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Aims To evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD). Design Retrospective consecutive case series. Methods 27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed. Results Baseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P = 0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P = 0.10). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling. Conclusion SL can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SL fit is necessary in these compromised eyes.

Leprosy is a chronic multisystem disease caused by Mycobacterium leprae with frequent ocular manifestations such as madarosis, lagophthalmos, lid abnormalities, impaired corneal sensations, chronic uveitis, and cataract. Granulomas are characteristic lesion of lepromatous leprosy commonly seen as conjunctival and iris granulomas. We report a case of leprosy with a rare ocular manifestation in the form of angle mass lesion or suspected granuloma which has not been reported before and its successful management following treatment with favorable outcome. The index case also highlights the anterior segment fluorescein angiography features of the lesion and study of its vascular pattern.

Purpose To describe anterior segment fluorescein angiography (ASFA) of the normal canine eye using two different sedation/anesthetic protocols and a digital single lens-reflex (dSLR) camera adaptor. Methods Dogs free of ocular and systemic disease were used for this study. Dogs received maropitant citrate (1.0 mg/kg SQ) and diphenhydramine (2.0 mg/kg SQ) 20 min prior to butorphanol [n = 6] (0.2 mg/kg IV) or propofol [n = 6] (4 mg/kg IV bolus, 0.2 mg/kg/min CRI). Standard color and red-free images were obtained prior to administration of 10% sodium fluorescein (20 mg/kg IV). Image acquisition was performed using a dSLR camera (Canon 7D), dSLR camera adaptor, camera lens (Canon EF-S 60 mm f/2.8 macro), and an accessory flash (Canon 580EXII). Imaging occurred at a rate of 1/s immediately following bolus for a total of 30 s, then at 1, 2, 3, 4, 5, and 10 min. Results Twelve dogs with a combined mean age of 5.1 years and various iris colors were imaged. Arterial, capillary, and venous phases were identified and time sequences recorded. Visibility of the vascular pattern was inversely related to iris pigmentation. Complete masking of blood flow was noted with heavily pigmented irises. Vessel leakage was noted in some eyes. Proper patient positioning and restricted ocular movements were critical in acquiring quality images. No adverse events were noted. Conclusion This study demonstrated that quality high resolution ASFA images were obtainable using a novel dSLR camera adaptor. ASFA of the normal canine eye is limited to irises, which are moderately to poorly pigmented. Use of general anesthesia produced higher quality images and is recommended for ASFA in the dog.

To report the case of a patient with Fabry disease (FD) whose ocular presentation with chronic chemosis we feel is related to FD and to describe the conjunctival fluorescein angiographic findings.A 51-year-old male patient with FD on enzyme replacement therapy presented with 1-month chemosis and mild irritation in the left eye. Ocular examination revealed pronounced noninflammatory chemosis inferotemporally in the left eye with conjunctival tortuosity and microaneurysms bilaterally. There was mild corneal verticillata, spoke-like lens opacities, and retinal vascular tortuosity bilaterally, with no evidence of disc or macular edema. Evaluation revealed no systemic cause for his chemosis, including an orbital computerized tomography scan, which showed clear sinuses and no evidence of an intraorbital mass.Conjunctival fluorescein angiography revealed rapid subconjunctival accumulation of dye in the involved eye but failed to demonstrate leakage from tortuous conjunctival vessels or microaneurysms.Although the pathology of chronic chemosis in patients with FD is as yet unknown, we believe that FD should be considered in the differential diagnosis of patients presenting with chronic chemosis of unknown etiology.

A description is given of the apparatus and technique for carrying out cine photography of anterior segment fluorescein angiography with special emphasis on its application in the recording and diagnosis of iris tumours.

We have found ultrasound biomicroscopy to be a useful adjunct in the diagnosis and management of anterior segment tumors [1]. A combination of standardized ultrasound, clinical observation, and fluorescein angiography has proven very accurate in the diagnosis of posterior uveal melanomas [2], but many anterior segment lesions still present problems in differential diagnoses. Clinical observation remains the main method of differentiating and following these lesions, with little help from diagnostic testing. The small size of these lesions makes them difficult to image with conventional ultrasound, although water bath techniques can improve definition of larger lesions [3,4]. Anterior segment fluorescein angiography has been found to be of limited accuracy in differentiating iris tumors [5].

Anterior segment fluorescein angiography is a useful investigative technique for diagnosing and assessing anterior segment disease. However, a number of technical problems are inherent in current methodology, such as confounding reflexes, off-axis illumination, and shallow depth of field. We developed a simple technique using readily available equipment, polarized light, and an easy-to-construct auxiliary bracket to provide an inexpensive and optimal photographic system for anterior segment fluorescein angiography.

A description is given of apparatus and technique for carrying out cine photography and video recording of anterior segment fluorescein angiography. We found cine best for single-frame analysis and video tape recording less expensive.

Anterior segment fluorescein angiography was performed on 135 patients with scleritis and episcleritis and on several normal subjects. It was confirmed that the coats of the eye anterior to the extraocular muscles derive their blood supply from perforating ciliary vessels. Characteristic patterns were detected which could distinguish the various forms of scleritis and episcleritis. Fluorescein angiography was found to be particularly useful in the detection of those patients who have early, but not clinically recognisable, necrotizing scleritis. The fluorescein angiographic appearances have been used to help to determine whether treatment should be given with nonsteroidal anti-inflammatory drugs, with systemic steroids or other immunosuppressive agents.

• We use a technique for anterior segment fluorescein angiography that employs an unmodified retinal fundus camera. Examples of conjunctival, corneal, iris, anterior chamber angle, and posterior chamber fluorescein angiograms are illustrated. The advantages of this method include rapid-sequence exposures, high resolution and contrast for small vessel detail, time/frame recordings, and the dual capability of retinal and anterior segment fluoroangiography with use of the same camera.