Corneal Leukoma Research Articles

Укрепление бельма аутотрансплантатом височной фасции при кератопротезировании

Abstract Dependable covering of keratoprosthesis with temporal fascia autograft M.G. Kataev, A.V. Golovin, O.N. Nefedova, I.Yu. Trofimova S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To propose a surgical technique to secure keratoprosthesis from protrusion by covering the plate with temporal fascia autograft. Material and methods. This study included 17 patients (17 eyes) with corneal leucoma, who underwent surgery of covering the leucoma with temporal fascia autograft at the first stage of keratoprosthesis implantation (6 eyes), or transplantation of corneal-prosthetic complex (4 eyes) or protrusion of the keratoprosthesis supporting plate (7 eyes). 4 cm long skin linear incision was performed, temporal fascia autograft 15–18 mm in diameter was harvested and placed on cornea, fixed to the sclera by 8 peripheral not absorbable sutures. Flaps of Tenon’s capsule was undermined in the intermuscular quadrants and sutured together by purse absorbable suture covering the autograft. Conjunctiva was closed by running absorbable suture. Eyelids were secured together by one blepharorrhaphy stich. Patients were examined before surgery, 7–10 days and 6 months after surgery. The follow-up period was on average 18 months. Results. The depth of the keratoprosthesis supporting plate at least 6 months after surgery was on average 1141 µm. The following postoperative complications were noted: in 6 (35.3%) cases the optical cylinder of keratoprosthesis became overgrown. In one case (5.9%) the optical cylinder was opened by a local excision of the conjunctiva. In 5 cases (29.4%) the optical cylinder was replaced with a higher one. In one case (5.9%) protrusion of the keratoprosthesis supporting plate occurred and the leucoma was re-covered with temporal fascia autograft. In other cases, the keratoprosthesis supporting plate was tightly fused with the underlying tissues of the leucoma and its position was stable. Conclusion. The use of a temporal fascia autograft is an accessible and effective method of dependable covering of leucoma in the prevention of protrusions during the simultaneous first stage of keratoprosthesis, transplantation of the corneal-prosthetic complex and at the beginning stage of keratoprosthesis protrusion. Key words: keratoprosthesis, keratoprosthesis protrusion, temporal fascia, leucoma covering

Rubinstein Taybi syndrome with secondary glaucoma: An unusual case report and review of literature

Rubinstein Taybi syndrome is a rare neurodevelopmental disorder characterized by broad thumbs and first toe, microcephaly, developmental delay, beaked nose, talon cusps, and various systemic abnormalities like cardiac defects, hearing loss, respiratory infections, and ocular abnormalities which are common with this syndrome. The various ocular abnormalities reported in the literature are corneal opacities, lacrimal gland abnormalities, strabismus, coloboma, retinal dysfunction, and congenital glaucoma. We hereby report the case of a 7-year-old boy who presented in the glaucoma clinic of a tertiary eye care center with large eyeballs and a typical dysmorphic face characterized by high-arched brows with a low-hanging columella, grimacing smile, talon cusps, diffuse corneal haze, and enlarged corneal diameters (12.5 mm) and who was subsequently diagnosed with congenital glaucoma after evaluation under anesthesia (EUA). EUA revealed raised intraocular pressure (IOP) of 22 mmHg, and optic never head cupping in the right eye (RE) was 0.8:1 the other eye had a total leucomatous corneal opacity. The child was started on topical antiglaucoma medication in RE, and subsequent evaluation revealed well-controlled IOP on these medications.

