A comparison of the effects of topical cyclosporine and topical steroid on rabbit corneal allograft rejection.

A comparison was made of the effects of topically applied cyclosporine, and topically applied prednisolone acetate, on the prolongation of corneal allograft survival in a recently developed prevascularized rabbit eye model. Animals were treated four times daily for 28 days postgrafting. Both drugs prolonged graft survival when compared with placebo or no treatment but the corticosteroid was significantly more effective than cyclosporine. Furthermore, anterior segment inflammation and graft vascularization were considerably less marked in animals treated with steroid. No cyclosporine could be detected by radioimmunoassay in anterior chamber fluid removed by paracentesis from grafted animals treated with cyclosporine, suggesting poor absorption of the drug across the cornea.

Experimental trachoma in subcutaneous conjunctival autografts in macaques.

To study chlamydial conjunctivitis, conjunctival autografts subcutaneously implanted in pockets on the abdomens of rhesus (Macaca mulatta) and pig-tailed (M. nemestrina) monkeys were inoculated percutaneously (4-10 X 10(4) inclusion-forming units per pocket) with trachoma strains of Chlamydia trachomatis (serovars B & C). These conjunctival pockets were removed on days 2, 3, 4, 5, 6, 7, 8, 10, 14 and 16 post-inoculation (pi). Tissues (at least two samples at each time interval) were prepared either for reisolation of the organisms by cell culture or histologic examination by light and electron microscopy. Control tissue, inoculated with either HeLa cell material or UV-inactivated organisms, were prepared in parallel. Bloods were drawn and tear strips taken at weekly intervals for 8 weeks. A total of 221 bulbar and 99 palpebral conjunctival pockets were established over time with the success rate of 75% and 88%, respectively, in six rhesus and ten pig-tailed monkeys. Histological examination revealed widespread infiltration of mixed polymorphonuclear and mononuclear cells on days 2 and 3 pi. By day 5 pi, lymphocytes had migrated into the thinned epithelial layer. Patches of inflammatory infiltrate similar to trachoma follicles were observed, although distinct germinal centers were absent. Surface morphologies of normal and infected pocket conjunctiva were examined by scanning electron microscopy. Normal tissue was characterized by a regular mosaic pattern of closely packed epithelial cells containing numerous microvilli. Infected tissue was edematous, and the continuity of the mucosal surface had been altered. Chlamydiae were reisolated from the pockets on days 2, 3, 6, 8 and 10 pi.(ABSTRACT TRUNCATED AT 250 WORDS)

Light-induced maculopathy. Potential for recovery.

Operating room microscope-induced maculopathy is described in two patients following cataract surgery without intraocular lens implantation. Sequential fundus photographs of evolving retinal lesions are presented. Serial visual field testing disclosed marked recovery of paramacular scotomas over time. The effect of the pseudophakos in producing photochemical lesions is discussed. Proposed mechanisms for recovery of visual scotomas are reviewed.

Contamination of corneal tissue from infected donors.

Thirty-two corneas with scleral rims were cultured from the eyes of 17 cadavers that harbored systemic infection at the time of death. Twelve (71%) of 17 cadavers demonstrated corneal contamination from one or both corneas. Eleven (92%) of 12 donors with positive postmortem blood cultures had positive corneal cultures from at least one eye. Six of these 12 had the same organism isolated from both the blood and corneal tissue. Bacterial corneal cultures were negative in the five donors with negative postmortem blood cultures. Control cultures were obtained from 19 eyes of ten donors without evidence of infection at death. Four (21%) of 19 control eyes yielded Staphylococcus epidermidis. There was a significantly higher incidence of corneal contamination in donors who died with systemic infections. Eye banks should continue to screen donors carefully for documented or suspected sepsis in an effort to reduce the incidence of postkeratoplasty infections.

Lodoxamide tromethamine treatment for superior limbic keratoconjunctivitis.

PURPOSE: We studied the efficacy of topically applied lodoxamide tromethamine 0.1% in the treatment of superior limbic keratoconjunctivitis. METHODS: Three patients with clinical findings of bilateral superior limbic keratoconjunctivitis. were treated with topical lodoxamide tromethamine four times daily in both eyes. RESULTS: While the patients were taking lodoxamide tromethamine, symptoms and objective findings resolved. CONCLUSIONS: Topically applied lodoxamide tromethamine 0.1% is useful in the treatment of superior limbic keratoconjunctivitis. There may be a role for mast cell stabilizers in the treatment of this disorder.

Herpes simplex chorioretinitis in a healthy adult.

