Band Keratopathy Research Articles

Cysteamine eye drops in the treatment of cystinosis – an Australian perspective

AbstractCystinosis is a rare but very serious genetic disorder. Advancements in medical science, in the past few decades, have transformed this previously terminal condition into a manageable disease. Ophthalmic sequelae of cystinosis are caused by accumulation of cystine crystals in ocular tissues and are very troublesome for most cystinosis patients. Accumulation of crystals in the cornea causes debilitating photophobia and pain that does not respond to systemic cysteamine therapy. If left untreated, this can lead to structural damage (corneal ulcers, scarring and band keratopathy) and eventually result in corneal blindness requiring corneal transplant. Topical ophthalmic application of cysteamine can alleviate the symptoms and, if instituted early, may prevent the damage. There is no commercially manufactured ophthalmic cysteamine product available in Australia and patients who receive treatment are usually supplied with extemporaneously prepared cysteamine eye drops or ointment. Stability issues, various factors influencing product effectiveness and patient adherence are only few of the problems that make formulation and compounding of cysteamine ophthalmic products a complex task.

Uveitic band keratopathy: child and adult.

BackgroundCalcified band keratopathy is a chronic degenerative disease characterized by the deposition of gray to white opacity in superficial layers of the cornea that typically develops over months or years. It is associated with a variety of conditions, including chronic uveitis.PurposeThe objective of this study is to assess visual acuity and corneal changes in patients with band keratopathy secondary to uveitis who underwent phototherapeutic keratectomy (PTK).SettingThe place where this study was performed was in the Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo.DesignThis is a retrospective study.MethodsPatients with uveitic band keratopathy were submitted to PTK. The PTK was performed using Allegreto Wave EX500, with the ablation area of 6 mm.ResultsTwelve patients (13 eyes) diagnosed with band keratopathy secondary to chronic uveitis were analyzed. Of the 12 patients, 8 patients were female (66 %), aged 22 years (7–53 years). From the 12 patients (13 eyes) evaluated in this study, only one patient (one eye) did not have visual improvement, due to epithelial deposits 2 weeks after PTK, and all the others benefited with the procedure. In the children group, all eyes had visual improvement, and quantitatively speaking, the children had a more significant improvement than adults.ConclusionsPTK is a safe and effective procedure even for children. However, the improvement in visual acuity was restricted due to other ocular changes secondary to uveitis, such as cataract and retinal changes, or even the corneal irregularity.

Neovascular glaucoma following Nd:YAG laser capsulotomy in a patient with diabetes and syphilitic uveitis

A diabetic woman had been suffering from progressively blurry vision in the right eye for 1 year after cataract surgery. Slit lamp examination revealed bilateral band keratopathy with quiescent anterior-chamber reaction, an intumescent cataract in the left eye, and dense posterior capsular opacity in the right eye. Capsulotomy was performed, but this led to neovascular glaucoma. Because of a refractory elevation in intraocular pressure, trabeculectomy with mitomycin C treatment, vitrectomy with panretinal photocoagulation, and intravitreal injection of bevacizumab were performed. A positive rapid plasma reagin test and a positive Treponema pallidum hemagglutination assay led to the impression of syphilitic uveitis, and the patient was treated with intravenous penicillin for 2 weeks. The visual acuity of the right eye was 0.1 at the 12th-month follow up. This case shows that neovascular glaucoma may present as a complication of capsulotomy in uveitic/diabetic eyes.

Central islands: rate and effect on visual recovery after phototherapeutic keratectomy.

To retrospectively assess the proportion of patients affected by a central island (CI) and its effect on visual recovery after phototherapeutic keratectomy (PTK). This retrospective study evaluated 30 eyes of 21 consecutive patients (mean age ± standard deviation, 69.6 ± 6.8 years) undergoing PTK for the treatment of band keratopathy or granular corneal dystrophy. We investigated the rate of CI formation, which was defined as a steepening area of 3 D, 1.5 mm in diameter, on each corneal videokeratograph (ATLAS 9000; Carl Zeiss Meditec), and its effect on visual recovery at 3 months and at 1 year postoperatively. A CI was found in 22 of 30 eyes (73%) 3 months postoperatively and in 14 of 25 eyes (56%) 1 year postoperatively. The degree of CI was significantly correlated with the change in logMAR corrected visual acuity (Spearman correlation coefficient r = 0.445, P = 0.026). The degree of CI in eyes with band keratopathy was significantly larger than that in eyes with granular dystrophy 1 year postoperatively (Mann-Whitney test, P = 0.045). The degree of CI was not significantly correlated with the ablation depth (Spearman correlation coefficient r = 0.116, P = 0.582) or the residual corneal thickness (r = -0.235, P = 0.278). CI formation was found in as many as 73 and 56% of patients 3 months and 1 year after PTK, respectively, using the VISX Star S4 excimer laser system, and significantly affected the improvement of visual acuity. The anti-CI program should be applied by the manufacturer, not only for corneal refractive surgery but also for PTK in a clinical setting.

