scholarly journals A Case of Medication-Resistant Acanthamoeba Keratitis Treated by Corneal Crosslinking in Turkey

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Goktug Demirci ◽  
Akif Ozdamar
Keyword(s):  
Visual Acuity ◽  
Local Anesthesia ◽  
Symptomatic Relief ◽  
Acanthamoeba Keratitis ◽  
Symptomatic Improvement ◽  
Corneal Epithelial ◽  
Corneal Crosslinking ◽  
Corneal Melting

Purpose. To report a case of medication-resistant acanthamoeba keratitis (AK) treated successfully by corneal crosslinking (CXL).Methods. A 26-year-old male with medication-resistant AK underwent a standard CXL procedure with local anesthesia, followed by central corneal epithelial debridement, application of riboflavin 0.1%, and UV-A irradiation.Results. The patient experienced a dramatic symptomatic improvement within 24 hours. At two months, keratitis was healed with a semitransparent paracentral scar that did not affect visual acuity.Conclusions. Our experience, considered in the context of recent studies, suggests that CXL may be an option for selected patients with medication-resistant AK and corneal melting. CXL allows patients to avoid emergency keratoplasty and experience rapid symptomatic relief.

scholarly journals Amnwiotic Membrane Transplantation as a Treatment for Sterile Infiltration and Corneal Melting after Corneal Crosslinking for Keratoconus

2018 ◽  
Vol 9 (1) ◽  
pp. 185-189 ◽  
Author(s):  
Takanori Sasaki ◽  
Takeshi Ide ◽  
Ikuko Toda ◽  
Naoko Kato
Keyword(s):  
Visual Acuity ◽  
Diclofenac Sodium ◽  
Corneal Stroma ◽  
Amniotic Membrane Transplantation ◽  
Eye Drops ◽  
Epithelial Defect ◽  
Persistent Epithelial Defect ◽  
Corneal Crosslinking ◽  
Corneal Epithelial Defect ◽  
Corneal Melting

We report a case of corneal melting through sterile infiltration presumably due to excessive use of nonsteroidal anti-inflammatory eye drops after corneal crosslinking (CXL). It was treated using steroids combined with amniotic membrane transplantation (AMT). A 33-year-old man with progressing keratoconus underwent left eye CXL. We prescribed betamethasone and levofloxacin eye drops 5 times daily and diclofenac sodium eye drops 3 times daily for 3 days. Three days after CXL, there was a persistent epithelial defect and the left corneal stroma was clouded. His visual acuity remained unchanged. We prescribed betamethasone hourly and 20 mg prednisolone daily. At 1 week after CXL, the corneal epithelial defect and infiltration were unchanged. He had not stopped using diclofenac at the prescribed time. On day 17, we performed AMT and his cornea and visual acuity improved. AMT may be effective against persistent epithelial defects and corneal melting after CXL.

scholarly journals Safety and efficacy of repeated crosslinking assisted by transepithelial double-cycle iontophoresis in keratoconus progression after primary corneal crosslinking

Eye ◽  
2021 ◽  
Author(s):  
Huping Wu ◽  
Lan Li ◽  
Shunrong Luo ◽  
Xie Fang ◽  
Xumin Shang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
Good Alternative ◽  
Persistent Epithelial Defect ◽  
Safety And Efficacy ◽  
Corneal Epithelial ◽  
Epithelial Damage ◽  
Corneal Confocal Microscopy

