1/49. Bilateral keratoconus associated with Hashimoto's disease, alopecia areata and atopic keratoconjunctivitis.keratoconus is a progressive non-inflammatory corneal ectasia. alopecia areata is complete loss of hair patches on the hairy areas of the body in association with some ocular manifestations such as cataract, or disorders of the conjunctiva, iris, lens, choroid and retina pigment epithelium. A ten-year-old patient with atopic keratoconjunctivitis, keratoconus and alopecia areata is presented. This patient has also been receiving treatment for Hashimoto thyroiditis (chronic lymphocytic thyroiditis) for more than three years. The possible association of keratoconus with multisystem autoimmune disease is discussed.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
2/49. Bilateral circumscribed posterior keratoconus.BACKGROUND: Posterior keratoconus is a rare corneal disorder characterized by a diffuse or localized protrusion of the posterior corneal surface into a thinning stroma. It is believed to be a congenital, nonprogressive condition. CASE REPORT: A case of bilateral circumscribed posterior keratoconus is presented. Diagnostic ocular signs include localized protrusion of the posterior corneal surface, normal anterior corneal surface, stromal thinning, and endothelial changes. However, anterior corneal contour reveals progressive steepening in this case. CONCLUSION: Posterior keratoconus is an unusual corneal anomaly with subtle clinical features. Recognition of these signs is essential in the diagnostic and management processes.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
3/49. Denovo development of corneal guttae and Fuchs' dystrophy in corneal grafts.PURPOSE: To describe two cases of de novo development of corneal guttae and Fuchs' dystrophy in donor tissue following penetrating keratoplasty (PK) for unrelated conditions. methods: Two patients underwent PK for keratoconus and a disciform scar secondary to herpes simplex virus. They were followed clinically for a period of 16 and 11 years, respectively. Specular microscopy was used in one patient. RESULTS: Corneal guttae were first noted 10 years and 4 years following transplantation in the first and second patient, respectively. In both cases, the corneal guttae gradually increased in number, involving the central and temporal portions of the corneal graft There were no corneal guttae present in the host corneal rim or contralateral cornea of either patient. CONCLUSIONS: These cases provide evidence to suggest that some corneas may be genetically predetermined to develop corneal guttae and Fuchs' dystrophy many years before any changes can be clinically detected.- - - - - - - - - - ranking = 8.4291941210355keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
4/49. Circumscribed posterior keratoconus: case report.BACKGROUND: Posterior keratoconus has only a few scattered case reports in the literature. Posterior keratoconus is characterized by a posterior stroma thinning and a depression of the posterior corneal surface. The effect on acuity is variable and may be related to other ocular and systemic conditions. CASE REPORT: An African-American woman came to us with posterior concavity (corneal thinning), with stromal scarring in both eyes and an epithelial iron ring present in the left eye. The endothelia layer appeared intact in both eyes. corneal topography of the right eye demonstrated a central flattened zone with peripheral steepening, while the left eye an inferior nasal steepened zone was present. The patient was also diagnosed with myopic degeneration (O.D. > O.S.) as well as cataracts. CONCLUSIONS: Posterior keratoconus generally has a minimal effect on visual performance and requires no specific treatment. In cases in which visual defect is severe and is attributable to the posterior keratoconus--and not other ocular conditions, such as cataracts--penetrating keratoplasty should be considered.- - - - - - - - - - ranking = 2keywords = ocular (Clic here for more details about this article) |
