1/10. Hemorrhagic Descemet's membrane detachment as a complication of deep sclerectomy: a case report.PURPOSE: To report a case that developed hemorrhagic Descemet's membrane detachment after deep sclerectomy. PATIENT AND methods: Case report. A 63-year-old diabetic patient suffering from uncontrolled chronic open-angle glaucoma with full medication, underwent an uneventful deep sclerectomy operation combined with intraoperative mitomycin-C. RESULTS: On the second postoperative day, a hemorrhagic Descemet's membrane detachment (HDDM) was observed. The hemorrhage showed rapid absorption rate during the first two weeks along with reduction of the HDDM. After this period of time the rate of blood absorption was decreased. The Descemet's membrane reattached completely six months after surgery without any intervention but a paracentral corneal scar was present. The bleb was not functionally impaired during the whole postoperative period, and intraocular pressure remained stable at the level between 12 and 15 mmHg without medication. CONCLUSION: Hemorrhagic Descemet's membrane detachment should be considered as a potential complication of deep sclerectomy.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
2/10. Cogan's syndrome: clinical evolution of deafness and vertigo in three patients.The aim of this study was to evaluate the clinical symptoms, the otoneurological examinations, the treatment and the clinical course of three patients suffering from Cogan's syndrome, a rare disease based on the clinical association of a non-syphilitic interstitial keratitis with a cochleo-vestibular deficit. This case series involved three patients with follow up. The clinical course of the three patients (aged 30, 48 and 49 years) with Cogan's syndrome during a follow-up period of 2 to 6 years is reported. All patients underwent complete otoneurological, ophthalmologic and rheumatologic examinations and were treated with immunosuppressive therapy such as glucocorticoids and cyclophosphamide in two and glucocorticoids and methotrexate in one patient. Using immunosuppressive therapy, ophthalmologic symptoms disappeared rapidly in two patients. hearing improved only in one and stabilized in a second patient. One patient died after 6 years of treatment because of complications of generalized vasculitis. early diagnosis and rapid initiation of a combined immunosuppressive therapy such as corticosteroids and cyclophosphamide seem to be important in controlling the disease and avoiding persistent deafness. Whether systemic complications and a fatal outcome also can be prevented is still questionable.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
3/10. Clinical and ultrastructural findings in mare's tail lines of the corneal epithelium.AIMS: Mare's tail lines are uncommon, grey, parallel, tapering epithelial lines, which may give rise to discomfort or to visual symptoms. The authors report the clinical and ultrastructural findings in two patients methods: Therapeutic debridement was performed in two patients suffering from mare's tail disorder. The loosely attached epithelium was removed and fixed in glutaraldehyde containing cuprolinic blue and processed in a standard fashion for electron microscopy. RESULTS: Ultrastructural studies showed an avascular, collagenous pannus extending under the whole of the excised epithelium in each case and separated from it by a thickened basal lamina like zone. The basal laminar material extended into the epithelium in folds, in keeping with the clinical features. Interesting ultrastructural features included: (1) a lack of hemidesmosomes in relation to the basal laminar material; (2) trapping of degenerate keratocytes within the invaginating basal laminar folds; (3) an unusual regularity and fine dimensions of the collagen fibrils and proteoglycans making up the subepithelial pannus. The basal laminar material contained proteoglycans and small fibres similar in appearance to long spacing collagen. CONCLUSIONS: Mare's tail lines are caused by basal laminar material, assumed to be chiefly of epithelial origin, which invaginates the corneal epithelium. The presence of occasional keratocytes within the invaginating folds suggests that there may be a stromal contribution to the disorder. The visibility of mare's tail lines in the focal beam of the slit lamp is likely to be related to the thickness and light scattering properties of the invaginations and of the subepithelial deposits. Tractional forces, imposed by lid action, could explain their horizontal disposition.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
4/10. Relationship of eye burns with calcifications of the cornea?INTRODUCTION: The clinical pattern of corneal calcification has been considered to be a part of chronic eye diseases, such as uveitis, severe glaucoma, keratitis and eye burns. Since, in some cases of eye burns, we have found corneal calcifications to be related to the initial calciferous caustic agents and to the use of phosphate-buffer-containing fluids, we have reviewed our files of clinical eye burns for the incidence and appearance of corneal calcification. methods: A total of 176 burnt eyes of 98 patients suffering from severe eye burns were retrospectively reviewed. The following data set was acquired: the type of caustic agent, the time of the burns, the delay and type of immediate treatment and the time and type of first aid, the subsequent medication, the clinical grading and the later results. RESULTS: Calciferous burning agents and corneal calcification are correlated (P<0.01). Initial single rinsing with phosphate does not produce corneal calcification (P=0.134). There is evidence that corneal calcifications are correlated with chronically administered phosphate-buffered eye drops (P<0.005). DISCUSSION: eye burns followed by calcifications follow two different major patterns: the corrosive substance contained calcium or the continued therapy was applied with phosphate-buffered eye drops. We present case reports of three different types of eye burns and later therapy resulting in corneal calcification. Corneal calcifications are presumably related to longer-lasting phosphate application. One suspicious mechanism is the low content of calcium ion stabilizing proteins such as hyaluronate or fetuin in treatments for severe eye burns. The exceeding of the solubility product of Ca(2 ) and PO(4) (-) results in the precipitation of calcium phosphates. In cases of chronic corneal disturbance, we recommend the elimination of phosphate-buffered medications to prevent corneal calcification.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
