PURPOSE: To report a case of macular edema and retinal vasculitis treated with intravitreal dexamethasone implantation in a Behcet's disease patient after cataract surgery. CASE SUMMARY: A 26-year-old male with Behcet's disease, without recurrence of uveitis for 3 months, underwent phacoemulsification and posterior chamber intraocular lens implantation for a cataract in the left eye. The preoperative best corrected visual acuity (BCVA) of the left eye was 0.15. At day 1 after surgery, his BCVA was 0.4, and slit lamp examination of his left eye revealed a mild anterior chamber reaction. At 1 week after surgery, he presented with left vision impairment, his BCVA was 0.04, and mild inflammation was observed in both the anterior chamber and the vitreous in his left eye. Unilateral macular edema was confirmed with optical coherence tomography, and fluorescein angiography revealed retinal vasculitis on the fovea and peripheral retina. Intravitreal dexamethasone implantation was performed in his left eye, 1 month after treatment, the macular edema and retinal vasculitis had improved, and the BCVA of his left eye was 0.8. CONCLUSIONS: In patients with Behcet's disease, intravitreal dexamethasone implantation can be an effective treatment option for macular edema and retinal vasculitis after cataract surgery.
Adult ; Anterior Chamber ; Behcet Syndrome ; Cataract ; Dexamethasone ; Fluorescein Angiography ; Humans ; Inflammation ; Lens Implantation, Intraocular ; Macular Edema ; Male ; Phacoemulsification ; Recurrence ; Retina ; Retinal Vasculitis ; Slit Lamp ; Tomography, Optical Coherence ; Uveitis ; Vasculitis ; Visual Acuity

PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.
Aged ; Aged, 80 and over ; Anterior Chamber ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Breast ; Conjunctivitis, Allergic ; Cornea ; Female ; Hematologic Tests ; Humans ; Hyperemia ; Inflammation ; Keratoconjunctivitis ; Lubricant Eye Drops ; Medicine, Traditional ; Milk, Human ; Ophthalmic Solutions ; Slit Lamp ; Steroids ; Tuberculosis ; Visual Acuity

PURPOSE: Congenital double puncta are usually unilateral, and the accessory punctum exists on the medial side in a slit configuration that is distinct from the shape of the normal punctum. We report a case of an unusual case of double lacrimal puncta which the lateral, rather than the medial, punctum was judged to be the accessory punctum. CASE SUMMARY: A 39-year-old male patient with no underlying disease and no ophthalmologic history visited our clinic with right eye epiphora of 2 weeks duration. On slit lamp examination, double puncta were observed in the right lower eyelid and the remaining puncta were normal. On lacrimal syringing test and dacryocystography were performed and revealed incomplete obstruction with partial narrowing of the nasolacrimal duct. Silicone tube intubation was performed through the right lower medial punctum and symptoms improved postoperatively. CONCLUSIONS: The present case is an unusual case of double lacrimal puncta which has not been reported in Korea. Unlike the previous literature, the lateral, rather than the medial, punctum was judged to be the accessory punctum. Because accessory punctm can be present on the lateral side, it is necessary to distinguish between the accessory punctm and the main punctum through the accurate dacryocystography and lacrimal syringing test for the treatment of the patient.
Adult ; Eyelids ; Humans ; Intubation ; Korea ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases ; Male ; Nasolacrimal Duct ; Silicon ; Silicones ; Slit Lamp

