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Ward MS, Hastings JP, Shmunes KM, Ronquillo Y, Hoopes PC, Moshirfar M. Atypical presentation of acanthamoeba keratitis resembling central toxic keratopathy. Am J Ophthalmol Case Rep 2022; 25:101243. [PMID: 35028488 PMCID: PMC8715135 DOI: 10.1016/j.ajoc.2021.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To describe an atypical case of acanthamoeba keratitis with positive in vivo confocal microscopy in a non-contact lens user who presented with signs and symptoms suggestive of central toxic keratopathy. OBSERVATIONS The patient presented with bilateral, though sequential, decreased visual acuity with mild pain. Examination showed stromal haze with corneal flattening and thinning without epithelial defects. Optical coherence tonometry of the right eye revealed an inverse dome-shaped appearance of the opacity and in-vivo confocal imaging showed double-walled cysts consistent with acanthamoeba. Corneal haze, stromal loss, resolved and visual acuity improved over time. CONCLUSION AND IMPORTANCE Acanthamoeba is a rare cause of infectious keratitis that is most often associated with contact lens wear in developed countries. Typically, it presents with a unilateral decrease in visual acuity, photophobia, watering, and pain that is out of proportion to slit lamp examination findings. However, many atypical presentations have been reported in the literature. Consequently, it may be misdiagnosed, especially early in the course of the disease. This delay in diagnosis can lead to progressive ulceration and visual impairment. In addition, cyst formation can make eradication with anti-amoebic treatment especially difficult.Central toxic keratopathy is a non-inflammatory clinical syndrome of unknown etiology that is most often associated with excimer laser ablation, though other associated causes have been reported. It is characterized by a central or paracentral opacity with corneal stromal loss and resultant hyperopic shift. The opacification and stromal loss mostly resolve over the course of months with an improvement in visual acuity. This report may help physicians broaden their differential and correctly diagnose atypical presentations of amoebic infection.
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Affiliation(s)
| | - Jordan P. Hastings
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | | | | | | | - Majid Moshirfar
- Hoopes Vision Research Center, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
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Moshirfar M, Hall MN, West WB, McCabe SE, Miller CM, West DG, Shmunes KM, Hoopes PC. Five-Year Occurrence and Management of Central Toxic Keratopathy After Femtosecond Laser-Assisted LASIK. J Refract Surg 2021; 37:25-31. [PMID: 33432992 DOI: 10.3928/1081597x-20201030-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To report the 5-year occurrence, management, and outcomes of 12 eyes diagnosed as having central toxic keratopathy (CTK) after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS A retrospective chart review was conducted on 20,622 FS-LASIK procedures performed at a single site from January 2015 to December 2019 to identify patients diagnosed as having central toxic keratopathy. Preoperative and postoperative visual acuity, refraction, and imaging were recorded and analyzed. RESULTS CTK occurred in 12 eyes of 8 patients after FSLASIK. A total of 75% of eyes were diagnosed during an outbreak that happened over 2 months and the remaining 25% were considered sporadic. Five eyes were treated with flap lift and irrigation and 7 eyes were treated non-surgically. The average time to resolution of CTK in eyes that underwent flap lift and irrigation was 53 days compared to 33 days in eyes treated non-surgically. All 5 eyes treated with flap lift and irrigation ultimately achieved uncorrected distance visual acuity of 0.1 logMAR or better, whereas only 3 of 7 eyes treated non-surgically achieved the same. At the final postoperative visit, the eyes treated with flap lift and irrigation measured on average 14 µm thinner and 1.60 diopters (D) flatter than the expected postoperative pachymetry and keratometry, respectively. Those treated non-surgically were on average 28 µm thinner and 1.70 D flatter than expected. CONCLUSIONS CTK is a rare complication of FS-LASIK but can occur in clusters. Although management of CTK is debated, flap lift and irrigation may lead to better visual acuity and refractive and anatomic outcomes in some cases. [J Refract Surg. 2021;37(1):25-31.].
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Moshirfar M, Duong AA, Shmunes KM, Castillo-Ronquillo YS, Hoopes PC. Light Adjustable Intraocular Lens for Cataract Surgery After Radial Keratotomy. J Refract Surg 2021; 36:852-854. [PMID: 33295999 DOI: 10.3928/1081597x-20201002-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a case of light adjustable lens implantation after radial keratotomy. METHODS A patient with a 30-year history of radial keratotomy subsequently underwent phacoemulsification with implantation of intraocular light adjustable lenses. Serial refractions were performed at varying hours of the day postoperatively and were repeated for 3 months. The light adjustable lenses were adjusted twice, and the refractive power of the implant was eventually locked. RESULTS The patient was able to achieve uncorrected distance visual acuity of 20/25 in both eyes, improving from 20/125 in the right eye and 20/80 in the left eye, with no surgical complications. CONCLUSIONS The authors report the first case of light adjustable lens implantation after radial keratotomy, which has yielded promising results for mitigating intraocular lens miscalculations after radial keratotomy. [J Refract Surg. 2020;36(12):852-854.].
