In vivo confocal microscopy in hydroxychloroquine-induced keratopathy

Background: Vortex keratopathy, arising as a side effect of several medications, is characterized by golden-brown deposits in the cornea. Methods: A 41-year-old woman treated for sarcoidosis with hydroxychloroquine therapy and suffering from vortex keratopathy was examined by in vivo confocal microscopy. Scans of both corneas were performed. Results: By slit lamp examination, the left but not the right eye showed a golden-brown deposit throughout the cornea. In vivo confocal microscopy revealed the presence of highly reflective, dot-like intracellular inclusions concentrated in the basal epithelial layer. They were also detected within the anterior and posterior stroma, but not within the endothelium. In regions of the anterior stroma, devoid of inclusions, hyperreflective ramified keratocytes were observed, forming an extended interconnecting network. Conclusion: In addition to the granular deposits, in vivo confocal microscopy revealed hyperreflective, possibly phagocytic keratocyte

Bilateral corneal perforation in familial amyloidotic polyneuropathy

Purpose: We report the progression of bilateral central perforating ulceration in the cornea of a patient with familial amyloidotic polyneuropathy (FAP), also known as hereditary Portuguese amyloidosis, who received two corneal grafts in an interval of 6 years. The pathology of the original host and the grafted cornea is described. Methods: Overall histology and immunolocalization of transthyretin, amyloid beta (Aβ), and epithelial and inflammatory markers were performed. Results: Corneal sensitivity and tear film were reduced. The grafted but not the original tissue contained amyloid deposits with transthyretin immunoreactivity. Epithelial and stromal thinning was accentuated in the graft, with epithelial dysplasia, hyperproliferation, and parakeratosis. Abundance of basement membrane material in hyperproliferative regions suggested recurrent attempts of wound healing. Activated keratocytes, ingrowth of vessels, infiltrated inflammatory, and immune cells reflect both acute and chronic inflammation. Conclusion: Amyloid deposits may progressively reduce corneal sensitivity and damage epithelium and stroma. Corneal neuropathy, together with impaired tear film, may entail the pathology of dry eyes as a bystander effect, contributing to exacerbation of epithelial injury, deregulated proliferation, and parakeratosis. Once established, both acute and chronic inflammation may sustain progression of the corneal patholog

Thrombus and branch retinal vein occlusion

Branch retinal vein occlusion (BRVO) is often associated with arteriosclerosis. Typically the occlusion occurs at an arteriovenous crossing. We report a case of a previously healthy patient who developed a BRVO. Funduscopy and fluorescein angiography suggested an intravascular thrombus as the cause of the occlusion. The investigations performed were positive for systemic hypertension and hyperlipidaemia. After 2 months, fundus examination revealed disappearance of the intravascular thrombus, resolution of the macular edema and improvement of the — visual acuity. Certain physiological characteristics of the retinal circulation associated with hyperlipidaemia and systemic hypertension appear to favour thrombus formatio

Functional study in NSE-Hu-Bcl-2 transgenic mice: a model for retinal diseases starting in Müller cells

In NSE-Hu-Bcl-2 transgenic mice, line 71, retina undergoes early postnatal degeneration linked to the prior death of Müller cells. The purpose of this study was to complete the characterization of this retinal dysfunction by using electroretinographic (ERG) recordings in both scotopic and photopic conditions. Here, we showed that both rod and cone systems were profoundly affected in NSE-Hu-Bcl-2 transgenic mice as soon as 15 postnatal days in accordance with histological study performed previousl

Outbreak of Endophthalmitis After Cataract Surgery: The Importance of the Quality of the Surgical Wound

Postoperative endophthalmitis is a rare but potentially devastating condition. We investigated an outbreak of 8 cases of endophthalmitis in patients who underwent phakectomy performed by a single surgeon from January through September 2004. The outbreak was traced to damaged surgical blades, and it highlights the importance of the quality of the surgical woun

