Corneal infection in Shandong peninsula of China: a 10-year retrospective study on 578 cases.

AIM: To determine the epidemiological characteristics, clinical signs, laboratory findings, and outcomes in patients with corneal infection in Shandong peninsula of China. METHODS: The medical records of 578 inpatients (578 eyes) with corneal infection were reviewed retrospectively for demographic characteristics, risk factors, seasonal variation, clinical signs, laboratory findings, and treatment strategy. Patient history, ocular examination findings using slit-lamp biomicroscopy, laboratory findings resulted from microbiological cultures, and treatment. RESULTS: Fungal keratitis constituted 58.48% of cases of infectious keratitis among the inpatients, followed by herpes simplex keratitis (20.76%), bacterial keratitis (19.03%) and acanthamoeba keratitis (1.73%). The most common risk factor was corneal trauma (71.80%). The direct microscopic examination (338 cases) using potassium hydroxide (KOH) wet mounts was positive in 296 cases (87.57%). Among the 298 fungal culture-positive cases, Fusarium species were the most common isolates (70.47%). A total of 517 cases (89.45%) received surgical intervention, including 255 (44.12%) cases of penetrating keratoplasty, 74 (12.80%) cases of lamellar keratoplasty which has become increasingly popular, and 77 cases (13.32%) of evisceration or enucleation. CONCLUSION: At present, infectious keratitis is a primary corneal disease causing blindness in China. With Fusarium species being the most commonly identified pathogens, fungal keratitis is the leading cause of severe infectious corneal ulcers in Shandong peninsula of China.

Comparison of the in vitro toxicity of indocyanine green to that of trypan blue in human retinal pigment epithelium cell cultures.

PURPOSE: To compare the in vitro toxicity of indocyanine green (ICG) to that of trypan blue (TB) in human retinal pigment epithelium cell cultures. The use of ICG and TB in macular hole surgery is discussed. DESIGN: In vitro cell biology experimental study. METHODS: The ICG dye and TB were applied to ARPE-19, a commercially available human retinal pigment epithelium cell line. Cultures were established and maintained according to supplier protocols. The ICG dye, TB or Hank's balanced salt solution (controls) were then applied to the cells at varying concentrations and over various exposure periods. Fiberoptic light was also applied to cells to assess for the possibility of a potentiating phototoxic effect. Cell viability fractions were determined using a well-studied mitochondrial dehydrogenase assay. RESULTS: The TB was not toxic to the retinal pigment epithelium cell cultures at any concentration or over any period of exposure, whereas ICG dye demonstrated dose-dependent and exposure-dependent toxicity. The ICG dye was found to be toxic to the cells at all tested concentrations between 5.0 mg/ml (stock concentration, 26.1% cell survival) and 0.5 mg/ml (92.8% cell survival) over a 3-minute exposure. No toxicity to TB was seen at the stock concentration of 1.5 mg/mL. Addition of light to the cultures did not significantly alter cell viability with either dye. Long periods of exposure, 2 hours, 24 hours, and 72 hours, to minute concentrations of either dye did not produce significant cell death. CONCLUSIONS: Indocyanine green demonstrates more toxicity than TB to human retinal pigment epithelium cell cultures. This is independent of any phototoxic potentiating effect of fiberoptic light or solvent toxicity. A clinically useful concentration of 0.5-mg/ml ICG causes low cytotoxicity at 3 minutes' exposure (cell survival 92.8%) and shows no detectable toxicity at 1-minute exposure (cell survival 102%).

Can preoperative anterior chamber angle width predict magnitude of intraocular pressure change after cataract surgery?

OBJECTIVE: To determine whether preoperative anterior chamber angle width, captured by anterior segment optical coherence tomography (AS-OCT), can be a predictor of intraocular pressure (IOP) change following cataract surgery. DESIGN: Prospective comparative observational study. PARTICIPANTS: Fifty-three eyes of 53 patients awaiting cataract surgery were included. METHODS: Measurement of anterior chamber angle width and IOP using AS-OCT and Goldmann's applanation tonometry, respectively, were performed before and 6 months after phacoemulsification and intraocular lens implantation. Preoperative and postoperative measurements were compared using paired t test. The prediction rule defined success as > or =20% IOP reduction from the baseline preoperative IOP measurement. Multivariate regression analysis was performed to assess the association of postoperative IOP with independent variables, including age, sex, systemic hypertension, diabetes mellitus, glaucoma, and preoperative anterior chamber angle width. RESULTS: Data were collected from 32 females and 21 males with visually significant cataract. Mean age was 73.3 (SD 8.2) years. Mean IOP dropped from 15.1 (SD 3.1) mm Hg to 12.8 (SD 2.5) mm Hg (p < 0.0001) after cataract extraction. Mean anterior chamber angle width increased from 24.7 degrees (SD 7.1 degrees ) to 38.1 degrees (SD 6.0 degrees ) after surgery (p < 0.001). Multivariate regression analysis did not identify preoperative variables to be significantly associated with > or =20% postoperative IOP reduction. CONCLUSIONS: Cataract surgery results in significant and sustained mean reductions in IOP and concurrent increases in anterior chamber angle width for a period of at least 6 months after surgery. However, measurements of the preoperative anterior chamber angle width did not predict the IOP-lowering effect of cataract surgery.

Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension.

PURPOSE: To develop and validate a prediction rule to estimate the probability of acceptable intraocular pressure (IOP) reduction after selective laser trabeculoplasty (SLT) in ocular hypertension and open-angle glaucoma. PATIENTS AND METHODS: The study population was derived from a cohort of 220 patients with ocular hypertension, open-angle glaucoma, or normal tension glaucoma. A > or =20% reduction in IOP (mm Hg) from the baseline IOP at 6 months after SLT was considered treatment success. Logistic multivariate regression modeling was performed to develop a prediction rule. RESULTS: In multivariate logistic regression analyses, pre-SLT IOP and maximum IOP were identified as independent predictors for > or =20% IOP reduction at 6 months with adjusted odds ratios of 1.3 and 0.9, respectively, controlling for sex, diagnosis, pigment of anterior chamber, and washout of eye drops. The area under receiver operator characteristic curve was 0.716. Calibration of this prediction rule showed good agreement between predicted and observed probabilities of acceptable IOP reduction. If a probability of acceptable IOP reduction of 50% or greater is used as the minimal clinical threshold for treatment, the prediction rule had a sensitivity and specificity of 91.3% and 30.4%, respectively. CONCLUSIONS: SLT efficacy is positively associated with IOP elevation before SLT treatment and adversely associated with the maximum IOP ever recorded in history. Pigmentation of the anterior chamber angle, diagnosis, washout of eye drops, and sex are not associated with SLT treatment efficacy. This prediction rule should be further validated with a comparable prospective clinical study cohort.