Keratoprosthetics as a visual rehabilitation method in patients with graft-versus-host disease

The article is concerned with the treatment of a patient with allogeneic hematopoietic stem cell transplantation (HSCT) complicated by graft-versus-host disease with severe ocular manifestations. Hematopoietic stem cell transplantation is the standard therapy for a number of hemoblastoses and hereditary blood diseases, ensures the restoration of the immune system, however, in 40–60% of cases it is complicated by the development of graft-versus-host disease, with a five-year survival rate of no more than 40%. Patient S., 22 years old, was admitted to the ophthalmological center of Saint Petersburg Multifield Hospital No. 2 in 2019 with a diagnosis of “Acute keratitis, corneal ulcer of both eyes”. History of hematopoietic stem cell transplantation in 2018, complicated by graft-versus-host disease with multiorgan damage development was present. In total during the period 2019–2022, 7 tectonic keratoplasties were performed on both eyes, as well as penetrating keratoplasty on the left eye. After inflammation setback and left eye vascularized corneal leukoma formed, in December 2022, the first stage of keratoprosthetics (installation of the support element) was performed, and in May 2023, the second stage (implantation of the optical cylinder) took place. Visual acuity in one month after the implantation of the keratoprosthesis increased from light perception to 20/100, no correction possible. The use of “classical” methods of corneal ulcer perforation treatment in patients with graft-versus-host disease is ineffective due to the severe ocular surface xerosis, and keratoprosthetics seems to be the only effective method for restoring visual functions.

AMNIOTIC MEMBRANE TRANSPLANT AS ADJUVANT THERAPY FOR SEVERE INFECTIOUS CORNEAL ULCER

Introduction : Infectious corneal ulcer may lead to visual impairment and contribute to five percent of blindness worldwide. Amniotic membrane transplant is one of adjuvant therapies listed to aid in the management of corneal ulcer.
 Case Illustration : There were two cases of severe corneal ulcer, both patients had exposure from vegetative matter. Case 1: A 40 years old male came with decreased VA in left eye (VA OS 1/300) and VAS 4, corneal epithelial stromal defect measuring 3x5 mm with 2 mm hypopyon. After three days of inpatient management, AMT procedure was done followed by temporary tarsorrhaphy. On 14th day of observation, tarsorrhaphy was removed, VAS was decreased to 0 and hypopyon resolved. On 28th day, corneal leukoma was observed with visual acuity improved (VA OS 1/60). Case 2: A 63 years old female came with decreased visual acuity (VA OD 1/300), followed by VAS 4, epithelial stromal defect measuring 7.3x5.4 mm, and 1 mm hypopyon. AMT procedure was done in fourth day of hospitalization. On seventh day, VAS was reduced to 1-2. On 14th day, tarsorrhaphy was removed, corneal leukoma was observed and on 28th day of observation, visual acuity was improved (VA OD 6/21).
 Discussion : AMT may induce faster regeneration of wound healing, as it halts inflammation, fibrosis, angiogenesis, and protease activities. AMT also increases the stromal thickness, as the membrane becomes incorporated into the stroma. By placing a temporary tarsorrhaphy, it may promote healing further into the corneal defects.
 Conclusion : AMT is effective in promoting epithelialization and preventing corneal perforations in corneal ulcers.

The visual impact of higher-order aberrations in patients with pediatric blepharokeratoconjunctivitis.

To analyze higher-order aberrations (HOAs) and their visual impact in a pediatric blepharokeratoconjunctivitis (PBKC) cohort compared with healthy controls. Prospective case-control study of pediatric patients (≤ 16 years old). Subjects underwent wavefront aberrometry analysis to compare HOAs and their impact on visual quality. A total of 150 eyes from 76 patients were included in the analysis. The PBKC group consisted of 50 eyes and the control group of 100 healthy eyes. Mean age was 10.39 ± 3.81 years for the PBKC group and 10.80 ± 3.61 years for the controls. Mean corrected-distance visual acuity (CDVA) was 0.24 ± 0.21 logMAR in the PBKC group and 0.07 ± 0.1 in the controls (P < 0.001). Mean astigmatism was 1.6 ± 1.98D in the PBKC group vs. 0.67 ± 0.76D in the control group (P = 0.01). Mean RMS of HOAs was 1.05 ± 1.7mm in the PBKC group and 0.41 ± 0.18mm in the controls (P < 0.001). The mean modulation transfer function (MTF) in the PBKC group was significantly lower (16.37 ± 16.32) than controls (30.3 ± 23.57) (P < 0.001). Corneal leukomas, stromal vascularization, peripheral nummular subepithelial scars, and pannus formation are associated with increased HOAs. There was a significant increase in total HOAs of eyes with PBKC compared to healthy controls. Corneal opacity, vascularization, and scarring are associated with increased HOAs. The PBKC eye aberration profile: coma, secondary astigmatism, quadrafoil, and pentafoil, were associated with decreased CDVA and visual quality (PSF and MTF).

