Confocal Scan Features of Keratic Precipitates in Granulomatous versus Nongranulomatous Uveitis

Purpose: To compare the morphologic features of keratic precipitates (KPs) by confocal microscopy in granulomatous versus nongranulomatous noninfectious uveitis. Methods: KP morphology was determined by confocal scan in patients with noninfectious granulomatous and noninfectious nongranulomatous uveitic cases. Results: One hundred and twenty-seven eyes of 90 subjects with noninfectious uveitis were studied. Thirty-nine eyes had granulomatous and 88 had nongranulomatous uveitis. Smooth-rounded KPs were significantly more common in the granulomatous subgroup (P<0.001) while cruciform and dendritiform KPs were more frequent in nongranulomatous uveitis (P<0.001 and P<0.005 respectively). Conclusion: Confocal scan may be used as an adjunctive tool for differentiating granulomatous from nongranulomatous uveitis. Smooth-rounded KPs are strongly suggestive of granulomatous inflammation

Bilateral Primary Intraocular Lymphoma

Purpose: To report a case of bilateral primary intraocular lymphoma. Case report: A 33-year-old man presented with bilateral blurred vision since two years ago. Examination revealed large keratic precipitates, anterior chamber reaction, posterior subcapsular cataracts, and vitreous infiltration. After a short trial of topical and periocular steroids, diagnostic 25-gauge pars plana vitrectomy was performed and cytologic evaluation of the aspirate confirmed a diagnosis of intraocular lymphoma. The patient was subsequently managed with intravitreal methotrexate in both eyes and responded favorably. Central nervous system workup for lymphoma was negative. Conclusion: Primary intraocular lymphoma should be considered in young adults suffering from chronic recalcitrant panuveitis

A 27-Year Report from the Central Eye Bank of Iran: A complete translation from Farsi

This article is based on a study first reported in Farsi in the Bina Journal of Ophthalmology, titled گزارش عملکرد سه دهه اي بانک چشم جمهوري اسلامي ايران, Volume 24, Issue 2 (Winter 2019) 2019/05/28. Original URL: https://www.sid.ir/fa/journal/ViewPaper.aspx?ID=487896 Purpose: To report the 27-year statistical data from the Central Eye Bank of Iran (CEBI) and its activity. Methods: All CEBI records regarding procured eyes, tissue utilizations, corneal transplants per capita, and indications for keratoplasty from 1991 to 2017 were analyzed. Results: In total, 115,743 whole eyes were donated during the 27-year period. Out of the 114,169 eyes donated between 1994 and 2017, 95,314 eyes were distributed for transplantation, and 95,057 corneas were actually transplanted. The mean annual rate of corneal transplants per capita was 55.10−6 ± 27.10−6. Although penetrating keratoplasty (PKP, 70%) was the most common technique of corneal transplantation during the study period, it exhibited a decreasing trend between 2006 and 2017 (P = 0.048). It was in contrast to Descemet stripping automated endothelial keratoplasty (DSAEK) that demonstrated an increasing trend during the same period (P &lt; 0.001). Keratoconus (KCN, 39.70%) was the most leading indication for keratoplasty over the last three decades followed by bullous keratopathy (BK, 18.5%), corneal scar and opacities (15.7%), and graft failure (GF, 7.5%), with an increasing trend for BK, GF, and KCN. A majority of scleral tissues (83.7%) were utilized for orbital implant protection. Conclusion: An increasing trend in the number of procured eyes was observed over the past 27 years in Iran. The most leading indications for corneal transplantation were KCN and BK. While PKP was the most common keratoplasty technique, DSAEK showed an increasing trend over the last 12 years

Specular Microscopic Features of Corneal Endothelial Vacuolation

Purpose: To introduce a specular microscopic reference image for endothelial vacuolation in donated corneas. Methods: Two corneas from a donor with diffuse, round to oval dark areas at the endothelial level on slit lamp biomicroscopy and one normal-appearing donor cornea underwent specular microscopy, histopathologic evaluation and transmission electron microscopy. Results: Specular microscopy of the two corneas with abnormal-looking endothelium revealed large numbers of dark, round to oval structures within the endothelium in favor of endothelial vacuolation. Light microscopy disclosed variable sized cyst-like structures within the cytoplasm. Transmission electron microscopy showed electronlucent and relatively large-sized intracytoplasmic vacuoles. These features were not observed in the endothelium of the normal cornea. Conclusion: The specular microscopic features of endothelial vacuolation in donated corneas were confirmed by light microscopy and transmission electron microscopy, therefore the specular image may be proposed as a reference to eye banks

Thickness Profile of Donated Corneas Preserved in Optisol-GS versus Sinasol: An Ex-vivo Study

