1/23. Mycotic keratitis in non-steroid exposed vernal keratoconjunctivitis.PURPOSE: To report a patient with vernal keratoconjunctivitis who developed mycotic keratitis in absence of known risk factors. methods: A 17-year-old male suffering from vernal keratoconjunctivitis presented with infective keratitis. The patient had been treated in the past with topical antihistaminics and vasoconstrictors. The patient had not been exposed to topical steroids in 2 years of follow-up. He did not have dry eye or corneal micro or macroerosions prior to the development of infective keratitis. Corneal scrapings were obtained and subjected to KOH wet mount smear, calcofluor and Grams stain as well as bacterial culture sensitivity and fungal culture. RESULTS: Clinical diagnosis of mycotic keratitis in association with vernal conjunctivitis was supported by microbiological investigations. KOH wet mount and calcofluor staining showed presence of filamentous septate hyphae while fungal culture showed growth of aspergillus fumigatus. Antifungal therapy was initiated in the form of topical natamycin 5% suspension to which the patient responded and recovered 6/6 final visual acuity. CONCLUSION: The authors wish to conclude that patients suffering from vernal keratoconjunctivitis, even in the absence of corneal involvement, steroid exposure and trauma, may be at increased risk of developing keratomycosis.- - - - - - - - - - ranking = 1keywords = keratoconjunctivitis (Clic here for more details about this article) |
2/23. corneal perforation in nontuberculous (staphylococcal) phlyctenular keratoconjunctivitis.An 18-year-old white man with severe staphylococcal blepharokeratoconjunctivitis of several years' duration developed phylctenules intermittently. At age 22 an active corneal phlyctenule caused perforation of the cornea. Seven days after this occurrence, the perforation closed spontaneously but perforated again ten days later. This occurrence may have been caused by an increase in the patient's hypersensitivity to the Staphylococcus as a result of concurrent viral infection, or it may have been due to the patient's failure to return for treatment at the scheduled time. The area of perforation appeared to be healed 10 and one half months later.- - - - - - - - - - ranking = 0.71428571428571keywords = keratoconjunctivitis (Clic here for more details about this article) |
3/23. Amniotic membrane transplantation in the management of shield ulcers of vernal keratoconjunctivitis.PURPOSE: To report our experience with amniotic membrane transplantation in the management of severe shield ulcers. DESIGN: Retrospective, interventional, noncomparative case series. PARTICIPANTS: Four patients (seven eyes) with grade 2 (ulcer with opaque base) and grade 3 (plaquelike lesions) shield ulcers not responding to steroid therapy with or without surgical debridement. INTERVENTION: Amniotic membrane transplantation with stromal side down was performed after meticulous debridement of the ulcer. MAIN OUTCOME MEASURES: Healing of the ulcer with no epithelial defect. RESULTS: The ulcers healed with disintegration or retraction of the membrane in all patients within 2 weeks. CONCLUSIONS: Amniotic membrane transplantation in combination with debridement is an effective surgical modality in the management of severe shield ulcers. Further studies are warranted to confirm the efficacy of amniotic membrane transplantation in the management of shield ulcer and its correct position in the treatment algorithm.- - - - - - - - - - ranking = 0.57142857142857keywords = keratoconjunctivitis (Clic here for more details about this article) |
4/23. Toxic eosinophil granule protein deposition in corneal ulcerations and scars associated with atopic keratoconjunctivitis.PURPOSE: Recurrent or persistent corneal erosions and ulcerations are typical complications of atopic keratoconjunctivitis. Toxic eosinophil granule proteins such as major basic protein (MBP) and eosinophil cationic protein (ECP) may be involved in this pathogenetic process. This study was designed to demonstrate the presence of toxic eosinophil granule proteins in corneal tissue from a patient with corneal complications of atopic keratoconjunctivitis. DESIGN: Observational case report. methods: Three corneal buttons of a patient with atopic keratoconjunctivitis associated ulcerations or scarring were examined by light microscopy and by immunofluorescence technique. RESULTS: A linear deposition of eosinophil granular substance was detected subepithelially above Bowman's membrane in all corneal buttons. Indirect immunofluorescence identified this material as MBP and ECP. The deposits were not limited to the area of ulceration, but were also found underneath intact corneal epithelium. Multiple eosinophils were present in the upper corneal stroma. Normal corneas and negative control sections of the pathologic buttons revealed only minimal nonspecific staining at the surface of the epithelium. CONCLUSIONS: Both MBP and ECP are known to affect human corneal epithelial cell viability and morphology in vitro. Moreover, MBP was shown to inhibit epithelial migration and protein synthesis. These toxic eosinophil proteins may also be responsible for corneal instability, recurrent and persistent corneal epithelial defects and ulcerations in patients with atopic keratoconjunctivitis.- - - - - - - - - - ranking = 1.1428571428571keywords = keratoconjunctivitis (Clic here for more details about this article) |
