To describe two cases of herpetic keratitis after corneal collagen cross-linking (CXL) for progressive keratoconus. An 18-year-old male and a 21-year-old male with rapidly progressive keratoconus were treated with CXL. Postoperatively, on the 6th and 9th days respectively, a dendritic ulcer was observed in the treated eye. The corneal sensation was significantly diminished compared to the fellow eye. Both patients had no prior history of herpetic eye disease or cold sores. The keratitis improved dramatically over the following days after initiation of antiviral therapy. At 4 months, the visual acuity was stable without corneal scarring. Herpetic keratitis could be induced by CXL even in patients with no history of previous herpetic eye disease. Early diagnosis and proper treatment can facilitate the successful management of this rare but important complication.
PURPOSE:The purpose of the study is to determine the safety and efficacy of corneal collagen cross-linking for keratoconus in pediatric patients with and without vernal keratoconjunctivitis (VKC).METHODS:This is a retrospective analysis of 89 eyes of 58 patients <18 years of age that underwent corneal collagen cross-linking for progressive keratoconus; inclusion criteria included a minimum of 2-year follow-up after cross-linking. The main outcomes measures included keratometry, pachymetry, vision, and complications following epithelial-off cross-linking with the Dresden protocol.RESULTS:VKC patients were more likely to be male; 81.6% of the non-VKC patients and 96.3% of VKC patients were male (P = 0.038). Comparing pretreatment to the 2-year follow-up, there was no statistically significant change in the mean steep or flat keratometry, corneal thickness, and uncorrected visual acuity or best spectacle-corrected visual acuity in either group. There were no statistically significant differences in the mean visual, keratometric, or adverse event outcomes between the two groups. The proportion exhibiting progression of ectasia at 2 years was 18.5% in the VKC group and 16.7% in the non-VKC group (P = 0.83).CONCLUSIONS:Cross-linking appears to be as safe and effective in pediatric patients with vernal keratoconjunctivits as in those without, with similar outcomes, adverse events, and progression of keratoconus after treatment. The proportion of patients exhibiting progression appears to be higher in pediatric patients than adults, and there is an association between male sex and diagnosis of VKC.
Background Professionalism is hard to quantify but essential in medical practice. We present a survey tool for ophthalmologists that assessed professionalism using case-based scenarios in central Saudi Arabia. Methods Ophthalmologists (resident, fellows and consultants) participated in a web-based survey in 2015. Out of 44 attributes related to professionalism, experts selected 32 attributes with validity indices of ≥0.80. To evaluate these attributes, 51 scenario-based questions were developed and included in the survey. For each attribute, participants were given choices of close ended responses: unacceptable (1), probably unacceptable (2), acceptable (3), probably acceptable (4). The attribute score was compared to the gold standard (responses of an expert group). An attribute score was generated and compared among subgroups. Results Of the 155 ophthalmologists, responses of 147 ophthalmologists who completed more than 50% of questions were reviewed. Their mean attribute score was 84.1 ± 10.1 (Median 87.1; 25% quartile 78.1; minimum 50; and maximum 100). The variation in attribute score among consultants, fellows and resident ophthalmologists was significant (P = 0.008). The variation of attribute score by groups of attributes was also significant (P < 0.05). The score for ‘Personal characteristics’ was on a lower scale compared to that of other attribute groups. The variation in the scores for attribute groups; ‘Personal characteristics attribute’ group (p < 0.01) and ‘Workplace practices & relationship’ group (P = 0.03) for consultants, fellows and residents were significant. Conclusions Professionalism among ophthalmologists and those in training was high and influenced by years of experience. The survey tool appeared to show differences in responses to specific professional attribute groups between trainees and consultants. Additional studies with a larger sample size might be helpful in validating the survey as a tool to be used to assess professionalism in graduate medical education in ophthalmology.
Purpose: To report a rare incidence of corneal endothelial cell loss following airbag injury. Observation: A 27-year-old female who sustained a motor vehicle accident with airbag deployment presented with hand motion vision in the left eye. Ocular examination demonstrated corneal abrasion, significant corneal stromal edema with descemet folds, and a central pachymetry of 999 µm. The patient was managed with topical steroids and antibiotic drops. One week later, specular microscopy revealed a central endothelial cell count of 2200/mm2 with pleomorphism, polymegathism, and a decreased central corneal thickness of 569 µm. A repeat of specular microscopy 6 months later showed a decreased central endothelial cell count of 1611/mm2 with recovered visual acuity of 20/30. Conclusion: Corneal endothelial loss is a severe complication of ocular airbag injury. Serial ophthalmic assessment is recommended because endothelial cell loss may continue for some time after the initial impact.
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