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1
Rachdan, Diyaa, M. Saad Khan, Asim Ali, and Kamiar Mireskandari. "Severe corneal complications in children with blepharitis." Journal of American Association for Pediatric Ophthalmology and Strabismus 19, no. 4 (August 2015): e30-e31. http://dx.doi.org/10.1016/j.jaapos.2015.07.083.
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Drozdova, E. A., and E. V. Mikhailova. "Individual Approach to the Treatment of Complicated Forms of Blepharitis: from Theory to Practice." Ophthalmology in Russia 17, no. 4 (December 27, 2020): 830–37. http://dx.doi.org/10.18008/1816-5095-2020-4-830-837.
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High prevalence of blepharitis, multifactorial etiology and chronic course with the possibility of serious complications, including conjunctivitis, multiple chalazions, keratitis, dry eye syndrome — cause significant difficulties in the treatment of this disease. Prescribing treatment of the process only in case of exacerbation with the use of even modern antimicrobial and anti-inflammatory drugs gives only a short-term effect.The aim is to present the clinical features of the blepharitis of different localization and the choice of the optimal treatment algorithm on the example of specific clinical cases. The article presents current data on the classification, etiology and mechanism of blepharitis development. Based on a detailed description of two clinical cases of blepharitis, the features of the clinical course, the range of necessary examinations and consultations of specialists are presented. The first case describes blepharitis associated with the severe rosacea in a teenager with a typical complication in the form of rosacea — keratitis. The second case is devoted to the features of the posterior blepharitis clinical course with meibomian gland dysfunction, complicated by multiple chalazions. The article explains in detail the stages of prescribing various medications, including eyelid hygiene, antibacterial, anti-inflammatory therapy and artificial tears, discusses possible side effects of the therapy and ways to restore the eye surface.Conclusion. The basis of blepharitis treatment is regular three-component eyelid hygiene. In case of exacerbation it is advisable to prescribe antibacterial and anti-inflammatory drugs, taking into account the sensitivity and ability to destroy microbial biofilms. In order to increase patient adherence to treatment, the choice of hygiene products and moisturizing drops should take into account the tolerability of the drug and the convenience of its use.
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Ahmad, Adnan. "Ophthalmic Complications Associated with Atopic Dermatitis: A Review." Journal of Islamic International Medical College 17, no. 4 (December 29, 2022): 286–91. http://dx.doi.org/10.57234/1396.
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Atopic dermatitis (AD) is a long-lasting dermatological disease that is associated with ophthalmic complications in the long run. Those having AD are more likely at risk of developing comorbidities in eye as compared to normal persons. This review encompasses the clinical manifestations, pathophysiology and treatment of common ophthalmic complications presented with AD i.e., blepharitis, kerato-conjunctivitis, corneal ectasias, glaucomatous eyes, lens opacification, detachment of retina, herpetic eye disease (HED) and dupilumab associated eye toxicities. It is necessary for dermatology colleagues to be vigilant enough not to miss ophthalmic problems associated with AD, as an early detection and management can save the vision.
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Puri, Sonam, Jitesh Joshi, Olga Derman, Noah Kornblum, Amit Verma, Ira Braunschweig, and Ramakrishna Battini. "Ocular Complications of Bortezomib Therapy in Multiple Myeloma." Blood 124, no. 21 (December 6, 2014): 5743. http://dx.doi.org/10.1182/blood.v124.21.5743.5743.
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Abstract Introduction: Bortezomib (Velcade¨; V), a proteasome inhibitor, is currently FDA (Food and Drug Administration) approved for the treatment of multiple myeloma (MM) and relapsed mantle cell lymphoma. Common side effects reported with its use include thrombocytopenia, fatigue, peripheral neuropathy and neutropenia. Ocular complications associated with bortezomib are less well described. We describe 6 patients with multiple myeloma who developed meibomitis, multiple chalazions and blepharitis after treatment with bortezomib containing regimens, resulting in delay and in some cases termination of the therapy. Methods: We reviewed the charts of forty patients who received induction chemotherapy for multiple myeloma between June 2013-June 2014 at Montefiore Medical Center, New York. Charts were reviewed for data pertaining to demographics, chemotherapy regimen and schedule as well as follow up of ocular symptoms. Results: Six of these forty (15%) patients complained about bilateral eye soreness, itching and redness. They did not have any evidence of viral or upper respiratory infections. Ophthalmology evaluation showed blepharitis, meibomitis and multiple chalazion. Majority of the patients were 60 years or greater, with 50% African-Americans. Half of the cases had stage 3 MM with a median duration of chemotherapy 8 weeks prior to onset of ocular symptoms. 4 of these 6 patients received VCD regimen (Bortezomib via subcutaneous route and Cyclophosphamide/ Dexamethasone as tablets) while the remaining 2 patients received VD and VCD-R (addition of Lenalidomide) via intravenous and subcutaneous route respectively. Ocular symptoms led to a 1-3 week delay in the next cycle of chemotherapy. These symptoms promptly responded to withdrawal of chemotherapy and other conservative measures. Chemotherapy was resumed in 4 out of 6 patients, with recurrence of chalazion in two patients within 3 weeks of starting Bortezomib. Conclusions: Ocular symptoms are commonly seen but rarely reported with bortezomib therapy. They can adversely affect patient's quality of life as well as lead to interruption in chemotherapy. Although these symptoms respond well to withdrawal of chemotherapy and conservative measures, the rate of recurrence is high once bortezomib is resumed. Awareness of these complications and early intervention can potentially avoid treatment delay. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.
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Arrico, L., A. Abbouda, I. Abicca, and R. Malagola. "Ocular Complications in Cutaneous Lupus Erythematosus: A Systematic Review with a Meta-Analysis of Reported Cases." Journal of Ophthalmology 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/254260.
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Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease.
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Nesterov, A. P. "Diabetic involvement of the organ of vision." Problems of Endocrinology 43, no. 3 (September 18, 2019): 16–19. http://dx.doi.org/10.14341/probl10388.
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Diabetic involvements of the organ of vision may be divided into extraocular and ocular. The first group includes xanthelasma and eczemas of the eyelids, hordeolum, chalasion, blepharitis, acute and chronic conjunctivitis, conjunctival angiopathies, and pareses of the extraocular muscles. The second group in- cludes*iridal dystrophy, anterior uveitis, cataract, glaucoma, asteroid hyalosis, lipemia rctinalis, and diabetic retinopathy with its complications (hemophthalmia, detachment of the retina, and neovascu- lar glaucoma). Diabetic retinopathy is a late complication of diabetes mellitus. The author discusses the epidemiology of this condition, its pathophysiological and clinical features, classification, contribution of local factors to its pathogenesis, and possibilities of treatment and prevention of the disease. He emphasizes the leading role of optimal correction of carbohydrate metabolism as a means preventing diabetic retinopathy and of timely laser photocoagulation of the retina in its treatment.
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Manabe, Yusuke, Akira Sawada, and Kiyofumi Mochizuki. "Corneal sterile infiltration induced by topical use of ocular hypotensive agent." European Journal of Ophthalmology 30, no. 5 (May 17, 2019): NP23—NP25. http://dx.doi.org/10.1177/1120672119850080.
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Purpose: To report two cases with corneal sterile infiltration presumably due to topical ocular hypotensive agent. Method: Case report. Results: Case 1: A 65-year-old man presented with corneal opacity and neovascularization in his left eye. A diagnosis of glaucoma was made 2 years previously, and anti-glaucoma agents were prescribed (brimonidine tartrate, ripasudil hydrochloride hydrate, and brinzolamide) for both eyes. Case 2: A 75-year-old woman noticed corneal opacity in the left eye. A diagnosis of glaucoma was made 35 years previously, and anti-glaucoma agents were prescribed (brimonidine tartrate, 1% dorzolamide, and bimatoprost) for both eyes. In both cases, ocular examination revealed follicular conjunctivitis and blepharitis in both eyes, and corneal sterile infiltration with neovascularization in the left eyes. The three topical drugs were discontinued and replaced with 0.1% fluorometholone. Both the blepharitis and corneal sterile infiltration improved thereafter, although corneal opacity remained across the stromal layer. Conclusion: We encountered two cases of corneal and conjunctival complications that were suspected as side effects after brimonidine eye drop use. Special care should be taken to observe the condition of ocular surface when topical brimonidine is administered.
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Saraswati Surya, Putu Ayu Adindhya, and Ni Nyoman Sunariasih. "Blepharoconjunctivitis as Manifestation of Stevens-Johnson syndrome." Medical and Health Science Journal 5, no. 2 (August 31, 2021): 26–32. http://dx.doi.org/10.33086/mhsj.v5i2.2189.
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Background: Stevens Johnson syndrome (SJS) is a collection of acute and life threatening skin symptoms caused by an allergic drug reaction. SJS also attacks the other mucous membranes, one of which is the eye. SJS is a rare case. The initial complaint of SJS is the eruption on the skin in the form of redness followed by blisters and attacking other mucous membranes. The ocular manifestations of SJS are conjunctivitis, corneal erosion, corneal ulcers, and blepharitis. Methods: Treatment of SJS’s ocular manifestation is administration of drugs and surgical intervention. Administration of drugs that often done in the acute phase is antibiotic eye drops with steroids to prevent complications. Complications that can occur include symblepharon, districhiasis, and keratitis. This complication can cause a sharp decrease in vision. Results: This case report discusses a 68 year old male patient with blisters all over his body accompanied by swelling in both eyes, redness in both eyes, and difficult to open eyes. Patients with history of taking the new drug a month ago. No history of drug allergy. The patient suffered from hypertension, non-hemorrhagic stroke, and epilepsy with irregular treatment. Patient was performed a fluorescein test. In this case, the patient is given antibiotic ointment and artificial tears with steroids. In this case there were no complications. Conclusion: The ocular manifestations of SJS if handled quickly and properly can prevent long-term complications.