5/49. Acute hydrops in the corneal ectasias: associated factors and outcomes.PURPOSE: To identify factors associated with the development of hydrops and affecting its clinical outcome. methods: Chart review of all patients with acute hydrops seen by a referral cornea service during a 2.5-year period between June 1996 and December 1998. RESULTS: Twenty-one patients (22 eyes) with acute hydrops were seen. Nineteen patients had keratoconus, 2 had pellucid marginal degeneration, and 1 had keratoglobus. Twenty-one of 22 (95%) eyes had seasonal allergies and 20 of 22 (91%) eyes had allergy-associated eye-rubbing behavior. Six of 22 (27%) had a diagnosis of Down's syndrome. Six patients were able to identify a traumatic inciting event: vigorous eye rubbing in 4 and traumatic contact lens insertion in 2. The affected area ranged from 7% to 100% of the corneal surface area and was related to disease duration and final visual acuity. Proximity of the area of edema to the corneal limbus ranged from 0 to 2.3 mm and was also related to prognosis. Three serious complications were observed: a leak, an infectious keratitis, and an infectious keratitis and coincidental neovascular glaucoma. Various medical therapies did not differ significantly in their effect on outcome, and ultimately 4 (18%) of 22 patients underwent penetrating keratoplasty. Best-corrected visual acuity was equal to or better than prehydrops visual acuity in 5 of the 6 patients in whom prehydrops visual acuity was known, without corneal transplantation. CONCLUSIONS: Allergy and eye-rubbing appear to be important risk factors in the development of hydrops. Visual results are acceptable in some patients without surgery. Close observation allows for the early detection and treatment of complications such as perforation and infection.- - - - - - - - - - ranking = 1284.3448772819keywords = keratitis (Clic here for more details about this article) |
6/49. Graft failure in human donor corneas due to transmission of herpes simplex virus.AIM: To report the clinical consequences of contamination of human donor corneas by herpes simplex virus (HSV) in organ culture. methods: Two patients without previous history of ocular HSV infection underwent penetrating keratoplasty (PK), one for keratoconus and the other for fuchs' endothelial dystrophy. One patient suffered primary graft failure while the other developed a persistent epithelial defect, ultimately resulting in graft failure. Viral culture of swabs taken from both corneas during the early postoperative period was undertaken. The failed donor corneas were examined histopathologically by immunohistochemistry (IHC) for HSV-1 antigens, transmission electron microscopy (TEM), and by polymerase chain reaction (PCR) for HSV dna. Both failed corneas were replaced within 6 weeks of the initial surgery. The records of the fellow donor corneas were also examined for evidence of infection. RESULTS: HSV was cultured from both corneas during the early postoperative period. histology of both donor corneas demonstrated a thickened corneal stroma with widespread necrosis of keratocytes and loss of endothelial cells. IHC showed keratocytes positive with antibodies to HSV-1 antigens. TEM demonstrated HSV-like viral particles within degenerating keratocytes. PCR performed on the failed corneal grafts was positive for HSV-1 dna, whereas PCR performed on the excised host corneal buttons was negative in both patients. Records of the fellow donor corneas showed that one cornea was successfully transplanted into another recipient after 18 days in organ culture, whilst the other was discarded because of extensive endothelial cell necrosis noted after 15 days in organ culture. CONCLUSION: HSV within a donor cornea may cause endothelial destruction in organ culture and both primary graft failure and ulcerative keratitis after transplantation. Endothelial necrosis of a donor cornea in culture also raises the possibility of HSV infection within the fellow cornea.- - - - - - - - - - ranking = 685.31840924611keywords = keratitis, herpes simplex, simplex, ocular, herpes (Clic here for more details about this article) |
7/49. keratoconus associated with continual eye rubbing due to punctal agenesis.PURPOSE: To highlight a possible causal effect of eye rubbing in the etiology of keratoconus. methods: A 43-year-old man presented to the practice of one of the authors (I.F.G.) with the complaint of gradual onset reading difficulty. history revealed the patient to have experienced constant epiphora in the right eye throughout his life as a result of punctal agenesis, which necessitated frequent wiping of this eye. Vision in the patient's right eye had been reduced for approximately 20 years. RESULTS: Based on ocular examination, the patient was diagnosed as having unilateral keratoconus in the right eye. CONCLUSION: It is thought by some that keratoconus is associated with, or indeed caused by, persistent rubbing of the anterior eye. While a number of studies support a genetic basis for keratoconus in some patients, it is possible that mechanical factors play a role in the development of this condition in other patients. This paper presents a case of unilateral keratoconus, where there is a confirmed history of habitual eye rubbing and wiping of excess tears as a result of punctal agenesis in the ipsilateral eye, thereby suggesting a possible causal relationship of eye rubbing in the etiology of keratoconus.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
