https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-0691.2010.03175.x

Lyme borreliosis: Clinical case definitions for diagnosis and management in Europe

Purpose: Uveitis is a common, sight-threatening inflammatory ocular disease and includes multiple heterogeneous clinical entities. The prevalence of various types of uveitis depends upon multiple f...

A Focus on the Epidemiology of Uveitis.

Purpose To formulate and test an algorithm using minimal topographic criteria for accurately diagnosing clinical keratoconus. Setting Subspecialty cornea practice and Keratoconus Genetic Research Project. Methods Both eyes of 86 keratoconic patients who had never worn contact lenses and 195 normal participants were studied with the TMS-1 videokeratoscope to evaluate the KISA% index, an algorithm that topographically quantifies the phenotypic features of keratoconus. The diagnostic efficacy of the KISA% index was compared with that of the modified Rabinowitz/McDonnell (K- and I–S values) and the Maeda/Klyce (KCI% and KPI) indices. The same indices were calculated for an additional 8 eyes with keratoconus-suspect topography and 12 eyes with early keratoconus. Results The mean KISA% was significantly greater in the keratoconus group (10 382%) than in the normal control group (20.44%) with minimal overlap. At a cutoff point for KISA% of 100, 280 of 281 participants (99.6%) were correctly classified. In contrast, the correct classification rate for the other indices were KCI%, 274 of 281 (97.5%); KPI, 249 of 281 (88.6%); K, 272 of 281 (96.8%); I–S, 269 of 281 (95.7%). Six of the 8 eyes with keratoconus-suspect topography had a KISA% between 60% and 100%, and 11 of the 12 eyes with early keratoconus had a KISA% greater than 100%. Conclusions The KISA% index set at 100 was highly sensitive and specific for diagnosing keratoconus; a range of 60% to 100% may be useful for designating suspects. This index is more useful than any of the other currently available tools for classifying patients with keratoconus for computerized segregation analysis and for distinguishing eyes with keratoconus from normal eyes in topographic screening of refractive surgical candidates.

KISA% index: a quantitative videokeratography algorithm embodying minimal topographic criteria for diagnosing keratoconus

PURPOSE To use the anterior corneal surface higher order aberrations as a tool to detect and grade keratoconus using corneal map analysis videokeratoscopy. METHODS A prospective observational comparative study of 80 eyes was performed. The eyes were divided into two groups. Group A comprised 40 eyes of 20 asymptomatic individuals with no ocular pathology. Mean sphere was -0.03 diopters (D) (range: +0.75 to -0.75 D), mean cylinder was -0.27 D, mean average K was 43.28 D, and mean uncorrected visual acuity (UCVA) was 1.01. Group B comprised 40 eyes of 25 patients with keratoconus. Mean sphere was -3.70 D (range: +2.00 to -10.00 D), mean cylinder was -3.82 D, mean average K was 49.29, and mean best spectacle-corrected visual acuity (BSCVA) was 0.61. RESULTS In group A, mean root-mean-square (RMS) of spherical (Z4 and Z6), coma-like (Z3, Z5, and Z7), and higher order aberrations (Z3-7) were 0.38 microm, 0.35 microm, and 0.52 microm, respectively. In group B, mean RMS of spherical, coma-like, and higher order aberrations were 1.06 microm, 2.90 microm, and 3.14 microm, respectively, for a 6.0-mm simulated pupil diameter. Mean RMS differences between the two groups were 0.68 microm (P < or = .0002), 2.55 microm (P < or = .0001), and 2.61 microm (P < or = .0001) for spherical, coma-like, and total higher order aberrations, respectively. In group B, according to Amsler-Krumeich classification, the mean RMS of coma-like aberration was 1.87 microm in grade I (14 eyes), 2.97 microm in grade II (11 eyes), 3.46 microm in grade III (12 eyes), and 5.20 microm in grade IV (3 eyes). CONCLUSIONS Corneal higher order aberrations, especially coma-like aberrations, are significantly higher in eyes with keratoconus than normal eyes. Coma-like aberrations, with the aid of a corneal aberrometry map, are good indicators for early detection and grading of keratoconus.

Corneal Higher Order Aberrations: A Method to Grade Keratoconus

A review of keratoconus: Diagnosis, pathophysiology, and genetics.