Ketamine/Xylazine-Induced Corneal Damage in Mice.

PurposeWe have observed that the commonly used ketamine/xylazine anesthesia mix can induce a focally severe and permanent corneal opacity. The purpose of this study was to establish the clinical and histological features of this deleterious side effect, its sensitivity with respect to age and anesthesia protocol, and approaches for avoiding it.MethodsYoung C57BL/6J, C57BLKS/J, and SJL/J mice were treated with permutations of anesthesia protocols and compared using slit-lamp exams, optical coherence tomography, histologic analyses, and telemetric measurements of body temperature.ResultsKetamine/xylazine induces corneal damage in mice with a variable frequency. Among 12 experimental cohorts, corneal damage associated with ketamine/xylazine was observed in 9 of them. Despite various treatments to avoid corneal dehydration during anesthesia, the frequency of corneas experiencing damage among responding cohorts was 42% (26% inclusive of all cohorts), which is significantly greater than the natural prevalence (5%). The damage was consistent with band keratopathy. It appeared as a white or gray horizontal band located proximal to the pupil and was positive for subepithelial calcium deposition with von Kossa stain.ConclusionsThe sum of our clinical and histological observations is consistent with ketamine/xylazine-induced band keratopathy in mice. This finding is relevant for mouse studies involving the eye and/or vision-dependent behavioral assays, which would both be prone to artifact without appreciation of the damage caused by ketamine/xylazine anesthesia. Use of yohimbine is suggested as a practical means of avoiding this complication.

23 gauge pars plana vitrectomy for the removal of retained intraocular foreign bodies.

BackgroundTo evaluate the morpho-functional outcomes and safety of transconjuctival 23-gauge pars plana vitrectomy(PPV) for removal of intraocular foreign bodies (IOFBs).MethodsA retrospective study of 36 consecutive cases (mean age; 34,2 ± 10,9 years (between 15 and 60), 27 M,9 F) of 23-G PPV for the removal of IOFBs during the period of April 2009 and December 2011 and followed 9,4 ± 6,4(2–27) months were conducted. Visual outcomes, slit lamp biomicroscopy, intraocular pressure (IOP), and posterior segment visualization by indirect ophthalmoscopy, A-B mode ultrasonography, and computed orbital tomography were performed for all cases. Main outcomes including anatomic and visual outcomes, and both intraoperative and postoperative complications were recorded.ResultsOf the 36 cases available for the study, the IOFBs (size range, 3 to 12 mm) could be removed in all eyes. Mean preoperative LogMAR BCVA was 1.44 ± 138 (range, 1.00 to 0.00) and mean postoperative LogMAR BCVA at final visit was 0,78 ± 0,98 (range, 1.00 to 0.00). (P = 0,007) Anatomic success was obtained in 97.2 % of eyes. 16 patients needed primary wound repair due to the leakage in insertion sites before the PPV, however remaining 20 cases were not. Fibrin reaction was seen in 8 (22.2 %) patients in early postoperative period, intraocular pressure elevation was detected in 12 (33.3 %) patients in which the silicone oil was used as an intravitreal tamponade, one patient with silicone oil tamponade developed band keratopathy and phthisis bulbi.Conclusions23-Gauge PPV is a feasible, effective approach in the surgical management of the patients with posterior segment intraocular foreign bodies.

Outcomes of cataract surgery in graft-versus-host disease.

