Meesmann corneal epithelial dystrophy in a Saudi Arabian family.

PURPOSE: Meesmann corneal epithelial dystrophy is a dominantly inherited disorder that was originally reported in Germany and later in descendants of German immigrants to the United States. We report Meesmann corneal epithelial dystrophy in a family that cannot be traced to Germanic origin. METHODS: A 17-year-old Saudi boy from the Al-Qahtani tribe of the Asir region of the kingdom came to the King Khaled Eye Specialist Hospital with classic clinical findings of Meesmann corneal epithelial dystrophy. We examined all members of the immediate family of the index case and members of five branches of the extended family. RESULTS: Meesmann corneal epithelial dystrophy was present in the father and one sister of the index case. Four additional affected individuals were identified in three generations of one branch of the extended family. All but one of the seven affected individuals were aged 17 years or older. Our findings are consistent with previous reports of an autosomal dominant pattern of inheritance, with probable incomplete penetrance or delayed onset of phenotypic expression. CONCLUSION: We report Meesmann corneal epithelial dystrophy in a family without German ancestry.

Phototherapeutic keratectomy for macular corneal dystrophy.

PURPOSE: To report a case of early intervention with phototherapeutic keratectomy for treatment of macular corneal dystrophy. METHODS: We report a 21-year-old Saudi male with early macular corneal dystrophy, recurrent erosions, and decreased visual acuity, who underwent phototherapeutic keratectomy in the right eye and penetrating keratoplasty in the left eye with more than 2 years of follow-up. RESULTS: Following phototherapeutic keratectomy, uncorrected visual acuity in the right eye improved from 20/80 to 20/30. Following penetrating keratoplasty in the left eye, uncorrected visual acuity deteriorated from 20/80 to 20/120 due to irregular astigmatism; the eye was not amenable to improvement with spectacle correction, and the patient declined contact lens therapy. In the right eye, there has been no anterior recurrence, although some mid- to deep stromal haze, which is not visually significant, has developed. CONCLUSIONS: Early intervention for symptomatic, anterior macular corneal dystrophy with phototherapeutic keratectomy is relatively safe and preferable to observation or penetrating keratoplasty.

Excimer laser phototherapeutic keratectomy for shield ulcers and corneal plaques in vernal keratoconjunctivitis.

BACKGROUND: Shield-shaped corneal ulcers and corneal plaques in vernal keratoconjunctivitis are associated with delayed epithelial healing, as well as the risks of infectious keratitis and sterile stromal ulceration. Significant visual impairment due to scarring and irregular astigmatism may result from central corneal lesions. METHODS: Three eyes with central corneal lesions resulting from vernal keratoconjunctivitis were treated by excimer laser after active vernal keratoconjunctivitis was controlled and inflammatory plaque overlying the shield ulcers was removed. RESULTS: All three eyes showed rapid reepithelialization within 1 week. Spectacle-corrected visual acuity of 20/30 or better was obtained in each eye. CONCLUSIONS: In selected patients, excimer laser phototherapeutic keratectomy may be a useful adjunct in the treatment of shield-shaped corneal ulcers and plaques in vernal keratoconjunctivitis.

Photorefractive keratectomy after radial keratotomy.

BACKGROUND: Twenty-three eyes of 22 patients remained undercorrected 5 to 49 months after radial keratotomy, either alone or in combination with transverse keratotomy. METHOD: We attempted to correct the residual myopia ranging from -1.25 to -5.75 diopters (D) (with astigmatism of 0 to 1.25 D) with photorefractive keratectomy. The mean age of patients was 26 years (range 22 to 40 years). RESULTS: After photorefractive keratectomy (follow-up 6 to 17 months) uncorrected visual acuity was equal to or better than 20/20 in 39% (9 eyes), better than 20/25 in 65% (15 eyes), and better than 20/40 in 74% (17 eyes). Spectacle-corrected visual acuity was equal or better than 20/40 in all eyes; one eye (4%) lost two lines of spectacle-corrected visual acuity. Refractive error was within +/- 0.50 D in 48% (11 eyes) and within +/- 1.00 D in 65% (15 eyes). Undercorrections of more than 1.00 D occurred in 22% (5 eyes) and overcorrections of more than 1.00 D occurred in 13% (3 eyes). No or minimal haze was present in 57% (13 eyes), mild haze in 39% (9 eyes) and moderate haze in 4% (1 eye). Final uncorrected visual acuity was better (p = 0.0002) and haze was less (p = 0.003) in the group with less than -3.00 D than in the group with greater than or equal to -3.00 D. CONCLUSION: Photorefractive keratectomy after radial keratotomy is safe but less effective and less predictable in eyes with greater than or equal to -3.00 D compared to those with less than -3.00 D.

Bacterial keratitis following phototherapeutic keratectomy.

BACKGROUND: Phototherapeutic keratectomy (PTK) is effective in the treatment of many superficial corneal disorders. The incidence of bacterial keratitis following PTK has not been assessed in a large, prospective clinical trial. METHODS: We report three cases of bacterial keratitis that occurred in a prospective study of 258 consecutive PTK procedures at King Khaled Eye Specialist Hospital. RESULTS: Three (1.2%) of 258 eyes developed bacterial keratitis during a period of follow up ranging from 1 to 24 months. All three cases were in 183 eyes (1.6%) with a diagnosis of climatic droplet keratopathy, while no cases were observed in 75 eyes with other anterior corneal disorders. Gram-positive species (Streptococcus pneumonia in two, coagulase-negative Staphylococcus in one) were the predominant species isolated from all three cases. Two of the cases were polybacterial. The final visual outcomes ranged from 20/125 to 20/400. CONCLUSIONS: The risk of bacterial keratitis following treatment of superficial corneal disorders with PTK is low but its occurrence may adversely affect the final visual outcome.

