Herpetic Eye Disease Study: A Controlled Trial of Topical Corticosteroids for Herpes Simplex Stromal Keratitis.

PURPOSE: To evaluate the efficacy of topical corticosteroids in treating herpes simplex stromal keratitis. METHODS: The authors performed a randomized, double-masked, placebo-con- trolled, multicenter clinical trial of 106 patients with active herpes simplex stromal keratitis who had not received any corticosteroids for at least 10 days before study enrollment. Patients were assigned to the placebo group (n = 49) or the steroid group (topical prednisolone phosphate; n = 57); both regimens were tapered over 10 weeks. Both groups received topical trifluridine. Visual acuity assessment and slit-lamp biomicroscopy were performed weekly for 10 weeks, every other week for an additional 6 weeks or until removal from the trial, and at 6 months after randomization. RESULTS: The time to treatment failure (defined by specific criteria as persistent or progressive stromal keratouveitis or an adverse event) was significantly longer in the steroid group compared with the placebo group. Compared with placebo, corticosteroid therapy reduced the risk of persistent or progressive stromal keratouveitis by 68%. The time from randomization to resolution of stromal keratitis and uveitis was significantly shorter in the steroid group compared with the placebo group even though both groups included patients who were removed from the study and treated with topical corticosteroids according to best medical judgment. Nineteen (33%) of the steroid-treated patients and 11 (22%) of the placebo-treated patients completed the 10 weeks of protocol therapy and had stable, noninflamed corneas after 16 weeks. At 6 months after randomization, no clinically or statistically significant differences in visual outcome or recurrent herpetic eye disease were identified between the steroid and placebo groups. CONCLUSIONS: The topical corticosteroid regimen used in this study was significantly better than placebo in reducing persistence or progression of stromal inflammation and in shortening the duration of herpes simplex stromal keratitis. Postponing steroids during careful observation for a few weeks delayed resolution of stromal keratitis but had no detrimental effect as assessed by visual outcome at 6 months.

Episodes of microbial keratitis with therapeutic silicone hydrogel bandage soft contact lenses.

OBJECTIVE: To report the therapeutic practice patterns of silicone hydrogel (SiH) bandage soft contact lenses (BSCL) and the resultant rate of microbial keratitis (MK). METHODS: A retrospective case series of patients treated with therapeutic BSCLs for ocular surface disease from January 2006 to January 2009 in a tertiary care cornea practice. All patients had a history of ocular surface disease. RESULTS: Seventy-four patients were treated with a therapeutic SiH BSCL (102 intervals of use) for complicated ocular surface disease. Two patients developed infectious corneal infiltrates (2/102, 2.0%) [corrected]. Two of 3 MK episodes were in patients with limbal stem-cell deficiency (2/102, 2.0%). CONCLUSIONS: Therapeutic SiH BSCLs were safely used in most patients. However, results suggest that prophylactic antibiotic use did not eliminate the risk for MK with SiH BSCL use in patients with chronic ocular surface disease.

Herpes zoster ophthalmicus: comparison of disease in patients 60 years and older versus younger than 60 years.

OBJECTIVE: To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients aged <60 years versus patients aged ≥60 years at the time of diagnosis. DESIGN: Retrospective chart review of all 112 patients presenting for management of HZO from January 1, 2008 to December 31, 2008. PARTICIPANTS: A total of 112 patients (58 aged <60 years and 54 aged >60 years) at the time of HZO onset. INTERVENTIONS: Anterior segment complications, treatments, and surgical procedures were documented at 3 months, 6 months, and 1 year, and then annually for the remainder of the follow-up period. MAIN OUTCOME MEASURES: Intraocular pressure, inflammation, steroid use, surgical procedures, anterior segment complications, post-herpetic neuralgia, and delayed herpes zoster pseudodendrites. RESULTS: Equal numbers of patients were affected with HZO in the younger and older age groups (51.8%, n = 58 vs. 48.2%, n = 54, respectively, P = 0.69). The most common decade of HZO onset was between 50 and 59 years. Younger patients were more likely to be healthy compared with older patients (P = 0.05). Delayed herpes zoster pseudodendrites were more common in the younger patients (36.7% vs. 16.7%, P = 0.03). The mean number of flares per patient-years was significantly higher in the younger patients (z test, P = 0.024). Post-herpetic neuralgia, neurotrophic keratopathy, and secondary infectious keratitis were more frequent in the older patients (P = 0.05). Prevalence of corneal perforation, corneal thinning, cataract formation, and glaucoma was similar between the 2 groups. Most patients in both groups (84.2% of younger patients and 89.5% of older patients) were taking topical steroids 3 years after referral for HZO. CONCLUSIONS: Herpes zoster ophthalmicus affects individuals aged younger than and older than 60 years in similar numbers, with the most common decade of onset between age 50 and 59 years. Younger patients had more episodes of delayed pseudodendritiform keratitis and flares of inflammation compared with older patients, who had more problems related to neurotrophic keratopathy. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Recurrent corneal erosions and epithelial basement membrane dystrophy.

