Dehiscence of radial keratotomy wounds without globe rupture following explosion injury.

PURPOSE: To report a case of explosive trauma to a patient with a history of radial keratotomy (RK), which resulted in multiple wound dehiscences but not globe rupture. METHODS: A 29-year-old male underwent radial keratotomy 1 year before he sustained facial trauma from a gasoline tank explosion. Corneal abrasions were treated with copious irrigation, topical antibiotics, corticosteroids, and scopolamine. He did not have a ruptured globe in either eye. RESULTS: The incision sites from radial keratotomy had evidence of anterior dehiscence in both eyes. One month following the injury, the patient had corrected visual acuity of 20/20-1 in the right eye and 20/25+1 in the left eye. At that time, the RK wounds were well healed with minimal irregularity over the incision sites. CONCLUSION: This case demonstrates the excellent recovery of visual acuity in a patient with a partial thickness traumatic wound rupture 12 months following radial keratotomy.

Ocular morbidity associated with airbag deployment: a report of seven cases and a review of the literature.

PURPOSE: To review ocular injuries secondary to airbag deployment that were seen in our institution and were reported in the literature. METHODS: Patients examined at our institution between 1997 and 2000 were evaluated for ocular injuries caused by airbags. A review of the medical literature using Medline was performed. All reports involving ocular injuries secondary to airbags were included in this study. RESULTS: Seven cases from our medical center were identified to involve airbag-related eye injuries. The ages of the patients ranged from 4 to 73 years. Ocular injuries included corneal abrasion, corneal decompensation, corneal alkali injury, hyphema, iris sphincter tears, vitreous hemorrhage, macular retinal pigment epithelium disruption, dislocated posterior chamber intraocular lens, and commotio retinae. A review of the medical literature showed 74 cases involving 80 eyes. The ages of the patients ranged from 2 to 81 years. Males slightly outnumbered females by a ratio of 1.1 to 1.0. The speed of the vehicles ranged from 0 to 65 miles per hour, with an average reported speed of 31 miles per hour. Reported injuries ranged from mild corneal abrasions to open globes. CONCLUSIONS: Ocular morbidity secondary to airbag deployment must be recognized as a significant risk for motor vehicle drivers and passengers. Improvements in airbag safety will include increased consumer awareness and manufacturer design modification.

Ocular complications of thermal injury: a 3-year retrospective.

BACKGROUND: Diagnosis and treatment of thermal ocular injuries are often delayed because facial burns are usually associated with life-threatening injuries requiring immediate intervention. The purpose of the present study is to review the diagnosis and management of ocular complications associated with thermal burns in a tertiary care burn unit. METHODS: In this retrospective study, the charts of patients admitted to the Loyola University Medical Center Burn Unit between January 1993 and January 1996 were reviewed. RESULTS: Of the 1,461 patients who were admitted to the burn unit during that period, 155 (10.6%) required ophthalmic consultation. Sixty-one patients (4.2%) had ocular injury, the most common type being periorbital burn and edema followed by corneal involvement. Thirty-one of the 61 patients (51%) received consultation on the day of admission. Six of the 61 patients (10%) required surgical intervention. There was no correlation between number of days to consultation and need for surgical intervention. Patients requiring surgery were more likely to have suffered third-degree burns. CONCLUSION: Because it is difficult to predict which patients suffering from thermal burns involving the eyes will require surgical intervention, ophthalmic consultation should be sought early.

Effect of topical anti-inflammatory drugs on corneal and limbal wound healing.

PURPOSE: To examine the effect of topical treatment with either steroidal or nonsteroidal anti-inflammatory drugs (NSAIDs) on the wound healing of corneal and limbal incisions using histologic criteria. SETTING: Loyola University Medical Center, Maywood, Illinois, USA. METHODS: Eighteen eyes of 9 cats were used for the study. All right eyes received a temporal limbal incision and the left eyes, a clear corneal incision. All eyes were treated with ofloxacin 0.3% postoperatively for 3 days. The animals were equally divided among 3 groups. Group 1 received topical steroid drops (prednisolone acetate 1%) for 7 days maximum; Group 2 received topical NSAID drops (ketorolac tromethamine 0.5%) for 7 days maximum; Group 3 received no additional treatment. One animal from each group was killed and the eye enucleated 3, 7, or 28 days postoperatively. The eyes were processed for staining with hematoxylin-eosin and smooth muscle actin, and corneal sections were evaluated in a blind fashion by an ophthalmic pathologist. RESULTS: Three and 7 days after surgery (1) the limbal incision exhibited more prominent wound healing than the similarly treated clear corneal incision, and (2) the steroid-treated corneas had less wound healing than untreated or NSAID-treated corneas. At 28 days, the wounds in all eyes were almost completely healed. CONCLUSIONS: Limbal incisions heal faster than clear corneal incisions. Steroids, but not NSAIDs, inhibit wound healing. Cataract surgery using limbal incisions and postoperative topical NSAIDs may result in faster wound healing and provide a reduced risk of related postoperative complications.

Orbital Wegener granulomatosis without systemic findings.

