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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Aberrometric Outcomes of Intrastromal Corneal Ring Segment (KeraRing 355) Implantation Using Pocket Maker Microkeratome in Patients with Keratoconus

Keratoconus, the most common primary corneal ectasia, is a bilateral asymmetric corneal degeneration which accompanies with local corneal thinning and occurs mostly in inferior and central part of the cornea. Initiating in puberty, Keratoconus (KCN) often progresses until fourth decade of life.

Affecting all ethnic groups equally, KCN usually causes high myopia and irregular astigmatism which results in poor quality of vision. Based on disease severity, many treatment modalities exist including glasses and contact lenses for mild to moderate disease while corneal graft preserved for more advanced disease. High costs, need to long follow-ups, long periods for visual rehabilitation, risks of graft rejection or infection, wound dehiscence and suture-related problems make corneal grafts preserved for the last therapeutic choice by many ophthalmologists.

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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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Intraocular Pressure Measurement after Photorefractive Keratectomy: Does Contact Area Matter?

Refractive laser surgery induces substantial changes in corneal structure, causing inaccurate intraocular pressure (IOP) readings. Pascal dynamic contour tonometry (PDCT) and I care rebound tonometer (RBT) are two novel devices that do not depend on applanationto measure IOP. Purpose of this prospective study was to compare PDCT and rebound tonometry versus Gold man tonometry (GAT) in a group of patients who underwent photorefractive keratectomy (PRK). 

Central corneal thickness and IOP were measured in 54 eyes before and after PRK. All IOP measurements were taken by the same examiner, using PDCT, RBT and GAT in a randomised, masked fashion. After excimer laser surgery, PDCT measurements were higher than GAT (p<0.0001) and RBT (p=0.0012). Multiple linear regression analysis indicated that size of contact area was significant (b=-0.504; p<0.0001) while corneal thickness was not (b=0.003; p=0.169). 

Human Turbinate-derived Mesenchymal Stem Cells Differentiated into Keratocyte Progenitor Cells

Though keratoplasty is used to treat corneal blindness, donor shortage, tendency of stimulated keratocyte transformed to fibroblast and immunological rejection are still big problems. As a solution, cornea tissue engineering using non-corneal tissue sourced cells become emerging issue. Thus, this study was designed to find novel material for keratoplasty.

Human turbinate-derived mesenchymal stem cells (hTMSCs) were obtained from patients and cultured with differentiation medium for 14 days. The keratocyte markers, stem cell markers, early corneal stromal stem cell (CSSC) markers, were measured by real time-PCR. The MSC markers were detected by FACS. Results: After 14 days of differentiation medium exposure, hTMSCs expressed markers of keratocyte such as keratocan sulfate proteoglycan (KERA) and aldehydrogenase (ALDH). As the hTMSCs became keratocytes, the expression of embryonic ocular precursor markers ABCG2 and PAX6 decreased but were still measurable. Early CSSC markers including SIX2, SIX3, BMI expression was elevated after 7 d and reduced after 14 d of KDM treatment.

The Disease Course of Bilateral Endogenous Fungal Endophthalmitis

To report the dynamic disease course of a case of bilateral endogenous fungal endophthalmitis, which was successfully treated? Case Report: A 54 year old Chinese man with a history ofextracorporeal shock wave lithotripsy (ESWL) and ureteroscopy was referred to our center. After 1 week, his best corrected Snellen visual acuity (BCVA) values were 20/100 and 20/25; the interface between the posterior vitreous face and the retinal surface appeared to be rough in the right eye, and a similar, larger, low-rounded circumscribed apophysis could be observed in the left eye.

During the 2nd week, his BCVA values decreased to 20/400 and 20/32. He was diagnosed with bilateral endogenous Candida albicans endophthalmitis after a vitreous biopsy and then underwent binocular pars plana vitrectomy (PPV) with silicone oil injection in both eyes. Post operatively, his BCVA values were 20/63 and 20/32, and fundoscopy and optical coherence tomography (OCT) showed a regular and smooth interface and retina surface after the removal of the silicone oil at 3 months. 

