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Gu SF, Gao S, Wang HK, He LH, Peng RM, Xiao GG, Hong J. Three-dimensional in vivo evaluation of the cornea in patients with unilateral posterior interstitial keratitis. Front Med (Lausanne) 2023; 10:1180208. [PMID: 37671398 PMCID: PMC10475563 DOI: 10.3389/fmed.2023.1180208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/17/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose The purpose of this study was to investigate the in vivo morphologic features of the cornea in patients with unilateral posterior interstitial keratitis. Methods Seven eyes of 7 patients with unilateral posterior interstitial keratitis were examined by slit-lamp biomicroscopy, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM). The imaging features of the cornea were evaluated and analyzed. Results By slit-lamp examination, the posterior corneal stromal opacities were observed in all 7 eyes, and deep neovascularization in 4 eyes. The posterior stromal opacities showed higher reflectivity with an intact overlying epithelium by AS-OCT and did not invade the Bowman's layer in all cases. IVCM revealed highly reflective dispersed microdots, needle-shaped bodies, and increased reflectivity of keratocytes in the lesion site in all patients. Active Langerhans cells and an attenuated subbasal nerve plexus were observed in 5 eyes. After treatment, the active Langerhans cells disappeared; however, highly reflective microdots and needle-shaped bodies remained. Conclusion The three-dimensional evaluation of slit-lamp biomicroscopy, AS-OCT, and IVCM may help in the early diagnosis of patients with posterior interstitial keratitis.
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Affiliation(s)
- Shao-Feng Gu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, Beijing, China
| | - Shuang Gao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, Beijing, China
| | - Hai-Kun Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, Beijing, China
| | - Lin-Hui He
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, Beijing, China
| | - Rong-Mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, Beijing, China
| | - Ge-Ge Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, Beijing, China
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Gupta N, Ganger A, Bhartiya S, Verma M, Tandon R. In Vivo Confocal Microscopic Characteristics of Crystalline Keratopathy in Patients with Sclerokeratitis. Ocul Immunol Inflamm 2017; 26:700-705. [DOI: 10.1080/09273948.2017.1281422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Noopur Gupta
- Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Ganger
- Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shibal Bhartiya
- Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meena Verma
- Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Crystalline keratopathy due to intravenous immunoglobulin in a 12-year-old girl with Kawasaki disease. J AAPOS 2016; 20:466-468.e1. [PMID: 27667371 DOI: 10.1016/j.jaapos.2016.07.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/26/2016] [Accepted: 07/01/2016] [Indexed: 11/22/2022]
Abstract
Kawasaki disease (KD) is an acute, self-limiting, medium-vessel vasculitis that occurs predominantly in young children. The treatment of KD consists of intravenous immunoglobulin (IVIG) along with aspirin and, in IVIG-resistant cases, corticosteroids. Crystalline keratopathy with corneal deposition of the immunoglobulin is a rare complication of IVIG therapy. We report the case of a 12-year-old girl who received IVIG for KD and developed visual complaints, which were attributable to crystalline keratopathy and corneal edema. Cessation of IVIG and treatment with topical and systemic corticosteroids reversed the finding. At final follow-up, vision in both eyes was normal.
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Crystalline-like keratopathy after intravenous immunoglobulin therapy with incomplete kawasaki disease: case report and literature review. Case Rep Ophthalmol Med 2013; 2013:621952. [PMID: 23607016 PMCID: PMC3625593 DOI: 10.1155/2013/621952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/11/2013] [Indexed: 11/18/2022] Open
Abstract
A 7-year-old girl had presented with high body temperature and joint pain which continued for 3 days. Because of the prolonged history of unexplained fever, rash, bilateral nonpurulent conjunctival injection, oropharyngeal erythema, strawberry tongue, and extreme of age, incomplete Kawasaki disease was considered and started on an intravenous immunoglobulin infusion. Six days after this treatment, patient was referred to eye clinic with decreased vision and photophobia. Visual acuity was reduced to 20/40 in both eyes. Slit-lamp examination revealed bilateral diffuse corneal punctate epitheliopathy and anterior stromal haze. Corneal epitheliopathy seemed like crystal deposits. One day after presentation, mild anterior uveitis was added to clinical picture. All ocular findings disappeared in one week with topical steroid and unpreserved artificial tear drops. We present a case who was diagnosed as incomplete Kawasaki disease along with bilateral diffuse crystalline-like keratopathy. We supposed that unusual ocular presentation may be associated with intravenous immunoglobulin treatment.