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Suvajac, Gordana. "Soft-contact-lenses-induced complications." Vojnosanitetski pregled 65, no. 1 (2008): 15–20. http://dx.doi.org/10.2298/vsp0801015s.
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Background/Aim. Soft contact lenses occupy significant place in ophthalmology, both in the correction of refraction anomalies and in the treatment of many eye diseases. The number of patients that wear soft contact lenses for the purpose of correcting ametropia is constantly increasing. Due to the increasing number of wearers, the percentage of complications that can lead to serious eye damage and serious vision loss is also increasing. The aim of this study was to point out the most common complications related to soft contact lens use. Methods. In the period from 1995?2004 this prospective study included 510 patients wearing soft contact lenses for correcting ametropia. None of the patients wore contact lenses before and none suffered from any system or local diseases that could affected the development of eventual complications. The study took seven years with the patients who wore conventional lenses and three years with those who wore replacement contact lenses. All the necessary ophthalmologic examinations were done (visual acuity, refractokeratometry, the quantity of tear film, biomicroscopic examination of anterior eye segment). All the complications were filmed by video camera. Results. Of all the patients, 19 had blepharitis, 73 suffered from ?dry eye?, 57 had conjunctival hyperemia, 12 had conjunctivitis, 34 had gigantopapillary conjunctivitis (GPC), 93 had punctiform epitheliopathy, 20 had corneal infiltration, one patient had keratitis, 91 had corneal vascularisation, and 95 patients had corneal deposits. Conclusion. Both the type and frequency of complications related to soft contact lens use in our group of patients, proved to be significant. Some of this complications (keratitis) can significantly damage vision and lead to loss of vision and sometimes can require operative treatment.
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Bozkurt, B., M. T. ÍRkeç, N. Atakan, M. Orhan, and P. Ö. Geyik. "Lacrimal Function and Ocular Complications in Patients Treated with Systemic Isotretinoin." European Journal of Ophthalmology 12, no. 3 (January 2002): 173–76. http://dx.doi.org/10.1177/112067210201200316.
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Purpose To evaluate the effect on lacrimal function and ocular complications in patients with severe acne vulgaris during systemic treatment with 13- cis -retinoic acid (isotretinoin). Methods Forty patients with acne vulgaris were treated with systemic isotretinoin at dosages of 0.5-1 mg/kg per day for two months. Full ophthalmologic examination, Schirmer / test, fluorescein break-up (BUT) and microbiological investigations of the conjunctival flora were done before, during the second month and at least one month after the end of the treatment. Results The average Schirmer values before and after the treatment were 21.6 mm/5 minutes (SD ± 7.01) and 18.48 mm/5 minutes (SD ± 7.87) respectively. After the treatment BUT was less than 10 seconds in 50% of the patients and 55% had blepharitis. Subjective symptoms like dryness, itching and contact lens intolerance occurred in 42.5% and colonization of the conjunctiva by Staphylococcus aureus increased significantly during treatment (p = 0.031). All abnormal findings disappeared one month after the cessation of treatment. Discussion Isotretinoin causes signs and symptoms of dry eye, probably by reducing meibomian gland function, but ocular complications are generally not serious when low doses are used for a limited time, and are reversible after discontinuation.
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Mustapha, Jalikatu, Enanga Sonia Namanga, Baimba Idriss, Daniel Sesay, Darlinda F. Jiba, James B. W. Russell, Mathew J. Vandy, Gibrilla F. Deen, George A. Yendewa, and Sulaiman Lakoh. "Ophthalmic Manifestations among HIV Patients at the Main Tertiary Hospital in Freetown, Sierra Leone: A Cross-Sectional Study." Venereology 1, no. 2 (July 4, 2022): 161–69. http://dx.doi.org/10.3390/venereology1020011.
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Ophthalmic diseases are common among people living with HIV (PLHIV) in developing countries. However, there are currently no published studies on ophthalmic complications among PLHIV in Sierra Leone. We conducted a cross-sectional study of PLHIV presenting at Connaught Hospital in Freetown, Sierra Leone from January through March 2020. Logistic regression was used to identify associations between ophthalmic manifestations and potential risk factors. A total of 103 PLHIV were studied (78.6% female, median age 41 years, 100% treatment-experienced). The median CD4 cell count was 374 cells/mm3 and 76.7% were virologically suppressed. Overall, 44.7% of study participants had at least one ophthalmic complication and 51.5% had poor visual acuity in at least one eye. The most common conditions were dry eye (21.4%), cataract (20.4%), blepharitis (10.7%), nucleosclerosis (6.8%), conjunctivitis (5.8%), penguecula (5.8%), toxoplasmic retinochoroiditis (3.9%), and posterior vitreous detachment (2.9%). In multivariate logistic regression analysis, poor visual acuity (adjusted odds (aOR) 2.75, 95% confidence interval (CI) [1.12–6.78]; p = 0.040) and CD4 cell count < 100 cells/mm3 (aOR 3.91, 95% CI [1.07–14.31]; p = 0.028) were independently associated with ophthalmic disease. A high proportion of PLHIV in this study had ophthalmic complications. This calls for greater integration of HIV and ophthalmologic care.
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Lyadova, Marina A., and Vladimir K. Lyadov. "Immune-mediated adverse events in immune checkpoint inhibitors therapy: literature review." Journal of Modern Oncology 23, no. 2 (August 16, 2021): 319–26. http://dx.doi.org/10.26442/18151434.2021.2.200502.
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Immune-mediated adverse events (imAEs) are complications of therapy with immune checkpoint inhibitors, which arise as a result of autoimmune inflammation. The article summarizes systemic (fatigue, fever), cutaneous (rash, itching), gastrointestinal (diarrhea, colitis, hepatitis, pancreatic dysfunction), endocrinological (hypothyroidism, hypophysitis, adrenal insufficiency, diabetes mellitus), pulmonary (pneumonitis, pleuritis), rheumatological (arthralgia), neurological (headache, sensory and motor disorders), renal (acute interstitial nephritis, lupus-like nephritis, granulomatous nephritis, diffuse interstitial nephritis and minimal change disease), hematological (anemia, cytopenia), cardiovascular (myocarditis) and ocular (conjunctivitis, episcleritis, ceratitis, blepharitis and uveitis) imAE. Pathogenetic mechanisms and treatment approaches (in accordance with toxicity grade and clinical recommendations) are discussed. Early symptom recognition, patient education and timely intervention are crucial for imAE correction.
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Tatyana, Y. M., O. I. Lebedev, and K. K. Nadyarnaya. "Post covid keratitis." Modern technologies in ophtalmology, no. 6 (November 9, 2022): 126–31. http://dx.doi.org/10.25276/2312-4911-2022-6-126-131.
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A new coronavirus infection has a trace in the human body for a long time as the form of a log-covid syndrome. In ophthalmological practice, there are pathological changes of an inflammatory in all parts of the eye. Сases of dry eye syndrome, blepharitis, conjunctivitis, keratitis, uveitis, vascular disorders and optic neuritis, orbital manifestations (mucormycosis) are described as ophthalmological complications of postcovid syndrome. Post covid keratitis should be differentiated from the traditional forms of viral keratitis. There are some features of post covid keratitis: the lesion of the meibomian glands, the superficial nature of corneal inflammation, and the effectiveness of steroid therapy. Keywords: log-covid syndrome, post covid keratitis, steroid therapy
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Prokopiv, O. V., and N. M. Prykuda. "Clinical characteristics of bacterial complications of chickenpox in children." Likarska sprava, no. 1-2 (March 26, 2019): 121–25. http://dx.doi.org/10.31640/jvd.1-2.2019(18).
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The article presents data on the frequency of development and clinical course of bacterial complications of chickenpox in children aged from 2 months to 18 years, who were treated at inpatient department of Infectious Diseases Communal Clinical Hospital in Lviv and surgical department of Communal Municipal Children’s Clinical Hospital in 2000–2016. Bacterial complications were diagnosed in 136 patients (27.2 % out of total number of hospitalized children with chickenpox). Among the complications of chickenpox – lesions of the skin, underlying soft tissues and mucous membranes dominated (43.4 %): surface (pyoderma, erysipelas, conjunctivitis, blepharitis, gingival stomatitis), deep circumscribed (furuncle, abscess), as well as deep non-circumscribed (phlegmons) lesions of various body regions. Particularly severe flow was characterized by phlegmon, which developed in 18.4 % of children, 68% of them with mild forms of chickenpox. Most frequently, phlegmons were diagnosed in children under age 4 years. The first clinical symptoms (swelling and hyperemia with distinct margins, acute tenderness on palpation) appeared on the 3rd–10th day of the disease. Complication of respiratory organs – pneumonia, was diagnosed in 30.1 % of patients. The development of pneumonia was primarily observed in severe forms of chickenpox. Pneumonia, as a rule, developed on the 4th–10th day of the disease and was accompanied by intensification of the signs of intoxication syndrome, appearance of respiratory failure manifestations, cough. Other bacterial complications of chickenpox were also observed in patients: purulent otitis (7.4 % of patients), phlegmonous appendicitis (5.1 %), lacunar tonsillitis (4.4 %), pyelonephritis (3.7 %) cervical lymphadenitis (2.2 %), erosive gastroduodenitis (1.5 %), purulent meningitis (1.5 %), and osteomyelitis (0.7 %). On bacteriological examination of the content, obtained in surgical interventions from the lesion regions in 26 (19.1 %) children, pathogenic and conditionally pathogenic bacteria were isolated. Dominant etiological agents were S. pyogenes та S. aureus.
