PURPOSE: We report short-term treatment effects of a mini-scleral lens in patients with Stevens-Johnson syndrome and corneal ectasia. CASE SUMMARY: A 54-year-old female who had been diagnosed with Stevens-Johnson syndrome and keratoconus presented with persistent right eye pain and decreased visual acuity. Therapeutic lenses, topical antibiotic eye drops, and topical steroid eye drops were used; however the symptoms were not controlled, then the patient was treated with a mini-scleral contact lens in the right eye. At the time of the first visit to our hospital 17 years ago, and the best-corrected visual acuity (BCVA) of the right eye was logMAR 0.22. However, Stevens-Johnson syndrome and corneal ectasia were severe and cataract surgery was considered because of worsening cataracts, but the patients refused this surgery. At the time, the BCVA of the right eye was then reduced to logMAR 1.10. On ophthalmic examination, there was conjunctival fibrosis and corneal neovascularization of the right eye. The symptoms were not managed with a using a therapeutic lens, and then the patient was prescribed a mini-scleral contact lens. After wearing the mini-scleral contact lens, the corneal and conjunctival neovascularization was reduced. After 6 months, the BCVA of the right eye improved to logMAR 0.60. CONCLUSIONS: In patients with Stevens-Johnson syndrome and corneal ecstasia, mini-scleral contact lens can be considered as a useful treatment option for visual improvement and symptom control.
Cataract ; Contact Lenses ; Corneal Neovascularization ; Dilatation, Pathologic ; Eye Pain ; Female ; Fibrosis ; Humans ; Keratoconus ; Middle Aged ; Ophthalmic Solutions ; Stevens-Johnson Syndrome ; Visual Acuity

PURPOSE: To report the first case of endophthalmitis due to Streptococcus dysgalactiae after phacoemulsification and posterior chamber intraocular lens implantation in the Republic of Korea. CASE SUMMARY: A 65-year-old male was transferred because of endophthalmitis following cataract surgery. His initial visual acuity was light perception. Because inflammation of the anterior chamber and vitreous cavity progressed rapidly, we performed total pars planar vitrectomy and intraocular lens extraction in addition to administering intravitreal antibiotics and intravitreal dexamethasone injections. Streptococcus dysgalactiae was identified in samples cultured from the vitreous and anterior chamber fluid. Four days after surgery, we washed the anterior chamber and intravitreal antibiotics were again injected because of increased inflammation of the anterior chamber and vitreous. The patient was discharged 25 days after surgery but corneal neovascularization, contraction, edema, infiltration, and hypopyon remained. Visual acuity progressed to no light perception and there was shrinkage of the globe. CONCLUSIONS: Endophthalmitis due to Streptococcus dysgalactiae is very rare. We report the first case of endophthalmitis caused by Streptococcus dysgalactiae in the Republic of Korea. The prognosis for recovery was poor despite aggressive treatment.
Aged ; Anterior Chamber ; Anti-Bacterial Agents ; Cataract ; Corneal Neovascularization ; Dexamethasone ; Edema ; Endophthalmitis ; Humans ; Inflammation ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Male ; Phacoemulsification ; Prognosis ; Republic of Korea ; Streptococcus ; Visual Acuity ; Vitrectomy

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

OBJECTIVETo evaluate the efficacy of epigallocatechin gallate (EGCG) in treatment of corneal alkali burn injury in mice.

METHODSCorneal alkali burn injury was induced by sodium hydroxide method in C57BL/6J mice. The mice with cornea burns were treated intraperitoneally with EGCG solution or phosphate buffer solution (PBS) respectively. The healing of corneal epithelium, the formation of corneal neovascularization (CNV) and the inflammation reaction were assessed by slit -lamp microscopy and histological examination. Expression of vascular endothelial growth factor (VEGF) mRNA and protein in cornea was evaluated by real -time reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry, respectively. Myeloperoxidase (MPO) assay was used to quantitatively evaluate the polymorphonuclear neutrophils (PMNs) infiltration in the corneas.

RESULTSThe healing rate of corneal epithelium in EGCG group was significantly higher than that of PBS group at d1, d3 and d7 after treatment (d1: 41.0%±13.0% vs 23.8%±7.6%; d3: 76.6%±7.5% vs 61.2%±6.8%; d7: 87.8%±8.5% vs 74.0%±9.1%; all P <0.05). The CNV scores and the number of CNV in the corneal sections of EGCG group were significantly lower than those of PBS group at d3, d7 and d14 after treatment (CNV score: d3: 1.1±0.5 vs 6.6±1.0; d7: 1.3±0. 3 vs 8.1±1.0; d14: 0.9±0.2 vs 9.2±1.1; CNV number: d3: 1.68±0.61 vs 2.92±0.95; d7: 4.80±1.36 vs 7.92±1.28; d14: 3.64±0.71 vs 5.88±0.76; all P<0.05) . The expression of VEGF protein at d3 (0.19±0.05 vs 0.45±0.08) and d7 (0.42±0.07 vs 0.84±0.09), the expression of VEGF mRNA at d1, d3 and d7 in EGCG group were significantly lower than those in PBS group (all P <0.05). Compared to PBS group, the inflammatory index at d3 (3.2±0.4 vs 3.7±0.5) and d7 (2.3±0.5 vs 4.0±0.0), the number of PMNs in the corneal sections and the MPO values at d3, d7 and d14 in EGCG group were significantly decreased (PMNs: d3: 34.5±15.7 vs 90.0±28.8; d7: 17.1±11.4 vs 54.9±25.9; d14: 12. 8±4.6 vs 39.0±17.9; all P <0.05).

