[Corneal infection in wearers of contact lenses: causes, effect on visual acuity and prevention].

This is a 5-year retrospective survey of corneal infection in wearers of optical contact lenses (OCL). 23 of the 61 patients (38%; Hasharon Hospital) with positive cultures wore OCL. Visual acuity improved in 15 (65%), no change was noted in 4 (17.5%) and there was deterioration in 4 (17.5%), as compare with status on admission. Pseudomonas aeruginosa was the most common cause of infections among OCL wearers. The improvement in visual acuity expected due to wearing OCL was affected by infections. Those after Staphylococcus albus infections had the highest rate (100%) of improvement in visual acuity and after Ps. aeruginosa the lowest rate (57.2%) of improvement, as well as the highest rate of deterioration (42.8%) found following recovery. OCL wearers are at higher risk for damage to visual acuity following corneal infection, and highly virulent infections in OCL wearers are responsible for a high risk of damage to visual acuity.

[Corneal infection, cause and effect on vision].

We conducted a retrospective 5-year survey of corneal infections treated in the ophthalmology ward of Hasharon Hospital. The most frequent type of corneal infection was corneal abscess; the most frequent cause was Staphylococcus albus, although this bacterium is not reported as a frequent cause of corneal infections. There was improvement in visual acuity in 69.2% and no change in 15.4%. Corneal infection by Pseudomonas aeruginosa was the most frequent cause of worsening of corneal acuity (23.08%). The greatest improvement of visual acuity was in those with corneal ulcers. The worst visual acuity was in those with corneal abscesses. Pseudomonas aeruginosa was the main cause of infection in contact-lens wearers. In the world medical literature, Staphylococcus albus is considered of very low virulence. This bacterium was the most frequent cause of corneal infections in our study so it may have greater virulence in Israel.

The combination of topical ceftazidime and aminoglycosides in the treatment of refractory pseudomonal keratitis.

BACKGROUND: Pseudomonal keratitis is a serious and potentially blinding infection. METHODS: We treated 12 patients with culture-positive fulminant pseudomonal keratitis with a topical combination of ceftazidime ophthalmic solution (50 mg/ml) and aminoglycosides (14 mg/ml). None of these patients had responded to the standard initial therapy with topical fortified gentamicin or tobramycin (14 mg/ml) combined with cefazolin (50 mg/ml). RESULTS: Substitution of cefazolin by ceftazidime achieved a remarkable clinical improvement during the first 24-48 h of administration in all cases. The average time of healing after initiation of the combination of ceftazidime and fortified aminoglycosides was 21+/-15 days. No serious side effects accompanied ceftazidime administration. In vitro susceptibility testing showed resistance to gentamicin or tobramycin in 33% of cases (4/12) and sensitivity to ceftazidime in all cases. CONCLUSIONS: The combination of ceftazidime, in a 5% solution, and fortified aminoglycosides (1.4%) may be a useful, safe and effective topical therapy for the treatment of pseudomonal keratitis resistant to aminoglycosides.

Mitomycin C treatment for conjunctival-corneal intraepithelial neoplasia: a multicenter experience.

OBJECTIVE: The purpose of the study is to evaluate the efficacy and risks of topical mitomycin C (MMC) for conjunctival-corneal intraepithelial neoplasia (CCIN). DESIGN: The study design was a clinical case series of CCIN. PARTICIPANTS: Seventeen patients, 16 with biopsy-confirmed CCIN and 1 with invasive squamous cell carcinoma (SCC), were included in the study. INTERVENTION: Patients received topical drops of MMC 0.02% to 0.04% four times daily from 7 to 28 days. Retreatment was done in cases of lesion recurrence. MAIN OUTCOME MEASURES: The size of the CCIN before and after the treatment and ocular complications post-MMC application were evaluated. RESULTS: Ten patients remained disease-free after one course of MMC application. In one case, residual CCIN remained very small without regrowth. In the one patient with invasive SCC and in five patients with CCIN, regrowth occurred within 6 months of the first treatment. After retreatment, invasive SCC and CCIN in an additional two patients were eradicated. In two cases, although the size of the lesions decreased after two and three applications of MMC, regrowth occurred, and the CCIN returned to its original size. In the final case, limited recurrence has occurred and no retreatment has been done. The complications of MMC use included mild-to-moderate conjunctival hyperemia and mild allergy, which resolved after discontinuation of the treatment. Severe pain manifested when treatment was longer than 14 days. CONCLUSIONS: Application of topical MMC is an efficient treatment for most but not all cases of CCIN.

