Effect of Direction and Tension of Kinesio Taping Application on Sensorimotor Coordination.

The present study investigates whether different directions and tensions of Kinesio(®) Tex tape (KT) application differently influence the precision of sensorimotor synchronization, defined as the ability to coordinate actions with predictable external events. 10 healthy participants performed sets of repetitive wrist flexion-extensions synchronized to a series of paced audio stimuli with an inter-onset interval (IOI) of 500 and 400 ms. KT was applied over the wrist and finger extensor muscles. 2 facilitatory (light and moderate tension) and one inhibitory KT applications were used in different sessions. Standard deviation of the asynchrony (SDasy) and percentage difference of SDasy were calculated and compared across KT and the no-KT control cases. Direction and tension of KT application did not differently influence the ability to coordinate rhythmic movements to an auditory stimulus. However, compared with the no-KT control case, SDasy decreased significantly in all KT cases in both 500- and 400-ms IOI. Independent of direction/tension, the effect of KT on improving sensorimotor synchronization is likely associated with variations in the nature of the neuro-anatomical constraints determining the control of voluntary movement. KT is then proposed to be tested on sensorimotor disorders associated with intense repetitive exercise to check for regaining effective motor control.

Long-term results after penetrating keratoplasty for Fuchs' endothelial dystrophy.

OBJECTIVE: To determine the graft survival, visual outcome, complications, and frequency of subsequent cataract extraction after penetrating keratoplasty for Fuchs' dystrophy. DESIGN: The medical records of 236 patients with the diagnosis of Fuchs' dystrophy who were examined on the Cornea Service at Wills Eye Hospital, Philadelphia, Pa, between January 1, 1988, were reviewed retrospectively. SUBJECTS: Penetrating keratoplasties had been or were subsequently performed on 130 phakic eyes of the 236 patients with Fuchs' dystrophy. Results were analyzed in 126 eyes with at least 1 year of follow-up. Statistical analysis was done to determine the risk factors for subsequent cataract surgery in the first eye of patients who had penetrating keratoplasty as their initial surgical procedure. RESULTS: Mean +/- SD follow-up after transplantation was 8.4 +/- 4.8 years. The graft remained clear in 112 eyes (89%). A best corrected acuity of 20/40 or better was achieved in 81 eyes (64%). Graft rejection occurred in 37 eyes (29%). Subsequent cataract surgery was performed in 55 eyes (44%), and the mean time from transplantation was 3.5 +/- 3.4 years. Advanced age at the time of transplantation was a significant risk factor for having cataract extraction (P = .003, Mantel-Haenszel chi 2 test) and a shorter time to cataract surgery after penetrating keratoplasty (P = .04, Mantel-Haenszel chi 2 test). Pregraft lens status approached significance as a risk factor for subsequent cataract surgery (P = .07, Mantel-Haenszel chi 2 test). CONCLUSIONS: Long-term results are favorable after penetrating keratoplasty for Fuchs' dystrophy. In older patients with Fuchs' dystrophy and mild-to-moderate lens changes, combines penetrating keratoplasty, cataract extraction, and intraocular lens implantation procedure should be considered.

Triple vs nonsimultaneous procedures in Fuchs' dystrophy and cataract.

OBJECTIVES: To determine the outcome and refractive status after triple and nonsimultaneous procedures for Fuchs' endothelial dystrophy and cataract. DESIGN: Records of 236 patients with Fuchs' endothelial dystrophy who were examined during 1988 were reviewed retrospectively. SUBJECTS: Group 1 consisted of 93 patients who had triple procedures (penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation); group 2 consisted of 32 patients who had nonsimultaneous procedures (penetrating keratoplasty followed by extracapsular cataract extraction and posterior chamber intraocular lens implantation). Variables in the first eye that had surgery for each patient were compared between the groups by means of unpaired t tests and Fisher's exact test. RESULTS: Mean follow-up after undergoing transplantation was 6 years in group 1 and 8 years in group 2. Clear grafts were obtained in 89 (96%) of eyes of group 1 and in 29 (91%) of eyes in group 2 (P = .37). A best-corrected visual acuity of 20/40 or better was achieved in 60 (65%) of eyes in group 1 and in 21 (66%) of eyes in group 2. Refractive errors within 2 diopters of emmetropia were found in 37 (42%) of eyes in group 1 and in 15 (48%) of eyes in group 2 (P = .51). Mean refractive cylinder was 3.9 diopters in group 1 and 4.1 diopters in group 2 (P = .67). CONCLUSIONS: There was no statistically significant difference in the outcome and refractive status after triple and nonsimultaneous procedures. To avoid increased cost and delay in visual rehabilitation, we recommend a triple procedure for patients with Fuchs' endothelial dystrophy and visually significant cataracts.

