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.

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.

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.

Effect of light and sucrose on photoautotrophic and photomixotrophic micropropagation of Physalis angulata / Efeito da luz e sacarose na micropropagação fotoautotrófica e fotomixotrófica de Physalis angulata

The biotechnological interest in genus Physalis has increased in the last decades, however, there are still few micropropagation studies of this genus. The objective of this study was to evaluate P. angulata photoautotrophic and photomixotrophic micropropagation with gas exchange under seven light spectra and five concentrations of sucrose. Lighting were yellow, blue, white, red, green, red + blue LEDs and natural light filtered by mesh. Sucrose concentrations were 0, 7.5, 15, 22.5 and 30 g.L-1. Phytotechnical, anatomical features and photopigment contents were evaluated through stem and root segment length, leaf number, leaf area, chlorophyll a and b contents, carotenoids, adaxial epidermis, palisadic and spongy parenchyma and abaxial epidermis. The data were compared by Scott-Knott's mean test and principal components analysis using the R software. Comparing the variables within lighting types, it was observed that only the screen treatment, screen-filtered natural illumination, obtained assessment in all variables. Comparing the levels of sucrose, it was observed that the treatment 15 g.L-1 sucrose obtained the highest number of averages with maximum evaluation. It was concluded that the natural light filtered by screen with 50% of shading allowed the photoautotrophic micropropagation of P. angulata. Better development results were observed in photomixotrophic micropropagation with 15 g.L-1 of sucrose.

O interesse biotecnológico em Physalis aumentou nas últimas décadas, porém, ainda existem poucos trabalhos de micropropagação desse gênero. Objetivou-se avaliar sua micropropagação fotoautotrófica e fotomixotrófica com troca gasosa sob sete tipos de iluminação e cinco concentrações de sacarose. Foram utilizados LEDs amarelo, azul, branco, vermelho, verde, vermelho + azul e luz natural filtrada por malha. As concentrações de sacarose foram 0, 7,5, 15, 22,5 e 30 g.L-1. Características fitotécnicas, anatômicas e teor de fotopigmentos foram avaliados através de comprimento de segmento de caule e raíz, número de folhas, área foliar, teores de clorofilas a e b, carotenoides, epiderme adaxial, parênquimas paliçádico e esponjoso e epiderme abaxial. Os dados foram comparados por teste de média Scott-Knott e análise de componentes principais utilizando-se o software R. Comparando-se as variáveis dentro de tipos de iluminação, observou-se que apenas o tratamento screen, iluminação natural filtrada por malha, obteve avaliação máxima em todas as variáveis. Comparando-se os níveis de sucrose, observou-se que o tratamento 15 g.L-1 sacarose obteve o maior número de médias com avaliação máxima. Concluiu-se que a luz natural filtrada por tela com 50% de sombreamento permitiu a micropropagação fotoautotrófica de P. angulata. Observou-se melhores resultados de desenvolvimento na micropropagação fotomixotrófica com 15 g.L-1 de sacarose.

Polyploidy induction in Physalis alkekengi / Indução de poliploidia em Physalis alkekengi

Physalis alkekengi is an ornamental plant that can also be used as a medicinal plant due to its anti-inflammatory, bactericidal, antitumor and fungicidal properties. Polyploidization can be an important tool in the genetic improvement of this species. The objective this work was to obtain tetraploids in vitro and to evaluate the phytotechnical traits of P. alkekengi. For this, nodal segments of P. alkekengi var. Franchettii were inoculated into petri dishes containing 100 ml of MS medium supplemented with colchicine at concentrations 0; 0.04; 0.08; 0.12; and 0.16% and kept in the dark for 24 and 48h. After the respective treatment periods with colchicine the segments were inoculated into test tubes. The tetraploids were identified by flow cytometry and classical cytogenetics. In vitro seedlings were measured: root length, nodal segment length, leaflet number and total leaf area. In the acclimatization phase, the area of the second leaf and total leaf, petiole radius, stem length, fruit weight with calyx, without calyx, fruit diameter, number of seeds and brix of the pulp were evaluated. Chlorophyll a, chlorophyll b, total chlorophyll, total carotenoid, total chlorophyll / total carotenoid ratio and chlorophyll a / b ratio were also estimated. The treatment that most produced tetraploid seedlings was with 0.08% colchicine per 24h. No significant difference was observed in 7 (seven) variables, these being all variables of photopigments, stem diameter (steam) and brix. In general, diploid (2x) plants were better in 9 (nine) while tetraploid seedlings were better in 6 (six) of the phytotechnical variables. It was concluded that the MS medium supplemented with 0.08% colchicine for 24 h allowed P. alkekengi tetraploides to be obtained with better phytotechnical qualities.

