CORNEAL ULCERS Diagnosis and Management
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Medical Diary Official Publication for the Federation of Medical Societies of Hong Kong
VOL.12 NO.9 SEPTEMBER 2007 ॷġ෫ġᚂġଉ THE HONG KONG MEDICAL DIARY OFFICIAL PUBLICATION FOR THE FEDERATION OF MEDICAL SOCIETIES OF HONG KONG www.fmshk.org Editorial Editorial Dr. Timothy YY Lai Medical Bulletin Management of Tearing in Adults Dr. Alan CK Ng Dr. Dylan DN Chan Ocular Allergy in Children Dr. Koon-man Lam Neuro-ophthalmology for General Practitioners: A Revision Dr.CarmenKMChan Normal Tension Glaucoma - a Sick Eye in a Sick Body Dr. Dexter YL Leung Retinal Complications of High Myopia Dr. Timothy YY Lai Amblyopia: An overview Dr. Wilson WK Yip Prof. Dorothy SP Fan Surgical Correction for Near Sightedness Dr. Arthur CK Cheng Traditional Chinese Medicine and Ophthalmology Dr. Jane CC Yeung Special Feature Rosiglitazone and Risk of Myocardial Infarction: Clear Danger or Dr. Norman Chan Media Hype? Clinical Quiz Clinical Quiz Dr. Helen KS Tung Society News Medical Diary of September Calendar of Events ISSN 1812 - 1691 ᚂᖒԙষΙড়ᒑȅᩧҕஶቆᜰЖ VOL.12 NO.9 SEPTEMBER 2007 Contents The Federation of Medical Societies of Hong Kong 4/F Duke of Windsor Social Service Building, Contents 15 Hennessy Road, Wanchai, Hong Kong Tel: 2527 8898 Fax: 2865 0345 Editorial President Dr. FONG To-sang, Dawson 方道生醫生 1st Vice- President Editorial 2 Dr. CHAN Chi-kuen 陳志權醫生 2nd Vice- President Dr. Timothy YY Lai Dr. LO Sze-ching, Susanna 盧時楨醫生 Hon. Secretary Dr. LO See-kit, Raymond 勞思傑醫生 Medical Bulletin Deputy Hon. Secretary Dr. CHAN Sai-kwing 陳世炯醫生 Management of Tearing in Adults 4 Hon. Treasurer Mr. LAM Lop-chi, Nelson 林立志先生 Dr.AlanCKNg Deputy Hon. Treasurer Dr. Dylan DN Chan Mr. -
Long Term Follow-Up of Limbal Transplantation for Unilateral Chemical Injuries: 1997-2014 Nikolaos S
perim Ex en l & ta a l ic O Tsiklis et al., J Clin Exp Ophthalmol 2016, 7:6 p in l h t C h f Journal of Clinical & Experimental a o DOI: 10.4172/2155-9570.1000621 l m l a o n l o r g u y o J Ophthalmology ISSN: 2155-9570 ResearchResearch Article Article Open Access Long Term Follow-up of Limbal Transplantation for Unilateral Chemical Injuries: 1997-2014 Nikolaos S. Tsiklis1, Dimitrios S. Siganos2, Ahmed Lubbad3, Vassilios P. Kozobolis4 and Charalambos S. Siganos1,3* 1Department of Ophthalmology, Heraklion University Hospital, Greece 2Heraklion, Crete, Vlemma Eye Institute of Athens, Greece 3Laboratory of Vision and Optics, School of Medicine, University of Crete, Greece 4Eye Institute of Thrace, Democritus University, Alexandroupolis, Greece Abstract Purpose: To evaluate the long term results of limbal transplantation (LT) in patients with unilateral total limbal stem cell deficiency (LSCD) after chemical injury. Methods: The study includes 22 eyes of 22 consecutive patients (20 males and 2 females) who presented with total LSCD after unilateral chemical burns and underwent Limbal transplantation (LT) in the Cornea Service of the Depart- ment of Ophthalmology at the Heraklion University Hospital in Crete during the period from 1997 to 2014. All 22 cases underwent Conjunctival Limbal autogaft (CLAU) while in 14 surgeries it was combined with amniotic membrane trans- plantation (AMT). A second stage penetrating keratoplasty (PKP) was performed in 11 cases for visual rehabilitation. The healing time, the changes in VA and the stability of epithelial ocular surface integrity were looked for. Results: One case failed within 3 months of surgery, while the rest 21 eyes after CLAU maintained ocular surface epithelial integrity during the follow up period (7.8 ± 3.5 years), and showed improvement partially or totally in corneal neovascularization, symblepharon and ocular motility. -
Confocal Microscopy in Cornea Guttata and Fuchs' Endothelial Dystrophy
