Primary follicular lymphoma of the conjunctiva in a 6-year-old child.

Primary follicular lymphomas arise in the lymph nodes or spleen or in extranodal sites. Ocular adnexal tumors are rare. We report the case of a 6-year-old boy with a 3-mm conjunctival mass. The lesion was resected with clean surgical margins. The child has been closely monitored and has remained cancer free for 3 years.

A review of pediatric uveitis: part II. Autoimmune diseases and treatment modalities.

Uveitis is a manifestation of complex processes that can represent an infectious process or a dysfunction of the immune system that may have grave effects on the eye. Although infectious causes, once properly identified, may be successfully treated by addressing the inciting organism with recognized interventions, the immune-modulated chronic forms of uveitis often provide more complex challenges in management. Recent strides in understanding the inflammatory pathway and better bioengineering capabilities have resulted in some new modalities of treatment.

A review of pediatric uveitis: Part I. Infectious causes and the masquerade syndromes.

Uveitis is a manifestation of complex processes that can represent an infectious or a purely immune system modulated condition and may have grave effects on the eye. Much of the morbidity in these conditions is the result of the immune response to these stimuli. These infectious diseases may be successfully treated by addressing the inciting organism with recognized interventions. Treatment of the immune response to the organism often must be pursued simultaneously to minimize long-term complications caused by structural changes within the eye. Assisting the individual's immune response to eliminate the organism while minimizing the immune response's damaging effects remains a unique challenge drawing on both the science and the art of medicine. Several non-infectious conditions that are not autoimmune diseases may commonly masquerade as uveitis, leading to delays in appropriate treatment.

Cataract surgery in keratoconus.

PURPOSE: To evaluate the visual and topographic outcomes in patients with keratoconus who have undergone cataract surgery and to analyze different methods of keratometry and formulas for intraocular lens (IOL) calculation in patients with keratoconus. METHODS: In a retrospective case series, 12 eyes (nine patients) with keratoconus underwent phacoemulsification with IOL implantation. The IOL power was determined by using standard and corneal topography-derived keratometry in three formulas: SRK, SRKII, and SRKT. Three months after surgery, best-corrected visual acuity (BCVA), visual improvement, simulated keratometry, and contact lens fit were assessed. Retrospectively, the difference between spherical equivalent and desired refraction was evaluated for the ideal IOL power. The difference between the ideal IOL power and the calculated IOL power from the three formulas was determined to evaluate the best formula for these patients. RESULTS: The mean age was 55 years (range, 38-76 years). All eyes had improved BCVA (mean of four lines). Of the five eyes with mild keratoconus, three were switched from rigid gas-permeable lens wear before surgery to soft toric contact lenses (n = 2) or spectacles (n = 1). Patients with moderate and severe keratoconus (7 of 12) still required rigid gas-permeable lenses after surgery. In mild keratoconus, there was no difference between standard and topography-derived keratometry. The most accurate IOL power was found by using SRKII. CONCLUSIONS: Cataract surgery can improve BCVA in all severities of keratoconus without significant corneal change. IOL calculation is more predictable in mild keratoconus than in moderate and severe disease.

Acanthamoeba keratitis: a parasite on the rise.

PURPOSE: To report a recent significant increase of the number of patients diagnosed with Acanthamoeba keratitis (AK) at Wills Eye Hospital between 2004 and 2005. To determine the risk factors, clinical characteristics, treatments, and outcomes of patients with AK. METHODS: Retrospective consecutive case series of 20 eyes with AK. The information included the incidence from 1995 to 2005, initial and final best-corrected visual acuity (BCVA) at 3-month follow-up, risk factors [contact lenses (CL) history, history of swimming with CL, and exposure to well water and/or contaminated water], clinical characteristics, methods of diagnosis, and treatments. RESULTS: A statistically significant increased incidence of AK was seen in 2004 and 2005 compared with cases from 1995 to 2003 (P < 0.01). All patients wore CL; 19 of 20 wore frequent-replacement soft CL and used multipurpose disinfecting solutions. Other risk factors were exposure to well water in 40%, swimming with CL in 25%, and overnight wear in 25%. The diagnosis was made by histopathology in 50%, by microbiology in 15%, and by initial classic clinical signs and response to treatments in 35%. Herpes simplex virus was the misdiagnosis in 70%. Patients who presented with dendritiform keratitis or radial keratoneuritis had a BCVA better than 20/30 in 8 of 9 (89%) and patients with ring ulcers or stromal disease who had a BCVA less than finger counting in 5 of 8 (62.5%). CONCLUSIONS: We observed an increased incidence of AK. Patients with proper use of frequent-replacement CL and multipurpose solutions can develop AK. Advanced stromal disease at diagnosis is associated with worse outcome.