AN UNILATERAL SCLEROMALACIA PERFORANS IN YOUNG PATIENT MANAGED BY MYOCONJUNCTIVAL ENUCLEATION AND DERMIS FAT GRAFT

Introduction : Scleromalacia perforans is a disease that might compromise vision and globe integrity. The possible associations of systemic disease are autoimmune diseases such as rheumatoid arthritis, lupus, and Wegener's granulomatosis. Determining the underlying etiology in such cases also possess a great challenge to treat disease, especially in this case.&#x0D; Case Illustration : A 19-year-old female with a progressed protrusion of the left eye since she was 1 year old. Six years ago, she had redness, worsen protrusion, photophobia, tearing, and pain, but resolved without treatment. Her cousin had the same condition but refused to continue the examination. Visual acuityof the left eye was no light perception with 4x4 mm of corneal leukoma, and 360 degrees of anterior scleral ectasia covered with conjunctival neovascularization. USG showed posterior vitreous detachment and 28,9 mm axial length. Systemic examination found ANA test and HLA B27 were normal, positive hypermobility joint, and Rheumatologists ruled out the possibility of autoimmune disease. Myoconjuctival enucleation was performed with a dermis fat graft for cosmesis, and pathological examination showed nonspecific chronic inflammation.&#x0D; Discussion : A childhood-onset scleromalacia perforans with positive family history and hypermobility joints might be a sign of connective tissue disorder. Possible autoimmune diseases were ruled out by a rheumatologist. The genetic examinations may be necessary to establish the diagnosis.&#x0D; Conclusion : Scleromalacia perforans is rare yet it is strongly believed to have an association with systemic disease. Collaboration between ophthalmologists, rheumatologists, and geneticist is essential to manage this kind of case.

Familial Congenital Aniridia with Subluxated Lens and Glaucoma

Introduction: Congenital aniridia is a bilateral iris aplasia or hypoplasia associated with other ocular disorders. The purpose of this case report is to describe the clinical manifestation of congenital aniridia in two members of one family. Case Presentation: The first patient (mother) is a 43-year-old and the second patient (daughter) is a 12-year-old. Both patients complained of blurred vision since childhood. The visual acuity of the first patient was a positive light perception on the right eye (RE) and no light perception on the left eye (LE); the visual acuity of the second patient was 1/60 on the RE and 3/32 on the LE. Both patients had horizontal nystagmus and increased intraocular pressure (IOP) (N+1 palpation) in both eyes. Anterior segment abnormalities of both patients include aniridia with iris rudimentary and superiorly subluxated lens. The first patient also had LE corneal leukoma and RE cataract. The second patient also had right and left eye corneal conjunctivalization. Fundus examination showed no fundus reflex on the first patient and tigroid retina with foveal hypoplasia on the second patient. Eye ultrasounds of both patients showed vitreous opacity. Conclusions: Congenital aniridia primarily originates from a mutation in the paired box gene-6 (PAX6) and is associated with other ocular anomalies such as nystagmus, amblyopia, keratopathies, cataract, lens luxation, glaucoma, fovea, optic nerve hypoplasia. Patients in this case showed similar conditions between mother and daughter, however, the mother's condition was more advanced and more degenerated than the daughter's condition.

Characterisation of cataracts and other ophthalmic findings in various species of captive penguins.

