Iridotrabecular and Iridocorneal Contact Changes after Cataract Surgery and Endothelial Keratoplasty in Bilateral Iridoschisis

We report a case of bilateral iridoschisis with corneal oedema and a quantitative evaluation of the changes in iridotrabecular and iridocorneal contact before and after cataract surgery and after Descemet stripping automated endothelial keratoplasty (DSAEK). A 76-year-old woman with iridoschisis and cataracts, previously managed with laser iridotomy, experienced progressive vision loss. The preoperative iridotrabecular contact (ITC) index measured by anterior segment optical coherence tomography was 23.6% in the right eye and 24.4% in the left eye. Preoperative corneal oedema in the right eye was more severe than that in the left eye. Cataract surgery, followed by DSAEK, was performed in the right eye and subsequently in the left eye. Her visual acuity improved postoperatively, and the corneal oedema of both eyes was treated successfully. Moreover, the ITC index improved in both eyes, to 4.7 and 6.9% after cataract surgery and to 0 and 0% after DSAEK in the right and left eyes, respectively. Staged cataract surgery and DSAEK were effective for endothelial decompensation caused by iridoschisis. Additionally, we confirm that iridotrabecular and iridocorneal contacts improved after both surgical procedures not only after cataract surgery but also after DSAEK. This case report showed the clinical usefulness of the ITC index in the detection of changes after different surgical procedures.

To compare corneal confocal microscopy of eyes with Fuchs’ endothelial corneal dystrophy after two different endothelial surgeries

Purpose: To study the features of corneal confocal microscopy of eyes with Fuchs’ endothelial corneal dystrophy (FECD) after successful Descemet stripping automated endothelial keratoplasty (DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK). Methods: Thirty-two eyes affected by FECD with corneal oedema requiring a corneal graft were treated with DSAEK (15 eyes) or DMEK (17 eyes). All patients underwent in vivo corneal confocal microscopy (IVCCM) at 6 months postoperatively. We evaluated preoperative and postoperative corrected distance visual acuity (CDVA) and the correlation with IVCCM characteristics. Results: Using IVCCM, Z-scan curve analysis showed similar subepithelial reflectivity peaks between the two groups (DSAEK 1256 SU ± 514 vs DMEK 1118 SU ± 408, p = 0.411), while the interface reflectivity was significantly higher in the DMEK group (1511 SU ± 357) than in the DSAEK group (1029 SU ± 413, p = 0.002). Conclusion: Comparing the corneal confocal microscopic characteristics after DMEK with those after DSAEK and their correlation with visual outcome at 6 months, we hypothesized that the presence of a third reflectivity peak in the Z-scan curves of DSAEK patients could justify the poorer visual outcome with this endothelial surgery than with DMEK.

Should Veterinary Practitioners Be Concerned about Acanthamoeba Keratitis?

When presented with an animal exhibiting signs of keratitis (inflammation of the cornea), such as impaired vision, mucoid discharges, redness, swelling, and corneal oedema, most veterinarians would think of bacteria, viruses, or fungi as the potential causative agent(s). However, evidence has arisen in recent years of a possible connection between the protozoan Acanthamoeba and keratitis in animals. Acanthamoeba infection is underdiagnosed, but potentially common, in animals. In view of the paucity of evidence regarding Acanthamoeba keratitis (AK) in animals, this review has been written to increase awareness of veterinary professionals of the potential threat associated with AK and to stimulate more studies into the extent of occurrence and clinical impact of AK in animals.

Cytomegalovirus endotheliitis with recurrent anterior uveitis and secondary glaucoma misdiagnosed as HLA-B27 uveitis

A 61-year-old male patient presented with decreased vision and recurrent redness in his right eye since the past 4 years. He had been diagnosed elsewhere as HLA-B27 positive anterior uveitis and was on oral methotrexate and topical corticosteroids for recurrent disease. He was on maximal medical therapy for glaucoma. Examination showed prominent inferior corneal oedema with pigmented keratic precipitates and elevated intraocular pressure. He underwent combined trabeculectomy with mitomycin C and cataract surgery. The aqueous sample tested positive for cytomegalovirus. He responded well to oral valganciclovir with resolution of uveitis, the intraocular pressure was well controlled and the corneal oedema resolved completely.

Ocular Toxicity due to Accidental Exposure to Plant Latex by Calotropis procera and Calotropis gigantea

Introduction: Calotropis is a member of the milkweed or Asclepiadeae family. The latex of Calotropis gigantea (C gigantea) contains cardiac glycosides, fatty acids and calcium oxalate. The sap of Calotropis procera (C procera) produces acidic latex. Toxic effect of latex manifests after a few hours with diminution of vision due to corneal oedema with folds in Descemet’s membrane. Aim: To evaluate the ocular toxicity by the latex of calotropis procera and calotropis gigantea due to accidental exposure. Materials and Methods: This was a prospective observational study conducted for a duration of six months (September 2018 to February 2019) on 18 patients with alleged accidental exposure to calotropis latex. The patients were examined in the Department of Ophthalmology, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India. After a thorough saline wash under topical anaesthesia, visual acuity was measured by using Snellen’s chart, then patients were subjected for slit lamp biomicroscopy examination, Intraocular Pressure (IOP) measurement and undilated fundus examination and the findings were noted. Demographic details like age and sex, activity at time of injury, mode of injury were noted and follow-up was done for a period of 30 days. Data were analysed using Epi info software and descriptive statistics like mean and percentage were calculated. Results: Total 18 patients reported with calotropis associated eye toxicity, among which 11 (61.1%) were of C gigantea and seven (38.9%) were of C procera. Out of total, seven (38.9%) were males and 11 (61.1%) females. A total of 14 (77.8%) patients presented within 24 hours of injury. Eleven (61.1%) patients had involvement of both the eyes. The main symptoms were burning, irritation, foreign body sensation and diminution of vision. Best Corrected Visual Acuity (BCVA) varied from 6/9 to 6/60. Corneal oedema or striate keratopathy was the most common sign. Corneal oedema resolved in one week in case of C procera with use of topical corticosteroids except in three cases of C gigantea which took two weeks. Conclusion: C procera and C gigantea causes significant corneal oedema and ocular morbidity. By simple health education and occupational precaution, we can prevent ocular morbidity.