PURPOSE: We report a case of herpes simplex keratitis after Descemet membrane endothelial keratoplasty (DMEK). CASE SUMMARY: A 67-year-old male underwent DMEK in his left eye due to pseudophakic bullous keratopathy. One week after DMEK, re-bubbling was performed due to partial detachment of Descemet's membrane at the corneal periphery. After re-bubbling, the cornea remained clear and the patient's visual acuity gradually improved. Two months after DMEK, the patient presented with mild discomfort and decreased visual acuity. The cornea showed an irregular, narrow dendrite with an epithelial defect and surrounding opacity. After confirming that Descemet's membrane was attached, the patient was started on oral valacyclovir for suspected herpes keratitis. Herpes simplex virus type 1 was eventually identified by polymerase chain reaction. The corneal lesion resolved after three weeks of antiviral treatment. CONCLUSIONS: Similar to penetrating keratoplasty, DMEK can trigger outbreaks of herpes simplex keratitis. Herpes simplex keratitis should remain on the clinician's differential diagnosis for patients who present with a corneal epithelial irregularity and decreased visual acuity following DMEK.
Aged ; Cornea ; Corneal Transplantation ; Dendrites ; Descemet Membrane ; Diagnosis, Differential ; Disease Outbreaks ; Herpes Simplex ; Herpesvirus 1, Human ; Humans ; Keratitis ; Keratitis, Herpetic ; Keratoplasty, Penetrating ; Male ; Polymerase Chain Reaction ; Visual Acuity

Acanthamoeba keratitis (AK) is a rare sight-threatening corneal infection, often reporting from contact lens wearers. An asymptomatic human immunodeficiency virus (HIV)-infected Thai male without history of contact lens use complained foreign body sensation at his left eye during motorbike riding. He had neither specific keratitis symptoms nor common drugs responding, which contributed to delayed diagnosis. By corneal re-scraping, Acanthamoeba-like cysts were detected by calcofluor white staining and agar culture. The etiological agent obtained from the culture was molecularly confirmed by Acanthamoeba spp.-specific PCR, followed by DNA sequencing. The results from BLAST and phylogenetic analysis based on the DNA sequences, revealed that the pathogen was Acanthamoeba T4, the major genotype most frequently reported from clinical isolates. The infection was successfully treated with polyhexamethylene biguanide resulting in corneal scar. This appears the first reported AK case from a non-contact lens wearer with HIV infection in Thailand. Although AK is sporadic in developing countries, a role of free-living Acanthamoeba as an opportunistic pathogen should not be neglected. The report would increase awareness of AK, especially in the case presenting unspecific keratitis symptoms without clinical response to empirical antimicrobial therapy.
Acanthamoeba Keratitis ; Acanthamoeba ; Agar ; Asian Continental Ancestry Group ; Base Sequence ; Corneal Injuries ; Delayed Diagnosis ; Developing Countries ; Foreign Bodies ; Genotype ; HIV Infections ; HIV ; Humans ; Keratitis ; Male ; Off-Road Motor Vehicles ; Polymerase Chain Reaction ; Sensation ; Sequence Analysis, DNA ; Thailand

PURPOSE: We report a case of Aeromonas keratitis presenting as radial keratoneuritis. CASE SUMMARY: A 33-year-old woman with a history of cleaning her contact lenses with tap water presented with decreased visual acuity for 1 day in the left eye. The patient showed diffuse corneal edema, stromal infiltration, and radial keratoneuritis, which were thought to be pathognomonic for Aeromonas keratitis. Based on the patient's clinical findings and past history, a diagnosis of Aeromonas keratitis was made and she was prescribed topical fortified cefazolin (50 mg/mL, 5%), tobramycin (3 mg/mL), and 0.02% chlorhexidine per hour. Culture results from the contact lens and contact lens solution confirmed infection by Aeromonas hydrophilia. Polymerase chain reaction results for Aeromonas were negative. After 8 days of treatment, the uncorrected visual acuity was 0.7/0.3 with improvement in her corneal findings. CONCLUSIONS: Radial keratoneuritis is not always pathognomic for Aeromonas keratitis and can be present in Aeromonas keratitis. Therefore, ophthalmologists should be cautious when interpreting this clinical sign.
Adult ; Aeromonas ; Cefazolin ; Chlorhexidine ; Contact Lens Solutions ; Contact Lenses ; Cornea ; Corneal Edema ; Diagnosis ; Female ; Humans ; Keratitis ; Polymerase Chain Reaction ; Tobramycin ; Visual Acuity ; Water

