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Fossati G, Bartoli E, Montericcio A, Buzzi M, Barone G, Santoru F, Allegrini D, Romano MR, Panico C. Neurotrophic Keratopathy after wide retinal endolaser and postoperative Ketorolac eye drops: A case series. Eur J Ophthalmol 2024; 34:NP18-NP21. [PMID: 38254249 DOI: 10.1177/11206721241228005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
PURPOSE We report a series of 5 cases, happened in a period of 5 months, who developed neurotrophic keratopathy (NK) following pars plana vitrectomy (PPV) and retinal endolaser for rhegmatogenous retinal detachment (RRD). In our several decennary experience of surgical center predominantly based on vitreoretinal surgery, we had rare cases of postoperative NK. These recent cases of post-surgical NK happened contextually to our change of postoperative non-steroidal anti-inflammatory drugs (NSAIDs) drops, based on Ketorolac Tromethamine 0.5% eye drops. CASES PRESENTATION Five patients with a mean age of 61 ± 7.3 years were treated with one or more PPV with intraoperative peripheral endolaser for RRD. Nobody had previous herpetic keratitis, systemic disease like diabetes mellitus or other predisposing factors for NK. In the postoperative period, all patients received Ketorolac Tromethamine 0.5% eye drops for a mean period of 54 ± 25 days. During follow-up visits they developed NK and they were successfully treated with suspension of Ketorolac eye drops, application of therapeutic contact lens or amniotic membrane patch and topical lubricant therapy. CONCLUSIONS Postoperative Ketorolac eye drops, in patients who underwent PPV with endolaser, may reduce the corneal sensitivity, predispose to epithelial disruption and NK development. Studies are needed to explore the effect of NSAIDs on corneal sensitivity reduction in patient who will undergo PPV and extensive endolaser.
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Affiliation(s)
- Giovanni Fossati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Ophthalmology, Humanitas Gradenigo, Corso Regina Margherita 8/10, 10153 Torino, Italy
| | - Elena Bartoli
- Department of Ophthalmology, Humanitas Gradenigo, Corso Regina Margherita 8/10, 10153 Torino, Italy
| | - Alessio Montericcio
- Department of Ophthalmology, Humanitas Gradenigo, Corso Regina Margherita 8/10, 10153 Torino, Italy
| | - Matilde Buzzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, 24128 Bergamo, Italy
| | - Gianmaria Barone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, 24128 Bergamo, Italy
| | - Francesco Santoru
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Ophthalmology, Humanitas Gradenigo, Corso Regina Margherita 8/10, 10153 Torino, Italy
| | - Davide Allegrini
- Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, 24128 Bergamo, Italy
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, 24128 Bergamo, Italy
| | - Claudio Panico
- Department of Ophthalmology, Humanitas Gradenigo, Corso Regina Margherita 8/10, 10153 Torino, Italy
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Carlo C, Poddi M, Mocini S, Boni N, Damiani F, Battini MA, Mirabella G, Tataranno M. Clinical evaluation of tear substitute utility after anti-VEGF intravitreal injection. Eur J Ophthalmol 2024:11206721241234427. [PMID: 38389327 DOI: 10.1177/11206721241234427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE The purpose of this study is to evaluate the role of a polyethylene glycol 400 - propylene glycol - hydroxypropyl guar - hyaluronic acid eye drops in relieving the symptoms of dry eye syndrome after anti-VEGF intravitreal injection. METHODS In this randomized, parallel-group study, patients were randomized to receive standard therapy alone or study eye drops plus standard therapy. Patients enrolled were older than 50 with exudative age-related macular degeneration, who have never had intravitreal injections, and without severe dry eye condition or severe ocular or systemic conditions. Patients had baseline preoperative evaluation (V0), and successively after 15 (V1) and 30 (V2) days. At VO and V1 T-BUT, Schirmer's test, fluorescein staining, DEQ5 and OSDI questionnaires were performed and at V2 (30) the OSDI questionnaire was administered. RESULTS 80 patients were included in the study, of them 40 received standard therapy plus study eye drops. DEQ5 questionnaire showed an increase in the control group between the values at V0 and V1, while in the study group a decrease was observed. No changes in T-BUT, Schirmer, and fluorescein staining values between V0 and V1 were observed in both groups. OSDI data in the control group showed no statistically significant differences, while in the study group they showed a statistically significant difference. CONCLUSIONS In our study patients undergoing for the first time intravitreal treatment presented dry eye symptoms in the postoperative period: in this group of patients the use of a tears substitute reduces postoperative ocular discomfort.
