We report the histopathology of epithelial overgrowth in the Boston type I keratoprosthesis. The authors describe the transient, self-limiting nature of cranial nerve (CN) VI palsy with favorable prognosis. Several studies, in some cases involving prolonged treatment, have reported complications associated with the administration of topical bevacizumab that were not identified in our preliminary study, including spontaneous corneal epitheliopathy, stromal thinning, and corneal perforation.19,20 The present study was limited to cases of stable corneal NV in order to avoid conditions such as pre-existing corneal epitheliopathy that may be associated with adverse events; moreover, the exclusion of active corneal NV potentially reduced the confounding effects of active ocular surface inflammation. Since the introduction of selective laser trabeculoplasty (SLT) as an effective means of intraocular pressure (IOP) reduction by Latina and colleagues, SLT has been a popular form of treatment for eyes with glaucoma. Of the 50 patients, 34 (68%) had traumatic and 16 (32%) had spontaneous SCH. the notable ocular manifestations included micro-vasculopathy of the retina in 25%, uveitis in 8%, CMV retinitis in 7%, neuro-ophthalmic manifestation in 6%, Herpes zoster ophthalmicus in 5%, Kaposi’s sarcoma in 3% and conjunctival carcinoma in 2% of cases. During early uveitis transient high intraocular pressure (IOP) developed in 5 patients.
Varicella zoster virus (VZV) may persist in the cornea and retina. A significantly high number of cases (70%) had ocular manifestations. Around 53% had additional anterior segment disorders like conjunctivitis, blepharitis and corneal ulcers. A World Health Organisation (WHO) report estimated that currently around 32 million people including around 2 million children have been infected with human immunodeficiency virus (HIV) worldwide (1,2). Consult ophtho regarding steroid use. Neurotrophic keratopathy is thought to result from loss of corneal sensation owing to denervation, damaged epithelial basement membrane, stromal inflammation, and toxicity from topical medications.1 Neurotrophic keratopathy may present clinically with decreased visual acuity, persistent corneal epithelial defects, stromal opacification, corneal neovascularization, and stromal melts. Posterior segment changes include an HIV-associated retinopathy and a number of opportunistic infections of the retina and choroid.
The mycobacteria can infect the eye, resulting in keratitis, conjunctivitis, and endophthalmitis among other ocular infections.1 Risk factors for ocular RGNTM infections include trauma, previous corneal infection or surgery, corticosteroid use, and systemic immunosuppression.3 We report a case of recurrent atypical mycobacterial endophthalmitis in the context of neurotrophic keratopathy secondary to herpes zoster ophthalmicus (HZO) that had an atypical presentation and complex course, and highlight the challenges of causative organism identification and therapeutic interventions in this condition. HIV and AIDS-related ocular manifestations may affect 45–75% of HIV+ individuals, although the types of manifestations seen in developing nations varies in comparison to those reported in developed countries (3,4,5,6). Herpes zoster outbreaks may be precipitated by aging, poor nutrition, immunocompromised status, physical or emotional stress, and excessive fatigue. Most notably, while antibodies against cytomegalovirus (CMV) are detectable in 90% of people living with HIV and AIDS (PLWHA), CMV retinitis is rare (less than 5%) in AIDS patients in developing countries (6,9). However, ocular manifestations affecting only one eye, like Herpes zoster ophthalmicus (HZO) and conjunctival squamous cell carcinoma, are relatively common in developing countries (10). This is a rare but frequently misdiagnosed cause of a red, painful eye. The earlier WHO clinical staging of HIV recommended in 1990 was modified in 2005.
A. PCR testing was positive for HSV1 DNA and negative for the other herpes viridae (Herpes Zoster, HSV2, Epstein–Barr, and Cytomegalovirus). Clinical stage III is known as the intermediate stage in which the CD4 T-cell count is usually between 200–500, and the common ocular manifestations noted are dry eyes, blepharitis, bacterial and follicular conjunctivitis, Kaposi’s sarcoma, molluscum contagiosum, HZO, herpes simplex, HIV retinopathy and Aspergillosis. Clinical stage IV represents the stage of AIDS in which the CD4 T-cell count stays below 200 and the ocular manifestations are due to on various opportunistic infections (11,12,13). The goal of the present study was to discover the types of ocular manifestations and their severity in HIV cases referred for ophthalmological examination. This cross sectional study was performed in a specialty hospital of Tanzania called TMJ Hospital. Herpes zoster ophthalmicus: comparison of disease in patients 60 years and older versus younger than 60 yearsNeelofar GhaznawiWills Eye Institute, Cornea Service, Department of Ophthalmology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USAOphthalmology 118:2242-50.
Check the pupils for irregularity in size or reactivity and photophobia. The hospital has a bed capacity of 100 and a Voluntary Counseling and Testing Clinic where both selfreferred individuals and physician-referred patients are tested for HIV. Hospital policy requires all admitted cases of diagnosed HIV / AIDS to undergo ocular examination. In addition, there are no blood vessels, which is likely due to the lack of inflammatory impetus. For the laboratory diagnosis of HIV, serum samples were considered positive only if they were found to be repeatedly reactive by the rapid enzyme immunoassays (Serocard and Tridot screening tests). Vessel caliber was calculated using a computational technique that measures the largest diameter circle (centered at each pixel) inside of a blood vessel. Her vision only mildly decreased from 20/25 before treatment to 20/30.