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Gokulgandhi MR, Vadlapudi AD, Mitra AK. Ocular toxicity from systemically administered xenobiotics. Expert Opin Drug Metab Toxicol 2012; 8:1277-91. [PMID: 22803583 DOI: 10.1517/17425255.2012.708337] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The eye is considered as the most privileged organ because of the blood-ocular barrier that acts as a barrier to systemically administered xenobiotics. However, there has been a significant increase in the number of reports on systemic drug-induced ocular complications. If such complications are left untreated, then it may cause permanent damage to vision. Hence, knowledge of most recent updates on ever-increasing reports of such toxicities has become imperative to develop better therapy while minimizing toxicities. AREAS COVERED The article is mainly divided into anterior and posterior segment manifestations caused by systemically administered drugs. The anterior segment is further elaborated on corneal complications where as the posterior segment is focused on optic nerve, retinal and vitreous complications. Furthermore, this article includes recent updates on acute and chronic ocular predicaments, in addition to discussing various associated symptoms caused by drugs. EXPERT OPINION Direct correlation of ocular toxicities due to systemic drug therapy is evident from current literature. Therefore, it is necessary to have detailed documentation of these complications to improve understanding and predict toxicities. We made an attempt to ensure that the reader is aware of the characteristic ocular complications, the potential for irreversible drug toxicity and indications for cessation.
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Affiliation(s)
- Mitan R Gokulgandhi
- University of Missouri-Kansas City, School of Pharmacy, Division of Pharmaceutical Sciences, HSB 5258, 2464 Charlotte St, Kansas City, MO 64108, USA
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Barot RK, Viswanath V, Pattiwar MS, Torsekar RG. Crystalline deposition in the cornea and conjunctiva secondary to long-term clofazimine therapy in a leprosy patient. Indian J Ophthalmol 2011; 59:328-9. [PMID: 21666328 PMCID: PMC3129769 DOI: 10.4103/0301-4738.82012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
PURPOSE The purpose of this study was to report an unusual pattern of immunoglobulin deposition in the corneas of a patient with dysproteinemia. METHODS Clinical examination, slit lamp examination, a deep lamellar corneal biopsy, and serum and aqueous protein electrophoresis were obtained. RESULTS Slit lamp evaluation revealed amorphous, cloud-like opacities in the midperiphery at the level of deep stroma and Descemet's membrane. Electron microscopy demonstrated deep lamellar extracellular deposits consistent with immunoglobin. The serum protein electrophoresis revealed a monoclonal IgG kappa band, but the aqueous electrophoresis showed no bands in the gamma region. CONCLUSION This case documents a rare pattern of immunoglobulin deposition in the corneas in a patient with gammopathy. Despite its deep corneal distribution, the analysis of the aqueous specimen suggests that the source of the immunoglobulin is through a route other than from the aqueous.
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Tamaki K, Nakazawa T, Mamehara A, Tsuji G, Saigo K, Kawano S, Morinobu A, Kumagai S. Successful treatment of pyoderma gangrenosum associated with myelodysplastic syndrome using high-dose intravenous immunoglobulin. Intern Med 2008; 47:2077-81. [PMID: 19043265 DOI: 10.2169/internalmedicine.47.1280] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 61-year-old man with pyoderma gangrenosum (PG) who was successfully treated with high-dose intravenous immunoglobulin (IVIg). He was transported to hospital with fever, pain and ulcer of the left inner thigh, and pancytopenia. PG associated with myelodysplastic syndrome was diagnosed, and treatment with methyl-prednisolone at 1.0 g/day for 3 days was followed by oral prednisolone. As the ulcer deteriorated when prednisolone dose was reduced, he was admitted to our hospital. IVIg was administered twice, with high fever promptly subsiding and the ulcer markedly decreasing in size. IVIg may represent a good option when steroid therapy proves insufficient.