CONCLUSIONIn the murine corneal alkali burn model, intraperitoneal injection of EGCG solution can promote the healing of corneal epithelium, inhibit the formation of CNV and reduce the inflammatory cell infiltration in the corneas.

Alkalies ; Animals ; Burns, Chemical ; drug therapy ; Catechin ; analogs & derivatives ; therapeutic use ; Cornea ; drug effects ; pathology ; Corneal Neovascularization ; prevention & control ; Disease Models, Animal ; Eye Burns ; drug therapy ; Inflammation ; drug therapy ; immunology ; Mice ; Mice, Inbred C57BL ; Neutrophils ; cytology ; RNA, Messenger ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo investigate the effects of ursolic acid on corneal graft rejection in a rat model of othotopic corneal allograft transplantation.

METHODSForty-eight recipient Wistar rats were divided into normal control group with saline treatment (group A), autograft group with saline treatment (group B), SD rat allograft group with saline treatment (group C), and SD rat allograft group with intraperitoneal ursolic acid (UA) treatment group (group D). The rats received saline or UC (20 mg·kg(-1)·d(-1)) treatment for 12 days following othotopic graft transplantation. The grafts were evaluated using the Larkin corneal rejection rating system, and the graft survival was assessed with Kaplan-Meier analysis. On day 14, the grafts were harvested for histological examination, Western blotting, and assessment of expressions of interlukin-2 (IL-2), interferon-γ (IFN-γ), nuclear transcription factor-κB (NF-κB) p65, vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1).

RESULTSThe allograft survival was significantly longer in group D than in group C (29.12±9.58 vs 9.67±2.16 days, P<0.05). UC treatment obviously reduced the expression levels of IL-2, IFN-γ, NF-κBp65, ICAM-1 and VEGF and increased inhibitory kappa B alpha (IκB-α) expression in the grafts, where no obvious inflammatory cell infiltration or corneal neovascularization was found.

CONCLUSIONAs a NF-κB inhibitor, ursolic acid can prevent corneal neovascularization and corneal allograft rejection to promote graft survival in rats following orthotopic corneal allograft transplantation.

Animals ; Cornea ; metabolism ; Corneal Neovascularization ; prevention & control ; Corneal Transplantation ; Graft Rejection ; prevention & control ; Graft Survival ; drug effects ; I-kappa B Proteins ; metabolism ; Intercellular Adhesion Molecule-1 ; metabolism ; Interferon-gamma ; metabolism ; Kaplan-Meier Estimate ; NF-KappaB Inhibitor alpha ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Transcription Factor RelA ; metabolism ; Transplantation, Homologous ; Triterpenes ; pharmacology ; Vascular Endothelial Growth Factor A ; metabolism

PURPOSE: To report the clinical outcomes of 360-degree keratolimbal allograft in 2 patients. CASE SUMMARY: An 83-year-old female who had uncontrolled Mooren's ulcer invading 360 degrees of the limbus with corneal opacity received a 360-degree keratolimbal allograft (KLAL). Another 63-year-old female who had central corneal opacity and corneal neovascularization due to severe limbal cell deficiency with chemical injury received a 360-degree KLAL. During the average 17.5 months of follow-up, both eyes were tectonically maintained without severe graft rejection. CONCLUSIONS: A 360-degree KLAL may be an effective tectonic procedure for corneal opacity caused by limbal stem cell deficiency. Herein, we report 2 cases of successfully performed 360-degree KLAL with a literature review.
Aged, 80 and over ; Allografts* ; Corneal Neovascularization ; Corneal Opacity ; Female ; Follow-Up Studies ; Graft Rejection ; Humans ; Middle Aged ; Stem Cells ; Ulcer

PURPOSE: To report a case of corneal opacity improved by treatment of demodex blepharitis. CASE SUMMARY: A 50-year-old female who received sub-laser-assisted in situ keratomileusis (LASIK) flap surgery was referred to our clinic with corneal opacity and neovascularization in her left eye. Her visual acuity was 0.5. Telangiectasis of the eyelid margin and meibomian gland dysfunction were observed. Seven Demodex folliculorum were found in 4 eyelashes of the left eye. Lid scrub with 0.4% polyhexamethylene biguanide (PHMB) and ointment containing dexamethasone was started for demodex blepharitis treatment. After 6 months of treatment, the number of Demodex folliculorum was decreased to 2 and the best corrected visual acuity was 0.8. Corneal opacity and neovascularization were also improved. CONCLUSIONS: The present study showed that demodex blepharitis can induce atypical corneal opacity and neovascularization after LASIK surgery. Evaluation and treatment of demodex blepharitis in these patients is important.
Blepharitis* ; Corneal Neovascularization ; Corneal Opacity* ; Dexamethasone ; Eyelashes ; Eyelids ; Female ; Humans ; Keratomileusis, Laser In Situ ; Meibomian Glands ; Middle Aged ; Telangiectasis ; Visual Acuity

