Esthetic soft tissue management for teeth and implants.

CONTEXT: Can newly introduced graft materials be successfully used in soft tissue augmentation around teeth and dental implants? EVIDENCE ACQUISITION: An electronic search on the PubMed database for English articles published before March 31, 2012, was performed using the following key words: "root coverage," "soft tissue graft," "periodontal plastic surgery," "subepithelial connective graft (SCTG)," "acellular dermal matrix (ADM)," "guided tissue regeneration based root coverage (GTRC)," "recession defects," "mucogingival defects," "collagen matrix," "living cellular construct (LCC)," "mucograft," and "biologic agents." Literature featuring new soft tissue graft materials, such as ADM, collagen matrix, GTRC, and biologic agents, were included. EVIDENCE SYNTHESIS: Data showed (1) allogeneic grafts were comparable to SCTG in terms of mean complete root coverage (CRC), mean root coverage (RC), and mean amount of keratinized tissue (KT) gain; (2) xenogeneic collagen matrix was as comparable to SCTG in terms of mean amount of KT gain around teeth and dental implants but inferior in achieving RC; (3) GTRC was inferior to SCTG in terms of mean CRC and mean RC; (4) LCC was inferior to free gingival graft in terms of mean amount of KT gain but was superior in esthetics and patient satisfaction; and (5) adjunctive use of biologic agents did not exert a significant effect on mean CRC, mean RC, and mean amount of KT gain. CONCLUSIONS: Although these new materials do not surpass the gold standard (SCTG), they do provide improved patient satisfaction and esthetics, are available in abundance, and lead to reduced postoperative discomfort and surgical time.

Immunologic and clinical manifestations of infectious scleritis after pterygium excision.

PURPOSE: To present the immunologic status and clinical manifestations of patients who had infectious scleritis after pterygium excision. METHODS: This prospective noncomparative study of immunologic status and clinical manifestations involved 18 eyes of 18 patients with infectious scleritis (16 bacterial and 2 fungal infections) with a history of pterygium excision from 1999 to 2001. RESULTS: The period between pterygium excision and scleritis ranged from 1 to 36 years. None of the 18 patients had any history of systemic autoimmune disease. Elevated erythrocyte sedimentation rates were found in 9 (50%) of 18 patients. Elevated serum C-reactive protein levels were found in 9 (75%) of 12 patients. Other serologic tests were all negative. The most common pathogen of infectious scleritis, Pseudomonas aeruginosa, was present in 13 patients (72.2%), significantly higher than any others (P < 0.05). All of the eyeballs were salvaged, and 9 (50%) of 18 patients had final vision better than 2/20. CONCLUSION: There was no underlying autoimmune disease associated with infectious scleritis in this study. Early diagnosis and aggressive medical and surgical treatment might have saved the eyes.

Phototherapeutic keratectomy in treating keratomycosis.

PURPOSE: To evaluate the efficacy of using phototherapeutic keratectomy (PTK) in the treatment of superficial keratomycosis. METHODS: We studied 9 patients with superficial keratomycosis that had infiltrated less than half of the corneal thickness and responded poorly to topical antifungal therapy. Using a 193-nm excimer laser, we performed PTK to try to eradicate the infiltrates and facilitate antifungal therapy. We compared our study group findings with those of a control group made up of 31 cases of keratomycosis, also involving infiltration of less than half of the corneal thickness that had been treated with traditional surgical procedures and topical antifungal agents. RESULTS: Using PTK and short-term antifungal eyedrops, we were able to eradicate keratomycosis without recurrence in all 9 study patients. Much less time was needed to treat the PTK group (12.9 +/- 3.6 days) than the control group (40.8 +/- 26.4 days) (P <0.05). After PTK, the ablated area underwent rapid reepithelialization (average, 3.6 +/- 1.8 days). Final vision ranged from 20/200 to 20/20. The PTK group had an average visual improvement of 2.9 +/- 2.1 lines, which was significantly better than final improvement found in the control group (average, 0.6 +/- 1.7 lines) (P < 0.05). PTK complications included mild corneal haze, astigmatism, and thinning cornea. CONCLUSIONS: Because PTK can shorten treatment time, hasten reepithelialization, and restore reasonably good vision, it can be a valuable therapeutic alternative for superficial keratomycosis, especially in instances in which there is poor response to treatment by topical antifungal agents alone.

Risk of microbial contamination of unit-dose eyedrops within twenty four hours after first opening.

The purpose of this study was to evaluate the risk of microbial contamination of sterile, preservative-free, unit-dose ocular medications within 24 h after the first opening. Four different unit-dose ocular medications (cromolyn sodium, timolol, gentamicin sulfate, and betamethasone) in 1 mL containers, were tested. After opening, the preparations were stored in an acrylic protector with or without cap, at room temperature or in a refrigerator at 4 degrees C. Samples were collected for microbiological cultures at 0, 4, 10, 14, and 24 h after opening from the identical container. No bacteria or fungus was detected in the samples throughout the period of the study. Microbial air contamination of the experimental environment was also studied. The culture results of environmental microbial air contamination were positive for both bacteria and fungi. This study suggests that unit-dose eyedrops remain free of microbial air contamination for up to 24 h after the first opening.

Correction of astigmatism after penetrating keratoplasty by relaxing incision with compression suture: a comparison between the guiding effect of photokeratoscope and of computer-assisted videokeratography.

PURPOSE: To report the results of astigmatism correction after penetrating keratoplasty by relaxing incision with compression suture and to compare the guiding ability of a photokeratoscope with that of computer-assisted videokeratography. METHODS: In the two independent retrospective series, 11 eyes received a relaxing incision with compression suture guided by photokeratoscope or computer-assisted videokeratography. RESULTS: In 22 eyes, the relaxing incision with compression suture showed a mean 56% reduction in astigmatism and 78% reduction in vector-calculated astigmatism. The mean postoperative visual acuity was improved 2.92 Landolt lines. The 11 eyes in which treatment was guided by photokeratoscope demonstrated a mean reduction of 50% and 71% in astigmatism and vector-calculated astigmatism, respectively, and visual acuity increased 2.44 Landolt lines. Another 11 eyes in which treatment was guided by computer-assisted videokeratography achieved a mean reduction of 67% and 90% in astigmatism and vector-calculated astigmatism, respectively, together with 3.41 Landolt lines improvement in visual acuity. There were no significant differences in astigmatism correction and visual acuity improvement between the two groups. CONCLUSION: The results demonstrate that the relaxing incision with compression suture is an effective and safe procedure for correcting high astigmatism after penetrating keratoplasty. The two instruments have no significant difference in their guiding capacities for this procedure.

Anterior stromal puncture for bullous keratopathy.

BACKGROUND AND OBJECTIVE: To evaluate the effects of anterior stromal punctures on the symptomatic relief of patients with bullous keratopathy considered ineligible for penetrating keratoplasty. PATIENTS AND METHODS: Five eyes of five patients with bullous keratopathy who had intolerable pain, tearing, and photophobia and were ineligible for penetrating keratoplasty were enrolled. Under slit-lamp magnification, anterior stromal punctures were applied directly at the bullae with a 24-gauge needle. Supplementary anterior stromal punctures were applied for recurrent bullae, if any, during the follow-up. The condition of the cornea was recorded by taking photographs. Pain and discomfort were subjectively evaluated. RESULTS: A significant reduction in pain and tearing was achieved. Epithelial and subepithelial fibrosis with scarred small bullae formation was observed during the follow-up. CONCLUSIONS: The anterior stromal puncture is an effective and low-cost method to relieve troublesome symptoms in patients with bullous keratopathy who are not eligible for corneal grafts.