Alfonso Strianese, Valentino de Ruvo, Chiara Quisisana, Francesco Pozzo Giuffrida, Saverio Luccarelli, Francesco Viola, Luca Mario Rossetti, Paolo Fogagnolo
Purpose The purpose of this study was to describe a case of paraproteinemic keratopathy (PPK) in a patient with monoclonal gammopathy of undetermined significance (MGUS) Methods A 56 years old man was assessed using a slit lamp and in vivo confocal microscopy (IVCM) with Heidelberg HRT Rostock II. Results The patient showed bilateral diffuse, symmetric, non-polychromatic, punctiform crystals in all layers of the cornea. The remaining part of the ophthalmic clinical assessment was normal. Esthesiometry was normal in all quadrants. Anterior segment OCT confirmed diffused hyperreflectivity of the epithelium and corneal stroma. IVCM was then executed, showing polymorphic (granular, needle-like, stellate) hyperreflective crystals in all layers of corneal epithelium and anterior stroma, subbasal plexus nerves beading, cytoplasmatic hyperreflectivity of the keratocytes of the posterior stroma without any endothelial involvement After considering the age, health status, and ocular signs the primary entities to be investigated were adult benign cystinosis and paraproteinemic disorder. All the diagnostic tests were negative except for a monoclonal component IgG/k of 1.37 d/dl. A hematological examination was then performed with the resulting diagnosis of MGUS. In this paper, we analyzed 11 articles about IVCM in PPK in MGUS and other paraproteinemias highlighting IVCM features compatible with our findings allowing us to generalize a first diagnostic IVCM pattern for PPK. Conclusions In this case report we suggest the IVCM diagnostic patterns that may be used to identify PPK without corneal biopsy.
{"title":"CLINICAL AND IN VIVO CONFOCAL MICROSCOPY FINDINGS IN MGUS - A CASE REPORT","authors":"Alfonso Strianese, Valentino de Ruvo, Chiara Quisisana, Francesco Pozzo Giuffrida, Saverio Luccarelli, Francesco Viola, Luca Mario Rossetti, Paolo Fogagnolo","doi":"10.57073/001c.88919","DOIUrl":"https://doi.org/10.57073/001c.88919","url":null,"abstract":"Purpose The purpose of this study was to describe a case of paraproteinemic keratopathy (PPK) in a patient with monoclonal gammopathy of undetermined significance (MGUS) Methods A 56 years old man was assessed using a slit lamp and in vivo confocal microscopy (IVCM) with Heidelberg HRT Rostock II. Results The patient showed bilateral diffuse, symmetric, non-polychromatic, punctiform crystals in all layers of the cornea. The remaining part of the ophthalmic clinical assessment was normal. Esthesiometry was normal in all quadrants. Anterior segment OCT confirmed diffused hyperreflectivity of the epithelium and corneal stroma. IVCM was then executed, showing polymorphic (granular, needle-like, stellate) hyperreflective crystals in all layers of corneal epithelium and anterior stroma, subbasal plexus nerves beading, cytoplasmatic hyperreflectivity of the keratocytes of the posterior stroma without any endothelial involvement After considering the age, health status, and ocular signs the primary entities to be investigated were adult benign cystinosis and paraproteinemic disorder. All the diagnostic tests were negative except for a monoclonal component IgG/k of 1.37 d/dl. A hematological examination was then performed with the resulting diagnosis of MGUS. In this paper, we analyzed 11 articles about IVCM in PPK in MGUS and other paraproteinemias highlighting IVCM features compatible with our findings allowing us to generalize a first diagnostic IVCM pattern for PPK. Conclusions In this case report we suggest the IVCM diagnostic patterns that may be used to identify PPK without corneal biopsy.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136253817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Casado-López, Gloria Segura Duch, Víctor Lázaro-Rodríguez, Clara Álvarez de Toledo, Ainhoa Martínez-Grau, María Fideliz de la Paz
Objective To describe a case of severe chemical burn treated with a novel Boston type I keratoprosthesis (B1-KPro) technique. Methods We present the case of a 25-year-old woman with poor light perception in both eyes who had bilateral chemical burn with caustic soda 3 months earlier. She underwent several amniotic membrane implants and subconjunctival triamcinolone injections without significant improvement. We decided to perform a two-stage surgery on the right eye (RE). Reconstruction of the ocular surface was first performed using a buccal mucosa allograft. Nine months later the second surgical stage was performed, which consisted of partial lifting of the buccal mucosa, B1-KPro implantation covered with the buccal mucosa overlay and exposing the optics of the keratoprosthesis. Results Two days following surgery the uncorrected visual acuity (UCVA) was +0.2 logMAR. Best-corrected visual acuity (BCVA) at one month was 0,0 logMAR, remaining stable after one year and eleven months of follow-up. Conclusions Boston type 1 keratoprosthesis covered with buccal mucosa (B1-KPro with mucosa overlay technique) could be considered an alternative in severe ocular chemical burn with marked shortening of the fornix, as an alternative to osteo-odonto-keratoprosthesis (OOKP) or tibial bone keratoprosthesis or when the Boston type II keratoprosthesis is not available. It allows restoration of the anatomy and condition of the ocular surface using autologous tissue, with better aesthetics than OOKP and material easily available as it has the CE marking.
