Bilateral penetrating keratoplasty – indications, results and review of literature

Purpose: To analyze the indications, functional results, and rates of graft rejection and failure after bilateral penetrating keratoplasty (PK) in a major eye care hospital and research center in India. Methods: Retrospective review of the case records of 38 patients who underwent bilateral PK and had at least 6 months follow-up after cornealtransplantation in the second eye. Results: The mean age of the 38 patients (20 M, 18 F) was 35 ± 25 years (range, 0.5 to 79 years). Mean follow-up was 49 ± 23 months (range, 13.4 to 116.4 months) after surgery in the first eye and 31 ± 22 months (range, 6.6 to 103.6 months) after surgery in the second eye. The average time interval between surgery in the first and second eye was 18 ± 10 months (range, 0 to 38 months). The commonest indications for surgery were corneal dystrophies (50%),aphakic bullous keratopathy (21%), and keratoconus (11%). Postoperatively, secondary glaucoma occurred in 2 first and 3 second eyes. Best-corrected visual acuity at last follow-up was > 6/12 in 34% of first eyes and 50% of second eyes, and was > 6/60 in 26% and 18% of first and second eyes respectively. Allograft rejection occurred in 4 of the first eyes and 3 of the second eyes. The two-year graft survival rate in first eyes was 70% and in second eyes was 83%. Worse outcomes were noted in grafts performed for secondary endothelial failure. Earlier graft failure occurred in first eyes (54 ± 5 months) compared to second eyes (79 ± 10 months) (Logrank Test p = 0.2311).Conclusions: Bilateral penetrating keratoplasty has reasonable success in selected patients. Corneal transplantation in the second eye does not seem to increase the risk of graft rejection in either eye.     

Scleral buckling—a brief historical overview and current indications

Graefe's Archive for Clinical and Experimental Ophthalmology - The key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the...     

Paracentral acute middle maculopathy—review of the literature

Graefe's Archive for Clinical and Experimental Ophthalmology - Paracentral acute middle maculopathy (PAMM) is a recently identified spectral-domain optical coherence tomography (SD-OCT) finding...     

Ocular effects of Zika virus—a review

Zika virus was considered an innocent pathogen while restricted to the African and Asian population; however, after reaching the Americas in March 2015, it became a global threat. Despite usually causing mild or no symptoms in infected adults, Zika virus displays a different behavior toward fetuses. When infected during gestation, fetuses have their immature neural cells killed by the virus and consequently have devastating findings at birth. In the past year the drastic effects of Zika virus infection in newborns include neurological, ophthalmological, audiological, and skeletal abnormalities. These findings represent a new entity called congenital Zika syndrome. We summarize the ocular findings of congenital Zika Syndrome, as well as the current understanding of the illness, systemic manifestations, laboratory investigation, differential diagnosis, prophylaxis, and treatment for this disorder.     

Metastatic malignant teratoid medulloepithelioma – a case report and review of the literature

Medulloepitheliomas are rare congenital tumours arising from the epithelium lining the medullary tube. They are usually detected in the first decade of life. They may be teratoid or non-teratoid. Regional and distant metastases are rare. Extraocular extension of disease appears to be the most important prognostic feature. Surgical resection is the usual mode of treatment. The role of other adjuvant modalities is as yet unclear.     

Sino-orbital desmoid tumor in a pediatric patient – Case report with review of literature

We report a case of a 2-year-old female who presented with bilateral progressive proptosis, visual loss, nasal obstruction, and breathing difficulty. Magnetic resonance imaging revealed a large sino-orbital mass that was extending to the orbital apex and skull base. An initial diagnosis of rhabdomyosarcoma was made elsewhere on the basis of the presence of round and spindle cell tumor. Subsequent biopsy with immunohistochemical staining was positive for nuclear staining with β-catenin, shifting the diagnosis to a myofibroblastic tumor, favoring desmoid-type fibromatosis. With image guidance, near complete excision of tumor was performed by a multidisciplinary team, while respecting danger zones such as the skull base and the optic nerve. Following a recurrence over 2 months, additional excision was performed with a 6-month treatment of methotrexate and vinblastine. Desmoid tumor is a rare form of soft tissue tumor uncommonly seen in the orbital area. Although benign, it is known to be recurrent and infiltrative. Few data are known and further information will aid in the management of these tumors.     

Primary tubercular dacryocystitis – a case report and review of 18 cases from the literature

Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy.

