By Jesper Hjortdal. EuCornea has decided to put the Journal on hold and make the homepage of EuCornea more active with a newsletter with case reports, highlights on innovation and well-illustrated review articles.
Purpose To analyze vision-related quality of life in patients with fungal keratitis treated with topical antifungal medications and adjuvant crosslinking in the Cross-Linking Assisted Infection Reduction (CLAIR) trial Methods Study participants were randomized to one of four treatment combinations: (1) topical natamycin 5%, (2) topical natamycin 5% plus CXL, (3) topical amphotericin 0.15%, and (4) topical amphotericin 0.15% plus CXL. All participants responded to the Indian visual function questionnaire (IND-VFQ) at the baseline visit and 3 months after enrollment. Responses were averaged within four subscales (mobility, activity limitation, psychosocial impact, and visual function). Scores were compared between the acute phase of infection and after treatment. Linear regressions were then performed to compare IND-VFQ results between the four arms. Results IND-VFQ scores improved in patients three months after initiating treatment compared to baseline (P<0.01). Participants treated with amphotericin had a VFQ score 2.60 points (95% CI, -6.90-12.10) higher than those treated with natamycin (P=0.59). Participants treated with CXL had an average VFQ score 4.15 points (95% CI, -5.43-13.70) higher than those treated with medication only (P=0.29). Subscale analysis did not show significant differences between treatment groups. Conclusions All patients reported improved vision-related quality of life after treatment of fungal keratitis. Treatment with natamycin and amphotericin B produced similar results. Primary adjunctive CXL did not benefit patients with respect to vision-related quality of life in fungal keratitis patients. These results reflected primary results of CLAIR regarding microbiological cure, infiltrate and/or scar size, percent epithelialization, and frequency of adverse events.
Purpose The purpose of this study was to describe a case of paraproteinemic keratopathy (PPK) in a patient with monoclonal gammopathy of undetermined significance (MGUS) Methods A 56 years old man was assessed using a slit lamp and in vivo confocal microscopy (IVCM) with Heidelberg HRT Rostock II. Results The patient showed bilateral diffuse, symmetric, non-polychromatic, punctiform crystals in all layers of the cornea. The remaining part of the ophthalmic clinical assessment was normal. Esthesiometry was normal in all quadrants. Anterior segment OCT confirmed diffused hyperreflectivity of the epithelium and corneal stroma. IVCM was then executed, showing polymorphic (granular, needle-like, stellate) hyperreflective crystals in all layers of corneal epithelium and anterior stroma, subbasal plexus nerves beading, cytoplasmatic hyperreflectivity of the keratocytes of the posterior stroma without any endothelial involvement After considering the age, health status, and ocular signs the primary entities to be investigated were adult benign cystinosis and paraproteinemic disorder. All the diagnostic tests were negative except for a monoclonal component IgG/k of 1.37 d/dl. A hematological examination was then performed with the resulting diagnosis of MGUS. In this paper, we analyzed 11 articles about IVCM in PPK in MGUS and other paraproteinemias highlighting IVCM features compatible with our findings allowing us to generalize a first diagnostic IVCM pattern for PPK. Conclusions In this case report we suggest the IVCM diagnostic patterns that may be used to identify PPK without corneal biopsy.
The development of pterygium after keratoplasty is a very unusual situation. We report a case of pterygium that developed 8 years after corneal transplantation, which makes our case quite unusual. The fact that few similar cases have been reported in the literature on the association between pterygium and corneal transplantation makes our decision very difficult.
Prof. Leonardo Mastropasqua is Director at the National High-Tech Eye Center, Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D’Annunzio of Chieti-Pescara, Chieti, Italy. In the following editorial, talk about the prospects for corneal lenticule implantation. Mario Nubile is Associate Professor of the same faculty. Both are specialized in corneal, cataract and refractive surgery and focus on imaging technologies of the anterior eye segment. In the following editorial, they talk about the prospects for corneal lenticule implantation and tissue-addition techniques for reshaping the diseased cornea.
