Cases reported "Corneal Diseases"

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1/14. corneal transplantation in a patient with mucopolysaccharidosis type VII (Sly disease).

    PURPOSE: To illustrate a good visual outcome following penetrating keratoplasty in a patient with Sly disease, a rare mucopolysaccharidosis (MPS) caused by a deficiency of beta-glucuronidase. methods: A 15-year-old male with progressive bilateral corneal opacification had a complete medical, genetic, and ophthalmic evaluation followed by a penetrating keratoplasty. RESULTS: The cornea has remained clear for two years following surgery. Histopathology of the corneal button demonstrated vacuoles and granular inclusions consistent with this lysosomal storage disease. CONCLUSION: While research is ongoing in the fields of enzyme replacement and bone marrow transplantation, these treatments may not alleviate or reverse the corneal clouding. This case illustrates that cornea transplantation may be a valuable treatment option for visually rehabilitating such patients.
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keywords = research
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2/14. A new surgical technique for keratoglobus-tectonic lamellar keratoplasty followed by secondary penetrating keratoplasty.

    PURPOSE: To develop a technique that achieves satisfactory visual rehabilitation in keratoglobus, without the problems of re-epithelialization failure and with minimal risk of graft rejection. methods: A patient with bilateral keratoglobus and visual acuities of light perception in the right eye and 6/60 in the left underwent a tectonic lamellar keratoplasty to the right eye. The cornea was first trephined to the depth of the anterior stroma within the limbus. A lamellar dissection technique then was used to tunnel into sclera under the limbus to preserve stem cells. The host corneal epithelium was completely debrided, and a donor corneoscleral button, denuded of its endothelium, was laid on top. A paracentesis was made, and aqueous was aspirated until the anterior chamber had collapsed enough to take up a more physiologic shape. The donor corneoscleral graft was sutured into the prefashioned scleral bed with long, interrupted sutures. Once in situ, the donor graft was debrided of epithelium, and the host limbus was sutured on to it, covering its scleral component. Six months later, a penetrating keratoplasty was performed. The same procedure was performed on the left eye 2 years later. RESULTS: The right eye maintained a best-corrected visual acuity of 6/60 for 16 months after the penetrating graft until the graft decompensated, leaving a final acuity of counting fingers. The left eye maintained a best-corrected visual acuity of 6/18. CONCLUSION: Tectonic lamellar keratoplasty to preserve the host limbus, followed by secondary penetrating keratoplasty, is a realistic alternative to other procedures for the surgical management of keratoglobus.
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ranking = 29.656222833218
keywords = perception
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3/14. Seoul-type keratoprosthesis: preliminary results of the first 7 human cases.

    OBJECTIVE: To evaluate the clinical efficacy of a newly designed Seoul-type keratoprosthesis (S-KPro). methods: The S-KPro, which consists of a polymethyl methacrylate optic, a skirt (polyurethane or polypropylene), and polypropylene haptics, was developed and implanted into 2 unsighted and 5 sighted eyes of 7 patients. One patient had a chemical burn, another had an ocular pemphigoid, and the remainder were diagnosed as having stevens-johnson syndrome. The preoperative visual acuities ranged from light perception to hand motions. The average follow-up time was 25.6 months. MAIN OUTCOME MEASURES: We evaluated anatomical stability, visual acuity, retinal status, and the visual field. RESULTS: At the last follow-up visit, the S-KPro was well placed in 6 patients. The best-corrected visual acuities of the sighted patients ranged from 20/100 to 20/60 in the affected eye. One patient each experienced retinal detachment or endophthalmitis. Partial extrusion was found in the patient with glaucoma. A retroprosthetic membrane was detected in 1 patient and was treated with an Nd:YAG laser. No glaucomatous visual field defects were found in any of the sighted patients. CONCLUSIONS: Anatomical success was achieved in 6 of 7 eyes. In 3 of the 5 sighted eyes, the S-KPro could rehabilitate corneal blindness not correctable with keratoplasty.
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ranking = 29.656222833218
keywords = perception
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4/14. Reversibility of corneal pigmented arc associated with orthokeratology.

    Corneal pigmented (brown) arcs were observed in two orthokeratology patients, both aged 23 years. The preorthokeratology refractive data were OD -5.25 -0.50 x 175 and OS -6.00 -0.75 x 5 for patient A and OD -3.75 -1.00 x 10 and OS -3.00 -1.25 x 175 for patient B. The time course for the development of the arcs was different not only between the two patients but also between the two eyes of patient A. For patient A, the pigmented arc was observed in the left eye 1 week after commencement of lens wear and was not observed in his right eye until a visit about 6 weeks later. For patient B, the arcs were only observed at an aftercare visit about 28 weeks after commencing lens wear. Both patients had been participating in an orthokeratology research study for about 12 months and decided to stop the treatment after completion of the study. The pigmented arcs were no longer present when they returned about 2 months later for assessment of the regression of the refractive and corneal changes induced by the procedure.
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ranking = 1
keywords = research
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5/14. Management of corneal ectasia and cataract following photorefractive keratectomy.