Phototherapeutic keratectomy for climatic droplet keratopathy, KKESH Excimer Laser Study Group. King Khaled Eye Specialist Hospital.

BACKGROUND: Phototherapeutic keratectomy (PTK) is an effective treatment for many superficial corneal disorders. The efficacy of PTK for the treatment of climatic droplet keratopathy (CDK) has not been reported. METHODS: We report the results of excimer laser (Summit Technology, Inc, Waltham, Mass) PTK on 75 eyes (67 patients) with "smooth" climatic droplet keratopathy (55 eyes) and "irregular" climatic droplet keratopathy (20 eyes) in whom more than 6 months of follow up are available. RESULTS: PTK was successful in reducing corneal opacification in both smooth (98%) climatic droplet keratopathy and irregular (80%) climatic droplet keratopathy. Achievement of a clear or mildly hazy cornea following PTK was more likely to occur with smooth (80%) climatic droplet keratopathy than irregular (25%) climatic droplet keratopathy (P = 0.01). Eyes with smooth climatic droplet keratopathy were more likely to obtain more than one line of improved uncorrected (56% vs. 25%) or spectacle-corrected visual acuity (61.8% vs. 21.2%) than those with irregular climatic droplet keratopathy (P = 0.03 and 0.005, respectively). Delayed re-epithelialization (longer than 14 days) was more common in irregular CDK (21%) than in smooth CDK (9%), as was the incidence of secondary microbial keratitis (10.0% vs. 1.8%). CONCLUSIONS: PTK is effective in reducing superficial corneal opacification in CDK, although serious complications may occur, especially in advanced irregular CDK.

Changing pattern of childhood blindness in Saudi Arabia.

We studied 187 patients attending special educational institutions in Saudi Arabia who were blind before the age of 14. All patients underwent complete ophthalmological evaluation. The visual acuity in 31% of the patients was no light perception and in 58% light perception to counting fingers at 3 feet (1 m). 70% were blind before age 2. Prior to 1962 acquired diseases led to blindness in 75% of the patients. From 1962 onwards genetically determined diseases accounted for 84% of childhood blindness. 56% of this group were the product of consanguineous marriages. On the other hand in the group who acquired blindness only 14% were from consanguineous marriages (p less than 0.0001). We here describe guidelines for the prevention of childhood blindness in Saudi Arabia.

Chrysosporium parvum keratomycosis.

PURPOSE: To report a case of corneal infection with Chrysosporium parvum, a filamentous fungus usually associated with pulmonary infections. METHODS: A 43-year-old Saudi man had a corneal stromal infiltrate and perforation of his left eye. He was treated with a therapeutic penetrating keratoplasty and topical and systemic antifungal therapy. Corneal scrapings, microbiologic evaluation, and histopathologic examination of the surgical specimen were performed to establish the diagnosis. After the development of recurrent stromal keratitis at the graft-host junction, similar diagnostic and therapeutic maneuvers were performed. RESULTS: Corneal scrapings and histopathologic examination were positive for numerous septate hyphae with endospores, consistent with a diagnosis of filamentous keratomycosis. Microbiologic isolation confirmed the diagnosis of Chrysosporium parvum. Similar diagnostic maneuvers for recurrent keratitis produced identical results. CONCLUSION: To our knowledge, this is the first case of Chrysosporium parvum keratomycosis.

Contamination of donor cornea: postpenetrating keratoplasty endophthalmitis.

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.

Endophthalmitis cluster from contaminated donor corneas following penetrating keratoplasty.

OBJECTIVE: To attempt to identify common events or factors in four cases of endophthalmitis that developed after penetrating keratoplasty performed within a 1-week interval. DESIGN: Case series. SETTING: Tertiary care eye hospital in Riyadh, Saudi Arabia. PATIENTS: Four patients in whom endophthalmitis developed after penetrating keratoplasty performed in May 1993. OUTCOME MEASURES: Source of donor tissue, transportation of corneas, handling of corneas at the eye hospital, and causative organism and sensitivity profile. RESULTS: The donor tissue in all four cases originated from the same eye bank. Organisms were cultured from 10 of the 11 donor rims from eye bank A tissue used during the week in question. The causative organisms were Enterococcus faecalis in three patients and Torulopsis glabrata in one patient. In each case the same organism was cultured from the recipient eye and the corresponding donor rim. Two of the four patients had a favourable outcome. CONCLUSIONS: Donor rim culture is essential if the cause of endophthalmitis after penetrating keratoplasty is to be determined. Close communication between eye bank personnel, the microbiology laboratory and the operating surgeon is important as it may influence early detection, choice of treatment and outcome of endophthalmitis after penetrating keratoplasty. Epidemiologic studies from both the source eye bank and the recipient facility are required to fully investigate the cause of a cluster of endophthalmitis cases from contaminated donor tissue following penetrating keratoplasty.