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Moshirfar M, Somani SN, Tingey MT, Hastings JP, Shmunes KM, Hoopes PC. Marginal Keratitis with Secondary Diffuse Lamellar Keratitis After Small Incision Lenticule Extraction (SMILE) After Initiation of Continuous Positive Airway Pressure (CPAP) Therapy. Int Med Case Rep J 2020; 13:685-689. [PMID: 33328768 PMCID: PMC7735781 DOI: 10.2147/imcrj.s285625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Marginal keratitis, also known as catarrhal infiltrates, is a common, self-limiting condition characterized by inflammation at the peripheral aspect of the cornea. This non-infectious process is most typically a reaction to bacteria such as Staphylococcus, and results from a cell-mediated immune response to the bacterial antigens. This hypersensitivity reaction leads to the formation of stromal infiltrates that run parallel to the limbus. These infiltrates may extend around the limbal edge and can lead to the formation of marginal ulcers. Often the patient will have associated blepharoconjunctivitis. Both marginal keratitis and blepharoconjunctivitis are treated with topical steroids, with or without antibiotics, and good lid hygiene. We report a case of a patient who previously underwent small incision lenticule extraction (SMILE) who presented with marginal keratitis and secondary diffuse lamellar keratitis (DLK) in the right eye following recent initiation of continuous positive airway pressure (CPAP) therapy. There was no antecedent ocular trauma. With the initiation of steroid therapy, the patient returned to baseline visual acuity within one week. Though recurrence may be common in cases of marginal keratitis, our patient has not had any recurrence of symptoms or disease. DLK has previously been reported in the literature; however, there has been no reported case of marginal keratitis with secondary DLK after initiation of CPAP therapy to date.
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Affiliation(s)
- Majid Moshirfar
- HDR Research Center, Hoopes Vision, Draper, UT, USA.,John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.,Utah Lions Eye Bank, Murray, UT, USA
| | - Shaan N Somani
- Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mitchell T Tingey
- HDR Research Center, Hoopes Vision, Draper, UT, USA.,Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Jordan P Hastings
- California Northstate University College of Medicine, Elk Grove, CA 95757, USA
| | - Kathryn M Shmunes
- HDR Research Center, Hoopes Vision, Draper, UT, USA.,Department of Ophthalmology, University of Florida, Gainesville, FL, USA
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Desautels JD, Moshirfar M, Martheswaran T, Shmunes KM, Ronquillo YC. Risks Posed to Corneal Transplant Recipients by COVID-19-Affected Donors. Ophthalmol Ther 2020; 9:371-379. [PMID: 32378180 PMCID: PMC7202264 DOI: 10.1007/s40123-020-00254-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 12/31/2022] Open
Abstract
The recent emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant human disease, COVID-19, will likely have a significant impact on the corneal tissue donor pool. Current recommendations from the United States and global eye bank associations call for the outright avoidance of tissues from donors recently infected with or exposed to COVID-19. This conservative recommendation is currently appropriate given the reported ocular sequelae, tear film viral detectability, and transmissibility of COVID-19. However, the rapidly increasing global prevalence and mortality of COVID-19 threatens the tenability of current tissue exclusion guidelines, and may necessitate their relaxation in the near future.
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Affiliation(s)
- Jordan D Desautels
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Majid Moshirfar
- Hoopes Vision Research Center, Draper, UT, USA. .,John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Utah Lions Eye Bank, Murray, UT, USA.
| | - Tanisha Martheswaran
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
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Somani SN, Moshirfar M, Shmunes KM, Ronquillo YC. Comparison and application of commercially available fibrin sealants in ophthalmology. Ocul Surf 2020; 18:418-426. [PMID: 32361085 DOI: 10.1016/j.jtos.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/03/2020] [Accepted: 04/16/2020] [Indexed: 01/07/2023]
Abstract
Fibrin glues carry many advantages over traditional suture as a tissue adhesive and have been increasingly used in a variety of ophthalmic procedures over the past 15 years. Several fibrin sealants are commercially available worldwide, each of which differs slightly in its composition and mechanism of delivery. The focus of our review is to briefly discuss the reported uses of fibrin in ophthalmic surgery and provide a broad overview of the properties associated with each commercially available fibrin sealant.
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Affiliation(s)
- Shaan N Somani
- Northwestern Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; Utah Lions Eye Bank, Murray, UT, USA; HDR Research Center, Hoopes Vision, Draper, UT, USA.
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Moshirfar M, Somani SN, Shmunes KM, Ronquillo YC. Will Tonic Water Stop My Eyelid Twitching? Clin Ophthalmol 2020; 14:689-691. [PMID: 32184555 PMCID: PMC7061523 DOI: 10.2147/opth.s235895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/21/2020] [Indexed: 11/25/2022] Open
Abstract
Eyelid myokymia, commonly referred to as “eyelid twitching”, is a common, benign condition that resolves in most individuals within hours to days; however, chronic cases can persist for several weeks to months, prompting the search for home remedies that may reduce the frequency or duration of symptoms. In this article, we discuss the proposed pathophysiologic mechanism and safety concerns surrounding tonic water as a treatment for eyelid myokymia.
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Affiliation(s)
- Majid Moshirfar
- HDR Research Center, Hoopes Vision, Draper, UT, USA.,John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.,Utah Lions Eye Bank, Murray, UT, USA
| | - Shaan N Somani
- Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
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