No abstract

The corneal endothelial abnormalities after SLT shown in this study may be transient, and long-term effects are probably negligible in normal corneas or single treatments. However, in corneas with reduced transparency of the endothelium, such as compromised corneas and corneas with pigment deposits on the endothelium, there may be a risk of further corneal endothelial compromise, especially after repeated SLT. Larger and longer term studies with histopathologic evaluation would be useful to evaluate the effect of SLT on normal and subnormal corneal endothelium. Until further studies are done, it would be wise to minimize the number and energy of SLT laser shots.

The presence of alpha-smooth muscle actin-reactive elongated cells at the plaque suggests that the cuboidal lens epithelial cells making up the anterior subcapsular cataract have transdifferentiated into spindle-shaped myofibroblastic cells that produce and deposit aberrant extracellular matrix. This transdifferentiation process, more commonly known as an epithelial-mesenchymal transition, contributes to a fibrotic response leading to the development of human anterior subcapsular cataract.

hyperostosis. 4 The direct correlation of hyperostosis relating to malignancy was not convincing, and the likely cause for bone growth would be inflammation related to ISOI. In cases of chronic refractory sinusitis, lytic and blastic forms of osteitis occur, and can result in hyperostosis of the nasal and paranasal bones, which was seen in 64% of patients with recurrent rhinosinusitis. 5 The chronic inflammation of ISOI likely caused a corresponding osteitis, an osteoblastic type in this case, producing hyperostosis and the bony changes seen in this case.Diagnosing ISOI is difficult and can further be complicated by the unusual finding of hyperostosis. Treatment of ISOI is controversial as studies using steroids, azathioprine, cyclosporine and radiation have been used with limited success. 1,2 With our patient's age and the systemic complications associated with his mesothelioma, treatment was deferred. This case highlights ISOI associated with hyperostosis, and it is important with this presentation that a concomitant work-up for occult malignancy is considered.