Epithelial basement membrane dystrophy, the most common hereditary anterior corneal dystrophy and considered a "category 1" dystrophy in some cases, encompasses microcystic dystrophy and other conditions affecting the epithelial basement membrane. The management of symptomatic epithelial basement membrane dystrophy includes alleviating blurred vision, treating recurrent corneal erosion, or both. Treatment of distorted vision may be as simple as prescribing lubricating drops and/or ointment, and posttrauma corneal erosion is often a limited problem that disappears over time and does not require laser or surgical treatment. This article describes treatment for more severe cases of corneal erosion, which includes mechanical debridement of the loosened epithelium.

Demographics of patients older than 50 years with keratoconus.

PURPOSE: This study was designed to determine the demographics of patients aged 50 years or more with a diagnosis of keratoconus, who were seen on the Cornea Service at Wills Eye Hospital. METHODS: A retrospective chart review of all patients with the diagnosis of keratoconus was undertaken to identify demographics characteristics between January 1, 2005 and December 31, 2005. RESULTS: A total of 697 patients were identified. Two hundred seventy-nine (40.0%) patients were age 50 years or more. The age ranged from 50 to 93 years (average 60.2 +/- 8.2 years). Keratoconus was diagnosed as a bilateral disease in 266 (95.3%) and as a unilateral disease in 13 patients (4.7%). In 186 patients (66.6% of the total), the average age at the time of diagnosis was 31.7 +/- 10.9 years (range from 13 to 70 years). Of the 279 patients, 167 had surgery (59.8%). In the group of 112 patients that did not have surgery, 25 (9.0%) were treated with glasses in both eyes, 85 (30.5%) with contact lenses in both eyes, and 2 (0.7%) with glasses in one eye and contact lenses in the other eye. The average time of follow-up was 13.6 +/- 10.5 years (range from 0.1 to 38.7 years). CONCLUSIONS: In a corneal referral practice, the number of patients older than 50 years with keratoconus is higher than previously reported in the literature. We believe that this is because our practice has a strong interest in both contact lenses and corneal surgery with the ability to follow up patients on a long-term basis.

Referrals to the Wills Eye Institute Cornea Service after laser in situ keratomileusis: reasons for patient dissatisfaction.