Abstract Objectives To evaluate the safety and efficacy of repeated corneal collagen crosslinking assisted by transepithelial double-cycle iontophoresis (DI-CXL) in the management of keratoconus progression after primary CXL. Methods A retrospective analysis was conducted in the patients who underwent repeated CXL between 2016 and 2018. These patients were treated with DI-CXL if keratoconus progression was confirmed after primary CXL. Scoring of ocular pain and corneal epithelial damage, visual acuity, corneal tomography, in vivo corneal confocal microscopy (IVCM) was performed before and at 3, 6, 12, and 24 months after DI-CXL. Results Overall, 21 eyes of 12 patients (mean age 17.3 ± 1.9 years) were included in this study. Before DI-CXL, an average increase of 4.26 D in Kmax was detected in these patients with a mean follow-up interval of (23.0 ± 13.7) months. After DI-CXL, corneal epithelial damage rapidly recovered within days. Visual acuity remained unchanged with follow-up of 24 months. When compared to baseline, significant decreases were observed in Kmax (at 3 months) and K2 (at 3 and 6 months) after DI-CXL. Corneal thickness of thinnest point significantly decreased at 3 months postoperatively. When compared to baseline, no significant differences were found in any of the refractive or tomographic parameters at 12 and 24 months. IVCM revealed trabecular patterned hyperdense tissues after DI-CXL in the anterior stroma at the depth of 200 μm or more. No corneal infiltration or persistent epithelial defect was recorded after DI-CXL. Conclusion DI-CXL is safe and effective as a good alternative in stabilizing keratoconus progression after primary CXL.

scholarly journals Corneal Cross-linking in Combination with Intracorneal Ring Segments

2017 ◽  
Vol 6 (2) ◽  
pp. 92-96
Author(s):  
Aylin Kiliç
Keyword(s):  
Visual Acuity ◽  
Cross Linking ◽  
Corneal Crosslinking ◽  
Distance Visual Acuity ◽  
Corrected Distance Visual Acuity ◽  
Ring Segment

ABSTRACT The goal of ring segment surgery is to reduce the degree of myopia and astigmatism, improving uncorrected and corrected distance visual acuity. The crosslinking is a procedure used for stabilizing the cornea in patients with progressive keratoconus. Corneal crosslinking surgery and combination of an intracorneal ring segments seems to be as effective for corneal stability and refractive improvement in keratoconic eyes. How to cite this article Kiliç A. Corneal Cross-linking in Combination with Intracorneal Ring Segments. Int J Kerat Ect Cor Dis 2017;6(2):92-96.

scholarly journals Markedly Increased Ocular Side Effect Causing Severe Vision Deterioration After Chemotherapy Using New or Investigational Epidermal or Fibroblast Growth Factor Receptor Inhibitors.

2019 ◽  
Author(s):  
Eunhae Shin ◽  
Dong Hui Lim ◽  
Jisang Han ◽  
Do-Hyun Nam ◽  
Keunchil Park ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Visual Acuity ◽  
Growth Factor ◽  
Fibroblast Growth Factor ◽  
Fibroblast Growth Factor Receptor ◽  
Growth Factor Receptor ◽  
Eye Drops ◽  
Fibroblast Growth ◽  
Ocular Complication ◽  
Corneal Epithelial

Abstract Background To describe corneal epithelial changes after using epidermal (EGFR) or fibroblast growth factor receptor (FGFR) inhibitors as chemotherapy and to clarify incidence and prognosis. Materials Retrospective chart review. Results Among 6,871 patients and 17 EGFR or FGFR inhibitors, 1,161 patients (16.9%) referred for ophthalmologic examination. Authors identified that in twelve patients, 3 EGFR inhibitors and 2 FGFR inhibitors that caused corneal epithelial lesions. Vandetanib, Osimertinib, and an EGFR agent under clinical trial (ABT-414) caused vortex keratopathy in nine patients and ASP5878 and FPA144, the FGFR inhibitors of clinical trial caused epithelial changes resembling corneal dysmaturation in three patients. Mean interval until symptoms appear was 246 days with Vandetanib, 196 days with Osimertinib, 30 days with ABT-414, 55 days with ASP5878 and 70 days with FPA144. Mean of lowest logarithm of minimal angle of resolution units (logMAR) visual acuity of right eye after chemotherapy was 0.338 and 0.413 in left eye. Incidence of epithelial changes were 15.79% with Vandetanib, 0.005% with Osimertinib, 100% with ABT414, 50.0% with ASP5878 and 18.2% with FPA144. After excluding deceased patients, or were lost to follow-up or were still undergoing treatment, we confirmed the reversibility of corneal lesions after discontinuation of each agent. Although patients diagnosed with glioblastoma used prophylactic topical steroids before and during ABT-414 therapy, all developed vortex keratopathy. Conclusions EGFR and FGFR inhibitors are well known chemotherapy agents and could make corneal epithelial changes. Contrary to low probability of ocular complication with old EGFR drugs, recently introduced EGFR and FGFR agents showed high incidence of ocular complication with severe vision distortion. Doctors should forewarn patients planning chemotherapy with EGFR or FGFR inhibitors that decreased visual acuity could develop due to corneal epithelial changes, and also reassure them that the condition could be improved after the end of treatment without the use of steroid eye drops.

