Lichen Planus in Ocular Surface: Major Presentations and Treatments

Ocular lichen planus (LP) is a rare disease which has been increasingly reported in the literature in the last two decades involving conjunctiva, cornea, and lacrimal drainage system. Most reported cases of ocular LP are cicatricial conjunctivitis with subepithelial fibrosis, fornix shortening, and symblepharon formation. It is not clear whether corneal involvement is a primary event or secondary to these changes. Topical cyclosporine and corticosteroid can be considered as first-line therapy in ocular surface involvement, while treatment regimen in more aggravated disease should be boosted with systemic immunosuppressives. After resolving acute inflammation, the patient should be treated with long-term maintenance therapy to halt the chronic progression of the disease. Lacrimal drainage system could also be involved, usually in a bilateral bicanalicular pattern with severe punctal/canalicular stenosis. Because of severity, the surgical outcomes are not favorable but successive treatments with dacryocystorhinostomy + mitomycin C (MMC), Jones tube implantation, and systemic cyclosporine are reported.     

Conjunctival cicatrizing disease presenting with lacrimal obstruction

Patients with conjunctival cicatrizing disease may develop lacrimal obstruction. Little is published on lacrimal obstruction as the presenting feature of otherwise asymptomatic cicatrizing conjunctival disease. The records of all patients presenting between 1994 and 2015 with lacrimal obstruction found to have cicatrizing conjunctival disease were reviewed. Demographic details, clinical findings, disease progression and treatment were analyzed. Thirty-five patients (25 female), aged 43–91 years (median 74, mean 71.3 years) had epiphora and a mild conjunctival cicatrizing process. Nine patients had onset of epiphora after cataract surgery. All except one patient had obstruction of the proximal lacrimal system (punctum and/or canaliculus). In 14 cases, the obstruction was unilateral (both puncta or canaliculi), with one progressing to bilateral obstruction after 11 years. In 19, all 4 puncta or canaliculi were obstructed. Two patients had unilateral nasolacrimal duct obstruction; one developed contralateral canalicular obstruction 2 years later. Conjunctival biopsies were obtained in 19 of 35 cases (54%), and OCP immunohistochemistry was positive in 7/19 (37%). All other biopsies showed chronic inflammation. Two patients had lichen planus. In follow-up (range 0.1–11 years, mean 3.2 years), 2 patients’ conjunctival disease progressed mildly, and 3 progressed moderately, with 2 of these 5 having positive OCP immunohistochemistry, and 1 having lichen planus. Patients with conjunctival cicatrization may present with lacrimal obstruction, usually punctal or canalicular. Conjunctival disease is usually mild and non-progressive, but patients should be monitored for disease progression.     

Anaerobic Corneal Ulcers

In a series of 162 bacterial corneal ulcers, 27 were culture positive for anaerobic organisms. Applying strict microbiologic criteria, 11 ulcers were determined to be due to anaerobic infection. No morphologic characteristic was identified to distinguish anaerobic from other types of corneal ulcers. All of the anaerobic ulcer patients manifested one or more predisposing factors. A total of 13 anaerobes were cultured from the 11 confirmed anaerobic ulcers. Five previously unreported anaerobic strains were identified as causes of bacterial keratitis. Over one third of the anaerobic organisms occurred in mixed cultures with other organisms. Most of the anaerobic isolates were susceptible to all antibiotics routinely used for their treatment. The use of topical chloramphenicol is recommended for treatment of confirmed anaerobic ulcers, and topical cefazolin or one of the other cephalosporins effective against anaerobes is suggested to be included in the treatment of all ulcers requiring broad spectrum antibiotic coverage.     