{"title":"CASE REPORT: “Boston type I keratoprosthesis with buccal mucosal overlay in severe chemical burn” ‘Barcelona CP’","authors":"Daniel Casado-López, Gloria Segura Duch, Víctor Lázaro-Rodríguez, Clara Álvarez de Toledo, Ainhoa Martínez-Grau, María Fideliz de la Paz","doi":"10.57073/001c.87564","DOIUrl":"https://doi.org/10.57073/001c.87564","url":null,"abstract":"Objective To describe a case of severe chemical burn treated with a novel Boston type I keratoprosthesis (B1-KPro) technique. Methods We present the case of a 25-year-old woman with poor light perception in both eyes who had bilateral chemical burn with caustic soda 3 months earlier. She underwent several amniotic membrane implants and subconjunctival triamcinolone injections without significant improvement. We decided to perform a two-stage surgery on the right eye (RE). Reconstruction of the ocular surface was first performed using a buccal mucosa allograft. Nine months later the second surgical stage was performed, which consisted of partial lifting of the buccal mucosa, B1-KPro implantation covered with the buccal mucosa overlay and exposing the optics of the keratoprosthesis. Results Two days following surgery the uncorrected visual acuity (UCVA) was +0.2 logMAR. Best-corrected visual acuity (BCVA) at one month was 0,0 logMAR, remaining stable after one year and eleven months of follow-up. Conclusions Boston type 1 keratoprosthesis covered with buccal mucosa (B1-KPro with mucosa overlay technique) could be considered an alternative in severe ocular chemical burn with marked shortening of the fornix, as an alternative to osteo-odonto-keratoprosthesis (OOKP) or tibial bone keratoprosthesis or when the Boston type II keratoprosthesis is not available. It allows restoration of the anatomy and condition of the ocular surface using autologous tissue, with better aesthetics than OOKP and material easily available as it has the CE marking.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136240936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To report a case of idiopathic corneal perforation with chronic inflammation in the setting of a persistent cyanoacrylate corneal glue patch lasting 420 days. Cyanoacrylate glue is a fast-acting and effective adhesive which has been utilised in the repair of corneal perforations. Their strength, quick drying, non-biodegradable and anti-microbial properties make them a valuable tool in closing small corneal wounds, often as a temporising measure before definitive management is performed. Complications associated with cyanoacrylate patch include glue toxicity, inflammation, corneal neovascularisation and giant papillary conjunctivitis. Cyanoacrylate glue should be considered a transitory measure. It is preferable to remove cyanoacrylate at the end of the treatment unless the glue has self-dislodge. Controversies surround the issue of selecting proper timing for removal of cyanoacrylate glue with no clear consensus.