Efficacia del Trattamento Dell'ipertrofia Prostatica Benigna Con Finasteride: Valutazione Urodinamica pre e Post Terapia

1994 ◽  
Vol 61 (1_suppl) ◽  
pp. 86-89
Author(s):  
A. Carbone ◽  
F. Pesce ◽  
M. Ciccariello ◽  
R. Pacchiele ◽  
N. Cerulli
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Treatment Period ◽  
Symptomatic Relief ◽  
Symptomatic Improvement ◽  
Prostatic Hyperplasia ◽  
Functional Improvement ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Ultrasound Evaluation ◽  
Score Analysis ◽  
Symptom Scores

19 patients suffering from symptomatic benign prostatic hyperplasia (BPH) underwent symptom score analysis, serum PSA level determination, trans-rectal ultrasound, flowmetry and pressure/flow (P/F) studies both before and at the end of a six month treatment period with finasteride, 5 mg a day. After six months of therapy, 89.5% of the pts had a significant symptomatic improvement, according to the decrease in symptom scores. Urodynamic evaluation showed a significant decrease in voiding pressure in 84% of the pts. 5 pts moved from the “obstructed” to the “unobstructed” section of the Abrams-Griffiths nomogram. 15/19 pts had a significant decrease in prostatic weight, as showed by means of ultrasound evaluation. This study confirms the efficacy of finasteride both in the symptomatic relief and in the functional improvement of BPH pts.

P217 SAFETY OF ESOPHAGEAL DILATION IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS IN A SINGLE CENTER COHORT

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Zhao Weidan ◽  
Ali Asad ◽  
Rosenstengle Craig ◽  
Shan Kuangda ◽  
Assouline-Dayan Yehudith
Keyword(s):  
Eosinophilic Esophagitis ◽  
Symptomatic Relief ◽  
Univariate Analysis ◽  
Symptomatic Improvement ◽  
Current Data ◽  
Esophageal Dilation ◽  
Single Center ◽  
University Of Iowa ◽  
Immune Mediated ◽  
Related Risk

Abstract Aim This study is aimed to assess the safety of esophageal dilation (ED) in a large cohort of eosinophilic esophagitis (EoE) cases in a single center. Background & Method EoE, the leading cause of food impaction, is a chronic immune-mediated disorder characterized by esophageal dysfunction and mucosal eosinophilic infiltration (≥ 15 eos/hpf). ED is considered a second-line therapy for EoE after failure of medication, due to concern of perforation. We performed a retrospective review of EoE patients who received ED at University of Iowa Hospitals and Clinics from 2006 to 2018. ED types, complications, and symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed. Results Of 1050 EoE patients, 160 received 295 EDs, ranging from 1-12 dilations per patient, with 67 patients requiring >1 dilations. Procedures were generally well-tolerated, without major bleeds or perforations. The overall complication rate was 6.1%, mostly post-procedural chest pain (4.8%). Three patients had sedation-related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Symptomatic improvement was documented in 87% of dilations on follow up. Conclusion EoE prevalence is increasing with rates of 1 cases per 1000 individuals, with up to one-third requiring ED for symptomatic relief. Previous reports suggested an increased procedure-related risk, mainly esophageal perforation. However, recent systematic reviews have shown low perforation rate of <0.3%, approximating that of other benign conditions. Our findings are consistent with current data, suggesting that ED should be considered a safe treatment for EoE along with dietary and pharmacological interventions.

