Showing papers in "Cornea in 1991"
TL;DR: It is found that tear osmolarity correlated positively with gland dropout and negatively with excreta volume, which supports the significance of meibomian gland dysfunction on tear oSMolarity and the evaporative state of the eye.
Abstract: We examined 57 patients with symptoms of chronic blepharitis using meibomian gland expression, meibography, tear osmolarity, and the Schirmer's test. We also performed meibography on 20 normal patients free of chronic blepharitis. We found that 42 blepharitis patients (74%) had evidence of meibomian gland loss, whereas only four of 20 normal patients (20%) had any gland dropout. We performed cluster analysis on the data from the patients with blepharitis and found that these patients tended to fall into distinct groups with clinically relevant characteristics. We also found that tear osmolarity correlated positively with gland dropout (+0.413) and negatively with excreta volume (-0.499). This study demonstrates that an objective analysis of meibomian gland function may be used to assess chronic blepharitis and define subsets of blepharitis with measurable differences. It also supports the significance of meibomian gland dysfunction on tear osmolarity and the evaporative state of the eye.
251 citations
TL;DR: Sixty‐three eyes of 49 patients with keratoconus were studied by means of computer‐assisted corneal topographic analysis, finding a large and statistically significant disparity between the two eyes in the power at the apex of the cone and the total cylinder.
Abstract: Sixty-three eyes of 49 patients with keratoconus were studied by means of computer-assisted corneal topographic analysis. Two patients with keratoconus in one eye had no topographic evidence of keratoconus in the opposite eye. Keratoconic topographic alterations were classified into two groups. The majority of the patients (72%) had peripheral cones, with steepening extending to the limbus. In this group, the steepening was commonly restricted to one or two quadrants. In some cases, however, the changes involved nearly the entire corneal surface. The remaining group (about one quarter of the keratoconus patients) had steepening that was restricted to the central cornea. In either group, the topographic alterations in the two eyes of any single patient were characterized by a high degree of nonsuperimposable mirror-image symmetry (enantiomorphism). In the majority of patients, however, there was a large and statistically significant disparity between the two eyes in the power at the apex of the cone and the total cylinder [mean differences 8.2 +/- 6.0 D (p less than 0.0001) and 4.3 +/- 2.7 D (p less than 0.0001), respectively].
209 citations
TL;DR: The surgical technique and postoperative problem management of conjunctival autograft transplantation for advanced primary and recurrent pterygium are reviewed andLimbal-conjunctival Autograft for recalcitrant recurrent cases is proposed.
Abstract: The surgical technique and postoperative problem management of conjunctival autograft transplantation for advanced primary and recurrent pterygium are reviewed Problems such as graft edema, corneoscleral dellen, and epithelial inclusion cysts infrequently occur Corneal astigmatism, Tenon's granulo
168 citations
TL;DR: It is suggested that the clinical symptoms of blepharitis during Accutane therapy are related to decreased meibomian gland function and consequent increased tear evaporation and tear osmolarity.
Abstract: We evaluated the meibomian gland function of 11 patients before and during treatment with isotretinoin (Accutane) by assessing tear osmolarity, meibomian gland morphology, tear production, rose bengal staining, and meibomian gland excreta. We found, during Accutane use, that meibomian glands appeared significantly less dense and atrophic by meibography. Excreta thickness increased from 1.7 +/- 0.9 to 3.1 +/- 1.2 (p less than 0.005), and expressible excreta volume decreased from 1.52 +/- 0.68 to 1.10 +/- 0.3 (p less than 0.05) (scale 1-4). We also found a significant increase in tear osmolarity from 304.9 +/- 11 to 316.3 +/- 10 mosmol/L (p less than 0.005). There was no significant change in the Schirmer test during treatment. We suggest that the clinical symptoms of blepharitis during Accutane therapy are related to decreased meibomian gland function and consequent increased tear evaporation and tear osmolarity.
161 citations
TL;DR: Stratification of results revealed that DAP was the most effective initial agent for modestly active OCP, whereas CYC was themost effective initial choice for highly active cases.
Abstract: The records of 105 patients treated with three different chemotherapeutic agents for ocular cicatricial pemphigoid (OCP) were reviewed to compare long-term efficacies, side effects, and tolerance of different regimens. For the entire group, OCP progressed in 6% of eyes in 10% of patients (follow-up
134 citations
TL;DR: It is demonstrated that patients with blepharitis are more likely to have normal skin bacteria on their lids and in greater quantities than nonblepharitic patients.
