1/14. Amniotic membrane in the surgical management of acute toxic epidermal necrolysis.OBJECTIVE: To report a new surgical technique to manage severe acute toxic epidermal necrolysis. DESIGN: Two interventional case reports. PARTICIPANTS: Two patients. Case 1: A 6-year-old boy had severe toxic epidermal necrolysis develop after being treated with trimethoprim and sulfamethoxazole for chronic otitis media. Both eyes and eyelids were affected. He underwent bilateral lysis of symblepharon and all adhesions and bilateral amniotic membrane transplantation to the entire ocular surface except the cornea. Loss of eyelid skin required transplantation of amniotic membrane to all four eyelids and strips of amniotic membrane at the eyelid margins. Case 2: An 8-year-old girl with severe toxic epidermal necrolysis associated with mycoplasma pneumonia had bilateral, diffuse keratoconjunctivitis, diffuse corneal epithelial defects, and bilateral symblepharon. Amniotic membrane transplantation was performed bilaterally, using a symblepharon ring in the left eye. INTERVENTION: Amniotic membrane transplantation. MAIN OUTCOME MEASURES: Preservation of normal ocular and eyelid surfaces and prevention of blindness. RESULTS: Case 1: Thirty-six months after bilateral ocular surgery, there is no symblepharon, good ocular surface wetting, and an uncorrected bilateral vision of 20/20. Case 2: Amniotic membrane transplantation protected both ocular surfaces and prevented conjunctival contracture without adhesion of the eyelids to the ocular surface. The central vision was preserved. There was minimal peripheral corneal vascularization and mild conjunctival scarring of the tarsal conjunctival surface 34 months postoperatively. CONCLUSIONS: These are the first cases of acute toxic epidermal necrolysis treated with amniotic membrane transplantation and the first use of the procedure on external eyelid surfaces with good healing of the eyelids. This new treatment for acute toxic epidermal necrolysis preserves normal ocular and eyelid surfaces and may prevent blindness.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/14. Reconstruction of the ocular surface by transplantation of a serum-free derived cultivated conjunctival epithelial equivalent.PURPOSE: The purpose of this study was to investigate the use of a serum-free derived cultivated conjunctival epithelial sheet for ocular surface transplantation and reconstruction. methods: Seven subjects with various ocular surface disorders were selected for the procedure: one patient had an extensive conjunctival nevus, three patients had pterygium, two patients had persistent leaking trabeculectomy blebs, and one patient had bilateral superior limbic keratoconjunctivitis. Conjunctival epithelial cells were harvested from the forniceal conjunctiva of patients 2 weeks before the definitive surgery. Cultivation of conjunctival epithelial cells on human amniotic membrane (HAM) was carried out under serum-free conditions. At the time of transplantation, the area of diseased conjunctiva was excised and the cultured conjunctival epithelium-HAM composite was transplanted onto the surgical defect. patients were followed up with serial slit-lamp examinations, fluorescein staining, and photographic documentation. RESULTS: A confluent stratified conjunctival epithelial sheet was formed on the HAM within 12 to 14 days. Transplanted grafts remained well-epithelialized after surgery. A successful outcome, defined as resolution of the disease, maintenance of conjunctival epithelialization, maintenance of graft integrity, and absence of significant complications, was obtained in all seven patients. A good functional and cosmetic result was achieved in all eyes. The mean follow-up period was 11.6 months (range, 6-18 months). CONCLUSIONS: transplantation of a serum-free derived autologous cultivated conjunctival epithelial sheet on HAM was successfully performed in seven patients with ocular surface disorders. This may provide a novel method for conjunctival replacement in conditions where the normal conjunctiva is damaged or deficient.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
3/14. 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 = 0.72727272727273keywords = membrane (Clic here for more details about this article) |
4/14. A rare ocular complication of mumps: kerato-uveitis.PURPOSE: To report a child who developed kerato-uveitis associated with mumps infection. methods: A prospective study of a child who was observed at the Department of ophthalmology, Marmara University, faculty of medicine, during spring 2003. RESULTS: An 11-year-old male patient noticed decreased vision in his left eye. His right eye was completely normal. visual acuity was perception of hand movements in the left eye. Ocular examination revealed ciliary injection and diffuse hyperemia of the conjunctiva, interstitial keratitis characterized by prominent stromal infiltrates and edema, folds in the Descemet's membrane, and microcystic epithelial edema in his left eye. The patient had been diagnosed as having mumps 10 days previously by a pediatrician. Complete recovery of the keratitis occurred on the 10th day of topical steroid treatment. CONCLUSIONS: keratitis and/or iritis are rare complications of mumps. Corneal involvement is characterized by unilateral and painless interstitial keratitis that may cause a significant decrease in vision. keratitis resolves with treatment and does not have any sequelae.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
5/14. Confocal microscopy of subepithelial infiltrates occurring after epidemic keratoconjunctivitis.PURPOSE: To describe the confocal microscopic findings in subepithelial infiltrates (SEIs) associated with epidemic keratoconjunctivitis (EKC). methods: Observational case report. RESULTS: A 14-year-old Saudi girl with keratoconus developed SEIs after the onset of bilateral EKC. Confocal microscopy of the left cornea 8 weeks after the onset of EKC showed many highly reflective dendritic cells at the level of basal epithelium, epithelial basement membrane zone, and anterior stroma, as well as many highly reflective fusiform and round cells within the anterior stroma, with decreasing density in progressively deeper layers of the stroma. These findings were not present on confocal microscopy that had been performed 2 weeks before the onset of EKC. CONCLUSION: Confocal microscopic examination of SEIs after EKC provides evidence of an inflammatory response localized to the basal epithelium and anterior stroma of the central cornea.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