To study the outcomes of cataract surgery in patients with graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). Retrospective review of 72 eyes of 41 patients (age, 17-69 years at the time of surgery) with chronic GVHD after HSCT, who underwent cataract surgery between 2008 and 2012 at the Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan. Ophthalmic data collected included best-corrected visual acuity (BCVA), responses to Ocular Surface Disease Index (OSDI) questionnaire, dry eye severity, and postoperative complications. BCVA improved from 20/49 to 20/25 (P < 0.0001) after surgery. Eight patients (20%) had pretransplantation total body irradiation and 39 patients (95%) received systemic corticosteroids for the treatment of GVHD. Postoperative complications included cystoid macular edema (4 eyes), corneal ulceration with perforation (2 eyes: 1 infected and 1 sterile), and band keratopathy (1 eye). After surgery, subjective OSDI responses and dry eye disease (DED) did not change significantly from before cataract surgery, although OSDI showed a trend toward worsening. With careful monitoring and management of DED and concurrent ocular surface disease, cataract surgery generally has good visual outcomes in patients with GVHD. However, aggravation of the preexisting ocular surface disease is frequent, and despite meticulous postoperative maintenance therapy, vision-threatening complications may occur.

Uveitis associated with juvenile idiopathic arthritis.

Uveitis is a potentially sight-threatening complication of juvenile idiopathic arthritis (JIA). JIA-associated uveitis is recognized to have an autoimmune aetiology characterized by activation of CD4(+) T cells, but the underlying mechanisms might overlap with those of autoinflammatory conditions involving activation of innate immunity. As no animal model recapitulates all the features of JIA-associated uveitis, questions remain regarding its pathogenesis. The most common form of JIA-associated uveitis is chronic anterior uveitis, which is usually asymptomatic initially. Effective screening is, therefore, essential to detect early disease and commence treatment before the development of visually disabling complications, such as cataracts, glaucoma, band keratopathy and cystoid macular oedema. Complications can result from uncontrolled intraocular inflammation as well as from its treatment, particularly prolonged use of high-dose topical corticosteroids. Accumulating evidence supports the early introduction of systemic immunosuppressive drugs, such as methotrexate, as steroid-sparing agents. Prospective randomized controlled trials of TNF inhibitors and other biologic therapies are underway or planned. Future research should aim to identify biomarkers to predict which children are at high risk of developing JIA-associated uveitis or have a poor prognosis. Such biomarkers could help to ensure that patients receive earlier interventions and more-potent therapy, with the ultimate aim of reducing loss of vision and ocular morbidity.

Corneal epithelial debridement for diagnosis and therapy of ocular surface disease

BackgroundThere is a wide range of ocular surface conditions that can be diagnosed or treated with epithelial debridement. The purpose of this study is to analyse the indications, instrumentation and outcomes of corneal epithelial debridement for anterior segment pathology.MethodsOne hundred and thirty‐three eyes of 129 patients with ocular surface disease were treated with epithelial debridement. Different methods were used, appropriate to the specific disease, aetiology and outcome measure.ResultsThe mean patient age was 56 years and 81 (60.9 per cent) were male. Sixty‐two eyes (46.6 per cent) were undertaken for diagnosis and 71 (53.4 per cent) for therapy. Common indications for diagnostic corneal debridement included infective keratitis 48 (36.1 per cent), neoplasia 14 (10.5 per cent), while those for therapeutic corneal debridement included recurrent erosion 30 (22.5 per cent) and band keratopathy 16 (12.0 per cent). The most common post‐operative complication was pain, occurring in all patients to some extent. Band keratopathy was seen to recur in two (12.5 per cent) of the treated eyes and there was a single relapse of recurrent erosion during the follow‐up period.ConclusionThe techniques presented can be undertaken in the office rather than a day procedural unit, improving time and cost‐effectiveness for the ophthalmologist and patient.

Pars Planitis: Epidemiology, Clinical Characteristics, Management and Visual Prognosis.