Abstract: The microbiologic evaluations of 332 consecutive patients with the primary diagnosis of chronic blepharitis were reviewed and compared to those of 160 control patients. The most commonly isolated organisms from lids with blepharitis were Staphylococcus epidermidis (95.8%), Propronibacterium acnes (92.8%), Corynebacterium sp. (76.8%), Acinetobacter sp. (11.4%), and Staphylococcus aureus (10.5%). Compared to controls, S. epidermidis (p less than 0.01), P. acnes (p less than 0.02), and Corynebacterium sp. (p less than 0.001) were present significantly more often. S. aureus and the isolation of more than one microbial species were not more common in blepharitis patients. Quantitatively, heavy growth, by total and individual species, was significantly more common in blepharitis patients (total, p less than 0.001; S. epidermidis, p less than 0.001, P. acnes, p less than 0.001). These data demonstrate that patients with blepharitis are more likely to have normal skin bacteria on their lids and in greater quantities than nonblepharitis patients.
119 citations
TL;DR: Nine cases (0.41%) of bacterial and fungal endophthalmitis developed out of a total of 2,210 consecutive penetrating keratoplasties performed between November 1983 and April 1989, with a retrospective analysis showing a contamination rate of 29%.
Abstract: Nine cases (0.41%) of bacterial and fungal endophthalmitis developed out of a total of 2,210 consecutive penetrating keratoplasties performed between November 1983 and April 1989. Five of the nine cases (0.23%) had endophthalmitis related to donor tissue contamination. The donor tissue of these cases had a storage time of greater than 5 days. A retrospective analysis of 1,399 consecutive corneoscleral rim cultures showed a contamination rate of 29%. The most common organisms isolated were Propionibacterium 26%, diphtheroids 24%, Staphylococcus epidermidis 22%, and fungi 9%. There is a statistically significant increase (p less than 0.005) in the percentage of contaminated donor rims with a preservation time of more than five days. The risk of developing endophthalmitis is 12 times greater with a positive donor rim culture. Prolonged preservation of donor tissue can be a risk factor in developing endophthalmitis.
103 citations
TL;DR: The findings emphasize the role of early nonspecific inflammation in the wound and around the sutures, and delineate the cellular immune response and class II antigen expression in corneal allograft rejection.
Abstract: We used immunohistologic techniques with a penetrating keratoplasty model in the rat to study the mechanisms of corneal transplant rejection. Thirteen of 14 syngeneic grafts remained clear in contrast to 24 of 26 allogeneic grafts, which had a rejection reaction. Immunohistochemical studies of syngeneic grafts showed only rare inflammatory cells in the central grafts; however, a focal inflammatory reaction made up of macrophages and T-helper/inducer lymphocytes was seen surrounding the sutures and in the wound. In contrast, immunohistochemical studies of allogeneic grafts showed diffuse inflammation throughout the donor and recipient corneas with T-suppressor/cytotoxic cells, T-helper/inducer cells, and macrophages, resulting in destruction of the donor endothelium, neovascularization, and graft failure. Class II antigen expression was seen extensively on Langerhans cells, donor keratocytes, and both the donor and recipient endothelial cells. These findings emphasize the role of early nonspecific inflammation in the wound and around the sutures, and delineate the cellular immune response and class II antigen expression in corneal allograft rejection.
82 citations
TL;DR: A retrospective analysis was undertaken of the clinical diagnoses of 1594 eyes that underwent penetrating keratoplasty performed in a private-referral corneal practice over a 9-year period, 1980-1988, finding pseudophakic bullous keratopathy became the leading indication and correlates well with known complications associated with closed-loop anterior chamber lenses.
Abstract: A retrospective analysis was undertaken of the clinical diagnoses of 1594 eyes that underwent penetrating keratoplasty performed in a private-referral corneal practice over a 9-year period, 1980-1988. The seven most common indications for surgery were keratoconus (24.0%), pseudophakic or aphakic bul
78 citations
TL;DR: The presence of mast cells and eosinophils was found to be correlated with the early detection, but not the clinical severity, of allergic conjunctivitis.