The Effects of Intense Pulsed Light on Tear Osmolarity in Dry Eye Disease

In this prospective study we show the influence of Intense Pulsed Light Therapy (IPL) on tear osmolarity, an increasingly important metric of dry eye disease. Previous studies have measured the effectiveness IPL has had on other metrics including tear break up time (TBUT), lipid layer grade (LLG), tear evaporation rate (TER), tear meniscus height (TMH), and subjective responses from patients.

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The Effects of Intense Pulsed Light on Tear Osmolarity in Dry Eye Disease

In this prospective study we show the influence of Intense Pulsed Light Therapy (IPL) on tear osmolarity, an increasingly important metric of dry eye disease. Previous studies have measured the effectiveness IPL has had on other metrics including tear break up time (TBUT), lipid layer grade (LLG), tear evaporation rate (TER), tear meniscus height (TMH), and subjective responses from patients.

Single center prospective study included 16 patients and 32 eyes. Patient ages ranged from 18 to 90 years old with 75% of participants being female. All patients had an at least one eye with a tear osmolarity of 308 mOsm/L or greater, or had an inter-eye difference in tear osmolarity of 11 mOsm/L or greater. Tear osmolarity was measured bilaterally before a single IPL treatment followed by one drop of topical NSAID. Bilateral tear osmolarity was then measured again one month later.

Screening and Diagnosis of Hydroxychloroquine Toxicity: Advances and Controversies

Hydroxychloroquine (HCQ) is a widely-used medication. Although classically associated with the treatment of malaria and systemic lupus erythematosus (SLE), the potential spectrum of HCQ utility is actually quite expansive, and may come to include more common diseases and disorders. 

Although generally considered a safe medication in the medical community, the adverse effect profile of HCQ is distinguished by irreversible retinal toxicity, with a reported prevalence between 0.5% and 7.5%. Primary prevention is a key for these patients, because the retinal damage is considered largely irreversible. However, the means of primary prevention, i.e. screening, has been at the center of controversy in the ophthalmology community for several years.

Investigation of Electrolyte Changes in Bovine Vitreous at Different Postmortem Interval

Investigation of the changes in electrolyte level in the Bovine vitreous at different postmortem interval under two different temperature conditions. Ninety eight bovine right eyes from freshly slaughtered healthy cows were gotten from the government abattoir in Edo State, Nigeria. 

They were divided into two sets; forty nine right eyes were kept at 32°C while forty nine right eyes were kept at 4°C in a mobile refrigerator. The samples of vitreous were carefully aspirated from the bovine eyes within an hour of death of the animals. Measurements of the levels of cations (sodium and potassium) and anions (chloride and bicarbonate) were taken at various postmortem intervals of 2, 12, 24, 36, 48, 60 and 72 hours, using E110111 Flame Photometer.

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.

Correlation of Retinal Vessel Analysis and Nerve Fiber Layer Thickness in Normal Tension Glaucoma

Background: To investigate the retinal vessel diameter and its possible relationship with the retinal nerve fiber layer (RNFL) thickness in normal tension glaucoma (NTG).

Methods: 86 NTG patients with detailed eye examination including retinal vessel analysis (DVA) and measurement of the RNFL thickness with scanning laser polarimetry (SLP; GDxVCC) were included in this retrospective study. The temporal retinal arteriolar diameters, temporal retinal venular diameters, vascular flicker response were compared with RNFL thickness and NFI (nerve fiber index).

Results:The flicker response of DVA was significantly reduced as compared to normal eyes. The diameters of the temporal retinal arteriolar vessels were significantly correlated with RNFL thickness (P=0.0204) and NFI of GDxVCC (P=0.0021). The diameters of the temporal retinal venular were significantly correlated withthe NFI (P=0.0298).

Conclusion: Our results show that narrower arteriolar vessels are found in advanced NTG patients. These findings may be due to the decreased demand for retinal blood flow in damaged retina, but also may be one reason for the damage. Vessel analysis can contribute to the available tools predicting glaucomatous damage before visual field loss becomes manifest.