Br J Ophthalmol 1999;83:185–189 185 Confocal microscopy in cornea guttata and Fuchs’ Br J Ophthalmol: first published as 10.1136/bjo.83.2.185 on 1 February 1999. Downloaded from endothelial dystrophy Auguste G-Y Chiou, Stephen C Kaufman, Roger W Beuerman, Toshihiko Ohta, Hisham Soliman, Herbert E Kaufman Abstract conventional imaging methods.3–13 Because of Aims—To report the appearances of cor- its ability to focus the light source and the nea guttata and Fuchs’ endothelial dystro- image on the same focal plane, it allows real phy from white light confocal microscopy. time in vivo assessment of the diVerent layers Methods—Seven eyes of four consecutive of the cornea, including the endothelial layer. patients with cornea guttata were pro- Therefore, it may be an alternative method in spectively examined. Of the seven eyes, evaluating cornea guttata or Fuchs’ endothelial three also had corneal oedema (Fuchs’ dystrophy. dystrophy). In vivo white light tandem In the current study, we analysed the scanning confocal microscopy was per- appearances of cornea guttata and Fuchs’ dys- formed in all eyes. Results were compared trophy from confocal microscopy and compare with non-contact specular microscopy. the technique with non-contact specular mi- Results—Specular microscopy was pre- croscopy. cluded by corneal oedema in one eye. In the remaining six eyes, it demonstrated typical changes including pleomorphism, polymegathism, and the presence of gut- tae appearing as dark bodies, some with a central bright reflex. In all seven eyes, confocal microscopy revealed the pres- ence of round hyporeflective images with an occasional central highlight at the level of the endothelium. -
Pupillary Disorders LAURA J
13 Pupillary Disorders LAURA J. BALCER Pupillary disorders usually fall into one of three major cat- cortex generally do not affect pupillary size or reactivity. egories: (1) abnormally shaped pupils, (2) abnormal pupillary Efferent parasympathetic fibers, arising from the Edinger– reaction to light, or (3) unequally sized pupils (anisocoria). Westphal nucleus, exit the midbrain within the third nerve Occasionally pupillary abnormalities are isolated findings, (efferent arc). Within the subarachnoid portion of the third but in many cases they are manifestations of more serious nerve, pupillary fibers tend to run on the external surface, intracranial pathology. making them more vulnerable to compression or infiltration The pupillary examination is discussed in detail in and less susceptible to vascular insult. Within the anterior Chapter 2. Pupillary neuroanatomy and physiology are cavernous sinus, the third nerve divides into two portions. reviewed here, and then the various pupillary disorders, The pupillary fibers follow the inferior division into the orbit, grouped roughly into one of the three listed categories, are where they then synapse at the ciliary ganglion, which lies discussed. in the posterior part of the orbit between the optic nerve and lateral rectus muscle (Fig. 13.3). The ciliary ganglion issues postganglionic cholinergic short ciliary nerves, which Neuroanatomy and Physiology initially travel to the globe with the nerve to the inferior oblique muscle, then between the sclera and choroid, to The major functions of the pupil are to vary the quantity of innervate the ciliary body and iris sphincter muscle. Fibers light reaching the retina, to minimize the spherical aberra- to the ciliary body outnumber those to the iris sphincter tions of the peripheral cornea and lens, and to increase the muscle by 30 : 1. -
Accommodation in the Holmes-Adie Syndrome by G
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.21.4.290 on 1 November 1958. Downloaded from J. Neurol. Neurosurg. Psychiat., 1958, 21, 290. ACCOMMODATION IN THE HOLMES-ADIE SYNDROME BY G. F. M. RUSSELL From the Neurological Research Unit, the National Hospital, Queen Square, London In 1936, Bramwell suggested that the title response to near and far vision respectively. But it "Holmes-Adie syndrome" be given to the clinical has also been noted that the reaction to convergence complex of a slowly reacting pupil and absent tendon may be remarkably wide in its range, considering reflexes in recognition of the descriptions by Holmes that it often follows a stage