Clear corneal wound infection after phacoemulsification.

OBJECTIVE: To evaluate clear corneal wound infections after phacoemulsification. MATERIALS AND METHODS: The medical records of 7 patients with clear corneal wound infections after phacoemulsification were reviewed retrospectively. Data that were reviewed included patient age, sex, onset of symptoms and signs after surgery, possible risk factors for infection, concomitant ocular disease, use of perioperative prophylactic antibiotics and steroids, culture and antibiotic sensitivity results, treatment regimen, and outcome. RESULTS: The median onset of signs and symptoms after surgery was 10 days (range, 4-60 days). Corneal cultures yielded methicillin-resistant Staphylococcus aureus in 2 cases, Streptococcus pneumoniae in 1 case, and Staphylococcus epidermidis in 1 case. Cultures yielded no microorganisms for 1 patient. Corneal cultures were not obtained in 2 patients. In 3 of the 4 culture-positive cases, the isolated microorganisms were resistant to the perioperative prophylactic antibiotics (fluoroquinolones and tobramycin) that were used. No possible risk factors were noted except use of topical steroids 4 times a day without antibiotic coverage for iritis before referral in one of our patients. Six of these 7 wound infections healed with topical antibiotic therapy. One of the patients required lamellar keratectomy and conjunctival flap for complete healing. In 4 of the 7 cases, best-corrected visual acuity at the last follow-up visit was better than 20/40. CONCLUSIONS: Clear corneal wound infection after phacoemulsification is a serious complication of cataract surgery. Infections are caused by gram-positive organisms sensitive to bacitracin and the combination of trimethoprim-sulfamethoxazole but often resistant to aminoglycosides and/or fluoroquinolones.

Use of routine antibiotic sensitivity testing for the management of corneal ulcers.

OBJECTIVE: To prospectively evaluate the clinical importance of antibiotic sensitivities for the management of corneal ulcers. METHODS: Thirty-two consecutive patients referred to the Cornea Service at Wills Eye Hospital, Philadelphia, Pa. between October 1, 1993, and May 31, 1994, with a culture-positive corneal ulcer were studied prospectively. Broad-spectrum empirical antibiotic therapy with intensive topical fortified antibiotics was initiated after smear and culture results were obtained. The therapy was modified based on clinical appearance, stain results, or organism identification. Clinicians were masked to the sensitivity results. RESULTS: Fifteen patients healed after receiving the initial empirical antibiotic therapy (group 1). The antibiotic regimens of 6 patients were modified after the stain and/or culture results were available, although the clinical appearance suggested continued improvement while taking the initial regimen (group 2). Eleven patients had ulcers that either failed to improve or worsened after receiving the initial empirical therapy (group 3). Seven of these patients ultimately improved with a change in therapy; treatment failed in 4 patients. Nine patients (5 for whom antibiotic therapy succeeded and 4 for whom it failed) should have been adequately treated by the initial antibiotic therapy, according to sensitivity results. In the remaining 2 patients, in vitro sensitivity testing did not include the antibiotics used for the initial treatment. In all cases, the organisms were sensitive to the empirically altered regimen of antibiotics. CONCLUSIONS: These preliminary results suggest that routine antibiotic susceptibility tests do not provide clinically useful information for the management of corneal ulcers. The identification of the organisms based on the results of smears and cultures was sufficient for the selection and modification of topical antibiotic therapy.

Oral acyclovir after penetrating keratoplasty for herpes simplex keratitis.

