Covid-19 vaccination and possible link to Herpes zoster.

PURPOSE: To report 3 otherwise healthy patients with Herpes zoster reactivation shortly after administration of a mRNA vaccine against the novel COVID-19 virus. OBSERVATIONS: Patient 1 is a 54 year old who presented with Herpes zoster meningitis complicated by enhancing nodular leptomeningeal lesions of the spinal cord. The subsequent two patients had Herpes zoster ophthalmicus of the cornea (Case 2) and eyelid (Case 3). All three presented within 2 weeks of receiving the Pfizer/BioNTech COVID-19 vaccine. CONCLUSIONS: Herpes zoster may be a side effect of m RNA vaccination against the Sars-CoV2 vaccine and requires further investigation.

Phototherapeutic keratectomy for anterior scarring in an epikeratophakia lenticule.

PURPOSE: To present a case of anterior scarring in an epikeratophakia lenticule and its partially successful treatment with the excimer laser. METHODS: Excimer laser phototherapeutic keratectomy (PTK) was used to reduce corneal scarring in an epikeratophakia lenticule. RESULTS: Visual acuity improved after two sessions of PTK. CONCLUSIONS: PTK is an alternative to epikeratophakia lenticule removal.

Linear IgA dermatosis mimicking ocular cicatricial pemphigoid.

PURPOSE: To describe an unusual case of cicatrizing conjunctivitis. METHODS AND RESULTS: A 59 year old male presented in July 1997 with a complaint of intermittent redness and discharge of the right eye. Medical history was significant for a buccal mucosal lesion biopsy taken two years earlier that revealed subepidermal fibrosis. Conjunctival biopsy, performed to rule out ocular cicatricial pemphigoid, yielded a diagnosis of linear IgA dermatosis, an unusual diagnosis not often considered by ophthalmologists. CONCLUSIONS: The diagnosis of cicatrizing conjunctivitis is often overlooked. Its importance as it pertains to the life threatening disease of ocular cicatricial pemphigoid is clear.

Excimer laser keratectomy for astigmatism occurring after penetrating keratoplasty.

PURPOSE: To review the results of photorefractive keratectomy used to treat astigmatism occurring after penetrating keratoplasty. METHODS: Seven patients who had undergone corneal transplantation previously and had significant postoperative astigmatism were included. All these patients were intolerant of spectacle and contact lens correction. Excimer laser keratectomy was performed to reduce the astigmatic error. Minimum follow-up of 12 months was necessary for study inclusion. RESULTS: The average refractive cylinder decreased from 5.32 diopters (D) preoperatively to 2.79 D postoperatively. The refractive cylinder was reduced in six of the seven eyes attempted. The average preoperative keratometric cylinder decreased from 5.54 D (range, 1.50-10.00 D) to 4.00 D (range 1.00-7.50 D) postoperatively. The best spectacle-corrected visual acuity was unchanged (within 1 line) in three eyes, improved in two, and decreased in two. The complications included a loss of at least two lines in spectacle-corrected visual acuity in two eyes and scarring in one. CONCLUSIONS: Excimer laser keratectomy can reduce the astigmatism after penetrating keratoplasty. The excellent results in some eyes offer promise for this technique in the future.

Combined wedge resection and relaxing incisions for astigmatism after penetrating keratoplasty.

BACKGROUND: Videokeratography may provide information for surgical correction of astigmatism after penetrating keratoplasty. We used a combination of wedge resection and relaxing incisions to treat high refractive astigmatism after penetrating keratoplasty. METHODS: Videokeratography using the normalized scale of the Topographic Modeling System was used as a guide in determining the location and the length of incisions and resections. Nine eyes were treated with both relaxing incisions and a wedge resection. All patients had more than 3.00 diopters (D) of refractive astigmatism. All patients were intolerant of spectacles or contact lenses. The depth of the corneal relaxing incisions was constant at 0.5 mm and the width of the corneal wedge resections was constant at 0.75 mm. RESULTS: The relaxing incisions produced flattening of the steeper meridian and the wedge resection produced steepening of the flatter meridian. The average preoperative keratometric astigmatism was 7.44 D (range, 3.50 to 11.00 D) and the average refractive astigmatism was 5.56 D (range, 4.00 to 8.00 D). The average preoperative spherical equivalent was 0.08 D (range, -7.00 to 4.25 D). Postoperatively, the average keratometric astigmatism was 2.97 D (range, 1.00 to 5.00 D) and the average refractive astigmatism was 2.58 D (range, 0.00 to 5.00 D). The average postoperative spherical equivalent refraction was -0.32 D. CONCLUSIONS: Combined corneal wedge resection and relaxing incisions appears to be effective in reducing high refractive astigmatism following corneal transplantation.

High frequency ultrasound imaging in pupillary block glaucoma.

BACKGROUND: The diagnosis of pupillary block glaucoma requires sufficient clarity of the ocular media. This is particularly important for assessment of both the presence and patency of an iridotomy, and the determination of central anterior chamber depth. METHODS: High frequency ultrasonography was used in three patients with suspected pupillary block to determine iris configuration, posterior chamber volume, and ciliary body conformation. RESULTS: All patients demonstrated high frequency ultrasonographic findings consistent with pupillary block: iris bombé, a formed posterior chamber, and a lack of anterior rotation of the ciliary processes. CONCLUSION: High frequency ultrasound imaging appears to be a valuable adjunct in making or corroborating the diagnosis of pupillary block glaucoma.

High-frequency ultrasound spectral parameter imaging of anterior corneal scars.

High frequency (50-MHz) ultrasound allows greater resolution (approximately 30 microns) and improved tissue differentiation of the anterior ocular structures than conventional (8-10 MHz) ultrasonic techniques. Spectral analysis of tissue acoustic backscatter is sensitive to both the concentration and size of tissue inhomogeneities. We studied the healing process of experimentally induced corneal scars using high frequency ultrasound spectral analysis. Scatterer size and concentration parameter images of scarred corneas showed distinctive patterns that were correlated with histology over time. This quantitative technique offers a new, noninvasive, in vivo method for the assessment of the internal microarchitecture of surgically altered corneal tissue and its healing dynamics.

High frequency ultrasound evaluation of radial keratotomy incisions.

Radial keratotomy is a surgical procedure to correct myopia that involves placing corneal incisions of precise partial thickness to induce flattening. It has yielded positive but sometimes unpredictable results. Many surgical variables influence the final result. Among them, incision depth is probably the most difficult to control and evaluate. In this study, we used very high frequency (50 MHz) ultrasound (HFU) to image radial keratotomy incisions in post-radial keratotomy human corneas to obtain high definition images of the cornea. The images allowed us to measure the depth of incisions as a percentage of corneal thickness.