of complete paralysis (1931) and Adie (1932). Both authors had empha- (Strasburger, 1902). Not only is the reaction to sized the chief clinical features-dilatation of the convergence well preserved when compared to the pupil, apparent loss of the reaction to light, slow reaction to light, but it may in fact be excessive constriction and relaxation in response to near and (Alajouanine and Morax, 1938; Heersema and distant vision, and partial loss of the tendon reflexes. Moersch, 1939). In assessing the degree of tonicity Although the syndrome had been recognized wholly there are, therefore, two criteria: slowness ofguest. Protected by copyright. or in part many years previously (Strasburger, 1902; pupillary movement and preservation of the range Saenger, 1902; Nonne, 1902; Markus, 1906; Weill of movement. and Reys, 1926), credit must go to Adie for stressing Adler and Scheie (1940) showed that the tonic the benign nature of the disorder and distinguishing pupil constricts after the conjunctival instillation it clearly from neurosyphilis. -
Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Curvularia Keratitis*
09 Wilhelmus Final 11/9/01 11:17 AM Page 111 CURVULARIA KERATITIS* BY Kirk R. Wilhelmus, MD, MPH, AND Dan B. Jones, MD ABSTRACT Purpose: To determine the risk factors and clinical signs of Curvularia keratitis and to evaluate the management and out- come of this corneal phæohyphomycosis. Methods: We reviewed clinical and laboratory records from 1970 to 1999 to identify patients treated at our institution for culture-proven Curvularia keratitis. Descriptive statistics and regression models were used to identify variables associ- ated with the length of antifungal therapy and with visual outcome. In vitro susceptibilities were compared to the clini- cal results obtained with topical natamycin. Results: During the 30-year period, our laboratory isolated and identified Curvularia from 43 patients with keratitis, of whom 32 individuals were treated and followed up at our institute and whose data were analyzed. Trauma, usually with plants or dirt, was the risk factor in one half; and 69% occurred during the hot, humid summer months along the US Gulf Coast. Presenting signs varied from superficial, feathery infiltrates of the central cornea to suppurative ulceration of the peripheral cornea. A hypopyon was unusual, occurring in only 4 (12%) of the eyes but indicated a significantly (P = .01) increased risk of subsequent complications. The sensitivity of stained smears of corneal scrapings was 78%. Curvularia could be detected by a panfungal polymerase chain reaction. Fungi were detected on blood or chocolate agar at or before the time that growth occurred on Sabouraud agar or in brain-heart infusion in 83% of cases, although colonies appeared only on the fungal media from the remaining 4 sets of specimens. -
Neurotrophic Keratopathy and Diabetes Mellitus a Lockwood Et Al 838
Eye (2006) 20, 837–839 & 2006 Nature Publishing Group All rights reserved 0950-222X/06 $30.00 www.nature.com/eye 1 1 2 Neurotrophic A Lockwood , M Hope-Ross and P Chell CASE SERIES keratopathy and diabetes mellitus Abstract no history of previous corneal trauma or herpes simplex infection. Ocular examination revealed Diabetes mellitus is frequently associated a best-corrected visual acuity of 6/12 in both with microvascular complications such as eyes. There was an epithelial irregularity retinopathy, nephropathy, and peripheral extending across the inferonasal quadrant of the neuropathy. Neurotrophic keratopathy occurs right cornea. A diagnosis of exposure in response to a neuropathy of the ophthalmic keratopathy was made. She was treated with division of the trigeminal nerve. Rarely has artificial tears and a month later the epithelium diabetic neurotrophic keratopathy been had healed. A year later, an epithelial defect in described. This paper discusses the the same area was seen at follow-up. Again she ophthalmic histories of three patients who was asymptomatic and the visual acuity was presented with diabetic neurotrophic unchanged. Decreased corneal sensation was keratopathy. In one patient the corneal noted using a cotton swab to touch the ulceration was the sole presenting feature of peripheral and central cornea. A diagnosis of his diabetes. We discuss the need for increased diabetic neurotrophic keratopathy was made. vigilance in the ophthalmic community for She was treated with ocular lubricants. After suspecting diabetes in patients with 6 months, the defect had increased in size to unexplained corneal epithelial disease. 5.5 mm. There was associated corneal Eye (2006) 20, 837–839. -
