Reha Ersoz

Umbilical cord blood serum therapy for the management of persistent corneal epithelial defects

AIM To evaluate the role of umbilical cord blood serum (CBS) therapy in cases with persistent corneal epithelial defects (PED). METHODS Sixteen eyes of 14 patients with PED who were resistant to conventional treatment were treated with 20% umbilical cord serum eye drops. Patients were followed-up weekly until epithelization was complete. The collected data included the grade of corneal lesion (Grade I: epithelial defect+superficial vascularization, Grade II: epithelial defect+stromal edema, Grade III: corneal ulcer+stromal melting), the size of epithelial defect (pretreatment, 7(th), 14(th) and 21(st) days of treatment), and follow-up time was evaluated retrospectively. RESULTS The mean size of epithelial defect on two perpendicular axes was 5.2×4.6-mm(2) (range: 2.5-8×2.2-9 mm(2)). Mean duration of treatment was 8.3±5wk. CBS therapy was effective in 12 eyes (75%) and ineffective in 4 eyes (25%). The epithelial defects in 4 ineffective eyes were healed with amniotic membrane transplantation and tarsorrhaphy. The rate of complete healing was 12.5% by 7d, 25% by 14d, and 75% by 21d. The healing time was prolonged in Grade III eyes in comparison to eyes in Grade I or Grade II. CONCLUSION The results of the current study indicated the safety effectiveness of CBS drops in the management of PED. The grade of disease seems have a role on the healing time.

Topical anesthetic eye drops abuse: are we aware of the danger?

Abstract Objective: To investigate the clinical results of topical anesthetic drug (TAD) abuse and to evaluate the results in terms of preventive medicine and public health. Methods: Patients who had been followed in a cornea unit between March 2009 and November 2011 for TAD abuse keratopathy were included in the study. The demographics, duration of TAD use, symptoms, ocular findings, treatment modalities, visual acuities, complications and accompanying psychiatric problems data were obtained from medical records. Results: Twelve eyes of 8 patients (3 females and 5 males) were evaluated retrospectively. One of the patients was provided the drug with a primary care pratitioner’s prescription and for the other 7 patients, it was available from pharmacies without prescription. According to their clinical history, 4 patients were suffering from exposure to welding flash with a corneal foreign body, 2 from lagophthalmus-related keratopathy, 1 from traumatic corneal abrasion, and 1 from exposure to silica dust at work. The mean duration of TAD usage was 14.8 ± 7.78 days. Slit-lamp examination revealed corneal epithelial defect in all eyes, stromal opacity in 11 eyes and ring-shaped infiltrates in 8 eyes. Conclusion: Uncontrolled overuse of TAD can lead to serious ocular morbidities. Similarity of the clinical signs of this abuse to those of infectious keratitis together with the fact practitioners and managers to take measures to prevent the ready supply of these drugs from pharmacies and to raise public awareness with education programs.

Non-contact lens use-related Acanthamoeba keratitis in southern Turkey: evaluation of risk factors and clinical features.

Purpose: To assess the diagnostic methods, risk factors, and clinical features of Acanthamoeba keratitis cases in patients who do not wear contact lenses. Methods: Medical records of 26 consecutive patients with non—contact lens—related Acanthamoeba keratitis, who were followed up at the tertiary eye care center between May 2010 and May 2012, were analyzed. Laboratory, demographic, and clinical findings were evaluated pertaining to the patients. Results: Twenty-six non—contact lens—related Acanthamoeba keratitis cases were included in the study. The main risk factors were trauma (group 1, n = 13 patients) and ocular surface disease (group 2, n = 12 patients). One patient had both of the risk factors mentioned above. Overall test results showed that Acanthamoeba positivity rates were 15.3% for direct microscopy, 46.1% for culture, 92.3% for conventional polymerase chain reaction (PCR), and 100% for real-time PCR. The rates of full-thickness corneal involvement and ring-shaped infiltrations were higher in group 2, whereas superficial keratitis and radial keratoneuritis were higher in group 1. The final visual acuities were significantly better in group 1 than group 2 (p<0.025). Conclusions: This study is the first regional report from Turkey about Acanthamoeba keratitis in non—contact lens users. A majority of cases admitted to a tertiary eye care center were related to trauma or ocular surface disease. Physician suspicion is critically important for the timely diagnosis of these cases. At this point, molecular diagnostic tests (PCR or real-time PCR) seem to support the clinical diagnosis of Acanthamoeba keratitis with the help of fast and reliable results.

Posttraumatic keratitis caused by Elizabethkingia meningosepticum.

Objective: To present a case of bacterial keratitis caused by Elizabethkingia meningosepticum in an eye after trauma. Method: Case report. Result: A 45-year-old woman was referred to our cornea clinic for keratitis, which had developed following nonpenetrating eye trauma from a tree branch. Cultures from a corneal smear demonstrated heavy growth of E. meningosepticum. Treatment with a combination of topical moxifloxacin and topical trimethoprim/polymyxin B effectively controlled the corneal ulcer. Corneal infection resolved within 2 months, but a central corneal scar and vascularization remained. Conclusions: E. meningosepticum is an opportunistic bacterium and gives rise to severe systemic infections in immunocompromised patients. Ocular infections caused by this bacterium are extremely rare in the literature. To our knowledge, this is the first report of posttraumatic keratitis caused by E. meningosepticum.