Remodeling of retinal capillaries in the diabetic hypertensive rat

PURPOSE. To document the effect of sustained systemic hypertension on the integrity and ultrastructural morphology of retinal capillaries in diabetic and nondiabetic rats. METHODS. Normotensive (strain Wistar-Kyoto; WKY) and genetically hypertensive (spontaneously hypertensive; SHR) rats were rendered diabetic by intravenous streptozotocin injection. At 20 weeks of diabetes, endothelial cells, pericytes, and extracellular matrix were evaluated by ultrastructural morphometry. Serum albumin was localized by immunofluorescence microscopy. RESULTS. The endothelial cell layer was markedly thinner in the diabetic normotensive animals. The number of intercellular junctions was reduced in both the nondiabetic and diabetic hypertensive group but less so in the diabetic normotensive group. No significant endothelial cell loss was noted in either of the experimental groups, whereas the number of pericytes and the number of their cytoplasmic processes were reduced in diabetic and hypertensive animals. Significant thickening of the basement membrane and increased permeability to serum albumin were observed in diabetic and hypertensive rats and were strongly enhanced in the combined diseases. CONCLUSIONS. Endothelial thinning and shape changes from an elaborate to a simpler form as well as rounding up of the pericytes and loosening of their vascular sheaths indicate remodeling of the vascular wall during chronic diabetes and sustained hypertension, before a characteristic vasculopathy becomes manifest. The combination of diabetes and hypertension enhances these features, as well as basement membrane thickening and breakdown of the blood-retinal barrier. (Invest Ophthalmol Vis Sci. 1999;40:2405-2410 E ssential hypertension, prevailing in persons with diabetes, 1,2 increases the risk of nephropathy 3,4 and morbidity and death of cardiovascular disease. 5 It is also one of the most important risk factors for diabetic retinopathy, influencing both its development and severity, 6 -8 and thereby plays a major role in visual loss in diabetic patients. -10 Because both hypertension and diabetes have an impact on the vascular wall, 11,12 they may act in an additive or synergistic manner. Indeed, thickening of the basement membrane, degeneration of pericytes, and rarefaction of vessels are features common to both diseases, whereas constriction of the capillaries in the hypertensive state or their dilation in the diabetic state are divergent traits. 22 This situation may lead to an increase in vascular wall shear stress and, eventually, to lasting endothelial damage. Moreover, in spontaneously hypertensive diabetic rats (SHR strain), the deposition of advanced glycation end products (AGEs) in arterioles and the occurrence of acellular retinal capillaries and microthromboses are strongly enhanced but can be corrected by aminoguanidine treatment that prevents the formation of AGEs. In this study, we documented the effect of diabetes on the structure of retinal capillaries in SHR and normotensive (Wistar-Kyoto; WKY) rats. The model of the SHR rat shares several features with essential hypertension in human

Clinical course of epidemic keratoconjunctivitis: evaluation by in vivo confocal microscopy

PURPOSE: To describe, by in vivo confocal microscopy, the structural changes occurring during the course of adenovirus epidemic keratoconjunctivitis (EKC), from the onset of the disease up to 24 weeks of follow-up. METHODS: Eight patients (age, 8-57 years) with clinical evidence of EKC were examined and photographed in vivo with a Heidelberg Retina Tomograph II, Rostock Cornea Module. RESULTS: At 1 week, confocal microscopy revealed clusters of hyperreflective cells in the basal epithelial cell layer. In these sites, we observed subepithelial accumulations of dendritic cells, located mainly at the level of the Bowman layer. Underneath in the anterior stroma, we detected clusters of highly reflective, irregularly shaped cells. At 2 weeks, all patients presented follicular conjunctivitis, focal keratitis, and subepithelial infiltrates. At this point, confocal microscopy revealed persistent clusters of hyperreflective basal epithelial cells intermingled with roundish cells that probably represent leukocytes. Underneath, dendritic cells had formed an intricate network and, in the anterior stroma, we detected a hyperreflective cellular plaque that corresponded to the subepithelial infiltrate. At 24 weeks after onset of the symptoms, density and dimension of dendritic cell clusters were decreased, but we now detected stromal hyperreflectivity in the midstroma. CONCLUSIONS: In vivo confocal microscopic examination of subepithelial infiltrates appearing during EKC suggests that the innate immune system, as represented by the dendritic cells, is highly active early on. Nonetheless, the inflammatory component in both epithelium and stroma is massive and, in deeper stromal layers, long standing

Hémorragie intra-vitréenne et « whole-body vibration training » — une association ?

Des exercices statiques ou non statiques effectués sur une plateforme vibrante (Whole-body vibration training — WBV) sont proposés comme un complément attractif et efficace, voire comme une alternative à un entraînement d'endurance. Jusqu'à présent, aucun effet oculaire secondaire n'a été décrit. Nous rapportons le cas d'un homme, âgé de 43 ans, ayant présenté une hémorragie vitréenne spontanée deux semaines après avoir débuté un entraînement avec plateforme vibrante. Nous rappelons brièvement les effets secondaires connus au niveau oculaire lors d'une exposition répétée à des vibrations, et discutons de la possible association entre la survenue de cette hémorragie vitréenne et l'utilisation de cet appareil. À notre connaissance, il s'agit de la première description d'un effet secondaire oculaire probablement dû au WBV. Whole-body vibration training, i.e., standing in different static positions or exercising on a vibrating platform, has been promoted as an attractive and efficient complement, or even alternative, to resistance training. No ocular side effects have been described until now. We describe the case of a 43-year-old man who presented 2 weeks after starting whole-body vibration training with a spontaneous vitreous hemorrhage. We briefly discuss the ocular effects of habitual exposure to vibration described in the literature. This case suggests that whole body vibration training can cause spontaneous vitreous hemorrhage. To our knowledge, this is the first report of a possible ocular side effect of whole-body vibration training