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AlQahtani, Bader, Ahmad Abdelaal, and Ehab Karamallah. "Spontaneous Cataractous Lens Extrusion in a Patient with Corneal Melting." Case Reports in Ophthalmology 11, no. 2 (May 8, 2020): 177–80. http://dx.doi.org/10.1159/000507476.
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Purpose: The aim of this report is to describe an unusual case of cataractous lens extrusion through a diseased cornea in the absence of any history of trauma or surgery. Patient and Methods: An elderly female with a history of blepharitis, corneal vascularization, and scarring presented with foreign body sensation, mild ocular pain, and a brunescent cataractous lens extruding through an area of corneal melt of the right eye after being lost to follow-up. The patient was operated urgently and then referred to a specialized eye hospital for further management. Conclusion: In the setting of social neglect and poor compliance to treatment and appointments, consequences of common ophthalmic conditions can lead to serious vision and organ-threatening complications. These might require prompt medical and surgical attention.
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Brzheskiy, Vladimir V. "Modern opportunities for the prevention and treatment of inflammatory eye diseases of an infectious nature in children." Ophthalmology journal 12, no. 4 (March 5, 2020): 57–65. http://dx.doi.org/10.17816/ov18917.
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The development of inflammatory diseases of the cornea and conjunctiva, as well as the occurrence of infectious complications of intraocular surgery, are largely associated with the presence of saprophytic and pathogenic microflora in the conjunctival cavity. This circumstance is more characteristic of children. At the same time, the possibilities of antibacterial therapy of inflammatory eye diseases of bacterial and chlamydial etiology, as well as perioperative prophylaxis of infectious complications of intraocular surgical procedures in children, have significantly expanded today. The widespread use of fluoroquinolones has significantly improved the treatment of children with acute and chronic bacterial conjunctivitis, keratitis, blepharitis, meibomyitis, chalazion, as well as those with chronic conjunctivitis of chlamydial etiology. At the same time, levofloxacin fluoroquinolone of the 3rd generation, which is used in our country in the form of a 0.5% solution as eye drops Oftaquix (Santen, Finland), has demonstrated high efficacy for this purpose. The widespread introduction of the original 0.5% levofloxacin (Oftaquix), in the treatment regimen for children with inflammatory diseases of the cornea and conjunctiva, as well as for a perioperative prevention of infectious complications of surgical procedures involving them, is a promising way to solve the problem.
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Barbosa, V. T., R. Thiesen, E. G. Soares, M. R. F. Machado, and J. L. Laus. "Effects of ethyl-cyanoacrylate and octyl-cyanoacrylate on experimental corneal lesions in rabbits." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 61, no. 5 (October 2009): 1067–76. http://dx.doi.org/10.1590/s0102-09352009000500009.
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The use of ethyl-cyanoacrylate and octyl-cyanoacrylate were clinically and histopathologically compared on the corneas of 36 rabbits after lamellar keratectomy (standardized diameter and depth). The animals were distributed into two groups, one for each type of adhesive. From each group, six subgroups were histopathologically evaluated on the 3rd, 7th, 14th, 21st, 30th, and 60th day post-operative. General (daily) and ophthalmic (days 0, 1, 3, 5, 7, 14, 21, 30, 44, and 60) evaluations clinically indicated that there were significant differences for the variables water intake, attitude, blepharitis, corneal edema, and fluorescein test. The adhesive permanence time for octyl-cyanoacrylate (17.22 days) was greater than that for ethyl-cyanoacrylate (7.66 days). With respect to the histopathological evaluation, corneal epithelization and collagen organization occurred without severe complications. However, treatment with ethyl-cyanoacrylate led to a moderate inflammatory reaction in the initial phases. With octyl-cyanoacrylate, re-epithelization and collagen organization proceeded more slowly with a discrete inflammatory reaction in the initial phases. From clinical and histopathologic points of view, octyl-cyanoacrylate showed advantages over ethyl-cyanoacrylate, whereas wound healing was achieved in both groups without major complications.
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Nguyen, Chu Luan, Tony S. Chen, Khoi Tran, James E. H. Smith, and Noni Lewis. "Simultaneous Subconjunctival Triamcinolone and Bevacizumab Injections for Management of Blepharokeratoconjunctivitis in Children." Case Reports in Ophthalmological Medicine 2018 (June 5, 2018): 1–4. http://dx.doi.org/10.1155/2018/2602487.
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Purpose. To report the efficacy of subconjunctival triamcinolone (Kenalog A-40, Alcon) and bevacizumab (Avastin, Genentech) injections in fraternal twins with blepharokeratoconjunctivitis (BKC) causing progressive, bilateral corneal neovascularization and scarring. Methods. In this retrospective observational case series, two three-year-old male twins with BKC had presented with bilateral red eyes, photophobia, and frequent blinking. Examination of each child showed bilateral deep stromal and superficial corneal neovascularization, corneal infiltrates, multiple follicles on the palpebral conjunctiva bilaterally with blepharitis, and thick turbid sebum expressed from the Meibomian glands. Their disease progressed despite conventional treatment. Both twins were managed with subconjunctival triamcinolone injection and subconjunctival bevacizumab injection of each eye. Results. The treatment resulted in improvement of symptoms, and examination over an 8-10-month period postinjections showed fading stromal corneal infiltrates, partially regressed corneal neovascularization, and reduced conjunctival injection without complications. Conclusion. This case series highlights the potential vision threatening complications of BKC. In addition to conventional management options, this report is the first published use of subconjunctival triamcinolone and bevacizumab injections for BKC in children in an attempt to minimize and improve corneal neovascularization and scarring and subsequently to retain useful vision.
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Khallaayoune, Mehdi, Siham Belmourida, Fatima Azzahra Elgaitibi, and Mariame Meziane. "Eyelid discoid lupus erythematosus." Our Dermatology Online 12, e (May 15, 2021): e28-e28. http://dx.doi.org/10.7241/ourd.2021e.28.
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Discoid lupus erythematosus (DLE) most commonly affects the face and scalp. Palpebral involvement is rare and not evocative when presenting as the prime manifestation of the disease. We report hereby the case of a young male patient with isolated palpebral and labial DLE. A 34-year-old patient with no medical history was referred from ophthalmology for an erythematous plaque of the eyelid resisting usual treatment of blepharitis. Skin examination revealed a congestive erythema on the right lower eyelid with eyelash fall (Fig. 1). There was also an atrophic cheilitis of the lower lip with slight erosions (Fig. 2). Scalp, oral mucosa and the rest of the integument were not affected. Skin biopsy of the eyelid revealed marked orthokeratosis with slight basal vacuolization and perivascular lymphoplasma cells infiltrate. Direct immunofluorescence displayed a positive lupus band (Fig. 3). Work-up for systemic involvement was negative. Ophthalmologic assessment found no intraocular involvement. Hydroxychloroquine 200mg twice a day with clothing and chemical photoprotection were implemented allowing significant improvement after 3 months (Fig. 4). Palpebral involvement of DLE is uncommon compared to the other suggestive locations including scalp, nose, cheekbones, ears, neckline and hands. An isolated involvement does not suggest DLE at first sight and often leads to delayed diagnosis while scarring and lid deformities might be expected if left untreated [1]. Most commonly it presents as erythematous telangiectasic scaly plaques on the external third of lower eyelid. Blepharitis-like, madarosis, periorbital edema or cellulitis presentations have also been reported [2]. Differential diagnosis may arise with several chronic palpebral dermatoses, as carcinomas, eczema, blepharoconjunctivitis, or seborheic dermatosis. Assessment for intraocular involvement such as keratitis should always be performed [3]. Early recognition and treatment are essential to avoid eyelid complications as ectropion, entropion, and trichiasis. Photoprotection and antimalarials are the mainstay treatment showing remarkable efficacy.
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Djakovic, Zorana, Jelica Vukicevic-Sretenovic, Danijela Dobrosavljevic, and Svetislav Milenkovic. "Ocular rosacea." Vojnosanitetski pregled 61, no. 2 (2004): 205–9. http://dx.doi.org/10.2298/vsp0402205d.
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Five cases of ocular rosacea (one male and four females) are reported in this paper. Two of the patients were with keratoconjunctivitis sicca, one with conjunctivitis chronica and blepharitis, one with conjunctivitis chronica and meibomitis, and one with reccurent corneal erosions with meibomitis and chordeloum. In four patients ocular symptoms preceded the occurence of skin lesions. The treatment with oral tetracyclines significantly improved the state of ocular rosacea in four patients, while in one case the changes of the anterior eye segment progressed in more severe state of ulcerative keratitis. It is considered that in almost 20% of the patients with rosacea ocular lesions may precede the skin changes, representing a diagnostic problem. Thus, in those cases multidisciplinary approach is suggested. Such approach is particularly important because of the decrease of morbidity and the prevention of the onset of the eye complications such as drastic worsening of visual acuity, i.e., the blindness.