{"title":"‘BARCELONA CP’ A case of chronic cyanoacrylate glue","authors":"V. Nguyen, Richa Sharma","doi":"10.57073/001c.87406","DOIUrl":"https://doi.org/10.57073/001c.87406","url":null,"abstract":"To report a case of idiopathic corneal perforation with chronic inflammation in the setting of a persistent cyanoacrylate corneal glue patch lasting 420 days. Cyanoacrylate glue is a fast-acting and effective adhesive which has been utilised in the repair of corneal perforations. Their strength, quick drying, non-biodegradable and anti-microbial properties make them a valuable tool in closing small corneal wounds, often as a temporising measure before definitive management is performed. Complications associated with cyanoacrylate patch include glue toxicity, inflammation, corneal neovascularisation and giant papillary conjunctivitis. Cyanoacrylate glue should be considered a transitory measure. It is preferable to remove cyanoacrylate at the end of the treatment unless the glue has self-dislodge. Controversies surround the issue of selecting proper timing for removal of cyanoacrylate glue with no clear consensus.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83351617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To present the emergency management of a patient with corneal perforation secondary to post-herpetic neurotrophic keratopathy (NK) with fibrin glue and amniotic membrane transplantation (AMT) in the absence of a tectonic corneal graft. A 26-year-old male patient with a history of herpetic keratitis was admitted to our clinic with a finding of approximately 1 mm corneal central perforation in his right eye. The best corrected visual acuities of right and left eyes were 2.3 and 0 logMAR, respectively. Anterior segment examination revealed corneal edema, vascularization, shallow anterior chamber and central corneal perforation in the melting area. No pathology of the retina or vitreous was detected in B-scan ultrasonography. Anterior and posterior segment examination of left eye was normal. Conventional approaches including bandage contact lens failed to buffer the leak. Since human corneal donor tissue was not available, fibrin glue application from inside to outside along the perforation area combined with AMT was applied. Even after 2 weeks when the amnion was degraded, it was observed that the perforation area was stable without any additional intervention. NK is one of the challenging reasons of corneal perforation. Although tectonic keratoplasty is the main treatment modality owing to transparency and high tissue resistance in the central corneal perforation repair, alternative treatment methods are necessary due to difficulty of access to donor cornea. Tissue adhesives and AMT are conservative methods to buffer leak with easier access. Present case clarifies the importance of alternative management modalities of corneal perforation in the absence of tectonic graft. Considering that only 1 donor cornea is available to 70 needed around the world, corneal perforation repair with fibrin glue combined with AMT seems wise.
{"title":"Case Report: Central Corneal Perforation Management Secondary to Neurotropic Keratopathy in the Absence of Tectonic Corneal Graft, Barcelona CP","authors":"M. Çiftçi, Ozlem Barut Selver","doi":"10.57073/001c.84834","DOIUrl":"https://doi.org/10.57073/001c.84834","url":null,"abstract":"To present the emergency management of a patient with corneal perforation secondary to post-herpetic neurotrophic keratopathy (NK) with fibrin glue and amniotic membrane transplantation (AMT) in the absence of a tectonic corneal graft. A 26-year-old male patient with a history of herpetic keratitis was admitted to our clinic with a finding of approximately 1 mm corneal central perforation in his right eye. The best corrected visual acuities of right and left eyes were 2.3 and 0 logMAR, respectively. Anterior segment examination revealed corneal edema, vascularization, shallow anterior chamber and central corneal perforation in the melting area. No pathology of the retina or vitreous was detected in B-scan ultrasonography. Anterior and posterior segment examination of left eye was normal. Conventional approaches including bandage contact lens failed to buffer the leak. Since human corneal donor tissue was not available, fibrin glue application from inside to outside along the perforation area combined with AMT was applied. Even