Abbreviations: PCR: polymerase chain reaction; NAAT: nucleic acid amplification test     

Epidemic studies of diabetic retinopathy in China—a review

The prevalence of diabetic retinopathy (DR) is increasing dramatically as the population of patients with diabetes continues to rise. This paper wants to investigate the prevalence and risk factors of DR in China through reviewing the research from Pubmed about population-based epidemic studies. The results of observational studies suggested that the overall prevalence of DR was 1.6%-6.5% in population, 19.9%-43.1% in diabetes and 13.6% in population without diabetes, most of the DR were the mild type, macular edema and vision-threatening were 5.2% and 1.2%. The risk factors for DR were longer duration of diabetes, plasma glucose concentration, concentrations of HbA1c level, higher systolic blood pressure(BP), higher diastolic BP, male gender, rural region, and methods of diabetic treatment and so on. The prevalence of DR which was strongly related to duration of diabetes was higher with the increase of diabetes. DR would be the major leading cause of visual impairment in China, it is very important to prevent DR by early screening and any other methods.     

Dome-shaped macula—Review of literature

Dome-shaped macula is a convex retinochoroidal elevation within the region of a posterior staphyloma seen commonly in high myopia on optical coherence tomography. With growing awareness of the condition facilitated by inclusion of optical coherence tomography in routine retinal practice, coupled with evolution of enhanced depth optical coherence tomography imaging, multiple studies have attempted to shed light on pathogenesis of this complex pathology, its clinical implications, and treatment of associated complications such as serous macular detachment and choroidal neovascularization with variable success. Our review aims to assimilate, scrutinize, and discuss the available literature for a comprehensive insight into dome-shaped macula.     

Optometry or ophthalmology? A historical review of early literature

In scientific literature dating back to the days of Leonardo da Vinci and earlier, all works and discoveries--be they in eye care, eyewear, ocular anatomy or surgery--are reported from a medical viewpoint as "contributions" to the development of ophthalmology. This paper reviews some of the early literature, points out those events that lay the foundation for the profession of optometry, and encourages optometrists to preserve their profession's heritage through research and writing from an optometric point of view.     

Malignant transformation of optic disc melanocytoma? A clinical dilemma at presentation with a review of the literature

Malignant transformation of optic disc melanocytoma is an uncommon feature, although in the past a few cases have been reported. Though our case, a healthy 30-year-old female, presented with all clinical features of melanocytoma, the triad of moderate visual loss, elevation of the lesion of 5.2 mm and an atypical ultrasonic picture could be an indication of malignant change at presentation. In the event of a moderate visual loss, long-term follow-up with serial fundus photographs and ultrasonic measurements is necessary for further management.     

Is primary optic nerve sheath schwannoma a misnomer? Report of two cases and literature review

Aims: To report clinicopathological characteristics of two patients with optic nerve sheath schwannoma (ONSS) and review the literature.

Method: The first patient (22-year-old man) presented with left eye proptosis and decreased vision in 2012 whose orbital imaging showed a large cystic lesion around the optic nerve. The second patient (52-year-old man) presented with decreased vision in the left eye (without proptosis) in the 2006. His imaging showed a small orbital apex lesion between the medial rectus and optic nerve. Both lesions were histopathologically consistent with ONSS. ONSS has previously been reported in 12 patients.

Results: Orbital biopsy and subsequently external beam radiotherapy were performed for the first patient who showed a temporary improvement of vision. However, his proptosis progressed and vision decreased to light perception (LP) a few months after radiotherapy when the lesion was resected in April 2013. Second patient declined any procedure until his vision gradually decreased to LP in October 2007. It was then removed through a combined medial and lateral orbitotomy procedure. Both patients ended up with visual acuity of no LP and no recurrence in their last follow up visits in April 2018. No histopathological evidence was found to show that optic nerve sheath could be the origin for presenting and previously reported cases in the literature.

Conclusion: Presenting cases and literature review imply that ONSS is a misnomer and all the lesions are different types of orbital schwannomas with optic nerve sheath attachment.     

Asteroid hyalosis—a comprehensive review

Asteroid hyalosis is a relatively common cause of vitreous opacities, which is possibly associated with diabetes mellitus and hereditary pigmentary retinopathies. We review the history, epidemiology, and biochemistry of asteroid hyalosis, as well as its relationship with ocular and systemic conditions. We describe imaging modalities used for diagnostic evaluations in cases of severe asteroid hyalosis and propose hypotheses regarding its lack of significant effects on vision. We discuss cataract surgery in patients with asteroid hyalosis and the selection of intraocular lenses for implantation.