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Elssen, Catharina Van, Mohammad Rashidian, Vladimir Vrbanac, Christian Freund, Juanjo Cragnolini, Jessica Ingram, Andrew Tager, and Hidde Ploegh. "Imaging Human Immune Cell Infiltration in a Xenograft Graft-Versus-Host Disease Model." Blood 128, no. 22 (December 2, 2016): 5720. http://dx.doi.org/10.1182/blood.v128.22.5720.5720.
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Abstract Graft versus host disease (GvHD) is one of the major complications of hematopoetic stem cell transplantation (HSCT), and is characterized by massive alloreactive T cell infiltration into target organs and tissues. Currently, non-invasive tools to diagnose and follow up disease are lacking. Here we show non-invasive imaging of infiltrating immunocytes in a human xenograft model for chronic GvHD, using a single domain camelid-derived antibody fragment (VHH) specific for human Class II MHC products present on myeloid cells, B cells and activated T cells. NSG (NOD-scid gamma) mice reconstituted with human fetal thymus, bone marrow and liver (BLT mice) spontaneously develop a GvHD-like condition, characterized by alopecia, blepharitis and target organ infiltration by activated human T cells. In diseased animals, we show an increased PET signal in the liver, attributable to infiltration of activated Class II MHC positive T cells. Non-invasive imaging of specific immune infiltration and activation could thus be of importance for diagnosis and treatment evaluation of GvHD and holds promise for other diseases characterized by inflammation. Disclosures No relevant conflicts of interest to declare.
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Richdale, Kathryn, Cecilia Chao, and Marc Hamilton. "Eye care providers’ emerging roles in early detection of diabetes and management of diabetic changes to the ocular surface: a review." BMJ Open Diabetes Research & Care 8, no. 1 (April 2020): e001094. http://dx.doi.org/10.1136/bmjdrc-2019-001094.
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US adults visit eye care providers more often than primary healthcare providers, placing these doctors in a prime position to help identify and manage patients with prediabetes and diabetes. Currently, diabetes is identified in eye clinics in an advanced stage, only after visible signs of diabetic retinopathy. Recent ophthalmic research has identified multiple subclinical and clinical changes that occur in the anterior segment of the eye with metabolic disease. The corneal epithelium exhibits increased defects and poor healing, including an increased risk of neurotrophic keratitis. Increased thickness and stiffness of the cornea artificially alters intraocular pressure. There is damage to the endothelial cells and changes to the bacterial species on the ocular surface, both of which can increase risk of complications with surgery. Decreased corneal sensitivity due to a loss of nerve density predispose patients with metabolic disease to further neurotrophic complications. Patients with diabetes have increased Meibomian gland dysfunction, blepharitis and reduced tear production, resulting in increased rates of dry eye disease and discomfort. Early detection of metabolic disease may allow eye care providers to be more proactive in recommending referral and intervention in order to reduce the risk of blindness and other diabetes-related morbidity. Continued research is needed to better understand the time course of changes to the anterior segment and what can be done to better detect and diagnose patients with prediabetes or undiagnosed diabetes and provide improved care for these patients.
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Rizyal, Aparna, Deeptara Pathak, and Roji Manandhar. "Ocular manifestations and its associated factors in patients with dermatitis at a tertiary care hospital in Kathmandu." Nepal Medical College Journal 24, no. 1 (April 4, 2022): 40–45. http://dx.doi.org/10.3126/nmcj.v24i1.44139.
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Dermatitis also known as eczema, is inflammation of the skin, typically characterized by itchiness, redness and a rash. Dermatitis was estimated to affect 245 million people globally in 2015 or 3.34% of the world population. In Nepal, studies from different parts of the country have reported the prevalence of dermatitis between 15.9 to 39.2%. Severe dermatitis with repeated scratching and rubbing of the face predisposes the patient to various ocular complications. A hospital-based, cross-sectional, descriptive study was conducted to assess the overall frequency and type of ophthalmological complications among patients with dermatitis at a tertiary care hospital in Kathmandu. A total of 91 patients were enrolled for this study. The minimum age was 5 years and maximum was 78 years, with the mean of 30.48 with a standard deviation of ± 20.28. The upper and lower limits for estimated mean age were 34.63 years to 26.33 years at 95% confidence interval. Seventy-one (78.0%) of all patients had ocular manifestations, many of them had more than one manifestation. Females outnumbered the males (41.8%; 36.3%) with respect to the occurrence of ocular manifestations in dermatitis. The commonest ocular manifestations were blepharitis in 35 (38.5%) patients, followed by eyelid eczema in 13 (14.3%) patients, allergic conjunctivitis in 5 (5.5%) and patients with other manifestations. Based on professional classification, over one fourth of the participants were students accounting for 44.0%, followed by homemakers accounting for 23.1% and shopkeepers accounting for 11.1%, respectively. A statistically significant association was observed with the ocular manifestation in relation to gender (p value=0.03) and occupation (p value=0.03). However, no association was observed between ocular manifestation with duration of dermatitis (p value=0.65), type of dermatitis (p value=0.94), personal and family history of allergy/atopy (pvalues=0.26; 0.58, respectively).
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Mandal, Shouvik. "Ectodermal Dysplasia and Anodontia associated with Ring Chromosome 18." Journal of Contemporary Dentistry 6, no. 3 (2016): 220–24. http://dx.doi.org/10.5005/jp-journals-10031-1175.
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ABSTRACT Ectodermal dysplasia (ED) is a heritable condition and represents a multifarious group of diseases comprising different clinical signs and symptoms. The ED occurs as a result of disturbances in the ectoderm of the evolving embryo. Agenesis of teeth or anodontia is also the result of disturbance in this process, which prevents the proliferation of tooth buds. In the present case, an 18-month-old child with history of congenital anomalies (CAs), severely delayed developmental milestones, and mental retardation presented with complete anodontia and ED. The CA included pulmonary stenosis, pulmonary valvar regurgitation, ventricular septal defect (VSD), absence of grips, absence of head-holding capacity, inability to sit, simian crease (R), visual impairment with corectopia, blepharitis, lagophthalmos with cortical visual impairment, telecanthus, hypotrichosis, hypertelorism, high philtrum, high arched palate, degenerated nails, and depressed third toes. Routine karyotyping via peripheral blood culture revealed a ring chromosome 18, which was confirmed de novo after parental karyotyping. Although a straightforward association between r(18) and anodontia is yet to be established, it is apparent that anodontia coupled with multiple CA and systemic complications was caused by chromosomal/genetic mutations in the present case, and thus, this report strongly recommends phenotypic and genotypic examination in dental management in such a complex scenario. How to cite this article Mandal S, Kadam NN, Ram SM, Ganguly BB, Shenoy VU. Ectodermal Dysplasia and Anodontia associated with Ring Chromosome 18. J Contemp Dent 2016;6(3):220-224.
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Greenberg, Harry S., William F. Chandler, Richard F. Diaz, William D. Ensminger, Larry Junck, Michaelyn A. Page, Stephen S. Gebarski, et al. "Intra-arterial bromodeoxyuridine radiosensitization and radiation in treatment of malignant astrocytomas." Journal of Neurosurgery 69, no. 4 (October 1988): 500–505. http://dx.doi.org/10.3171/jns.1988.69.4.0500.
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✓ Bromodeoxyuridine (BUdR), a nonhypoxic radiosensitizing drug, is a halogenated pyrimidine analog that is incorporated into the deoxyribonucleic acid of dividing cells in a competitive process with thymidine; BUdR also sensitizes these cells to radiation therapy. Neurons and glial cells have a very low mitotic rate. They will not incorporate BUdR and will not be sensitized. Bromodeoxyuridine is best delivered intra-arterially because of its regional advantage, calculated to be between 6 and 16. An 8-week BUdR infusion is delivered before and during radiation therapy through a permanently implanted pump with a catheter placed retrograde into the external carotid artery. Eighteen patients with malignant glioma (15 grade IV, and three grade III) were entered into a Phase I dose-escalation protocol with BUdR dosages ranging from 400 to 600 mg/sq m/day. The maximum dose that can be tolerated appears to be 400 mg/sq m/day for 8 weeks. The 18 patients entered in this study have a median Kaplan-Meier estimated survival time (± standard error of the mean) of 22 ± 5 months with 11 patients still alive. Three patients are alive at 30, 29, and 21 months after diagnosis with no evidence of tumor on computerized tomography. There have been no vascular complications. Side effects in all patients have included anorexia, fatigue, ipsilateral forehead dermatitis, blepharitis, iritis, and nail ridging. Myelosuppression requiring dose reduction occurred in one patient. One patient had a Stevens-Johnson syndrome requiring termination of BUdR. It is concluded that intra-arterial BUdR may improve survival times in patients with malignant gliomas.
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Osta, Lana EL, and Badi EL Osta. "Acute blepharitis: an unusual complication of zoledronic acid." International Journal of Rheumatic Diseases 20, no. 4 (September 10, 2015): 515–18. http://dx.doi.org/10.1111/1756-185x.12743.
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Kumar, Jitendra, Apurva Jain, and Archie Gupta. "OCULAR PATHOLOGY OF HYPEROPIC PATIENTS PRESENTING TO THE TERTIARY HEALTH CARE CENTRE." International Journal of Advanced Research 10, no. 08 (August 31, 2022): 324–30. http://dx.doi.org/10.21474/ijar01/15182.
