PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.
Anterior Chamber ; Cornea ; Corneal Edema ; Corneal Transplantation ; Descemet Membrane ; Endothelial Cells ; Female ; Humans ; Lenses, Intraocular ; Methods ; Middle Aged ; Phacoemulsification ; Tissue Donors ; Transplants ; Visual Acuity

PURPOSE: To report a case of Epstein-Barr virus-related corneal endotheliitis accompanied by secondary glaucoma.CASE SUMMARY: A 73-year-old male presented with blurred vision in his right eye. In the ophthalmic evaluation, there were dispersed keratic precipitates overlying corneal edema. The anterior chamber showed trace ~1+ graded inflammation and an endothelial density decrease. His best-corrected visual acuity and intraocular pressure in the right eye were 0.2 and 34 mmHg, respectively. Paracentesis was performed on the anterior chamber of the right eye to confirm the diagnosis under the suspicion of corneal endotheliitis with trabeculectomy for the intraocular pressure control. Epstein-Barr virus was confirmed using a multiplex polymerase chain reaction (PCR), and oral and eye drops of Acyclovir were used to treat the patient. There was no evidence of a recurrence over 2 years and his intraocular pressure was 12 mmHg and best-corrected visual acuity was maintained at 0.5.CONCLUSIONS: A case of Epstein-Barr virus-related corneal endotheliitis was diagnosed using PCR of the aqueous humor. The patient was treated with an oral antiviral agent and eyedrops without a recurrence.
Acyclovir ; Aged ; Anterior Chamber ; Aqueous Humor ; Corneal Edema ; Diagnosis ; Glaucoma ; Herpesvirus 4, Human ; Humans ; Inflammation ; Intraocular Pressure ; Male ; Multiplex Polymerase Chain Reaction ; Ophthalmic Solutions ; Paracentesis ; Polymerase Chain Reaction ; Recurrence ; Trabeculectomy ; Visual Acuity

An 8-year-old Shih Tzu, a 5-year-old Maltese, and a 10-year-old Maltese presented with conjunctival hyperemia and peripheral corneal edema. Severe conjunctival thickening with varying degrees of corneal extension was observed. Cytological examination showed many large lymphocytes with malignant changes in the conjunctiva which was consistent with findings in fine-needle aspiration samples taken from regional lymph nodes. They were diagnosed as having Stage V multicentric lymphoma. When conjunctival thickening is observed in canine patients with multicentric lymphoma, conjunctival metastasis with infiltration of neoplastic lymphoid cells should be included in the differential diagnosis.
Animals ; Biopsy, Fine-Needle ; Child ; Child, Preschool ; Conjunctiva ; Cornea ; Corneal Edema ; Diagnosis, Differential ; Dogs ; Humans ; Hyperemia ; Lymph Nodes ; Lymphocytes ; Lymphoma ; Neoplasm Metastasis ; Uvea

PURPOSE: To report a case of anterior uveitis secondary to Listeria monocytogenes infection. CASE SUMMARY: A 57-year-old male presented to our clinic with ocular pain and decreased vision in the right eye for 2 days. The patient had a history of liver transplantation 2 years prior and used immunosuppressive agents. Listeria monocytogenes was identified in blood cultures 1 month before his visit. At presentation, best-corrected visual acuity (BCVA) of the right eye was counting fingers at 20 cm and the intraocular pressure (IOP) was 50 mmHg. Conjunctival hyperemia, corneal edema, keratic precipitates, and cells in the anterior chamber were observed in the right eye. The patient was diagnosed as anterior uveitis in the right eye. Conventional uveitis treatment was initiated but clinical features did not improve and black hypopyon appeared. The possibility of anterior uveitis caused by Listeria monocytogenes infection was considered. An anterior chamber tap and culture were conducted to identify pathogens. Anterior chamber antibiotic injections and systemic antibiotic injections were performed. One week after injection, the BCVA of the right eye improved to 0.4 and the IOP decreased to 14 mmHg. One month after injection, the BCVA of the right eye improved to 1.0 and the IOP decreased to 16 mmHg. No inflammation of the anterior chamber was observed. CONCLUSIONS: When nonspecific uveitis occurs in immunosuppressed patients, cultures and appropriate antibiotics should be considered because of the possibility of infection.
Anterior Chamber ; Anti-Bacterial Agents ; Corneal Edema ; Endophthalmitis ; Fingers ; Humans ; Hyperemia ; Immunosuppressive Agents ; Inflammation ; Intraocular Pressure ; Listeria monocytogenes ; Listeria ; Liver Transplantation ; Male ; Middle Aged ; Uveitis ; Uveitis, Anterior ; Visual Acuity

