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.

Influence of haptic materials on the adherence of staphylococci to intraocular lenses.

A recent case-control study indicated that the insertion of an intraocular lens with polypropylene (Prolene) haptic materials was a significant risk factor for postoperative endophthalmitis (odds ratio = 4.5, P < .01). In the present study, we used quantitative techniques to evaluate adherence of Staphylococcus epidermidis to two intraocular lens types--lenses with polypropylene haptic materials and all-polymethyl methacrylate optic and three-piece all-polymethyl methacrylate lenses--using a quantitative culture method, a radioisotope technique, and scanning electron microscopy. All three methods demonstrated approximately twice as many bacteria adherent to lenses with polypropylene haptic materials as to all-polymethyl methacrylate lenses. Scanning electron microscopy showed preferential bacterial adherence to the polypropylene haptic materials. These data provide a pathogenic mechanism to explain our epidemiologic findings of an increased risk of postoperative endophthalmitis associated with implantation of intraocular lenses with polypropylene haptic materials.

Blepharitis.

Blepharitis is an acute or chronic inflammatory process involving the eyelids that is frequently associated with conjunctivitis. In its many clinical forms, blepharitis is one of the most common diseases seen by ophthalmologists; yet it remains a diagnostic and therapeutic challenge. This article reviews the clinical presentation, classification, diagnosis, etiology and pathogenesis, and treatment of blepharitis.

Reducing eyelid retraction following subperiosteal face lift.

The most common complication of lower blepharoplasty is malposition of the lower eyelid. This deformity may present as scleral show, ectropion, entropion, or canthal dystopia, with dry eye or epiphora. These problems occurred frequently in our initial series of patients undergoing blepharoplasty with subperiosteal face lift. The key to prevention lay in avoiding the potential causes of these problems: overresection of eyelid skin, retraction of the orbital septum, orbicularis oculi dysfunction, postoperative swelling, and downward pull from the facial suspension. This article reviews the cases of 14 consecutive patients who underwent a modified subperiosteal face lift with blepharoplasty. Eleven of the patients had a concomitant endoscopically assisted brow lift. This group is compared with a prior series of 16 patients who underwent 12 endoscope-assisted brow lifts without special modifications. The modifications in the second series consisted of the following: (1) Improved patient selection; (2) minimal tissue trauma; (3) intact orbital septum; (4) lengthening of the septum; (5) secure midfacial suspension; (6) three-step lateral canthoplasty; (7) limited resection of skin; and (8) specific postoperative care. Results regarding the incidence of eyelid malposition and reoperations were subjected to Fisher's exact test. In the 14 consecutive patients who underwent the modified procedure, two temporary episodes of lower eyelid malposition occurred (follow-up of 12 to 20 months). In the 16 patients who underwent a nonmodified procedure, five temporary and three permanent episodes of eyelid malposition occurred (follow-up of 20 to 30 months). Fisher's exact test demonstrated a significant difference with a p value of 0.038. Modifications of the subperiosteal face lift and lower blepharoplasty reduced significantly but did not eliminate the incidence of lower eyelid malposition.

A case-control study of risk factors for postoperative endophthalmitis.

The authors conducted a case-control study to identify risk factors for postoperative endophthalmitis. Fifty-four cases of patients who developed endophthalmitis after intraocular surgery at the New York Eye and Ear Infirmary during the period from January 1988 through October 1990 were identified. A control group of 228 patients was randomly selected from the 24,105 patients who underwent intraocular surgery during this same period. Logistic regression analysis identified significant independent risks associated with intraoperative communication with the vitreous cavity (risk ratio 13.7, P less than 0.001) and use of an intraocular lens with haptics made of polypropylene (risk ratio 4.5, P = 0.007). The study predicts that there would be approximately 700 fewer cases of postoperative endophthalmitis annually in the United States (approximately a 50% decrease in incidence) if intraocular lenses with haptics made of polymethyl-methacrylate, rather than polypropylene, were used exclusively.

Granulomatous idiopathic orbital inflammation.

One category of idiopathic orbital inflammation (IOI) displays a granulomatous inflammatory pattern that mimics sarcoidosis, although this has not been extensively addressed in most published series of IOI. We analyzed the clinicopathologic features of patients with biopsy-proven noninfectious granulomatous inflammation of the orbit. Review of surgical pathology records from January 1988 to May 1992 identified 12 patients with a diagnosis of sarcoidosis or other noninfectious granulomatous process involving the orbit. Clinical records were reviewed, and the patients' physicians contacted to determine if the diagnosis of sarcoidosis was confirmed. Five cases in which the systemic diagnosis was not established despite thorough evaluation are reported here. We report five cases of noninfectious IOI in which sarcoidosis was suspected clinically and histologically. In these, however, further systemic evaluation at 15 to 32 months (mean 22.4) failed to reveal evidence of systemic involvement. A spectrum of histopathologic patterns was seen, including non-necrotizing foreign body type granulomas, lipogranulomatous inflammation, and variable sclerosis. Patients with solitary orbital noncaseating granulomatous inflammation should be thoroughly evaluated before a diagnosis of sarcoidosis is made. Practitioners should be aware of the existence of granulomatous IOI not associated with systemic sarcoidosis as a distinct clinicopathologic entity.

Prediction of late enophthalmos by volumetric analysis of orbital fractures.

The purpose of this study was to determine whether orbital volume assessment by computerized tomography (CT) could provide additional information for the initial evaluation of orbital blowout fractures and guide optimal treatment. The medical records of 30 patients with orbital blowout fractures, either surgically or conservatively managed, were retrospectively reviewed. Orbital volumetric analysis was then determined from digitized CT scans. Fracture-related volume expansion relative to the unaffected fellow orbit was correlated with motility deficits and location and degree of enophthalmos. Early Hertel's measurements (< 4 weeks) were available in 21 patients and did not correlate with the computer volumetric values or with subsequent late enophthalmos. Late Hertel's measurements (> 4 weeks) were obtained in 13 of 15 nonrepaired fractures and in 5 of 15 surgically repaired patients (late presentation; 18 patients). When seen at more than 4 weeks, 11 (92%) of 12 patients with > or = 13% orbital volume expansion manifested significant enophthalmos (> 2 mm) compared with 1 (17%) of 6 patients with < 13% orbital expansion (p = 0.004). Fractures presenting with enophthalmos on initial examination had extensive medial wall involvement in addition to the floor fracture (p = 0.003). CT measurements of orbital volume can predict the final degree of late enophthalmos and may facilitate the planning of surgical intervention.