The majority of the spontaneous SCH group was female (68.8%) whereas it was male in traumatic group (70.6%). The cases were staged as per WHO staging criteria. All cases underwent a detailed anterior segment and posterior segment slit lamp and +90D lens examination. Fundoscopy was performed after thoroughly dilating the pupil with Tropicamide eye drop. Fundus photographs were taken for cases showing posterior segment changes. When indicated, conjunctival and lid masses were subjected to histo-pathological examination. Blindness was defined as a visual acuity (VA) less than counting fingers (CF) at three meters with the better eye.
Data collection and analysis was performed using a standard format. Another striking finding was the presence of hyporeflective rings around the hyperreflective cell nucleoli in patients with severe sensation loss. The mean age was 34±13 years old, ranging from 18–82 years, and 69 of the patients were male. There was no corneal infiltrate, but 4+ white blood cells in the AC, recurrent layered hypopyon (Figure 1C), mild anterior vitritis, and unaffected posterior vitreous were observed. No patients in stage I were observed (Table 1). Enrolled patients (n=150) had a median CD4 cell count of 190 cells/µL. The majority of cases in the present study had a CD4 cell count between 200–500 cells per microlitre of blood.
Two cases (1.3%) had CD4 T-cell counts below 200 cells per microlitre of blood. Ocular involvements were documented in 105 (70%) individuals. The ocular manifestations observed included retinal micro-vasculopathy in 26 (25%), neuro-ophthalmic disorders in 7 (6%), uveitis in 9 (8%), herpes zoster (HZO) in 6 (5%), CMV retinitis in 8 (7%) and conjunctival carcinoma in 3 (2%) cases. Kaposi’s sarcoma in the eyelid was found in 4 (3%) of the cases. It remains unclear how the virus travels from the sensory ganglia and sensory axons to motor fibers. Two patients had bilateral blindness due to CMV. Six patients had unilateral blindness.
The most common cause of unilateral blindness was HZO in three patients, followed by toxoplasma-induced retinochoroiditis in two patients and anterior uveitis of unknown aetiology in one individual. Cotton wool spots were observed in 80% of the patients with micro-vasculopathy, and retinal haemorrhage and perivascular sheathing were also found in a few patients. The most common presentations of neuro-ophthalmic disorders were papilloedema, followed by optic atrophy and cranial nerve palsy (III & VII). Neonates also get conjunctivitis as the result of a blocked tear duct. Two patients had sub-conjunctival haemorrhage. The haemorrhage in one patient subsided spontaneously. The most common opportunistic disease was tuberculosis (40%).
The present study indicates that most of the HIV/AIDS patients (90%) referred to the eye department were in late stages of the disease. The reductions in invasion area from baseline were −3.6% ± 7.1% (n = 20) at week 3 and −20.0% ± 9.9% (n = 18) at week 24 (). Most of the cases with ocular manifestations had a CD4 T-cell count in the range of 200–500. These findings are similar to the frequency of ocular complications reported in a study carried out in Senegal, (14) but are higher than previous reports from Burundi and Malawi (Table 3). A recent report from one of the studies conducted in western India reported that around 45% of patients had ophthalmic manifestations (7). The fact that more than 90% of the patients were in the later stages of the disease might partially explain the higher occurrence of eye manifestations in this study. In this study, the most common ocular manifestation observed was retinal microvasculopathy (25%).
Previous cross-sectional studies from other African countries found micro-vasculopathy to be the most common manifestation, ranging between 10% and 42% (15). A report from India found microvasculopathy in 50% of the study subjects (16). On the other hand, prospective cohort studies from developed countries showed a high prevalence of micro-vasculopathy (70%–80%) (17). The most common types of retinal micro-vasculopathy were cotton wool spots, but their magnitude may be underestimated because they are typically transient and asymptomatic. It is thus likely that decreased neural innervation in the cornea may lead to changes in neuropeptide levels, resulting in epithelial cell changes detected by IVCM in our HZO patients. This is in agreement with the rates reported elsewhere (3). chelonae.
Kaposi’s sarcoma of the eyelid was found in 3% of the patients, which may be slightly lower than the results of other studies. Subconjuctival haemorrhaging was observed in two patients. In one of the patients, the haemorrhage was drug-induced (Fansidar) pancytopenia, and the problem gradually disappeared when the patient stopped taking the drug. The haemorrhage in the second patient might represent an early sign of conjunctival Kaposi’s sarcoma. Blindness due to CMV retinitis was present in only 2% of patients, comparable to reports from other African countries (Table 3). Other important observations in the present study were the other anterior segment ocular manifestations, including conjunctivitis, blepharitis and corneal ulcer. These observations were probably due to most of our recruited cases having opportunistic infections.
Kemanetzoglou, and E. All of the recruited cases in this study were admitted cases in various inpatient departments of the hospital that had been referred for ophthalmological examination which explains the higher percentage of cases having eye manifestations as well as the severity of HIV infection in this study. Although the ocular manifestations found in this study are consistent with most of the documented eye manifestations found in the literature (11,12,13), a bigger sample size especially from a community-based study would have revealed a more accurate picture. Conclusion Most of the cases recruited in our study were in the late stages of HIV, as defined by WHO clinical staging of HIV. A significantly higher number (70%) of cases had ocular manifestations. Our study reported a higher number of retinal manifestations in comparison to two studies performed in other African nations. If bacterial superinfection exists, a broad-spectrum topical antibiotic should be prescribed.
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