Open Access Case study

Infectious Crystalline Keratopathy Caused by Diphtheroids Treated with Intrastromal Antibiotics in a Post-corneal Transplant Patient

Archimedes Lee D. Agahan, Raymond Nelson C. Regalado

Ophthalmology Research: An International Journal, Page 1-5
DOI: 10.9734/OR/2016/22864

Purpose: To present a case of infectious crystalline keratopathy caused by Diphtheroids in a post-corneal transplant patient.

Design: Prospective, interventional case report.

Case Report: This is a case of a 44 year-old male seen at a tertiary hospital in Manila, Philippines. He underwent penetrating keratoplasty of the right eye 5 years prior to present consult for a corneal scar secondary to trauma sustained in childhood. Three years after the initial surgery, patient suffered another blunt trauma incident, causing graft dehiscence, and eventually necessitating graft re-suturing. In the interim, he experienced recurrent eye redness, to which he self-medicated with topical corticosteroids. Non-resolution of symptoms prompted the present consult.

Methodology/Results: The patient consulted 9 months after the second surgery. Initial examination revealed an intact corneal epithelium, with white branching needle-like infiltrates located from the anterior to midstroma of the corneal graft. Culture of the corneal scraping was done, which revealed growth of Diphtheroids. Moxifloxacin was injected intrastromally. Topical corticosteroid was discontinued and topical Moxifloxacin was started. After 1 month of therapy, the infiltrates were eradicated and a vascularized scar developed on the graft.

Conclusion: Diphtheroids can be a causative organism of infectious crystalline keratopathy, with a clinical presentation similar to those caused by Gram positive cocci. Intrastromal antibiotic injection and discontinuation of topical corticosteroids are essential in the treatment of this condition.


Open Access Case study

Blue-Eyed Asian: A Case Report of Waardenburg Syndrome Type 1

Kris Zanna B. Acluba, Archimedes L. D. Agahan

Ophthalmology Research: An International Journal, Page 1-5
DOI: 10.9734/OR/2016/23417

Aims: To report a case of Waardeenburg Syndrome Type 1 presenting with bilateral blue iris in a young Asian.

Presentation of Case: A 7-year old Filipino girl was referred for ophthalmologic evaluation for bilateral blue eyes. She also presented with an eyebrow flare, broad nasal root, dystopia canthorum, heterochromic fundi and mild hearing loss. Her medical, developmental and family histories were unremarkable.

Discussion: Waardenburg Syndrome is a rare clinical disorder with oculocutaneous pigmentary anomalies, deafness and dystopia canthorum as major features. Diagnosed clinically using a Consortium criteria, this is one of the differential diagnoses when presented with a patient with bilateral blue eyes. There have been reports of this disorder in Asia but there are no known published articles or cases from the Philippines.

Conclusion: This is the first reported case of Waardenburg Syndrome in the country. This case presented with an atypical combination of bilateral blue eyes and heterochromic fundi in a young Asian girl.


Open Access Original Research Article

Retinal Nerve Fiber Layer Thickness in Normal Indian Pediatric Population of North India Measured with Optical Coherence Tomography

Ojha Sushil, Sharma Reena, Tandon Anupama, Jain Vaibhav, Singh Brijesh, Babbar Meenu, Shukla Dipendra

Ophthalmology Research: An International Journal, Page 1-6
DOI: 10.9734/OR/2016/20797

Purpose: To measure the peripapillary retinal nerve fiber layer thickness in normal paediatric population of rural India

Materials and Methods: 59 normal Indian children (117 eyes) of age range 5­17 years presenting to the Pediatric Clinic were included in this Observational cross sectional study. RNFL thickness was measured with cirrus high definition optical coherence tomography (OCT).

Inclusion Criteria: Any child of age 5 years to 17 years but cooperative for OCT.

Exclusion Criteria: Children with refractive errors strabismus or amblyopia, with neurological, metabolic, vascular, or other disorders and those with abnormal optic discs were excluded. Both eyes of each subject were scanned and selected for statistical analysis. The effect of age and gender on RNFL thickness was investigated statistically.

Results: The mean global RNFL thickness in males was 92.75±15.107 μm (range 48-144  μm) and that in females was 89.98±11.080 μm (range 68-101 μm) and the difference was not statistically significant (p=0.193). RNFL was thickest inferiorly (123.5±19.56 μm) and superiorly (112.7±25.16 μm), thinner nasally (68.95±13.24 μm), and thinnest temporally (66.36±12.97 μm). In correlation analysis, age had no statistically significant (P =0.702) effect on RNFL thickness.

Conclusion: Although in normal children, variation in RNFL thickness is large OCT can be used to measure and analyse RNFL thickness in children. The normative data provided by this study may assist in identifying changes in RNFL thickness in children of rural Indian population.


