Rodolfo Monti

Alternaria keratitis and hypopyon after clear-cornea phacoemulsification

UNLABELLED We report a case of Alternaria keratitis and hypopyon following clear-corneal cataract surgery. A 66-year-old woman presented with a painful red left eye several months after uneventful self-sealing clear-corneal phacoemulsification that was unresponsive to prolonged treatment with topical/oral quinolones and topical corticosteroids. A full-thickness stromal white dense infiltrate in the area of the intrastromal tunnel incision and a 2.0 mm hypopyon were observed. Culture from corneal scrapings revealed Alternaria species. Treatment included topical and subconjunctival injections of amphotericin-B (5 mg/mL) and 200 mg of oral ketoconazole. Complete resolution of the corneal infiltration and hypopyon was observed after 30 days of treatment, with no recurrence during 6 years of follow-up. To our knowledge, this is the first report of Alternaria species keratitis complicating self-sealing clear-corneal cataract surgery. Topical and subconjunctival injections of amphotericin-B and oral ketoconazole were effective in resolving the corneal abscess and anterior chamber inflammatory reaction. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

In situ carcinoma of the conjunctiva: surgical excision associated with cryotherapy

Background Although frequently underdiagnosed, squamous cell carcinoma is the most commonly observed malignancy of the conjunctiva. Multiple different treatments have been proposed to date. The purpose of this paper is to report our experience in the treatment of In situ carcinoma of the conjunctiva by surgical excision associated with cryotherapy. Methods Four eyes in four consecutive patients (two men and two women) of average age 53.2 (range 39–71) years at the time of diagnosis of ocular surface squamous neoplasia were treated by simple surgical excision and cryotherapy of the resulting surgical bed margins. In all cases, the diagnosis of in situ carcinoma was confirmed histopathologically. Results On histopathology, the edges of the surgical specimens were free of malignant cells in three of four patients. All patients showed excellent evolution without recurrence. Mean follow-up was 6.5 (range 2–14) years. Conclusion In situ carcinoma of the conjunctiva may be simply and successfully treated with surgical excision and cryotherapy.

The eye and the skin in endocrine metabolic diseases

The eye and skin may offer critical clues to the diagnosis of a varied spectrum of metabolic diseases from endocrine origin and their different stages of severity, such as diabetes mellitus and Graves disease. On the other hand, such entities may compromise the eye and visual function severely, and awareness of these possible associations is an important step in their diagnosis and management. A large number of less common endocrine diseases may also have significant ocular/visual or skin involvement. Often the etiologic relationship between the endocrine metabolic disease and the ocular compromise is unknown, but diverse pathogenetic mechanisms may act through a common pathologic pathway producing ocular damage, as occur in diabetic retinopathy. This review emphasizes the ocular and skin manifestations of different metabolic diseases of endocrine origin.

Climatic Droplet Keratopathy in Argentina: Involvement of Environmental Agents in Its Genesis Which Would Open the Prospect for New Therapeutic Interventions

Climatic droplet keratopathy (CDK) is a degenerative corneal disease of unknown etiology. We described CDK for the first time in Latin America in the Argentinean Patagonia (El Cuy). A deeper knowledge of CDK pathogenic mechanisms will provide new therapeutic strategies. For that reason we investigated the prevalence of CDK in El Cuy and its existence in other 3 provinces with similar climate. Patients eyes were examined, habits throughout lives were inquired about, and serum ascorbate (sAA) was determined. All individuals work outdoors for most of the day. All regions had normal O3 levels. Individuals from regions 1, 2, and 3 had very low consumption of vegetables/fruits and low sAA levels. Conversely, region 4 individuals had balanced diet and higher sAA concentrations. CDK was only found in region 3 where individuals had partial deficiency of sAA and did not use eye protection. No CDK was found in regions 1 and 2 where individuals had similar work activities and dietary habits to those in region 3 but wear eye protection. No disease was found in region 4 where individuals work outdoors, have balanced diet, and use eye protection. To summarize, the CDK existence was related not only to climate but also to the dietary habits and lack of protection from sunlight.

Válvula de Ahmed en glaucoma refractario. Comportamiento de la presión intraocular a 24 meses

Purpose: To evaluate the results of Ahmed valve implantation in refractory glaucoma patients. Patients, Material and Methods: 14 eyes in 13 patients with refractory glaucoma to medical treatment, which underwent an implantation of an Ahmed valve between August 2007 and April 2015, with a minimum follow up of 24 months were retrospectively reviewed. Success was defined as a postoperative intraocular pressure (IOP) between 5 and 22 mmHg without antiglaucomatous medications, relative success when postoperative IOP was within that range but with one or more glaucoma drops, and failure when postoperative IOP was < 5 or > 22 mmHg or when the valve was explanted. Results: An absolute success was obtained in 14.29% (n = 1) of patients with primary open angle glaucoma a relative success in 57.14% (n = 4), and a Correspondencia: *Julio A. Urrets-Zavalía E-mail: julioaurrets@gmail.com Disponible en internet: 06-04-2018 Rev Mex Oftalmol. 2018;92(2):94-100 www.rmo.com.mx Fecha de recepción: 17-02-2017 Fecha de aceptación: 24-08-2017 DOI: 10.24875/RMO.M18000019 0187-4519/© 2017 Sociedad Mexicana de Oftalmología. Publicado por Permanyer México. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). Si n co nt ar c on e l c on se nt im ie nt o pr ev io p or e sc ri to d el e di to r, no p od rá r ep ro du ci rs e ni f ot oc op ia rs e ni ng un a pa rt e de e st a pu bl ic ac ió n.

Clinical, Functional and Structural Studies of Humans and Merino Sheep Corneas from Two Different Regions of Argentina

Objective: The purpose of our work was to study and compare the cornea and tear film of people and sheep inhabiting in a region of Argentinean Patagonia (PATG), and in a geographically and climatically different region in the Argentinean Pampa (CAPT). Methods: Using cross sectional study, corneal examinations were performed in people and Merino sheep inhabiting PATG and CAPT regions, respectively. All people completed a questionnaire related to work activity, diet, and the use of hats or sunglasses during their life. Eyes from all participants were examined with a portable handheld slitlamp biomicroscope (BM) to evaluate corneal appearance, epithelium integrity, and transparency. Later on, in a subgroup of participants we studied eyeblinking frequency (EBF), ocular surface staining (FS), breakup time (BUT), Schirmer Tear Test (STT), corneal structure using confocal laser scanning microscopy (CLSM) and light microscopy (LM), and concentrations of serum ascorbate (sAA). Results: BM studies revealed numerous cases of Climatic Droplets Keratopathy (CDK) only in people inhabiting the PATG region. CLSM studies confirmed typical punctiform deposits at the Bowman´s layer in CDK patients living in that region. CLSM images from sheep did not show any abnormalities at the Bowman´s layer but exhibited small hyper reflective dots at the epithelium only in animals pasturing in the PATG region. FS and EBF mean values were significant higher in sheep grazing in the PATG region (p <0.05). No differences were found in surface eye tests when people from both regions were analyzed. Low sAA levels were found only in CDK people living in PATG region. Conclusions: CDK is a multi-factorial disease not only associated to harsh climate. We provide data that low sAA levels can play a role in its genesis in Patagonia patients’... Sheep pasturing in this region with a high prevalence of CDK have high concentration of sAA and did not present any sub epithelial corneal abnormalities.