Ocular Foreign Bodies: A Review

A foreign body is any abnormal substance or object that does not belong to the body (eye). The incidence of foreign body in the eye is high especially in the industrial towns. It can occur at any age and in both genders. It affects the eye by mechanical effects, by introduction of infection or by specific reaction. Introduction of a foreign body is a significant disturbance and can create health problem. The study of the foreign body presents unparalleled opportunities for reducing morbidity and for realizing significant savings in both financial and human terms.

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Corneal Toxicity after Self-Application of Calotropis procera (Ushaar) Latex: Case Report and Analysis of the Active Components

Calotropis procera (ushaar) produces a copious amount of latex, which has both inflammatory and antiinflammatory pharmacological properties. Local application produces an intense inflammatory response and causes significant ocular morbidity. 

We report corneal toxicity following self-application of latex from C. procera in a 74-yearold man. He reported painless decreased vision in the affected eye with diffuse corneal edema, and specular microscopy revealed a reduced endothelial cell count. After he was treated with topical corticosteroids, his visual acuity improved from HM to 20/80. The composition of the active compounds in the latex was analyzed. When topically administered, the latex may cause severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage

Maculopathy associated with Prior Tamoxifen Use Diagnosed with Commercially Available Fourier-Domain Optical Coherence Tomography: A Case Series

Tamoxifen is a drug used to treat estrogen receptor positive breast cancer that can induce retinopathy. The diagnosis of tamoxifen retinopathy is traditionally established by macularedema seen on fluorescein angiography and retinal crystalline deposits seen on funduscopy. Macular edema associated with tamoxifen retinopathy has been reported to be reversible after cessation of the drug but the retinal crystalline opacities usually persist. 

Recently, a case of bilateral microcystoid maculopathy with patches of photoreceptor loss associated with concurrent tamoxifen use was detected using a research-grade high resolution Fourier-domain optical coherence tomography (Fd-OCT) in a patient with vision loss unexplained by funduscopy, fluorescein angiogram (FA), multifocal electro retinography and Stratus OCT. This report describes two new cases of maculopathy associated with prior tamoxifen use in which similar morphologic changes were seen using commercially available Fd-OCTs, Cirrus (Carl Zeiss Meditec, Dublin, CA) and RTVue (Optovue, Fremont, CA), in eyes that appeared unremarkable on funduscopy.

Management of Corneal Graft Rejection - A Case Series Report and Review of the Literature

To report long-term results in a case series of patients treated with systemic immune suppression for prevention of penetrating keratoplasty (PKP) graft rejection. Retrospective non comparative chart review. Three patients presented with PKP graft failure. 

Patients received oral prednisone, azathioprine and cyclosporine to prevent rejection of repeat corneal transplant. Patients received repeat PKPand graft outcome was reported. Main outcome measures: Visual acuity and graft survival were recorded. Mean age was 55 years, two male and one female. Mean follow-up period was 37 months (range 24- 46). All three patients completed the treatment protocol with minimal adverse effects. All grafts remained clear over observational period. Conclusion: Our study suggests that systemic immune suppression with 2 or more agents may be helpful to prevent corneal graft rejection in high-risk patients.

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Combined Antifungal therapy is effective in handling fungal keratitis

Fungal keratitis is an alarming disease with a significant impact on the vision quality. Although anti fungal drugs are effective in controlling this disorder, a significant challenge lies in the management of the disease. 

The drug delivery into the corneal tissues and identification of fungal pathogens play important roles in management of fungal keratitis. Although 10 different varieties of antibacterial, antifungal and cycloplegic drugs are available, a combined therapy of antifungal agents achieved the best treatment modality in cases of fungal keratitis.

Retreatment Rate Following Supracor Treatment of Hyperopic Presbyopia

To report the retreatment rate and safety of presbyopia treatment using the corneal laser in situ keratomileusis (LASIK) procedure, Supracor. In this case series, bilateral LASIK using the Supracor algorithm was performed on consecutive hyperopic presbyopic patients. 

