Dacryoadenitis and extraocular muscle inflammation associated with contact lens-related Acanthamoeba keratitis: A case report and review of the literature

The present report discusses a new case of dacryoadenitis with extraocular muscle inflammation associated with Acanthamoeba keratitis (AK) in a contact lens wearer. A 41-year-old male, who has worn silicone hydrogel contact lenses on an extended basis for about 10 years, attended with the complaints of vision disturbance, hyperemia, and pain in his right eye. His history revealed that 1.5 month ago, he had been diagnosed with allergic conjunctivitis and had used steroid eye drops. Biomicroscopic examination revealed eyelid edema, chemosis, and ring infiltration, radial keratoneuritis and an epithelial defect in the cornea. Magnetic resonance imaging demonstrated enlarged lacrimal gland with edematous changes consistent with inflammation due to dacryoadenitis. There were also thickening and edema of the right superior oblique and lateral rectus muscle. The treatment protocol for AK was applied with no specific treatment for dacryoadenitis. After 4 months of the treatment, dacryoadenitis and keratitis regressed. Dacryoadenitis and extraocular muscle inflammation may accompany AK more frequently than expected and previously known. The evaluation of the lacrimal gland and extraocular muscles in presence of AK might be beneficial for understanding better the exact clinical picture and course of the keratitis.

Success of hydrocone (TORIS-K) soft contact lens for keratoconus and traumatic keratopathy

Objective:

To present success of Toris-K contact lenses in keratoconus and traumatic keratopathy with irregular corneal surface.

Methods:

Toris-K contact lenses were used to treat 7 eyes of 4 patients with traumatic keratopathy (Case 1) or keratoconus (Case 2, Case 3, and Case 4). All cases had a complete eye examination before the contact lens application. The case with traumatic keratopathy was a 32-year-old male who had corneal penetrating injury due to hobnail strike 23 months ago. The other 3 keratoconus cases were females at the age of 14, 16 and 22 years old. They had high myopia and irregular astigmatism due to keratoconus. All patients refused using rigid gas permeable contact lens because of intolerance. Toris-K contact lenses were fitted on all eyes. All patients were followed-up for 28 months with a complete ophthalmic examination and corneal topography every two months.

Results:

Improvement of BCVA of the cases was remarkable. All cases were comfortable with their Toris-K contact lenses for 28 months. There was no significant distortion on the lenses during follow-up period.

Conclusion:

Toris-K lenses may be an effective alternative treatment option for the patients with keratoconus and traumatic keratopathy, especially who cannot tolerate rigid gas permeable contact lenses.

Confocal scanning laser tomography of the optic nerve head on the patients with Alzheimer's disease compared to glaucoma and control

The purpose of this study was to evaluate optic nerve head (ONH) differences of the patients with Alzheimer's disease (AD) measured by confocal scanning laser tomography [Heidelberg Retina Tomograph (HRT) III] and compare with glaucoma and control subjects. Eighty-four patients were enrolled into the study: 44 eyes of 24 patients with mild to moderate AD (Group 1), 68 eyes of 35 patients with glaucoma (Group 2), and 49 eyes of 25 heathy volunteers as a control (Group 3). A complete ophthalmologic examination as well as a confocal scanning laser ophthalmoscopic assessment with HRT III were performed on all patients. Mean values of the ONH topographic parameters such as rim area (RA), rim volume (RV), height variation contour, linear cup/disc ratio, cup shape measure, and retinal nerve fiber layer (RNFL) were recorded. Mean values of RNFL thickness was 0.23 ± 0.07 in AD, 0.22 ± 0.09 in glaucoma and 0.24 ± 0.07 in the control group (p = 0.323). RA and RV were significantly lower, and linear C/D ratio was significantly higher in the glaucoma group when compared to AD and control (p < 0.05). There was no statistically significant difference between AD and control for the optic disc parameters tested (p > 0.05). We observed a negative correlation of the age with RNFL in all of the groups (p < 0.005). Age was the most important parameter affecting RNFL. Our results suggest that HRT does not demonstrate ONH differences between AD and control group, while it successfully differentiates glaucoma from AD and control cases of older age.

Success of ranibizumab in central serous chorioretinopathy resistant to bevacizumab

PURPOSE

To present effectiveness of intravitreal ranibizumab (IVR) injection for central serous chorioretinopathy (CSC), resistant to intravitreal bevacizumab (IVB) injection.

METHODS

Files of the patients who had the diagnosis of CSC between 2005 and 2013 were reviewed retrospectively. Eighty-five eyes of 81 patients' files have been investigated. Ten eyes of 10 patients that were resistant to IVB, with no history of photodynamic therapy, were included in to this study. Demographic details, best-corrected visual acuity (BCVA), and central macular thickness (CMT) were studied to analyze the effectiveness of IVR.

