Muneera A. Mahmood

An in Vivo Study of Corneal Surface Morphologic Features in Patients with Keratoconjunctivitis Sicca

We used wide-field color specular microscopy to study the corneal epithelium of 13 normal subjects and 13 patients with keratoconjunctivitis sicca. The frequencies of small, medium, and large cells were different in the two groups, with a shift to small cells in patients with keratoconjunctivitis sicca. Increased uptake of rose bengal dye, filaments, coarse mucus plaques, and pre-exfoliative sheets were also found in the patients with keratoconjunctivitis sicca. These findings suggest accelerated epithelial cell loss from the surface of the eye in keratoconjunctivitis sicca.

Complete evulsion of the globe and optic nerve.

A 17-year-old boy had an evulsion of globe and optic nerve from an automobile accident. Computed tomography showed a severed optic nerve on the injured side. A visual field defect was demonstrated in the other eye.

Pyogenic Granulomas of the Cornea

BACKGROUND Pyogenic granulomas are vascular inflammatory lesions that represent an aberrant wound healing response. They typically arise from mucous membranes or skin. Pyogenic granulomas primarily involving the cornea have been rarely reported. METHODS Between January 1983 and July 1994, 14 patients with histologically proven pyogenic granulomas of the cornea were treated. RESULTS The precipitating event was a persistent epithelial defect in nine patients. Ocular surface disease was present in all patients. Predisposing conditions included indolent corneal ulceration, cry eye syndrome, trachoma, trichiasis, alkali burn, multiple topical drug use, previous orbital irradiation, and ocular cicatricial pemphigoid. CONCLUSIONS Ophthalmologists should be aware that pyogenic granulomas may involve the cornea and include this entry in the differential diagnosis of tumors involving the limbus or cornea. The typical clinical appearance, rapid growth, minimal staining with rose bengal dye, response to topical steroids, and associated ocular surface disease help to distinguish this lesion from a neoplastic epithelial tumor of the conjunctiva or cornea.

Superior Corneal Thinning With Pellucid Marginal Corneal Degeneration

cavernous carotid artery, no fistula mass, and loss of anatomic definition of Meckels cave on the right (Fig. 2). We believe that his cold-induced corneal edema reflected previous trigeminal ganglion, or ophthalmic division, injury caused by fistula compression (Fig. 1). Perhaps, he did not notice this symptom during the fall and winter seasons after the accident because visual acuity was so impaired from optic nerve dysfunction. Our case provides additional support for the localizing value of cold-induced corneal edema. This symptom should prompt an examination of the parasellar region by using magnetic resonance imaging.! regardless of whether other symptoms or signs of trigeminal neuropathy are apparent.

Sclerokeratitis : An unusual presentation of Squamous cell carcinoma of the conjunctiva

OBJECTIVE To describe three cases of squamous cell carcinoma of the conjunctiva presenting with corneal and scleral inflammation, thinning, and perforation without any tumor formation. DESIGN Three case reports. PARTICIPANTS Three male subjects aged 76, 66, and 61 years. INTERVENTION The subjects had symptoms of external ocular inflammation with focal corneal or scleral thinning and inflammation, as well as interstitial keratitis in two cases. Initial diagnosis of sclerokeratitis with limbal thinning was made in all three in addition to a pterygium in case 2. MAIN OUTCOME MEASURES Diagnosis of the carcinoma was delayed for 2 to 24 months in two cases, whereas case 2 was diagnosed on excision of a pterygium from the involved area. RESULTS All subjects developed intraocular extension after further scleral thinning and perforation without tumefaction. CONCLUSIONS Squamous cell carcinoma of the conjunctiva may be seen without a distinct mass and can masquerade as sclerokeratitis, scleromalacia, or interstitial keratitis. It seems that diffuse growth with inflammation leads to thinning, necrosis, and perforation of the ocular wall with resultant intraocular spread. Squamous cell carcinoma should be considered in the differential diagnosis of corneal and scleral thinning, perforation, and inflammation of unknown cause, especially in the older male subject.

Transient Lenticular Opacification Following Trabeculectomy

Permanent lens changes may occur following filtering procedures for glaucoma, most often within a few years after the surgery. We present a case in which transient lenticular opacification occurred two days after trabeculectomy without intraoperative injury to the lens. The patient regained her preoperative vision 2 weeks postoperatively. We postulate that such reversible lenticular opacities may be due to changes in lens metabolism associated with hypotony.

In vivo Surface Morphology of the Human Cornea by Color Microscopy

We have employed the wide-field specular microscope in combination with color photography in the use of water soluble stains to study the surface morphology of 10 normal subjects. Based on size, three populations of corneal cells are discerned: small, medium, and large cells. Thirty-two percent of the cells were small, approximately 67% were medium, and less than 1% were large cells. Uptake by either rose bengal or fluorescein dye was rare, and when it did occur, it was more frequent in medium and large cells. These observations are consistent with the previously advanced hypothesis that small cells represent younger cells, which as they age become larger and eventually develop areas of discontinuity in their cell surface. The use of this technique to study pathological eyes should be valuable in discerning changing patterns of cellular exposure, maturation, and exfoliation.

