Endogenous endophthalmitis caused by Escherichia coli.

Endophthalmitis is a rare complication of Escherichia coli-induced septicemia. Nine cases of endogenous endophthalmitis caused by E. coli have been reported previously, all except one in patients with diabetes. The most common primary site of infection is the urinary tract. The course of illness is rapidly progressive with a poor visual prognosis. Concurrent systemic morbidity, including body abscesses and endocarditis, is high. We report an additional case of endogenous endophthalmitis from E. coli in a diabetic woman. Enucleation was required despite aggressive topical and systemic treatment. The pertinent literature is reviewed.

Techniques for application of tissue adhesive for corneal perforations.

We describe a modified technique of using cyanoacrylate adhesive to seal corneal perforations. Easily performed at the slit lamp, its advantages over previously described methods include a smooth, contoured collagen surface overlying the adhesive, which is easily wet by the tear film. Even greater comfort and protection are provided by the addition of a hydrophilic bandage lens or collagen shield.

Early visual rehabilitation following keratoplasty using a single continuous adjustable suture technique.

We measured postkeratoplasty visual acuity, refraction, retinoscopy, keratometry, and corneal topography in 105 patients, in 33 of whom an adjustable continuous technique had been used, and in 72 of whom a standard technique (in which the continuous suture was not adjusted) had been used. In the eyes in which the sutures were adjusted (within 6 weeks following surgery), acuity improved (preadjustment mean, 20/205; postadjustment mean, 20/100), and astigmatism decreased (preadjustment mean, 8.41 diopters; postadjustment mean, 2.22 D). Visual acuity and astigmatism in the control group were unchanged at the same point after surgery.

Posterior scleritis as an intraocular tumour.

Posterior scleritis rarely presents as a large 'intraocular tumour' and continues to be a challenge in diagnosis and management. We present the case of a 66-year-old male with no known rheumatic disease, pain, proptosis, or diplopia, but with progressively decreasing visual acuity and a large, discrete 'subretinal tumour', 15 X 17 mm basal diameter and 8.3 mm apical height. Histologically the tumour was shown to be grossly thickened and necrotic sclera.

Seventy-six consecutive cases of IOGEL intraocular lens implants.

A single piece hydrogel IOGEL (poly-HEMA) intraocular lens was implanted in 76 eyes. Patients obtained a visual acuity of 20/40 or better in 86.9% of cases and a best case visual acuity of 20/40 or better in 98.5% of cases. Patients were followed an average of 12 months (four to 19 months). Two lenses were exchanged with poly(methyl methacrylate) lenses because of decentration-induced glare. Cystoid macular edema occurred in two cases, resulting in visual acuity worse than 20/40 in one case. Results of the study at one year mean follow-up indicate the safety and efficacy of the IOGEL lens as an intraocular implant.

Fibronectin on excimer laser and diamond knife incisions.

The experiment was designed to illustrate the difference between the diamond knife and the excimer laser (ArF 193 nm) on keratotomy incisions. The histopathologic effect of fibronectin applied to these wounds was observed. Fibronectin demonstrated a chemotactic effect on fibroblasts and increased the amount of newly synthesized collagen deposited at the incision sites. The excimer laser incisions treated with fibronectin had 43% more fibroblasts per 2,500 microns 2 than the excimer laser incisions not treated with fibronectin. The adjustable diamond knife incisions treated with fibronectin had 42% more fibroblasts than the adjustable diamond knife incisions not treated with fibronectin. The excimer laser ArF 193 nm incisions had 18% more fibroblasts in the incision area than the adjustable diamond knife incisions independent of fibronectin usage. This indicates that the excimer laser incisions and the diamond knife incisions may have different healing mechanisms--perhaps because of the distinctive modes of action of these instruments.

Bacillus Calmette-Guerin (BCG) endophthalmitis.

A patient who had been treated for metastatic bladder carcinoma with bacillus Calmette-Guerin (BCG) vaccine subsequently developed bilateral visual loss secondary to an infiltrative retinitis and vitreitis. Although assumed to have candida endophthalmitis, vitrectomy demonstrated mycobacterium bovis. The patient was placed on systemic anti-tuberculous therapy, and there was noted to be a reduction in retinal lesions prior to his death. This is the first report in the literature documenting endogenous endophthalmitis after BCG usage.