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

Low-Power Very-Large-Scale Integration Implementation of Fault-Tolerant Parallel Real Fast Fourier Transform Architectures Using Error Correction Codes and Algorithm-Based Fault-Tolerant Techniques

As technology advances, electronic circuits are more vulnerable to errors. Soft errors are one among them that causes the degradation of a circuit’s reliability. In many applications, protecting critical modules is of main concern. One such module is Fast Fourier Transform (FFT). Real FFT (RFFT) is a memory-based FFT architecture. RFFT architecture can be optimized by its processing element through employing several types of adder and multipliers and an optimized memory usage. It has been seen that various blocks operate simultaneously in many applications. For the protection of parallel FFTs using conventional Error Correction Codes (ECCs), algorithmic-based fault tolerance (ABFT) techniques like Parseval checks and its combination are seen. In this brief, the protection schemes are applied to the single RAM-based parallel RFFTs and dual RAM-based parallel RFFTs. This work is implemented on platforms such as field programmable gate arrays (FPGAs) using Verilog HDL and on application-specific integrated circuit (ASIC) using a cadence encounter digital IC implementation tool. The synthesis results, including LUTs, slices registers, LUT–Flip-Flop pairs, and the frequency of two types of protected parallel RFFTs, are analyzed, along with the existing FFTs. The two proposed architectures with the combined protection scheme Parity-SOS-ECC present an 88% and 33% reduction in area overhead when compared to the existing parallel RFFTs. The performance metrics like area, power, delay, and power delay product (PDP) in an ASIC of 45 nm and 90 nm technology are evaluated, and the proposed single RAM-based parallel RFFTs architecture presents a 62.93% and 57.56% improvement of PDP in 45 nm technology and a 67.20% and 60.31% improvement of PDP in 90 nm technology compared to the dual RAM-based parallel RFFTs and the existing architecture, respectively

A case series of neuroendocrine (carcinoid) tumor metastasis to the orbit

PURPOSE/BACKGROUND: To report the clinical and radiographic features and treatment outcome of neuroendocrine tumor (carcinoid) metastasis to the orbit. MATERIALS AND METHODS: Retrospective chart review of four cases. RESULTS: Mean patient age at the time of diagnosis of the primary neuroendocrine tumor and orbital metastasis was 58 and 66 years, respectively, with a mean duration of 8 years between diagnosis of primary tumor and orbital metastasis. Primary neuroendocrine tumor sites were gastrointestinal tract (n = 2), lung (n = 1), and testicle (n = 1). The most common presenting symptom was diplopia (three cases). Magnetic resonance imaging revealed orbital tumor in all cases. Octreotide scan was positive in one case. Treatment was tumor excision in three cases followed by external beam radiotherapy in two cases and one patient was followed without treatment. Tumor cells showed immunoreactivity to chromogranin, synaptophysin, and neuron-specific enolase in all cases. Mean follow-up after orbital tumor diagnosis was 39 months. Three patients had known systemic extraorbital metastasis before orbital involvement (mean interval of 5.9 years) and one case had immediately after development of orbital metastasis. One patient had multiple recurrences of orbital metastasis and eventually underwent exenteration. Two patients died of disseminated metastasis between 2 and 3 years after diagnosis of orbital metastasis. CONCLUSION: All four patients with orbital metastasis from neuroendocine tumor had evidence of systemic extraorbital metastasis. Aggressive metastatic neuroendocine tumors of orbit can lead to local recurrence even after surgical excision and radiation. Imaging tests were helpful in allowing early diagnosis and for monitoring after treatment