Abstract: The presence of eosinophils in the conjunctival epithelium is indicative of allergies, and detection is currently performed by cotton swab scrapings. Although mast cells are thought to be chemotactic for eosinophils and thus presage their accumulation, the former's use as early indicators of allergy has heretofore been hindered by poor detection methods. The recent development of a special brush now makes it possible to collect many cells with less disturbance of the conjunctival epithelium. In the present study, we have used this brush for conjunctival scraping in 18 patients with vernal and allergic conjunctivitis, and 10 patients serving as controls. The superior and inferior tarsal conjunctiva in both eyes were examined, and the specimens were stained using Hansel's method. Mast cells were observed in at least one of the tarsal conjunctivae in all cases of vernal and allergic conjunctivitis, whereas eosinophils were so observed in only eight cases (44.4%). Neither mast cells nor eosinophils were present in the conjunctivae of the normal group. Although treatment by mast cell stabilizers produced clinical remissions, they induced disappearance of mast cells in only 10 cases (55.6%), whereas in six cases (33.3%) the mast cells increased, and in two cases they were unchanged (11.1%). Six cases (33.3%) each showed disappearance of, increase in, and no change in eosinophils, reflecting even less of a response of these allergic cells to the treatment. The presence of mast cells and eosinophils, as determined by our cytologic method, was found to be correlated with the early detection, but not the clinical severity, of allergic conjunctivitis.
77 citations
TL;DR: Virtually all of the gentamicin-resistant bacteria isolated from cornea rims were found to be sensitive to vancomycin, and eye banks should consider the addition of other antibiotics to storage media to reduce donor cornea contamination.
Abstract: The incidence of culture-positive cornea rims from 446 consecutive donor corneas cultured at the Doheny Eye Institute between 1986 and 1988 was determined. Both the identity and antibiotic sensitivities of the contaminating organisms were reviewed. Sixty-three (14.1%) of 446 cornea rims were culture-positive, but none of the 63 patients who received these contaminated donor corneas developed endophthalmitis. Streptococcus (26 of 63), Propionibacterium (15 of 63), Stphylococcus (14 of 63) species and diptheroids (8 of 63) were the most common cornea rim contaminants, and in most cases were resistant to gentamicin (i.e., 21 of 26 or 81%, 9 of 15 or 60%, 10 of 14 or 71%, 4 of 8 or 50%, respectively). Virtually all of the gentamicin-resistant bacteria isolated from cornea rims were found to be sensitive to vancomycin. Eye banks should consider the addition of other antibiotics to storage media to reduce donor cornea contamination. Surgeons performing corneal transplantation should also consider these results when selecting antibiotics for use at the time of surgery and in the postoperative period.
TL;DR: The present results suggest that both the normal and tissue- cultured human corneal epithelium contain α2β1, α3 β1, and probably also αvβ 1, and α6β4 integrin dimers or complexes.
Abstract: Monoclonal antibodies (Mabs) were used for immunohistochemical location of integrin beta- (beta 1,3, and 4) and alpha subunits (alpha 1-6 and alpha v) in the epithelium of both normal and tissue-cultured human cornea. Immunoreaction for the beta 1 integrin subunit was the most intense at the membranes of the basal epithelial cells and weaker at the superficial cell membranes. Anti-beta 4 immunofluorescence appeared in the basal part of the epithelium only, apposing the basement membrane. Both anti-alpha 2 and anti-beta 3 Mabs showed an immunoreaction with distribution similar to the beta 1 integrin subunit. Immunoreaction for the alpha 6 integrin subunit resembled the distribution of the beta 4 subunit. Anti-alpha v showed a faint immunoreaction at the basal and lateral aspects of the basal cell layer. Antisera against beta 3, alpha 1, alpha 4, and alpha 5 integrin subunits showed no specific reactions. The present results suggest that both the normal and tissue-cultured human corneal epithelium contain alpha 2 beta 1, alpha 3 beta 1, and probably also alpha v beta 1 and alpha 6 beta 4 integrin dimers or complexes. We discuss their role as possible receptors for some known ligands.
TL;DR: Although no apparent changes of the epithelium could be detected in the diabetic corneal epithelia under biomicroscopy, abnormalities that could be evaluated by specular microscopic images and morphometric analysis were observed.
