A non-healing corneal ulcer as the presenting feature of type 1 diabetes mellitus: a case report.

INTRODUCTION: Diabetic keratopathy is a rare complication of diabetes mellitus. This case illustrates the importance of checking blood sugar levels of patients with non-healing corneal ulcers to rule out the possibility of undiagnosed diabetes mellitus. CASE PRESENTATION: We report the unusual case of a 24-year-old southeast Asian woman who presented with a sterile corneal ulcer to our hospital and later was found to be diabetic after a prolonged hospital stay. Despite all efforts, the corneal ulcer had failed to heal until treatment for previously undiagnosed diabetes was started. The sterile corneal ulcer began to heal once blood sugar levels began to normalize. CONCLUSIONS: Diabetic keratopathy is a rare complication of diabetes mellitus and needs to be considered as a diagnosis in younger patients with non-healing sterile corneal ulcers. Blood sugar levels should be checked in these cases for undiagnosed diabetes mellitus.

Successful corneal autograft after clearance of anterior chamber cytomegalovirus with oral valganciclovir in a patient with multiple failed corneal allografts.

PURPOSE: To report a case of recurrent corneal graft failure because of cytomegalovirus (CMV) infection and to demonstrate successful clearance of the virus with oral valganciclovir, confirmed by polymerase chain reaction (PCR) assay. This allowed for a successful corneal autograft to be performed. METHODS: Interventional case report. RESULTS: A 90-year-old white man with 4 previous corneal graft failures in his right eye is presented. His visual acuity was no light perception in the left eye subsequent to ocular trauma. His initial penetrating keratoplasty for pseudophakic bullous keratopathy was from a human leukocyte antigen-matched multiorgan donor who was CMV-seropositive. An anterior chamber paracentesis was performed to exclude an infective etiology. CMV was detected on PCR of aqueous humor. After a 12-week course of oral valganciclovir, a repeat aqueous PCR test confirmed the clearance of CMV. A corneal autograft from his left eye was subsequently performed with good outcome. CONCLUSIONS: We present a case of successful corneal autograft after clearance of CMV from the anterior chamber (PCR confirmed) in a patient treated with oral valganciclovir.

Orbital cellulitis following cataract surgery.

Orbital cellulitis is an extremely uncommon complication following cataract surgery. Herein, a patient who developed orbital cellulitis less than 24 h after undergoing cataract surgery is described. She responded well to systemic antibiotic treatment and ultimately achieved good visual acuity in the affected eye. The most likely mode of pathogen entry in such cases is considered to be the anaesthetic block given before the cataract surgery. It has been suggested that a careful skin antiseptic preparation before the block is given could prevent this occurrence, but such a preparation did not do so in our case.

Six-year review of Acanthamoeba keratitis in New South Wales, Australia: 1997-2002.

AIM: To assess the incidence and risk factors for Acanthamoeba keratitis (AK), the diagnostic interval, and the efficacy and outcome of current treatment among the population of New South Wales, Australia. METHODS: A retrospective review was carried out of all cases of AK treated at the Sydney Eye Hospital between January 1997 and December 2002. RESULTS: Twenty patients were identified with a mean follow up of 24.8 +/- 21.5 months. Acanthamoeba keratitis constitutes 4.7% of severe infective keratitis treated at Sydney Eye Hospital. The mean interval from first presentation to diagnosis was 26.6 +/- 35.1 days overall; 17.2 +/- 33.1 days for those presenting directly to our unit (69% being diagnosed within 72 h of presentation), and 44.1 +/- 34.0 days for those first presenting elsewhere. Of those with a diagnostic delay >1 month, 57% had been mistakenly diagnosed with Herpes simplex keratitis. Sixteen (80%) wore contact lenses, and eight (40%) had additional risk factors including poor lens hygiene. Complications occurred in 16 (80%), with seven (35%) requiring surgical intervention. Visual acuity improved in 18 (90%), worsened in two patients (10%), and 75% achieved 6/12 or better at last follow up. CONCLUSIONS: Acanthamoeba keratitis is a rare infection, and contact lens wear remains the commonest association, with poor hygiene constituting significant additional risk. The visual outcome has improved with the availability of effective amoebicidal agents, but patients with a diagnostic delay and non-contact lens wearers are at increased risk of recurrent disease. A high index of clinical suspicion remains the most effective strategy in implementing early treatment, and enabling a favourable outcome.