after 2 weeks when the amnion was degraded, it was observed that the perforation area was stable without any additional intervention. NK is one of the challenging reasons of corneal perforation. Although tectonic keratoplasty is the main treatment modality owing to transparency and high tissue resistance in the central corneal perforation repair, alternative treatment methods are necessary due to difficulty of access to donor cornea. Tissue adhesives and AMT are conservative methods to buffer leak with easier access. Present case clarifies the importance of alternative management modalities of corneal perforation in the absence of tectonic graft. Considering that only 1 donor cornea is available to 70 needed around the world, corneal perforation repair with fibrin glue combined with AMT seems wise.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83917195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. M. M. Tawfeek, Dalia Tohamy, Hanan Mohamed Abdel Hamid Ahmed, A. M. N. A. Rady
The aim of this work is to evaluate the effect of transepithelial accelerated cross-linking (Epi-on CXL) on the macular function and morphology in progressive keratoconus. The study included 25 patients with progressive keratoconus with age ranged between 18 and 32 years. Epi-On Accelerated CXL was done for all cases. Evaluation was performed 2 and 6 weeks postoperatively after transepithelial (Epi-on) accelerated CXL by Optical coherence tomography (OCT) and multifocal electroretinography (mf-ERG). The central foveal thickness (CFT) decreased from 165.1 ± 21.5 µm to 163.4 ± 24.2 µm 2 weeks postoperatively to 164.8 ± 23.9 µm 6 weeks postoperatively, with no statistically significant difference. The preoperative retinal response density (RRD) decreased in macular ring 1 (foveal area of 2.8 degrees) from 179.5 ± 52.1 nV/deg2 preoperatively to 134.7 ± 43.2 nV/deg2 and 146.7 ± 41.6 nV/deg2 in 2 and 6 weeks, respectively postoperatively with statistically significant difference (p = 0.012), while the other 4 rings showed statistically insignificant difference (p >0.05) .On the other hand, implicit time latency (Pl) showed statistically insignificant difference between preoperative and postoperative values (p >0.05) in all macular rings. There is a minimal change in macular morphology after Epi-on accelerated CXL in progressive keratoconus, however, no significant change in macular function without any structural changes in progressive keratoconus 6 weeks postoperatively. A longer follow-up period studies are recommended to provide more information.
{"title":"Study Of Macular Function and Morphology After Transepithelial Accelerated Corneal Collagen Cross-linking in Progressive Keratoconus","authors":"M. M. M. Tawfeek, Dalia Tohamy, Hanan Mohamed Abdel Hamid Ahmed, A. M. N. A. Rady","doi":"10.57073/001c.83392","DOIUrl":"https://doi.org/10.57073/001c.83392","url":null,"abstract":"The aim of this work is to evaluate the effect of transepithelial accelerated cross-linking (Epi-on CXL) on the macular function and morphology in progressive keratoconus. The study included 25 patients with progressive keratoconus with age ranged between 18 and 32 years. Epi-On Accelerated CXL was done for all cases. Evaluation was performed 2 and 6 weeks postoperatively after transepithelial (Epi-on) accelerated CXL by Optical coherence tomography (OCT) and multifocal electroretinography (mf-ERG). The central foveal thickness (CFT) decreased from 165.1 ± 21.5 µm to 163.4 ± 24.2 µm 2 weeks postoperatively to 164.8 ± 23.9 µm 6 weeks postoperatively, with no statistically significant difference. The preoperative retinal response density (RRD) decreased in macular ring 1 (foveal area of 2.8 degrees) from 179.5 ± 52.1 nV/deg2 preoperatively to 134.7 ± 43.2 nV/deg2 and 146.7 ± 41.6 nV/deg2 in 2 and 6 weeks, respectively postoperatively with statistically significant difference (p = 0.012), while the other 4 rings showed statistically insignificant difference (p >0.05) .On the other hand, implicit time latency (Pl) showed statistically insignificant difference between preoperative and postoperative values (p >0.05) in all macular rings. There is a minimal change in macular morphology after Epi-on accelerated CXL in progressive keratoconus, however, no significant change in macular function without any structural changes in progressive keratoconus 6 weeks postoperatively. A longer follow-up period studies are recommended to provide more information.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78825628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louisa Lu, A. Shen, C. DeBoer, V. Mahajan, Charles Lin, Jennifer Rose-Nussbaumer