Bilateral Same-Day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project
ORIGINAL STUDY Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project Michael Waisbourd, MD,* Anousheh Shafa, BS,* Radha Delvadia, BS,* Harjeet Sembhi, MPH,* Jeanne Molineaux, COA,* Jeffery Henderer, MD,w Laura T. Pizzi, PharmD, MPH,z Jonathan S. Myers, MD,* Lisa A. Hark, PhD, RD,* and L. Jay Katz, MD* reported in 2 patients (3%) and glare in 1 patient (1.5%). Thirteen Purpose: To report the outcomes of bilateral, same-day laser patients (19.7%) had repeat LPI treatment. All patients success- peripheral iridotomy (LPI) in the Philadelphia Glaucoma Detec- fully tolerated LPI treatment without serious complications. tion and Treatment Project. Conclusions: Performing bilateral, same-day LPI was well tolerated Methods: The Philadelphia Glaucoma Detection and Treatment in a large community-based, glaucoma detection and treatment Project was a community-based initiative aimed to improve project. Applying this treatment strategy may be considered in detection, management, treatment, and follow-up care of individ- similar settings, where patients’ access to eye care is limited and it uals at high risk for glaucoma. This novel project performed LPI, may be a cost-effective strategy. where 2 eyes received laser therapy on the same day. Of the 1649 patients examined between January 1, 2013 and May 31, 2014, Key Words: glaucoma detection, angle closure, laser peripheral patients who underwent bilateral, same-day LPI were included in iridotomy, bilateral same-day ocular procedures our analysis. Main outcome measures were visual acuity, intra- (J Glaucoma 2016;25:e821–e825) ocular pressure (IOP), and postoperative complication rates. Results: A total of 132 eyes of 66 patients underwent bilateral, aser iridotomy is aimed to eliminate the relative pupil- same-day LPI. -
Traumatic Glaucoma Mimicking Primary Open Angle Glaucoma
Traumatic glaucoma mimicking primary open angle glaucoma Xiaoming Duan ( [email protected] ) Research article Keywords: Traumatic glaucoma, Primary angle glaucoma, Trabecular pigmentation, Angle recession, Iridodialysis Posted Date: July 24th, 2019 DOI: https://doi.org/10.21203/rs.2.11863/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/9 Abstract Backgrounds To retrospectively analyze the clinical and ocular features in eyes with traumatic glaucoma misdiagnosed as primary open angle glaucoma (POAG). Methods We reviewed nineteen eyes with traumatic glaucoma misdiagnosed and collected their ocular and supplementary examination results. Results The outpatient age was 47.1±12.8 years old. The traumatic history was from 1 to 40 years. The history of hand or stone was present about 21.1% of patients, followed by balls (15.8%) and wooden stick (15.8%). The peak IOPs were 33.0±10.6mmHg. Iridodialysis was seen in 2 patients. Trabecular pigmentation grade more than 3 was noticed in 15 patients. Angle recession was found in all patients. No patient was found lens location and fundus damage. Conclusions Patients with long traumatic history, mild ocular signs and insidious symptoms were more likely to be misdiagnosed. It might be more prudent to diagnose as POAG while there was signicant difference in the condition of both eyes. Background Glaucoma is characterized by retinal ganglion cell degeneration, alterations in optic nerve head topography, and associated visual eld (VF) loss. It was known as a group of diseases, not a single disease. It was divided into many types, including in primary, secondary and developmental glaucoma. -
