Chiao-Hong Chen

Hyperbaric oxygen therapy ameliorates the blood-retinal barrier breakdown in diabetic retinopathy.

Background:  To study the effect of hyperbaric oxygen (HBO) therapy on diabetic retinopathy in a streptozotocin‐induced diabetic rat model.

A Rare Case of Conjunctival Myxoma and a Review of the Literature

Background: To report on an 11-year-old boy with a painless slow-growing temporal bulbar conjunctival mass of his left eye. Methods: A case report and review of the literature. Results: An 11-year-old boy presented with a painless slow-growing mass in the temporal bulbar conjunctiva of his left eye, which had been noted for 1 year. After ophthalmic and systemic evaluations, the clinical differential diagnosis at the time included amelanotic naevus, amelanotic melanoma, myxoma, fibrous histiocytoma, reactive lymphoid hyperplasia and lipoma. This lesion was excised under local anaesthesia. From the histopathological features, conjunctival myxoma was confirmed. After 12 months, the patient remained healthy, with no recurrence or metastasis of the conjunctival lesion or evidence of a systemic abnormality. Conclusion: We report this case to emphasize that conjunctival myxoma can appear as a well-circumscribed, translucent, yellow-pink conjunctival mass in teenage patients. Successful healing is usually achieved by complete surgical resection. Cardiac, endocrine, and family screening is required to reduce the risk of morbidity and mortality.

Acute corneal hydrops with perforation after LASIK-associated keratectasia

Herein a case of acute corneal hydrops with perforation in keratectasia 9 years after bilateral laser in situ keratomileusis is presented. A 27‐year‐old man presented with right eye sudden loss of vision. Right eye best‐corrected visual acuity was counting fingers. Left eye best‐corrected visual acuity was 6/9. Right eye slit‐lamp examination revealed diffuse corneal oedema with central epithelial cystic change. The interface between the flap and residual stroma was open and filled with fluid. This separation extended nearly to the flap margin. Shallow anterior chamber and aqueous leakage were noted the following day. An emergency penetrating keratoplasty was performed to the right eye. Histopathology of corneal button revealed reactive keratocytes with irregular, wrinkled collagen formation over ablated stroma. Marked stromal oedema was observed. Twelve months after corneal transplantation, vision improved to 6/6 with correction in the right eye.

Infectious crystalline keratopathy caused by Serratia marcescens.

Purpose: To report the case of a 70-year-old woman with Serratia infectious crystalline keratopathy. Methods: Case report. Results: This is a report of a 70-year-old woman with a history of chronic open-angle glaucoma and trachoma with lagophthalmos, entropion, and trichiasis in both eyes who developed crystalline keratopathy after penetrating keratoplasty and cataract extraction in the right eye followed up with treatment with long-term topical steroids. Ten months after the initial penetrating keratoplasty and cataract extraction, the patient had decreased visual acuity, intense pain, and tearing in the right eye. Corneal cultures showed Serratia marcescens. Topical steroids were discontinued, and treatment with tobramycin and vancomycin ophthalmic solution every hour was initiated. Despite 1 week of aggressive therapy, there was an increase in corneal infiltrate, epithelial defects, and melting, which eventually involved the peripheral recipient cornea. Therapeutic penetrating keratoplasty, debridement of the peripheral cornea, and amniotic membrane transplantation were performed. Antibiotic agents were used postoperatively. There has been no evidence of recurrent infection. The best-corrected visual acuity improved to 6/15 at the 6-month follow-up period after the second intervention. Conclusions: S. marcescens may cause infectious crystalline keratopathy after penetrating keratoplasty in patients treated with long-term topical steroids. Therapeutic penetrating keratoplasty, surgical debridement, and amniotic membrane transplantation may be necessary when the clinical response to intensive medical treatment is inadequate.

Woman with Iron Deficiency Anemia and Nonarteritic Anterior Ischemic Optic Neuropathy

Purpose: To describe a 47-year-old female with iron deficiency anemia developing nonarteritic anterior ischemic optic neuropathy (NAION). Methods: Retrospective review of medical chart and literature. A 47-year-old female without major sysremic diseases presented with blurring of vision in her right eye for 3 days. Physical defect, and disc edema OD. Anterior segment examinations were unremarkable. The left eye was normal. Automated Humphrey visual field test revealed an inferior altitudinal defect and brain computerized tomography showed on brain or orbital abnormality. Pulse steroid tomography showed no brain or orbital abnormality. Pulse steroid therapy was started for suspected optic orbital abnormlity. Pulse steroid therapy was started for suspected optic neuritis, which revised later as NAION, but persistent disc edema and progressing visual field defect were noted in follow up examinations. Laboratory studies showed hemoglobin 7.0g/dL. Ferrous sulfate was prescribed for iron deficiency anemia with normalization of hematocrit and hemoglobin, while peripheral visual field defect was progressing and the disc showed pallor change. Conclusions: NAION may occur in relatively young women with iron deficiency anemia.

Juxtapapillary Choroidal Melanoma-A Case Report

Purpose: To report a case of medium size of juxtapapillary choroidal melanoma. Method: Retrospective review of literatures. Result: Fundus examination of a 36-year-old female revealed a dome-shaped and pigmented subretinal lesion straddling the superonasal retina with disc insertion in the right eye. Ultrasonography showed an acoustically hollow lesion with initial high amplitude echoes and low-amplitude internal reflections. Based on clinical and ultrasonographic findings, the diagnosis was choroidal melanoma. The eye was enucleated. Histopathologic examination revealed a picture of malignant melanoma of choroid characterized by prominent nuclei and nucleoli (Spindle B cells). Conclusion: Treatment of melanomas should be directed toward minimizing the potential for recurrence and metastasis. However, few literatures have reported the treatment of jaxtapapillary choroidal melanoma. With the uncertain outcome of conservative treatment, the patient was treated with enucleation.

A Case of Bilateral Branch Retinal Vein Occlusion after Medical Treatment for Lower Limb Cellulitis

Purpose: To describe a 62-year-old male developing bilateral branch retinal vein occlusion after medical treatment for lower limb cellulitis. Methods: Retrospective review of medical chart and literature. Results: A 62-year-old male without major systemic diseases presented with blurring of vision in both eyes. According to the patients statement, he had medications prescribed for cellulitis on his left leg with varicose veins. He took Cloxacillin 250mg qid for one week, followed by Cephalexin 250mg qid for another week one month before the presentation. Physical examination revealed best-corrected visual acuity of 20/50 in the right eye and 20/70 in the left. Anterior segment examinations were unremarkable. Indirect ophthalmoscopy and fluorescein angiogram revealed occlusion of superiotemporal branch retinal vein in the right eye and inferiotemporal branch in the left. Laboratory studies showed no coagulatory abnormality. Slow resolution of the retinal hemorrhages and mild improvement of best-corrected visual acuity to 20/40 bilaterally were observed in five months. Conclusions: Bilateral branch retinal vein occlusions may occur after medical treatment for cellulitis in the extremities with varicose veins.