PURPOSE: To review the symptoms, findings, and management options in patients referred to the Cornea Service who were unsatisfied with results after laser in situ keratomileusis (LASIK). SETTING: Cornea Service, Wills Eye Institute, Philadelphia, Pennsylvania, USA. METHODS: A retrospective chart review was conducted of all patients seen for consultation between January 1, 2004, and December 31, 2006, who had LASIK performed elsewhere. The parameters extracted were demographic data, history, symptoms, postoperative best corrected and uncorrected visual acuities, surgical complications, examination findings, and treatment recommendations. The data were also compared with previously unpublished data collected at Wills Eye from 1998 to 2003. RESULTS: One hundred fifty-seven eyes of 109 patients seen in consultation after LASIK were identified. Twenty-eight percent were referred by the LASIK surgeon and 54%, by another eye doctor; 17% were self-referred. The most common chief complaints were poor distance vision (63%), dry eyes (19%), redness/pain (7%), and glare and halos (5%). Forty-four eyes (28%) had surgical complications or enhancements. The most common diagnoses were dry eye or blepharitis (27.8%), irregular astigmatism (12.1%), and epithelial ingrowth (9.1%). Eleven percent were referred in the first month after LASIK; 23% and 10% were referred between 1 and 6 months and 7 and 12 months, respectively. Medical management (eg, artificial tears, steroids, other dry-eye treatment) was offered in 39% of cases, surgical intervention in 27%, and observation only in 7%. Nonsurgical therapy was offered in 73% of cases. CONCLUSIONS: Most patients who came for consultation were referred by a doctor other than their LASIK surgeon. Poor distance vision, dry eye, redness/pain, and glare and halos were the most common chief complaints and dry eye or blepharitis, irregular astigmatism, and epithelial ingrowth, the most common diagnoses.

Meesmann corneal dystrophy associated with epithelial basement membrane and posterior polymorphous corneal dystrophies.

PURPOSE: To report a rare case of bilateral and symmetric Meesmann corneal dystrophy concurrent with bilateral epithelial basement membrane dystrophy and bilateral but asymmetric posterior polymorphous corneal dystrophy in a patient of Armenian origin. METHODS: Complete ophthalmologic examination was performed on a 6-year-old boy from Armenia who was diagnosed with bilateral symmetric Meesmann corneal dystrophy combined with bilateral epithelial basement membrane dystrophy and bilateral but asymmetric posterior polymorphous corneal dystrophy. This case was observed and treated for 24 years. RESULTS: On slit-lamp biomicroscopy, the patient showed bilateral multiple intraepithelial cystic lesions, bilateral irregularly shaped grayish-white opacities in the superficial corneal epithelium, and bilateral but asymmetric transparent vesicles surrounded by gray halos at the level of the Descemet membrane and the endothelium. CONCLUSIONS: This case is reported because of the unusual occurrence of Meesmann corneal dystrophy with other corneal dystrophies.

Indications for penetrating keratoplasty and associated procedures, 2001-2005.

PURPOSE: To identify current indications and trends in indications for penetrating keratoplasty (PKP) and associated procedures. METHODS: Retrospective chart review of all patients who underwent PKP at Wills Eye Institute from January 1, 2001, to December 31, 2005. RESULTS: A total of 1,162 cases were performed in this 5-year period. Leading indications for PKP were pseudophakic corneal edema (PCE) in 330 (28.4%) cases, followed by regraft in 250 (22.0%), keratoconus in 186 (16%), and Fuchs' endothelial dystrophy in 126 (10.8%) cases. Of the 330 cases of PCE, 232 (70.3%) were associated with posterior chamber intraocular lenses (PCIOLs) and 96 (29.1%) with anterior chamber lenses. In 330 eyes with PCE, the lens was not exchanged in 246 (74.5%) cases and was exchanged in 76 (23%) cases. Seventy of the exchanged lenses were anterior chamber intraocular lenses (ACIOLs) and six lenses were PCIOLs. In cases of ACIOL exchanges, 10 were for scleral sutured IOLs, 18 for PCIOLS, and 42 for another ACIOL. CONCLUSIONS: Pseudophakic corneal edema remains the leading indication for PKP at our institution followed by regraft, continuing a trend noted in our previous studies. Although the percentage of cases of PCE associated with PCIOLS increased, fewer lenses were exchanged, perhaps reflecting increased confidence in biocompatibility of newer IOLs. The decrease in overall number of corneal transplants in these 5 years continues a trend noted in our previous study and mirrors the national decline in PKP.

Epithelial herpetic simplex keratitis recurrence and graft survival after corneal transplantation in patients with and without atopy.