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Purpose:To study the ocular pathology of hyperopic patients presenting to the tertiary health care centre. Methods: This was a retrospective observational study that involved 60 eyes of 30 patients with hypermetropia complaining of diminution of vision with asthenopic symptoms like tiredness of eyes, frontal or frontotemporal headache, watering and mild photophobia. There were three groups based on the criteria of age, i.e, <20 years, 20-40 years, 40-60 years with each group comprising of 10 patients. Complete ophthalmic examination was done in diffuse light followed by direct and indirect opthalmoscopic examination. Results:There were 15 males and 15 females. The common hypermetropiarelated findings in patients varying between age of 0-20 years was strabismus and amblyopia. Recurrent styes, recurrent blepharitis infection, recurrent chalazion were seen in equal proportions in all age groups. Primary open angle glaucoma and angle closure glaucoma were reported more in adults ranging between 20-40 years and 40-60 years.Fundus examination in high hypermetropic patients revealed a small optic disc with ill defined margins simulating papillitis which is pseudopapillitis because there is no swelling of the disc and the retina shines due to greater brilliance of light reflections giving shot silk appearance of retina. Conclusion:Hyperopia also termed hypermetropia or farsightedness, is a common refractive error in children and adults. Its effect on an individual and the symptoms produced varies greatly, depending on the magnitude of hyperopia, the age of the individual, the status of the accommodative and convergence system, and the demands placed on the visual system. Individuals with uncorrected hyperopia may experience symptoms such as blurred vision, asthenopia (e.g., headaches and eyestrain) while reading, accommodative/binocular dysfunction, amblyopia, and/or strabismus. Furthermore, uncorrected amblyopia in case of adults can lead to various complications like open angle or angle closure glaucoma, uveal effusion syndrome, non arteritic anterior ischemic optic neuropathy, central serous chorioretinopathy, age related macular degeneration, etc.
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Mitrovic, M., M. Jeremić, D. Zlatković, M. Pantelić, and D. Vrinić-Kalem. "P360 The correlation between ophthalmological posterior segment findings and disease severity in patients with inflammatory bowel disease." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i368. http://dx.doi.org/10.1093/ecco-jcc/jjab232.487.
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Abstract Background Inflammatory bowel disease (IBD) is often associated with ophatlmological complications, such as blepharitis, conjunctivitis, episcleritis and iridociclitis. Although present in approximately quarter of all IBD patients, ophthalmological posterior segment findings are often overseen and possibly related to disease activity. Methods A total of, 136 patients, with previous IBD, underwent a complete ophthalmological examination, including fundus photography and optical coherence tomography/angiography (OCT/OCTA) using Optovue Avanti XR HD-OCT. The retinal foveolar avascular zone (FAZ) and choroidal thickness was measured using AngioPlex OCTA software. IBD activity was evaluated using adapted Mayo score and Crohn’s disease activity index (CDAI), for ulcerative colitis (UC) and Crohn’s disease (CD), respectively, as well as faecal calprotectin and serum C-reactive protein levels. UC remission based on the modified Mayo score was defined as stool frequency sub-score, 0 to, 1, rectal bleeding sub-score of, 0, and endoscopy sub-score, 0 to, 1. CD remission was defined with CDAI score bellow, 150. Patients with recent ophthalmological surgery, refractive errors greater than +3 or -3, as well as patients with retinopathies were excluded from analysis. Results We performed a cross-sectional study of, 272 eyes of, 136 IBD patients (91 UC and, 45 CD) average age, 45 years, of which, 87 females. A total of, 37 patients (27.2%), of which, 18 UC and, 19 CD patients, were defined as having an active disease. The most prevalent fundoscopic finding was vascular tortuosity, observed in, 47 eyes (17.2%). The difference between choroidal thickness between UC and CD patients was not observed (308±35µm vs, 314±29µm, p=0.32), as well as the FAZ difference (0.32 vs, 0.33 mm2, p=0.21). On the other hand, if we take in count only patients with active disease, the FAZ area of CD patients was significantly greater in comparison to UC patients (0.31 vs, 0.34 mm2, p=0.028). Correlation study showed significant correlation between choroidal thickness and CDAI (Rho, 0.448, p=0.036). Conclusion The choroidal thickness and FAZ area are ophthalmological parameters that could be easily obtained using OCTA and may be taken in count as possible non-invasive markers of disease severity, especially in CD patients.
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John, Michael A., Thomas W. Austin, and Anne Marie Bombassaro. "Pseudomonas aeruginosaBlepharitis in a Patient with Vancomycin Induced Neutropenia." Canadian Journal of Infectious Diseases 7, no. 1 (1996): 63–65. http://dx.doi.org/10.1155/1996/301396.
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A patient who developed a necrotizing pseudomonas blepharitis as a complication of drug induced neutropenia is reported. Although the patient’s neutrophil count recovered and he survived his infection, radical reconstructive surgery of his eyelids was required. Clinicians should keep in mind that in patients with predisposing risk factors, even commonly encountered infections such as blepharoconjunctivitis may be caused by atypical pathogens.
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Popat, Rakesh, Aikaterini Kazantzi, Asim Farooq, Praneetha Thulasi, Sagar Lonial, Andrzej Jakubowiak, Ashraf Z. Badros, et al. "Ocular Health of Patients with Relapsed/Refractory Multiple Myeloma (RRMM): Baseline Data from the DREAMM-2 Trial of Belantamab Mafodotin (Belamaf)." Blood 136, Supplement 1 (November 5, 2020): 43–44. http://dx.doi.org/10.1182/blood-2020-139315.
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Introduction: The treatment paradigm for RRMM is characterized by continuous treatment to suppress the malignant plasma cell clone. Some treatments may affect the eye, leading to a broad spectrum of ocular disorders, from dry eye to glaucoma, causing impaired quality of life. Therefore, we examined the baseline eye health of patients with RRMM receiving single-agent belamaf in the DREAMM-2 study (NCT03525678) and compared the findings to those of age-matched individuals in the general population. A better understanding of baseline ocular status is important as patients may have existing, undiagnosed eye conditions that may affect future treatment options. Methods: DREAMM-2 investigated belamaf, a B-cell maturation antigen-targeted antibody-drug conjugate in patients with RRMM. Eligible patients had received ≥3 prior therapies and were refractory to an immunomodulatory agent, a proteasome inhibitor, and refractory and/or intolerant to an anti-CD38 monoclonal antibody. Prior to receiving belamaf, patients underwent systematic ocular history collection and eye examination and completed the eye-specific National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25). We report pretreatment eye-related findings to describe the baseline ocular status of patients with RRMM in DREAMM-2. Results: Of 221 patients enrolled, 100 (45%) were female and 121 (55%) were male, with a median age (range) of 66 years (34-89), median time from diagnosis of 5.4 years (1.1-12.1), and median 6 (3-21) prior lines of therapy; 98% patients had received bortezomib. Previous ocular history reported by patients were cataract (60%), intraocular surgery and/or laser treatment (35%), dry eye (20%), and glaucoma (6%), and history of ocular disease requiring medical treatment (12%). On examination, the mean best corrected visual acuity (BCVA) Snellen score was worse than 20/50 in one or both eyes in 20 and 4 of 218 patients with data, respectively. Blepharitis (anterior) was evident in approximately 20% and the corneal epithelium was abnormal (mainly mild-grade keratopathy) in 43% of patients. Impaired tear film production was reported with meibomian gland dysfunction (MGD) in 33% of patients, and evidence of dry eye (Schirmer's test, median 8.2 mm [normal ≥15 mm] in the worse eye. Median worse-eye tear break up time was 8.6 sec [normal >10 sec]). Slit-lamp examination revealed a cataract in approximately 50% of patients. Ten (8%) patients had evidence of prior cataract surgery with an implanted lens (pseudophakia). Dilated fundoscopy identified an abnormal optic nerve in 10% of patients in either eye; of these, glaucomatous cupping was noted in 43% (right eye) to 50% (left eye) of patients. Median (range) overall composite vision score by NEI-VFQ-25 was 95.3 (28-100). Conclusions: There was a 60% prevalence of cataract in the study cohort and an increased prevalence of glaucoma (6% vs expected 3% in patients >65 years old; Kreft et.al. BMC Public Health 2019) in RRMM patients treated in the DREAMM-2 study. Both conditions can be associated with corticosteroids, often used in MM treatments, although cataract is also an age-related phenomenon. We noted a significant number of patients with blepharitis (anterior), dry eye, and MGD, which may be associated with prior bortezomib treatment. Forty-three percent of patients had an abnormal corneal epithelium at baseline, which may be related to dry eye. This is relevant as belamaf is associated with keratopathy (microcyst-like epithelial changes visible on slit-lamp examination, with or without symptoms). Overall NEI-VFQ-25 scores were comparable to those reported in patients >65 years old (Nickels et al. Health Qual Life Outcomes 2017). Patients with RRMM may have a number of baseline ocular abnormalities suggesting a need for regular ophthalmic examinations in this vulnerable population to identify and manage underlying conditions and treatment-related complications. Specifically, attention should be paid to patients who may have ocular conditions associated with prior treatment with corticosteroids or bortezomib. The optimization of ocular heath in this population is particularly relevant given that emerging RRMM therapies such as belamaf are associated with significant ocular side effects. Funding: GSK (Study 205678); drug linker technology licensed from Seattle Genetics; monoclonal antibody produced using POTELLIGENT Technology licensed from BioWa. Disclosures Popat: GSK: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Celgene: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Other: Travel support, Research Funding; Janssen: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); AbbVie: Consultancy, Honoraria. Farooq:University of Chicago: Current Employment; GlaxoSmithKline: Consultancy. Thulasi:Emory University: Current Employment. Lonial:Novartis: Consultancy, Honoraria, Other: Personal fees; Janssen: Consultancy, Honoraria, Other: Personal fees, Research Funding; BMS: Consultancy, Honoraria, Other: Personal fees, Research Funding; GSK: Consultancy, Honoraria, Other: Personal fees; Abbvie: Consultancy; Merck: Consultancy, Honoraria, Other: Personal fees; Takeda: Consultancy, Other: Personal fees, Research Funding; Amgen: Consultancy, Honoraria, Other: Personal fees; Sanofi: Consultancy; Genentech: Consultancy; Karyopharm: Consultancy; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees; JUNO Therapeutics: Consultancy; Millennium: Consultancy, Honoraria; Onyx: Honoraria. Jakubowiak:AbbVie, Amgen, BMS/Celgene, GSK, Janssen, Karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Adaptive, Juno: Consultancy, Honoraria. Badros:Amgen: Consultancy; University of Maryland: Current Employment. Jeng:University of Maryland: Current Employment; EyeGate: Current equity holder in publicly-traded company; Kedrion, Merck, GSK: Consultancy. Opalinska:GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Baron:GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Piontek:GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Byrne:Adaptimmune, Novartis: Current equity holder in publicly-traded company; GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Womersley:GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Gupta:GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company; Novartis: Current equity holder in publicly-traded company. Degli Esposti:Moorfields Eye Hospital: Current Employment; GlaxoSmithKline: Consultancy, Honoraria.