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Affiliation(s)
- Cagini Carlo
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Maria Poddi
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Stefano Mocini
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Niccolò Boni
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Francesco Damiani
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Michele Apponi Battini
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Giuseppe Mirabella
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Mario Tataranno
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
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Leitão M, Cabral D. Isolated corneal involvement by Lichen Planus - multi-modal evaluation. Eur J Ophthalmol 2024; 34:NP48-NP53. [PMID: 37192672 DOI: 10.1177/11206721231174931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE To describe a case of ocular Lichen Planus, successfully managed using a multimodal evaulation, including Anterior Segment OCT (AS-OCT). OBSERVATIONS A female patient in her forties with a history of cutaneous Lichen Planus presents with blurred vision and burning eye sensation. Anterior segment evaluation revealed bilateral punctate keratitis, stromal haze and subepithelial pigmented dots. AS-OCT was pivotal for diagnosis, showing anterior stromal hyperreflective dots. A diagnosis of ocular Lichen Planus was estabilished and the patient was treated with topical hydrocortisone, with complete subsidence of the complaints. CONCLUSIONS AND IMPORTANCE Ocular Lichen Planus can present as isolated corneal involvement independent from severe cicatrizing conjunctivitis. Appropriate and timely treatment can prevent irreversible ocular surface disease. Ophthalmologists should be aware of Lichenoid Tissue Reaction (LTR) disorders, especially in patients with relentless blepharitis and/or ocular surface disease.
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Affiliation(s)
- Miguel Leitão
- Department of Ophthalmology, Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal
| | - Diogo Cabral
- Department of Ophthalmology, Hospital Garcia de Orta, Almada, Portugal
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Csorba A, Maneschg OA, Resch MD, Nagy ZZ. Examination of corneal microstructure in the quiescent phase of vernal keratoconjunctivitis using in vivo confocal microscopy. Eur J Ophthalmol 2023; 33:196-202. [PMID: 35509192 DOI: 10.1177/11206721221099778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION This study investigated the morphological characteristics of corneal microstructure in the quiescent phase of vernal keratoconjunctivitis (VKC). METHODS Twenty patients with quiescent VKC and 25 healthy subjects were included. In vivo confocal microscopy (IVCM) of the central cornea was performed. Cellular density of each layer and the morphology of subbasal nerve plexus (SBNP) was analysed. Langerhans cell density (LCD), morphology (LCM), and field area (LCF) were also examined. RESULTS No differences were found either in cell densities nor in SBNP morphology (p > 0.05). LCD, LCM and LCF were significantly higher in the VKC group (p = 0.005, p < 0.001 and p < 0.001, respectively). The severity of papillary hypertrophy had a significant impact on LCD, LCM and LCF (β-coefficient: 19.541, p < 0.001; β-coefficient: 0.283, p < 0.001 and β-coefficient: 595.255, p < 0.001, respectively). DISCUSSION In quiescent VKC, LCD, LCM, and LCF were increased, and they were associated with the severity of papillary hypertrophy. Alterations of Langerhans cells indicate a subclinical inflammatory process without ocular symptoms.
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Affiliation(s)
- Anita Csorba
- Department of Ophthalmology, 97848Semmelweis University, Budapest, Hungary
| | | | - Miklós Dénes Resch
- Department of Ophthalmology, 97848Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, 97848Semmelweis University, Budapest, Hungary
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Pena-Verdeal H, Noya-Padin V, Losada-Oubiña M, Saborido-Rey M, Vilas-Alonso M, Giraldez MJ. Changes of symptomatology, tear film and ocular surface integrity one week during Somofilcon-A and Omafilcon-A lens wear. Eur J Ophthalmol 2022; 33:11206721221131131. [PMID: 36214157 DOI: 10.1177/11206721221131131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE Clinicians play a key role in prescribing contact lenses that best suited for fitting which materials had an impact on ocular surface parameters. The present study aimed to evaluate the impact on symptomatology, tear film dynamics and ocular surface integrity of a silicone-hydrogel (Somofilcon-A) and a hydrogel (Omafilcon-A) lens before and after wearing for one week in contact lens neophyte participants. METHODS A Somofilcon-A and Omafilcon-A were randomly fitted to one or other the eye on an initial group of 28 participants. Subjects were scheduled for three sessions: basal session previous fitting, second session after 4-wear hours, and final session after 7-wear days for up to 10 h. In each session, CLDEQ-8, tear meniscus height and hyperemia with and without lenses, as well as lipid layer thickness and corneal/conjunctival staining without lenses were assessed. Values were compared between lenses and sessions. RESULTS In intrasession comparison, there were no differences in any parameter between materials on any session with or without lenses (all p≥0.176), except on the conjunctival staining where values obtained during Somofilcon-A wear (all p ≤ 0.006). In intersession analysis, CLDEQ-8 score, tear meniscus height and lipid layer thickness showed a statistical difference during both materials wear (all p ≤ 0.009), while conjunctival hyperemia does not (p = 0.237); corneal staining showed differences during Omafilcon-A wear (p = 0.037), contrary to conjunctival staining which showed differences only during Somofilcon-A wear (p < 0.001). CONCLUSION Contact lenses wear had an impact on ocular parameters that have some specific influences of the material on which lenses were manufactured.
