Outbreak of Fusarium keratitis in soft contact lens wearers in San Francisco.
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Adult↗
Biomedical subjects
Erich C Strauss
Publications and source records attributed to Erich C Strauss.
Metaplastic squamous epithelial downgrowth after clear corneal cataract surgery.
PURPOSE: To report a case of metaplastic squamous epithelial downgrowth after cataract surgery. DESIGN: Interventional case report. METHODS: Clinical, laboratory, and histologic findings are presented. Our study is in compliance with institutional review board guidelines. RESULTS: A 76-year-old man developed anterior chamber inflammation five months after uncomplicated clear corneal cataract surgery. Despite antimicrobial and anti-inflammatory therapies, the inflammation persisted. An extensive examination failed to demonstrate an infectious etiology or lymphoma. Subsequently, the patient developed an incipient limbal lesion and iris mass. Immunostaining of a biopsy specimen from the iris mass indicated an epithelial-derived tumor. The prephthisical and painful eye was enucleated; histopathology of the globe revealed a contiguous lesion extending from the limbal mass to the iris tumor through the surgical incision site, a finding consistent with metaplastic squamous epithelial downgrowth. Systemic evaluation was negative. CONCLUSIONS: After intraocular surgery, metaplastic epithelial downgrowth may occur as a consequence of occult ocular surface squamous neoplasia and masquerade as chronic inflammation; clinicians should be aware of this rare complication.
Aged↗
"Steel wool keratopathy": a clinical sign of chronic inflammation.
PURPOSE: To introduce into the clinical nomenclature a sign frequently observed in our patients with persistent corneal inflammation associated with herpetic stromal keratitis. METHODS: Case reports and review of the literature. RESULTS: Four representative patients with herpesvirus stromal keratitis are presented. Herpes simplex virus-1 (HSV-1) was confirmed by culture in 1 case and by polymerase chain reaction in a second case. In the remaining 2 cases, the diagnosis was made based on characteristic clinical findings for herpes simplex virus and varicella zoster virus (VZV). On clinical examination, all 4 representative cases of stromal keratitis revealed a well-defined, localized region of intertwined, metallic-like, polychromatic material in the corneal stroma, a sign we have termed steel wool keratopathy. We have only rarely observed this finding in patients with stromal keratitis not caused by a herpesvirus. CONCLUSION: Steel wool keratopathy seems to represent a focal region of stromal degeneration or deposition associated with chronic inflammation. Although we most often observe this finding in patients with stromal keratitis secondary to HSV or VZV, we cannot exclude the possibility that this sign represents the sequelae of chronic/recurrent inflammation rather than a specific pathologic response to herpetic antigens.
Acyclovir↗
Management of prominent iris vascular tufts causing recurrent spontaneous hyphema.
PURPOSE: To report the management of recurrent, spontaneous hyphema associated with florid iris vascular tufts in a patient presenting for cataract surgery. METHODS: Interventional case report and review of the literature; presentation of clinical findings, iris angiography, and the argon laser regimen used to minimize potential corneal complications with increased total treatment energy. RESULTS: An 80-year-old man with a 20-year history of bilateral, recurrent, spontaneous hyphema associated with extensive iris vascular tufts presented with visually significant cataracts. Serial argon laser photocoagulation treatment of the prominent, circumferential iris vascular tufts of the left eye arrested further episodes of spontaneous hyphema and facilitated uneventful cataract surgery. Argon laser parameters were titrated to therapeutic effect during the initial treatment sessions, and sectoral photocoagulation of the circumferential vascular tufts was performed during a 5-month period to accommodate increased laser power and energy. The total energy required to complete treatment of the extensive lesions was substantially more than that in similar previous reports; however, no adverse corneal complications were associated with the laser therapy. CONCLUSIONS: This case appears to represent the first description of chronic, bilateral, recurrent spontaneous hyphema associated with iris vascular tufts. Argon laser treatment of symptomatic iris vascular tufts promotes resolution of recurrent, spontaneous hyphema and may serve to mitigate the risk of hemorrhage from these lesions during subsequent intraocular surgery. Conservative management of increased total treatment energy may minimize the potential risk of corneal decompensation with argon laser therapy.
Aged↗
Diagnosis of conjunctival B-cell lymphoma by polymerase chain reaction heteroduplex analysis.
PURPOSE: To report a case initially assessed as giant papillary conjunctivitis and subsequently as B-cell lymphoma by the molecular technique of polymerase chain reaction heteroduplex analysis. DESIGN: Observational case report. METHODS: Clinical, histologic, immunohistochemical, and polymerase chain reaction heteroduplex analysis findings are presented. RESULTS: A 32-year-old man developed unilateral blepharoptosis secondary to an extensive palpebral conjunctival follicular-like process. Excisional biopsy showed a dense small lymphocyte infiltrate consistent with benign lymphoid hyperplasia by histology and immunohistologic marker studies. Polymerase chain reaction heteroduplex analysis revealed low-grade B-cell lymphoma, however. Systemic examination was negative. Focal radiation therapy was performed, and preliminary results show no signs of lymphoma. CONCLUSIONS: Polymerase chain reaction heteroduplex analysis established a diagnosis of conjunctival B-cell lymphoma in the absence of supporting histology and immunohistochemistry studies. This technique may provide independent, diagnostic distinction between benign lymphoid hyperplasia and low-grade B-cell lymphoma of the ocular adnexa.
Adult↗
Atopic ocular disease.
Atopic ocular diseases involve a spectrum of immuno-inflammatory responses. There are minimal pathologic changes with SAC. With PAC, there is increased mast cell activation and late-phase inflammatory cell infiltrate as a consequence of continued allergic stimulation. Associated with the more chronic and severe forms of atopic ocular disorders, GPC, VKC and AKC, there is persistent mast cell, eosinophil, and lymphocyte activation resulting in pathologic changes. Therapeutic intervention for atopic ocular diseases has focused on symptomatic improvement. However, with an increasing understanding of the molecular mechanisms associated with the allergic inflammatory response, experimental studies may facilitate the development of preventative strategies.
Conjunctivitis, Allergic↗