Late-onset lattice corneal dystrophy associated TGFBI p.H626R mutation in members of a Canadian familyWithin the over 70 reported transforming growth factor-beta–induced (TGFBI) corneal dystrophy mutations,1 more than 40 are associated with lattice corneal dystrophy (LCD), subtypes I, III, IIIA, and IIIB according to the Human Gene Mutation Database (QIAGEN, Hilden, Germany). This is a follow-up investigation to a study we published in 2018 in the Canadian Journal of Ophthalmology entitled Trauma-induced exacerbation of epithelial-stromal TGFBI lattice corneal dystrophy. This study reported 2 cases of post-laser-assisted in situ keratomileusis (LASIK) and postcorneal injury exacerbated late-onset LCD, attributed to a p.H626R mutation in the TGFBI protein.
Inadvertent corneal stromal staining by trypan blue following Descemet's membrane endothelial keratoplastyTrypan blue is an azo dye solution that effectively stains basement membranes such as the anterior lens capsule and Descemet's membrane.1 In Descemet's membrane endothelial keratoplasty (DMEK), where the host Descemet's membrane and corneal endothelium are initially removed, trypan blue is used to stain the donor graft before injection to provide visibility during the unscrolling process in the anterior chamber. Trypan blue can also be injected after the descemetorrhexis and before graft injection to visualize any irregular tags or retained Descemet's membrane, both of which may increase the risk for graft detachment.
Trauma-induced exacerbation of epithelial-stromal TGFBI lattice corneal dystrophySeveral heritable diseases of the cornea known as corneal dystrophies are caused by mutations within the human genome. With the advent of genetic sequencing, it is possible to link most corneal dystrophies to a specific gene mutation.1 While Transforming Growth Factor Beta I (TGFBI) is the most studied gene, with over 60 documented single point mutations,2 without sequencing the patient’s DNA it is difficult to determine if mutations within TGFBI are causal when a patient has symptoms of the disease.
TegadermTMdressing and Lacri-lube ointment moisture chamber to manage exposure keratopathyA 21-year-old male patient was admitted to the trauma/neurosurgical intensive care unit after a seatbelted, motor vehicle collision with a tree, which involved airbag deployment. He suffered extensive injuries, including a left parietal skull fracture, basal skull fracture, intraventricular hemorrhage, epidural hematoma, and multiple open extremity fractures. He was intubated and sedated. An initial ocular examination was performed within an hour of admission. Periocular lid ecchymosis and edema were present bilaterally.
Scleral thinning after I-BRITE procedure treated with amniotic membrane graftA 39-year-old female was referred for punctal plug insertion for dry eye complaints and a nonhealing conjunctival defect in both eyes. She had a history of right eye pterygium and left eye pingecula removal with the I-BRITE (Boxer Wachler Vision Institute, Beverly Hills, Calif.) procedure 2 years previously. The I-BRITE procedure is advertized for the treatment of conjunctiva hyperemia, pterygium, and pinguecula.1 Postoperatively, she recounted using, in both eyes, topical antibiotics 4 times daily, preservative-free artificial tears, testosterone 10% ointment to the eyelids, mitomycin C (MMC) drops of unknown concentration 4 times daily, and a tapering course of topical steroids.
Late spontaneous dislocation of a silicone iris-claw phakic intraocular lensA 43-year-old female presented with sudden monocular diplopia and blurred vision OD for 4 days. Three years prior in Peru she had undergone successful implantation of bilateral Artiflex (Ophtec, Groningen, The Netherlands) phakic intraocular lenses (pIOL) for high myopia. The patient denied any recent or previous trauma. On examination, her Snellen uncorrected distance visual acuity (UDVA) was 20/30 OD and 20/50 OS. Intraocular pressures (IOPs) were normal in both eyes (13 mm Hg OD, 12 mm Hg OS).
Pagetoid spread of sebaceous cell carcinoma to the corneaSebaceous cell carcinoma (SebCC) is a malignancy that most commonly presents in the eyelid.1 Pagetoid spread to the conjunctiva has been well documented,1-3 but spread to the cornea is less common.4 We report a 64-year-old female who was diagnosed with pagetoid spread of SebCC to her right cornea. She initially presented with a 3-year history of red eyes and trichiasis. After multiple epilations, she was referred to the oculoplastics service for electrolysis. On examination, her visual acuity was 20/70 in the right eye and counting fingers in the left eye (the vision was limited due to a central stromal scar and a dense cataract).