RESULTS

The mean age of the patients was 38.8 years (SD=4.7 years). The mean follow-up time after first IVR injection was 7.9 months (SD=1.5 months). The mean number of IVB and IVR injections was 2.0 (SD=0.7) and 1.3 (SD=0.4), respectively. The mean CMT before IVR injection was 392.4 μm (SD=66.3) and decreased to 194.1 μm (SD=9.3, P<0.001) at the last visit. The mean BCVA before IVR injection was 0.50 logMAR (SD=0.23) and improved to 0.05 logMAR (SD=0.06, P<0.001) at the last visit. In all cases after IVR injection, the subretinal fluid almost resolved completely, and leakage disappeared in fundus fluorescein angiography.

CONCLUSION

Ranibizumab might be a promising option for the patients with CSC, resistant to bevacizumab in acute or early chronic stage.

High Dk piggyback contact lens system for contact lens-intolerant keratoconus patients

BACKGROUND

The aim of the study was to examine the clinical success of high Dk (oxygen permeability) piggyback contact lens (PBCL) systems for the correction of contact lens intolerant keratoconus patients.

METHODS

Sixteen patients (29 eyes) who were not able to wear gas-permeable rigid lenses were included in this study. Hyper Dk silicone hydrogel (oxygen transmissibility or Dk/t = 150 units) and fluorosilicone methacrylate copolymer (Dk/t = 100 units) lenses were chosen as the PBCL systems. The clinical examinations included visual acuity and corneal observation by biomicroscopy, keratometer reading, and fluorescein staining before and after fitting the PBCL system.

RESULTS

INDICATIONS FOR USING PBCL SYSTEM WERE: lens stabilization and comfort, improving comfort, and adding protection to the cone. Visual acuities increased significantly in all of the patients compared with spectacles (P = 0). Improvement in visual acuity compared with rigid lenses alone was recorded in 89.7% of eyes and no alteration of the visual acuity was observed in 10.3% of the eyes. Wearing time of PBCL systems for most of the patients was limited time (mean 6 months, range 3-12 months); thereafter they tolerated rigid lenses alone except for 2 patients.

CONCLUSION

The PBCL system is a safe and effective method to provide centering and corneal protection against mechanical trauma by the rigid lenses for keratoconus patients and may increase contact lens tolerance.

Administration of the fixed combination of latanoprost 0.005% and timolol 0.5% in glaucoma patients with an intraocular pressure over 30 mmHg

Purpose:

To evaluate the intraocular pressure (IOP) reducing effect of a fixed combination of 0.005% latanoprost and 0.5% timolol in patients with an IOP of 30 mmHg or higher.

Design:

Prospective, randomized clinical trial.

Participants:

Twenty-eight patients.

Methods:

Patients had received no prior medical glaucoma treatment. Routine ophthalmic examinations and visual field tests were performed before and after treatment for each patient.

Results:

Mean IOP was 32.28 ± 0.92 mmHg before treatment. Mean IOP levels were 18.75 ± 0.68 for the first day, 17.96 ± 0.90 for the first week and 17.64 ± 0.66 for the first month after treatment.

Conclusion:

A fixed combination of latanoprost 0.005% and timolol 0.5% is effective in significantly reducing IOP in glaucoma patients with an IOP greater than 30 mmHg.

Dynamic MR dacryocystography in patients with epiphora

OBJECTIVE

The purpose of this study was to investigate the diagnostic value of dynamic MRI dacryocystography (dMR-DCG) for the assessment of nasolacrimal drainage system (NLDS).

METHODS

The study population consisted of 35 patients with a history of epiphora. Each patient underwent bilateral dMR-DCG and conventional dacryocystography (DCG) to assess the NLDS. Two radiologists, who were unaware of the clinical data, evaluated the images separately for the level of obstruction at the nasolacrimal passage and the presence or absence of lacrimal sac dilatation. The findings from the dMRI-DCG and DCG images were compared. DCG was considered to be the gold standard imaging technique.

RESULTS

dMRI-DCG had a sensitivity of 90.5% and a specificity of 89.3% to detect nasolacrimal passage. In 24 out of 70 NLDS that were assessed, there was 100% agreement between the dMRI-DCG and DCG images in the detection of the obstructed level in the nasolacrimal pathway. The lacrimal sac dilatation finding detected by DCG was not observed by dMRI-DCG in only two patients, in whom there was a prior history of dacryocystorhinostomy (DCR) operation. These findings suggest that dMRI-DCG has 94.3% sensitivity and 100% specificity for the diagnosis of lacrimal sac dilatation.

CONCLUSION

dMRI-DCG is an easily performed, minimally invasive imaging technique to identify the presence or absence of obstruction and its level, and lacrimal sac dilatation in the evaluation of NLDS. dMRI-DCG does not require the use of contrast material and ionizing radiation and provides functional information by depicting dynamic behaviour. Thus, dMRI-DCG could be useful as a reliable diagnostic imaging technique in many patients prior to surgery.