Preoperative iris configuration and intraocular pressure after cataract surgery

PURPOSE: To determine predictors of long‐term intraocular pressure (IOP) after cataract surgery. SETTING: Hunter Holmes McGuire Veterans Administration Hospital, Richmond, Virginia, USA. DESIGN: Case series. METHODS: Clinical variables, IOP by applanation tonometry, anatomic features on anterior segment optical coherence tomography (AS‐OCT), and gonioscopy were assessed before and after uneventful cataract surgery in eyes with open filtration angles. Multivariate linear regression of preoperative measurements was used to predict the mean IOP from 2 to 18 months postoperatively. RESULTS: The study enrolled 77 eyes (77 patients). Prediction of the mean postoperative IOP improved when up to 4 preoperative IOP values were averaged (r2 = 0.20) compared with using the final preoperative IOP value only (r2 = 0.13). The mean iris cross‐sectional area decreased after surgery, from 3.84 mm2 to 3.70 mm2 (P=.01). The mean convex hull of the iris segments also decreased, from 5.05 mm2 to 4.19 mm2 (P<.001). The mean postoperative IOP was independently predicted by the preoperative average IOP, primary open‐angle glaucoma, and the convex hull of cross‐sectional iris segments (P=.001, model r2 = 0.38) or iris cross‐sectional area (P=.003, model r2 = 0.36). Phacoemulsification parameters, incision type, and anterior chamber angle and depth did not predict postoperative IOP. CONCLUSIONS: Averaging up to 4 preoperative IOP values improved postoperative IOP predictions. A high iris cross‐sectional area or convex hull of the iris segments on AS‐OCT was associated with lower postoperative IOP. These findings might help identify patients who are likely to have the largest IOP drop after cataract surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Corneal amyloidosis associated with congenital hereditary endothelial dystrophy.

Purpose. To report the unusual occurrence of corneal amyloidosis indistinguishable from primary gelatinous drop-like dystrophy in three members of a family with congenital hereditary endothelial dystrophy (CHED). Method. Case study of three patients. Results. Three patients, a 5-year-old girl, her 21-year-old maternal aunt, and a 16-year-old paternal uncle, presented with bilateral corneal edema and opacification secondary to CHED. All three underwent penetrating keratoplasty, cases 1 and 3 in one eye and case 2 in both eyes. Histopathology confirmed the diagnosis of CHED in all three patients but also revealed multiple subepithelial nodular deposits of amyloid, consistent with the diagnosis of primary gelatinous drop-like dystrophy, in all four specimens. Three other members of the same family underwent penetrating keratoplasty with histologic confirmation of CHED with no deposits of amyloid. Conclusion. To our knowledge, this is the first report of subepithelial corneal amyloid deposits in association with CHED. This may represent the concurrence of two primary dystrophies, although secondary amyloidosis cannot be ruled out. Early manifestation and absence of amyloid in three other family members with CHED lends more weight to a primary etiology.

Postoperative Astigmatism in the Second Eye Undergoing Cataract Surgery

OBJECTIVE To predict postoperative refractive astigmatism in the second eye undergoing cataract surgery using standard biometry and information obtained from the first eye. METHODS We conducted a retrospective study of 160 patients undergoing bilateral sequential phacoemulsification with capsular bag implantation of a hydrophobic acrylic lens at a Veterans Affairs medical center. Keratometric and refractive astigmatism were described by Jackson cross cylinder with-the-rule (J(0)) and oblique (J(X)) components. Preoperative predictors of postoperative refractive astigmatism in the second eye were determined by multivariable regression. RESULTS The postoperative refractive astigmatism in the first eye predicted 40% of the variation in the second eye (r(2) = 0.40; P < .001). The multivariable model to predict postoperative with-the-rule astigmatism was J(0PostopEye2) = (0.376 × J(0PostopEye1)) + (0.327 × J(0KeratomEye2)) + (0.097 × J(0PreopEye2)) - 0.099 (P < .001 for first 2 terms; r(2) = 0.56). The multivariable model for oblique astigmatism was J(XPostopEye2) = (0.350 × J(XKeratomEye2)) + (0.231 × J(XKeratomEye1)) + (0.064 × J(XPreopEye2)) - 0.07 (P ≤ .01 for first 2 terms; r(2) = 0.20). CONCLUSIONS Refractive with-the-rule astigmatism observed postoperatively in the first eye is a strong independent predictor of postoperative with-the-rule astigmatism in the second eye. Keratometric oblique astigmatism in the first eye is a weak but statistically significant independent predictor of postoperative oblique astigmatism in the second eye. Both findings are consistent with mirror symmetry of the corneas about the midsagittal plane and may improve the prediction (and hence control) of postoperative astigmatism in the second eye.