Pars planitis is an idiopathic chronic intermediate uveitis which predominantly affects children and adolescents, and accounts for 5-26.7% of pediatric uveitis. Although an autoimmune process with a genetic predisposition has been suggested, its etiology still remains unknown. The most common presenting symptoms are floaters and blurred vision. Diffuse vitreous cells, haze, snowballs and snowbanks are typical findings of pars planitis. Peripheral retinal vasculitis, optic disc edema and anterior segment inflammation are other well-known findings. Although pars planitis is known to be a benign form of uveitis in most cases, it may become a potentially blinding disease due to complications including cataract, cystoid macular edema, vitreous opacities and optic disc edema. Cystoid macular edema is the most common cause of visual morbidity. Band keratopathy, epiretinal membrane formation, vitreous condensation, neovascularizations, vitreous hemorrhage, retinal detachment, cyclitic membranes, glaucoma and amblyopia may develop as a consequence of the chronic course of the disease. Exclusion of infectious and non-infectious causes which may present with intermediate uveitis is of utmost importance before starting treatment. Treatment of pars planitis has been a controversial issue. There is no consensus specifically for treatment of cases with minimal inflammation and relatively good visual acuity. However, current experience shows that pars planitis may cause severe inflammation and needs an aggressive treatment. A stepladder approach including corticosteroids, immunosupressive agents, anti-tumor necrosis factor-alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Adequate control of inflammation and prompt detection of associated complications are crucial in order to improve the overall prognosis of the disease.

Deep anterior lamellar keratoplasty using irradiated acellular cornea with amniotic membrane transplantation for intractable ocular surface diseases.

PurposeTo report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) when sterile gamma-irradiated acellular corneal tissues (VisionGraft) are used in combination with amniotic membrane transplantation (AMT) for intractable ocular surface diseases.MethodsThe medical records of fifteen patients who had DALK with AMT were retrospectively reviewed. Indications for surgery included ocular burn, bacterial keratitis, herpes simplex virus keratitis, corneal opacity with Stevens-Johnson syndrome, Mooren's ulcer, idiopathic myxoid degeneration of corneal stroma, and recurrent band keratopathy. DALK was performed using partial-thickness acellular corneal tissue and a temporary amniotic membrane patch was added at the end of the operation.ResultsAll cases that underwent DALK with AMT became epithelialized within 2 postoperative weeks. Twelve patients showed favorable outcomes without graft rejection, corneal opacification, or neovascularization. The other three grafts developed corneal opacification and neovascularization, and required additional penetrating keratoplasty (PK). Unlike the results of previous PKs, there were no graft rejections and the graft clarity was well-maintained in these three cases for at least 8 months after PK.ConclusionsDALK using sterile acellular corneal tissues in combination with AMT may be a good therapeutic strategy for treating intractable ocular surface diseases because of lowered immune rejection, fibroblast activation, and facilitation of epithelialization. Furthermore, DALK can help stabilize the ocular surface, prolong graft survival, and may allow better outcomes when combined with subsequent PK.

Corneal calcification and phosphates: do you need to prescribe phosphate free?

Both superficial band keratopathy and deeper calcareous calcification have been linked to the presence of phosphate excipients in topical ophthalmic medicines. (1-3) The European Medicines Agency (EMA) has concluded that patients with ocular surface disease are at greatest risk. This potential side effect should be highlighted to both prescribers and patients. (4) We aimed to review the excipients of commonly prescribed ophthalmic medicines to prepare a list of phosphate-containing drugs and also to investigate where to find this information. We reviewed 78 commonly used ophthalmic drops and ointments for the information about their excipients. We reviewed the information written on drug boxes, bottles, patient leaflets, and in the electronic Medicines Compendium (EMC), which contains up-to-date details of all medicines licensed for use in the United Kingdom. The British National Formulary (BNF) was also reviewed. We found 22 phosphate-containing, 13 unbuffered, and 43 ophthalmic drugs containing buffers other than phosphate based. Most displayed the list of their excipients on their boxes and in patient leaflets. This information was also available on the EMC website but not in the BNF. Despite the EMA recommendation, none of the phosphate-containing medicines mentions corneal calcification as a potential side effect. We present a reference list of phosphate-based ophthalmic drugs to be used with caution for patients with a compromised ocular surface. We found the EMC to be a reliable and easily accessible source of information about drug components. This information will also be included in the new editions of the BNF.

Surgical intrastromal keratopigmentation using tattoo ink

Case reportA 31-year-old woman who had undergone surgery for a congenital cataract as a newborn developed bilateral malignant glaucoma, which was refractory to medical-surgical treatment. The patient currently has terminal glaucoma and severe band keratopathy. For esthetic purposes, we performed intrastromal keratopigmentation surgery using ink for skin tattoos supplied in sterile single-dose vessels. No secondary effects or complications were observed. DiscussionKeratopigmentation or corneal tattooing can now be used as a last resort in patients who are unable to tolerate cosmetic contact or intraocular lenses, or in whom corneal transplant is contraindicated.