PURPOSE: To compare the incidence of herpes simplex virus (HSV) epithelial recurrence and graft survival after penetrating keratoplasty (PK) in patients with and without self-reported atopy. DESIGN: Retrospective cohort comparative study. SETTING: Cornea Service, Wills Eye Hospital. STUDY POPULATION: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004 and who underwent primary PK for ocular HSV at the Cornea Service. From the 58 patients invited, 49 patients (50 eyes) were included. Nine patients were ineligible in accordance with the exclusion criteria: no active classic HSV episode before PK, immunosuppression, less than one year of follow-up, previous history of PK before presentation at the Service. Eligible patients filled out a questionnaire regarding their history of atopic disease, considering: presence of allergic rhinitis, asthma, or atopic dermatitis. Ocular history was obtained through chart review. main outcome measures: Incidence of epithelial HSV recurrences and corneal graft survival in both groups. RESULTS: Each group (atopic and nonatopic) included 25 eyes. The atopic patients had a mean incidence of 0.07 episode/eye year (SD +/- 0.9) compared with 0.12/eye year (standard deviation [SD] +/- 0.21) in the nonatopics (P = .002). At 10 years of follow-up, the survival rate in the atopics was of 92% and in the nonatopics was of 79% (P = .88). CONCLUSIONS: Nonatopics had significantly more epithelial recurrences after PK compared to atopics; however, both groups presented low incidences of recurrences and high graft survival rates.

Acanthamoeba keratitis: a parasite on the rise.

PURPOSE: To report a recent significant increase of the number of patients diagnosed with Acanthamoeba keratitis (AK) at Wills Eye Hospital between 2004 and 2005. To determine the risk factors, clinical characteristics, treatments, and outcomes of patients with AK. METHODS: Retrospective consecutive case series of 20 eyes with AK. The information included the incidence from 1995 to 2005, initial and final best-corrected visual acuity (BCVA) at 3-month follow-up, risk factors [contact lenses (CL) history, history of swimming with CL, and exposure to well water and/or contaminated water], clinical characteristics, methods of diagnosis, and treatments. RESULTS: A statistically significant increased incidence of AK was seen in 2004 and 2005 compared with cases from 1995 to 2003 (P < 0.01). All patients wore CL; 19 of 20 wore frequent-replacement soft CL and used multipurpose disinfecting solutions. Other risk factors were exposure to well water in 40%, swimming with CL in 25%, and overnight wear in 25%. The diagnosis was made by histopathology in 50%, by microbiology in 15%, and by initial classic clinical signs and response to treatments in 35%. Herpes simplex virus was the misdiagnosis in 70%. Patients who presented with dendritiform keratitis or radial keratoneuritis had a BCVA better than 20/30 in 8 of 9 (89%) and patients with ring ulcers or stromal disease who had a BCVA less than finger counting in 5 of 8 (62.5%). CONCLUSIONS: We observed an increased incidence of AK. Patients with proper use of frequent-replacement CL and multipurpose solutions can develop AK. Advanced stromal disease at diagnosis is associated with worse outcome.

Phototherapeutic keratectomy with intraoperative mitomycin C to prevent recurrent anterior corneal pathology.

PURPOSE: To determine the safety and efficacy of the use of intraoperative mitomycin C (MMC) during phototherapeutic keratectomy (PTK) for anterior corneal disease. DESIGN: Retrospective consecutive case series. METHODS: Retrospective chart review of 13 eyes from 12 patients with various anterior corneal disorders who had phototherapeutic keratectomy with the use of intraoperative MMC from July 2001 to present. Data on healing time of epithelial defects, complications, and recurrence of disease were recorded. RESULTS: Average time to heal of the epithelial defects was three days, no patient had corneal or scleral melting, and, as of the printing of this report, no patient has had recurrence of disease in the MMC-treated area. CONCLUSIONS: MMC is safe for intraoperative use during PTK and does not appear to inhibit epithelial healing and may help prevent recurrent anterior corneal disease.

Efficacy of oral antiviral prophylaxis in preventing ocular herpes simplex virus recurrences in patients with and without self-reported atopy.