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Affiliation(s)
- Hugo Pena-Verdeal
- Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, 16780Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - Veronica Noya-Padin
- Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, 16780Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - Martin Losada-Oubiña
- Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, 16780Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - Marcos Saborido-Rey
- Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, 16780Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - Manuel Vilas-Alonso
- Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, 16780Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - Maria J Giraldez
- Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, 16780Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
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Abstract
PURPOSE To evaluate the efficacy and safety of cenegermin 0.002% ophthalmic drops in the management of pediatric neurotrophic keratopathy (NK). METHODS Retrospective chart review of children under the age of 18 years diagnosed with NK at Boston Children's Hospital/Massachusetts Eye and Ear Infirmary and treated with topical cenegermin 0.002% ophthalmic solution between June 2018 and June 2021 was performed. Data collection included etiology of NK, age at time of initiation of topical cenegermin, laterality, ethnicity, gender, history of previous ocular therapy, pre- and post-therapy best corrected visual acuity, pre- and post-therapy cornea examination, any adverse events from topical cenegermin, associated ocular conditions, and history of ocular surgeries. RESULTS The current study includes four eyes of four pediatric patients with a mean age of 4.5 ± 2.0 years at the time of initiation of topical cenegermin therapy. The mean time from NK diagnosis until start of topical cenegermin drops was 5.2 ± 4.3 months and mean follow-up time was 15 ± 9.6 months. In all four patients, marked improvement in epitheliopathy was demonstrated after completion of therapy. Best corrected visual acuity was measurable in 3 eyes of 3 patients, and it improved from a mean of 0.07 ± 0.01 to a mean of 0.29 ± 0.26 (P = 0.3). No adverse events related to cenegermin therapy were noted. CONCLUSION Topical cenegermin was effective in improving corneal healing for pediatric NK.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Ophthalmology, 1866Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Aisha S Traish
- Department of Ophthalmology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, 1866Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, 1866Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Iason S Mantagos
- Department of Ophthalmology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, 1866Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Botella García J, Lázaro-Rodríguez V, de la Paz MF. The use of topical cyclosporine A 0.05% as treatment for primary alacrimia in Allgrove syndrome. Eur J Ophthalmol 2022; 32:NP9-NP11. [PMID: 32698619 DOI: 10.1177/1120672120945109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose is to report a case on the use of cyclosporine A 0.05% for primary alacrimia in Allgrove syndrome or triple A syndrome (alacrimia, achalasia, and adrenal insufficiency). CASE DESCRIPTION A 37-year-old man with achalasia treated surgically 11 years ago presented with sensation of a foreign body, irritation, and intermittent ocular redness for several years. Ophthalmological examination revealed bulbar hyperemia, Oxford grade 4 corneal staining, anisocoria, and optic atrophy. The patient was initially treated with washing with serum and lubricants. Due to the persistence of symptoms, treatment with cyclosporine A 0.05% was started observing a clinical improvement with a decrease in the symptoms caused by tear deficiency. CONCLUSION It is important to emphasize the relevance of establishing an early diagnosis through a complete multidisciplinary clinical examination and a study of adrenal function. The treatment of dry eye in these patients is difficult to manage, with topical immunomodulators such as cyclosporine A as a good alternative when lubricants are insufficient. To our knowledge this is the first case of subjective and objective improvement of dry eye using cyclosporine A 0.05% in a case of alacrimia in triple A syndrome. Allgrove syndrome presentation does not always manifest with the classic triad and some symptoms may be not present at the time of diagnosis. Ophthalmologist and pediatrician should consider this syndrome in patients with symptoms as complex as lack of growth, crying without tears, and convulsions.
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Affiliation(s)
- Jéssica Botella García
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor Lázaro-Rodríguez
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Fideliz de la Paz
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vidal Oliver L, López Montero A, Gil Hernández I, García Ibor F, Vela Bernal S, Duch Samper AM. Monitoring therapy in anterior necrotizing scleritis with inflammation with anterior segment optical coherence tomography. Eur J Ophthalmol 2021; 33:11206721211065564. [PMID: 34866457 DOI: 10.1177/11206721211065564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Early diagnosis and initiation of immunosuppression can prevent the necessity of surgical intervention in necrotizing scleritis with inflammation and lowers the risk of perforation and loss of vision. However, clinical signs for early diagnosis and methods for monitoring response to immunosuppressive therapy are missing. METHODS Here, we present a case of necrotizing scleritis with inflammation where avascular plaques precede scleral defects. We use slit lamp imaging and anterior segment optical coherence tomography to evaluate evolution lesions depth and impact on scleral structure. RESULTS The patient presented 5 months after detection of avascular plaques with a new scleral ulcer of the left eye. After 3-day-administration of i.v. corticosteroids anterior segment optical coherence tomography showed progressive scleral thickening. The patient was therefore spared surgical intervention and discharged resulting in complete remission under decreasing doses of oral corticosteroids. CONCLUSIONS Avascular plaques can precede necrotizing scleritis with inflammation by several months and may therefore qualify as early clinical signs. Anterior segment optical coherence tomography enables objective evaluation of scleral structure for making rational decisions about surgical intervention.