Aging and the Cornea
814 British Journal of Ophthalmology 1997;81:814–817 Br J Ophthalmol: first published as 10.1136/bjo.81.10.814 on 1 October 1997. Downloaded from BRIEF REVIEWS ON ASPECTS OF AGING AND THE EYE Aging and the cornea RGAFaragher, B Mulholland, S J Tuft, S Sandeman, P T Khaw Aging, the persistent decline in age specific fitness of an also known as contact inhibition. Rather confusingly, both organism as a result of internal physiological deterioration, senescence and quiescence are referred to as the G0 phase is a common process among multicellular organisms.1 In of the cell cycle (sometimes more helpfully distinguished as humans, aging is usually monitored in relation to time, G0Q and G0S).15 Senescence is also distinct from cell which renders it diYcult to diVerentiate between time death, occurring either by apoptosis or necrosis, and it is dependent biological changes and damage from environ- not a form of terminal diVerentiation.16 17 The phenotypes mental insults. There are essentially three types of aging at of growth and senescence are totally distinct cell cycle work in any adult tissue; the aging of long lived proteins, compartments; there is no such thing as a half senescent the aging of dividing cells, and the aging of non-dividing cell. Cells that enter replicative senescence acquire two cells.2 Dividing cells may be derived from renewing popu- phenotypes: they leave the cell cycle with a G1 DNA lations in which the rate of cell loss and division is great. An content,18 and they undergo a characteristic series of example is the corneal epithelium in which complete changes in biology and gene expression that alters the turnover occurs within 5–7 days after terminal function of the cell.13 19 In this latter situation some genes diVerentiation.34 Conditional renewal populations, which are transcriptionally repressed, some gene expression is normally have an extremely low proliferation rate, can also upregulated, and some totally senescent specific genes are produce dividing cells in response to extrinsic stimuli. -
Improved Preservation of Human Corneal Basement Membrane
BritishJournal ofOphthalmology 1994; 78: 863-870 863 Improved preservation ofhuman corneal basement membrane following freezing of donor tissue for Br J Ophthalmol: first published as 10.1136/bjo.78.11.863 on 1 November 1994. Downloaded from epikeratophakia Robert D Young, W John Armitage, Paul Bowerman, Stuart D Cook, David L Easty Abstract States, good results continue to be achieved by Current methods for the production of the small number ofBritish surgeons performing lenticules for epikeratophakia involve rapid the technique.4 However, no comprehensive freezing, cryolathing, and slow warming of the account of its long term outcome has yet been donor cornea. We have found that this pro- published. cedure causes structural damage to the Several complications resulting in the failure epithelial basement membrane in the donor of epikeratophakia have been reported, includ- cornea which may subsequently contribute to ing infection, graft dehiscence, persistent inter- poor postoperative re-epithelialisation of the face haze or opacity, ulceration, and imperfect implant, leading to graft failure. Endeavouring re-epithelialisation. Among these, the failure of to overcome these problems, the effects of host epithelial cells to migrate over and re- cryoprotection of donor cornea were investi- surface the anterior face of the grafted tissue gated, using dimethyl sulphoxide, in conjunc- continues to be the major reason for the removal tion with different cooling and warming rates ofepikeratophakia lenticules.'-'0 as part of the protocol for cryolathing. The Epithelial healing is itselfa complex phenome- structural integrity of the epithelial basement non involving mitosis of host cells at the graft membrane zone (BMZ) was then assessed by periphery, centripetal migration, and attach- electron microscopy and by immunofluores- ment.