Cirrus HD-OCT测量近视患者角膜厚度的应用研究

目的　对比分析ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量中央角膜厚度的差异性及相关性,并探索ＣｉｒｒｕｓＨＤ-ＯＣＴ角膜测厚与眼轴长度的关系。方法　回顾性研究２０１５年１月至４月拟在我院行角膜激光矫正近视手术的患者４２例（８４眼）,按眼轴长度分为三组,Ａ组（３２眼）:眼轴长度２４～２６ｍｍ组;Ｂ组（３１眼）:眼轴长度＞２６～２８ｍｍ组;Ｃ组（２１眼）:眼轴长度＞２８ｍｍ组。利用ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超分别测量患者的中央角膜厚度,用配对ｔ检验来比较两种方法测厚的差异性,用Ｐｅａｒｓｏｎ分析两种方法测厚的相关性,用两独立样本ｔ检验比较不同眼轴组角膜厚度的差异性。结果　Ａ组ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量患者的中央角膜厚度分别为（５３９．９１±３０．７４）μｍ和（５４０．２２±３０．７９）μｍ,测量结果差异无统计学意义（ｔ＝０．２３０,Ｐ＞０．０５）。Ｂ组ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量患者的中央角膜厚度分别为（５４３．９４±３１．７５）μｍ和（５４４．３６±３３．５８）μｍ,测量结果差异无统计学意义（ｔ＝０．３０４,Ｐ＞０．０５）。Ｃ组ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量患者的中央角膜厚度分别为（５４８．１９±２５．８１）μｍ和（５４５．４３±２６．７０）μｍ,测量结果差异也无统计学意义（ｔ＝１．７６６,Ｐ＞０．０５）。ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量结果具有显著正相关性（ｒ＝０．９７,Ｐ＜０．０５）。三组间ＣｉｒｒｕｓＨＤ-ＯＣＴ角膜测厚的差异性比较,Ａ组与Ｂ组测量值差异无统计学意义（ｔ＝０．５０４,Ｐ＞０．０５）、Ａ组与Ｃ组测量值差异无统计学意义（ｔ＝０．９９９,Ｐ＞０．０５）、Ｂ组与Ｃ组测量值差异无统计学意义（ｔ＝０．４９９,Ｐ＞０．０５）。ＣｉｒｒｕｓＨＤ-ＯＣＴ测量角膜厚度与眼轴长度无相关性。结论　ＣｉｒｒｕｓＨＤ-ＯＣＴ测量中央角膜厚度结果可靠,且ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超的测量结果显著的正相关。ＣｉｒｒｕｓＨＤ-ＯＣＴ角膜测厚与眼轴长度无关。     

Corneal Transplantation and Glaucoma

Abstract

Glaucoma is the leading cause of irreversible vision loss post-keratoplasty and an important cause of graft failure. With newer techniques, such as lamellar, endothelial, and laser-assisted keratoplasty as well as keratoprosthesis gaining popularity, clinicians will need to consider the incidence, risks, evaluation, and management of glaucoma for each type of keratoplasty when determining which type of transplant may be most appropriate. A comprehensive literature search of glaucoma in the setting of corneal transplantation was performed and serves as the basis for this review. Preexisting glaucoma and aphakia are notable risk factors. Patients that are candidates for deep anterior lamellar keratoplasty may benefit from reduced rates of post-keratoplasty glaucoma. Although glaucoma also complicates eyes with Descemet stripping endothelial keratoplasty, the severity is less and the intraocular pressure is more easily controlled when compared to penetrating keratoplasty. Endothelial keratoplasty creates unique perioperative issues mostly related to management of anterior chamber air bubbles.     

准分子激光治疗性角膜切削术治疗角膜弥漫性火药伤

目的:探讨准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中的应用,为角膜弥漫性火药伤提供一种新的有效的治疗方法。方法:收集1999年12月至2003年12月期间在我院就诊的25例(39只眼)角膜浅层弥漫性火药伤患者,采用准分子激光治疗性角膜切削术进行异物清除。术后观察视力、角膜上皮恢复时间、眼压、远视状态和Haze等状况。结果:该手术与常规手术相比,缩短了手术时间,一只眼激光手术过程在10min以内。一次手术即可完成绝大部分的异物剔除,手术损伤小,一般在1周内角膜上皮可以完全恢复。术后在角膜光学区基本不残留角膜斑翳,术后视力显著提高。术后10d平均视力为0.6。术后患者轻度远视38例,中度远视1例。该手术产生的并发症在术中和术后也能得到良好的控制,安全性和预测性较高。结论:准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中是一种方便、效果好、费用低廉并值得推广的治疗方法。     