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Almater AI, Abusayf MM, Alshahrani S, Alfawaz AM, Alkatan HM, Al-Faky YH. Paraneoplastic pemphigus associated with rapidly progressing endophthalmitis caused by Morganella Morganii: A case report. Eur J Ophthalmol 2021; 32:NP69-NP72. [PMID: 34269096 DOI: 10.1177/11206721211033465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The ocular presentation of paraneoplastic pemphigus (PNP) has rarely been reported in the literature. In this report, we describe a 61-year-old male presenting with eruptive skin lesions associated with underlying non-Hodgkin's lymphoma who had rapid progressive corneal perforation with secondary endophthalmitis in the setting of PNP. CASE DESCRIPTION A 61-year-old male presented to the emergency department complaining of skin eruption mimicking Stevens-Johnson syndrome, which was later found to be related to PNP. Initially, the patient complained of progressive ocular surface dryness in both eyes. Meanwhile, he developed mild pain in the right eye associated with blurry vision in both eyes and was managed with lubricants and topical antibiotics. A few days later, he was found to have corneal perforation with features suggestive of left endophthalmitis with possible early panophthalmitis. Intravenous antibiotic was administered, and primary evisceration of the left globe was performed. Histopathology revealed acute necrotizing keratitis and endophthalmitis. Vitreous analysis showed numerous gram-negative bacilli and a positive culture of Morganella morganii. The patient continued to be managed with frequent lubrications and punctual plugs in the fellow eye during the follow-up period. CONCLUSION We describe the first case of endophthalmitis developing secondary to PNP-induced corneal melting and perforation. Anticipating unusual infectious sequelae in the setting of PNP might be warranted to actively detect and successfully manage dry eye disease before devastating complications develop.
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Affiliation(s)
- Abdullah I Almater
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed M Abusayf
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saeed Alshahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Alfawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Abstract
The red eye is one of the most common cause encountered in ophthalmic practice but a red eye is not always related to eye diseases, instead, it may be a clinical sign of several systemic diseases which may the alarmin signal of sight-threatening or life-threatening condition. Frequently, GPs, pediatricians, immunologists, and rheumatologists are the first landing of patients with a "red eye." This paper is addressed to non-ophthalmic specialists who may be faced with patients having a red eye. Inspection of the external eye under standard office lighting or with a bright light can be easily and accurately made by a general practitioner. Three major caveats should alert the GPs to promptly refer the patient to the ophthalmologist: the presence of pain; the loss of the natural corneal transparency and specular reflex; and any patient-described reduction of visual acuity. In most cases, a red eye is due to occasional and mild ocular surface reaction as consequence of exposure of the external eye to irritants and naturally occurring environmental agents. In these cases washing the eye with a tear lubricant may help in relief of symptoms. If this treatment fails within a few days, a consultation with an ophthalmologist is suggested. The role of the general physician is crucial in the decision making to judge the severity of the ocular condition. Managing a red eye often requires the support of other specialists. Our goal is not only to preserve vision but to globally cure the patient health.
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Affiliation(s)
- Stefano Bonini
- Department of Ophthalmology, University of Rome Campus BioMedico, Rome, Italy
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Leshno A, Stern O, Barkana Y, Kapelushnik N, Singer R, Prat DL, Cohen G, Ben-David G, Abrahami D, Huna-Baron R, Skaat A. Ocular surface temperature differences in glaucoma. Eur J Ophthalmol 2021; 32:1518-1524. [PMID: 34105387 DOI: 10.1177/11206721211023723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Accumulating evidence suggests that neuroinflammation and immune response are part of the sequence of pathological events leading to optic nerve damage in glaucoma. Changes in tissue temperature due to inflammation can be measured by thermographic imaging. We investigated the ocular surface temperature (OST) profile of glaucomatous eyes to better understand the pathophysiology of these conditions. METHODS Subjects diagnosed with glaucoma (primary open angle glaucoma [POAG] or pseudo exfoliation glaucoma [PXFG]) treated at the Sam Rothberg Glaucoma Center (11/2019-11/2020.) were recruited. Healthy subjects with no ocular disease served as controls. The Therm-App thermal imaging camera was used for OST acquisition. Room and body temperatures were recorded, and the mean temperatures of the medial cantus, lateral cantus, and cornea were calculated with image processing software. RESULTS Thermographic images were obtained from 52 subjects (52 eyes: 25 POAG and 27 PXFG) and 66 controls (66 eyes). Eyes with glaucoma had a significantly higher OST compared to controls (mean 0.9 ± 0.3°C, p < 0.005). The difference between the two groups remained significant after adjustment for age, sex, intraocular pressure (IOP) and room and body temperatures. Lens status and topical IOP-lowering medication did not significantly affect OST. A subgroup analysis revealed that the OST was higher among eyes with POAG compared to eyes with PXFG, but not significantly. CONCLUSIONS Differences in the OST between glaucomatous and normal eyes strengthens current thinking that inflammation affects the pathophysiology of glaucoma. Longitudinal studies are warranted to establish the prognostic value of thermographic evaluations in these patients.