Abstract: The corneal epithelia of phakic control (n=13), aphakic control (n=10), diabetic phakic (n=10), and diabetic aphakic patients (n=13) were surveyed under a widefield specular microscope with a special contact lens. In control patients, the corneal epithelium showed relatively hexagonal cells, which w
TL;DR: The ferning phenomenon observed when a drop of tears is allowed to dry at room temperature on a clean microscope slide is to a large extent determined by the electrolyte concentration, especially the ratio of monovalent sodium and potassium ions to divalent calcium and magnesium ions.
Abstract: The biochemical agents involved in fern formation on drying tears were investigated by studying the different patterns of ferning of tears from normal and pathological eyes, mucus glycoprotein, saliva, serum, and various salt solutions. We conclude that the ferning phenomenon observed when a drop of tears is allowed to dry at room temperature on a clean microscope slide is to a large extent determined by the electrolyte concentration, especially the ratio of monovalent sodium and potassium ions to divalent calcium and magnesium ions. The presence of a biopolymer is essential, but this need not specifically be mucus as previously thought. The test may therefore be useful clinically in indicating the need for further tear analysis.
TL;DR: Two patients with advanced pellucid marginal corneal degeneration received bilateral epikeratoplasty grafts and provided patients with a satisfactory best corrected visual acuity.
Abstract: Two patients with advanced pellucid marginal corneal degeneration (PMCD) received bilateral epikeratoplasty grafts ranging in diameter from 9 to 12 mm. Corneal astigmatism was greatly reduced in every case and the possibility of resuming contact lenses for daily wear, obtained after surgery, provided patients with a satisfactory best corrected visual acuity. Peculiarities of surgical procedure and clinical experience are reported.
TL;DR: It is demonstrated that human corneal endothelium, when cultured and subsequently transplanted, retains its in vivo pump function and suggests the possibility of endothelial cell replacement for therapeutic purposes.
Abstract: The ability to successfully transplant human corneal endothelium would offer a significant advance in the treatment of many corneal diseases. To investigate the feasibility of this, we established cultures of endothelial cells derived from neonatal human corneas. Eye bank donor corneas were either e
TL;DR: Clinical, histopathological, and ultrastructural features of silicone oil‐induced keratopathy in patients who developed corneal complications requiring penetrating keratoplasty are evaluated and are consistent with changes previously reported in rabbits and cats receiving intracameral silicone oil injections.
Abstract: Corneal endothelial decompensation is a frequent complication when silicone oil is used as a tamponade following vitrectomy for treatment of proliferative vitreoretinopathy in an aphakic eye. We evaluated the clinical, histopathological, and ultrastructural features of silicone oil-induced keratopathy in 10 patients who developed corneal complications requiring penetrating keratoplasty. Clinically, some cases showed corneal edema, corneal hypesthesia, endothelial opacification, band keratopathy, and peripheral corneal vascularization. Histopathologically, retrocorneal membranes were present, and different degrees of stromal hypercellularity, superficial stromal calcification, and vascularization were noted. The ultrastructural features of endothelial cell loss and retrocorneal membrane formation are consistent with changes previously reported in rabbits and cats receiving intracameral silicone oil injections.
TL;DR: It is conclusively demonstrate that the human lacrimal gland synthesizes EGF and suggest that the lacrima gland could have a regulatory role in maintaining the ocular surface and possibly regulating corneal wound healing through the secretion of EGF.
Abstract: Experimental models and clinical investigations have suggested that epidermal growth factor (EGF) may have a role in corneal wound healing. It has been identified as a normal component of human tears. Rabbit and mouse lacrimal glands have recently been shown to synthesize EGF messenger RNA (mRNA). The purpose of the present study was to determine whether the human lacrimal gland synthesizes EGF mRNA. Total cellular RNA was isolated from pathologic specimens of normal human lacrimal glands from two individuals. Reverse transcriptase was used to generate complementary DNA (cDNA) using a human EGF-specific mRNA primer. Amplification of EGF-related cDNA sequences was performed with the polymerase chain reaction (PCR) and human EGF-derived up- and downstream primers. The PCR products from both lacrimal glands contained an amplified product of the expected length of approximately 410 base pairs. The PCR-generated fragment was verified as an EGF-related amplification product with Southern blotting using a synthetic oligonucleotide probe derived from the mature coding sequence of EGF. These results conclusively demonstrate that the human lacrimal gland synthesizes EGF and suggest that the lacrimal gland could have a regulatory role in maintaining the ocular surface and possibly regulating corneal wound healing through the secretion of EGF.