Corneal hysteresis in mucopolysaccharidosis I and VI

Purpose: High intraocular pressure (IOP) and glaucoma are often suspected in patients with mucopolysaccharidosis (MPS). To determine corneal hysteresis (CH) and IOP in children with mucopolysaccharidosis I‐Hurler (MPS I‐H) and MPS VI. Methods: Clinical measurements with ocular response analyzer (ORA). Results: In seven patients, five with MPS I‐H treated with stem cell transplantation (SCT), and two with MPS VI, one treated with SCT and the other with enzyme therapy, the IOP was examined with ORA. Ocular response analyzer measurements were made at a median age of 8.7 years in the patients with MPS I‐H and at a median age of 9.3 years in the patients with MPS VI. Earlier measurements had raised suspicion of high IOP in one patient. The ORA showed an increased CH and a falsely high IOP values in all 14 eyes. The recalculated IOPs were normal in all 14 eyes. Mild to severe corneal opacities were present in all 14 eyes. Optic disc areas, borders and cupping were clinically normal in the 12 of 14 eyes that were possible to examine. Severe corneal opacities hampered optic disc evaluation in the older patient with MPS VI. Three eyes in two patients had normal thickness of the retinal nerve fibre layer measured with scanning laser polarimetry with corneal compensation (GDx VCC). No patient was diagnosed or treated for glaucoma. Conclusion: The IOPs are often falsely high because of an increased resistance of the cornea and correlate to the extent of corneal clouding. In this small, cross‐sectional study, it appears that corneal resistance is directly correlated with corneal clouding, although a longitudinal study that evaluates resistance as the cornea clears with treatment would provide more direct evidence that corneal deposits are directly related to resistance. A correct measured IOP can avoid unnecessary medical or surgical hypotensive treatment.     

同轴微切口超声乳化白内障吸出术后角膜生物力学变化

目的　比较同轴微切口超声乳化白内障吸出术（ｐｈａｃｏｅｍｕｌｓｉｆｉｃａｔｉｏｎ,Ｐｈａｃｏ）及标准切口Ｐｈａｃｏ术后角膜生物力学的变化。方法　年龄相关性白内障患者３１２例（３１２眼）随机分成两组。其中研究组（２．２ｍｍ同轴微切口组）１５９例,对照组（３．０ｍｍ标准切口组）１５３例。记录两组术前数据,包括年龄、性别、裸眼视力（ｕｎｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＵＣ-ＶＡ）、最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、角膜滞后性（ｃｏｒｎｅａｌｈｙｓｔｅｒｅｔｉｅ,ＣＨ）、角膜阻力因数（ｃｏｒｎｅａｌｒｅｓｉｓｔａｎｃｅｆａｃｔｏｒ,ＣＲＦ）、Ｇｏｌｄｍａｎｎ相关眼压（ｇｏｌｄｍａｎｎｃｏｒｒｅｌａｔｅｄｉｎｔｒａｏｃｕｌａｒｐｒｅｓｓｕｒｅ,ＩＯＰｇ）、角膜补偿眼压（ｃｏｒｎｅａｌｃｏｍｐｅｎｓａｔｅｄＩＯＰ,ＩＯＰｃｃ）、中央角膜厚度（ｃｅｎｔｒａｌｃｏｒｎｅａｌｔｈｉｃｋｎｅｓｓ,ＣＣＴ）、角膜内皮细胞计数（ｅｎｄｏｔｈｅｌｉａｌｃｅｌｌｃｏｕｎｔ,ＥＣＣ）;术中数据包括累积能量复合参数（ｃｕｍｕｌａｔｉｖｅｄｉｓｓｉｐａｔｅｄｅｎｅｒｇｙ,ＣＤＥ）、手术时间。术后１ｄ、１周、２周、１个月复查,比较两组ＵＣＶＡ、ＢＣＶＡ、ＥＣＣ、ＣＣＴ、ＣＨ、ＩＯＰｇ、ＣＲＦ和ＩＯＰｃｃ。结果　术后１ｄ两组ＣＨ、ＣＲＦ均较术前明显降低,差异均有统计学意义（均为Ｐ＜０．０５）。术后１周,研究组ＣＨ、ＣＲＦ与术前差异均无统计学意义（均为Ｐ＞０．０５）;对照组ＣＨ、ＣＲＦ较术前降低,差异均有统计学意义（均为Ｐ＜０．０５）。术后２周,两组ＣＨ、ＣＲＦ均恢复至术前水平（均为Ｐ＞０．０５）;两组ＩＯＰｇ、ＩＯＰｃｃ仍高于术前（均为Ｐ＜０．０５）,而低于术后１周（均为Ｐ＜０．０５）;两组ＣＣＴ恢复至术前水平（均为Ｐ＞０．０５）。术后４周,两组ＣＨ、ＣＲＦ、ＩＯＰｇ、ＩＯＰｃｃ、ＣＣＴ均恢复至术前水平（均为Ｐ＞０．０５）。术前,两组ＣＨ、ＣＲＦ与ＣＣＴ存在正相关性（研究组:ｒ１＝０．４３,ｒ２＝０．５２,对照组:ｒ１＝０．５６,ｒ２＝０．５３;均为Ｐ＜０．０５）。术后１ｄ,两组ＣＨ与ＣＣＴ均无相关性（ｒ１＝０．１３,ｒ２＝０．１０,均为Ｐ＞０．０５）。两组的ＣＲＦ值与ＣＣＴ在不同时相始终存在相关性（均为Ｐ＜０．０５）。两组间不同时相的ＣＨ与ＣＲＦ均存在正相关性（均为Ｐ＜０．０５）。结论　同轴微切口Ｐｈａｃｏ和标准切口Ｐｈａｃｏ均会改变角膜生物力学特征。同轴微切口Ｐｈａｃｏ比标准切口Ｐｈａｃｏ术后角膜生物力学特征恢复更快。     