OBJECTIVE: To determine the efficacy of systemic acyclovir in decreasing complications and improving the outcome of penetrating keratoplasty for herpes simplex virus (HSV) keratitis. METHODS: Retrospective study of 53 primary penetrating keratoplasties for HSV keratitis at an eye hospital from January 1, 1989, through December 31, 1996. Medical records were analyzed for history of HSV keratitis, preoperative neovascularization, and disease activity. Postoperative use of acyclovir, recurrence of HSV keratitis, rejection, uveitis or edema, and graft failure were evaluated. RESULTS: Twenty-four patients (mean +/- SD follow-up, 44.7 +/- 32.6 months) received no acyclovir and were compared with 20 patients, (mean +/- SD follow-up, 28.8 +/- 16.7 months), who received 400 mg acyclovir twice a day for at least 1 year. No patient in the acyclovir group had a recurrence of dendritic keratitis in the first year compared with 5 (21%) of the patients who did not receive acyclovir (P = .03). No patient had graft failure in the acyclovir group compared with 4 (17%) in the group without acyclovir after 1 year of follow-up (P = .06). CONCLUSION: Postoperative systemic acyclovir therapy after penetrating keratoplasty for HSV keratitis is associated with a reduced rate of recurrent HSV dendritic keratitis and possible graft failure at 1 year of follow-up.

Effect of gas-permeable contact lenses on the endothelium of corneal transplants.

The effects of gas-permeable contact lens wear on the density and morphologic characteristics of corneal endothelial cells were prospectively studied by wide-field specular microscopy in 18 eyes that had undergone keratoplasty at least 14 months previously. Daily-wear rigid gas-permeable lenses were fitted to allow as much movement and tear exchange as possible. There was no evidence of morphologic instability of the endothelial cells during the course of the study, with a mean duration of lens wear of 9.8 months. Although there is concern over adverse effects associated with polymethylmethacrylate contact lens wear, this study suggests that the endothelium of a corneal transplant tolerates rigid gas-permeable lens wear without adverse effect during a limited period of follow-up.

Role of débridement and trifluridine (trifluorothymidine) in herpes simplex dendritic keratitis.

Thirty-four patients with herpes simplex dendritic keratitis were randomized into three treatment categories: Group A had débridement alone; group B, trifluridine (trifluorothymidine) alone; and group C, débridement and trifluridine. Patients treated with débridement alone had a statistically higher failure rate than did the other two groups. No statistically significant difference was observed between trifluridine treatment alone and débridement combined with trifluridine treatment, with regard to healing time. Our results suggest that débridement alone is suboptimal therapy for herpes simplex dendritic keratitis and that débridement combined with trifluridine appears to offer no advantage over trifluridine alone.

Central corneal endothelial cell density after argon laser trabeculoplasty.

We report our experience using specular microscopy to perform endothelial cell counts in a series of 16 patients with bilateral, uncontrolled, primary open-angle glaucoma undergoing argon laser trabeculoplasty (ALT). Trabeculoplasty was performed in 20 eyes of these 16 patients. Untreated fellow eyes in 11 patients were used as controls for this series. Endothelial specular microphotographs and pachymetry were done using a Pocklington specular microscope (Keeler-Konan) before ALT and again approximately one and four months later. The endothelial cell densities were normal in all of the affected eyes before treatment and in the control eyes. No statistically significant differences between the pretreatment and posttreatment cell densities and pachymetry values relative to the controls were observed during the course of this study.

Corneal ulcers associated with contact lens wear.

We reviewed the experience with ulcerative keratitis associated with contact lens wear at Wills Eye Hospital, Philadelphia, from Jan 1, 1978 through July 1, 1983. Of the 322 cases of ulcerative keratitis, 56 cases (17%) were associated with the use of contact lenses. Twenty-nine (52%) of the 56 cases of contact lens-associated ulcers were culture positive. Pseudomonas was the most common isolate, occurring in 13 (23%) of the 56 cases. Staphylococcus species were the second most common, occurring in 11 (20%) of the 56 cases. In this series, contact lens-associated ulcers were seen frequently in those wearing soft lenses (48/56 cases or 86%) and in those wearing aphakic lenses (32/56 cases or 57%). Contact lens use is an increasingly important risk factor for the development of corneal ulcers. Prompt, appropriate, and intensive treatment is necessary to prevent visual loss.

