Terrien Marginal Degeneration Complicated by a Corneoscleral Cyst.

PURPOSE: To describe a case of inflammatory Terrien's marginal degeneration (TMD) in a young Chinese girl complicated by a corneoscleral cyst who ultimately underwent surgical treatment with cyst excision, corneal patch graft and amniotic membrane graft. METHODS: Case report. RESULTS: A 12-year-old Chinese female presented initially with redness and discharge from her right eye with bilateral superior corneal thinning. The patient was diagnosed with TMD. She subsequently developed a corneoscleral cyst 2 years later which doubled in size within 1 year. The patient underwent a cyst excision with lamellar corneal patch graft and amniotic membrane grafting. Histopathological examination of the cyst wall showed a lining of squamous epithelium, consistent with a corneoscleral cyst. CONCLUSIONS: This is an interesting case highlighting the rare complication of corneoscleral cyst in a young patient with inflammatory TMD. Excision of the cyst with a corneal patch graft and amniotic membrane grafting without any chemical cautery is effective in preventing recurrence.

Disseminated nontuberculous mycobacterial infection with multifocal retinitis and vasculitis in an immunocompromised patient with anti-IFN-É£ autoantibodies.

BACKGROUND: Nontuberculous mycobacteria (NTM) are found ubiquitously in the environment. Since exposure to NTM is universal, infection likely represents underlying host susceptibility factors. Anti-IFN-É£ autoantibodies have been described previously in patients with NTM. Up to 88 % of patients with disseminated NTM or other opportunistic infections have high-titer anti-IFN-É£ autoantibodies, compared with 2 % of patients with TB and healthy controls. FINDINGS: We report a unique presentation of a patient with anti-IFN-É£ autoantibodies with disseminated NTM infection who presents with panuveitis with multifocal retinitis and vasculitis. Treatment with systemic anti tubercular therapy resulted in complete clinical resolution with good visual recovery. CONCLUSIONS: Patients with anti-IFN-É£ autoantibodies present with a novel syndrome that links autoimmunity and immunodeficiency. This case emphasizes the importance of testing for anti-IFN-É£ autoantibodies in patients with disseminated mycobacterial infection.

Intraocular pressure spikes after a sequential laser peripheral iridotomy for angle closure.

OBJECTIVE: To determine the incidence of intraocular pressure (IOP) spikes within the first 30 minutes after sequential argon-Nd:YAG laser peripheral iridotomy (LPI) in patients with angle closure and to explore risk factors for their occurrence. METHODS: A total of 428 consecutive eyes of 298 patients who had undergone LPI at the Singapore National Eye Centre between June 2011 and August 2011 were reviewed retrospectively. There were 238 primary angle closure suspect eyes, 85 primary angle closure eyes, 92 primary angle closure glaucoma eyes, and 13 acute primary angle closure (APAC) eyes. The pre-LPI IOP and post-LPI IOP, gonioscopic findings, medications, laser parameters, and the need for acute IOP-lowering treatment were recorded. RESULTS: The proportion of patients with a post-LPI IOP elevation ≥8 mm Hg was 10.7% (n=46) and those with a significant IOP spike of ≥30 mm Hg was 31 (7.2%). There were no significant differences between those with or without a post-LPI IOP elevation ≥8 mm Hg and those with or without a post-LPI IOP of ≥30 mm Hg, in terms of age, gender, race, total laser energy used, and seniority of the physician performing the procedure. Patients who experienced IOP spike ≥8 mm Hg were on fewer pre-LPI medications (P=0.009). On logistic regression, patients with APAC had a significantly higher probability of an IOP spike (P=0.003). CONCLUSIONS: The incidence of postsequential LPI IOP elevation ≥8 mm Hg was 10.7%. The primary diagnosis of APAC was a risk factor, and using preprocedure ocular hypotensives can potentially reduce their occurrence.

Imaging of the iridocorneal angle with the RTVue spectral domain optical coherence tomography.

PURPOSE: To determine the ability of the RTVue spectral domain optical coherence tomography (SDOCT) to image the anterior chamber angle (ACA). METHODS: Consecutive subjects, recruited from glaucoma clinics, prospectively underwent ophthalmic evaluation including gonioscopy by an ophthalmologist and anterior chamber imaging with SDOCT, adapted with a corneal lens adapter (cornea anterior module-low magnification [CAM-L]) and anterior segment OCT (ASOCT), both performed by a technician. Two different ophthalmologists, masked to gonioscopy findings, assessed visualization of the scleral spur (SS), Schwalbe's line (SL), and trabecular meshwork (TM) by the two modalities. The ability to detect a closed angle was compared with gonioscopy. RESULTS: The average age (SD) of the 81 subjects enrolled was 64.1 (11.4) years; the majority were Chinese (91.4%) and female (61.7%). SDOCT images revealed the SS in 26.9% (56/324) of quadrants and the SL in 44.1% (143/324) of quadrants; in ASOCT images, the SS could be visualized in 69.1% (224/324) of quadrants (P < 0.0001), but the SL was undetectable. The TM was detected equally well (17.3%, P < 0.92) using either device. The angle status was gradable in only 41.7% images with SDOCT, compared with 71.3% of ASOCT images (P < 0.0001). ACA was classified as closed in 19.3% of quadrants (26/135) with SDOCT images and in 44.2% (102/231) with ASOCT images compared with 37.7% (122/324) on gonioscopy. When analyzing the horizontal quadrants only, both modalities agreed well with gonioscopy, 0.75 and 0.74, respectively (AC1 statistics). CONCLUSIONS: The RTVue SDOCT allowed visualization of SL, TM, and SS. However, these landmarks were not detected in a large percentage of images.