Ex-PRESS mini-shunt implanted in a pregnant patient with iridocorneal endothelial syndrome

2019 ◽  
Vol 30 (1) ◽  
pp. NP25-NP28 ◽  
Author(s):  
Teresa Colás-Tomás ◽  
Elena López Tizón
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Young Patients ◽  
Pregnant Patient ◽  
Corneal Epithelial ◽  
Aqueous Shunt ◽  
Post Surgery ◽  
Iridocorneal Endothelial Syndrome ◽  
First Case ◽  
Filtration Area

Introduction: The failure rate of both filtration surgery and of aqueous shunt implantation is higher for iridocorneal endothelial syndrome than in other scenarios, due to the continuous proliferation of abnormal endothelial cells over the trabecular meshwork and the filtration area and also due to the more pronounced cicatrizing response shown by these young patients. We present the first case ever described in the literature of a pregnant patient with iridocorneal endothelial syndrome and uncontrolled ocular hypertension who was implanted an Ex-PRESS mini-shunt. Clinical case: A 35-year-old female presented with diminution of vision in the left eye for 2 months. She was 20 weeks pregnant. Her visual acuity was 20/20 in right eye and 20/25 in left eye, and intraocular pressure was 11 mmHg in right eye and 34 mmHg in left eye. Slit lamp biomicroscopic examination revealed no alterations in right eye, whereas left eye showed corectopia and uveal ectropion, stroma of iris’ sectoral atrophy and moderate corneal epithelial edema. Gonioscopy showed some anterior iris synechiae in left eye. Fundus evaluation was normal. Based on clinical features and examination, the diagnosis of left eye iridocorneal endothelial syndrome with decompensated intraocular pressure was made. She was prescribed topical timolol (0.5%) and dorzolamide. As a result of uncontrolled intraocular pressure and the impossibility to prescribe other hypotensive treatment available due to her being pregnant, it was decided to perform surgery in left eye using an Ex-PRESS mini-shunt and Ologen®; 6 months post surgery, intraocular pressure was 9 mmHg with no need for hypotensive treatment. The cornea was transparent, and the patient maintained her left eye visual acuity. Conclusions: Ex-PRESS mini-shunt can be considered a surgical option for iridocorneal endothelial syndrome. Its composition allows the ostium to remain open and the device triggers a milder postoperative inflammatory response. In our particular case, taking into account that the subject was a young, phakic, pregnant woman, whose intraocular pressure had to be closely controlled and we had to ensure that her postoperative care included as few drugs and as few reoperations as possible, we thought that using this device was the most appropriate option.

scholarly journals Infective Keratitis Following Iontophoresis-assisted Corneal Crosslinking (I-CXL): A Case Report

2021 ◽  
Vol 15 (1) ◽  
pp. 1-4
Author(s):  
Noor M. Alqudah ◽  
Hisham M. Jammal
Keyword(s):  
Clinical Examination ◽  
Comparable Efficacy ◽  
Case Description ◽  
Safety And Efficacy ◽  
Corneal Epithelial ◽  
Topical Antibiotics ◽  
Corneal Crosslinking ◽  
Negative Results ◽  
Increased Risk ◽  
The Right

Introduction: The standard corneal crosslinking (S- CXL) technique requires corneal epithelial removal, thus increasing the risk of postoperative complications. Newer technique like iontophoresis-assisted corneal crosslinking (I-CXL) with comparable efficacy as S-CXL but without the increased risk of complications associated with corneal epithelium removal is used. However, being a comparatively newer technique, the safety and efficacy of I-CXL have not been fully explored. Case Description: Here, we present a case of a 28-year-old woman who presented with infective keratitis in one eye after uneventful bilateral I-CXL for keratoconus. Two days after the procedure, the patient presented with decreased vision and pain in the right eye. Clinical examination revealed ciliary injection and central corneal rounded infiltrates measuring 3.0 mm × 3.0 mm with an overlying epithelial defect. Microbiological studies revealed negative results. Based on clinical examination, the patient was managed successfully with fortified topical antibiotics. Conclusion: To the best of our knowledge, we report the first documented case of unilateral infective keratitis following bilateral I-CXL. Ophthalmologists should monitor the possible complications post-I-CXL as it might not be as safe as we expect.

