Corneal tattooing with Chinese ink is a simple, effective outpatient procedure for treating painful BK in eyes with no visual potential.

Rationale:Canaliculitis is a frequently overlooked and misdiagnosed disease. Concurrent corneal ulceration with canaliculitis is uncommon. We report such a case.Patient concerns:An 87-year-old woman complained of swelling and pain of the right eye after acute angle closure glaucoma attack. Slit-lamp examination was compatible with the features of infectious keratitis, and the cultures from corneal scrapings grew Streptococcus anginosus later. Hourly topical vancomycin (25 mg/ml) was instilled, then the corneal ulceration improved initially but became stationary after 1-week treatment.Diagnosis:Discharge from the upper punctum was noted subsequently and canalicular concretions were found through curettage. The cultures from canalicular discharge and concretions also revealed the presence of S. anginosus. Thus, infectious keratitis secondary to canaliculitis was diagnosed.Interventions:Canaliculotomy was performed to remove the large concretion and vancomycin was injected locally.Outcomes:The corneal ulceration resolved after canaliculitis was appropriately treated.Lessons:Canaliculitis could be a reservoir for organisms that may make compromised corneas liable to infections. Only the appropriate diagnosis and aggressive treatment of canaliculitis leads to the eradication of associated corneal infections.

Purpose To report six cases of Klebsiella pneumoniae orbital cellulitis without preceding endophthalmitis. Method Retrospective chart review. Results We reported four females and two males admitted to our hospital for Klebsiella pneumoniae orbital cellulitis proven by computed tomographies and bacterial cultures from May 1995 to March 2017. Proptosis, conjunctival congestion, and chemosis and limitation of ocular motility were present in all six patients. Four patients had decreased visual acuities, and three of them recovered completely after treatment. The origin of the infection was sinus in four patients, skin wound in one patient, and sepsis presumably caused by a dental procedure in one patient. Three of all six patients had underlying diabetes mellitus. Two patients had orbital cellulitis before they were diagnosed of diabetes during hospital stay. Conclusion Diabetes may be a risk factor of Klebsiella pneumoniae orbital cellulitis, especially for those of nonsinus origin.

BACKGROUND: A smartphone microscope adapter is an alternative to a permanently mounted camera, which often requires a specially designed light path as well as a computer system for data storage and network connectivity. A common disadvantage of these adapters is that they need to be repeatedly mounted and dismounted; this is inconvenient during serial observations. PURPOSE: The study purpose is to develop and test a semi-permanent microscope adapter. METHODS: Our prototype was designed using three-dimensional (3D) computer-aided design software and was 3D printed for testing. Two tests were designed to quantify the workflow improvement by measuring the time required to complete specific movements, which simulated the actions of capturing photographs by using an adapter and a slit-lamp biomicroscope. Our prototype was the experimental adapter, and two commercially available products were used as references. A single-shot test measured the average time required to complete a photographing cycle, in which a single photograph was recorded. A multiple-shot test measured the time required to complete cycles in which a different number of photographs were captured; thus, the time required specifically for the preparation phase of photographing was determined. Both tests were performed by 4 researchers. RESULTS: The average time required to complete a cycle using our prototype in single-shot test was significantly shorter than that using one of the references. For the other reference, significances were shown in 2 testers’ results. In the multiple-shot test, the linear regression analysis also showed that the preparation phase of our prototype was significantly shorter than the preparation phase of the two commercially available products ( P < 0.001). CONCLUSIONS: The semi-permanent design may improve the workflow of photography using smartphone adapters, thereby reducing the time and effort required for preparing devices, particularly when making multiple consecutive observations or when the targets disappear fast.

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The size of one’s pupil can indicate one’s physical condition and mental state. When we search related papers about AI and the pupil, most studies focused on eye-tracking. This paper proposes an algorithm that can calculate pupil size based on a convolution neural network (CNN). Usually, the shape of the pupil is not round, and 50% of pupils can be calculated using ellipses as the best fitting shapes. This paper uses the major and minor axes of an ellipse to represent the size of pupils and uses the two parameters as the output of the network. Regarding the input of the network, the dataset is in video format (continuous frames). Taking each frame from the videos and using these to train the CNN model may cause overfitting since the images are too similar. This study used data augmentation and calculated the structural similarity to ensure that the images had a certain degree of difference to avoid this problem. For optimizing the network structure, this study compared the mean error with changes in the depth of the network and the field of view (FOV) of the convolution filter. The result shows that both deepening the network and widening the FOV of the convolution filter can reduce the mean error. According to the results, the mean error of the pupil length is 5.437% and the pupil area is 10.57%. It can operate in low-cost mobile embedded systems at 35 frames per second, demonstrating that low-cost designs can be used for pupil size prediction.

We try to evaluate glaucoma management numbers in patients with both glaucoma and obstructive sleep apnea (OSA) using the National Health Insurance Research Database (NHIRD) of Taiwan. A retrospective cohort study was conducted and patients with glaucoma were enrolled and divided into the OSA and non-OSA populations. A total of 11,778 participants were selected in both the OSA and non-OSA groups. The primary outcomes were the number of anti-glaucomatous medications each year and the total number of glaucoma laser and glaucoma surgeries. The Cox proportional hazard regression was utilized to produce the adjusted hazard ratios (AHR) with corresponding 95% confidence intervals (CI) between the two groups. After a study period of 18 years, 286 and 352 events of laser and surgeries for glaucoma were found in the OSA and non-OSA groups, respectively. After considering the effect of potential confounders, no significant difference concerning the numbers of laser trabeculoplasty, trabeculectomy and tube shunt surgery, cyclodestructive procedure and eyeball removal were found between the two groups (all 95% CIs included one). In addition, the multiple anti-glaucomatous medication usages were similar between the two groups (all p > 0.05) In the subgroup analyses, glaucoma patients older than 60 years and with OSA received significantly lesser trabeculectomy and tube shunt surgery compared to glaucoma patients older than 60 years without OSA (AHR: 0.774, 95% CI: 0.611–0.981) while other analyses revealed insignificant results (all 95% CIs included one). In conclusion, the presence of OSA does not increase the need for glaucoma management.

We aimed to survey the risk of external eye diseases in those with ankylosing spondylitis (AS) via the National Health Insurance Research Database (NHIRD) in Taiwan. We conducted a retrospective cohort study, and subjects diagnosed with AS were selected from the NHIRD. Then, the AS patients were matched 1:1 by propensity-score matching (PSM) to non-AS patients, and a total of 6754 participants were included in the AS and non-AS groups. The main outcomes were regarded as the occurrence of dry eye disease (DED), superficial keratopathy and corneal ulcers. We used Cox proportional hazard regression to yield the adjusted hazard ratios (AHR) with 95% confidence intervals (CI) between the AS and non-AS groups. There were 709 and 408 external eye disease events that occurred in the AS and non-AS groups after a tracking interval of up to 17 years. The incidence of all external eye diseases was significantly higher in the AS group than the non-AS group (AHR: 1.826, 95% CI: 1.616–2.063, p < 0.0001). Additionally, the rates of DED (AHR: 1.973, 95% CI: 1.701–2.290, p < 0.0001) and superficial keratopathy (AHR: 1.593, 95% CI: 1.347–1.883, p < 0.0001) were significantly higher in the AS group than the non-AS group. In the sub-group analyses, the possibility of any external eye disease (p = 0.0030) and DED (p = 0.0386) was decreased in the older age group compared to those in the middle-aged group. In conclusion, AS is significantly correlated to subsequent external eye diseases, mainly the DED and superficial keratopathy.