PURPOSE: We report two cases of uveo-meningeal syndrome involving the retina, uvea, and optic disc in both eyes after viral meningitis. CASE SUMMARY: A 16-year-old female was referred to our department with blurred vision in both eyes. She was hospitalized in the pediatric ward with viral meningitis. She showed a norma best-corrected visual acuity (BCVA) and normal intraocular pressure in both eyes, but had severe inflammation in the anterior chamber on slit lamp examination, and optic disc edema and multiple whitish lesions on fundus examination. She was treated with intravenous antibiotic injections and steroid eye drops. After close observation, inflammation in the anterior chamber, optic disc edema, and the multiple whitish lesions in the retina were improved. A 27-year-old male who was treated for viral meningitis at the neurology department was referred to us with blurred vision in both eyes. His BCVAs were 0.7 (right eye) and 0.6 (left eye). The intraocular pressure was normal in both eyes. Slit lamp examination revealed inflammation in the anterior chamber and optic disc edema, and a fundus examination revealed multiple infiltrations. He received treatment for presumed herpes virus infection. After close observation, inflammation in the anterior chamber, optic disc edema, and multiple infiltrations with hemorrhage in the retina were improved. CONCLUSIONS: Clinicians should consider the possibility of uveo-meningeal syndrome, which can cause inflammation in the uvea,retina, and optic disc simultaneous with viral meningitis accompanying blurred vision.
Adolescent ; Adult ; Anterior Chamber ; Edema ; Female ; Hemorrhage ; Humans ; Inflammation ; Intraocular Pressure ; Male ; Meningitis ; Meningitis, Viral ; Neurology ; Ophthalmic Solutions ; Retina ; Slit Lamp ; Uvea ; Vision Disorders ; Visual Acuity

PURPOSE: To report a case of corneal and lenticular pigmentation after prolonged clozapine therapy. CASE SUMMARY: A 56-year-old male visited our hospital with a progressive decline in vision that affected both eyes. He had a history of schizophrenia. He was being treated with 200 mg clozapine and 1 mg lorazepam daily, and had been treated with clozapine for 5 years. At the first visit, his best-corrected-visual acuity was 20/32 in both eyes. Slit lamp examination of the corneas showed bright, fine, grayish-brown deposits on the endothelium, and on dilation, bilateral central stellate opacity of the anterior portion of the lens capsule was revealed. CONCLUSIONS: Clozapine may induce corneal and lenticular pigmentation and thus may lead to a decline in vision. Patients on long-term clozapine therapy should be considered for regular ophthalmic review.
Clozapine ; Cornea ; Endothelium ; Humans ; Lorazepam ; Male ; Middle Aged ; Pigmentation ; Schizophrenia ; Slit Lamp

PURPOSE: We report two cases of intraocular lens (IOL) pupillary optic capture following IOL scleral fixation treated with argon laser iridotomy. CASE SUMMARY: (Case 1) A 69-year-old man presented with suddenly decreased visual acuity of the left eye. The best-corrected visual acuity was finger count (FC) 30 cm in the left eye. Slit lamp examination revealed subluxation of the left eye IOL. An IOL scleral fixation and anterior vitrectomy were performed and no specific findings were observed. During the follow-up period, pupillary optic capture was repeated without specific causes, such as trauma, or IOL decentration thus, argon laser iridotomy was performed. (Case 2) A 77-year-old man presented with a 3-day history of congestion of the left eye and decreased visual acuity. Best-corrected visual acuity was 0.4 logarithm of the minimum angle of resolution (logMAR) in the left eye. Slit lamp examination revealed subluxation of the left eye IOL. An IOL scleral fixation and anterior vitrectomy were performed, and no specific findings were observed. During the follow-up period, pupillary optic capture was found, and IOL repositioning and argon laser iridotomy were performed. CONCLUSIONS: Laser iridotomy can be used to prevent recurrence of pupillary optic capture in eyes with IOL scleral fixation without decentration or distortion.
Aged ; Argon ; Estrogens, Conjugated (USP) ; Fingers ; Follow-Up Studies ; Humans ; Lenses, Intraocular ; Recurrence ; Slit Lamp ; Visual Acuity ; Vitrectomy

PURPOSE: To report the surgical technique to remove a chestnut thorn through a corneal incision. CASE SUMMARY: A 54-year-old female visited our clinic complaining of a sudden foreign body sensation and conjunctival injection in her left eye after picking chestnuts 4 days prior to her visit. Visual acuity of both eyes was 1.0 and the intraocular pressures were within normal limits. Slit lamp examination revealed that a chestnut thorn had deeply penetrated the left corneal stroma and a small number of inflammatory cells were observed in the anterior chamber. There was no corneal defect stained with fluorescein and the Seidel test was negative. A corneal foreign body comprised of a chestnut thorn and its remnants was diagnosed and emergency surgery was performed. A partial corneal incision was made along the foreign body and the exposed foreign body was easily and completely removed. The patient was treated with topical antibiotics after surgery and no complication was observed during a follow-up period of 3 months. CONCLUSIONS: In the case of a corneal foreign body comprised of a chestnut thorn, the foreign body with its remnants were easily removed by performing a partial corneal incision.
Anterior Chamber ; Anti-Bacterial Agents ; Corneal Injuries ; Corneal Stroma ; Emergencies ; Eye Foreign Bodies ; Female ; Fluorescein ; Follow-Up Studies ; Foreign Bodies ; Humans ; Intraocular Pressure ; Middle Aged ; Sensation ; Slit Lamp ; Visual Acuity