scholarly journals Thickness profiles of the corneal epithelium along the steep and flat meridians of astigmatic corneas after orthokeratology

2020 ◽  
Author(s):  
Jiaqi Zhou ◽  
Feng Xue ◽  
Xingtao Zhou ◽  
Rajeev Krishnan Naidu ◽  
Yishan Qian
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Prospective Study ◽  
Corneal Epithelium ◽  
Fourier Domain ◽  
Corneal Epithelial ◽  
Epithelial Thickness ◽  
Corneal Epithelial Thickness ◽  
A Prospective Study ◽  
Lens Wear

Abstract Background: To investigate the changes in corneal epithelial thickness along the principle meridians of astigmatic corneas after six months of overnight spherical myopic orthokeratology (OK) lens wear. Methods: A prospective study. Fifty-seven subjects with up to 1.50 diopters (D) of corneal toricity wore spherical OK lenses for 6 months. Evaluations of OK lens fit, visual acuity, refractions and corneal toricity (CT) were performed. Fourier-domain optical coherence tomography (FD-OCT) was conducted to measure the corneal epithelial thickness (ET) along the principle meridians of corneal toricity over a diameter of 6mm. The means of △ET of the same diameter at individual meridians (△ETSm and △ETFm) were calculated and compared. Results: Visual acuity and refraction improved significantly after OK lens wear. △ETFm (-4.2±3.4μm) thinned more than △ETSm (-3.4±4.0μm, P=0.027) at 1.5mm in radius. △ETSm thickened more than △ETFm at 2.5mm (△ETSm: 4.1±5.1μm, △ETFm: 2.8±4.2μm, P=0.019) and 3.0mm (△ETSm: 5.0±5.0μm, △ETFm: 3.7±4.9μm, P=0.036).∣△ETSm - △ETFm∣ were significantly correlated with the baseline central CT at 2.0mm, 2.5mm and 3.0mm (2.0mm: r=0.285, P=0.032; 2.5mm: r=0.422, P=0.001; 3.0mm: r=0.239, P=0.027). ∣△ETSm - △ETFm∣was significantly correlated with the baseline peripheral CT at 2.5mm (r=0.299, P=0.028). Conclusions: Overnight wear of spherical OK lenses resulted in differential changes in the thickness profiles of the corneal epithelium between the steep and flat meridians in eyes with corneal toricity.

scholarly journals Beta-adrenergic receptor blocking therapy for congestive heart failure: an overview

2000 ◽  
Vol 1 ◽  
pp. 6-8
Author(s):  
JC Mohan
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Adrenergic Receptor ◽  
Symptomatic Relief ◽  
Blocking Agent ◽  
Symptomatic Improvement ◽  
Beta Adrenergic Receptor ◽  
Remarkable Change ◽  
Beta Adrenergic ◽  
Receptor Blocking

It is uncommon for clinical trials to be prematurely terminated because of formidable evidence in favour ofa particular agent or strategy and rare for such trials to be reported in lay press. This is what has precisely happened with regard to beta-adrenoceptor blocking therapy in patients with congestive heart failure twice once in 1996 and again in March, 2000. The drug in question has been carvedilol (a beta-adrenergic receptor blocking agent) and the trials were Carvedilol US Heart Failure Study and GOPERNICUS (Carvedilol Prospective Randomised Cumulative Outcome Study). The therapy in patients of congestive heart failure has shown a remarkable change over a period of last three decades ever since it was shown by a Swedish team that in some patients with heart failure, beta-blocking agents can cause symptomatic improvement in refractory heart failure. The current theme is no longer symptomatic relief which is variable butsurvival benefits and less need for cardiac transplantation and recurrent hospitalization.Saga of beta-blocker therapy taught us how mechanistic approach and experimental data do not always provide the correct answer to a complex pathophysiological syndrome.

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