A previously healthy 20-year-old man developed bilateral chorioretinitis that included mild anterior uveitis, vitreous cells, multifocal chorioretinitis, and optic nerve swelling that progressed to severe optic neuropathy in one eye. Chorioretinal biopsy specimens cultured herpes simplex type 1 from separate chorioretinal and vitreous samples. Although the visual acuity of one eye remained at light perception, sight in the second eye was saved when treatment with systemic acyclovir and corticosteroids led to resolution of the inflammation. A recurrence was successfully treated with acyclovir alone and the patient shows no evidence of active disease.

Donor corneal endothelial striae.

Excessive traction during excision of donor corneoscleral buttons can result in damage or death to corneal endothelial cells. This damage manifests as multiple peripheral and, less commonly, central striae or stretch marks that correspond to linear opacities at the level of the endothelium. The striae consist of parallel lines of degenerate endothelium, each line three to eight cells wide, and stain readily with trypan blue, which is indicative of cell damage or death. Light and electron microscopy demonstrates cell membrane lysis with abrupt demarcation between abnormal and normal endothelial cells. The number of these striae correlates with the degree of traction or stretch applied during corneoscleral excision. Careful slit-lamp biomicroscopy of corneoscleral buttons discloses endothelial striae in approximately 5% of specimens. Careful excisions of corneoscleral buttons are necessary to decrease the incidence and severity of endothelial striae.

Congenital iris cysts.

Unilateral, spontaneous, non-pigmented iris cysts appeared before the age of 2 years in four patients. Histopathological specimens obtained in three cases showed stratified to cuboidal, non-pigmented, epithelial lined cysts. Goblet cells were recognised in two of the three specimens. The clinical features and histopathological findings indicate that these cysts are derived from surface ectoderm and may be congenital.

Scleral ectasia secondary to Acanthamoeba keratitis.

An unrecognized case of Acanthamoeba keratitis became quiescent after prolonged scleritis, resulting in a central corneal scar with extensive scleral ectasia. Twenty-one months after the onset of the sclerokeratitis, a penetrating keratoplasty was performed. Acanthamoeba cysts were found in the host corneal button. The corneal transplant has remained thin and clear for 2 1/2 years following surgery. Acanthamoeba keratitis extending to the limbus may become self-limited due to immunologic mechanisms available at the limbus, which do not appear to be active within the cornea itself. However, the prolonged inflammatory reaction manifesting as scleritis may result in extensive scleral ectasia.

Ocular disease from wearing contact lenses. A potentially devastating complication.

Because of the continued popularity of contact lenses in the United States, ocular inflammatory diseases are being encountered with increasing frequency by both ophthalmologists and primary care physicians. Distinction between minor noninfectious inflammation and serious, sight-threatening infection is crucial to the proper management of these patients. Symptoms of infectious keratitis are pain and loss of vision. Signs include infiltration or loss of clarity of the cornea, eyelid swelling, and purulent discharge. If an infectious process is suspected, the patient should be referred to an ophthalmologist immediately. If this is not possible, the contact lens should be removed and a culture performed, if possible. Aminoglycoside antibiotic drops should be applied frequently until ophthalmologic consultation is obtained. Patients should be reminded of the need for strict adherence to disinfection techniques and avoidance of homemade saline preparations. They should also be told to discontinue use of contact lenses at the first sign of ocular irritation or inflammation and to report to their physician if inflammation persists.

Herpetic eye disease.

Herpetic keratitis is a common condition which can produce severe complications. The pattern of disease created by the virus depends on an interaction of virus and host mediated mechanisms. The changes in the epithelium are a consequence of the cytopathic effect of the virus and are related directly to virus replication. Changes produced in the stroma are due to inflammatory mechanisms initiated by the presence of virus antigens. The treatment of epithelial disease is aimed at reducing virus replication. The treatment of stromal disease is directed towards suppressing inflammation without increasing virus replication. Various anti-viral agents are available and each has a different mechanism of action and properties which make each anti-viral agent more suitable in particular situations. Many clinical trials have been conducted which indicate the place of anti-viral agents. The management of stromal disease is more complicated and less information is available from clinical trials to indicate the best possible method of treatment.

Radial keratotomy complicated by sterile keratitis and corneal perforation. Histopathologic case report and review of complications.

A 35-year-old physician had radial keratotomy (RK) for correction of myopia. Combined radial and transecting circumferential incisions were used which resulted in wound gape, persistent epithelial defect, and severe sterile keratitis. Progressive corneal decompensation required an initial patch graft followed by a penetrating keratoplasty four months after RK. Histopathology of the cornea demonstrated epithelial edema and persistent incisional epithelial plug formation, deep and superficial vascularization, variable incision depth (superficial to full thickness), endothelial cell loss, and inflammatory cell infiltration at all levels of the cornea. A review of the reported complications of RK is included in the discussion of this case.