5/10. Topical anesthetic abuse.Topical ocular anesthetic abuse is a serious disorder causing keratitis and persistent epithelial defects. It may be the result of either prescription by the patient's eye care practitioner, theft from the practitioner's office, or occult additives in therapeutic medications. The authors report observations of six individuals suffering from this disorder which suggest that persistent epithelial defects, corneal stromal ring infiltrates, disproportionate pain, and prescription or nonprescription substance abuse may be factors involved. Penetrating keratoplasty was required to treat corneal perforation in two patients, and permanent corneal structural damage was noted in two eyes. Two eyes had a relentless downhill course culminating in enucleation. Because five of the six patients were diagnosed and treated as having presumed acanthamoeba keratitis during the course of their disease, topical ocular anesthetic use should be included in the differential diagnosis of chronic keratitis and may masquerade as acanthamoeba keratitis. The authors believe that practitioners should not prescribe or dispense topical anesthetics and should avoid clinical settings which provide an opportunity for the theft of topical ocular anesthetics.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
6/10. Secondary corneal amyloidosis: clinical and pathohistological examinations.A patient suffering from an excentric vascularized tumorlike corneal change is reported who submitted to a penetrating optic keratoplasty. The diagnosis of a secondary corneal amyloidosis was established by histological examination. The clinical course and pathological findings by means of light- and electron microscopy are described and discussed.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
7/10. Use of amiodarone in bradycardia-tachycardia syndrome.Five patients with the bradycardia-tachycardia syndrome have been treated successfully with the antiarrhythmic agent amiodarone. Three patients were treated for over nine months and one of these patients had corneal micro deposits. One patient had to be taken off the drug because of side effects. amiodarone should be tried in patients suffering from the bradycardia-tachycardia syndrome before resorting to cardiac pacing.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
8/10. Keratopathy associated with hypoparathyroidism and Addison's disease.Two siblings suffering from keratopathy, one with hypoparathyroidism associated with Addison's disease and the other with Addison's disease alone, are described. The hypothesis that there was an autoimmune etiology with variant manifestations in each subject is suggested and discussed.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
9/10. Corneal endothelial cell abnormalities in an early stage of the iridocorneal endothelial syndrome.A corneal disc, obtained from a 52-year-old woman suffering from an early stage of the iridocorneal endothelial syndrome (ice), was investigated by various morphological techniques to analyse the structural variations in the endothelial cells and to identify the collagen types within the abnormal layer of Descemet's membrane. Scanning electron microscopy of the posterior corneal surface revealed a mosaic of (a) flat hexagonal cells resembling irregular but normal endothelial cells, and (b) rounded hexagonal (ice) cells with numerous surface microvilli. Degenerative changes were present in each cell type, but were more common in the flat hexagonal cells which contained intracytoplasmic spaces. By transmission electron microscopy the flat hexagonal cells exhibited many of the features of normal endothelial cells in terms of organelles and intercellular attachments, but lateral invaginations were absent. The ice cells differed in that the apical surface was covered by microvilli and the cytoplasm contained tonofilaments, which were also observed by light microscopic immunocytochemical staining. Most commonly, intercellular attachments were rudimentary in both types of cell and intercellular spaces were dilated, but desmosomes were sometimes prominent in the ice cells where interdigitations were pronounced. In some sectors, the basal surface of the ice cells was indented by deposition of clumps of fibrillar collagenous material. An immunocytochemical study of the abnormal posterior deposits localised type IV collagen to the amorphous matrix and collagen types III and V, but not type I, to the collagen fibril bundles. Mononuclear inflammatory cells were identified between the ice cells in the monolayer. The evidence suggests that some of the flat hexagonal cells were undergoing a degenerative change while others were transforming into ice cells.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
10/10. Recurrent corneal erosion associated with Alport's syndrome. Rapid communication.Ocular defects associated with Alport syndrome (AS) include anterior lenticonus and retinal flecks. We report on recurrent corneal erosion (RCE) as another ocular manifestation of the disease. Three brothers with AS reported a history of spontaneous attacks of RCE (2 episodes over 1 to 3 years in 2 of them and about 60 episodes in one brother over the last 10 years) characterized by acute ocular pain, lacrimation and photophobia lasting two to five days. The absence of RCE in the two other non-affected brothers from the same kindred suggested an association between AS and RCE, and prompted us to assess its prevalence. Forty-one patients with AS and renal failure and 67 control transplanted patients (with another original nephropathy) were evaluated. Seven AS patients had a history of RCE (first manifested between the ages of 12 and 21) versus only one control patient (P = 0.003). In conclusion, a history of RCE is found in about 20% of patients with AS and renal failure. RCE is likely to result from an inherent structural weakness of the corneal epithelial basement membrane (containing type IV collagen). A history of RCE should be sought when evaluating a patient for AS. Ophthalmologists should also be aware of this association, when confronted with a patient suffering from non-traumatic RCE.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
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