Nancy Chen

Human adenovirus type 8 epidemic keratoconjunctivitis with large corneal epithelial full-layer detachment: an endemic outbreak with uncommon manifestations.

Epidemic viral conjunctivitis is a highly contagious disease that is encountered year-round. The causative agents are mainly adenoviruses and enteroviruses. It occurs most commonly upon infection with subgroup D adenoviruses of types 8, 19, or 37. For common corneal involvement of human adenovirus type 8 epidemic keratoconjunctivitis, full-layer epithelial detachment is rarely seen. Herein, we report three cases of epidemic keratoconjunctivitis during an outbreak which manifested as large corneal epithelial full-layer detachment within a few days. The lesions healed without severe sequelae under proper treatment. The unique manifestation of this outbreak may indicate the evolution of human adenovirus type 8.

The prevalence and risk factors of visual impairment among the elderly in Eastern Taiwan

Visual impairment is associated with disability and poor quality of life. This study aimed to investigate the prevalence and associated risk factors of visual impairment among the suburban elderly in Eastern Taiwan. The cross‐sectional research was conducted from April 2012 to August 2012. The ocular condition examination took place in suburban areas of Hualien County. Medical records from local infirmaries and questionnaires were utilized to collect demographic data and systemic disease status. Logistic regression models were used for the simultaneous analysis of the association between the prevalence of visual impairment and risk factors. Six hundred and eighty‐one residents participated in this project. The mean age of the participants was 71.4 ± 7.3 years. The prevalence of vision impairment (better eye < 6/18) was 11.0%. Refractive error and cataract were the main causes of vision impairment. Logistic regression analysis showed that people aged 65–75 years had a 3.8 times higher risk of developing visual impairment (p = 0.021), while the odds ratio of people aged > 75 years was 10.0 (p < 0.001). In addition, patients with diabetic retinopathy had a 3.7 times higher risk of developing visual impairment (p = 0.002), while the odds ratio of refractive error was 0.36 (p < 0.001). The prevalence of visual impairment was relatively high compared with previous studies. Diabetic retinopathy was an important risk factor of visual impairment; by contrast, refractive error was beneficial to resist visual impairment. Therefore, regular screening of ocular condition and early intervention might aid in the prevention of avoidable vision loss.

Orbital Manifestations of Immunoglobulin G4–Related Disease in Bilateral Lacrimal Glands, Optic Nerves, Trigeminal Nerves, and Maxillary Sinuses

Abstract Immunoglobulin G4 (IgG4)-related disease is characterised by numerous aggregates of IgG4-positive plasma cells in multiple organs. We report two patients who had bilateral proptosis associated with extensive inflammation bilaterally in lacrimal glands, optic nerves, trigeminal nerves, and maxillary sinuses. The patients were treated as idiopathic orbital inflammation syndrome with corticosteroid pulse therapy. As symptoms relapsed upon tapering, a reassessment of immunohistochemical stains of the lacrimal glands confirmed the diagnosis of IgG4-related disease. During 2 years of follow-up, the inflammation regressed spontaneously without any medical treatment in the first patient; however, inflammation in the other patient progressed, and he lost his vision. The extensive orbital involvement, characteristic pathological findings, and slowly progressive clinical course might help practitioners differentiate orbital IgG4-related disease from presumed idiopathic orbital inflammation syndrome.

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

BackgroundAZOOR was first described by Gass in 1993 as a syndrome with rapid loss of one or more extensive zones of the outer retinal segments. It is characterized by photopsia, minimal funduscopic changes, and electroretinographic abnormalities. The efficacy of systemic steroids in treating AZOOR has been previously described and advocated by the concept of autoimmune retinopathy. However, the use of intravitreal of sustained-released steroid had not been mentioned to date.Case presentationA 34-year-old man had sudden onset of central scotoma and photopsia in the left eye. His visual acuity continued deteriorating. The visual field defect demonstrated bilateral enlarged blind spots and altitudinal defects. Fluorescein angiography (FA) showed nonspecific retinal inflammation, and an electroretinogram (ERG) illustrated decreased amplitude of the b wave in both eyes. Optical coherence tomography (OCT) examinations revealed parafoveal loss of the photoreceptor inner/outer segment (IS/OS) junction. Therefore, acute zonal occult outer retinopathy (AZOOR) was diagnosed. Although his vision did not improve under the initial treatment of systemic corticosteroid and calcium channel blocker, remarkable improvement was noticed after the intravitreal injection(IVI) of Ozurdex, consistent with the recovered IS/OS junction disruption.ConclusionsWe herein report a typical case of AZOOR, suggesting that the intravitreal injection of steroid may benefit in certain patients.