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Pyoderma gangrenosum with necrotizing sclerokeratitis after cataract surgery. J Cataract Refract Surg 2007; 33:1987-90. [PMID: 17964412 DOI: 10.1016/j.jcrs.2007.06.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 06/27/2007] [Indexed: 11/20/2022]
Abstract
A 78-year-old man who had had uneventful extracapsular cataract extraction in the left eye 3 months earlier developed pyoderma gangrenosum (PG)-associated peripheral ulcerative keratitis (PUK) after suture removal. The patient had a 13-year history of PG associated with monoclonal immunoglobulin-A gammopathy. He presented with extensive, painful PUK at the incision site, with a descemetocele and a high risk for perforation. Fibrin glue tissue adhesive was used to stabilize the corneal ulcer as an adjunct to topical and systemic treatment. The patient had been treated with tapering doses of prednisone and cyclophosphamide (50 mg/day). High-dose human intravenous immunoglobulin (0.4 mg/kg/d for 4 days) was administered. The ulcer healed 1 month later with a loss of visual acuity. To our knowledge, this is the first reported case of PG-associated sclerokeratitis following cataract surgery. Early recognition of this rare ocular localization of PG is important to institute the appropriate therapy.
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Meyer N, Ferraro V, Mignard MH, Adamski H, Chevrant-Breton J. Pyoderma gangrenosum treated with high-dose intravenous immunoglobulins: Two cases and review of the literature. Clin Drug Investig 2007; 26:541-6. [PMID: 17163287 DOI: 10.2165/00044011-200626090-00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic skin disease commonly treated with immunosuppressants. High-dose intravenous immunoglobulins are used to treat a range of inflammatory diseases, but we found only five reports of the use of high-dose intravenous immunoglobulins in the treatment of PG. We report on two patients with PG for whom immunosuppressants could not be prescribed and who were treated with high-dose intravenous immunoglobulins. Case 1 was a 58-year-old man who presented with a 6-year history of PG. He was initially treated with prednisone. The 20 mg/day dosage of prednisone could not be reduced and treatment had to be discontinued after 1 year because of serious adverse effects. Minocycline treatment led to improvement but had to be discontinued after 6 years because of facial skin hyperpigmentation. Case 2 was a 66-year-old man who presented with a 3-year history of PG. Different therapeutic procedures for PG (prednisone, topical tacrolimus or betamethasone) had failed. High-dose intravenous immunoglobulins were administered monthly at a dose of 2 g/kg for 6 months. The treatment induced stabilisation of the disease and made it possible to reduce corticosteroid use in both patients. These cases show that high-dose intravenous immunoglobulins represent a therapeutic alternative for PG, but the efficacy of this treatment should be confirmed in further studies.
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Affiliation(s)
- Nicolas Meyer
- Department of Dermatology, Pontchaillou Hospital, Rennes, France.
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Affiliation(s)
- S Jolles
- Department of Clinical Immunology, Royal Free Hospital London, UK.