Corneal hysteresis in patients with dry eye

Purpose

To measure corneal hysteresis and intraocular pressure (IOP) in patients with dry eye and to compare with normal subjects.

Methods

This cross-sectional study consists of 70 eyes of 40 patients with dry eye (group 1) and 75 eyes of 40 normal subjects (group 2). Eyes were diagnosed as dry eye or normal according to the clinical symptoms, biomicroscopical evaluation, and Schirmer test. Corneal hysteresis (CH), corneal resistance factor (CRF), and cornea-compensated intraocular pressure (IOPcc) were measured by the Ocular Response Analyser (ORA).

Results

Mean CH values were 10.56±0.25 mm Hg and 10.34±0.26 mm Hg, mean CRF values were 10.75±0.28 mm Hg and 10.70±0.28 mm Hg, mean CCT values were 542±3.20 μm and 543±3.89 μm in group 1 and group 2, respectively. There was no statistically significant difference between the groups for these three parameters. IOPcc values measured with ORA were 15.73±0.36 mm Hg in group 1 and 16.60±0.33 mm Hg in group 2, and there was no statistically significant difference between the two groups.

Conclusions

Corneal biomechanical parameters such as CH and CRF are not influenced in dry eye. Also statistical difference was not found between the two groups according to CCT and IOPcc values.     

Corneal Involvement of Patients with Polymyositis and Dermatomyositis

ABSTRACT

Purpose: To evaluate corneal parameters in patients with polymyositis (PM) and dermatomyositis (DM) and compare them with those of healthy controls.

Methods: A total of 43 PM and 32 DM patients and 93 controls were enrolled in this cross-sectional, observational, case-control study. Corneal parameters were evaluated by Pentacam. Objective clinical tests of dry eye disease (DED) were also performed.

Results: All pachymetric measurements and corneal volumes (CVs) proved to be significantly lower both in PM and DM patients. The values of DM patients were closer to control values than those of the PM patients. For tear break-up time and Schirmer-I test values significant differences were observed between patients and controls, with values decreased both in PM and DM patients.

Conclusions: PM patients rather than DM patients tend to develop thinner and low-volume corneas as compared to controls. Additionally, a high prevalence of DED among both PM and DM patients was also detected.     

表面麻醉剂对眼表影响的地形图分析

目的了解表面麻醉剂对眼表面毒性损伤的情况.方法分别用30g·L     

Evaluation of the Corneal Layers in Meibomian-Gland-Dysfunction-Related Dry Eye by In Vivo Slit-Scanning Confocal Microscopy

In the current study it was aimed to evaluate the findings of cornea in Dry Eye related Meibomian Gland Dysfunction through in vivo confocal microscopy. 30 patients of Dry Eye related Meibomian Gland Dysfunction (DEMGD) and 30 healty individuals were included. 46 eyes of 30 DEMGD patients (group 1) and 46 eyes of 30 healthy individuals (group 2) were formed as control group and images were captured from the centre of the cornea. 26 of the patients (%86,6) in Group 1 were male, and four of them (%13,4) were female and 25 of healthy individuals (% 83,3) were male and 5 of them(%16,7) were female. The ages of the patients in Group 1 were between 23-67 (51,58±13,4 on average). The ages of the healthy individuals in Group 2 were between 23-67 (51,45±10,4 on average). Tear film break-up time and Schirmer 1 values were significantly lower in the MGDDE group than the control group (p<0.001). There were statistically significant intergroup differences in basal epithelial cell density and area and stromal nerve thickness (p<0.05). Surface epithelium changes, anterior stromal hyperreflectivity and subepithelial nerve morphology changes were not observed in the control group. As a result, some of the effects on cornea tissue caused by Dry Eye related Meibomian Gland Dysfunction were able to be visualized with confocal microscopy at micro level.     