PURPOSE: To report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi. CASE SUMMARY: A 53-year-old female complained of pain and secretion in her right eye, which started 6 weeks before her visit. She applied steroid ointment, which was received from the dermatologist, to her eyelid 7 days prior to her visit but this treatment worsened her symptoms. At the initial visit, the visual acuity of the right eye was light perception, and purulent secretions were observed. Using a slit lamp, severe conjunctival hyperemia, hypopyon, and a ring-shaped central corneal ulcer were observed. The anterior chamber and fundus were not observed due to corneal lesions but ultrasonography showed no intraocular inflammation. Infectious keratitis was suspected and cultured by corneal scraping. During the incubation period, 0.5% moxifloxacin, 2% voriconazole, and 1% cyclopentolate were administered. A total of 400 mg of moxifloxacin and 100 mg of doxycycline were given orally. In the primary culture, Pseudomonas aeruginosa and Acinetobacter baumannii were identified so 5% ceftazidime, which was sensitive for the antibiotic susceptibility results was further instilled. Thereafter, the keratitis improved but the keratitis again worsened while maintaining the topical treatment. A secondary culture was positive for Ochrobactrum anthropi. Treatment with 1.4% gentamicin, which was sensitive for the antibiotic susceptibility test was added and the keratitis improved. A conjunctival flap was performed because of the increased risk of perforation. CONCLUSIONS: We report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi for the first time in the Republic of Korea.
Acinetobacter baumannii ; Acinetobacter ; Anterior Chamber ; Ceftazidime ; Corneal Ulcer ; Cyclopentolate ; Doxycycline ; Eyelids ; Female ; Gentamicins ; Humans ; Hyperemia ; Inflammation ; Keratitis ; Middle Aged ; Ochrobactrum anthropi ; Ochrobactrum ; Pseudomonas aeruginosa ; Pseudomonas ; Republic of Korea ; Slit Lamp ; Ultrasonography ; Visual Acuity ; Voriconazole

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: To compare the efficacy and complications of scleral fixation of posterior chamber intraocular lens (IOL) and retropupillary fixation of iris claw IOL for dislocated IOL or aphakia without sufficient capsular support. METHODS: This retrospective study was comprised of 17 eyes of 16 patients undergoing scleral fixation and 14 eyes of 13 patients undergoing retropupillary fixation from August 2013 to June 2018. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, corneal topography, refractive indices, corneal curvatures, corneal endothelial cell density, and complications of both groups were examined preoperatively and 1 day, 1 week, 1 month, 2 months, and 6 months postoperatively. RESULTS: Six months after the operation, UCVA and BCVA improved in both groups; however, there were no significant differences between the two groups (UCVA, p = 0.162; BCVA, p = 0.418). IOP was temporarily higher in the scleral fixation group at one day postoperatively (p = 0.023). The mean absolute prediction error was smaller in the retropupillary iris fixation group at 6 months postoperatively (p = 0.034). Postoperative total astigmatism, corneal astigmatism, and corneal endothelial cell density were not significantly different between the two groups. CONCLUSIONS: The retropupillary iris fixation group did not show significant improvement in visual acuity compared with the scleral fixation group. However, the retropupillary iris fixation group provided better mean absolute prediction error and a low risk of postoperative increase in IOP compared with the scleral fixation group. Retropupillary fixation of iris claw IOL is a promising option for scleral fixation of posterior chamber IOL for dislocated IOL or aphakia without sufficient capsular support.
Animals ; Aphakia ; Astigmatism ; Corneal Topography ; Endothelial Cells ; Hoof and Claw ; Humans ; Intraocular Pressure ; Iris ; Lenses, Intraocular ; Refractometry ; Retrospective Studies ; Slit Lamp ; Visual Acuity