All patients were followed for a minimum of six months postoperatively. The principal outcome measures were re treatment rate, safety, efficacy in terms of uncorrected distance visual acuity (UDVA) and uncorrected reading ability (vocational reading test), patient satisfaction, stability and predictability. Results: 76 eyes of 38 patients were treated. 42% of patients (16 patients) that were treated required at least one re-treatment.

Epidermal Cyst of Upper Eyelid: A Case Report with Literature Review

Epidermal cysts are benign slow growing tumors resulting from proliferation of epidermal cells. Usually cysts are asymptomatic; however, they may become inflamed or secondarily infected. Epidermal cysts are solitary sub epithelial cysts, are slowly progressive and firm in consistency. They are most commonly seen on the face, scalp, neck and trunk. Epidermoid cysts are frequently seen on the upper eyelid, mainly on the conjunctiva or on the skin. This may be misdiagnosed as chalazion or sebaceous cyst. Surgical excision of the cyst in toto is the treatment of choice or else there will be recurrence, granulomatous reaction or foreign body reaction.

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Automatic Measurement of Choroidal Thickness with Swept-Source Optical Coherence Tomography for Clinical Follow-Up in Acute Vogt-Koyanagi-Harada Disease

Vogt-Koyanagi-Harada (VKH) syndrome is a bilateral granulomatous uveitis that typically presents with distinct clinical features based on the duration and stage of the disease. The acute stage of VKH is characterized by diffuse choroiditis, multifocal areas of subretinal fluid and/or bullous serous retinal detachments, with or without neurologic (headaches, meningismus) or auditory (tinnitus, hypoacusia) symptoms. 

The convalescent stage of the disease develops 12 weeks after onset and is characterized by resolution of retinal detachments with disappearance of cells from the anterior chamber and the vitreous, with characteristic pigmentary changes in the macula and sunset glow fundus. The chronic/recurrent phase is characterized by clinical signs of disease activity in the anterior segment of the eye with anterior granulomatous uveitis and dermatologic signs (vitiligo, alopecia, poliosis).

Prologue to the Special Issue: Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss among people age 50 and older. Based on the presence or absence of blood vessels, it is classified intotwo types, wet and dry. In the past decades, significant progress has been made in understanding the molecular mechanisms underlying wet AMD, and several robust therapeutic drugs were developed to block the development of new blood vessels and leakage from the abnormal vessels with favorable clinical effect.

In contrast, there are no approved treatments for dry AMD and the mechanisms are not completely known. However, it has been approved that genetics, complement dysregulation, oxidative stress, mitochondria DNA damage were involved in the mechanisms. Variety of scientific studies, including gene replacement therapy, retinal cell transplantation, pharmaceutical intervention and vitamin dietary supplementation, hold promise in developing treatment to prevent or slow the progression of the disease. In the clinical aspect, multiple clinical studies and trials have been done to further our knowledge of AMD, and on-going studies are raising hopes for improved treatments.

Neuronavigational Approach for Orbital Neurofibroma Excision: A Case Report

Orbital neurofibromas are uncommon in adults, accounting for approximately 1%-3% of all space occupying lesions of the orbit. The complex anatomy of the orbital region, with the pronounced vulnerability of its neurovascular structures, requires particular surgical precautions. Neuronavigation, as a high-tech device for intraoperative safety,represents a valuable option for the confined orbital space. However, the application of neuronavigation in orbital surgery has been rarely reported. The authors present a case report of a 32-year-old female with an isolated localized neurofibroma surgically approached by intraoperative navigation and a review of the literature.

A 32-year-old female presented with a 2-year history of left upper lid swelling and progressive onset of proptosis and double vision (Figure 1). She had no family history of neurofibromatosis.

Ophthalmologist’s examinationrevealed a decreased visual acuity 7/10 associated with ptosis, unilateral exophthalmos with restricted eyeball movement on upward and lateral gaze in the left eye. The visual field examination was normal.