Cases reported "Corneal Ulcer"

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1/12. Topical cyclosporin stimulates neovascularization in resolving sterile rheumatoid central corneal ulcers.

    OBJECTIVE: To report the successful use of topical cyclosporin for treatment of central sterile corneal ulcers associated with rheumatoid disease. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS/INTERVENTION: Five patients (7 eyes) with collagen vascular disorders presented with central, sterile corneal ulcers. An extensive medical evaluation did not reveal active underlying rheumatoid disease in any patient. Inadequate clinical response with use of topical steroids and lubricants led to corneal perforations requiring multiple tectonic procedures. Systemic immunosuppressive therapy either could not be initiated owing to a systemic contraindication or was discontinued owing to intolerance and side effects. The patients were ultimately treated with topical cyclosporin. RESULTS: Six of the 7 eyes responded favorably. An intense limbal vascularization began within 48 hours of treatment. The neovascularization progressed centrally with the simultaneous arresting of epithelial and stromal ulceration. Over a 2-week period, re-epithelization occurred with vascularization proceeding throughout the cornea. After several months, the corneal vessels attenuated, and all signs of inflammation subsided. Intrastromal bleeding with corneal blood staining occurred in 1 patient; this resolved over several months. No recurrences of corneal ulceration occurred in a mean follow-up period of 28 months (range, 7 to 60 months). None of the 5 patients have had a reactivation of their rheumatoid disease in the follow-up period. CONCLUSION: The clinical response in these patients contrasts with previous animal studies demonstrating an anti-angiogenic property of cyclosporin. We report that an immediate intense neovascularization is the first sign of a favorable clinical response. Treatment with topical cyclosporin alone may be considered in patients with sterile corneal ulcers associated with rheumatoid disease in the absence of systemic activation.
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2/12. Formation of a unilateral form deprivation myopia (FDM) due to a congenital eyelid entropium with a consecutive corneal ulcer: an illustrated case report.

    eye growth is regulated by a precise, sharp image of a distant object on the photoreceptor layer. A variety of laboratory investigations report that translucent occluders may induce axial eye elongation in animals. This axial growth is also called form deprivation myopia (FDM). In our pediatric ophthalmology clinic we observed the clinical correlate of FDM in a male infant with unilateral corneal ulcer due to a congenital tarsal malformation. Examination in the postnatal period under anesthesia revealed identical axial length in both eyes. Refraction of the affected eye could not be measured due to severe corneal ulcer. During an observation period of two years, the deep corneal opacification of the affected eye induced unilateral disproportionate axial elongation with formation of myopia. Formation of FDM may complicate treatment of amblyopia following unilateral media opacification. Periodic measurements of refraction should be performed to allow appropriate correction.
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3/12. Intrahyphal hyphae in corneal tissue from a case of keratitis due to Lasiodiplodia theobromae.

    Lasiodiplodia theobromae, a recognized plant pathogen, was isolated in culture from a case of human mycotic keratitis. Chemotherapy with a variety of azoles was unsuccessful and the lesion was removed surgically. Electron microscopy of thin sections of the excised corneal tissue revealed several examples of intrahyphal hyphae, a unique process described previously in in vitro cultures of various zoopathogenic fungi. We believe this to be the first report of the presence of intrahyphal hyphae in parasitized animal or human tissue. The demonstration of this process in vivo is thought to be consistent with the hypothesis that intrahyphal hyphae might represent an attempt by the invading fungus to survive in an otherwise unfavourable environment.
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4/12. Clinical and experimental mycotic keratitis caused by Aspergillus terreus and the effect of subconjunctival oxiconazole treatment in the animal model.