Open Access Original Research Article

Measurement of Choroidal Thickness in Patients of Pseudoexfoliation Syndrome Using Spectral Domain Optical Coherence Tomography

Shah Nawaz, Ejaz Akbar, Tariq Querishi, Asima Afzal

Ophthalmology Research: An International Journal, Page 1-7
DOI: 10.9734/OR/2016/23869

Introduction: Pseudoexfoliation (PEX) is a disorder characterized by the progressive accumulation of fibrillary extracellular deposits in several ocular tissues including the iris, anterior chamber angle, lens capsule and zonules. Pseudoexfoliation (PEX) syndrome is known to be associated with both ocular and choroidal blood flow changes. However there are only few studies regarding the Choroidal Thickness (CT) changes in PEX.

Aim: To evaluate the choroidal thickness in eyes with pseudoexfoliation syndrome using optical coherence tomography and to compare them with healthy controls.

Materials and Methods: Macular Choroidal thickness 70 patients of pseudoexfoliation syndrome and 70 control subjects were compared in this prospective study using Cirrhus Spectral Domain OCT (Carl Zeiss). The choroidal thickness (CT) is measured perpendicularly (from the outer edge of the hyper reflective retinal pigment epithelium to the inner sclera) at the fovea, and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal to the fovea using SD-OCT. Complete ocular and physical examination was also done in all subjects.

Results: The mean subfoveal CT was statistically significant thinner in PEX group as compared to healthy controls (245.48±36.42 μm vs. 312.43±30.21 μm, p value=0.03 respectively).

The mean CT 1.5mm and 3mm nasal of fovea was also statistically significant thinner in PEX group as compared to healthy controls (205.32±26.89 μm vs. 285.36±28.01μm, p value=0.02 and 145.28±38.92 μm vs. 198.56±32.21 μm, p value=0.04 respectively).

The mean CT 1.5 mm and 3 mm temporal of fovea was also thinner in PEX group as compared to healthy controls, however results did not reach any statistical significance.

Conclusion: PEX patients have thinner choroids as compared to clinically unaffected healthy individuals.


Open Access Original Research Article

Ocular Biometry Using Computed Tomography: In Jos, North Central Nigeria

A. J. Salaam, O. A. Aboje, S. M. Danjem, G. Tawe, A. A. Salaam

Ophthalmology Research: An International Journal, Page 1-6
DOI: 10.9734/OR/2016/23794

Aims and Objective: To determine the normal ocular dimensions (AP and width) in Jos, North Central Nigeria using computed tomography scan.

Subjects and Methods: The ocular images of 251 patients who had cranial CT in Jos University Teaching Hospital without obvious ocular anomaly were retrogressively studied. The antero-posterior (axial length) and width were obtained at the maximum mid-axial images showing the maximum size of the lens. Statistical information and analysis was performed using SPSS version 20. Pearson correlation was performed and the level of significance set at p=0.05 student t-test was also performed to compare the difference of the mean ocular dimensions and sexes.

Results: The mean axial length found was 24.61 mm (right) and 24.01 mm (Left) while the width was 24.31 mm (Right) and 23.21 mm (Left). The ocular biometry was slightly higher in the right eyeball than the left, and also in males than females (37.2±21.1 and 36.6±23.2 for the male and females respectively). All the axial lengths were higher than the width in both males and females.

Conclusion: The ocular biometry were noted to be higher in males compared to females. The dimensions were noted to increase with age, though not statistically significant. The axial length was higher than the width.


Open Access Review Article

Visual Impairment Following Stroke - The Impact on Quality of Life: A Systematic Review

Lauren R. Hepworth, Fiona J. Rowe

Ophthalmology Research: An International Journal, Page 1-15
DOI: 10.9734/OR/2016/23272

Background: The visual impairments caused by stroke have the potential to affect the ability of an individual to perform activities of daily living. An individual with visual impairment may also have reduced level of independence. The purpose of this review was to investigate the impact on quality of life from stroke related visual impairment, using subjective patient reported outcome measures.

Methods: A systematic search of the literature was performed. The inclusion criteria required studies to have adult participants (aged 18 years or over) with a diagnosis of a visual impairment directly resulting from a stroke. Studies which included visual impairment as a result of other intra-cranial aetiology, were included if over half of the participants were stroke survivors. Multiple scholarly online databases and registers of published, unpublished and ongoing trials were searched, in addition articles were hand searched. MESH terms and alternatives in relation to stroke and visual conditions were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second. The quality of the evidence was assessed using a quality appraisal tool and reporting guidelines.

Results: This review included 11 studies which involved 5646 participants, the studies used a mixture of generic and vision-specific instruments. The seven instruments used by the included studies were the EQ-5D, LIFE-H, SF-36, NEI VFQ-25, VA LV VFQ-48, SRA-VFP and DLTV.

Conclusion: A reduction in quality of life was reported by all studies in stroke survivors with visual impairment. Some studies used generic instruments, therefore making it difficult to extract the specific impact of the visual impairment as opposed to the other deficits caused by stroke. The majority of studies (8/11) primarily had participants with visual field loss. This skew towards visual field loss and no studies investigating the impact ocular motility prevented a comparison of the effects on quality of life due to different visual impairments caused by stroke. In order to fully understand the impact of visual impairment following stroke on quality of life, further studies need to use an appropriate vision-specific outcome measure and include all types of visual impairment which can result from a stroke.