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Affiliation(s)
- Ari Leshno
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Sheba Talpiot Medical Leadership Program
| | - Ori Stern
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Barkana
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Kapelushnik
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reut Singer
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Landau Prat
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Sheba Talpiot Medical Leadership Program
| | - Gal Cohen
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Ben-David
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dor Abrahami
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Huna-Baron
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Skaat
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Krolo I, Kasumović A, Radman I, Pavić P. Corneal cross-linking for treatment of progressive keratoconus in a patient with Alport syndrome: A case report. Eur J Ophthalmol 2021; 31:1584-1587. [PMID: 33631984 DOI: 10.1177/1120672121997672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Ocular features of Alport syndrome include anterior lenticonus, posterior polymorphous corneal dystrophy, and fleck-and-dot retinopathy in most cases. Keratoconus in such patients has been rarely mentioned in previous studies. To our knowledge, this is the first report of corneal cross-linking for halting the progression of keratoconus in a patient with Alport syndrome. CASE REPORT A 22-year-old male was referred for his initial corneal topography, after he was already prescribed with rigid gas-permeable contact lenses. Alport syndrome was diagnosed in his infancy and gene COL4A5 mutation was confirmed. Ophthalmological evaluation confirmed keratoconus. One-year follow-up showed a progression on his right eye and standard corneal cross-linking was performed. Stabilization of the disease marked by normalization in visual function and corneal tomography values was noticed 1 year after the procedure. CONCLUSIONS When diagnosing ocular clinical findings of Alport syndrome, keratoconus should be considered. Standard corneal cross-linking protocol can halt its progression.
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Affiliation(s)
- Iva Krolo
- University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Aida Kasumović
- University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Ivana Radman
- University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Pavao Pavić
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Spadea L, Giannico MI, Iannaccone A, Pistella S. Excimer laser-assisted phototherapeutic keratectomies combined to EDTA chelation for the treatment of calcific band keratopathy. Eur J Ophthalmol 2020; 32:NP42-NP46. [PMID: 33153293 DOI: 10.1177/1120672120969033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Calcific band keratopathy (CBK) is a relatively common chronic corneal degeneration and various forms of treatment are mentioned in the literature. CASES DESCRIPTION Two patients (89 and 37 yo, respectively) affected by diffuse long-standing CBK in one eye and complaining of ocular pain, foreign body sensation and decreased visual acuity are reported. An ethylenediaminetetraacetic acid (EDTA) application on the ocular surface was performed associated with a customized no-touch transepithelial phototherapeutic corneal remodeling in one patient and a standard phototherapeutic keratectomy (PTK) in the second patient. Corneal transparency progressively improved in both cases since the early follow-up visits and the cornea became clear 2 weeks after surgery. In both cases, a significant reduction of ocular discomfort was reported. CONCLUSIONS Combining EDTA chelation and excimer laser-assisted PTK represents an useful treatment of band keratopathy even in challenging cases and may help regularize corneal surface and improve corneal clarity.
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Affiliation(s)
- Leopoldo Spadea
- Department of Sense Organs, Eye Clinic, University "La Sapienza", Rome, Italy
| | | | - Andrea Iannaccone
- Department of Sense Organs, Eye Clinic, University "La Sapienza", Rome, Italy
| | - Santino Pistella
- Department of Sense Organs, Eye Clinic, University "La Sapienza", Rome, Italy
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Hoyek S, Arej N, El Rami H, Saba P, Antoun J. Corneal flattening following collagen crosslinking for keratoconus: Findings at 5-year follow-up. Eur J Ophthalmol 2020; 31:1525-1531. [PMID: 33135484 DOI: 10.1177/1120672120964080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the corneal flattening effect of cross-linking (CXL) overtime and to look for a potential association with preoperative topographic variables and the central depth of demarcation line (DDL). METHODS 201 eyes of 146 patients (mean age of 31.2 ± 7.3 years) with progressive keratoconus who underwent CXL between June 2007 and December 2012 were enrolled in this retrospective study. Follow-up visits were performed at different time intervals for at least 5 years. Preoperative parameters and depth of demarcation line were collected from LaserVision ophthalmology center in Lebanon. Corneal flattening was defined by a change in postoperative Kmax (ΔKmax) greater than 1.00 D. RESULTS ΔKmax increased from 50.25% to 61.69%, from first to last follow-up visits. The only factor significantly correlated to ΔKmax during all follow-up visits was preoperative maximum keratometry (Kmax) especially when greater than 50.00 D (OR, 1.92; 95% CI, 1.10-3.34). All eyes showed a corneal demarcation line (mean central depth (DDL): 217.11 ± 26.54 μm), with no statistically significant correlation between DDL and ΔKmax. CONCLUSION CXL effect on cornea can be cumulative overtime and delayed flattening occurs in some cases. ΔKmax is positively correlated with preoperative Kmax and no association was found between ΔKmax and DDL. Therefore, DDL may not be a valid measure for the efficacy of CXL.