The identification of ophthalmic diseases that affect vision and/or cause discomfort should be a priority in captive penguins to improve their overall health and quality of life. A routine ophthalmological examination was performed on 80 clinically normal penguins (160 eyes), and any lesions observed were recorded. Ocular lesions were frequent (56% of penguins), with cataracts being the most common (48.8% of penguins). Cortical cataracts (63% of eyes) and posterior subcapsular cataracts (27.4%) were the most commonly occurring. All maturation stages were found; incipient cataracts (52.1% of eyes with cataracts) were predominant, while Morgagnian cataracts (8.2%) were the least frequent. A correlation existed between lenticular changes and increasing age. Uveitis was present in 43.8% of eyes with cataracts, and ectropion uveae was the predominant clinical sign. Other ocular findings included blepharitis (3.8% of all eyes), corneal leukoma (5.6%) and posterior lens subluxation (7.5%). The small number of birds of some species prevented the comparison of ophthalmic findings between species. This study corroborates the high prevalence of ocular lesions in captive penguins. Cataracts were frequent and age related. Most cataracts were cortical, and the predominant maturation stage was incipient. Lens-induced uveitis was a common finding. Lowered intraocular pressure was related to cataract formation.

Кератопротезы в современной офтальмохирургии

The shortage of donor corneas for keratoplasty in patients with severe disorders (persistent opacity, corneal leucoma of IV–V categories, including leucoma with vascularization, after burns, multiple transplant failures, with extensive symblepharon, Stevens – Johnson syndrome, Lyell's syndrome, ocular cicatricial pemphigoid, etc) is currently compensated by keratoprostheses, which partly or completely consist of synthetic materials, show good engraftment and high vision restoration efficacy. The article is a review of main scientific papers on keratoprostheses. The authors state characteristics of different types of keratoprosthesis, indications and outcomes of their use, complications, efficacy rate and postoperative visual acuity. Each of the presented types of keratoprosthesis has its own benefits and drawbacks, so their improvement to achieve better surgical outcomes remains relevant and needs further study. Key words: ophthalmic surgery, corneal opacity, keratoplasty, multiple transplant failures, keratoprostheses

Does corneal tattooing affect the conjunctival microbiota?

Purpose This study aimed to investigate the effects of commercial tattoo inks used in corneal tattooing on conjunctival microbiota. Method This prospective case control study consisted of 125 participants divided in the following three groups: 35 patients with corneal tattoos, 40 patients with corneal leukoma, and 50 healthy subjects. Corneal tattooing was performed in all the cases in this study using a tattoo pen machine and commercial tattoo ink. A total of 500 cultures were taken from 250 eyes of 125 individuals on chocolate and sheep blood agar. Bacteriological samples were taken from the inferior eyelid conjunctiva using a sterile cotton swab. Without any contact elsewhere, the swabs were smeared on bedside chocolate agars and 5% sheep blood agar. Results In tattooed eyes, bacterial growth was detected in 42.9% of the chocolate and sheep blood agar samples. In other healthy eyes of patients with corneal tattoos, 54.5% bacterial growth on chocolate agar and 57.1% on sheep blood agar were detected. No statistical difference was detected in the conjunctival microbiota of chocolate and sheep blood agar (p = 0.254, p = 0.134, respectively) in the tattooed eyes compared to the other eye of the individual. No statistically significant difference was found in terms of bacterial growth in tattooed, leukoma, or healthy eyes on chocolate and sheep blood agar (p = 0.408, p = 0.349). The growth rate of Staphylococcus epidermidis decreased by 33.3% (from 12 to 8) on chocolate agar in 35 tattooed eyes, and it decreased by 28.5% (from 14 to 10) on sheep blood agar, while gram-negative bacteria Brevundimonas diminuta, Acinetobacter lwoffii, and Psychrobacter faecalis were detected in three patients. Conclusion Corneal tattooing using commercial dye does not affect conjunctival microbiota. In the past 3 years, 120 patients have been tattooed with commercial tattoo ink in Istanbul Medeniyet University Göztepe Training and Research Hospital. No complications related to infection were found in the 3-year follow-up. The gram-negative bacteria detected in the healthy control group and tattooed eyes were bacteria found on normal skin or in the respiratory tract. Although some gram-negative bacteria do not cause infection, careful eye examination, follow-up, and culture are required in suspicious cases.

The Use of Shells of Marine Molluscs in Spanish Ethnomedicine: A Historical Approach and Present and Future Perspectives.