To report the clinical course and treatment strategies employed in management of a case of multidrug-resistant Pseudomonas aeruginosa keratitis progressing to endophthalmitis. The drug-resistant strain was later traced to use of contaminated EzriCare Artificial Tears in a multi-state cluster outbreak. A 57-year-old male patient with a history of Descemet stripping automated endothelial keratoplasty was referred for a culture-positive Pseudomonas corneal ulcer in the right eye that had been treated with several weeks of topical moxifloxacin, fortified vancomycin and tobramycin, and intravitreal injections for endophthalmitis. His cornea was cultured off of antibiotics and grew only rare Propionibacterium acnes. Topical antibiotics and steroids were reduced, but his condition rapidly deteriorated with leading to corneal melt, perforation, and endophthalmitis. Repeat corneal cultures and sensitivity analyses revealed growth of a strain of Pseudomonas aeruginosa that was resistant to fluoroquinolones, aminoglycosides, cephalosporins, monobactams, and carbapenems, and only intermediate susceptibility to piperacillin-tazobactam. The patient underwent a therapeutic penetrating keratoplasty and was subsequently initiated on an intensive regimen of topical chlorhexidine and polymyxin-B/trimethoprim. He also underwent a pars plana vitrectomy with anterior chamber washout, followed by serial injections of intravitreal piperacillin-tazobactam at a dose of 225 mg/0.1 mL. After 8 weeks of intensive treatment, there was gradual with healing of his ocular surface, regression of his hypopyon and posterior inflammation, and no signs of recurrent infection. A public health investigation ultimately revealed that his infection was one of several cases involved in a multistate cluster outbreak of extensively drug-resistant Pseudomonas ocular infections that were traced to the use of contaminated EzriCare Artificial Tears. Multidrug-resistant keratitis and endophthalmitis caused by multidrug-resistant Pseudomonas keratitis requires consideration of nonconventional antimicrobial agents and experimental therapeutic alternatives. Topical chlorhexidine and intravitreal piperacillin-tazobactam are currently nonconventional therapies in the context of bacterial keratitis and endophthalmitis, but were safe and effective in the management of multidrug-resistant Pseudomonas aeruginosa ocular infection.
报告1例多药耐药铜绿假单胞菌角膜炎发展为眼内炎的临床过程及治疗策略。耐药菌株后来被追踪到在多州群集爆发中使用了受污染的EzriCare人工泪液。一名57岁男性患者，有Descemet剥离自动内皮角膜移植术史，因右眼培养阳性假单胞菌角膜溃疡而被转诊，该患者曾接受数周的局部莫西沙星、强化万古霉素和妥布霉素治疗，并通过玻璃体内注射治疗眼内炎。他的角膜在没有抗生素的情况下培养，只生长出罕见的痤疮丙酸杆菌。局部抗生素和类固醇减少，但他的病情迅速恶化，导致角膜融化，穿孔和眼内炎。重复角膜培养和敏感性分析显示，一株铜绿假单胞菌对氟喹诺酮类药物、氨基糖苷类药物、头孢菌素、单巴菌素和碳青霉烯类药物耐药，对哌西林-他唑巴坦只有中等敏感性。患者接受了穿透性角膜移植术，随后开始了局部氯己定和多粘菌素- b /甲氧苄啶的强化治疗方案。患者同时行玻璃体切除伴前房冲洗术，随后连续注射剂量为225 mg/0.1 mL的哌拉西林-他唑巴坦玻璃体内注射。强化治疗8周后，患者眼表逐渐愈合，下丘脑和后部炎症消退，无复发感染迹象。一项公共卫生调查最终显示，他的感染是多州广泛耐药假单胞菌眼部感染聚集性爆发的几个病例之一，这些感染可追溯到使用受污染的EzriCare人工泪液。多药耐药角膜炎和眼内炎由多药耐药假单胞菌角膜炎引起，需要考虑非传统抗菌药物和实验性治疗方案。目前，在细菌性角膜炎和眼内炎的治疗中，外用氯己定和玻璃体内注射哌哌西林-他唑巴坦是一种非传统的治疗方法，但在多药耐药铜绿假单胞菌眼部感染的治疗中是安全有效的。
{"title":"CASE REPORT: Multidrug-resistant Pseudomonas keratitis and sequential endophthalmitis treated with chlorhexidine and piperacillin-tazobactam","authors":"Louisa Lu, A. Shen, C. DeBoer, V. Mahajan, Charles Lin, Jennifer Rose-Nussbaumer","doi":"10.57073/001c.84184","DOIUrl":"https://doi.org/10.57073/001c.84184","url":null,"abstract":"To report the clinical course and treatment strategies employed in management of a case of multidrug-resistant Pseudomonas aeruginosa keratitis progressing to endophthalmitis. The drug-resistant strain was later traced to use of contaminated EzriCare Artificial Tears in a multi-state cluster outbreak. A 57-year-old male patient with a history of Descemet stripping automated endothelial keratoplasty was referred for a culture-positive Pseudomonas corneal ulcer in the right eye that had been treated with several weeks of topical moxifloxacin, fortified vancomycin and tobramycin, and intravitreal injections for endophthalmitis. His cornea was cultured off of antibiotics and grew only rare Propionibacterium acnes. Topical antibiotics and steroids were reduced, but his condition