Purpose: This study aimed to compare the thickness profile and the endothelial cell density (ECD) of donated corneas maintained in Optisol-GS with those preserved in Sinasol over seven days. Methods: Twenty paired donor corneas were received from the Central Eye Bank of Iran. After recording the osmolarity of each medium, one of each of the cornea pairs was preserved in either Optisol-GS or Sinasol media. Then, slit-lamp biomicroscopy and specular microscopic examinations were performed at the baseline and on day seven. Visante optical coherence tomography (V-OCT) was also performed at 1 hour (h), 24h, 72h, and one week post-preservation. The specular microscopic and V-OCT values were then compared between the two groups. Results: The mean osmolarity of the Sinasol group was significantly less than the Optisol- GS group (296 vs. 366 mOsm/L, p = 0.0008). The mean central corneal thickness at the measurement points was comparable between the two groups. However, the increase of thickness one week post-preservation in the Sinasol group was remarkably lower than those in the Optisol-GS group (p&nbsp;= 0.019). Conclusion: Corneal storage in Sinasol over seven days provides better and superior maintenance and preservation of corneal tissue deturgescence and a lower rate of ECD loss over Optisol-GS

Pathogenic Tau Protein Species: Promising Therapeutic Targets for Ocular Neurodegenerative Diseases

Tau is a microtubule-associated protein, which is highly expressed in the central nervous system as well as ocular neurons and stabilizes microtubule structure. It is a phospho-protein being moderately phosphorylated under physiological conditions but its abnormal hyperphosphorylation or some post-phosphorylation modifications would result in a pathogenic condition, microtubule dissociation, and aggregation. The aggregates can induce neuroinflammation and trigger some pathogenic cascades, leading to neurodegeneration. Taking these together, targeting pathogenic tau employing tau immunotherapy may be a promising therapeutic strategy in fighting with cerebral and ocular neurodegenerative disorders

Meesmann Corneal Dystrophy; a Clinico-Pathologic, Ultrastructural and Confocal Scan Report

Purpose: To report the microstructural features of Meesmann corneal dystrophy (MCD) in two patients. Case Report: The first patient was a 10-year-old boy who presented with bilateral visual loss, diffuse corneal epithelial microcystic changes, high myopia and amblyopia. With a clinical impression of MCD, automated lamellar therapeutic keratoplasty was performed in his left eye. Histopathologic examination of the corneal button disclosed epithelial cell swelling and cyst-like intracytoplasmic inclusions. The cells contained moderate amounts of periodic acid-Schiff-positive and diastase-sensitive material (glycogen). Transmission electron microscopy revealed numerous vacuoles and moderate numbers of electron-dense membrane-bound bodies in the cytoplasm, similar to lysosomes, some engulfed by the vacuoles. The second patient was a 17-year-old female with a clinical diagnosis of MCD and episodes of recurrent corneal erosion. On confocal scan examination of both corneas, hyporeflective round-shaped areas measuring 6.8 to 41.4 μm were seen within the superficial epithelium together with irregular and ill-defined high-contrast areas in the sub-basal epithelial region. The subepithelial nervous plexus was not visible due to regional hyperreflectivity. Conclusion: This case report further adds to the microstructural features of Meesmann corneal dystrophy and suggests confocal scan as a non-invasive method for delineating the microstructural appearance of this rare dystrophy

Mutation Screening of Six Exons of ABCA4 in Iranian Stargardt Disease Patients

Purpose: Stargardt disease type 1 (STGD1) is a recessively inherited retinal disorder that can cause severe visual impairment. ABCA4 mutations are the usual cause of STGD1. ABCA4 codes a transporter protein exclusively expressed in retinal photoreceptor cells. The gene contains 50 exons. Mutations are most frequent in exons 3, 6, 12, and 13, and exons 10 and 42 each contain two common variations. We aimed to screen these exons for mutations in Iranian STGD1 patients. Methods: Eighteen STGD1 patients were recruited for genetic analysis. Diagnosis by retina specialists was based on standard criteria, including accumulation of lipofuscin. The six ABCA4 exons were PCR amplified and sequenced by the Sanger method. Results: One or more ABCA4-mutated alleles were identified in 5 of the 18 patients (27.8%). Five different mutations including two splice site (c.1356+1G&gt;A and c.5836-2A&gt;G) and three missense mutations (p.Gly1961Glu, p.Gly1961Arg, and p.Gly550Arg) were found. The p.Gly1961Glu mutation was the only mutation observed in two patients. Conclusion: As ABCA4 mutations in exons 6, 12, 10, and 42 were identified in approximately 25% of the patients studied, these may be appropriate exons for screening projects. As in other populations, STDG1 causative ABCA4 mutations are heterogeneous among Iranian patients, and p.Gly1961Glu may be relatively frequent