    A 42-year-old man was referred to our clinic 18 months after bilateral photorefractive keratectomy (PRK). He had been on topical prednisolone acetate for 12 months because of post-PRK grade 4 haze. On his first visit, visual acuity was limited to light perception in both eyes because of moderate haze, significant corneal ectasia, and a white cataract. A 2-step surgical approach was elected in both eyes. First, a deep anterior lamellar keratoplasty was performed. Six weeks later, phacoemulsification with intraocular lens implantation was performed. Compared with a triple procedure combining penetrating keratoplasty and cataract surgery in 1 stage, the 2-step approach may lower the risk for corneal graft rejection and reduce ametropia.
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ranking = 29.656222833218
keywords = perception
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6/14. Human immunodeficiency virus-positive patient with bilateral corneal endothelial deposits.

    BACKGROUND: Ocular disorders associated with the human immunodeficiency virus are numerous as are ocular side effects from medications used to treat all of the manifestations of the virus. This report presents a unique case of bilateral, peripheral, and corneal endothelial deposits that may be a result of either the human immunodeficiency virus or the medication rifabutin. rifabutin was the only medication prescribed that is known to cause endothelial deposits. rifabutin is part of a multidrug therapy to prevent or treat mycobacterium avium complex, a common pulmonary disease of immunocompromised individuals. CASE REPORT: A 69-year-old man with a 20-year history of being human immunodeficiency virus-positive presented with bilateral, asymptomatic, peripheral, and corneal endothelial deposits of unknown etiology. literature research suggested that the deposits did not appear like cytomegalovirus retinitis-related deposits but rather a variant of rifabutin-associated deposits. CONCLUSIONS: These rifabutin-associated deposits differed from known rifabutin-associated deposits previously reported in the literature. These deposits have increased in pigmentation and density 5 years after the patient discontinued the drug. This case may represent another variation of rifabutin-associated endothelial deposits. knowledge of human immunodeficiency virus and all the associated ocular findings (owing to both the condition and its treatment) is important, because the length of time patients are living with human immunodeficiency virus is increasing.
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ranking = 1
keywords = research
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7/14. Penetrating keratoplasty for severe complications of radial keratotomy.

    Severe sight-threatening complications were seen in five eyes of three patients following improperly performed radial keratotomy. All patients exhibited neovascularization of the incision sites, severe stromal scarring or ulceration involving the visual axis, loss of the anterior chamber, and iridocorneal adhesions. These complications necessitated multiple and complex surgical interventions, including penetrating keratoplasty and anterior segment reconstruction. Final visual acuity was decreased to light perception in four eyes while one eye achieved 6/60 vision following repeated penetrating keratoplasty. The success and safety of radial keratotomy rely on careful case selection, appropriate instrumentation, specialized training, and the ability to perform complex secondary procedures to correct surgical complications.
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ranking = 29.656222833218
keywords = perception
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8/14. Corneal fistulas and their management.

    We reviewed three representative cases of chronic corneal fistula formation and provide a systematic approach to the assessment and therapeutic alternatives for this problem. In two of our patients, the fistula was managed surgically. The third patient developed endophthalmitis, which resulted in loss of light perception. Chronic corneal fistulization is a rare clinical entity resulting from malapposition of corneal tissue after traumatic, surgical, or infectious perforation. Fistulas may result in prolonged or recurrent hypotony, peripheral anterior synechia formation, or endophthalmitis. Accurate assessment of the risks associated with corneal fistula formation takes into account the type of fistula, its location in the cornea, and the condition of the ocular adnexae. We reviewed the risk factors that will determine the urgency and type of therapy used.
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ranking = 29.656222833218
keywords = perception
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9/14. endophthalmitis after penetrating keratoplasty.

    Of 445 eyes (305 of which were aphakic) that underwent penetrating keratoplasty, 11 developed endophthalmitis, three immediately after surgery, two after subsequent secondary surgery, and six after late ulceration of the transplanted cornea. The diagnosis was based clinically on the loss of the red reflex and vitreous opacification, and was confirmed by culture of vitreous aspirate. All patients who developed endophthalmitis were aphakic and had received corticosteroids at the time of infection; most had undergone previous ocular surgery. These patients differed from those previously described with this condition because neither the donor tissue nor the storage medium was the source of infection. Treatment included intracameral, systemic, and topical administration of antibiotics. When the endophthalmitis originated from a corneal ulcer in a graft, the infected tissue was replaced with a new transplant. Despite treatment, the final visual outcomes were not good. One eye had a final visual acuity of 20/200 and one eye had a final visual acuity of 20/400. Three eyes had light perception and six eyes had no light perception. One eye was eventually enucleated.
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ranking = 59.312445666436
keywords = perception
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10/14. iris diagnosis.

    iris diagnosis is a useful method of assessment that offers the potential to expand the physician's understanding of a patient's overall state of health and vitality, and of the aetiology of disease processes. As it becomes refined by research around the world (mostly in germany at present), its accuracy in predicting organ disease already quite remarkable, continues to improve. iris diagnosis offers a useful and quick screening method that may alert the physician to underlying problems as an aid to the holistic physician in nutritional counseling.
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ranking = 1
keywords = research
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