rapidly deteriorated with leading to corneal melt, perforation, and endophthalmitis. Repeat corneal cultures and sensitivity analyses revealed growth of a strain of Pseudomonas aeruginosa that was resistant to fluoroquinolones, aminoglycosides, cephalosporins, monobactams, and carbapenems, and only intermediate susceptibility to piperacillin-tazobactam. The patient underwent a therapeutic penetrating keratoplasty and was subsequently initiated on an intensive regimen of topical chlorhexidine and polymyxin-B/trimethoprim. He also underwent a pars plana vitrectomy with anterior chamber washout, followed by serial injections of intravitreal piperacillin-tazobactam at a dose of 225 mg/0.1 mL. After 8 weeks of intensive treatment, there was gradual with healing of his ocular surface, regression of his hypopyon and posterior inflammation, and no signs of recurrent infection. A public health investigation ultimately revealed that his infection was one of several cases involved in a multistate cluster outbreak of extensively drug-resistant Pseudomonas ocular infections that were traced to the use of contaminated EzriCare Artificial Tears. Multidrug-resistant keratitis and endophthalmitis caused by multidrug-resistant Pseudomonas keratitis requires consideration of nonconventional antimicrobial agents and experimental therapeutic alternatives. Topical chlorhexidine and intravitreal piperacillin-tazobactam are currently nonconventional therapies in the context of bacterial keratitis and endophthalmitis, but were safe and effective in the management of multidrug-resistant Pseudomonas aeruginosa ocular infection.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"2013 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86269007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Co-Editor-In-Chief Sebastian Siebelmann (Germany) recounts a very successful meeting, and looks forward to the future.
联合主编Sebastian Siebelmann(德国)讲述了一次非常成功的会议，并展望了未来。
{"title":"EuCornea Barcelona 2023 - We are going into the next round.","authors":"S. Siebelmann","doi":"10.57073/001c.84060","DOIUrl":"https://doi.org/10.57073/001c.84060","url":null,"abstract":"Co-Editor-In-Chief Sebastian Siebelmann (Germany) recounts a very successful meeting, and looks forward to the future.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"145 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73982543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To present a case of a combined procedure of heterotopic autokeratoplasty and ECCE with posterior chamber intraocular lens (IOL) implantation, and to demonstrate the novel use of an RGP lens as a safe, cost-effective alternative to temporary keratoprosthesis. A 65/F presented with blindness, OS from glaucoma but with a clear cornea, and corneal decompensation with cataract in OD with good visual potential. Heterotopic autokeratoplasty was performed due to the scarcity of corneal allografts and the high-risk nature of the case, with ECCE and IOL implantation in OD due to lens opacity. Temporary keratoprosthesis (TKP) (such as Eckardt and Landers models) was substituted with RGP due to lower cost and accessibility. Pre-placement of two polyglactin perpendicular mattress sutures in the episclera at the horizontal and vertical positions was done and left untied. Next, left corneal trephination was performed using an 8-mm vacuum trephine, followed by the instillation of oculoviscosurgical device (OVD) and placement of a 10-mm diameter RGP lens over the left open globe, secured in place by tying the pre-placed overlying cross sutures. Then, right corneal trephination using a similar-sized trephine proceeded. Cataract was extracted in open-sky technique with IOL in the bag implantation. The clear left corneal button was then transplanted to OD and vice-versa. Postoperatively, VA improved from hand motions to 10/200 (Day 1). The graft remained clear 4 weeks post-op with further improvement in VA. IOP was maintained below 15 mmHg. Heterotopic autokeratoplasty is a valid option for unilateral cornea blind patients who have clear corneas in the fellow eye with no visual potential. This is useful in countries where corneal transplantation is costly, especially during time of pandemic when corneal allografts are scarce. In our experience, it can be safely performed using an RGP lens as a safe and cost-effective alternative to temporary keratoprosthesis.
