Systemic immunosuppressive therapy for progressive bilateral Mooren's ulcer

Nine patients with progressive bilateral Mooren's ulcer unresponsive to conventional ocular and systemic therapy were treated with methotrexate or with cyclophosphamide. The progressively destructive inflammatory process was arrested, and ocular anatomy and function were preserved, in eight patients who were adequately treated with immunosuppressive doses of the cytotoxic drugs for 6 to 24 months. The inflammatory process eventually destroyed both eyes of one patient who received inadequate therapy and follow-up care. Used properly, cytotoxic immunosuppressive therapy may offer a reasonable option in the care of patients with bilateral progressive Mooren's ulcer.     

Amniotic membrane transplantation for Mooren's ulcer

Background: To describe the outcome of surgery using amniotic membrane transplantation for Mooren's ulcer. Design: A prospective interventional case series from the Vietnam National Institute of Ophthalmology. Participants: Eighteen eyes of 14 patients with Mooren's ulcer. Seven eyes had recurrent episodes of ulceration, and 11 were not responsive to medical therapy or conjunctival resection. Methods: All eyes were treated with amniotic membrane grafts for Mooren's ulcer (10 eyes with multilayer grafts; 8 with a single layer graft). Five eyes with a 360° peripheral ulcer were treated with an overlay amniotic membrane graft, and 13 eyes were treated with a freehand graft tailored to fit the localized defect. Main Outcome Measures: Time to epithelial healing. Visual acuity outcome. Result: Sixteen of 18 eyes were treated by a single surgery with amniotic membrane with rapid healing of the epithelial defect (mean time to complete epithelialization 12.4 days). Two eyes required a second amniotic membrane graft: one eye required regrafting following a subgraft haemorrhage and another eye required regrafting for a persistent epithelial defect. Vision was stabilized in all eyes with 10 of 18 eyes obtaining vision of 6/12 or better. Conclusion: Amniotic membrane transplantation may be a useful treatment for selected patients with Mooren's ulcer especially where systemic immunosuppressive drugs are unavailable.     

Immunosuppressive Therapy for External Ocular Inflammatory Disease

Fourteen patients with progressive ocular inflammation and destructive lesions, unresponsive to conventional therapy, were treated with systemic immunosuppression. Ten patients had connective tissuelvasculitis diseases; two, cicatricial pemphigoid; and two, bilateral Mooren's corneal ulcers. Control of underlying systemic disease by immunosuppression resulted invariably in concomitant control of ocular inflammation and destruction. Encouraging results were obtained in the patients with cicatricial pemphigoid and those with bilateral Mooren's ulcers.     

多层羊膜填塞术治疗单疱病毒性角膜溃疡

目的 评价多层羊膜填塞术在治疗单疱病毒性角膜溃疡中的效果．方法 临床选择单疱病毒引起的坏死性角膜基质溃疡患者40例（46眼），均行多层羊膜填塞术，随访观察其临床疗效。结果 平均随访（16±2．4）周，成功率达86．9％（40／46眼），溃疡的平均愈合时间为（4.2±1．4）周，术前角膜基质厚度为（407±32）μm，术后2个月增加至（428±21）μm，差异有非常显著性（P〈0．01）。6例（6眼）角膜溃疡未愈合，其中2例（2眼）因渍疡穿孔改行穿透性角膜移植术。结论 多层羊膜填塞术可有效治疗单疱病毒引起的坏死性角膜基质炎．该手术可以快速修复角膜创面．为后期角膜移植术创造良好的局部条件．     

Management of Acanthamoeba keratitis. A case report and review of the literature

A recalcitrant corneal ulcer resulted in an extensive corneal opacity requiring penetrating keratoplasty. Histopathologic studies and subsequent cultures established the diagnosis of Acanthamoeba keratitis. A second transplant was performed due to a culture-proven recurrence of the keratitis in both the recipient and the graft, with progressive thinning. This has remained clear for six months on systemic ketoconazole and topical miconazole drops. This case demonstrates the difficulty in initial diagnosis of Acanthamoeba keratitis and the apparent successful medical control of the infection despite transplantation into an infected recipient bed.     