Methods of disinfecting contact lenses to avoid corneal disorders.

The contact lens industry has grown rapidly over the past four decades due to the wide-spread demands of the American population for a convenient alternative to spectacle wear for the correction of myopia. Unfortunately, many people who wear contact lenses are not aware of the potential risks associated with them, and consumer education about lens care has not been adequate. This article reviews the role of disinfection in contact lens wear, summarizes the current available contact lens disinfection systems, and provides recommendations for safe contact lens use.

Fixation techniques for secretory component in human lacrimal gland and conjunctiva.

We compared biopsy specimens of human lacrimal gland and conjunctiva preserved by alcohol-acetic acid with the same tissues preserved by freezing to find secretory component. Secretory component was found in lacrimal gland preserved both by alcohol-acetic acid and by freezing. The structure of the tissue was better preserved with the alcohol-acetic acid fixation. Three of eight conjunctival specimens preserved by alcohol-acetic acid showed weak staining for secretory component in a few superficial epithelial cells. We found nonspecific staining of the conjunctiva with the control antiserum, rhodamine-labeled goat antibovine serum. Two specimens preserved by freezing were unreadable; four of the remaining six stained nonspecifically with the remaining two specimens stained with neither the control nor the experimental antiserum; the second may have had more staining with the experimental antiserum than with the control. We found no evidence for including the conjunctiva in the secretory IgA immune system.

Corneal topography for selective suture removal after penetrating keratoplasty.

Twenty-nine suture removals from 20 eyes (21 patients) on which penetrating keratoplasty had been performed were analyzed in a nonrandomized consecutive study to evaluate the role of computer-assisted corneal topography in selective suture removal to reduce astigmatism. Topographic guidance for suture removal resulted in a net decrease in refractive and keratometric astigmatism in 21 of the 29 cases. The net reduction in astigmatism averaged 1.4, 0.9, and 1.0 diopters when measured by refraction, keratometry, and topography, respectively. The preliminary choice of sutures to be removed on the basis of refraction, keratometry, and inspection was changed in 20 of the 29 cases when information added by the topographic map was considered. Although many variables of suture removal remain unpredictable, computer-assisted corneal topography is a powerful means of describing corneal power after penetrating keratoplasty and is useful as a guide in selective suture removal for reduction of astigmatism.

Accidental self-removal of a flap--a rare complication of laser in situ keratomileusis surgery.

PURPOSE: To report a rare complication in which the patient accidentally removed the laser in situ keratomileusis corneal flap. METHODS: Interventional case report. A 35-year-old woman underwent uncomplicated laser in situ keratomileusis surgery. Ten days after surgery, she inserted a soft contact lens into the right eye to improve her vision. She tried to remove the contact lens, but had pain and bleeding. She was referred 10 days later with a diagnosis of loss of flap. RESULTS: On examination, she had a best-corrected visual acuity of 20/70 in the right eye. The right eye examination revealed no corneal flap, mild corneal edema, and significant haze. A central epithelial defect was found. CONCLUSION: Accidental corneal flap removal can rarely follow laser in situ keratomileusis surgery. This complication provides insight into the weak adhesion of the flap onto the stromal bed after laser in situ keratomileusis surgery and, hence, the inherent risk of traumatic flap dislocation or amputation, which needs to be explained to the patient.

Corneal transplantation for herpes simplex keratitis.

We conducted a retrospective study of 107 penetrating keratoplasties in 99 eyes (99 patients) performed from 1970 to 1979 at the Wills Eye Hospital. The follow-up periods ranged from one to 12 years (median, three years). Overall, 86 of the 107 transplants (80%) remained clear and 63 eyes (59%) achieved good to excellent visual acuities (20/60 or better). Preoperative vascularization was not a significant prognostic factor with regard to final visual outcome, graft clarity, or graft rejection. Herpes simplex keratitis was inactive at the time of corneal transplantation in 100 of the eyes (93%). The overall rate of recurrent dendritic keratitis after transplantation for herpes was 19%.

Interferon treatment of adenoviral conjunctivitis.