{"title":"Use of RGP lens as Temporary Keratoprosthesis in Open-Sky Technique for Heterotopic Autokeratoplasty","authors":"Allurie Umel, Richmond Siazon, M. F. de la Paz","doi":"10.57073/001c.83224","DOIUrl":"https://doi.org/10.57073/001c.83224","url":null,"abstract":"To present a case of a combined procedure of heterotopic autokeratoplasty and ECCE with posterior chamber intraocular lens (IOL) implantation, and to demonstrate the novel use of an RGP lens as a safe, cost-effective alternative to temporary keratoprosthesis. A 65/F presented with blindness, OS from glaucoma but with a clear cornea, and corneal decompensation with cataract in OD with good visual potential. Heterotopic autokeratoplasty was performed due to the scarcity of corneal allografts and the high-risk nature of the case, with ECCE and IOL implantation in OD due to lens opacity. Temporary keratoprosthesis (TKP) (such as Eckardt and Landers models) was substituted with RGP due to lower cost and accessibility. Pre-placement of two polyglactin perpendicular mattress sutures in the episclera at the horizontal and vertical positions was done and left untied. Next, left corneal trephination was performed using an 8-mm vacuum trephine, followed by the instillation of oculoviscosurgical device (OVD) and placement of a 10-mm diameter RGP lens over the left open globe, secured in place by tying the pre-placed overlying cross sutures. Then, right corneal trephination using a similar-sized trephine proceeded. Cataract was extracted in open-sky technique with IOL in the bag implantation. The clear left corneal button was then transplanted to OD and vice-versa. Postoperatively, VA improved from hand motions to 10/200 (Day 1). The graft remained clear 4 weeks post-op with further improvement in VA. IOP was maintained below 15 mmHg. Heterotopic autokeratoplasty is a valid option for unilateral cornea blind patients who have clear corneas in the fellow eye with no visual potential. This is useful in countries where corneal transplantation is costly, especially during time of pandemic when corneal allografts are scarce. In our experience, it can be safely performed using an RGP lens as a safe and cost-effective alternative to temporary keratoprosthesis.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87192734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. M. M. Tawfeek, A. Bayoumy, A. Bor'i, Dalia Tohamy, A. M. N. A. Rady
The aim of this work is to evaluate the safety and efficacy of repeated sessions of modified corneal collagen cross linking (M-CXL) combined with intrastromal injection of voriconazole for the treatment of severe fungal keratitis with ongoing corneal melting and compare the outcome with intrastromal injection of voriconazole alone. This is a retrospective comparative clinical cohort study. Thirty eyes with clinically suspected and lab-confirmed severe fungal keratitis with ongoing corneal melting were included. These eyes were classified randomly into two groups each of 15 eyes. In group (A), all the eyes underwent repeated sessions of M-CXL with frequent instillations (FI) of topical voriconazole each week till the reversal of corneal melting, then intrastromal injections of voriconazole were added each week till complete corneal healing together with negative culture on lab examination. In group (B), all the eyes underwent repeated intrastromal injections of voriconazole each week together with frequent instillations (FI) of topical voriconazole till complete corneal healing with negative culture on lab examination. Identification of organisms was done by lab study before and after treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Successful treatment was reported in 13 eyes (86.7%) of group (A), while in group (B), successful treatment was reported in 9 eyes (60%), while failure of treatment with complications was reported in 2 eyes (13.3%) in group (A) , however, in group (B), failure of treatment with complications was reported in 6 eyes (40%), with statistically significant difference (p <0.05) between the two groups. Visual improvement was observed in group (A) more than group (B). M-CXL followed by intrastromal injection of voriconazole was found to be effective in treating severe fungal keratitis with ongoing corneal melting due to the known action of CXL for reversal of corneal melting and anti-infective properties. Our results revealed that combined M-CXL and intrastromal injection of voriconazole was safer than intrastromal injection of voriconazole alone for treating severe fungal keratitis with corneal melting with better visual outcomes.