THU0062 Course and Outcome of Uveitis in Patients with Ankylosing Spondylitis

BackgroundUveitis is most common extraskeletal manifestation of ankylosing spondylitis (AS). In accordance with traditional views, uveitis within AS characterized by favourable course and rarely leads to impaired vision.ObjectivesTo assess clinical...

Phototherapeutic Keratectomy for Treatment of Corneal Diseases : Our Experience at King Hussein Medical Center

phototherapeutic keratectomy for various corneal conditions were included in the study. Patients with any systemic disease that would affect epithelial healing such as diabetes or systemic lupus were excluded from the study. Data was collected including patient's age, gender, visual acuity, primary diagnosis, refraction, corneal thickness using Pentacam (Oculus, Wetzlar, Germany) and presence of any systemic disease. All patients were followed after one week of treatment. Bandage contact lens was removed and the cornea checked for epithelial healing and the patients were followed up for at least 6 months after treatment. Results: One hundred and forty-six eyes of 146 patients with a mean age of 57 years (range 7 to 74 years) were enrolled in the study, 87 of them were males. The most common type of corneal pathology found was band keratopathy (37%) followed by old superficial corneal scars (22%), other pathologies found included: Salzmann nodules (12%), bullous keratopathy (9%), spheroidal degeneration (6%), keratoconus with nebula (6%), granular dystrophy (3%), Reis Buckler dystrophy (3%) and recurrent corneal erosions syndrome (3%). Ninety percent of patients experienced improvement in their vision. All patients showed satisfactory improvement in either visual acuity or symptoms of pain and discomfort in the immediate post operative period. Conclusion: Phototherapeutic keratectomy is a safe and very effective procedure to be used for treatment of various surface corneal lesions.

A41: The Effects of Youngsters' Eyesight on Quality of Life as a Measure of Uveitis Activity, Visual Function and Vision Related Quality of Life in Childhood Uveitis