Since ancient times, the shells of marine molluscs have been used as a therapeutic and/or prophylactic resource. In Spain, they were part of practical guides for doctors or pharmacists until the 19th century. In general, seashells were prepared by dissolving in vinegar and were part of plasters or powders used as toothpaste, or to treat dyspepsia, heartburn and leprosy. Thus, the nacre or mother-of-pearl of various molluscs was regularly used in the Royal Colleges of Surgery and in hospitals during the times of the Cortes of Cadiz, as a medicine in galenic preparations based on powders. In contemporary Spanish ethnomedicine, seashells, with a high symbolic value, have been used as an amulet to prevent cracks in the breasts and promote their development during lactation, to avoid teething pain in young children, to eliminate stains on the face or to cure erysipelas. But, as in other countries, products derived from seashells have also been empirically applied. The two resources used traditionally have been the cuttlebone, the internal shell of cuttlefish and the nacre obtained from the external shells of some species. Cuttlebone, dried and pulverised, has been applied externally to cure corneal leukoma and in dental hygiene. In the case of nacre, a distinction must be made between chemical and physical remedies. Certain seashells, macerated in lemon juice, were used in coastal areas to remove spots on the face during postpartum. However, the most common practice in Spain mainland was to dissolve mother-of-pearl buttons in lemon juice (or vinegar). The substance thus obtained has been used to treat different dermatological conditions of the face (chloasma, acne), as well as to eliminate freckles. For the extraction of foreign bodies in the eyes, a very widespread traditional remedy has been to introduce small mother-of-pearl buttons under the lid. These popular remedies and practices are compared with those collected in classic works of medicine throughout history, and data on the pharmacological activity and pharmaceutical applications of the products used are provided. The use of cuttlebone powders is supported by different works on anti-inflammatory, immune-modulatory and/or wound healing properties. Nacre powder has been used in traditional medicines to treat palpitations, convulsions or epilepsy. As sedation and a tranquilisation agent, nacre is an interesting source for further drug development. Likewise, nacre is a biomaterial for orthopaedic and other tissue bioengineering applications. This article is a historical, cultural and anthropological view that can open new epistemological paths in marine-derived product research.

The ocular anterior segment examination of perinatal newborns by wide-field digital imaging system: a cross-sectional study

PurposeThe aim of this study was to evaluate and summarize the developmental rules of the ocular anterior segment of neonates by means of wild-field digital imaging system.MethodsWe used the wide-field digital imaging system to sequentially capture images of the neonates’ eyes within 42 days after delivery, including the ocular surface, anterior segment, and fundus. At the same time, basic information at the time of birth and examination was collected.ResultsAmong 248 newborns, 51.21% were male. Abnormalities of the anterior segment such as visualization of anterior chamber angle vessels (79.03%) and iris vessels (51.21%), iris process (42.34%), persistent pupillary membranes (19.35%), albinism, congenital cataracts, corneal leucoma, and subconjunctival hemorrhage were observed in this study. There were significant differences in the appearance of iris vessels among different sex, gestational age and birth weight, postmenstrual age and weight at the time of examination and iris color groups. The iris vessels were more visualized in males relative to females (OR = 6.313, 95% CI 2.529–15.759). The greater the postmenstrual age at the time of examination, the lower the visualization of iris vessels (OR = 0.377, 95% CI 0.247–0.575). In addition, although visualization of anterior chamber angle vessels differed within the birth gestation age and weight at examination groups, there was no significant correlation by regression analysis.ConclusionsThe anterior segment of perinatal neonates can be visualized by the wide-field digital imaging system. The neonatal iris and anterior chamber angle are immature, and the visible vessels at the anterior chamber angle that vanish later than the surface of the iris are characteristic structures.

Birth prevalence and characteristics of congenital corneal opacities.