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Affiliation(s)
- Sandra Hoyek
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Nicolas Arej
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon.,Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | | | - Peggy Saba
- Optometry Department, Laservision Center, Beirut, Lebanon
| | - Joelle Antoun
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon.,Beirut Eye Specialist Hospital, Beirut, Lebanon
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Vastardis I, Gatzioufas Z, McLintock C, Kohlhaas M, Hamada S, Lake D, Elalfy M. Tear film parameters before and after intracorneal ring segment implantation in keratoconic eyes. Eur J Ophthalmol 2020; 31:2213-2218. [PMID: 32951440 DOI: 10.1177/1120672120958301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess signs of dry eye syndrome in keratoconic eyes following intracorneal ring segment (ICRS) implantation. PATIENT AND METHODS Twenty eyes of 20 consecutive patients with keratoconus were assessed for tear film changes following ICRS implantation at 6 months postoperatively. Evaluated parameters included tear osmolarity, non-invasive tear breakup time test (NI-BUT test) and Schirmer test I and II before and after treatment. RESULTS No significant changes were found with respect to osmolarity, Schirmer I and II (p = 0.9, p < 0.64, and p < 0.91, respectively). The NITUBT was significantly lower after surgery (p = 0.04). CONCLUSION Our results suggest that implantation of ICRS does not result in a significant change in tear film osmolarity, or tear film volume nor improves the tear film stability.
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Affiliation(s)
| | - Zisis Gatzioufas
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Department of Ophthalmology, University Hospital Basel, Switzerland
| | - Cameron McLintock
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Princess Alexandra Hospital, Brisbane, Australia
| | | | - Samer Hamada
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Damian Lake
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Mohamed Elalfy
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,The Research Institute of Ophthalmology, Cairo, Egypt
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Jabbarvand M, Moravvej Z, Shahraki K, Hashemian H, Ghasemi H, Berijani S, Amiri Z, Jamali A. Corneal biomechanical outcome of collagen cross-linking in keratoconic patients evaluated by Corvis ST. Eur J Ophthalmol 2020; 31:1577-1583. [PMID: 32715752 DOI: 10.1177/1120672120944798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE A 6-month evaluation of the topographic and biomechanical changes induced by corneal collagen cross-linking (CXL) in keratoconic eyes using Pentacam and Corvis ST. DESIGN Longitudinal prospective case series. METHODS In this study, 67 eyes of 67 patients with progressive keratoconus (KCN) treated with "Epithelium-off" CXL were evaluated. Patients with stages 1 or 2 of KCN and a corneal thickness of at least 400 μm at the thinnest point were included. Standard ophthalmologic examinations were carried out for all patients. The topographic and biomechanical measurements of the cornea were obtained by Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) preoperatively and 6-month postoperatively. RESULTS The mean age of the participants was 21.68 ± 4.23 years. There was significant difference in mean spherical equivalent (SE) before and 6 months after CXL. Uncorrected and best corrected visual acuity improved postoperatively, although not statistically significant. The mean and maximum keratometry showed a significant decrease 6 months after CXL (0.93 ± 0.38 D and 1.43 ± 0.62 D, respectively p < 0.001). Among Corvis ST parameters, first applanation length and velocity (AL1 and AV1) showed statistically significant changes. The radius at highest concavity changed significantly (0.13 ± 0.37 mm mean increase after CXL; p < 0.001). A significant increase was observed in stiffness parameter A1 (SP-A1; p < 0.001) and significant decreases were noted in integrated radius (IR) and deformation amplitude ratio (DAR; p < 0.001). CONCLUSION Analyzing biomechanical changes after corneal cross-linking can provide basis for efficient KCN treatment. Corvis ST parameters demonstrated changes in corneal biomechanical characteristics indicative of stiffing after CXL.
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Affiliation(s)
- Mahmoud Jabbarvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Eye Research Center, Binaafarin Clinic, Tehran, Iran
| | - Zahra Moravvej
- Eye Research Center, Eye Department, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Gilan, Iran
| | - Kianoush Shahraki
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Eye Research Center, Binaafarin Clinic, Tehran, Iran
| | - Hessam Hashemian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghasemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Berijani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Amiri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Jamali
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Gomez-Elizondo DE, Lopez-Martinez M, Ruiz-Lozano RE, Valdez-Garcia JE, Hernandez-Camarena JC. Corneal perforation associated with isolated ocular lichen planus: a case report. Eur J Ophthalmol 2020; 31:NP9-NP12. [PMID: 32493062 DOI: 10.1177/1120672120932089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To report a case of unilateral corneal perforation due to isolated ocular lichen planus. METHODS Interventional case report. Informed consent by the patient was obtained to publish clinical images. A 64-year-old male presented with severe vision loss and a 2-week history of corneal perforation treated with penetrating keratoplasty in the left eye. He had a longstanding diagnosis of severe chronic dry eye disease. On the initial assessment a visual acuity of 20/50 in the RE and HM perception in the left eye were documented. Biomicroscopy revealed subepithelial fibrosis on the tarsal conjunctiva and clinical signs of severe dry eye disease in both eyes. A clear corneal button and a white cataract were observed in the left eye. No other skin or mucosal lesions were observed. RESULTS An excisional biopsy of the bulbar conjunctiva was performed under topical anesthesia. Direct immunofluorescence analysis revealed a linear deposit of fibrinogen in the basement membrane consistent with ocular lichen planus. Clinical improvement was achieved using aggressive topical lubrication, corneal epithelial regenerators, topical tacrolimus, and immunosuppressive therapy with systemic corticosteroids and cyclophosphamide. CONCLUSION Isolated ocular lichen planus is an extremely infrequent presentation of lichen planus often indistinguishable from other cicatricial conjunctivitis. Corneal perforation is a severe complication associated with severe dry eye, not previously reported with ocular lichen planus. An adequate clinical assessment and histopathologic diagnosis are crucial to lead prompt treatment and prevent sight-threatening complications.