环孢素A联合糖皮质激素治疗蚕食性角膜溃疡的疗效

目的:研究环孢素A联合糖皮质激素对蚕食性角膜溃疡的疗效。方法:选取2015-05/2018-05在我院就诊的蚕食性角膜溃疡患者200例,根据治疗方式的不同分为联合组和糖皮质激素组,各100例。糖皮质激素组给予糖皮质激素进行治疗,联合组在糖皮质激素组的基础上给予环孢素A治疗。检测患者C反应蛋白(CRP)、白介素-6(IL-6)水平,评估生存质量,检查临床症状,比较两组治疗有效率、复发率、不良反应发生率。结果:两组治疗后CRP、IL-6水平低于治疗前,生存质量高于治疗前(P<0.05)。联合组治疗后CRP、IL-6水平低于糖皮质激素组治疗后,生存质量高于糖皮质激素组治疗后(P<0.05)。联合组结膜充血消退时间、眼痛消失时间、溃疡愈合时间低于糖皮质激素组(P<0.05)。联合组治疗有效率高于糖皮质激素组,复发率低于糖皮质激素组(P<0.05)。结论:环孢素A联合激素治疗蚕食性角膜溃疡效果显著,能改善患者临床症状,降低炎症反应,提高患者生活质量,降低复发。     

Subconjunctival dendrimer-drug therapy for the treatment of dry eye in a rabbit model of induced autoimmune dacryoadenitis

Purpose

To investigate the efficacy of a single subconjunctival injection of dendrimer-dexamethasone conjugate in a rabbit model of induced autoimmune dacryoadenitis (AID).

Corneal dystrophies. I. Dystrophies of the epithelium,Bowman's layer and stroma

Most corneal dystrophies are autosomal dominant, bilateral disorders that primarily affect one layer of an otherwise normal cornea, progress slowly after their appearance in the first or second decade, and are not associated with a systemic disease. Epithelial basement membrane dystrophy and Fuchs' endothelial dystrophy are seen commonly by the general ophthalmologist; fleck, posterior polymorphous, granular or lattice dystrophies are seen more rarely, and others may never be seen in general office practice. While the distinctive clinical appearance of most corneal dystrophies allows accurate diagnosis, the integration of slitlamp findings with histopathologic and biochemical findings aids in the understanding of the clinical observations and provides a more rational basis for therapy. Transmission electron microscopy is the most accurate method of histopathologic diagnosis. Epithelial dystrophies usually manifest intraepithelial cysts and abnormal basement membrane. In stromal dystrophies, an abnormal substance accumulates within the keratocytes or among the collagen fibrils; it may be an excess normal metabolite (like glycosaminoglycans in macular dystrophy), a material not usually present (like amyloid in lattice dystrophy), or a substance of unknown composition (like hyaline in granular dystrophy). Each dystrophy is illustrated with a composite drawing. Endothelial dystrophies will be reviewed separately in a second article.     

The fate of anterior chamber flurescein in the monkey eye. 1. The anterior chamber outflow pathways.

As defined by freeze-dry tissue techniques, there are two distinct routes by which fluorescein leaves the anterior chamber of the living rhesus monkey eye. I. The conventional pathway: Within five minutes of the initiation of fluorescein perfusion through the anterior chamber, the conventional pathway filled. Tracer passed through the trabecular meshwork into Schlemm's canal, and flowed back within scleral and episcleral venous derivatives to enter large veins in the extraocular muscles. II. The uveo-vortex pathway: Fluorescein rapidly moved into the iris stroma and into the anterior part of the ciliary body. The anterior chamber border of the ciliary body is little more than a sparse mesh from which fluorescein entered directly into the substance of the anterior ciliary muscle. Fluorescein penetrated blood vessels in the iris stroma and in the anterior ciliary body from where it could be traced posteriorly to the equatorial choroid and vortex veins. The specific sequential tissue distribution of fluorescein strongly supports the existence of a uveo-vortex pathway for aqueous outflow.     

Morphologic characteristics of posterior polymorphous dystrophy. A study of nine corneas and review of the literature

Based on their own study of nine corneas with clinically documented posterior polymorphous dystrophy and a review of the literature, the authors describe the morphologic features of this entity. Study by phase contrast light microscopy and transmission and scanning electron microscopy found that changes were primarily in the endothelium and consisted of endothelial cell degeneration and loss with focal fibroblastic and epithelial-like cell transformation. Secondary alterations of Descemet's membrane were seen; they consisted of abnormal lamination with deposition of abnormal collagen material, particularly in the posterior collagen layer, and formation of guttate excrescences and pits.     

Progressive essential iris atrophy,Chandler's syndrome,and the iris nevus (Cogan-Reese) syndrome: A spectrum of disease

Progressive essential iris atrophy, Chandler's syndrome, and the iris nevus (Cogan-Reese) syndrome are considered to be variations of a single disease process, which is characterized by abnormalities of the cornea, anterior chamber angle, and iris. In each variation, the typical patient is a white woman with unilateral disease, negative family history, and an onset of symptoms in early to middle adulthood. Since the membrane theory of Campbell suggests that the disease is a fundamental abnormality of the corneal endothelium, rather than the iris, the term “iridocorneal endothelial syndrome”, as proposed by Yanoff, may be an appropriate inclusive term for the spectrum of disease, although further study of the pathogenesis is needed. For each variation of the disease, corneal edema and secondary glaucoma are both treated primarily by medical or surgical reduction of the intraocular pressure, although penetrating keratoplasty is occasionally required for cases with advanced corneal edema.