Background/Purpose:The Effects of Youngsters Eyesight on Quality of Life (EYE‐Q) is a valid instrument that measures visual function and vision related quality of life (QOL) in children with ocular disease. Our objective is to determine whether the EYE‐Q is valid in children with uveitis.Methods:Children with uveitis (JIA‐associated uveitis (JIA‐U) and idiopathic uveitis (IU)) who have had a slit lamp examination within one month of completing the EYE‐Q were included. We collected data related to uveitis clinical characteristics and the ocular examination (LogMAR visual acuity (VA), intraocular pressure (IOP), and # of cells) in the worse and better eye. Questionnaires were completed on overall QOL (Pediatric QOL Inventory—MPedsQL), and vision (EYE‐Q). We determined associations between the EYE‐Q and the ocular exam using Spearman's correlation coefficients.Results:There were 19 children with JIA‐U and 17 with I‐U included with a total of 42 ocular examinations performed. Females comprised 75%, with a mean age of diagnosis of 5.6 (SD = 3.6) years. There were 29 (80%) children with bilateral disease, with varied uveitis locations (anterior (69%), intermediate (25%), and panuveitis (6%)), and numerous ocular complications (synechiae (53%), cataracts (44%), band keratopathy (25%), cystoid macular edema (22%), and glaucoma (6%)). At time of examination, 28% were being treated with oral methotrexate, 52% with subcutaneous methotrexate, 14% with infliximab, and 2% with adalimumab. There were 71% of children on eye drops, 59% on ocular steroids, and 2% on mydriatics. Mean PedsQL score was 80.9 ± 15.6. Mean EYE‐Q score was 3.1 ± 0.6. Slit lamp examination showed worse LogMAR VA in children with I‐U compared to JIA‐U but similar IOP and # of cells (Table ).For both the child and parent reports, the EYE‐Q had moderate correlations with LogMAR VA and the PedsQL, and mild to no correlations with # of cells and IOP (Table ). The PedsQL had mild to no correlations with LogMAR VA, # of cells and IOP. Ocular examinations in children with uveitis Ophthalmology exam Uveitis (n=21) JIA‐U (n=21) Worse eye Intraocular pressure, mean±SD 17.9 ± 7.9 17.6 ± 7.3 LogMar visual acuity, mean±SD 0.75 ± 0.67 0.18 ± 0.20 Slit lamp exam Cells, N (%) 0 (&lt;1 cell in field) 11 (73.3%) 11 (55.5%) 0.5+ (1–5 cells in field) 1 (6.7%) 2 (10.0%) 1+ (6–15 cells in field) 1 (6.7%) 3 (15.0%) 2+ (16–25 cells in field) 0 (0.0%) 4 (20.0%) 3+ (26–50 cells in field) 2 (13.3%) 0 (0.0%) Better Eye Intraocular pressure, mean±SD 12.9 ± 5.0 13.9 ± 4.4 LogMar visual acuity, mean±SD 0.31 ± 0.38 0.07 ± 0.12 Slit lamp exam Cells, N (%) 0 (&lt;1 cell in field) 13 (86.7%) 16 (80.0%) 0.5+ (1–5 cells in field) 0 (0.0%) 1 (5.0%) 1+ (6–15 cells in field) 1 (6.7%) 1 (5.0%) 2+ (16–25 cells in field) 0 (0.0%) 2 (10.0%) 3+ (26–50 cells in field) 1 (6.7%) 0 (0.0% Correlation of the EYE‐Q and PedsQL with standard measures of uveitis activity EYE‐Q child (range 0–4) R [95% CI] P value Better Eye LogMAR VA −0.36 (−0.66−0.06) 0.089 Cells −0.16 (−0.56−0.31) 0.501 IOP 0.167 (−0.28−0.55) 0.463 Worse Eye LogMAR VA −0.51 (−0.75−(−0.12)) 0.010 Cells 0.063 (−0.39−0.49) 0.795 IOP −0.16 (−0.54−0.29) 0.492 PedsQL Total scale 0.66 (0.32–0.84) &lt;0.001 EYE‐Q parent (range 0–4) Better Eye LogMAR VA −0.31 (−0.56−0.004) 0.050 Cells −0.07 (−0.49−0.37) 0.751 IOP 0.06 (−0.46−0.22) 0.457 Worse Eye LogMAR VA −0.35 (−0.59−(−0.04)) 0.027 Cells −0.14 (−0.45−0.21) 0.411 IOP −0.14 (−0.46−0.22) 0.457 PedsQL Total scale 0.52 (0.23−0.72) &lt;0.001 PedsQL (range 0‐100) Better Eye LogMAR VA 0.03 (−0.30−0.35) 0.867 Cells −0.21 (−0.51−0.15) 0.240 IOP 0.05 (−0.32−0.41) 0.792 Worse Eye LogMAR VA −0.13 (–0.43–0.21) 0.434 Cells −0.25 (−0.54−0.11) 0.169 IOP 0.13 (–0.25–0.47) 0.494 Spearman's correlation coefficients p–value &lt;0.05 Mild correlations: R &lt;0.3; Moderate correlations: R = 0.3–0.7; Strong correlation: R = &gt;0.7 Effects of Youngsters Eyesight on QOL LogMAR visual acuity intraocular pressure Pediatric Quality of Life InventoryConclusion:The EYE‐Q is an important instrument in the measurement of QOL and function in children with uveitis. Since many children with active disease are asymptomatic, the EYE‐Q may not reflect the presence of active disease based on the slit lamp examination, but can detect changes in vision related to function and QOL. Since the EYE‐Q demonstrated moderate correlations with standard measures of QOL and function, whereas the PedsQL showed mild to no correlations, the EYE‐Q may be an important component of the global assessment of visual function and QOL in this population.

Treatment of nonhealing corneal ulcers in 60 horses with diamond burr debridement (2010–2013)