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Jolles S, Hughes J. Use of IGIV in the treatment of atopic dermatitis, urticaria, scleromyxedema, pyoderma gangrenosum, psoriasis, and pretibial myxedema. Int Immunopharmacol 2005; 6:579-91. [PMID: 16504920 DOI: 10.1016/j.intimp.2005.11.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There has been a rapid expansion in the use of IGIV for an ever-growing number of conditions. It is a product with an excellent safety record without the side effects of steroids or other immunosuppressive agents. There have been numerous recent advances in our understanding of the mechanisms of action of IGIV in many of the conditions for which it is being used, but there is still much to be learned. IGIV has had a major impact in neurology, haematology, immunology, rheumatology and dermatology. The limitations for IGIV are cost of the preparation itself and the logistical problems associated with its administration. Here we describe the published evidence for the use of high-dose IGIV in the dermatological conditions atopic dermatitis, urticaria, scleromyxedema, pyoderma gangrenosum, psoriasis and pretibial myxedema. These conditions have an emerging evidence base for hdIGIV which is relatively small consisting mainly of case reports and small case series. The outcomes in a number of these conditions appear encouraging, but as the reports are likely to reflect a bias for positive results, one must be cautious about drawing firm conclusions.
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Affiliation(s)
- Stephen Jolles
- National Institute for Medical Research, Mill Hill, London and University Hospital of Wales, Cardiff, UK.
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Garibaldi DC, Gottsch J, de la Cruz Z, Haas M, Green WR. Immunotactoid keratopathy: a clinicopathologic case report and a review of reports of corneal involvement in systemic paraproteinemias. Surv Ophthalmol 2005; 50:61-80. [PMID: 15621078 DOI: 10.1016/j.survophthal.2004.10.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Corneal deposits in association with paraproteinemias have been well described in the ophthalmic literature. Recent reports in the renal literature have described immunotactoid deposition associated with glomerulopathy-organized microtubular deposits of IgGkappa that measured 32-50 nm in diameter on renal biopsies. We present a case of corneal immunotactoid deposition in the setting of chronic lymphocytic leukemia and review previous reports of corneal deposition in the setting of systemic paraproteinemia, highlighting the etiology, differential diagnosis, prognosis, and treatment of corneal involvement. We propose the use of the term immunotactoid keratopathy to describe corneal IgGkappa deposits appearing as tubular, electron-dense, crystalloid deposits with a central lucent core on electron microscopy and suggest that these patients undergo directed systemic workup to evaluate for potential etiologies of their systemic paraproteinemia. To illustrate the spectrum of paraprotein deposition in the cornea, and to emphasize the importance of ophthalmic evaluation in the setting of systemic paraproteinemias, we include a case of a 44-year-old man with immunoprotein corneal deposition who was subsequently diagnosed with multiple myeloma.
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Affiliation(s)
- Daniel C Garibaldi
- Eye Pathology Laboratory, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Abstract
PURPOSE OF REVIEW To review the common corneal manifestations of systemic medications in order to describe the characteristic clinical features associated with particular systemic drugs, the indications for drug cessation, and the risks for irreversible ocular toxicity. RECENT FINDINGS Systemic medications may reach the cornea via the tear film, aqueous humor, and limbal vasculature. The corneal changes are often the result of the underlying chemical properties of medications. Amphiphilic medications (amiodarone, chloroquine, suramin, clofazimine, etc.) may produce a drug-induced lipidosis and development of a vortex keratopathy. Antimetabolites (cytarabine) may lead to a degeneration of basal epithelial cells with formation of epithelial microcysts. Additionally, systemically administered medications and drug metabolites may lead to a stromal or endothelial deposition. Corneal changes may result in reduced visual acuity, photophobia, and ocular irritation, though these symptoms typically resolve following drug cessation. Corneal manifestations of systemic medications are often dose related, and may reflect the potential risk for lenticular or retinal changes. SUMMARY Corneal changes secondary to systemic medications may affect all layers of the cornea. While corneal deposition is typically not an indication for drug cessation, patients receiving particular medications should be monitored for symptoms related to corneal deposition as well as for signs of irreversible ocular toxicity.
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Affiliation(s)
- David A Hollander
- The Cornea Service, Jules Stein Eye Institute, The University of California, Los Angeles, California 90095, USA
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Hsueh CM, Lin PY, Lee SM, Hsu WM. Corneal crystalline deposits as the initial manifestation of IgA-kappa multiple myeloma. Eye (Lond) 2004; 18:644-5. [PMID: 15184930 DOI: 10.1038/sj.eye.6700716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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