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Affiliation(s)
| | | | | | - Jorge E Valdez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
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Sabater-Cruz N, Dotti-Boada M, Rios J, Carrion MT, Chamorro L, Sánchez-Dalmau BF, Casaroli-Marano RP. Postoperative treatment compliance rate and complications with two different protocols after pterygium excision and conjunctival autografting. Eur J Ophthalmol 2020; 31:932-937. [PMID: 32338523 DOI: 10.1177/1120672120917335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate compliance rate to pterygium postoperative treatment with two different protocols. METHODS Review of clinical data of patients submitted to pterygium excision and conjunctival autografting in a single centre (and a single surgeon) in Barcelona between March 2014 and December 2017. Initial postoperative protocol (protocol 1) consisted of 4 months of topical steroids in a tapering fashion. Protocol 2 consisted of topical steroids tapered over 5 weeks. Compliance rate, complications and clinical outcomes were evaluated, and statistical comparisons were made. RESULTS 120 surgeries were performed in 99 patients. Protocol 1 was applied in 63 cases and the next 57 followed protocol 2. Compliance with protocol 1 (57.6%) was lower than with protocol 2 (84.9%) (p = 0.002). Intraoperative complications (graft tear, corneal thinning, corneal perforation and bleeding) were found in 10 cases of protocol 1 and three cases of protocol 2, p = 0.08. Postoperative complications (graft dislocation, graft haematoma, ocular hypertension and recurrence) were found in 31 cases of protocol 1 (46.2%) and eight cases of protocol 2 (14%), p = 0.001. Six weeks after surgery, ocular hypertension was detected in eight cases corresponding to protocol 1 (13.6%) and two cases of protocol 2 (3.8%), p = 0.099. Recurrence rate during first year was higher in protocol 1 (26.3%) compared to protocol 2 (7.6%), p = 0.011. No cases of visual acuity worsening or infection were registered. CONCLUSION Protocol 2 has shown to have higher compliance rate than protocol 1 and less postoperative complications, proving to be a safe and effective postoperative treatment after pterygium surgery.
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Affiliation(s)
- Noelia Sabater-Cruz
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain.,Ophthalmology Service, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Marina Dotti-Boada
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - José Rios
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Teresa Carrion
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lillian Chamorro
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Bernardo F Sánchez-Dalmau
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Surgery, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Ricardo-Pedro Casaroli-Marano
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Surgery, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
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Çolak S, Kazanci B, Ozçelik Soba D, Ozdamar Erol Y, Yilmazbas P. Effects of diabetes duration and HgA1C level on corneal endothelial morphology. Eur J Ophthalmol 2020; 31:967-975. [PMID: 32321301 DOI: 10.1177/1120672120914812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effects of the HbA1c level and the duration of diabetes mellitus on the corneal endothelium morphology and to compare between healthy individuals and diabetes mellitus patients with non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. MATERIAL AND METHODS Ninety patients who applied to the Health Sciences University Ulucanlar Eye Training and Research Hospital between January 2016 and January 2017 were included in this prospective randomized study. In the study, 45 diabetes mellitus patients and 45 healthy individuals were evaluated. The diabetes patients were compared in terms of HbA1c level, diabetes mellitus duration, corneal endothelial cell density, coefficient of variation, standard deviation, and hexagonality with healthy control group. RESULTS A statistically significant difference was found in the endothelial cell densitometer, coefficient of variation, and standard deviation measurements between the diabetes mellitus patients and the control (healthy) group. But, there was no statistically significant difference between 6A (hexagonality) and central corneal thickness measurements. There was a negative correlation between HbA1c levels and diabetes mellitus times and endothelial cell densitometer values in the patients with diabetes mellitus diagnosis and standard deviation values in the positive direction. There was a statistically significant difference between diabetes mellitus patients with the diagnosis of non-proliferative diabetic retinopathy and proliferative diabetic retinopathy in the endothelial cell densitometer and standard deviation values. But there was not any statistically significant difference between coefficient of variation, 6A, and central corneal thickness values. CONCLUSION The endothelial cell densitometer in diabetes mellitus patients with retinopathy is lower than that in healthy individuals. There is a negative correlation between retinopathy severity and corneal endothelial cell density. Diabetes affects negatively not only vascular tissues but also avascular cornea.