Physalis alkekengi é uma planta ornamental que também pode ser usada como planta medicinal devido às suas propriedades anti-inflamatórias, bactericidas, antitumorais e fungicidas. A poliploidização pode ser uma ferramenta importante para o melhoramento genético dessa espécie. O objetivo deste trabalho foi obter tetraplóides in vitro e avaliar as características fitotécnicas de P. alkekengi. Para isso, segmentos nodais de P. alkekengi var. Franchettii foram inoculados em placas de Petri contendo 100 ml de meio MS suplementado com colchicina nas concentrações 0; 0,04; 0,08; 0,12; e 0,16% e mantido no escuro por 24 e 48h. Após os respectivos períodos de tratamento com colchicina, os segmentos foram inoculados em tubos de ensaio. Os tetraplóides foram identificados por citometria de fluxo e citogenética clássica. As plântulas in vitro foram medidas: comprimento da raiz, comprimento do segmento nodal, número de folhetos e área foliar total. Na fase de aclimatação foram avaliadas a área da segunda folha e área foliar total, raio do pecíolo, comprimento do caule, peso do fruto com cálice, sem cálice, diâmetro do fruto, número de sementes e brix da polpa. Também foram estimadas clorofila a, clorofila b, clorofila total, carotenóides totais, razão clorofila total / carotenóide total e razão clorofila a / b. O tratamento que mais produziu mudas tetraplóides foi com colchicina a 0,08% por 24 horas. Não foi observada diferença significativa em 7 (sete) variáveis, sendo todas variáveis de fotopigmentos, diâmetro do caule (vapor) e brix. Em geral, as plantas diplóides (2x) foram melhores em 9 (nove) variáveis fitotécnicas, enquanto as mudas tetraplóides foram melhores em 6 (seis). Concluiu-se que o meio MS suplementado com colchicina a 0,08% por 24 h permitiu obter tetraploides de P. alkekengi com melhores qualidades fitotécnicas.

Long-term acyclovir use to prevent recurrent ocular herpes simplex virus infection.

OBJECTIVE: To evaluate the effectiveness of more than 12 months of oral acyclovir therapy in reducing recurrences of ocular herpes simplex virus. METHODS: We retrospectively compared ocular herpes simplex virus recurrence in 2 groups of patients. In group 1, patients used oral acyclovir for at least 12 months and then discontinued the treatment. In group 2, patients received the treatment for at least 18 months. We compared recurrences when both groups were using acyclovir (period 1) and when only group 2 was receiving the drug (period 2). Statistical analysis was performed with the t test, chi2 test, and Kaplan-Meier method. RESULTS: Group 1 had 18 patients and a mean +/- SD follow-up of 45.2 +/- 22.2 months. Group 2 had 22 patients and a mean +/- SD follow-up of 42.4 +/- 30.2 months. Six patients (33%) in group 1 and 4 patients (18%) in group 2 had recurrence in period 1 (P =.3). In period 2, 14 patients (78%) in group 1 and 8 patients (36%) in group 2 had recurrence (P =.01). Mean +/- SD recurrence-free survival in period 2 was 15.3 +/- 5.5 months in group 1 and 37.3 +/- 6.3 months in group 2 (P =.001). CONCLUSIONS: Long-term oral acyclovir use seems to remain effective in decreasing the number of ocular herpes simplex virus recurrences beyond 12 months.

New onset of herpes simplex virus epithelial keratitis after penetrating keratoplasty.

PURPOSE: To report a series of patients with no previous history of herpes simplex virus (HSV) infection who had new onset of herpetic keratitis after penetrating keratoplasty (PK). DESIGN: Noncontrolled, retrospective case series. METHODS: We included in the study the patients who had new onset of herpetic keratitis after penetrating keratoplasty for corneal diseases unrelated to HSV infection who were seen at the Cornea Service at Wills Eye Hospital (Philadelphia, Pennsylvania) from January 1996 to December 2002. The diagnosis of HSV epithelial keratitis was based on clinical characteristics of either a classic herpetic dendrite, a geographic ulcer, or a nonhealing epithelial defect that responded only to antiviral therapy. RESULTS: Fourteen patients were included in the study. Eight of these (57%) had presented with a geographic ulcer whereas six patients (43%) had a classic dendrite. The most common primary corneal disease that led to PK was pseudophakic bullous keratopathy (36%), followed by keratoconus (29%), Fuchs dystrophy (21%), and corneal scar unrelated to HSV (14%). CONCLUSIONS: The ophthalmologist should be aware of the possibility of herpetic keratitis in eyes after PK, even in patients with no previous history of HSV infection.

Effect of blue staining of expandable hydrophilic intraocular lenses on contrast sensitivity and glare vision.