{"title":"Modified Corneal Collagen Cross-linking (M-CXL) Combined With Intrastromal Injection Of Voriconazole For The Treatment Of Severe Fungal Keratitis With Ongoing Corneal Melting","authors":"M. M. M. Tawfeek, A. Bayoumy, A. Bor'i, Dalia Tohamy, A. M. N. A. Rady","doi":"10.57073/001c.75346","DOIUrl":"https://doi.org/10.57073/001c.75346","url":null,"abstract":"The aim of this work is to evaluate the safety and efficacy of repeated sessions of modified corneal collagen cross linking (M-CXL) combined with intrastromal injection of voriconazole for the treatment of severe fungal keratitis with ongoing corneal melting and compare the outcome with intrastromal injection of voriconazole alone. This is a retrospective comparative clinical cohort study. Thirty eyes with clinically suspected and lab-confirmed severe fungal keratitis with ongoing corneal melting were included. These eyes were classified randomly into two groups each of 15 eyes. In group (A), all the eyes underwent repeated sessions of M-CXL with frequent instillations (FI) of topical voriconazole each week till the reversal of corneal melting, then intrastromal injections of voriconazole were added each week till complete corneal healing together with negative culture on lab examination. In group (B), all the eyes underwent repeated intrastromal injections of voriconazole each week together with frequent instillations (FI) of topical voriconazole till complete corneal healing with negative culture on lab examination. Identification of organisms was done by lab study before and after treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Successful treatment was reported in 13 eyes (86.7%) of group (A), while in group (B), successful treatment was reported in 9 eyes (60%), while failure of treatment with complications was reported in 2 eyes (13.3%) in group (A) , however, in group (B), failure of treatment with complications was reported in 6 eyes (40%), with statistically significant difference (p <0.05) between the two groups. Visual improvement was observed in group (A) more than group (B). M-CXL followed by intrastromal injection of voriconazole was found to be effective in treating severe fungal keratitis with ongoing corneal melting due to the known action of CXL for reversal of corneal melting and anti-infective properties. Our results revealed that combined M-CXL and intrastromal injection of voriconazole was safer than intrastromal injection of voriconazole alone for treating severe fungal keratitis with corneal melting with better visual outcomes.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79438197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Younes Akannour, meryem elakhdari, K. Mrad, Kamal EL MAJDOUBI EL IDRISSI, L. serghini, E. Abdallah, A. Berraho
The development of pterygium after keratoplasty is a very unusual situation. We report a case of pterygium that developed 8 years after corneal transplantation, which makes our case quite unusual. The fact that few similar cases have been reported in the literature on the association between pterygium and corneal transplantation makes our decision very difficult.
{"title":"Pterygium in corneal graft: how to act?","authors":"Younes Akannour, meryem elakhdari, K. Mrad, Kamal EL MAJDOUBI EL IDRISSI, L. serghini, E. Abdallah, A. Berraho","doi":"10.57073/001c.74036","DOIUrl":"https://doi.org/10.57073/001c.74036","url":null,"abstract":"The development of pterygium after keratoplasty is a very unusual situation. We report a case of pterygium that developed 8 years after corneal transplantation, which makes our case quite unusual. The fact that few similar cases have been reported in the literature on the association between pterygium and corneal transplantation makes our decision very difficult.","PeriodicalId":100782,"journal":{"name":"Journal of EuCornea","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89271316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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