1/29. Sterile interface keratitis associated with micropannus hemorrhage after laser in situ keratomileusis. Numerous etiologies have been suspected to lead to sterile interface keratitis after laser in situ keratomileusis. This tan interface haze with a rippled appearance has been called Sands of the Sahara. We present 2 cases in which red blood cells entered the interface after a small hemorrhage from peripheral corneal vascularization during the microkeratome pass. Although this bleeding was controlled and all visible blood cells were removed at surgery, both patients developed the appearance of a focal interface keratitis on the first postoperative day. ( info) |
2/29. Intracorneal hematoma in Mooren ulceration. PURPOSE: To report a case of intracorneal hematoma occurring in association with Mooren ulceration. METHOD: Case report. RESULTS: In an 81-year-old man with bilateral Mooren ulceration, a dense intracorneal hemorrhage occurred in the right eye secondary to peripheral corneal neovascularization and was followed by slow resolution over a 3-year period. Following subsequent lamellar and penetrating keratoplasty, histopathologic examination demonstrated the association between the stromal neovascularization and the residual interlamellar hemorrhage, as well as phagocytosis of residual hemosiderin by macrophages. CONCLUSION: Intracorneal hematoma with spontaneous resolution has been documented clinically and histopathologically in an eye with Mooren ulceration. ( info) |
3/29. A case of atypical Cogan's syndrome with uncommon corneal findings. PURPOSE: We report a case of atypical bilateral interstitial keratitis associated with Cogan's syndrome. methods: A 28-year-old man presented with a 2-year history of recurrent bilateral keratitis. Bilateral hearing loss preceded the ocular symptoms by 2 years. The patient also complained of skin nodules, headache, back pain, and arthritis. Corneal finding were consistent with superior stromal keratitis with stromal neovascularization and lipid deposition in the stroma. The patient's audiogram revealed cochlear pathology compatible with Cogan's syndrome (sensorineural deafness). RESULTS: The patient was treated with topical steroids but eventually required corneal transplantation in the right eye as a consequence of progressive loss of vision secondary to progressive lipid keratopathy. Visual acuity at the patient's most recent follow-up evaluation was 20/40. CONCLUSION: This case represents an unusual type of interstitial keratitis associated with Cogan's disease. The absence of ocular symptoms at the time of initial ear involvement and the atypical presentation of the keratitis were responsible for the delay in diagnosis in this patient, resulting in hearing impairment. ( info) |
| PURPOSE: To report a case of corneal neovascularization possibly associated with latanoprost therapy. methods: Case report: A 67-year-old man developed a progressive stromal corneal neovascularization in his right eye within eight months of a corneal trauma. At admission, he was receiving latanoprost 0.005% therapy. His topical medications were rearranged: latanoprost was replaced with carteolol hydrochloride 1% twice daily bilaterally and prednisolone acetate 1% was added twice daily in the right eye. RESULTS: One month later, he presented regression of the corneal neovascularization and an increase in visual acuity. CONCLUSIONS: Latanoprost, an arachidonic acid derivative, could have directly or indirectly stimulated the corneal neovascularization in this patient with a history of nonpenetrating corneal trauma. ( info) |
| PURPOSE: To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne) on corneal neovascularization (CNV) in two patients. methods: Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months. RESULTS: Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases. CONCLUSIONS: PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required. ( info) |
6/29. Bilateral corneal neovascularization and opacification associated with unmonitored contact lens wear. PURPOSE: To report a case of severe bilateral deep stromal neovascularization and opacification associated with unmonitored contact lens wear. DESIGN: Observational case report. methods: A 46-year-old woman who had been using hydrogel contact lenses bought on the internet without a prescription for 5 years was found to have dense, bilateral corneal opacities with deep stromal neovascularization. RESULTS: The patient's contact lenses were found to be tight-fitting. Medical history and serological studies were negative for infectious or rheumatologic causes of interstitial keratitis. CONCLUSIONS: The deep stromal neovascularization and the associated corneal opacification are most likely related to the unmonitored contact lens use and the lack of routine eye examinations. We believe it is critical that all contact lens wearers receive professional eye care on a regular basis regardless of where they obtain their contact lens supplies. ( info) |
| Q-switched Nd:YAG laser treatment to occlude newly formed corneal vessels was performed in patients with herpetic keratitis to reduce corneal opacity and the risk of graft rejection. Nine neovascularized corneas of 9 patients were treated. In 8 of the 9 patients, corneal neovascularization was markedly reduced with a resulting decrease in corneal opacity. Penetrating keratoplasty was performed in 3 patients after the treatment. Two patients in whom YAG laser treatment was effective had uneventful postoperative courses for 13 and 17 months, respectively. In one patient with ineffective YAG laser treatment, rejection occurred 3 months after keratoplasty, and systemic steroid and ciclosporin therapy was needed. Ultrastructural examination of the corneal button removed during keratoplasty from a patient with successful laser treatment showed destruction of vascular endothelial cells and occlusion of the vascular lumen. ( info) |
8/29. Two patients with severe corneal disease in KID syndrome. PURPOSE: To report two independent Japanese patients with keratitis, ichthyosis, and deafness (KID) syndrome and severe corneal disorder. DESIGN: Observational case reports. methods: Clinical observation of a 5-year-old boy (Patient 1) and a 64-year-old man (Patient 2) with KID syndrome, presenting prominent corneal diseases. Molecular genetic assessment of the GJB2 gene encoding connexin-26 was performed. RESULTS: Patient 1 had bilateral diffuse superficial punctuate keratopathy with severe corneal neovascularization. He had a missense mutation of the GJB2 gene. Patient 2 had bilateral corneal stromal keratitis and right corneal ulceration with rupture of the descemet membrane. He did not have any pathologic mutation of the GJB2 gene. The area of palisades of Vogt was diminished and tear production reduced in both patients. Topical eye drops, and corticosteroid or antibiotics, respectively, relieved them effectively. CONCLUSION: The impaired ocular surface regulating system might be a cause of corneal disease in KID syndrome and it can be treated by eye drops. ( info) |
9/29. Effect of flap hinge placement on post-laser in situ keratomileusis wound healing in the presence of superior corneal vascularization. We report a case that demonstrates a difference in wound healing after laser in situ keratomileusis using microkeratomes with both superior and nasal hinges in a patient with bilateral superior corneal vascularization. Subsequently, the patient experienced lamellar keratitis, epithelial defects, and peripheral thinning in both eyes. These postoperative conditions were more extensive and required more time to resolve in the eye with a nasal hinge flap. Creating a superiorly hinged flap decreases the likelihood of transecting extensive corneal pannus and may reduce the degree of postoperative complications. ( info) |
10/29. fluorescein angiographic monitoring of corneal vascularization in lipid keratopathy. The use of digital fluorescein corneal angiography to assist argon laser photocoagulation is reported. Photocoagulation was performed on the vascular supply of lipid keratopathy in the left eye of a 44-year-old woman. ( info) |