PURPOSE: To report a case of corneal edema caused by an iatrogenic lidocaine injection into the corneal stroma created while performing a local anesthetic (lidocaine) injection into the eyelid for a blepharoplasty procedure. CASE SUMMARY: A 15-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection in the upper blepharon for a blepharoplasty procedure. At the first clinical visit, visual acuity was hand motion and an accurate anterior chamber examination was difficult because of corneal edema. The Seidel test was negative. On corneal optical coherence tomography, the corneal thickness was 1,580 µm without any sign of Descemet's membrane detachment. We prescribed 5% NaCl four times a day and prednisolone acetate eight times a day. On the next day after injury, the corneal edema was significantly improved (central corneal thickness: 660 µm), and Descemet's membrane detachment was still not observed. One week after injury, the naïve visual acuity was 20/20, the central corneal thickness was 560 µm, and the endothelial cell count was 3,260 cells/cm². Three weeks after injury, the corneal edema was fully resolved and only slight temporal corneal haziness remained. After 2 months, the cornea was clear without any subjective discomfort. CONCLUSIONS: Corneal edema without Descemet's membrane detachment can be resolved spontaneously without aggressive treatment such as gas or air injection. However, endothelial cell count and corneal opacity need to be monitored on follow up exam. This clinical experience suggests that severe corneal edema in anterior stromal layer could be spontaneously resolved without severe complication.
Adolescent ; Anesthesia, Local ; Anterior Chamber ; Blepharoplasty ; Cornea ; Corneal Edema ; Corneal Opacity ; Corneal Stroma ; Descemet Membrane ; Edema ; Endothelial Cells ; Eyelids ; Female ; Follow-Up Studies ; Hand ; Humans ; Lidocaine ; Prednisolone ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To report a case of a Corynebacterium macginleyi-infected corneal ulcer of a patient who had been treated for conjunctivitis for more than 3 months. CASE SUMMARY: A 72-year-old female was transferred from a private ophthalmic clinic for evaluation of herpetic keratitis with progressive corneal edema and infiltration in the left eye. She had a history of conjunctival hyperemia and eyeball pain in her left eye 3 months prior to her visit. She was treated with levofloxacin eye drops and acyclovir ointment (Herpesid®, Samil, Co., Ltd. Seoul, Korea). On slit lamp examination, 5.4 × 4.0 mm corneal epithelial defects and stromal infiltrations were observed in the upper to central cornea, and endothelial keratic precipitates were found. Gram positive bacteria were detected on Gram staining and Corynebacterium macginleyi was identified on bacterial cultures from the conjunctiva and cornea. She was treated with topical vancomycin eye drops. After 3 months of treatment, the corneal ulcer was completely resolved, leaving mild superficial opacity on the cornea. CONCLUSIONS: While Corynebacterium macginleyi, normal flora of the conjunctiva, is considered a major causative agent for conjunctivitis and blepharitis, Corynebacterium macginleyi should also be considered a possible cause of slowly progressive keratitis in patients with chronic conjunctivitis.
Acyclovir ; Aged ; Blepharitis ; Conjunctiva ; Conjunctivitis ; Cornea ; Corneal Edema ; Corneal Ulcer ; Corynebacterium ; Female ; Gram-Positive Bacteria ; Humans ; Hyperemia ; Keratitis ; Keratitis, Herpetic ; Levofloxacin ; Ophthalmic Solutions ; Seoul ; Slit Lamp ; Vancomycin

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

A 10-year-old intact female Jindo dog was presented with a 1-week history of conjunctival redness and ocular discharge in the left eye. There was an absence of menace response, dazzle reflex, and direct pupillary light reflex. Slit-lamp biomicroscopy revealed corneal edema, ciliary flush, and aqueous flare. Intraocular pressure was 68 mmHg. Based on the information available, a diagnosis of glaucoma and uveitis was made. Subsequent histopathologic examination showed the glaucoma was produced by the effects of goniodysgenesis, posterior synechia, and pigment dispersion in the trabecular meshwork. This is the first report of primary glaucoma caused by goniodysgenesis in Jindo dogs.
Animals ; Aqueous Humor ; Child ; Corneal Edema ; Diagnosis ; Dogs ; Female ; Glaucoma ; Humans ; Intraocular Pressure ; Reflex ; Trabecular Meshwork ; Uveitis

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; Aqueous Humor ; Blindness ; Cataract ; Cellulitis ; Cornea ; Corneal Edema ; Endophthalmitis ; Erythema ; Eye Infections ; Eyelids ; Humans ; Inflammation ; Intravitreal Injections ; Lens Implantation, Intraocular ; Male ; Necrosis ; Panophthalmitis ; Phacoemulsification ; Recurrence ; Streptococcus ; Visual Acuity ; Vitrectomy

PURPOSE: We evaluated the short-term clinical outcomes of patients who underwent modified scleral fixation of an intraocular lens (IOL) using a scleral tunnel and groove. METHODS: From June 2016 to May 2017, 34 eyes of 34 patients who underwent modified scleral fixation of an IOL using a scleral tunnel and groove were retrospectively studied. We evaluated the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, and postoperative complications at 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS: The BCVA was 0.85 ± 0.83 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.38 ± 0.61 logMAR at 6 months (p = 0.001). The corneal endothelial cell count was 1,955.12 ± 217/mm2 and 1,852.59 ± 190/mm2, before and after surgery, respectively, which was not significantly different (p = 0.186). Postoperative complications occurred in eight eyes (23.5%); IOP elevation in one eye (2.9%), IOL tilt or decentration in two eyes (5.7%), optic capture in four eyes (11.4%), and cystic macular edema in one eye (2.9%). The spherical equivalent showed myopic changes after surgery and decreased significantly over time (p = 0.001). CONCLUSIONS: Modified scleral fixation of the IOL using a scleral tunnel and groove improved the BCVA, but did not significantly affect corneal endothelial cell loss. This procedure can be a good alternative to conventional scleral fixation of an IOL, which has advantages in shortened surgical time and easy surgical manipulation.
Corneal Endothelial Cell Loss ; Endothelial Cells ; Humans ; Intraocular Pressure ; Lenses, Intraocular ; Macular Edema ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Visual Acuity