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Monova, D., S. Monov, D. Dimova, V. Tzankov, and M. Sotirova. "FRI0253 OCULAR MANIFESTATIONS IN PATIENTS WITH SYSTEMIC SCLEROSIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 711.1–711. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3166.
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Background:Systemic sclerosis (SSc) is a connective tissue disease with heterogeneous manifestations. It affects different organs and therefore requires interdisciplinary diagnostic and therapeutic management.Objectives:The aim of this study is to evaluate the frequency and characteristics of ocular manifestation in patients with systemic sclerosis.Methods:The study involved 31 patients with SSc. All the study subjects underwent complete ophthalmological examination involving visual acuity assessment, examination of anterior and posterior eye segments, Schirmer I test, diameter and mobility of pupils, as well as eyeball mobility assessment of intraocular pressure and ultrasound assessment of vitreous body. Data regarding age, gender, SSc subtype, disease duration, age at diagnosis, nailfold capillaroscopic pattern, systemic corticosteroid or chloroquine use, blood pressure, ocular symptoms and detailed ophthalmic history were recorded.Results:31 patients (3 male, 28 female, mean age 42,7 ± 14,3 years; mean disease duration 10,3±8,1 years) were enrolled in this study. 7 (22,58 %) of them had no ocular symptoms. Among the patients with ocular symptoms, 20 (64.52%) complained of decreased vision, 13 (41,93 %) - of itching, 14 (45,16%) - of burning, 8 (25,81%) - of eye fatigue,4 (12,90 %) - of ocular pain, 4 (12,90%) - of foreign body sensation, 16 (51,61 %) - of dry eye, 5 (52,03 %) -photophobia, 2 (6,45 %) - of floaters, 10 (32,26 %) - of redness. Hardening and thickening of palpebral skin was noted in 27 (87,10 %) patients. Ophthalmological examination revealed higher incidence of the following abnormalities in the study group: myopic astigmatism - in 20 (32,26 %) eyes, vascular abnormalities within fundus - in 24 (38,71%) eyes, increased intraocular pressure (> 21 mm Hg) - in 13 (20,97%) eyes. Mean IOP values were 18,21 ±4,2 mm Hg.Eyelid telangiectasias was noted in 9 (29,03 %) patients, chronic blepharitis - in 13(41,94 %). Lens opacity was found in 16 (51,61 %) patients (27 eyes), mostly in the form of posterior subcapsular cataract (in 20 eyes), nuclear cataract (in 6 eyes) and cortical cataract appearing as focal cystic opacities (in 1 eye). The mean age of patients with cataracts was 49,2 ± 12,3 years (11,4 years older than patients without cataracts). Additionally, 14 of the patients with cataracts were either currently taking or had previously taken systemic corticosteroids. Superficial conjunctival hyperaemia was noted in 20 (64,52 %), and varicose dilatation of subconjunctival and episcleral blood vessels in 9 (29,03 %) and 7 (22,58 %) patients, respectively. In 9 eyes (14,52 %) foci of pigment epithelium were found peripherally on the optic disc, In 6 (9,68 %) eyes - thinning of choroidal capillaries and retinal pigment epithelium, in 8 (12,90 %) - ischemic areas surrounded by microaneurysms and intraretinal extravasation, dilatation of the vessel-free fovea. сonjunctival fibrosis - in 8 (25,81 %) patients. In 25 eyes Schirmer I test results were below 10 mm, and in 7 eyes - below 5 mm. Eyelid stiffness was associated with difficulty in lid eversion and a woody texture upon palpation. Comparing patients with and without eyelid stiffness, we found that the mean age and the age at diagnosis were significantly lower in the former group (p < 0.01 and p < 0.05, respectively). The diffuse subtype was more prevalent among pts with eyelid skin changes (p < 0,05).Conclusion:In patients with SSc numerous abnormalities within the vision of organ may be found. Ocular symptoms are relatively common complications of SSc, and may result in serious, irreversible changes in the organ of vision. Regular ophthalmological examinations are essential among the patients with SSc.Disclosure of Interests:None declared
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Neupane, Karun, Apoorva Jayarangaiah, Yan Zhang, and Abishek Kumar. "VEXAS syndrome with progression of MDS to MDS/MPN overlap syndrome." BMJ Case Reports 15, no. 12 (December 2022): e251089. http://dx.doi.org/10.1136/bcr-2022-251089.
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VEXAS (vacuoles, E1 enzyme, X linked, autoinflammatory, somatic) syndrome is a novel inflammatory syndrome that was first described in December 2020. Patients with VEXAS syndrome have a somatic mutation in the UBA1 gene, inflammatory conditions and usually haematological conditions. Haematological conditions reported in patients with VEXAS syndrome include myelodysplastic syndrome (MDS), clonal cytopenia of undetermined significance, plasma cell neoplasm including multiple myeloma/monoclonal gammopathy of undetermined significance, haemophagocytic lymphohistiocytosis and monoclonal B-cell lymphocytosis. Here we describe a patient with VEXAS syndrome who had a progression of MDS to MDS/myeloproliferative neoplasm overlap syndrome. The ocular findings so far reported in these patients include episcleritis, uveitis, blepharitis and orbital cellulitis. Here we report retinal detachment as a clinical feature of VEXAS syndrome. This finding has a significant implication in patient management as it warrants higher vigilance for this sight-threatening complication.
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Larsen, I. V., H. Clausius, A. W. Kolb, and C. R. Brandt. "Both CD8+and CD4+T Cells Contribute to Corneal Clouding and Viral Clearance following Vaccinia Virus Infection in C57BL/6 Mice." Journal of Virology 90, no. 14 (May 11, 2016): 6557–72. http://dx.doi.org/10.1128/jvi.00570-16.
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ABSTRACTVaccinia virus (VACV) keratitis is a serious complication following smallpox vaccination and can lead to blindness. The pathological mechanisms involved in ocular VACV infection are poorly understood. Previous studies have used rabbits, but the lack of immune reagents and transgenic or knockout animals makes them less suitable for mechanistic studies. We report that infection of C57BL/6 mice with 1 × 107PFU of vaccinia virus strain WR results in blepharitis, corneal neovascularization, and stromal keratitis. The DryVax strain of VACV was completely attenuated. Infection required corneal scarification and replication-competent virus, and the severity of ocular disease was similar in 4- to 6-week-old and 1-year-old mice. Viral titers peaked at approximately 1 × 106PFU on day 5 postinfection, and virus had not cleared by day 13 postinfection. Neutrophils were found in the peripheral cornea on day 1 after infection and then declined, followed by infiltration of both CD4+and CD8+T cells, which remained peripheral throughout the infection. Blood vessel growth extended 2 to 5 mm into the cornea from the limbus. Infection of CD4−/−, CD8−/−, or antibody-depleted mice resulted in similar disease severity and corneal clouding, indicating that both T-cell subsets were involved in the immunopathological response. Depletion of both CD4+and CD8+T cells resulted in significantly more severe disease and failure to clear the virus. On the basis of our results, the pathology of VACV keratitis is significantly different from that of herpes simplex virus keratitis. Further studies are likely to reveal novel information regarding virulence and immune responses to viral ocular infection.IMPORTANCEPotentially blinding eye infections can occur after vaccination for smallpox. Very little is known about the pathological mechanisms that are involved, and the information that is available was generated using rabbit models. The lack of immunological reagents for rabbits makes such studies difficult. We characterized a mouse model of vaccinia virus ocular disease using C57BL/6 mice and strain WR and show that both CD4+and CD8+T-cell subsets play a role in the blinding eye disease and in controlling virus replication. On the basis of these results, vaccinia virus keratitis is significantly different from herpes simplex virus keratitis, and further studies using this model should generate novel insights into immunopathological responses to viral ocular infection.