Vascular endothelial growth factor inhibitor is an emerging therapeutic modality for various ocular diseases with neovascularization (NV). However, for corneal NV, controversy remains regarding whether bevacizumab or ranibizumab is superior. A 32-year-old female diagnosed with herpetic keratoconjunctivitis with refractory corneal NV despite two previous subconjunctival and intrastromal bevacizumab injections, received two subconjunctival and intrastromal ranibizumab injections. Six months postoperatively, there was significant regression of the neovascular area and vessel caliber. Here, the authors report a case of improvement in corneal NV with subconjunctival and intrastromal ranibizumab injections, which was previously refractory to bevacizumab injection. The findings may suggest a new prospect in treating corneal NV.
Adult ; Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Conjunctiva/blood supply ; Corneal Neovascularization/*drug therapy ; Corneal Stroma/blood supply ; Female ; Humans ; Injections, Intraocular/methods ; Keratitis, Herpetic/*drug therapy ; Visual Acuity/drug effects

PURPOSE: To investigate the clinical features and compliance of cosmetic contact lens (CL)-related complications compared with soft CL-related complications. METHODS: We performed a retrospective chart review of 97 patients (194 eyes) regarded as having CL-related complications at the outpatient clinic. The portion of complications, gender, age, and chief complaints at the initial visit were analyzed, as was compliance to cosmetic and soft CL-related guidelines for use. RESULTS: A total of 97 patients (49 patients with cosmetic CL-related complications and 43 patients with soft CL-related complications) were evaluated. The mean age of the subjects using cosmetic CL was 19.8 years (14-31 years), and all the patients were female. The chief complaints at the initial visit included ocular pain, injection, blurred vision, dryness, itching and foreign body sensation. The main complications included corneal erosion, sterile corneal infiltrate, allergic disease, neovascularization, corneal ulcer and dry eye syndrome. No statistical difference was found regarding chief complaints or complications. The proportion of patients lost to follow-up was 47% in cosmetic CL-related and 20% in soft CL-related complications, a significant difference (p = 0.015). CONCLUSIONS: Because young females are the most common CL patients and do not always fully comply with the guidelines for use, ophthalmologists need to warn these patients about the risk of serious complications.
Ambulatory Care Facilities ; Compliance* ; Contact Lenses, Hydrophilic ; Corneal Neovascularization ; Dry Eye Syndromes ; Female ; Foreign Bodies ; Humans ; Lost to Follow-Up ; Pruritus ; Retrospective Studies ; Sensation ; Ulcer

PURPOSE: To investigate the biometric risk factors for corneal surface complications associated with hydrogel soft contact lens (SCL) fitting in myopic patients in Korea. METHODS: This is a retrospective case-control study. The records of 124 subjects (124 eyes) who wore SCLs on a daily basis were reviewed. Thirty-one patients (31 eyes) who were diagnosed with corneal neovascularization (NV) while wearing SCLs were included in the complication group. Ninety-three age- and sex-matched patients (93 eyes) who wore SCLs, who did not have corneal NV and who visited our clinic for correction of refractive errors were included in the control group. The degree of spherical equivalent, astigmatism and corneal base curve radius (BCR) were compared in both groups. RESULTS: Patients with NV exhibited poorer best corrected visual acuity and more myopia than controls (p = 0.008 and 0.006, respectively). In univariate analysis, highly myopic patients (-9 diopters [D] or higher) were more likely to experience NV (odds ratio [OR], 2.232; 95% confidence interval [CI], 1.602 to 3.105). High astigmatism (> or =2 D) increased the risk of complications (OR, 2.717; 95% CI, 1.141 to 6.451). Steep cornea, in which BCR was <7.5 mm, also raised the risk of complications (OR, 4.000; 95% CI, 1.661 to 9.804). Flat cornea was not a risk factor for the development of NV. CONCLUSIONS: High myopia, high astigmatism, and steep cornea seemed to be risk factors in the development of corneal NV in SCL wearers.
Adult ; Astigmatism/diagnosis ; Biometry ; Case-Control Studies ; Contact Lenses, Hydrophilic/*adverse effects ; Corneal Neovascularization/diagnosis/*etiology ; Female ; Humans ; Hydrogel ; Male ; Myopia/diagnosis/*therapy ; Prosthesis Fitting ; Retrospective Studies ; Risk Factors ; Visual Acuity