Giant fornix syndrome: a case series.

PURPOSE: To describe the demographics, characteristics, and treatment of giant fornix syndrome, a rare cause of chronic purulent conjunctivitis in the elderly. METHODS: Retrospective chart review of five patients with giant fornix syndrome evaluated by the Cornea Service, Oculoplastics and Orbital Surgery Service and the Department of Pathology at the Wills Eye Institute. RESULTS: The median age of the 5 female patients was 75 years (mean 80, range 70-95). The median duration of eye symptoms before presentation was 2 years (mean 2.4, range 1-4). Before referral, the chronic conjunctivitis was treated with topical antibiotics in all 5 cases and with additional dacryocystorhinostomy in one case. The right eye was affected in 2 cases, and the left eye was affected in the other 3 cases. Floppy eyelids were present in 2 cases. The superior fornix was involved in 4 cases, and the inferior fornix was involved in one case. Pseudomembranes and superficial punctate keratitis (SPK) were seen in 3 cases. Diagnosis of giant fornix syndrome was made in all 5 cases. Conjunctival culture grew methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and S. aureus in singular cases. Case 1 was treated with topical moxifloxacin, Case 2 was treated with topical vancomycin and repair of the upper eyelid, Case 3 was treated with topical besifloxacin, and Case 4 was treated with dacryocystorhinostomy and topical vancomycin. Case 5 was treated with reconstruction of the left upper eyelid. The median duration of follow up was 4 months (mean 21.6, range 1-84). CONCLUSIONS: Giant fornix syndrome can lead to chronic relapsing conjunctivitis in the elderly. Deep conjunctival fornices in affected patients can be a site for prolonged sequestration of bacteria causing recurrent infections. Removing the infected debris from the superior fornix and reconstruction of the upper eyelid may prevent the recurrent chronic persistent infection

Macrostriae and Descemet\u27s membrane folds in the Descemet\u27s stripping endothelial keratoplasty graft.

Descemet\u27s stripping endothelial keratoplasty (DSEK) is a good alternative to penetrating keratoplasty in eyes with endothelial dysfunction due to faster healing, better refractive outcomes, absence of suture-related complications, and better wound security. The complications usually encountered after DSEK are graft dislocation, detachment, and rejection, secondary glaucoma, epithelial downgrowth, retrocorneal fibrous membrane, aqueous misdirection, cataract development and other minor non-vision threatening complications.[1–3] Wrinkles or folds after endothelial keratoplasty can cause poor visual outcome.[4] We report a case of macrostriae and Descemet\u27s membrane folds in a DSEK graft. A 63-year-old woman with a 4-year history of Fuchs\u27 endothelial dystrophy in both eyes (OU) presented with floaters in her left eye (OS). She had undergone uncomplicated cataract surgery with posterior chamber intraocular lens implantation OS 3 years ago. One year later, she developed blurred vision in the same eye. Visual acuity was 20/200 OU. Increasing corneal edema was noted OS. The intraocular pressure (IOP) was 15 mm Hg in the right eye (OD) and 18 mm Hg OS. Central corneal thickness was 575 mm OD and 630 mm OS. Pseudophakic bullous keratopathy and progressive Fuchs’ dystrophy OS was diagnosed and DSEK OS was performed

Assessing Corneal Endothelial Damage Using Terahertz Time-Domain Spectroscopy and Support Vector Machines

The endothelial layer of the cornea plays a critical role in regulating its hydration by actively controlling fluid intake in the tissue via transporting the excess fluid out to the aqueous humor. A damaged corneal endothelial layer leads to perturbations in tissue hydration and edema, which can impact corneal transparency and visual acuity. We utilized a non-contact terahertz (THz) scanner designed for imaging spherical targets to discriminate between ex vivo corneal samples with intact and damaged endothelial layers. To create varying grades of corneal edema, the intraocular pressures of the whole porcine eye globe samples (n = 19) were increased to either 25, 35 or 45 mmHg for 4 h before returning to normal pressure levels at 15 mmHg for the remaining 4 h. Changes in tissue hydration were assessed by differences in spectral slopes between 0.4 and 0.8 THz. Our results indicate that the THz response of the corneal samples can vary according to the differences in the endothelial cell density, as determined by SEM imaging. We show that this spectroscopic difference is statistically significant and can be used to assess the intactness of the endothelial layer. These results demonstrate that THz can noninvasively assess the corneal endothelium and provide valuable complimentary information for the study and diagnosis of corneal diseases that perturb the tissue hydration