Journal Article•
TL;DR: Diseases leading to corneal opacities are inflammations, infections, metabolic causes, trauma, or genetically determined diseases that may lead to Corneal dystrophies.
Abstract: Diseases leading to corneal opacities are inflammations, infections, metabolic causes, trauma, or genetically determined diseases. Corneal dystrophies may lead to corneal blindness. A clinical and pathological review of 2,108 corneal specimens received from December 1983 to January 1988 revealed 86 (4%) corneal specimens with corneal dystrophies. Fifty-three (62%) patients had macular dystrophy, 11 (13%) had congenital hereditary endothelial dystrophy (CHED), 12 (14%) had Fuchs' corneal dystrophy, 5 (6%) had lattice corneal dystrophy, and 3 (4%) had granular dystrophy. Macular dystrophy appears to be the most common cause of corneal dystrophy in Saudi Arabia. Twenty-two (42%) patients with macular dystrophy and 10 (91%) patients with CHED were the result of consanguineous marriages. Genetic counseling is advisable among families who carry the trait of CHED or macular corneal dystrophy.
TL;DR: The combined therapy of citrate and ascorbate was a significant improvement over citrate treatment alone and almost eradicated corneal ulceration.
Abstract: The incidence of ulceration and perforation in the cornea of alkali-injured eyes is significantly reduced by treatment with trisodium citrate or sodium ascorbate. Topical citrate reduces the inflammatory response in the cornea by inhibiting polymorphonuclear leukocytes. Topical ascorbate elevates the depressed level of this vitamin in the alkali-injured cornea, reversing a scorbutic condition. The purpose of the current study was to determine whether combined treatment with topical citrate and ascorbate has an additional therapeutic value when compared with citrate alone. Adsorbotear without EDTA was used as the vehicle for both medications. Rabbit eyes were injured with 1N NaOH for 35 s using a 12-mm well and were rinsed. Group I (47 eyes) received two drops of 10% citrate every hour on the hour and Adsorbotear on the half-hour for 14 h/day. Group II (48 eyes) received two drops of 10% citrate every hour on the hour and 10% ascorbate every hour on the half-hour for 14 h/day. The citrate/ascorbate group had significantly fewer ulcerations during the experiment than did the group receiving citrate alone (2 of 48 versus 10 of 47, 0.01 less than p less than 0.02). Both anterior ulcers in the citrate/ascorbate group and five ulcers in the citrate group healed to no ulcer by the end of the experiment (0 of 48 versus 5 of 47, 0.02 less than p less than 0.05). The average depth of ulceration was significantly less for the citrate/ascorbate group (p less than 0.001). No descemetoceles or perforations were observed in either group.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: It is concluded that ciprofloxacin may be a useful broad spectrum, topical chemotherapeutic agent in the therapy of aminoglycoside‐resistant P. aeruginosa keratitis.
Abstract: An aminoglycoside-resistant strain of Pseudomonas aeruginosa was injected intrastromally into the corneas of rabbits, and keratitis was allowed to develop over a 22-h period. Rabbits were treated with either 0.75% ciprofloxacin, 1% norfloxacin, or 1.36% tobramycin administered topically every 15 min for 1 h and then every 30 min for the following 3 h. All therapy ceased 26 h postinoculation. Rabbits were killed 1 h after the treatment, and the number of bacteria per cornea were quantified in terms of bacterial colony-forming units. Aqueous humor specimens were obtained from rabbits receiving norfloxacin and ciprofloxacin, and bioassays were performed to determine drug concentration. Ciprofloxacin caused a 5 log reduction in the number of bacterial colony-forming units, as compared with untreated controls (p less than 0.0001); it also produced a significantly greater reduction in bacterial colony-forming units than either norfloxacin or fortified tobramycin drops (p less than 0.0001). Norfloxacin produced a 2 log reduction in bacterial colony-forming units, as compared with untreated controls (p less than 0.0001). The mean aqueous concentration of norfloxacin (7.5 micrograms/ml) was substantially less than that achieved by ciprofloxacin (30.5 micrograms/ml). We conclude that ciprofloxacin may be a useful broad spectrum, topical chemotherapeutic agent in the therapy of aminoglycoside-resistant P. aeruginosa keratitis.