To report the birth prevalence and natural history of congenital corneal opacities among a population-based cohort of children. The medical records of patients <5 years diagnosed with a congenital onset corneal opacity while residing in Olmsted County, Minnesota, from January 1, 1977, through December 31, 2016, were retrospectively reviewed. Fourteen patients were diagnosed with a congenital corneal opacity during the 40-year study period for a birth prevalence of 1 in 5188 live births. The mean age at diagnosis was 7.5 months (range 0-48 months) and 9 (64.3%) were males. Four patients had congenital glaucoma, 4 had limbal dermoids, 2 had sclerocornea, and 1 patient each had Descemet's tear from birth trauma, herpes simplex virus type 1 keratitis, corneal leukoma, and an undiagnosed scar. Six (42.8%) patients required treatment for their underlying corneal opacity including the four patients with congenital glaucoma. The other 8 (57.1%) patients had a clear central axis. Four (28.6%) of 14 patients required amblyopia therapy, and 4 (28.6%) developed strabismus. Four (28.6%) patients had associated systemic conditions. During a mean follow up of 5.4 years (range 1.3-27.0 years), the median best corrected visual acuity (BCVA) was logmar 0.16 (20/25) (range 20/20-hand motion) with one patient with unilateral BCVA less than 20/60 and one patient with bilateral BCVA less than 20/60. In this 40-year cohort, congenital corneal opacities were relatively rare and the result of a variety of disorders. Although amblyopia and strabismus occurred commonly, most patients had good visual outcomes.

The continuous treatment of anterior segment open globe injury: an eye injury vitrectomy study.

The prognostic significance of debridement has long been demonstrated for trauma in tissues other than ocular. Unfortunately, the impact of wound healing in the anterior segment (AS) was not paid as much attention as in the posterior segment (PS). This study aims to evaluate whether a better prognosis can be obtained from continuous surgical treatment (CST) before fibrosis or scar formation in an open AS injury. In this prospective comparative cohort study, 19 eyes of 19 patients with an experience of AS open globe injury (OGI) were selected from the database of the eye injury vitrectomy study (EIVS) from January 1, 2020 to July 31, 2021. Of 19 patients, 9 who received CST were assigned to group 1, and 10 patients without CST after the initial wound repair were included in group 2. Comparison between the two groups was conducted in the final best corrected visual acuity (BCVA). Significant AS complications after injury were evaluated with χ2 test. The corneal leucoma area ratio, astigmatism, and the score of AS abnormalities were analyzed using the Student's t-test. The differences of baseline clinical factors between the two groups were not statistically significant. The final BCVA was better in group 1 than in group 2 (P=0.011). The complications directly caused by AS injury, namely adhesive corneal leucoma, uneven anterior chamber, block of light passing through the pupil, and fibrosis or scarring, were more frequent in group 2 than in group 1 (P=0.011, 0.022, 0.037, and 0.040, respectively). Secondary glaucoma (3 cases) and severe AS structure destruction (2 cases) occurred only in group 2 (P=0.037 and 0.474, respectively). The area ratio of leucoma (0.79±0.44, 0.82±0.50, respectively) and corneal astigmatism (3.69±1.90, 4.50±4.80, respectively) revealed no statistical significance between the two groups. On the other hand, the score of AS abnormalities, mean values being 93.33±11.18 for group 1 and 67.00±29.46 for group 2, was statistically different (P=0.022). Initiating CST before fibrosis or scar formation might improve the prognosis of open AS injury, which was preferable to natural wound healing after wound repair.

Aesthetic corneal tattooing/keratopigmentation using tattoo pen machine: choosing suitable method and color.