Primary diffuse large B cell lymphoma of the lacrimal sac

A 47-year-old man presented with epiphora and a mass around the lacrimal sac in his left eye. Imaging studies revealed a favorable diagnosis of sinusitis-related mucocele. However, the pathological study of the excised tumor demonstrated a diffuse large B cell lymphoma. The patient was consequently referred to the oncology department for further management. Malignant lymphomas of the lacrimal sac are rare and they can mimic mucoceles. As such, they should be included in the list of differential diagnoses for lacrimal sac mass.

Basaloid squamous cell carcinoma of the conjunctiva.

Basaloid squamous cell carcinoma is a distinct variant of squamous cell carcinoma, and it is more aggressive and has a poorer prognosis than conventional squamous cell carcinoma. Basaloid squamous cell carcinoma has been reported to arise from many organs, mainly in the upper aerodigestive tract. Herein, the authors present a 77-year-old woman with a basaloid squamous cell carcinoma over her limbal conjunctiva in the OD.

Traumatic Superior Orbital Fissure Syndrome - A Case Report

Purpose: To present clinical manifestations and treatment results of a patient with traumatic superior orbital fissure syndrome.Method: Case report.Results: A 39-year-old male had ptosis and diplopia in the right eye after a traffic accident. He had oculomotor nerve palsy with pupil involvement in the right eye. A CT image disclosed a fracture involving the right superior orbital fissure. After pulse steroid therapy, his ptosis and diplopia recovered.Conslusion: CT image studies are essential for making a diagnosis of superior orbital fissure syndrome. Pulse steroid therapy might be beneficial for non-surgical patients with traumatic superior orbital fissure syndrome.

Spectral Domain Optical Coherence Tomography Findings of Juxtapapillary Choroidal Naevus

The authors report on two middle-aged Asian females with unilateral juxtapapillary choroidal nevi. One was asymptomatic, and the other had an inferior arcuate defect with 20/20 vision. In addition to routine ophthalmic examinations, combined spectral domain optical coherence tomography (SD-OCT) and scanning laser ophthalmoscope (SLO) imaging were performed. The features of the in vivo cross-section, including extension of the juxtapapillary naevus, deformed retinal layers, and other subtle secondary structure changes, were recorded in well-oriented details. The image findings are complementary for diagnosis and periodic follow-up in patients with choroidal melanocytic lesions.

Panuveitis as the Initial Manifestation of Syphilis with Concurrent HIV Infection

Purpose: To report a patient with panuveitis as the initial presentation of syphilis and concurrent HIV infection. Method: Retrospective single case report. Result: A 25-year-old male suffered from progressively blurry vision in his right eye for 2 months, which ultimately became associated with ocular pain. Ophthalmic examination revealed that he had panuveitis (od). Laboratory tests for syphilis were positive with a rapid plasma reagin of 1:1028 and a Treponema pallidum hema-agglutination of 1:10240. In addition, spirochetes were found in the patients aspirated aqueous humor using dark field microscopy. Subsequent tests for HIV were positive and revealed a CD4 count of 93 cells/mm^3. The patient received full dose of intravenous penicillin G in addition to highly active antiretroviral therapy. Several small round exudations in vitreous and frosted angiitis with a candle-wax-like appearance, which resolved 10 days later, were able to be observed while the anterior chamber and vitreous reaction improved. After the treatment, the panuveitis subsided, and the patients vision improved in his right eye. During the eight months follow-up, there was no syphilitic uveitis recurrence. Conclusion: We report a patient with ocular syphilis and reveal a previously unknown HIV infection. The diagnosis of a concurrent infection by both T. pallidum and HIV was detected by performing a thorough examination. Patients with ocular syphilis should be screened for HIV co-infection in order to get early treatment.