PURPOSE: To compare the efficacy of oral antiviral prophylactic treatment for herpes simplex virus (HSV) recurrences in patients with and without self-reported atopy. DESIGN: Retrospective cohort comparative study. METHODS: setting: Cornea Service, Wills Eye Hospital. study population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004. From 244 patients invited, 54 patients (58 eyes) were included. One hundred and ninety patients were excluded according to exclusion criteria: no active episode during follow-up, immunosuppression, less than one year of follow-up, or previous history of penetrating keratoplasty. The Questionnaire regarding history of atopic disease, considers: presence of allergic rhinitis, asthma or atopic dermatitis, and chart review of ocular history. main outcome measures: Incidence of all types of HSV recurrences with and without antiviral prophylaxis within each group and between groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS: Atopic/nonatopic (P value): mean follow-up without prophylaxis 8.1 (+/- 8.2)/7.3 years (+/- 8.6) (P = .71); mean follow-up with prophylaxis 2.9 (+/- 2.3)/2.6 years (+/- 2.2) (P = .51); the effect of prophylaxis significantly reduced the all recurrences in both groups except in the inflammatory recurrences in the atopic group and in the mixed recurrences in both groups. Prophylaxis decreased infectious episodes by 44% in nonatopic and 76% in atopics and decreased inflammatory manifestations by 69% in the nonatopic group and 8% in the atopic group. CONCLUSION: Antiviral prophylaxis for HSV recurrences was more effective in reducing infections in atopics and less effective in reducing inflammatory episodes in atopics versus nonatopics.

Comparative study of ocular herpes simplex virus in patients with and without self-reported atopy.

PURPOSE: To compare the characteristics of ocular herpes simplex virus (HSV) in patients with and without atopy. DESIGN: Retrospective cohort comparative study. METHODS: Patients who presented at the Cornea Service, Wills Eye Hospital, between March 2003 and March 2004 who had been previously diagnosed in the same institution as having ocular HSV diagnosis or were just diagnosed as having the disease were asked to complete a study questionnaire that enabled categorization into atopic and nonatopic. In April 2005, 223 patients who agreed to be in the study had their charts reviewed, and 125 patients were excluded according to exclusion criteria: immunosuppression, follow-up less than one year, previous history of penetrating keratoplasty (PK) out of the Cornea Service, and no active HSV episode during follow-up. MAIN OUTCOME MEASURES: Incidence of all types of HSV recurrences. SECONDARY OUTCOME MEASURES: Bilaterality, visual loss, need for PK , and secondary bacterial infection in both groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS: Ninety eight patients (110 eyes) were included in the study. Atopic/nonatopic (P value): the mean follow-up was 11.6 (+/- 10.6)/8.8 years (+/- 8.4) (P = .14); the mean incidence of HSV episodes per year of follow-up was: total episodes 0.32 (+/- 0.36)/0.28 (+/- 0.33) (P = .14), infectious 0.16 (+/- 0.22)/0.10 (+/- 0.14) (P < .01), inflammatory 0.11 (+/- 0.19)/0.11 (+/- 0.19) (P < .01), and mixed 0.09 (+/- 0.20)/0.07 (+/- 0.16) (P = .06); bilateral HSV was present in 9/3 patients (P = .22); the mean loss of vision was four lines of Snellen in both groups; PK was performed in 14 of 16 eyes (P = .45); secondary bacterial infection was present in two of four eyes (P = .26). CONCLUSIONS: Atopic patients had considerably more infectious and fewer inflammatory episodes when compared with nonatopics.

Risk factors for the first episode of corneal graft rejection in keratoconus.