Retinal vascular involvement in acute toxoplasmic retinochoroiditis

The present study deals with the retinal vascular involvement in 64 patients with toxoplasmic retinochoroiditis during the acute phase of the disease and its evolution. Vascular involvement was noted in all 64 eyes during the acute phase of the disease. In 59 (92%) out of 64 cases the vascular involvement was located in the same retinal quadrant as the active toxoplasmic lesion. In the remaining 5 eyes (8%) the vascular participation was found in all four retinal quadrants. In 3 (5%) out of 64 cases, the vascular infiltration was extremely severe and resulted in retinal vascular obstruction. In all three cases the vessel traversed the active toxoplasmic lesion.In 35 (55%) out of 64 patients the initial vascular picture changed in the course of the acute phase of the disease. In these patients, the lesions had extended to the adjacent vessels or to other parts of the involved vessel. In the further course of the evolution of the active toxoplasmic lesion, the vascular involvement did not persist indiscriminately. It was noted that in 14 (22%) out of 64 cases the vascular lesions gradually regressed and eventually disappeared together with the active toxoplasmic lesion and the formation of the retinochoroidal scar. In the remaining 50 (78%) out of 64 cases the vascular involvement either disappeared after the establishment of the retinochoroidal scar in 3–12 months (29 cases) or remained permanently (21 cases).     

Incidence and Clinical Characteristics of Ocular Involvement in Mucous Membrane Pemphigoid

Purpose: To describe the risk of developing ocular mucous membrane pemphigoid (MMP) or a new extraocular site of MMP, and to identify risk factors for new involvement.

Methods: Retrospective chart review of 162 biopsy-proven MMP patients.

Results: At presentation, 109 of 162 MMP patients (67.3%) had ocular involvement and 53 patients did not. Of the 53 patients without ocular involvement at presentation followed up to 22 years, the risk of developing ocular MMP was 0.014 per person-year (PY, 95% confidence interval [CI]: 0.005/PY, 0.034/PY). The risk of developing any new location of extraocular MMP was 0.020/PY (95% CI: 0.007/PY, 0.043/PY). Smoking was a risk factor for developing an additional extraocular MMP location (hazard ratio [HR] = 4.09, p = 0.04).

Conclusions: Patients presenting with extraocular MMP are at risk for developing ocular MMP, and all MMP patients are at risk for developing secondary extraocular MMP locations, although the rates were low.     

Clinical spectrum of 15 patients with HIV-related ocular involvement in Tehran

AIM: To determine the frequency of HIV-related ocular involvement and to describe the characteristics of involvement in a special clinic in Tehran. METHODS: In this cross sectional study, 141 patients (125 male and 16 female, 282 eyes) of HIV-infected patients with various stages of HIV infection that were referred to Center of behavioral diseases were evaluated during a period of 7 months. Every patient had a complete profile including demographic data, method of HIV transmission, recent CD4 T cell lymphocyte count, serological studies for common sexual or blood-born viruses and toxoplasmosis, history of antiretroviral therapy, and associated systemic disease. RESULTS: A total of 141 patients were evaluated. HIV-related ocular involvement was detected in 15 patients (10.6%), including 3 mycobacterium tuberculosis-related choroiditis, 2 cytomegalovirus retinitis, 2 retinal toxoplas- mosis, 2 herpes simplex virus-related lesions, 1 HIV- associated retinopathy, 1 herpes zoster ophthalmicus, 1 undetermined vitritis, and 3 cases of cranial nerve involvement including 2 cases of gaze palsy and 1 case of papilitis. In our study, mean CD4 T cell lymphocyte count was fewer in patients with ocular involvement than in patients without ocular involvement (204.7±123.8 vs 403.7±339.7, P=0.029), but there was no difference in other possible associated factors between two groups. CONCLUSION: Mycobacterium tuberculosis-related choroiditis and neurophthalmic lesions are the most common HIV-related ocular involvements in Tehran that is different from those of recent publications in developed countries.     

Kikuchi-Fujimoto Disease: A Rare Case of Orbital Involvement

We describe a rare case of orbital involvement in Kikuchi–Fujimoto disease, a rare, benign, self limiting systemic disease, in a young Italian woman. The origin of the disease is unknown, so no specific treatment has been defined. Histology has an important role in establishing the diagnosis. In presence of an eyelid swelling, it is important to rule out infections, lymphoproliferative disorders, and connective tissue diseases. Despite the fact that it is rare in Europe, the possibility of this disease should be borne in mind.