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.

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.

Vantagens na utilizaçäo do sistema burst na facoemulsificaçäo / Advantages of burst system utilization in phacoemulsification surgeries

Resumo: Objetivo: Avaliar a influência da utilizaçäo do sistema Burst nos itens tempo e percentual de ultrassom durante a facoemulsificaçäo. Local: Prontoclínica de Olhos, Natal, RN, Brasil. Métodos: Foram analisadas 200 facectomias realizadas pelo mesmo cirurgiäo, utilizando o mesmo aparelho de facoemulsificaçäo. Em 100 olhos utilizou-se o sistema Burst e nos outros casos este näo foi utilizado. O tempo e o percentual de ultrassom foram registrados ao fim de cada cirurgia. A análise estatística baseu-se no teste t de student. Resultados: No grupo onde o sistema Burst foi utilizado, o tempo médio de ultrassom foi de 0,82 s (+ ou - 0,79) e opercentual médio foi de 19,34 (por cento) (+ ou -7,81). No grupo onde o Burst näo foi usado, o tempo e percentual médio de ultrassom foram de 1,80 s (+ ou -1,16) e 30,79 (por cento) (30,84 (por cento)), respectivamente. Essas diferenças foram estatisticamente significante (p<0,01). Conclusäo: O sistema Burst mostrou-se eficaz na reduçäo do tempo e do percentual de ultrassom da facoemulsificaçäo (au)