6/14. Confocal microscopy of subepithelial infiltrates occurring after epidemic keratoconjunctivitis.PURPOSE: To describe the confocal microscopic findings in subepithelial infiltrates associated with epidemic keratoconjunctivitis (EKC). methods: Observational case report. RESULTS: A 14-year-old Saudi girl with keratoconus developed subepithelial infiltrates (SEIs) after the onset of bilateral EKC. Confocal microscopy of the left cornea 8 weeks after the onset of EKC showed many highly reflective dendritic cells at the level of basal epithelium, epithelial basement membrane zone, and anterior stroma, as well as many highly reflective fusiform and round cells within the anterior stroma, with deceasing density in progressively deeper layers of the stroma. These findings were not present on confocal microscopy that had been performed 2 weeks before the onset of EKC. CONCLUSION: Confocal microscopic examination of SEIs after EKC provides evidence of an inflammatory response localized to the basal epithelium and anterior stroma of the central cornea.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
7/14. Epidemic keratoconjunctivitis and chronic papillary conjunctivitis in london due to adenovirus type 19.Since July 1973 cases of keratoconjunctivitis resembling epidemic keratoconjunctivitis were observed in the External Eye disease Clinic at Moorfields Eye Hospital; City Road, london. Adenovirus type 19 was isolated in human embryonic kidney cells from 21 patients. The majority were males between 20 and 40 years old. A small hospital outbreak involving six patients occurred. Clinical features of the disease, consisting of moderate to severe follicular conjunctivitis, major subepithelial punctate keratitis, sometimes with pseudomembrane and scarring, were closely similar to those of epidemic keratoconjunctivitis caused by adenovirus type 8. This similarity, as well as the ability of the agent to cause hospital outbreaks, indicates that adenovirus type 19 is a cause of epidemic keratoconjunctivitis. A case of bilateral chronic papillary conjunctivitis that persisted for 16 months following an acute onset was described. Adeno 19 was isolated from the eye of the patient after 12 months of recrudescent or recurrent illness. Chronic adenovirus infection lacking the usual clinical picture of an acute follicular reaction has not hitherto been described. Such cases are probably important because of the obvious danger of continuing the carriage and shedding of infective adeno 19 from one outbreak to another, by presenting subsequently in eye clinics, and providing an unrecognised source of infection to initiate further outbreaks of hospital transmission.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
8/14. Symblepharon formation in epidemic keratoconjunctivitis.Two case reports are presented in which patients with epidemic keratoconjunctivitis (EKC) develop symblepharon during the course of their infection. This report is the initial documentation of symblepharon formation in EKC and the first reported episode of conjunctival membrane formation in association with adenovirus type 2.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
9/14. Contact lens induced keratopathy: a severe complication extending the spectrum of keratoconjunctivitis in contact lens wearers.A 21-year-old woman developed bilateral keratoconjunctivitis from contact lens wear, which progressed to diffuse corneal scarring and vascularization after the patient refused to discontinue wearing contact lenses. The visual disturbance became so severe that a penetrating keratoplasty had to be performed in one eye for visual rehabilitation. Examination of the penetrating keratoplasty specimen disclosed destruction of Bowman's membrane throughout the superior half of the cornea, which was replaced by a fibrous scar that was only midly chronically inflamed. Deep vascularization occurred within the stroma. This case represents an extreme expression of a recently characterized syndrome consisting of conjunctival and corneal changes in patients who may be allergic to contact lenses or the solutions used in conjunction with their care. In the milder end of the spectrum, there is superior epibulbar conjunctival injection with associated tarsal injection, and a mild superficial punctate keratopathy without filaments. Some earlier workers have termed this syndrome a variant of superior limbic keratoconjunctivitis in association with contact lens wear, but this leads to confusion with Theodore's classical superior limbic keratoconjunctivitis, to which the present entity bears no etiologic relationship; it also fails to show many of the findings of Theodore's disease. In mild cases, we would recommend the term contact lens-induced keratoconjunctivitis, and in the more severe cases, such as demonstrated by our patient, we would suggest the term contact lens-induced keratopathy.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
10/14. Corneal histology after epidemic keratoconjunctivitis.Two years after typical signs and symptoms of epidemic keratoconjunctivitis developed in a 67-year-old woman, in whom locally effective steroids were not used for treatment, a lamellar graft was transplanted because of marked visual disturbances that were due to corneal opacities. Histopathology of the cornea revealed notable changes in the superficial stroma, including Bowman's membrane, with some lymphocytic infiltration of the stroma and the overlying epithelium. Electron microscopy showed no virus-like particles.- - - - - - - - - - ranking = 0.090909090909091keywords = membrane (Clic here for more details about this article) |
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