PURPOSE: We report an unusual case of presumptive diagnosis of herpes-induced anterior uveitis with acute hypopyon after trauma. CASE SUMMARY: A 82-year-old male was diagnosed with herpes keratitis due to dendritic keratitis in the left eye, and the lesion disappeared after antiviral treatment. However, 1 year later, the patient visited again with visual loss, pain, and tearing of the left eye after trauma. At the examination, best-corrected visual acuity was counting fingers and the intraocular pressure was 27 mmHg in the left eye. Slit-lamp examination revealed corneal epithelial erosion, moderate corneal edema, and prominent inflammation with 2 mm high hypopyon in the anterior chamber. We thought that bacterial endophthalmitis had rapidly progressed after trauma, so we performed bacterial cultures and an intravitreal antibiotics injection. Considering the clinical manifestations of lesions and herpes keratitis in the past, we could not exclude herpes virus infection. Cultures were negative and the symptoms improved, so the antiviral treatment was gradually reduced and stopped at 2 months. However, recurrence was observed on day 5 after stopping antiviral therapy. We therefore assumed that recurrent herpes virus caused anterior uveitis, and then, antiviral and steroid therapy was resumed. The patient subsequently showed improvement in his symptoms and recovered his visual acuity. CONCLUSIONS: When acute hypopyon is observed in the anterior chamber after trauma, not only bacterial iritis and endophthalmitis but also viral-induced anterior uveitis should be considered in the differential diagnosis.
Aged, 80 and over ; Anterior Chamber ; Anti-Bacterial Agents ; Corneal Edema ; Diagnosis ; Diagnosis, Differential ; Endophthalmitis ; Fingers ; Humans ; Inflammation ; Intraocular Pressure ; Iritis ; Keratitis ; Keratitis, Dendritic ; Male ; Recurrence ; Simplexvirus ; Tears ; Uveitis, Anterior ; Visual Acuity

PURPOSE: To report a case of acute interstitial keratitis as the first clinical sign in a patient with latent syphilis. CASE SUMMARY: A 23-year-old female presented with visual impairment and discomfort in her right eye that developed 3 days earlier. The visual acuity in the right eye was 20/200 and corrected to 20/100, and slit lamp examination showed round sub-epithelial opacification in the central cornea with stromal edema and neovascularization on the cornea of the right eye. Whole body tests including serological tests were performed. Under the suspicion of acute interstitial keratitis, topical antibiotics and steroids were applied 4 times a day initially. Serological tests were reactive for venereal disease research laboratory test (VDRL). Under the suspicion of acute interstitial keratitis due to syphilis, fluorescent treponemal antibody absorption test IgM/IgG (FTA-ABS IgM/IgG) was performed; a positive result for FTA-ABS IgG led to diagnosis of acute interstitial keratitis with latent syphilis. During treatment, systemic doxycycline 200 mg for 4 weeks with topical antibiotics and steroids were administered, the opacity and edema of the cornea regressed after 2 weeks of treatment, and visual acuity in the patient's right eye improved to 20/20. CONCLUSIONS: We report an unusual case of acute interstitial keratitis as the first clinical manifestation of latent syphilis in an immunocompetent patient.
Anti-Bacterial Agents ; Cornea ; Diagnosis ; Doxycycline ; Edema ; Female ; Fluorescent Treponemal Antibody-Absorption Test ; Humans ; Immunoglobulin G ; Keratitis* ; Patient Rights ; Serologic Tests ; Sexually Transmitted Diseases ; Slit Lamp ; Steroids ; Syphilis* ; Syphilis, Latent ; Treponema pallidum ; Vision Disorders ; Visual Acuity ; Young Adult

PURPOSE: In the present study, the effectiveness of topical chemotherapy for the primary treatment of ocular surface squamous neoplasia (OSSN) was evaluated. METHODS: We enrolled 10 patients (10 eyes) diagnosed with OSSN who received both clinical examination and anterior segment optical coherence tomography (AS-OCT) imaging. The patients were administered topical 0.02% mitomycin-C (MMC) 4 times/day in the affected eye. The patients with MMC-resistant OSSN received topical 1% 5-fluorouracil (5-FU) 4 times/day. AS-OCT imaging was performed before and after the treatment. Clinical examination and AS-OCT were used to monitor the efficacy of topical chemotherapy, recurrence and side effects. RESULTS: The mean age of the 10 patients (8 males, 2 females) was 76.7 years. The proportion of complete remission resulting from topical treatment with MMC was 80.0% (8 eyes) and 20.0% (2 eyes) when 5-FU was changed to MMC. The average duration of complete remission was 4.3 weeks and the average duration of no recurrence was 17.5 months. The epithelial thickness of the lesions, measured using AS-OCT, significantly decreased from 315.0 µm (pretreatment) to 105.3 µm (after complete remission). Additionally, the epithelial lesion appeared normal after treatment. The most common side effect was conjunctival hyperemia (60.0%, 6 eyes), followed by ocular allergy (30.0%, 3 eyes), superficial punctate keratitis (30.0%, 3 eyes) and corneal erosion (20%, 2 eyes). No serious complications were reported. CONCLUSIONS: Topical chemotherapy is as effective and well tolerated as a primary treatment for OSSN. Additionally, AS-OCT is a useful noninvasive adjunctive tool in the diagnosis and management of OSSN.
Diagnosis ; Drug Therapy* ; Fluorouracil ; Humans ; Hyperemia ; Hypersensitivity ; Keratitis ; Male ; Mitomycin ; Recurrence ; Tomography, Optical Coherence