Comparative study of tear substitutes and their immediate effect on the precorneal tear film.

Dry eye patients present with instability of the precorneal tear film which breaks up much earlier than normally. The instability of the precorneal tear film leads to dry eye symptoms such as the sensation of sand in the eye, recurrent blurred vision, itching, smartness, and the sensation of dryness. The stability of the precorneal tear film can be evaluated by the break-up-time test (BUT). The aim of treatment of dry eye is to increase the precorneal tear film stability. Tear substitutes are the most frequent medication for dry eye patients, who request life-long treatment. Therefore, we estimated the influence of tear substitutes on the precorneal tear film stability. The influence of unpreserved artificial tear substitute containing 0.1% sodium hyaluronate (Healon 0.1%) was compared with that of 7 different available tear substitute preparations containing preservatives. The results of the present study show that Healon 0.1% has the best influence on the precorneal tear film stability. These data were found to be independent of the viscosity property of Healon 0.1%.

Sodium hyaluronate as a tool in strabismus surgery in rabbits.

BACKGROUND AND OBJECTIVE: The authors tested whether coating tissue with sodium hyaluronate (Na-HA) reduced postoperative adhesions and accelerated the healing process in strabismus surgery. MATERIALS AND METHODS: The surgical technique was tested during recession and resection operations performed on 30 rabbits and was compared with the use of NaCl 0.9%. Clinical, biomicroscopic examinations were performed on postoperative days 1, 2, 7, and 30 and histopathologic examinations were performed on postoperative days 2, 7, and 30. RESULTS: Clinically, there were no statistically significant differences between the study group and the control group. Also, there were no statistically significant differences between the two groups for most of the histopathologic criteria; however, new vessel formation was smaller with Na-HA than without it. Statistical significance was defined as P < .05. CONCLUSION: The authors found no significant positive effect of Na-HA on postoperative healing in rabbits.

Panuveitis responsive to 2-CdA: an unusual ocular presentation of hairy cell leukemia.

Systemic involvement in hairy cell leukemia (HCL), has rarely been reported but ocular involvement is extremely uncommon. We report an unusual ocular presentation of HCL due to panuveitis with dramatic improvement following treatment with 2-chlorodeoxyadenosine (2-CdA).

Oral bromhexine has no effect on tear and lysosyme secretion in healthy subjects.

The purpose of the present study was to determine whether bromhexine (Solvex) affects the rate of tear secretion or the concentration of lysosyme in the tear fluid in healthy subjects. The rate of tear secretion and lysosyme concentration in tear fluid were estimated in 56 healthy volunteers before and after 3 weeks of oral administration of placebo (tablets of vitamin C, 200 mg per day) followed by bromhexine tablets, 32 mg per day. Shirmer's test I was performed to evaluate the tear secretion, and the lysosyme plate method was used to detect lysosyme concentration. Shirmer's test showed similar results before and after placebo and bromhexine administration. In conclusion, oral bromhexine was found to have no effect on the rate of tear secretion, nor on the concentration of lysosyme in the tear fluid of healthy subjects.

Ocular manifestation of hairy cell leukemia with dramatic response to 2-chloro-deoxy-adenosine.

PURPOSE: To demonstrate that hairy cell leukemia may involve the eye. METHODS: We examined a patient who had a unique ocular manifestation of hairy cell leukemia with severe panuveitis in one eye and leukemic retinopathy in the fellow eye. RESULTS: Therapy with 2-chloro-deoxy-adenosine, a drug recently introduced for treatment of hairy cell leukemia, led to dramatic improvement of the ocular complications. CONCLUSIONS: Hairy cell leukemia may involve the eye and ocular symptoms may respond to systemic treatment with 2-chloro-deoxy-adenosine.