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Purpose. To report the acute development of hypopyon after primary cryopreserved amniotic membrane transplantation (AMT) for persistent corneal epithelial defect and sterile ulceration. Case Presentation. A selected case report of a 71-year-old male who underwent primary cryopreserved AMT for the management of long-standing corneal epithelial defects and stroma thinning. The patient developed 2 mm sterile hypopyon within 48 hours after AMT for corneal surface reconstruction. He responded well to the intensified routine postoperative topical treatment of steroid and antibiotic eye drops with the hypopyon resolving completely one week later. Five weeks after surgery, the corneal surface was smooth and epithelialized with no anterior chamber reaction or recurrence of hypopyon. Discussion. Hypopyon may develop as a rare complication of primary cryopreserved AMT for sterile corneal defects. It may be attributed to immunologic or hypersensitivity reaction and should be differentiated from active ocular infection as it resolves spontaneously with the routine postoperative topical treatment of steroid and antibiotic drops.

Kaposi’s sarcoma is an uncommon endothelial malignant tumor, first described by Moricz Kaposi in 1872. It is commonly encountered in patients with acquired immunodeficiency syndrome (AIDS), immunosuppression or organ transplantation. Conjunctival Kaposi’s sarcoma is a rare tumor, mostly in patients with AIDS. We present a selected case with a superior bulbar conjunctival lesion in a patient who is HIV negative and immunocompetent, with an unremarkable general medical history. The lesion was surgically excised with no adjunctive treatment, and histological examination confirmed the diagnosis. There was no recurrence or metastasis 5 years after surgery.

Purpose. To report a case of Alternaria alternata keratitis in a patient with a corneal transplant in her right eye due to bullous pseudophakic keratopathy. Methods. A 66-year-old female underwent a full-thickness keratoplasty in her right eye due to bullous pseudophakic keratopathy. Three weeks after keratoplasty, epithelial edema and a stromal opacity with an infiltrate and development of peripheral corneal opacities appeared. The diagnosis of Alternaria alternata keratitis was made. Results. The patient underwent a second keratoplasty, due to the corneal melting as a result of the fungal infection. She was also given combined antifungal treatment locally and systematically. Conclusion. Corneal transplantation alone would not have been sufficient to keep the fungus in the anterior portion of the eye. Combined antifungal treatment, locally and systematically, was important in attempting to prevent the further spread of the fungus to the interior of the eye. To our knowledge, the case presented here is only the second one in the literature concerning a keratomycosis due to Alternaria alternata corneal transplant infection.

Objective Dry eye disease (DED) is a multifactorial disease involving the tears and ocular surface. It impacts a patient’s quality of life (QoL) and ability to perform daily activities. This study assessed the burden of self-reported DED among adults in eight European countries.Design Online cross-sectional survey.Setting General population in France, Italy, Germany, Greece, the Netherlands, Portugal, Spain and Sweden.Participants Adults aged ≥18 years with (n=6084) and without (n=6161) self-reported DED were recruited via emails and screened.Main outcome measures All participants completed National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and EuroQol-5 Dimension-5 Level Questionnaire (EQ-5D-5L). All DED participants completed the Eye Dryness Score (EDS) Visual Analogue Scale, and Ocular Comfort Index and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem questionnaires. In addition, half of the respondents with DED completed Survey A (Impact of Dry Eye on Everyday Life) and the other half completed Survey B (Standard Patient Evaluation of Eye Dryness Questionnaire) and Dry Eye Questionnaire-5.Results Participants with self-reported DED had lower functional vision and lower overall health status than participants without self-reported DED as measured by the NEI-VFQ and EQ-5D-5L, respectively.Increasing self-reported DED severity as measured by the EDS was shown to correspond with worse symptom severity/frequency, lower functional vision, higher impact on work productivity, daily activities and QoL.Conclusion This study showed that patients’ reported burden of self-reported DED was similar across the eight European countries. Those with self-reported DED reported lower health status and functional vision compared to those without self-reported DED and these parameters worsen with increasing disease severity.

Nikolaos Trakos, Emmanouil Mavrikakis, Kostas G Boboridis, Marselos Ralidis, George Dimitriadis, Ioannis MavrikakisOculoplastic Service, Metropolitan Hospital, Athens, GreecePurpose: To describe a modification of the retrograde intubation dacryocystorhinostomy (DCR) in patients with proximal canalicular obstruction.Materials and methods: Interventional case report of a 43-year-old female with a nine-month history of left epiphora following a road traffic accident involving the proximal lower canaliculus. An external DCR approach was performed. Following the creation of a lower canalicular pseudopunctum, the O’Donoghue silicone stent was introduced through the common ostium, out through the pseudopunctum of the lower canaliculus, and returned through the punctum of the normal upper canaliculus down through the common ostium into the nose.Results: The patient experienced complete resolution of symptoms and on her last follow-up, two years later, her lower canaliculus was patent to syringing.Conclusion: This modification of the retrograde intubation DCR is an effective technique which decreases the intraoperative time needed to insert the tubes and minimises further trauma to the newly created punctal area.Keywords: retrograde dacryocystorhinostomy, proximal canalicular obstruction, midcanalicular obstruction, conjuctivodacryocystorhinostomy