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Affiliation(s)
- Salih Çolak
- Ministry of Health, Osmaniye Government Hospital, Osmaniye, Turkey
| | - Burcu Kazanci
- Ministry of Health, Ulucanlar Eye Research and Education Hospital, Ankara, Turkey
| | - Dilek Ozçelik Soba
- Ministry of Health, Ulucanlar Eye Research and Education Hospital, Ankara, Turkey
| | - Yasemin Ozdamar Erol
- Ministry of Health, Ulucanlar Eye Research and Education Hospital, Ankara, Turkey
| | - Pelin Yilmazbas
- Ministry of Health, Ulucanlar Eye Research and Education Hospital, Ankara, Turkey
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Einan-Lifshitz A, Sorkin N, Smollan G, Barequet I. The effect of recurrent povidone-iodine usage on conjunctival flora in diabetic patients undergoing intravitreal injections. Eur J Ophthalmol 2020; 31:607-611. [PMID: 31983226 DOI: 10.1177/1120672120902032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose was to evaluate the change in the microbiological profile of diabetic patients undergoing intravitreal injections for diabetic macular edema. METHODS Patients were included in this prospective study when referred for the first time for intravitreal injection to treat diabetic macular edema. For each patient, conjunctival cultures were taken from the lower fornix of each eye prior to the povidone-iodine application and the intravitreal injection. An additional culture was taken from the treated eye 20 min after the injection. The same culture protocol was used for the two following injections of these patients. A later conjunctival culture was also taken a month after the last injection. RESULTS Twenty-one eyes of 21 patients were included. The mean duration of diabetes was 13.7 ± 7.9 years. Prior to the first intravitreal injection, 33% of cultures were positive. Prior to the third intravitreal injection, 26% of cultures were positive (p = 0.63), and 1 month after the last injection, 18% of cultures were positive (p = 0.495). The mean HbA1C was 8.1% ± 1.7%. HbA1C of patients with positive cultures was 8.0% ± 1.1% at the first intravitreal injection and 8.2% ± 1.0% at the third intravitreal injection. This was compared with HBA1C in eyes with negative cultures: 7.4% ± 1.2% (p = 0.45) and 7.1% ± 1.0% (p = 0.14), respectively. CONCLUSION Repeated intravitreal injection for diabetic macular edema with application of povidone-iodine 5% in diabetic patients did not lead to a significant change in the percentage of positive conjunctival cultures. Patients with higher HbA1C had a slight, non-statistically significant trend for positive cultures.
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Affiliation(s)
- Adi Einan-Lifshitz
- Department of Ophthalmology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Sorkin
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Gill Smollan
- Clinical Microbiology Laboratory, Sheba Medical Center, Ramat Gan, Israel
| | - Irit Barequet
- The Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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de Paula A, Oliva G, Barraquer RI, de la Paz MF. Prevalence and antibiotic susceptibility of bacteria isolated in patients affected with blepharitis in a tertiary eye centre in Spain. Eur J Ophthalmol 2019; 30:991-997. [PMID: 31232091 DOI: 10.1177/1120672119854985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe which bacteria can be found on lid margins in patients affected with blepharitis, to show their antibiotic susceptibility pattern, and to evaluate the antibiotic resistance trend of coagulase-negative Staphylococcus through time. MATERIALS AND METHODS Consecutive cases of 198 eyes affected with blepharitis between 2012 and 2018 were reviewed. A sample was collected by rubbing a swab against the base of the eyelashes of both the eyes of all patients. The samples were inoculated in blood agar and chocolate agar. The susceptibility of the identified bacteria to common antibiotics was tested. In addition, the antibiotic susceptibility pattern of coagulase-negative Staphylococcus detected from year 2016 to 2018 was compared with that of 4 years before. RESULTS The most common isolated bacterium was coagulase-negative Staphylococcus (89%) and Staphylococcus aureus (28%). Coagulase-negative Staphylococcus showed highest susceptibility to vancomycin (100%), neomycin (94%) and chloramphenicol (91%). Coagulase-negative Staphylococcus and Staphylococcus aureus were the most resistant to penicillin and erythromycin (resistance in 92%, 91% for coagulase-negative Staphylococcus, 86% and 43% of eyes for Staphylococcus aureus). Corynebacterium was resistant to oxacillin and erythromycin. Streptococcus viridans showed resistance to gentamycin and tobramycin. Moraxella was susceptible to most antibiotics. Bacillus was resistant to oxacillin. The antibiotic resistance trend of coagulase-negative Staphylococcus showed that the resistance to rifampicin increased through the years 2012-2018. CONCLUSION Coagulase-negative Staphylococcus and Staphylococcus aureus were the most isolated bacteria in patients affected by blepharitis in our tertiary eye centre. Both bacteria were resistant to erythromycin. Through the years, it seems that coagulase-negative Staphylococcus gained resistance to penicillin, erythromycin, ciprofloxacin and rifampicin.
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Affiliation(s)
- Alessandro de Paula
- Ophthalmology Unit, NESMOS Department St. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Gloria Oliva
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael Ignacio Barraquer
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maria Fideliz de la Paz
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
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