This article aims to present the corneal tattooing method and how using a tattoo pen machine can improve aesthetic appearance in patients with corneal leukoma. In this study, 42 patients were evaluated who had no visual potential and who had undergone colored corneal tattooing using an automatic tattoo pen machine for aesthetic purposes. The procedure was conducted according to the principles of the Declaration of Helsinki. The commercially available tattoo ink that has traditionally been used on human skin (brown, green, and black) for years was used for all the patients in this study, and 252 corneal photographs (with a Topcon slit lamp imaging device at 16 magnifications, i.e., 16 ×) taken within the last 2years were evaluated retrospectively. Red, green, and blue (RGB) and hue, saturation, and lightness (HSL) values of the tattooed areas, such as pupils and iris, in corneal photographs were determined online using the Color Code Finder program. The RGB and HSL values of the pupil and iris were compared before surgery on the first day and first week, first month, third month, and twelfth month after surgery. In the first postoperative month, the mean pupil lightness (L) and iris L values were found to have increased by 10.7% and 5.7%, respectively. Between the first month and the first year, the L value of the mean pupil and that of the iris increased by 1.7% and 5.2%, respectively. The increase in the RGB value of the mean pupil in the first month was statistically significant (p = 0.02). The highest increase in RGB values of the iris was observed in the first week and first month (p = 0.113). This result shows that the majority of fading occurred in the first month. After the first month, the increase in the L value in the black-colored pupil was less than that in the brown- or green-colored iris. These results show that light colors fade faster and more. Esthetically, corneal leukoma causes severe psychological problems. Many patients are unable to use prosthetic contact lenses. Evisceration surgery has many complications, and limbal stem cells are used in evisceration surgery. Corneal tattooing using a tattoo pen machine is an easy, practical, and repeatable method used for aesthetic purposes. Successful results require the use of appropriate methods, ink, and ophthalmologist's experience. All patients in this study had a more aesthetic appearance than the preoperative white eye. Further studies are needed to develop a colored aesthetic tattooing method with a tattoo pen machine.

Ophthalmic Manifestation in Neurofibromatosis Type 2

Neurofibromatosis type 2 (NF2) is a genetically determined tumor-predisposing syndrome. Ocular manifestations include cataracts, epiretinal membranes, retinal hamartomas, optic disk gliomas, and optic nerve sheath meningiomas. Moreover, optic disk edema, optical atrophy, motility disorders, pupil and lid dysfunction, and neurotrophic keratitis can be observed as indirect signs. An observational study was conducted with the aim to collect clinical data and describe the most frequent NF2 ocular manifestations. Fourteen patients affected by NF2, according to the Manchester criteria, were enrolled. All patients underwent complete ophthalmologic and orthoptic evaluation and a spectral domain optical coherence tomography. Ocular manifestations were present in all patients. The slit lamp evaluation of the anterior segment highlighted cataracts in five patients, keratitis in two patients, corneal leukoma in two patients, and corneal pannus in one patient. Fundus oculi and OCT evaluation identified epiretinal membranes in four patients, vitreoretinal tufts in three patients, optic nerve edema in one patient, and retinal hamartoma in one patient. Moreover, the orthoptic evaluation identified different types of ocular motility disorders in seven patients. This is a descriptive study of a rare disease with poor previous literature. Clinical data are shown, emphasizing the role of NF2-specific ophthalmological and orthoptic findings to help establish an early diagnosis.

Vernal keratoconjunctivitis in Down syndrome: a case report

BackgroundDown syndrome (DS) or Trisomy 21 is the most common chromosomal disease and is characterized by possible heart defects, cognitive impairment and visual disorders.Case presentationWe describe for the first time a 17-year-old Caucasian girl suffering from Down syndrome associated with vernal keratoconjunctivitis (VKC), a rare disorder of the anterior segment of the eye, characterized by intense photophobia, redness, watering eyes and itching due to an inflammatory-allergic reaction of the cornea and conjunctiva. On slit-lamp examination, the girl showed conjunctival hyperemia, papillary hypertrophy, giant papillae and corneal leukoma in right eye as a result of a previous corneal ulcer. A successful topical immunosuppressant therapy with cyclosporin 1% was started.ConclusionSo far, to our knowledge, this is the first description of VKC in a patient with DS. Finding an inflammatory-allergic disease such as VKC in DS is unusual but it must be taken into account because keratoconus, one of the most frequent eye pathologies in DS, can be secondary to an unrecognized VKC.

