Corneal keloid.

Reports of corneal keloids are rare, with fewer than 80 cases published since the first case was documented in 1865. Keloids can be congenital or primary, but most often are associated with ocular surface injury or pathology. They have been reported in association with a number of congenital conditions, notably lowe's syndrome. Keloids are characterized histopathologically by a haphazard arrangement of fibroblasts, collagen bundles, and blood vessels. They have sometimes been confused with hypertrophic scars, but differ from such scars in that they may appear months or years after initial trauma and enlarge over time. The underlying cornea may be clear and uninvolved, or it may be opaque, depending on the primary pathology of the keloid. Treatment options include superficial keratectomy, lamellar or penetrating keratoplasty, and sclerokeratoplasty. The purpose of this review is to tabulate features of the reported corneal keloids, describing their etiologic, clinical, and histopathologic characteristics and discussing possible mechanisms of keloid formation.

Filtering bleb-induced giant papillary conjunctivitis.

BACKGROUND: Pathogenesis of giant papillary conjunctivitis is still elusive and many hypotheses are being proposed to explain the irritative symptoms associated with it. The research data available to date shows that mechanical, immunological and allergic components are involved in this to various extents. We report a rare cause of giant papillary conjunctivitis which was induced by a large filtering bleb following trabeculectomy surgery for glaucoma. METHOD: A 30-year-old female, operated for glaucoma filtering surgery in her right eye 15 years back, presented with ocular irritation. Clinical evaluation revealed two giant papillae on the superior tarsal conjunctiva which coincided with the large filtering bleb with its peripheral extension. The fellow eye was normal and no association with any allergic disorders was noted. RESULT: The patient responded symptomatically to the topical application of anti-inflammatory and anti-allergic medications. The giant papillae decreased considerably in size but the diffuse papillary response persisted. CONCLUSION: Though multiple etiological factors have been proposed for the giant papillary conjunctivitis, only a single case report is available where a filtering bleb is the causative factor. The mechanical irritation caused by the large-sized bleb seems to be the provoking agent in our case taking into consideration the position of the papillae that coincides with the peripheral extension of the bleb.

A pilot trial for comparison of photodynamic therapy and transpupillary thermotherapy for the management of classic subfoveal choroidal neovascularization secondary to age-related macular degeneration.

AIM: The aim of the study was to compare the visual outcomes of photodynamic therapy (PDT) with verteporfin and transpupillary thermotherapy (TTT) for classic subfoveal choroidal neovascularization (CNVM) secondary to age-related macular degeneration (ARMD). SETTINGS AND DESIGN: Patients with subfoveal classic CNVM caused by ARMD attending vitreo-retinal services at a tertiary care setup were included in this nonrandomized, open label, prospective, clinical, comparative pilot trial. MATERIALS AND METHODS: Standardized refraction, visual acuity testing, evaluation of fundus and serial color photography and fundus fluorescein angiography were carried out to evaluate the effects of treatment in 32 eyes each undergoing either PDT or TTT. Follow-up was carried out at four weeks, 12 weeks and six months. Retreatment if indicated was carried out three months post treatment. RESULTS: Stabilization or improvement occurred in 69% of patients undergoing PDT and 50% patients undergoing TTT at six months of follow-up. Among patients with a pretreatment visual acuity greater than or equal to 20/63, only one out of six patients who underwent PDT had a drop of visual acuity > 2 lines as compared to four patients (100%) who underwent TTT. (P =0.0476, two-tailed Fisher's exact test). CONCLUSION: For short-term preservation of vision in patients of classic CNVM due to ARMD, PDT seems to be better than TTT if the pre-laser best corrected visual acuity is > 20/63 but both are equally effective if pre-laser best corrected visual acuity is < 20/63.

Rare presentation of fungal orbital cellulitis in an immunocompetent infant.

A 3-month-old infant presented with unilateral proptosis. Ophthalmic and physical examinations, computed tomography, and histopathologic examination of a biopsy specimen were performed. Histopathologic examination confirmed fungal orbital cellulitis. The patient responded to 6 weeks of antifungal therapy. Fungal orbital cellulitis should be included in the differential diagnosis for infants with proptosis.