Purpose: To report the clinical features of 93 eyes of 48 pa-tients with chro nic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented. Desi...Purpose: To report the clinical features of 93 eyes of 48 pa-tients with chro nic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented. Design: Retrospective, n oncomparative case series. Participants: Forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed-onset mustard gas keratitis. Methods: We reviewed the symptoms, clinical findings, course, and treatment of our patie nts and reviewed the literature. In 5 patients, histopathologic features of corn eal and conjunctival specimens were evaluated. Main Outcome Measures: Ocular fin dings, clinical course, treatment measures, and histopathologic studies. Results : Of 48 patients, 31 (64.6%) had chronic symptomatology, whereas 17 (35.4%)-e xperienced delayed-onset lesions. Visual acuity at referral ranged from hand mo tions to 20/20. Ocular surface changes included chronic blepharitis and decrease d tear meniscus in all patients, limbal ischemia (81.3%), and conjunctival vasc ular abnormalities (50%). Corneal signs in order of frequency were: scar or opa city (87.5%), neovascularization (70.8%), thinning (58.3%), lipoid deposits ( 52.1%), amyloid deposits (43.8%), and epithelial defects and irregularity (31. 3%). Many patients received conservative treatment; others underwent allograft stem cell transplantation (20 eyes of 17 patients), penetrating keratoplasty (12 eyes of 12 patients), and lamellar keratoplasty (4 eyes of 3 patients). Conjunc tival specimens were evaluated by light microscopy. Decreased goblet cell densit y, attenuated or thickened epithelium, scarring in the substantia propria associ ated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessel s were noted. Excised corneal buttons disclosed absence of epithelium and Bowman ’s layer, fibrovascular pannus, stromal scarring, and vascularization. Conclusi ons: Mustard gas causes chronic and delayed destructive lesions in the ocular su rface and cornea, leading to progressive visual deterioration and ocular irritat ion. The pathophysiologic features of these changes are not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory respons e without any specific features. Based on the clinical appearance of the lesions and the histopathologic findings, an immune-mediated component seems possible.展开更多
BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METH...BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: Retrospective chart review. Thirty-two eyes (28 patients) with non-metallic and non-magnetic metallic IOFBs underwent removal of IOFBs with intraocular forceps, either via the pars plana in 30 eyes (93.9%) or a limbal approach in 2 eyes (6.25%). The main outcome measures were postoperative visual acuity, rate of retinal break formation, development of retinal detachment, and type of IOFB. RESULTS: IOFBs were non-metallic in 22 eyes (68.7%) and non-magnetic metallic in 10 eyes (31.1%). The average follow-up period was 7.5 months. Overall, final visual acuity was 20/40 or better in 10 eyes (31.1%) and 5/200 to 20/50 in 10 eyes (31.1%). A higher incidence of retinal break formation posterior to the sclerotomy was seen with glass IOFBs (P=.02). Retinal detachment was observed preoperatively in 4 eyes (12.5%) and postoperatively in 2 eyes (6.25%). CONCLUSION: Final visual outcome was independent of size and type of IOFB. Pars plana extractions may be associated with a higher rate of retinal break formation and subsequent retinal detachment, particularly with glass IOFBs.展开更多
文摘Purpose: To report the clinical features of 93 eyes of 48 pa-tients with chro nic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented. Design: Retrospective, n oncomparative case series. Participants: Forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed-onset mustard gas keratitis. Methods: We reviewed the symptoms, clinical findings, course, and treatment of our patie nts and reviewed the literature. In 5 patients, histopathologic features of corn eal and conjunctival specimens were evaluated. Main Outcome Measures: Ocular fin dings, clinical course, treatment measures, and histopathologic studies. Results : Of 48 patients, 31 (64.6%) had chronic symptomatology, whereas 17 (35.4%)-e xperienced delayed-onset lesions. Visual acuity at referral ranged from hand mo tions to 20/20. Ocular surface changes included chronic blepharitis and decrease d tear meniscus in all patients, limbal ischemia (81.3%), and conjunctival vasc ular abnormalities (50%). Corneal signs in order of frequency were: scar or opa city (87.5%), neovascularization (70.8%), thinning (58.3%), lipoid deposits ( 52.1%), amyloid deposits (43.8%), and epithelial defects and irregularity (31. 3%). Many patients received conservative treatment; others underwent allograft stem cell transplantation (20 eyes of 17 patients), penetrating keratoplasty (12 eyes of 12 patients), and lamellar keratoplasty (4 eyes of 3 patients). Conjunc tival specimens were evaluated by light microscopy. Decreased goblet cell densit y, attenuated or thickened epithelium, scarring in the substantia propria associ ated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessel s were noted. Excised corneal buttons disclosed absence of epithelium and Bowman ’s layer, fibrovascular pannus, stromal scarring, and vascularization. Conclusi ons: Mustard gas causes chronic and delayed destructive lesions in the ocular su rface and cornea, leading to progressive visual deterioration and ocular irritat ion. The pathophysiologic features of these changes are not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory respons e without any specific features. Based on the clinical appearance of the lesions and the histopathologic findings, an immune-mediated component seems possible.
文摘BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: Retrospective chart review. Thirty-two eyes (28 patients) with non-metallic and non-magnetic metallic IOFBs underwent removal of IOFBs with intraocular forceps, either via the pars plana in 30 eyes (93.9%) or a limbal approach in 2 eyes (6.25%). The main outcome measures were postoperative visual acuity, rate of retinal break formation, development of retinal detachment, and type of IOFB. RESULTS: IOFBs were non-metallic in 22 eyes (68.7%) and non-magnetic metallic in 10 eyes (31.1%). The average follow-up period was 7.5 months. Overall, final visual acuity was 20/40 or better in 10 eyes (31.1%) and 5/200 to 20/50 in 10 eyes (31.1%). A higher incidence of retinal break formation posterior to the sclerotomy was seen with glass IOFBs (P=.02). Retinal detachment was observed preoperatively in 4 eyes (12.5%) and postoperatively in 2 eyes (6.25%). CONCLUSION: Final visual outcome was independent of size and type of IOFB. Pars plana extractions may be associated with a higher rate of retinal break formation and subsequent retinal detachment, particularly with glass IOFBs.