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Akram, Muhammad Abdul Rehman. "Ocular Presentations in Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) Patients undergoing highly- active antiretroviral therapy (HAART) Therapy in Jeddah, Kingdom of Saudi Arabia." Pakistan Journal of Ophthalmology 35, no. 3 (January 16, 2020). http://dx.doi.org/10.36351/pjo.v35i3.902.
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Purpose:
To detect the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) related ocular manifestations in Jeddah, Saudi Arabia.
Study Design: Retrospective study
Place and duration of study: A one-year retrospective study was conducted in Ophthalmology Clinic of East Jeddah Hospital in the western region of the Kingdom of Saudi Arabia, during 2016-2017
Material and methods
A one-year retrospective study was conducted in the Ophthalmology Clinic of East Jeddah Hospital in the western region of the Kingdom of Saudi Arabia, during 2016-2017. 47 referrals of HIV-positive patient data were collected from the Infectious Diseases Department by taking history, clinical examinations and, laboratory investigations. The ophthalmological examination included adnexal examination, bestcorrected visual acuity, intraocular pressure (IOP), anterior and posterior segment examination, B-scan and, MRI.
Results
Out of 47 referred patients from the In and Out-patient Departments in East Jeddah Hospital, patients presented as follows:
Single patient cases of retinal necrosis, anterior uveitis and neovascular glaucoma, with pterygium,sixth nerve palsy, bacterial conjunctivitis and, adenoviral conjunctivitis. Two cases presented with HIV microangiopathy, blepharitis, cortical blindness after brain abscess, herpes infection, Kaposi sarcoma and, cytomegalovirus (CMV) retinitis. Three patients presented with tuberculosis meningitis, and six with dry eyes. Eight patients presented with cataracts, and ten with refractive errors.
Conclusions
Ocular manifestations of HIV infection are relatively infrequent.HAART treatment is responsible for decreasing the HIV-related complications in ophthalmology. The CD4 T-lymphocyte result can be used to predict the beginning of certain eye infections in HIV-positive patients. Hidden indicators of complications of AIDS in patients confirm the strong rationale for alternating visits with those to an ophthalmologist and professionals discussing the best treatment accordingly.
Keywords: Ocular, HIV, AIDS, HAART
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Biermann, Julia, Friederike Bosche, Nicole Eter, and Flemming Beisse. "Treating Severe Pediatric Keratoconjunctivitis with Topical Cyclosporine A." Klinische Monatsblätter für Augenheilkunde, November 3, 2021. http://dx.doi.org/10.1055/a-1556-1182.
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AbstractThe incidence of chronic keratoconjunctivitis, which potentially causes long-term loss of visual acuity due to corneal opacity, is considerably less common in children than in adults. It is therefore in danger of being overlooked. In children the appropriate treatment is therefore often introduced too late, or to an insufficient extent. In this article we would like to raise awareness about the diagnosis of chronic keratoconjunctivitis in children, and to present an effective treatment plan for severe stages of the disease. There are two forms of chronic keratoconjunctivitis that occur most frequently in children: hyperergic blepharokeratoconjunctivitis (hBKC) and vernal keratoconjunctivitis (VKC). With hBKC, the patient often has a history of recurring hordeolum and also presents with blepharitis; it is characterized by the marked presence of corneal neovascularization in the lower circumference of the cornea. VKC is typically characterized by changes under the upper eyelid, with marked changes to the superior limbus. If there is a risk of complications involving the cornea, or in the presence of such complications, a consistent long-term topical immunosuppressive and anti-inflammatory treatment is required. Both of these properties are combined in the active ingredient cyclosporine A. Other advantages of topical CSA treatment are its steroid-sparing effect and the long-term reduction of exacerbations. Parents need to be informed about the chronic nature of these two diseases and their tendency to recur; because of these characteristics, treatment, in most cases, should be envisaged for at least one year in order to effectively disrupt the complex immunologic processes. This safeguards the childʼs visual development and prevents amblyopia caused by scarring and astigmatism. We hope that the data presented will lower the barriers related to prescribing CSA for topical eye application in children.
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Poyser, Alicia, Sundeep S. Deol, Lina Osman, Helen J. Kuht, Tharsica Sivagnanasithiyar, Roslyn Manrique, Linda O. Okafor, et al. "Impact of COVID-19 pandemic and lockdown on eye emergencies." European Journal of Ophthalmology, November 19, 2020, 112067212097494. http://dx.doi.org/10.1177/1120672120974944.
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Background: To characterise and compare ocular pathologies presenting to an emergency eye department (EED) during the COVID-19 pandemic in 2020 against an equivalent period in 2019. Methods: Electronic patient records of 852 patients in 2020 and 1818 patients in 2019, attending the EED at a tertiary eye centre (University Hospitals of Leicester, UK) were analysed. Data was extracted over a 31-day period during: (study period 1 (SP1)) COVID-19 pandemic lockdown in UK (24th March 2020–23rd April 2020) and (study period 2 (SP2)) the equivalent 2019 period (24th March 2019–23rd April 2019). Results: A 53% reduction in EED attendance was noted during lockdown. The top three pathologies accounting for >30% of the caseload were trauma-related, keratitis and uveitis in SP1 in comparison to conjunctivitis, trauma-related and blepharitis in SP2. The overall number of retinal tears and retinal detachments (RD) were lower in SP1, the proportion of macula-off RD’s (84.6%) was significantly ( p = 0.0099) higher in SP1 (vs 42.9% in SP2). Conclusion: COVID-19 pandemic related lockdown has had a significant impact on the range of presenting conditions to the EED. Measures to stop spread of COVID-19 such as awareness of hand hygiene practices, social distancing measures and school closures could have an indirect role in reducing spread of infective conjunctivitis. The higher proportion of macula-off RD and lower number of retinal tears raises possibility of delayed presentation in these cases. Going forward, we anticipate additional pressures on EED and other subspecialty services due to complications and associated morbidity from delayed presentations.
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Oberholzer, Marsha, Jacques Raubenheimer, Marga Lyell, Sade Pieterse, Aveli Keyser, Armandt Rautenbach, and Suandré Van Rooyen. "A comparison of the ability of three common contact lens solutions with different constituents to inhibit growth of Staphylococcus aureus." African Vision and Eye Health 74, no. 1 (March 26, 2015). http://dx.doi.org/10.4102/aveh.v74i1.27.
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Background: Staphylococcus aureus is a common commensal on skin and mucosal surfaces; its contact with the eye may cause a variety of ocular inflammations and infections such as blepharitis, conjunctivitis and keratitis, amongst others. Soft contact lenses provide perfect conditions for the breeding of certain pathogens, and disinfecting solutions for contact lenses are therefore of utmost importance. These solutions should be effective in inhibiting the growth of a variety of pathogens to protect the user from ocular infections.Aim: To highlight the need for clinicians to be aware of the effects of various recommended disinfecting contact lens solutions.Method: Three popular disinfecting contact lens solutions readily available in South Africa were chosen. These and a control solution (saline) were prepared and inoculated with S. aureus to evaluate the antimicrobial efficacy of each solution. The primary stand-alone test was used to evaluate the solutions according to the ISO standard specifically for this purpose.Results: The test results indicated that two of the solutions met the ISO standards; the third failed. Of the two that passed the test, only one showed the required 3-log reduction after 30 minutes, as per the ISO standard, although this solution is marketed as a ’10 minute system’.Conclusion: It is important for clinicians to be aware of the complications that may be caused by contaminated solutions, and patients should be warned about the effects thereof. To ensure healthy eyes for our patients, sufficient knowledge regarding the efficacy of recommended multipurpose solutions is necessary. Solutions that meet ISO standards promote good ocular health and ensure sufficient cleaning and disinfecting of contact lenses.
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Pequeno, Walter H. C., Rômulo F. F. Dias, Alexandra M. Oliveira, Lucas C. Dutra, Ivia C. Talieri, Ricardo B. Lucena, and Sara V. D. Simões. "Ocular and oral lesions caused by Tacinga inamoena in sheep and goats in Northeast Brazil." Pesquisa Veterinária Brasileira 41 (2021). http://dx.doi.org/10.1590/1678-5150-pvb-6915.
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ABSTRACT: Two outbreaks of traumatic injuries in goats and sheep associated with grazing and ingestion of the cactus Tacinga inamoena have recently been reported in the state of Paraíba, Brazil. In the first of these, which was detected in 2019 during a preliminary inspection of a herd of 70 animals, it was found that 15 showed certain ocular complications, and these animals were subjected to general physical and ophthalmic examinations. The clinical findings included excessive lacrimation, blepharitis, photophobia, corneal opacity, hyphema, corneal neovascularization, corneal ulcers, and adherence of gloquids to the bulbar conjunctiva and cornea. Large amounts of T. inamoena were found to be present in several areas in which these animals had been grazed and had been observed consuming the fruits of this plant. In the second outbreak during the following year, two sheep from a total of 100 animals were identified as having oral lesions associated with grazing in areas within which T. inamoena was growing. One of these animals was referred to a veterinary hospital, and on physical examination was found to show apathy, anorexia, a body score of 1.5, and the presence of gloquids within the fur. With respect to the oral cavity, halitosis, severe sialorrhea, extensive hemorrhagic ulcers, and painful tenderness on palpation were detected. Given the unfavorable prognosis, the sheep was subsequently euthanized. At necropsy, multifocal to coalescent plaques were detected on the upper and lower lips, oral mucosa, tongue, and hard and soft palates. These were generally elevated and firm and characterized by an irregular, ulcerated surface, sometimes crusty, with a yellow to light brown center and erythematous edges. The findings of this study highlight that the consumption of T. inamoena can cause serious oral and ophthalmic lesions in small ruminants in the northeastern semi-arid regions of Brazil, and can potentially contribute to substantial large economic losses. This problem tends to be exacerbated by the invasive behavior of T. Inamoena, particularly in areas in the process of environmental degradation.
