Tamoxifen keratopathy as seen with in-vivo confocal microscopy.

Tamoxifen is a triphenylethylene non-steroidal oestrogen antagonist widely used in oestrogen receptor-positive breast cancer, with well-documented ocular side-effects. Here we report a corneal confocal microscopy finding of a patient on low-dose tamoxifen. We believe that this is the first case report of a patient on low-dose tamoxifen with demonstrable corneal stromal crystalline deposits with confocal microscopy, but clinically asymptomatic with unremarkable corneal findings on cursory slit lamp examination. In summary, confocal microscopy is a useful adjunct in monitoring tamoxifen crystalline keratopathy, and helps detect subclinical deposits not visible/detected on slit lamp examination.

Corneal Endothelium in Brown-McLean syndrome: in-vivo confocal microscopy finding.

When Brown-McLean syndrome (BMS) was first described, there was no confocal microscopy to document corneal endothelial status, and it was understood as a disease entity involving a diseased endothelial layer. In the advent of confocal microscopy demonstrating healthy endothelium in BMS within the affected cornea, it can be inferred that BMS is a spectrum of disease ranging from healthy to decompensated corneal endothelium, rather than just a specific disease entity. Here we report a case of BMS with normal healthy corneal endothelium using corneal confocal microscopy. Any patient with BMS should be followed up to observe for any disease progression and should be educated regarding the signs and symptoms of corneal surface problems. Confocal microscopy documentation is a convenient and informative way and should form part of the follow-up of any BMS patient.

Minocycline induced conjunctival autofluorescence deposition.

Minocycline can cause palpebral conjunctival greyish deposits in which autofluorescence can be readily demonstrated. We believe that this is a first report of the demonstration of in-vivo conjunctival autofluorescence of palpebral conjunctival minocycline deposit. In conclusion, minocycline deposit can be shown clinically without the need of an invasive biopsy procedure in patients with a history of blepharitis on long-term tetracycline group of medication presenting with palpebral conjunctival deposits.

Xerophthalmia because of dietary-induced vitamin a deficiency in a young Scottish man.

Vitamin A deficiency causing xerophthalmia, although a major public health issue in sub-Saharan Africa, is rarely seen in people living in developed countries. In such cases, it is usually associated with severe malnutrition caused by intestinal disorders, such as celiac disease, pancreatitis, or extensive bowel surgery. Dietary-induced vitamin A deficiency leading to xerophthalmia has rarely been reported in the United Kingdom. In this case, we report on a young man who presented with corneal xerosis and whose history of corneal ulceration had not been linked to his restricted diet, which resulted in vitamin A deficiency. Unlike other cases, this young man had no history of psychiatric illness and led a normal active lifestyle.

Deep Anterior Lamellar Keratoplasty (DALK): visual outcome and complications for a heterogeneous group of corneal pathologies.

PURPOSE: To review the visual outcome and complications of deep anterior lamellar keratoplasty (DALK), using Melles technique. METHODS: All patients undergoing DALK between December 1999 and March 2005 were routinely entered into a longitudinal study. DALK was attempted in 80 eyes of 68 consecutive patients. Descemet membrane perforation occurred in 11 eyes, of which 7 required conversion to penetrating keratoplasty. The visual and refractive outcome of these eyes is presented separately. The mean follow-up was 21.2 months. Best-corrected visual acuities (BCVAs), refraction, graft clarity, and complications were recorded at each visit and analyzed. RESULTS: The mean patient age was 34.2 years. Keratoconus was the main indication for surgery (58 eyes), followed by herpes simplex keratitis (6 eyes), corneal stromal dystrophy (5 eyes), stem cell failure with scarring (2 eyes), corneal dermoid (1 eye), and corneal opacity (1 eye). The mean central corneal thickness changed from 0.42 +/- 0.07 mm preoperatively to 0.62 +/- 0.06 mm postoperatively. At latest follow-up, BCVA of 6/6 or better was present in 24.7%, 6/9 or better in 69.9%, and 6/12 or better in 84.9% of the eyes. The mean postoperative refractive cylinder was 3.31 +/- 2.59 D, and the mean spherical equivalent was -2.54 +/- 3.61 D; 52.2% of the eyes had a refractive cylinder less than +/-3 D and 49.3% of the eyes had a spherical equivalent less than +/-3 D. Rejection episodes occurred in 9.6% of the eyes but were successfully reversed in all eyes. Graft failure occurred in 1 eye with severe stem cell deficiency. CONCLUSION: This is the largest series of DALK cases using the Melles technique in a variety of corneal lesions. Our results confirm the usefulness and safety of this procedure in conditions with no endothelial involvement. Graft rejection remains a significant complication but is associated with good recovery because the endothelium is spared.