether HLA-DR matching has a beneficial effect on corneal graft survival of high risk patients. Until now, 196 donors have been typed in order to provide 20 patients with a matching graft. The results, though preliminary, are very encouraging.

Management of psoteriorly dislocated crystalline lenses or lens fragments.

The authors conducted a retrospective study during a 4-year period (jan. 91-dec. 94) of the charts of 26 patients (27 eyes) treated by pars plana vitrectomy for posteriorly dislocated crystalline lenses or lens fragments. One patient had a spontaneous lens luxation on both eyes and 3 patients presented with a posttraumatic dislocation of their lens. Twenty one eyes had retained intravitreal lens material after cataract surgery and 1 after perforating injury. Six eyes received an intraocular lens (IOL) at the end of the vitrectomy procedure; in 11 eyes an IOL had already been inserted at the time of primary cataract surgery. Ten eyes were left aphakic. Surgical details and visual outcome are discussed.

Therapeutic possibilities and limits of vitreoretinal surgery after expulsive choroidal hemorrhage.

The aim of this retrospective study was to demonstrate that in certain cases of expulsive choroidal hemorrhage (ECH) anatomical success and useful vision can be obtained with repeated vitreoretinal surgery. The authors report on their experience in 8 patients who were treated following ECH over the past 3 1/2 years. Three types of ECH could be identified. Two cases with massive hemorrhage and expulsion of retinal tissue (type 1) developed phthisis bulbi. Five patients with vitreous loss and an abolished vitreous cavity due to the extent of the ECH (type 2) needed early and usually several interventions to achieve a stable anatomical and functional outcome. Three out of the 4 cases who were anatomically successful had useful vision (1/10, 2/10 en 8/10). One patient with a less extensive choroidal hemorrhage and a partially preserved vitreous cavity (type 3) had a visual acuity of 8/10 after the intervention.