To review the signalment, clinical characteristics, and outcome of horses with nonhealing corneal ulcers treated with diamond burr debridement (DBD); and to evaluate the role of ulcer duration, size and location, and bandage contact lens (BCL) placement on healing. From January 2012-April 2013, 60 horses were diagnosed with ulcers classified as nonhealing based on the presence of raised epithelial margins and duration of at least 7 days. Retrospective record review. Average age of included horses was 14.68 years, SD 8.17 years. There were three times as many males (45) as females (15), (χ12 = 15, P = 0.001). Forty-eight horses (80%) had nonhealing ulcers uncomplicated by associated corneal disease. In the remaining horses, associated corneal disease included esinophilic keratitis (10%), calcific band keratopathy (5%), endothelial decompensation (1.67%), habronemiasis(1.67%), and lid suture abrasion (1.67%). Average corneal ulcer duration prior to diamond burr debridement (DBD) was 29.0 days (n = 56). Ulcers occurred most commonly in the axial cornea (41%). Fifty-five of 60 horses (92%) healed with DBD. Healing time, defined as time to epithelialization following DBD, averaged 15.5 days, SD 9.32 days, and was not correlated with patient age or ulcer duration, location, or size prior to or following DBD. Healing time was significantly longer for eyes in which a BCL had been placed (n = 28, 19.0 days) than for eyes without a BCL (n = 32, 12.9 days), F(1,58) = 5.543, P = 0.02. DBD was considered a failure for five horses (8%). DBD may be an effective treatment for nonhealing corneal ulcers in horses.

Juvenile Idiopathic Arthritis-associated Uveitis at an Italian Tertiary Referral Center: Clinical Features and Complications

Purpose: To describe the frequencies and risk factors of ocular complications and poor visual outcomes in children with juvenile idiopathic arthritis (JIA).Methods: Retrospective cohort study, including 69 consecutive children (116 eyes) affected by JIA-associated uveitis managed at a tertiary uveitis clinic.Results: The incidence of visual loss to the 20/50 or worse threshold was 0.04/eye-year (EY) and to the 20/200 or worse threshold was 0.02/EY. The most common complications at baseline were posterior synechiae (52%), band keratopathy (38%), and cataract (12%). Risk factor for a visual acuity threshold of 20/50 or worse included hypotony (p = 0.01; hazard ratio [HR] 3.7; 95% CI 1.3–10.4); anterior chamber flare >1 (p = 0.04; HR 1.3; 95% CI 0.5–3.4); a positive antinuclear antibody (ANA) (p = 0.02; HR1.4; 95% CI 0.8–2.4). Hypotony and positive ANA are also associated to the 20/200 or worse threshold (p = 0.03; HR 5.1; 95% CI 1.1–23.9 and p = 0.04; HR 1.0; 95% CI 0.4–2.3; respectively). Use of immunosuppressive drugs was associated with a reduced risk of visual loss of 20/200 or worse (odds ratio 0.14, 95% CI, 0.02–1.29; p = 0.04).Conclusions: Loss of vision and ocular complications still occur among children with JIA-related uveitis. Prompt diagnosis and a strict follow up associated to immunosuppressive therapy may decrease the poor visual outcome.

Calcium Hydroxyapatite Crystals in the Anterior Chamber of the Eye in a Patient With Renal Hyperparathyroidism

To report a case of calcium hydroxyapatite crystals in the anterior chamber of a patient with renal hyperparathyroidism. Case report. A 54-year-old man visited our clinic with mild ocular pain and decreased visual acuity in his left eye. A slit-lamp examination showed peripheral corneal band keratopathy and multiple white crystals in the anterior chamber. The patient had chronic renal failure and was on regular hemodialysis treatment for 12 years. He had previously undergone total parathyroidectomy because of secondary renal hyperparathyroidism. Aqueous humor analysis showed elevated phosphate levels. Multiple crystals were removed using a manual irrigation and aspiration cannula and were found to be calcium hydroxyapatite crystals on elemental analysis using energy dispersive x-ray spectroscopy. Ocular pain and visual acuity improved and corneal edema and ocular inflammation decreased after the surgery. Calcium hydroxyapatite crystals can form in the anterior chamber of the eye in a patient with renal hyperparathyroidism.

Calcific band keratopathy in an alpaca

A 4-year-old female Suri alpaca was presented for evaluation of acute onset weakness, lethargy, and recent development of opacities in both eyes. On ophthalmic examination, bilaterally symmetrical corneal opacities were noted along the interpalpebral fissures with a few corneal blood vessels intermingled. A presumed diagnosis of calcific band keratopathy was made based on location and appearance. The patient was euthanized a short while after diagnosis due to reasons unrelated to the eyes and histologic examination of the corneas revealed subepithelial calcium and vascularization, consistent with calcific band keratopathy. This case report is the first to document this ocular condition in an alpaca.