PURPOSE: To evaluate the effect of trypan blue staining of expandable hydrophilic acrylic intraocular lenses (IOLs) on contrast sensitivity and glare. SETTING: Department of Ophthalmology, Federal University, and Oculistas Associados, Rio de Janeiro, Brazil. METHODS: Phacoemulsification with expandable hydrophilic IOL implantation was performed in 19 eyes. Group 1 (stained group) consisted of 12 eyes with the IOL unintentionally stained by trypan blue 0.1% solution during surgery; Group 2 (unstained group) consisted of 7 eyes with IOLs that were not stained because trypan blue was not used during surgery. The eyes were examined postoperatively for Snellen best corrected visual acuity (BCVA), contrast sensitivity BCVA, and glare vision. The examiners were masked to whether the IOL was stained by trypan blue. Inclusion criteria included a BCVA of 20/30 or better 1 month postoperatively. Patients who had other ocular pathology or previous ocular surgery were excluded from the study. RESULTS: The mean postoperative BCVA was 20/24 in the stained group and 20/23 in the unstained group (P =.73). The mean contrast sensitivity visual acuity was 20/31 in the stained group and 20/26 in unstained group (P =.10). The mean glare visual acuity was 20/75 and 20/33, respectively (P =.03). CONCLUSIONS: Patients with expandable hydrophilic acrylic IOLs stained with trypan blue performed significantly worse on a glare vision test than patients whose IOLs were not stained. Cataract surgeons should avoid using trypan blue with this IOL type.

Complications associated with anterior basement membrane dystrophy after laser in situ keratomileusis.

PURPOSE: To evaluate the complications associated with anterior basement membrane dystrophy (ABMD) after laser in situ keratomileusis (LASIK). SETTING: Cornea Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. METHODS: In this noncontrolled retrospective case series, the medical records of all patients with LASIK complications seen in the Cornea Service at Wills Eye Hospital from January 1, 1998, to December 31, 2002, were reviewed. All patients who presented with ABMD changes after LASIK were included in the study. Patients with a history of trauma before or after surgery were excluded. RESULTS: Thirty-five eyes of 18 patients were included. The mean age was 46.2 years. Thirteen eyes (37.1%) had a flap-lift procedure to remove epithelial ingrowth or for an enhancement. The most common reason for the visit was visual complaints, which were seen in 77.8% of patients. Seven patients (38.9%) had visual complaints alone; 27.8% had visual complaints associated with recurrent erosions and 11.1%, with dry eyes. Four patients (22.2%) had recurrent corneal erosions with no visual complaints. On examination, the most common finding was negative staining with fluorescein dye within the LASIK flap, which was seen in all patients. In addition to the ABMD changes, 25.7% had some degree of epithelial ingrowth and 45.7%, irregular astigmatism. CONCLUSIONS: Anterior basement membrane dystrophy changes post LASIK were associated with visual complaints and/or recurrent erosions. Patients should be carefully screened for ABMD. Those who have ABMD signs or symptoms may not be ideal candidates for LASIK.

Congenital corneal opacities in a cornea referral practice.

PURPOSE: To address the primary causes of the congenital corneal opacities seen on the Cornea Service at Wills Eye Hospital (Philadelphia, PA), the associated systemic anomalies and their management. METHODS: Retrospective review of the medical records of all patients with the diagnosis of congenital corneal opacities seen at the Cornea Service from January 1, 1992 to June 30, 2003. Children 12 years old or younger at the first visit to our department were included in the study. We classified the location and extent of corneal pathology. We divided the management into medical and surgical. RESULTS: Seventy-two eyes of 47 patients were included in the study. The mean follow-up time from the first to the last visit was 33.1 months. The most common primary cause of congenital corneal abnormalities was Peters anomaly (40.3%), followed by sclerocornea (18.1%), dermoid (15.3%), congenital glaucoma (6.9%), microphthalmia (4.2%), birth trauma, and metabolic disease (2.8%). Seven eyes (9.7%) were classified as idiopathic. Ten patients had systemic abnormalities associated with their ocular condition. The management was medical in 38 eyes (52.7%). Twenty-four eyes (32.4%) underwent only 1 penetrating keratoplasty (PK). Only 1 eye received a regraft during the follow-up period. Eight grafts failed during the follow-up period. CONCLUSION: The importance of this study is to share our experience with this rare entity, congenital corneal opacities, describing their clinical presentation and their management.

Secondary glaucoma induced by bilateral acute depigmentation of the iris / Glaucoma secundário à despigmentação bilateral aguda da íris

Abstract We report a case of a middle-aged woman who developed acute, bilateral, symmetrical, slightly transilluminating depigmentation of the iris and pigment discharge into the anterior chamber following the use of oral moxifloxacin for bacterial sinusitis. She had been misdiagnosed as having autoimmune uveitis, treated with steroids and tropicamide, and underwent severe ocular hypertension and glaucoma despite posterior correct diagnosis.

Resumo Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentação bilateral simultânea aguda com dispersão de pigmentos na câmara anterior e discreta transiluminação após o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide tópico e tropicamida e evoluiu com hipertensão ocular grave e glaucoma apesar de ,posteriormente, o diagnóstico ter sido correto.