Polymicrobial Infection of the Cornea Due to Contact Lens Wear

A 38-year-old male presented with pain and redness in his left eye. He had a history of wearing contact lenses. His ophthalmic examination revealed a large corneal ulcer with surrounding infiltrate. Cultures were isolated from the contact lenses, lens solutions, storage cases, and conjunctivae of both eyes and also corneal scrapings of the left eye. Fortified vancomycin and amikacin drops were started hourly. Culture results of conjunctivae of each eye and left cornea were positive for Pseudomonas aeruginosa; cultures from the contact lenses, lens solution and storage case of both eyes revealed Pseudomonas aeruginosa and Alcaligenes xylosoxidans. Polymerase chain reaction of the corneal scraping was positive for Acanthameoba. The topical antibiotics were changed with ones that both bacteria were sensitive to and anti-amoebic therapy was added. The patient had two recurrences following initial presentation despite intensive therapy. Keratitis occurred due to multiple pathogens; the relapsing course despite adequate therapy is potentially associated with this polymicrobial etiology.

A Severe Aspect of Pediatric Ocular Allergy to Recognize: Vernal Keratoconjunctivitis

Aim: To determine the clinical features of vernal keratoconjunctivitis and to evaluate the safety and the efficacy of the medical treatment on clinical grades. Material and Method: All patients with vernal keratoconjunctivitis who had been treated with mast-cell stabilizers, antihistamines and artificial tear drops previously were enrolled in the study. Topical steroids were added during recurrences, were tapered and discontinued according to the clinical improvement. Topical cyclosporin 0.05% four times daily was used additio- nally in cases of inadequate response to treatment or evident steroid depen- dance. Main outcome measures were the clinical features, change of clini- cal grades, response to treatment, rate of recurrences and side effects of the eyedrops. Results: Twenty patients ( 13 males, 7 females) with vernal kera- toconjunctivitis in different severity scales were included. The median age of the patients was 10 (9-11) years. The median follow-up time was 35 (15-56) months. Ten patients received topical cyclosporine. The rate of recurrences was similar in patients who received topical cyclosporine compared to those who were followed with topical steroids. (p=0.17) No severe adverse reaction to any of the formulations was seen. Discussion: Topical 0.05% cyclosporin is safe and effective for the treatment of vernal keratoconjunctivitis as a stero - id sparing agent. It helps to obtain good clinical response without serious ad- verse effects and provides improvement on the clinical grades.

Coexistence of ocular cicatricial pemphigoid with Stevens Johnson syndrome.

Dear Sir, I am Dr. Hande Taylan Sekeroglu, from the Ophthalmology Department of Cukurova University Faculty of Medicine. I want to present a case of recalcitrant ocular cicatricial pemphigoid (OCP) which was coincidently diagnosed with Stevens Johnson syndrome (SJS), and which was successfully treated with intravenous immunoglobulin (IVIg). OCP being one of the subsets of autoimmune blistering diseases, is also a sight-threatening disease. The diagnosis requires compliance with clinical criteria and typical immunohistopathology confirmed by the biopsy. The uncontrolled slow and chronic inflammation of the eye causes dry eye, subepithelial fibrosis, fornix shortening, lid abnormalities, corneal complications and severe ocular surface damage which eventuates in blindness . The treatment consists of immunosupression and/or immunomodulation and sometimes surgical interventions, of all targeting to control the underlying destructive inflammation. A seventy-six year old woman presented with sudden onset of widespread rashes after taking oral metamizole for headache. She had widespread papules, buccal mucosal and plantar bullae, target lesions on the limbs and diffuse bilateral conjunctival hyperemia. Ophthalmological examination showed bilateral conjunctival hyperemia with prominent inferonasal corneal thinning of the right eye (Figure 1). There was no sign of symblepharon or subepithelial fibrosis. Initial treatment consisted of topical application of 1% dexamethasone (without preservatives) and cyclosporine 0.05% for the right eye and topical lubricants for both eyes. The initial visual acuity was 20/32 bilaterally because of nuclear sclerosis and macular drusens. The patient started with systemic steroid treatment 1mg /kg/day for SJS. Since the treatment was not sufficient in controlling the disease and ophthalmological status of the patient was started to deteriorate, oral azathioprine 1mg·kg-1·d-1 was added to treatment protocol. The conjunctival biopsy revealed linear deposition of immunoglobulin G and complement C3 along the epithelial basement membrane zone which confirmed the diagnosis of OCP. Nevertheless, the perilesional skin biopsy showed predominantly lymphocytic infiltration at the dermalepidermal junction and epidermal necrosis which was compatible with SJS. The systemic skin lesions responded well to systemic steroids and azathioprine, however the corneal thinning continued and caused perforation of the right eye five days after her presentation. A limbal corneal allotransplant was used to maintain anterior chamber stability and to cover the area of perforation (Figure 2). One month after the beginning of the treatment, the patient presented with spontaneous corneal perforation at the inferior quadrant of the right eye which could not be repaired with corneal grafting. The inflammation could not be brought under control and the limbal allotransplant failed, therefore the evisceration of the right eye was inevitable. Systemic steroids tapered and discontinued within one month but azathioprine treatment continued. One year after the operation, she presented again with foreign body sensation on her left eye. She had conjunctival hyperemia, progressive inferior corneal thinning, and pericentral corneal staining. Topical treatment including dexamethasone and cyclosporine was restarted in addition to Figure 1 Severe inferonasal corneal thinning in the right eye.