TL;DR: It is found that an insertion depth of 0.1 mm was sufficient to cause the production of new basement membrane and fibrocytic reaction in the anterior stroma, and analysis of the pathologic specimen supports the use of the larger 23- and 25-gauge needles, and cautions against theuse of small gauge needles, especially 30-g Gauge for this procedure.
Abstract: Despite conventional therapy, some patients continue to have episodes of erosion. Recent literature suggests the efficacy of corneal puncture, which is thought to induce adherence of the epithelium and basement membrane to the anterior stroma. We performed multiple corneal punctures with 23-, 25-, 2
TL;DR: Endothelial specular photomicroscopy (ESP) revealed distinctive characteristics of PPD vesicles and bands that distinguish them from other posterior corneal abnormalities, e.g., the iridocorneal endothelial syndrome and Haab's striae.
Abstract: Forty-eight cases of posterior polymorphous dystrophy (PPD), diagnosed on the presence of classic vesicles at the level of Descemet's membrane, were studied with the specular microscope. Vesicles alone occurred in 42% and were present in conjunction with PPD bands in 48% and a diffuse abnormality of Descemet's membrane in 10%. It was notable that none of the cases showed ocular abnormalities other than those of the cornea. Endothelial specular photomicroscopy (ESP) revealed distinctive characteristics of PPD vesicles and bands that distinguish them from other posterior corneal abnormalities, e.g., the iridocorneal endothelial syndrome and Haab's striae, which can appear similar at the slit lamp level. The interpretation of the ESP images was that vesicles are pits and bands are trenches in Descemet's membrane only. The endothelium was composed of enlarged cells in almost all cases. Other endothelial abnormalities reported by previous observers were not found. There was evidence that the affected corneas of children were more rigid than normal, and this is discussed in relation to the aetiology of the lesions of PPD.
TL;DR: The relaxing incisions procedure, eventually modified by either adding compression sutures or repeating the incisions after 8-10 weeks, offers the possibility of a wide range of corrections for postkeratoplasty astigmatism with acceptable postoperative periods for visual rehabilitation.
Abstract: We report 100 cases of postkeratoplasty astigmatism, ranging from 4 to 20.5 diopters, treated with the following procedures: relaxing incisions, relaxing incisions with augmentation sutures, and repeated relaxing incisions with augmentation sutures according to the degree of astigmatism. Patients we
TL;DR: It appears that entry into the cornea is a two-step process involving adherence and penetration by trophozoites.
Abstract: Human corneal buttons were exposed to Acanthamoeba castellanii trophozoites and cysts for 12 hours at 35 degrees C. The buttons examined by light microscopy and scanning and transmission electron microscopy had severe epithelial ulceration and penetration by trophozoites. Observations on trophozoites below the surface suggest that penetration is accomplished by both secreted cytolytic enzymes and phagocytosis. It is likely that the secretion of one or more enzymes constitutes the initial step in preparing the host tissue for endocytosis or that the secretory mechanism is used by the amebas to move through the outer squamous layer to the basement epithelium where phagocytosis occurs. Based on this study and a previous study, it appears that entry into the cornea is a two-step process involving adherence and penetration by trophozoites.
TL;DR: There was a trend toward improvement in the coefficient of variation in the eyes that were followed the longest, suggesting that the morphological changes induced by long-term use of contact lenses may be slowly reversible after prolonged discontinuation of contact lens wear.
Abstract: We performed specular microscopy on the corneal endothelium of 22 long-term hard contact lens wearers (15-32 years duration) and 22 age- and sex-matched controls. We found polymegethism in users as shown by a significant difference in the coefficient of variation in cell area (p less than 0.01) and pleomorphism as shown by a significant decrease in the percent of 6-sided cells (hexagonality, p less than 0.01). There was no significant difference in cell density and mean cell area between the 2 groups. Contact lens wear was discontinued in five eyes of three patients after they were entered into the study and switched to eye-glasses. Specular micrographs were taken up to 60 months after discontinuation of use of the lenses. Comparison of the above parameters before and after discontinuation of the lenses did not show a significant change. However, there was a trend toward improvement in the coefficient of variation in the eyes that were followed the longest. This finding suggests that the morphological changes induced by long-term use of contact lenses may be slowly reversible after prolonged discontinuation of contact lens wear.