PURPOSE: To evaluate the relationship between topical corticosteroids and other variables and the risk for rejection after penetrating keratoplasty for keratoconus. METHODS: The records of all keratoconus patients who, after their first penetrating keratoplasty in that eye, experienced a first episode of corneal graft rejection during a specific 3-year period were retrospectively reviewed in a case-control fashion. Twenty-three cases were identified, and they were matched with 3 controls each, for a total of 69 controls and 92 total patients. Multiple variables including steroid potency, recent steroid tapering, and length of time on the current level of steroids were analyzed to see whether there were any significant relationships between postoperative changes in steroid management and rejection. In addition, other variables such as graft size, suture technique, recent suture removal, suture status at the time of the rejection episode, and prior grafting in the fellow eye were examined to determine if any of these factors were associated with a higher risk of graft rejection. RESULTS: Most of the proposed risk factors, including steroid dose and tapering, differing suturing techniques, loose and/or broken sutures at the time of rejection, percentage of sutures remaining at the time of rejection, and prior grafting in the fellow eye, did not correlate with the risk of rejection. Only graft size had a correlation, with host trephination size > or = 8.25 mm having a nearly sixfold increased risk of rejection (P = 0.015). Most patients (70%) were diagnosed with rejection at a scheduled office visit rather than at an emergency visit, and correspondingly, nearly one half (43%) had no symptoms when rejection was identified. There was no significant difference in final best-corrected visual acuities between the cases and controls, and 91% of the corneas that underwent rejection did not progress to graft failure, remaining centrally clear at most recent follow-up. CONCLUSION: In this study, the most important risk factor for rejection after corneal transplantation for keratoconus was the size of the graft. Physician detection of rejection is paramount, because a graft rejection episode is more often diagnosed at a scheduled office visit than at an emergency visit. Fortunately, progression to graft failure can usually be prevented if treatment is started promptly and intensively.

Wound dehiscence after penetrating keratoplasty.

PURPOSE: To assess the patient characteristics, risk factors, and outcomes of penetrating keratoplasty wound dehiscence. METHODS: Retrospective chart review of 30 eyes of 29 patients with corneal grafts who underwent repair of penetrating keratoplasty wound dehiscence from January 1, 1998 to December 31, 2003, followed on the Cornea Service at Wills Eye Hospital. RESULTS: The mean time from penetrating keratoplasty to wound dehiscence was 7.5 years (range 1 week to 31 years). The mean age at time of wound dehiscence was 66 years (range 28-98 years). One eye developed wound dehiscence following suture removal, whereas the remaining 29 eyes sustained trauma-induced dehiscences. Falls were the most common mechanism of trauma, especially in the elderly population. There was a wide range of visual outcomes in the 21 patients followed for 1 year, with 4 patients maintaining best corrected visual acuity between 20/20 and 20/40 and 5 patients with light perception vision at 1 year. There were no cases of endophthalmitis. CONCLUSIONS: Patients with corneal transplants have a life-long risk for wound dehiscence. This complication may be reduced by the regular use of eye protection in all corneal transplantation patients.

Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.

PURPOSE: To develop current treatment recommendations for dry eye disease from consensus of expert advice. METHODS: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. RESULTS: A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. CONCLUSION: Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.

Blepharokeratoconjunctivitis in children.

OBJECTIVE: To evaluate the incidence, history, symptoms, clinical signs, and treatment outcomes of blepharokeratoconjunctivitis in a pediatric population at a tertiary cornea practice. METHODS: In a retrospective case series, we reviewed the medical records of all new pediatric patients from January 1, 1997, through December 31, 2002, noting the reason for referral and subsequent diagnosis. We further noted the history, clinical characteristics, and treatment outcomes of the patients with blepharokeratoconjunctivitis. RESULTS: Review of 195 medical records revealed that blepharokeratoconjunctivitis was the most common single diagnosis at consultation, accounting for 15% of referrals. Of the 29 cases identified, there were 16 girls (55%) and 13 boys (45%). The mean age at consultation was 6(1/2) years (age range, 2-12 years). On initial ophthalmologic examination, 11 (38%) of 29 patients were taking full-strength steroids and 4 patients (14%) were taking oral erythromycin. Oral therapy, in the form of erythromycin (n = 21) and doxycycline (n = 1), was prescribed to most patients (22/29 [76%]). Therapy with topical steroids was tapered at the initial visit in all patients. Follow-up was available for 15 of 29 patients, with a mean follow-up of 5.4 months (range, 2-25 months). The condition of all patients showed clinical improvement. Recurrences were noted in 6 (40%) or 15 patients; all were successfully managed with low-potency steroid therapy. CONCLUSIONS: Blepharokeratoconjunctivitis is a common reason for cornea referral in children. Oral erythromycin therapy is an effective treatment with a steroid-sparing effect. Recurrences are common and may be successfully managed with low-potency steroid therapy.

