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Ophthalmology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
CLINICAL FEATURES Can present acutely as a painful red eye with blurred vision and photophobia or more chronically with milder symptoms. A hypopyon may be present and there may be keratic precipitates (clumps of inflammatory cells) and synechiae (adhesions of the iris to the lens).
Special Cases in the Diagnosis and Treatment of Fungal Keratitis
Published in Mahendra Rai, Marcelo Luís Occhiutto, Mycotic Keratitis, 2019
Fungal infection causes suppurative inflammation of the cornea. In addition to the direct destruction of the mycotoxin, the fungal secreted enzymes also induce damage to the corneal stroma. After fungal hyphae adhere to the corneal stroma, fungal spores form hyphae and invade the stroma. Toxins, hydrolyzing enzymes, and proteases are produced to dissolve and destroy corneal tissue. Meanwhile, the fungal pathogens themselves induce secretion of chemokines and cytokines by the host cells, attracting inflammatory cells to gather toward the infected site. On one hand, inflammatory cells kill and clear pathogens. On the other hand, the substances produced and released by phagocytic cells cause lysis and destruction of the corneal tissue, leading to purulent inflammation. These inflammatory factors can also stimulate the iris to cause vasodilation, iris inflammation, and hypopyon. Generally, before perforation occurs, only in 34.62% of the patients, the hypopyon is reactive with hyphae; however, when perforation occurs, in up to 85.71% of the patients, hyphae are detected in hypopyon (Li et al. 2002). Increased hypopyon can stimulate iris neovascularization.
Anterior uveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
Cells are leucocytes that can be seen idling in and out of a highly magnified and brightly illuminated slice of aqueous humour much like dust particles passing in and out of a bright beam of sunlight in an old room. Flare implies a breakdown of the blood-aqueous barrier as protein and fibrin that have leaked into the aqueous have a blurring effect on what we see in and what the patient sees out. A hypopyon is an inferior collection of inflammatory material at the bottom of the anterior chamber which is a sign of severity. It is traditionally measured by vertical height at the slit lamp.
Applications of mesenchymal stem cells in ocular surface diseases: sources and routes of delivery
Published in Expert Opinion on Biological Therapy, 2023
Mohammad Soleimani, Ahmad Masoumi, Bita Momenaei, Kasra Cheraqpour, Raghuram Koganti, Arthur Y Chang, Mahmoud Ghassemi, Ali R Djalilian
There are few human studies that reported the application of MSCs for the treatment of ocular surface disorders (Table 2). Subconjunctival injections of BM-MSCs with amniotic membrane transplantations in 16 patients with severe ocular burns showed promising results [109]. Complete epithelialization occurred at 4–10 weeks after treatment in 81.3% of cases, and one third of patients experienced improvement in their vision. One patient developed a hypopyon, which resolved after treatment with topical anti-inflammatory drugs. 31.3% had a symblepharon at the last follow-up visit. Notably, all patients had partial or total LSCD at the end of the study, but this may not be a consequence of MSC therapy as it is a common complication of ocular burn injuries. None of the cases developed infection, conjunctival necrosis, tumor formation, or systemic adverse events, and none subsequently required keratoplasty [109]. Calonge et al. used allogeneic BM-MSCs for the treatment of LSCD and compared the outcomes to allogeneic cultivated limbal epithelial transplantation (CLET) [108]. Both methods were safe and effective for ocular surface regeneration. However, MSCs are more easily obtained and cultured than limbal epithelial cells and are not dependent on the availability of deceased donors. Moreover, there is no need to suppress the host immune system with MSCs in contrast to limbal cells [108].
Herpes Simplex Virus Anterior Uveitis in a Child Presenting as a Hypopyon in a White Eye
Published in Ocular Immunology and Inflammation, 2022
Somasheila I. Murthy, Brijesh Takkar, Manjushree Bhate, Dilip Kumar Mishra, Esther Sheba, Savitri Sharma
Oral acyclovir 100 mg/2.5 ml suspension was started five times a day for 2 weeks and decreased to twice daily subsequently. Corticosteroids were tapered. Within 1 week itself the hypopyon started reducing and disappeared after 2 weeks. Two months later, the inflammation had resolved. He was maintained on oral acyclovir 100 mg/2.5 ml twice daily, topical prednisolone acetate and atropine eyedrops once a day. In view of significant cataract progression and amblyogenic nature of the cataract, he underwent early intervention with pars plana lensectomy, primary posterior capsulotomy and anterior vitrectomy (4 months from initial presentation). The vitreous sample was once again sent to microbiology laboratory for direct microscopy, culture and was tested for conventional PCR for panfungal, eubacterial and HSV-1 DNA, all of which were negative.
Noninvasive Diagnosis of Viral Keratouveitis with Retro-corneal Endothelial Plaques: A Case Series
Published in Ocular Immunology and Inflammation, 2022
Shuo Yu, Debo You, Rupesh Agrawal, Yun Feng
Twelve eyes of six male and six female patients with unilateral viral keratouveitis with retrocorneal endothelial plaques were included in the study, with a mean age of 63.3 ± 19.0 (range: 16–87) years. Three patients (Patients 4, 6, and 7) had a previous history of penetrating keratoplasty, while the rest of the patients had no history of previous corneal disease or pathology. Presenting symptoms included foreign body sensation, pain, and redness combined with severe vision loss. Snellen’s visual acuity varied between 20/200 and counting fingers. Slit-lamp examination revealed a unilateral large epithelial defect with stromal infiltration, gray-white keratic precipitates, and retrocorneal endothelial plaque underlying the area of active stromal infiltration in all patients (Figure 1). Hypopyon was noted in six eyes (Patients 1, 3, 5, 10, 11, and 12) (Figures 2 and 4). Corneal sensation was reduced or absent in all the affected eyes. The results are shown in Table 1.