We conducted a randomized, double-masked, placebo-controlled study to evaluate the efficacy of topical interferon in the treatment of adenoviral conjunctivitis. The study was designed to determine the efficacy of plasmid-derived alpha-2 interferon treatment with regard to the duration of clinical disease, virus shedding, and the occurrence of bilateral infection and subepithelial infiltrates. Interferon therapy was not found to have a statistically significant effect with regard to these factors in the 14 patients who completed 14 days of treatment in the study with interferon or a placebo. Interferon therapy was, however, associated with a tendency toward asymptomatic infection in the second eye when compared to the controls.

Results of penetrating keratoplasty in aniridia.

Eight aniridic patients with bilateral corneal scarring, vascularization, or edema underwent corneal transplantation in one or both eyes (11 eyes). Follow-up ranged from eight months to 5 1/2 years (average, three years). Six of 11 eyes (55%) had at least a two-line improvement in visual acuity and eight of 11 (73%) had at least one line of improvement. Best-corrected visual acuity was 20/200 or worse in nine of 11 eyes (82%), however. Postoperative complications included whorl keratopathy, persistent epithelial defects, central subepithelial scarring, peripheral vascularization with pannus, and graft rejection. Glaucoma was well controlled medically but five of nine patients (56%) with preexisting glaucoma needed an increase in medication for intraocular pressure control. Graft rejection occurred in seven of 11 eyes (64%) and three of these eyes required repeat transplantation.

Retrocorneal fibrous membranes in failed corneal grafts.

Histopathologic slides from 170 failed grafts, excised between 1983 and 1990 were reviewed. The overall incidence of retrocorneal fibrous membrane was 54% (92 grafts). The incidence of diffuse (extensive) retrocorneal fibrous membrane was 17% (29 grafts) and that of focal (peripheral) retrocorneal fibrous membrane was 37% (63 grafts). A high correlation was found between the clinical presence of peripheral anterior synechiae or vitreous adherent to the wound and the finding of retrocorneal fibrous membrane in aphakic and pseudophakic failed corneal grafts. A high correlation was also found between tube-shunt operation and the presence of diffuse retrocorneal fibrous membrane. Sixteen of 63 (25%) regrafted failed grafts, that is second grafts, with focal retrocorneal fibrous membranes failed within 18 months following surgery. Thirteen of 29 (45%) regrafted failed grafts with diffuse retrocorneal fibrous membrane failed within the same period and 11 of these (85%) were associated with tube-shunt surgery.

Corneal ulcers in patients with cosmetic extended-wear contact lenses.

Although cosmetic extended-wear contact lenses are generally safe, they can be associated with a number of complications. A review of 124 cases of corneal ulcers treated between Jan. 1, 1982, and June 1, 1983, disclosed six cases in otherwise healthy patients (four women and two men, ranging in age from 15 to 41 years) who wore extended-wear contact lenses for correction of myopia. In five of the six, the contact lenses had undergone recent manipulation. Two patients had changed their contact lenses without proper disinfection procedures. Five of the six had been treated with antibiotics before corneal scrapings were cultured and three had been treated with corticosteroids. The cultures grew gram-negative rods (in three cases Pseudomonas organisms and in one case Serratia organisms); both patients whose cultures grew no organisms had received antibiotics. Vigorous treatment with tobramycin and cefazolin eyedrops and cycloplegics produced final corrected visual acuities of 20/20, 20/30, 20/60, 20/20, and 20/50. In the sixth case, the final uncorrected visual acuity was counting fingers at 1 foot.

Fitting gas-permeable contact lenses after penetrating keratoplasty.

Between Sept. 1, 1981, and Jan. 31, 1984, 74 eyes (70 patients) were fitted with gas-permeable Polycon contact lenses and monitored for at least six months (range, six to 33 months; mean, 14 months). The major indications for hard contact lens fitting were astigmatism and anisometropia. Astigmatism in this series ranged from 0 to 17.50 diopters (mean, 7.7 diopters). Most patients achieved visual acuities of 20/40 or better (67 of 74, 90%) with contact lenses. Contact lenses were discontinued in 18% (13 of 74), because of graft rejection in four cases and because of contact lens intolerance in nine cases. Our results demonstrated that gas-permeable hard lenses can be fitted successfully in most patients unable to achieve optimal vision with spectacle correction after penetrating keratoplasty.