8/49. Secondary keratoconus with corneal epithelial iron ring similar to Fleischer's ring.BACKGROUND: Fleischer's ring is considered to be a characteristic of keratoconus, but we have seen a ring similar to Fleischer's ring in patients with secondary keratoconus, in which the cornea becomes thinner secondarily for undetermined reasons. CASES: We report 6 cases of secondary keratoconus with a corneal epithelial ring similar to the Fleischer's ring pattern. OBSERVATIONS: In these 6 cases (2 men and 4 women), the causes of secondary keratoconus were trachoma in 2 cases, trauma in 2 cases, keratitis in 1 case and unknown etiology in one case. All showed thinning of the cornea and a corneal iron ring similar to Fleischer's ring pattern. The corneal button obtained after keratoplasty in 1 case showed the deposition of hemosiderin in the corneal epithelium after staining with Prussian blue. At the same time we confirmed the existence of iron in the corneal epithelium by x-ray ultimate analysis. CONCLUSIONS: All 6 patients we encountered had a past history of corneal disease in their childhood except for 1 case with unknown etiology. Primary keratoconus is also considered to develop by the early teens at the latest. These facts led us to an assumption that the occurrence of some abnormalities in the cornea during the growth period may result in iron deposition in the epithelium and thinning of the stroma. In light of these facts, abnormalities of the iron metabolism must be thoroughly investigated in considering the etiology of keratoconus.- - - - - - - - - - ranking = 642.17243864093keywords = keratitis (Clic here for more details about this article) |
9/49. Management of hypotony maculopathy and a large filtering bleb after trabeculectomy with mitomycin C: success with argon laser therapy.We report a patient with postkeratoplasty glaucoma that developed a large, filtering bleb following trabeculectomy with intraoperative antimetabolite treatment. The hypotony and the bleb were managed using argon laser photocoagulation. A 26-year-old female patient underwent penetrating keratoplasty in the left eye for keratoconus. Postoperatively, her elevated intraocular pressure could not be controlled medically, and the patient underwent a trabeculectomy with intraoperative antimetabolite application. Two months later, hypotony maculopathy, optic disc edema, and choroidal folds developed, and her vision dropped. Steroid treatment and soft contact lenses did not help. Photocoagulation was applied twice to the surface of the bleb and the surrounding area. After the photocoagulation therapy, the patient's vision improved, intraocular pressure increased, and the optic disc edema and macular folds had resolved. argon laser photocoagulation applied to a large filtering bleb associated with hypotony maculopathy is a useful treatment for bleb remodeling and elevating intraocular pressure.- - - - - - - - - - ranking = 3keywords = ocular (Clic here for more details about this article) |
10/49. Pseudokeratoconus caused by rosacea.PURPOSE: A case of inferior corneal thinning and high astigmatism with features of keratoconus in a patient with long-standing ocular rosacea is described. methods: Axial curvature mapping was performed with the Tomey TMS-1 videokeratoscopy instrument and corneal thickness mapping was performed with the Orbscan corneal topography System (CTS). Tear clearance was assessed by measuring the concentration of fluorescein in the tear fluid with a fluorometer. RESULTS: There were inferior corneal thinning and opacification in both eyes. Tear fluorescein clearance was markedly delayed in the right eye. There was asymmetric inferior corneal steepening in both eyes with I-S values of 1 in the right eye and 5.9 in the left eye. There were 5.9 diopters of astigmatism at 85 degrees in the right eye and 7.3 diopters of astigmatism at 73 degrees in the left eye. corneal pachymetry mapping with the Orbscan CTS showed a normal central corneal thickness and maximal thinning in the inferotemporal periphery of the right cornea and inferonasal periphery of the left cornea. CONCLUSION: Chronic ocular rosacea can produce inferior corneal thinning and high astigmatism with some features of keratoconus. The inferior pattern of thinning in rosacea may be related to chronic exposure of the inferior cornea to inflammatory and matrix-degrading factors in the inferior tear meniscus.- - - - - - - - - - ranking = 2keywords = ocular (Clic here for more details about this article) |
| | Next -> |