PURPOSE: To report an experience of improving symptoms through treatment with electrocauterization and subconjunctival bevacizumab injection in two patients with keratitis accompanied by corneal neovascularization and opacity. CASE SUMMARY: (Case 1) A 20-year-old woman visited our institution complaining of binocular blurred vision and congestion for the previous 3 years. Her best corrected visual acuity (BCVA) was 0.07 in the right eye and 0.4 in the left eye (Han Chun-suk visual acuity chart, decimal). The diagnosis was bilateral rosacea keratitis. Antibiotics, steroid eye drops and oral antibiotics were administered, but no improvement was observed. Electrocauterization was performed at the origin of the neovascularization of the cornea and bevacizumab was injected at the peripheral subconjunctiva in the right eye. Thereafter the corneal neovascularization did not recur, corneal opacity was reduced, and BCVA improved to 0.5. (Case 2) A 19-year-old woman visited complaining of left eye congestion for the previous 3 years. Her BCVA was 1.0 in the right eye and 0.08 in the left eye.The diagnosis was phlyctenular keratitis of the left eye. Antibiotics, steroid eye drops and oral antibiotics were administered, but no improvement was observed. Therefore, electrocauterization and subconjunctival bevacizumab injection were performed in the cornea of the left eye, after which corneal neovascularization and opacity decreased. CONCLUSIONS: In these cases, we report improvement of symptoms after treatment with electrocauterization and subconjunctival bevacizumab injection after failed treatment of palpebral sanitation, antibiotic and steroid.
Anti-Bacterial Agents ; Bevacizumab* ; Cornea ; Corneal Neovascularization* ; Corneal Opacity ; Diagnosis ; Electrocoagulation ; Estrogens, Conjugated (USP) ; Female ; Humans ; Keratitis ; Ophthalmic Solutions ; Rosacea ; Sanitation ; Telescopes ; Visual Acuity ; Young Adult

PURPOSE: To present a case of orbital inflammation and optic perineuritis preceding vesicular eruption in herpes zoster ophthalmicus(HZO). CASE SUMMARY: An 84-year-old woman with a history of gall bladder cancer and hypertension complained of left periorbital erythematous edema and discomfort. On examination, visual acuity was 20/25 bilaterally; no tenderness, proptosis or ophthalmoplegia was observed. Pupils were equal, round, and reactive to light without relative afferent pupillary defects. Slit-lamp examination revealed severe conjunctival injection and chemosis without keratitis or uveitis. The remainder of the ocular examination was unremarkable. Magnetic resonance imaging confirmed left-sided preseptal swelling with an enlarged left lacrimal gland, high signal intensity of the retrobulbar fat and optic nerve sheath. Systemic antibiotic therapy with steroids was started under a presumed diagnosis of idiopathic orbital inflammatory disease, but the clinical presentation was unresolved. After 2 days, vesicular lesions confined to the first division of the trigeminal nerve and pseudodendritic keratitis developed on the left side leading to a diagnosis of HZO. Treatment with acyclovir immediately resolved anterior segment inflammation and periorbital edema. While on therapy, visual acuity deteriorated to 20/125 and the pupil became dilated and unresponsive to light over a few days. All signs and symptoms of acute orbitopathy and postherpetic neuralgia had resolved 3 months later with the exception of pupil abnormality and visual acuity. CONCLUSIONS: HZO may present with symptoms and signs of orbital inflammation and optic perineuritis even in the absence of a vesicular rash. Thus, HZO should be considered in the differential diagnosis of unexplained acute orbital syndromes.
Acyclovir ; Aged, 80 and over ; Dacryocystitis ; Diagnosis ; Diagnosis, Differential ; Edema ; Exanthema ; Exophthalmos ; Female ; Gallbladder Neoplasms ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans ; Hypertension ; Inflammation* ; Keratitis ; Lacrimal Apparatus ; Magnetic Resonance Imaging ; Neuralgia, Postherpetic ; Ophthalmoplegia ; Optic Nerve ; Orbit* ; Pupil ; Pupil Disorders ; Steroids ; Trigeminal Nerve ; Uveitis ; Visual Acuity

PURPOSE: To describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection. METHODS: A total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed. RESULTS: The mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis. CONCLUSIONS: Visual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.
Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; HIV ; Humans ; Inflammation ; Keratitis ; Medical Records ; Optic Neuritis ; Panuveitis ; Penicillins ; Retrospective Studies ; Serologic Tests ; Syphilis* ; Tomography, Optical Coherence ; Uveitis ; Uveitis, Intermediate ; Uveitis, Posterior ; Vision Disorders ; Visual Acuity

No abstract available.
Aged ; Conjunctiva/*surgery ; Dacryocystorhinostomy/*adverse effects ; Eye Infections, Fungal/diagnosis/*etiology/microbiology ; Female ; Humans ; Keratitis/diagnosis/*etiology/microbiology ; Lacrimal Duct Obstruction/*diagnosis ; Paecilomyces/*isolation & purification ; Recurrence ; Surgical Wound Infection/diagnosis/*etiology/microbiology