Purpose The present study was designed to evaluate the topography of a series of keratoconus patients. Subjects and methods Using a computer-assisted videokeratography (Eye Sys) we determined the topographic findings of 85 eyes of 46 consecutive patients with keratoconus. We analysed some quantitative topographic parameters like: power at the apex, central corneal power, the amount of irregular astigmatism, distance between the apex and the visual axis, difference in central corneal power between the two eyes of the same individual and steepening of the inferior cornea compared with the superior cornea. Results Keratoconic topographic alterations were classified into two groups. Fifty seven of the cones (71%) could be described as peripheral with steepening of the cornea extending to the limbus. The remaining twenty three eyes (29%) had steepening confined to the central cornea. In many instances corneal topography was characterized by a high degree of nonsuperimposable mirror image symmetry (enantiomorphism) in the location of the topographic alterations between the two eyes of an individual patient. In all patients, irrespective of the topographic pattern, the inferior midperipheral cornea was steeper than superior cornea as quantified by an l-S value. Conclusion Study of the topography in keratoconus using this technique may prove useful for documenting the pattern of involvement of the anterior corneal surface and providing insight into the pathogenesis of this condition.

Corneal topography of keratoconus

The aim of this study was to assess and compare the frequencies of uveitis etiology in inhabitants of rural and urban areas of mid-eastern Poland. We reviewed the cases of 563 patients (263 males, 300 females; aged 2-87) with uveitis, treated at the 1st Department of Ophthalmology at the Medical Academy in Lublin and at the District Ophthalmic Hospital in Kielce, Poland, from January 1996-December 2000. Anatomical classification of uveitis was used according to the International Uveitis Study Group and etiological classification including uveitis associated with trauma, infection, systemic disease, non-associated with a systemic disease and masquerade syndromes. Data regarding age, gender, place of residence, anatomical location and etiology of uveitis were obtained. Statistical analyses were performed using Pearson's chi-square test, Spearman's rank correlation test and logistic regression. Etiology of uveitis was established in 70.0% of cases. The most common cause of uveitis was infection. Patients from rural areas were significantly more likely to have uveitis of infectious origin whereas patients from urban areas significantly more likely to have uveitis associated with a systemic disease. In conclusion, the pattern of uveitis in mid- eastern Poland confirms the influence of environmental factors on the etiology of this heterogenous disease.

http://www.aaem.pl/pdf-72755-12636?filename=Etiology of uveitis in.pdf

Etiology of uveitis in rural and urban areas of mid-eastern Poland.

We reviewed ophthalmic manifestations in Lyme borreliosis, concentrating on clinical and laboratory diagnosis, differential diagnosis and treatment options. Ocular involvement may occur in every stage of the disease. Conjunctivitis and episcleritis are the most frequent manifestations of the early stage. Neuro-ophthalmic disorders and uveitis occur in the second stage whereas keratitis, chronic intraocular inflammation and orbital myositis have been reported in the third stage of borreliosis.

Ophthalmic manifestations in Lyme borreliosis

Purpose The aim of the present study was to investigate the effect of conventional and mitomycin trabeculectomy on the corneal astigmatism. Subject and methods Measurements with the use of computer-assisted videokeratography (Eye-Sys) were performed in 34 glaucoma patients who underwent trabeculectomy. Color-coded topography maps were analyzed to obtain astigmatic data. Results The mean surgically-induced astigmatism in conventional trabeculectomy group was 2.2 D and in the mitomycin group 4.0 D, 1 day post-op, 1.3 D and 3.0 D after 10 days and 0.4 D and 1.1 D after 3 months, respectively. Conclusion There was an apparent correlation between the amount of induced astigmatism and the use of mitomycin. This may be related to the impaired healing process of trabeculectomy wound and lower intraocular pressure in the mitomycin group.

Corneal astigmatism after trabeculectomy

Fungal keratitis, an important cause of corneal infectious disease, is one of the most challenging types of microbial keratitis to diagnose, isolate the etiologic fungal organism and treat successfully. Aspergillus spp. are most commonly responsible for fungal keratitis worldwide. Most cases occur in hot, humid climates. Fungi invade the ocular surface only when it is compromised and gain access into the corneal stroma through a defect in the epithelial barrier. Pathogens multiply then, and cause inflammatory reaction together with tissue necrosis. Symptoms of fungal keratitis typically are not as acute as those of other forms of microbial keratitis. On examination, both signs seen in other forms of microbial keratitis and specific features of fungal keratitis are observed. In all cases with suspected fungal keratitis, corneal smears and cultures should be performed as soon as possible. Antifungal therapy should be restricted to those cases with fungus-positive laboratory results. The use of topical corticosteroids in the treatment of fungal keratitis is contraindicated. In about one-third of patients pharmacological therapy is not successful. In those cases, surgical intervention is essential. The main goal of surgical intervention is to control infection and maintain the integrity of the globe. The most commonly performed surgery in fungal keratitis is therapeutic penetrating keratoplasty. The use of topical corticosteroids is contraindicated in early postoperative period.

[Fungal infections of the cornea--diagnostics and management].

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