    Aspergillus terreus was isolated from a case of Keratomycosis. The patient, a 50 year old, female presented with a large corneal ulcer with hypopyon. The direct microscopic examination of the scrapings revealed hyaline, thin, septate and branched hyphae. in vitro some antimycotics (amphotericin b, 5-fluorocytosine, oxiconazole, amorolfine and ketoconazole) were tested against A. terreus by agar dilution method. ketoconazole with MIC of 3 micrograms/ml after 7 days of incubation was most effective followed by oxiconazole (10 micrograms/ml). Experimental corneal ulcer was produced by injecting intralamellary 0.1 ml of the spore suspension containing 10 x 10(6) cfu/ml into the eyes of previously immunocompressed albino rabbits. Histopathologic examination showed infiltration and large destruction of the corneal stroma. Subconjunctival oxiconazole therapy exhibited complete cure. Based on our findings, a clinical evaluation of oxiconazole in human keratomycosis seems to be justified.
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5/12. clostridium perfringens corneal ulcer.

    A corneal ulcer caused by clostridium perfringens developed in a 76-year-old woman with sjogren's syndrome. Experimental C perfringens keratitis was induced in rabbits by the intrastromal injection of 10(7) organisms. In both our patient and the experimental animals, a bullous lesion overlay the affected area of the cornea. This may be a specific lesion in clostridial infections of the cornea. clostridium perfringens should be regarded as an opportunistic corneal pathogen, and anaerobic cultures should be performed in all cases of suspected bacterial corneal ulcer.
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6/12. Clinical and experimental mycotic corneal ulcer caused by aspergillus fumigatus and the effect of oral ketoconazole in the treatment.

    aspergillus fumigatus was isolated from a case of keratomycosis. The patient, a 12-year-old boy presented with large corneal ulcer with hypopyon. The direct microscopic examination of scrapings revealed hyaline, septate mycelium. in vitro some antimycotics (amphotericin b,5-fluorocytosine, oxiconazole, amorolfine and ketoconazole) were tested against A. fumigatus by agar dilution method. ketoconazole with minimum inhibitory concentration of 30 micrograms/ml after 11 days of incubation was most effective against A. fumigatus. Experimental corneal ulcer was produced by injecting intralamellary spore suspension (2.5 x 10(6) c.f.u.) into the right eyes of previously immunosuppressed albino and black wild types of rabbits. The extent of ocular infection was graded up to 32 days. Histopathologic examination showed infiltration and large destruction of corneal stroma. Oral ketoconazole therapy exhibited partial response followed by relapse. The black type of rabbit appeared more suitable as an animal model for mycotic keratitis.
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7/12. pasteurella multocida corneal ulcer following a baseball injury.

    pasteurella multocida is an ubiquitous organism that can be isolated from a variety of animals and birds. It is an infrequent ocular pathogen but can cause infection as a result of injury or animal exposure. This article reports a case of P multocida corneal ulcer following a baseball injury.
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8/12. Isolation of rhodococcus rhodochrous from a chronic corneal ulcer.

    Organisms belonging to rhodococcus species have been isolated as the causative agent of infections in many animals and humans. The majority of the human infections so far reported have been limited to immunocompromised patients including AIDS patients. We report an elderly woman with a chronic corneal ulcer infected with rhodococcus. To our knowledge there is no previous report on a rhodococcus infection of the eye. Rarity of this type of infection by rhodococcus in a locally immunocompromised site in an otherwise healthy individual prompted this case history.
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9/12. corneal ulcer after exposure to vapours from bone cement (methyl methacrylate and hydroquinone).

    An operation nurse repeatedly developed a corneal ulcer while mixing bone cement. It is suggested that the ulcer developed because of a composite effect of vapours from bone cement (methyl methacrylate monomer and hydroquinone), in spite of the fact that the occupational health Guidelines and the national threshold limit values for chemical substances had been respected. In-vitro and in-vivo animal studies are reviewed.
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10/12. Human infectious corneal ulcer caused by pythium insidiosum.

    pythium insidiosum is a fungus-like organism known to infect a variety of animals. In humans, the few known cases involving pythium have included arterial infections and cellulitis. We present what we believe to be the first case of P. insidiosum recovered from a human corneal ulcer. The organism is difficult to isolate, causing delays in diagnosis. It is also resistant to the usual antifungal medications, making surgical excision the treatment of choice.
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