TL;DR: Surgery with concomitant immunosuppression preserved the eyes in all but two cases, and 8 of 17 eyes maintained or improved preoperative visual acuity, which can preserve eyes that might otherwise be lost to progressive inflammation.
Abstract: Peripheral ulcerative keratitis (PUK) is a destructive, inflammatory process that can lead to corneal perforation and visual loss. Successful control of PUK has been reported with conjunctival resection, cyanoacrylate adhesive, and systemic immunosuppression. Cases with impending or actual corneal perforation may require more extensive surgery, including lamellar or penetrating keratoplasty, to maintain the integrity of the globe. We report on 17 eyes of 14 patients with PUK that required tectonic keratoplasty because of progressive ulceration. Surgery with concomitant immunosuppression preserved the eyes in all but two cases, and 8 of 17 eyes maintained or improved preoperative visual acuity. Six eyes had final visual acuities of 20/200 or better. This therapeutic strategy can preserve eyes that might otherwise be lost to progressive inflammation.
TL;DR: An infectious etiology should be suspected in cases of necrotizing scleritis associated with a purulent discharge, and appropriate smears and cultures should be obtained.
Abstract: We retrospectively review our experience with four patients with Streptococcus pneumoniae scleritis. Two of the patients had been exposed to beta irradiation after pterygium removal 4 and 13 years previously. One patient had a 3-year history of chronic anterior nodular scleritis, and one patient had severe rheumatoid arthritis. All were treated with intensive i.v. and topical fortified antibiotics. In two of the cases, the infection was controlled and visual acuity returned to 20/30 and 20/60. In one patient, infectious scleritis progressed to endophthalmitis. This eye ultimately became phthisical and required enucleation because of chronic pain. In the remaining patient, infectious scleritis led to perforation, which required a corneal-scleral patch graft. This patient had a final visual acuity of counting fingers. An infectious etiology should be suspected in cases of necrotizing scleritis associated with a purulent discharge, and appropriate smears and cultures should be obtained. Infectious scleritis can be caused by streptococcal organisms. Appropriate topical and intravenous antibiotic treatment is effective in some cases.
TL;DR: It is tentatively concluded that the appearance of the abnormal cells is a function of their three-dimensional shape and that they produce blister-like vesicles that rupture, collapse, and eventually invaginate.
Abstract: The iridocorneal endothelial (ICE) syndrome is potentially a blinding condition as a result of glaucoma and/or corneal decompensation. The basic pathology seems to be in the corneal endothelium, which many studies confirm takes on a characteristic slit lamp appearance of hammered silver and image reversal with the specular microscope. The origin and morphology of the abnormal cells are unknown. Many histopathological studies of keratoplasty and trabeculectomy specimens reveal as many cell types. This paper reports some general and specular microscopical data from 57 cases of the syndrome, argues that the reason for the variety of histopathological findings in other studies is due to poor sampling of the study material, deduces the morphology of the abnormal cells on specular microscopical criteria, and compares the specular and scanning electron microscopical images in one case with those of other reports. It is tentatively concluded that the appearance of the abnormal cells is a function of their three-dimensional shape and that they produce blister-like vesicles that rupture, collapse, and eventually invaginate.
TL;DR: An 18-year-old female who initially presented with bilateral dacryoadenitis and a lacrimal gland biopsy was consistent with Wegener's granulomatosis is reported, which indicates the disease is potentially curable with cytotoxic therapy.
Abstract: Wegener's granulomatosis is a life-threatening condition characterized by the triad of necrotizing granulomatous inflammation of the respiratory tract, vasculitis, and glomerulonephritis. During early stages of the disease, some patients may present with only one or two components of the triad. Other patients may be affected by the limited form of Wegener's which lacks the renal involvement. We report an 18-year-old female who initially presented with bilateral dacryoadenitis. A lacrimal gland biopsy was consistent with Wegener's granulomatosis. A few months later she developed glomerulonephritis and responded well to cyclophosphamide treatment. Wegener's granulomatosis remains a diagnostic challenge and is frequently underdiagnosed. Early diagnosis is crucial in saving many lives because the disease is potentially curable with cytotoxic therapy. Dacryoadenitis may be one of the initial presentations of Wegener's granulomatosis.