Corneal fine‐needle diathermy with intrastromal and subconjunctival injection of bevacizumab in a child with corneal neovascularization of herpetic origin

AbstractPurpose: Corneal neovascularization (CNV) in the paediatric population has a variety of etiologies including bacterial ulcers, herpes keratitis, exposure keratopathy, blepharokeratoconjunctivitis and corneal anaesthesia. Monotherapy with antiangiogenic agents or corneal fine‐needle diathermy (FND) alone do not completely resolve CNV; however, the combined treatment of these two seems to offer better results.Methods: We present the results of FND with adjuvant injection of intrastromal and subconjunctival Bevacizumab in a child with CNV of herpetic origin.Results: A 3‐year‐old patient who has been treated in our hospital for corneal involvement in the left eye (LE) due to herpetic keratitis of weeks of evolution comes to our consultation. Examination under general anaesthesia reveals in LE an inferior paracentral corneal leukoma with partial involvement of the visual axis and CNV that enters through the limbus from 5 to 8 h and begins to involve corneal stroma; no epithelial lesions, no corneal oedema or inflammatory activity in the anterior segment. After not improvement, it was decided to perform FND of lower CNV in conjunction with an intrastromal injection and another subconjunctival injection of Bevacizumab. Subsequently, it remains stable with topical and oral antiherpetic treatment, and topical corticosteroid therapy. At 3 months, the CNV reactivated, for which FND + intrastromal and subconjunctival bevacizumab was performed again. Finally, at 2 months, the patient is asymptomatic with VA LE of 1.0, with 2 corneal leukomas without CNV or epithelial lesions, and continues to be treated with oral acyclovir at prophylactic doses.Conclusions: FND of CNV together with adjuvant treatment with intrastromal and subconjunctival Bevacizumab is a good choice in children to treat those active corneal neovascularizations that do not respond to corticosteroid.

Результаты хирургического лечения гнойной язвы роговицы у пациентов с ВИЧ-инфекцией

Purulent corneal ulcers – severe inflammatory disease, often with unfavourable outcome. Therapeutic keratoplasty of this disease is the main treatment way. The total number of HIV cases in Russia and throughout the world is permanently increasing. 75 % of HIV-infected have ophthalmology manifestations, among all of them only 5 % is infection corneal lesions. The information about patients initial immune status could contribute to the successful surgical results. Results of surgical treatment of corneal ulcer in HIV-patients was analysed. Period of operations was from 2018 to 2022 years and the clinical base was Kemerovo Regional Clinical Ophthalmological Hospital. Among patients were 2 females and 4 males, the age was from 36 to 72 years old. Penetrating keratoplasty for emergency reasons with tectonic or organ preservation aims was made for all of them. Retrospective analysis showed that transparent engraftment of the transplant was better after the only operation. The secondary keratoplasty was needed in 50 % cases. Corneal leucoma after the keratoplasty and the previous infection was in patients with 10 years HIV-infection in the anamnesis regardless of the number of keratoplasty and young ages of patients. Transparent condition of transplant was for the period from 4 months to 2 years and there were only uveitis after keratoplasty, there were not any cases of endophthalmitis. Keywords: purulent corneal ulcer; HIV-infection; keratoplasty

Ophthalmic examination findings in captive ring-tailed lemurs (Lemur catta, Linnaeus 1758)

This study aimed to document normal ophthalmic findings and ocular anomalies in captive ring-tailed lemurs (Lemur catta) and to establish reference intervals for the Schirmer tear test-1 (STT) and intraocular pressure (IOP). Sixty healthy adult lemurs (22 females, 38 males) aged from 6 months to 28 years underwent ophthalmic examination. Direct illumination, STT, diffuse and slit-lamp biomicroscopy, fluorescein dye test, IOP measurement, and indirect ophthalmoscopy were performed on each eye. Reference intervals were calculated non-parametrically for STT and IOP. The eyes of three lemurs, which had died from unrelated reasons, were examined histopathologically. The median STT in the lemurs was 9 mm/minute, with an estimated 95% reference interval of 2–15 mm/minute. The median IOP was 18 mmHg, with an estimated 95% reference interval of 11–24 mm Hg. Ophthalmic abnormalities were noted in 21 of 120 (17.5%) eyes, including third eyelid laceration, corneal leukoma, cataracts, chronic uveitis, and vitreous degeneration. Reference intervals of physiological ophthalmic parameters and the most common ophthalmic findings are defined and can be useful for clinical veterinarians during the eye examinations of ring-tailed lemurs.