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Seelarbokus, Muhammad Adil, and Clive Kelly. "P31 Cogan's syndrome—a neglected autoimmune vasculitis." Rheumatology Advances in Practice 5, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/rap/rkab068.030.
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Abstract Case report - Introduction Vasculitis carries high levels of morbidity and mortality. It can affect young people where the diagnosis is often unsuspected until life-threatening complications arise. Early intervention can dramatically improve the natural history of the condition and an awareness of the clinical presentation assists clinicians in diagnosis. Cogan’s syndrome is a rare variable-vessel vasculitis typically characterised by a non-syphilitic interstitial keratitis and vestibuloauditory symptoms, with a presumed autoimmune component. Systemic involvement may occur in up to 80% of patients. Despite over 300 cases being reported since its first description in 1934, its pathogenesis remains elusive and its diagnosis challenging. Case report - Case description We report the case of a 27-year-old fit and well woman who was referred to ophthalmology by her GP in August 2019 due to persistent bilateral epiphora. A full ophthalmic examination revealed significant bilateral blepharitis, but was otherwise unremarkable. Notably, the cornea was clear bilaterally. She presented again to her GP in February 2020, when she developed intermittent episodes of tinnitus and vertigo which resulted in marked disability, whereby standing led to vomiting. Initial ENT review proved unavailing and no explanation was found. An MRI scan was ordered, which was normal besides a non-specific small focus of T2 hypersensitivity in the left frontal lobe. In August 2020, she developed intermittent polyarthralgia starting with the ankles and extending proximally. Following a GP referral, she was reviewed by rheumatology in April 2021, by which point the combination of her vestibular symptoms and polyarthralgia had confined her to her house. The patient also reported daily nocturnal sweats but no weight loss. She also described a marked facial rash that extended over both cheeks down to the chin, which had resolved spontaneously and was reviewed on photographs. On examination, her lumbar spine was tender as was the ankle joint albeit no stiffness or swelling was noted. Neurological examination was normal, with no obvious hearing loss. The patient was systemically well with no evidence of cardiac involvement and no lymphadenopathy. A full vasculitic and autoimmune screen was sent. With the exception of a mildly raised ESR and total protein, the screen came back negative. The pattern and evolution of her symptoms led to a clinical diagnosis of Cogan’s syndrome, and treatment with prednisolone 0.5mg/kg was initiated. Her symptoms dramatically improved and dose tapering is now under way with a view of initiating mycophenolate mofetil if long-term immunosuppression proves necessary. Case report - Discussion This case is particularly interesting as it provides valuable first-hand insight into the manifestations and diagnostic challenges that still accompany the disease, 87 years after its first appearance in the literature. It is striking to note the functional impact of the vestibular symptoms and the polyarthralgia, which confined our young, active patient to her house. This highlights the potential morbidity that can result from this disease. As remarkable as the symptoms themselves is their response to steroids, as was the case here. As such the symptoms are often manageable by the astute clinician. Our patient’s constellation of symptoms was typical in that ocular and vestibuloauditory signs arose within the expected timeframe. However, her ocular symptoms were out of keeping with the usual features of Cogan’s syndrome, which usually comprise interstitial keratitis, conjunctivitis, uveitis, scleritis, and episcleritis. Instead, she presented with blepharitis, which had not been previously reported with Cogan’s syndrome, although there have been reports of epiphora. Moreover, it should be noted that although she had not reported hearing loss, a formal audiology assessment had not been done. Another limitation was the unavailability of inner ear auto-antibodies, which would have been helpful to consolidate the diagnostic reasoning albeit the eventual management would still be informed by clinical judgment and therefore unchanged. Another important point that this case illustrates is the central role of GP in the diagnosis of such challenging conditions. All too often GPs are not given enough credit for the pivotal role they play in unifying the care a patient may receive from specialties that may otherwise work independently of one another. Indeed, the GP was crucial in synthesising data from different tertiary referrals and providing the key findings and the history to the rheumatologist which led to her eventual diagnosis and timely management. Case report - Key learning points Whilst Cogan’s syndrome is now a relatively well-recognised albeit rare disease, it remains challenging to diagnose owing to its variable presentation and the lack of diagnostic tests. Consequently, its diagnosis often relies on clinical suspicion and pattern recognition. Typical Cogan’s syndrome refers to the appearance of ocular and vestibuloauditory symptoms within 2 years of each other. Systemic symptoms such as fever, weight loss, arthromyalgias, and skin rashes have all been reported. Delayed diagnosis is associated with permanent deafness and, of greater concern, a 10% risk of aortitis which may result in aortic insufficiency or dissection. This highlights the importance of prompt recognition and treatment of the disease. A common affliction of rare diseases is the difficulty of conducting large-scale studies looking into the most effective treatment options. However, papers are frequently being published describing different approaches to the management of Cogan’s syndrome with immunosuppressants. One of the of main challenges highlighted was the management of the vestibuloauditory symptoms. Indeed, whilst ocular manifestations usually resolve with first-line steroid therapy, vestibuloauditory symptoms often require second- or even third-line treatments with immunosuppressants. Irreversible sensorineural hearing loss and persistent vestibular symptoms result in significant morbidity, and treatment aims to counter this. It has been found that initiation of high-dose steroids within 2 weeks of the onset of hearing loss was associated with the highest rates of recovery. However long-term immunosuppression is often needed to manage relapses, which occur in around 30% of patients over 10 years. This highlights the necessity for clinical trials looking into the efficacy of different immunosuppressants on patient outcomes. As an ‘orphan disease’ with only over 300 cases reported worldwide in the last 87 years, it is a rare but reversible cause of vasculitis that all physicians should be alerted to.
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Bunod, Roxane, Mathieu Robin, Juliette Buffault, Chafik Keilani, Antoine Labbé, and Christophe Baudouin. "PreserFlo MicroShunt® exposure: a case series." BMC Ophthalmology 21, no. 1 (July 10, 2021). http://dx.doi.org/10.1186/s12886-021-02032-z.
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Abstract Background PreserFlo® MicroShunt (PM) (also known as InnFocus® MicroShunt) is a subconjunctival stent implanted ab externo via a minimally invasive surgical procedure. The current indication is progressive, mild to moderate, open angle glaucoma uncontrolled on topical medications. According to the literature, adverse events are rare, mild and transient. Case presentation Two cases of stand-alone PreserFlo MicroShunt® implantation in patients with uncontrolled open-angle glaucoma are reported. Exposure occurred 7 days and 3 months respectively after implantation. These cases shared common features including preexisting blepharitis and the lack of a Tenon’s flap. In both cases, removal of the device was required after several attempts at repair. Conclusions PreserFlo MicroShunt® exposure is a potentially vision-threatening complication because of the risk of endophthalmitis. Potential risk factors include the absence of a Tenon’s flap and pre-existing ocular surface inflammation. Ocular surface inflammation should be detected and treated prior to PM implantation. If a deficiency in Tenon’s capsule is noted intraoperatively, close monitoring should be performed because of the higher risk of PM exposure.
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Xu, Yue, Ying-Ming Wang, Zheng-Tai Sun, Xiao-Long Yang, Xin-Yu Zhuang, Ya-Ru Ren, Ying-Jie Chen, et al. "Corneal perforation associated with ocular graft-versus-host disease." Frontiers in Oncology 12 (September 15, 2022). http://dx.doi.org/10.3389/fonc.2022.962250.
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Corneal perforation is a rare and serious complication of ocular graft-versus-host disease (oGVHD) patients. This study was to retrospectively report seven corneal perforation patients after allogeneic hematopoietic stem cell transplantation (HSCT). Demographic, hematologic, and ophthalmological data of patients were clarified in detail. Nine eyes of seven corneal perforation patients were clarified (Cases 3 and 6 were bilateral and the others are unilateral). All the cases had other affected GVHD organs, especially skin involvement. The duration between HSCT and corneal perforation was usually long with 21 (17–145) months as median interval, whereas the duration between oGVHD diagnosis and corneal perforation was relatively shorter with 4 (2–81) months as median interval. Most patients presented to ophthalmology department with poor visual acuity, BUT and Schirmer’s test. Eyelid marginal hyperemia and irregularity were observed in most corneal perforation eyes. Keratoplasty or conjunctival flap covering (CFC) surgeries was performed after corneal perforation. After a long-term follow-up for most patients (median 21 months, range: 2–86 months), only two eyes of two patients (22.22%) had a final BCVA of 20/100 or better. Patients involved in both cutaneous GVHD and blepharitis indicate the aggressive development of oGVHD. Early diagnosis, long-term follow-up, and effective multi-disciplinary treatments for oGVHD patients are essential. Corticosteroids and immunosuppressor remain essential, whereas the use of topical corticosteroids should be carefully considered in corneal ulceration patients. In addition, appropriate surgeries should be performed to control oGVHD development in time.