5/23. Fungal keratitis associated with vernal keratoconjunctivitis.PURPOSE: To report a case of fungal keratitis associated with vernal keratoconjunctivitis. CASE REPORT: A 22-year-old man with a history of vernal keratoconjunctivitis since October 1999 developed a shield ulcer in the left eye in June 2000, which resolved with intensive topical steroid therapy. He presented in August 2001 with onset of acute pain, redness, and decreased vision. The tarsal conjunctiva in the left eye showed large papillae. The cornea showed a white plaque-like lesion with an underlying stromal infiltrate involving the upper half of the cornea. The overlying epithelial defect measured 4.5 x 2.5 mm. The anterior chamber showed 1 flare and cells and hypopyon measuring about 1 mm. RESULTS: Corneal scrapings were performed for microbiologic investigations. Smears of corneal scrapings revealed septate fungal filaments, and the culture showed a significant growth of aspergillus flavus. CONCLUSIONS: Fungal keratitis may be associated with vernal keratoconjunctivitis. Though rare, fungal keratitis should be considered in the differential diagnosis of infections associated with vernal keratoconjunctivitis.- - - - - - - - - - ranking = 1.1428571428571keywords = keratoconjunctivitis (Clic here for more details about this article) |
6/23. Recurrent shield ulcer following penetrating keratoplasty for keratoconus associated with vernal keratoconjunctivitis.Though penetrating keratoplasty for keratoconus secondary to vernal keratoconjunctivitis (VKC) invariably carries a good prognosis, the postoperative course may be complicated by recurrent epitheliopathy. Despite good medical control of VKC shield ulcer is still a possibility.- - - - - - - - - - ranking = 0.71428571428571keywords = keratoconjunctivitis (Clic here for more details about this article) |
7/23. sjogren's syndrome and drug reaction to practalol.A case is reported of a patient who developed exfoliative dermatitis while being treated with practalol for angina pectoris. The patient also had trigeminal neuropathy, renal impairment and keratoconjunctivitis sicca. The antinuclear factor was diffusely positive but other antibodies were negative. At post mortem the patient was found to have acute pancreatitis, and peritonitis. It is postulated that the patient has antecedent sjogren's syndrome and on introduction of practalol therapy developed a drug reaction with a generalised exfoliative dermatitis and exacerbation of keratoconjunctivitis sicca leading to bilateral corneal ulceration. The association of similar conditions in patients receiving practalol therapy is reviewed.- - - - - - - - - - ranking = 0.28571428571429keywords = keratoconjunctivitis (Clic here for more details about this article) |
8/23. Bacterial keratitis associated with vernal keratoconjunctivitis.We cared for two patients with longstanding vernal keratoconjunctivitis who had bacterial corneal ulcers in each eye. Both patients were young, black, and had histories of atopy. The patients came for treatment with acute symptoms of pain, redness, and reduced vision in the affected eye. On examination in each case we found an epithelial defect associated with dense stromal infiltration, a calcific plaque in the bed of the ulcer, and a severe anterior chamber reaction, including a hypopyon in two cases. Cultures of corneal scrapings from all four eyes were positive for staphylococcus aureus, and three of the four infections were polymicrobial. All four eyes responded rapidly to intensive topical antibiotic therapy, debridement of the calcific plaque, and subsequent treatment with topical corticosteroids and/or cromolyn sodium. Bacterial keratitis can occur in patients with vernal keratoconjunctivitis, especially those with vernal corneal ulcers. The abnormalities of ocular immune mechanisms found in patients with vernal keratoconjunctivitis may predispose them to bacterial keratitis.- - - - - - - - - - ranking = 1keywords = keratoconjunctivitis (Clic here for more details about this article) |
9/23. Surgical management of corneal plaques in vernal keratoconjunctivitis: a clinicopathologic study.PURPOSE: To describe the surgical management and histopathologic and immunohistochemical findings in corneal plaques of shield ulcers in vernal keratoconjunctivitis. patients AND methods: Three children (ages 4, 7.5, and 9) presented with corneal plaques unresponsive to conservative systemic and topical medical treatment. Plaques were scraped under general anesthesia, and soft bandage contact lenses were placed. The excised tissue was evaluated by histopathology and immunohistochemistry. RESULTS: During surgery, plaques were found to extend beyond the ulcer margins. Histopathology revealed granular, deeply-eosinophilic, laminar material, firmly attached to the Bowman layer in all cases. immunohistochemistry confirmed this to be eosinophil-derived major basic protein (MBP). After surgical removal, complete epithelization was evident within 1-4 weeks in all cases. CONCLUSIONS: Corneal plaque is a rare complication of vernal keratoconjunctivitis. These plaques usually do not resolve with standard conservative measures. Failure to epithelialize may be a result of the plaque material extending below the edges of adjacent epithelium. We suggest that MBP plaques precipitate on the denuded stromal bed, thereby playing a pathogenic role in nonhealing shield ulcers.- - - - - - - - - - ranking = 0.85714285714286keywords = keratoconjunctivitis (Clic here for more details about this article) |
10/23. Dramatic healing of an allergic corneal ulcer persistent for 6 months by amniotic membrane patching in a patient with atopic keratoconjunctivitis: a case report.PURPOSE: To present a case of allergic corneal ulcer in a patient with atopic keratoconjunctivitis (AKC) that was persistent for 6 months and healed by amniotic membrane patching. CASE REPORT: A 27-year-old male patient with a corneal ulcer associated with AKC persistent for 6 months despite conventional treatment underwent amniotic membrane patching. On removal of the amniotic membrane patch after 1 week, the corneal ulcer that had been persistent for 6 months had healed completely. CONCLUSION: We experienced a case with corneal ulcer that was persistent for 6 months and healed dramatically within 1 week with improved vision and corneal clarity. In such severe and persistent cases requiring rapid epithelialization, amniotic membrane should be considered as an adjunct to conventional therapy.- - - - - - - - - - ranking = 0.71428571428571keywords = keratoconjunctivitis (Clic here for more details about this article) |
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