Diamond burr treatment of poor vision from anterior basement membrane dystrophy.

PURPOSE: To determine the outcome of patients with decreased vision associated with anterior basement membrane dystrophy (ABMD) managed with diamond burr (DB) polishing. DESIGN: Retrospective nonrandomized case series. METHODS: A chart review of all patients with ABMD who underwent epithelial debridement and DB polishing to treat visual disturbances resulting from corneal epithelial irregularity was performed. RESULTS: Ten patients' charts were analyzed. The mean age was 57.4 years. DB treatment was performed in 13 eyes. The average preoperative BCVA was 0.40 (20/50). At the last follow-up (mean 21.8 months) the average visual acuity of these patients was 0.88 (20/23), significantly better than pre-operative readings (P < .001). There was no recurrence of dystrophic changes in the treatment zone seen with the slit lamp during the follow-up period. CONCLUSIONS: In this study, DB polishing was shown to be an effective and safe treatment for decreased vision caused by to ABMD over an average follow-up of 21.8 months.

Management of pellucid marginal corneal degeneration.

PURPOSE: This study was designed to determine how patients with pellucid marginal corneal degeneration (PMCD) are managed in a tertiary corneal practice. METHODS: A retrospective chart review of 45 patients with PMCD from a corneal referral practice was performed. Information collected from the medical records included demographic data, best-corrected visual acuity, videokeratography, contact lens use, and surgical procedures. RESULTS: Forty-five patients (85 eyes; 30 males, 15 females) with PMCD were included in this study. They were followed-up for an average of 4.7 years (standard deviation (SD), +/-8.7). Seventy-five eyes (88.2%) were managed nonsurgically with spectacles in 31 eyes (36.4%) or contact lenses in 44 eyes (51.8%). Contact lens management was initially attempted in 51 eyes (60%); however, 7 eyes failed contact lenses. Visual acuity of 0.5 (20/40) or better was noted in 34 eyes (75.5%) after contact lens fit. Ten eyes (11.8%) underwent penetrating keratoplasty with an average postoperative follow-up of 9 years (SD, +/-8.2; 1.5-20.5). Clear grafts were present in all 10 eyes at the end of the study (average, 9 years; SD, +/-82). CONCLUSIONS: Nonsurgical management of PMCD continues to play a predominant role in the management of this disorder. Poor best-corrected visual acuity at presentation of 0.2 (20/100) or worse and long follow-up (8 years or more) were significantly associated with surgery.

Serratia corneal ulcers: a retrospective clinical study.

PURPOSE: To study the clinical and microbiological profile of Serratia corneal ulcers at the Cornea Service of the Wills Eye Hospital. METHODS: This was a retrospective, observational case series. The clinical records of patients with Serratia marcescens corneal ulcers seen at the Cornea Service of the Wills Eye Hospital between January 1, 1998 and December 31, 2002 were reviewed. RESULTS: Twenty-four cases of Serratia keratitis were identified in 21 patients. Two patients (9.5%) had recurrent keratitis, 1 of which recurred twice. Both had corneal graft edema and were on topical steroids and antiglaucoma drops. The Serratia infection in 15 patients (71%) was associated with an abnormal corneal surface. Twelve of these patients (57%) had the ulcer in a corneal graft, 4 (19%) of which were associated with suture infiltrates. Fifteen patients (71%) were on topical medications-15 used corticosteroids and 13 used antiglaucoma drops. Six patients (29%) were contact lens wearers-1 had a concomitant suture infiltrate associated with a corneal graft, and 5 had otherwise healthy corneas. One isolate lacked in vitro susceptibility to ciprofloxacin and ofloxacin but was susceptible to gentamicin and tobramycin. Nineteen patients had a favorable response to medical therapy. Two patients with poor outcome had large corneal ulcers with severe necrosis and thinning associated with delay in treatment. CONCLUSIONS: Serratia marcescens keratitis is associated with the presence of an abnormal corneal surface, use of topical medications, and contact lens wear. Prompt medical therapy results in a good clinical response in the majority of cases.