PURPOSE: To describe a case of orbital Wegener granulomatosis without systemic disease. METHOD: Case report. RESULTS: A 69-year-old patient with bilateral inflammatory lacrimal gland masses underwent multiple biopsies that showed a nonspecific lymphoplasmacytic infiltrate consistent with orbital pseudotumor. After unsuccessful treatment with systemic corticosteroids and radiation, severe orbital disease rapidly progressed and the patient underwent unilateral enucleation. The enucleated specimen showed multifocal vasculitis, tissue necrosis, and granulomas consistent with Wegener granulomatosis (WG). Elevated antineutrophil cytoplasmic antibody titers supported the diagnosis of WG. The patient did not have any extraocular signs of WG and continues to be disease-free systemically. CONCLUSION: The authors believe this is the first report of bilateral lacrimal gland masses presenting as a localized form of WG in the total absence of systemic disease.

Delayed-onset expulsive choroidal hemorrhage following traumatic globe rupture.

The authors describe a 59-year-old woman who had a traumatic wound rupture 6 months following penetrating keratoplasty. While she was in the pre-operative holding area awaiting surgical repair, hemorrhagic choroidal detachments developed. Digital pressure was initiated on diagnosis of imminent expulsion of intraocular contents and maintained until repair of the wound rupture could be performed. Four months postoperatively, the patient's vision was 20/80 and her central pachymetry was 585 microns. This case demonstrates that a delayed-onset expulsive choroidal hemorrhage may be successfully managed with simple and rapid intervention based on knowledge of the disease process.

Bilateral peripheral ulcerative keratitis associated with pyoderma gangrenosum.

PURPOSE: A 37-year-old Hispanic man with a history of chronic myelogenous leukemia was first seen with fever and preseptal cellulitis of this right orbit after a tooth extraction. METHODS: The patient subsequently developed bilateral, severe peripheral ulcerative keratitis. He was treated with systemic antibiotics for a presumed underlying infectious cause. Several painful, necrotizing skin lesions developed over his face, trunk, and extremities. RESULTS: Repeated skin biopsies of the necrotizing lesions were consistent with pyoderma gangrenosum. Both the skin lesions and peripheral ulcerative keratitis responded dramatically to systemic prednisone. CONCLUSIONS: Pyoderma gangrenosum should be included in the differential diagnosis of peripheral ulcerative keratitis.

Bilateral fascia lata patch grafts in a patient with progressive scleromalacia perforans.

This study was performed to evaluate the use of autogenous fascia lata patch grafts with systemic immunosuppression in the treatment of progressive bilateral scleromalacia perforans. Autogenous fascia lata was compared with donor bank sclera and was demonstrated to be more suitable for this condition.

Indications and complications of therapeutic disposable Acuvue contact lenses.

PURPOSE: Although therapeutic hydrogel contact lenses have been used for many years, there have been few reports on the therapeutic use of disposable lenses. We evaluated lens fit, duration of wear, efficacy of therapy, complications, and concurrent treatment in patients with corneal or anterior segment problems who were managed with Acuvue contact lenses for therapeutic purposes. METHODS: We managed 38 patients with corneal or anterior segment disease during 1992-1994. The duration of lens wear ranged from several days to 12 months. Six patients were fit for mechanical reasons, six were fit for symptomatic relief, and 26 were fit as an adjunct to healing. Technical failures included lenses with inadequate movement and lenses that fell out of the eye. Therapeutic failures occurred when lens use did not help resolve the anterior segment problem. RESULTS: Seventy-one percent of patients were fit successfully, and 66% of patients were therapeutic successes. Complications with contact lens fitting included lens loss, discomfort, corneal ulceration, and tight lens syndrome. CONCLUSIONS: Although we found some difficulty in lens fitting, Acuvue lenses may provide a useful, disposable, and less expensive alternative to the traditional bandage contact lens.

Ocular surface upregulation of intercellular adhesive molecule-1 (ICAM-1) by local interferon-gamma (IFN-gamma) in the rat.

Inflammatory mediators such as interferon-gamma (IFN-gamma) are known to induce the expression of class II HLA (HLA-DR) and intercellular adhesion molecule 1 (ICAM-1) in a variety of cell types including epithelial cells. The coexpression of ICAM-1 and HLA-DR has been implicated in the pathogenesis of immune mediated ocular disease. We investigated the expression of ICAM-1 on the ocular surface of the rat eye following subconjunctival administration of IFN-gamma. A dose response study was performed using 100, 1,000 and 10,000 IU IFN-gamma/dose. The presence of ICAM-1 was determined using a standard immuno-peroxidase staining technique. The cornea, limbus, and conjunctiva were evaluated. The degree of reaction product in each area was graded by a masked observer. We found constitutive expression of ICAM-1 on the conjunctiva but not on the cornea. There was a significant relationship between the dose of IFN-gamma and the intensity of ICAM-1 staining on the conjunctiva (p < or = 0.05) and on the limbus (p < or = 0.04). Subconjunctival IFN-gamma had no effect on the expression of ICAM-1 in the cornea.

The kinetics of anterior chamber ofloxacin penetration.

Thirty-five patients received topical ofloxacin 0.3% before routine cataract surgery. Ofloxacin was administered one drop every 2 h for five doses 1 day before surgery and one drop every 5 min for five doses immediately before surgery. Aqueous sampling was performed at variable periods 30-150 min after the last topical dose. The mean aqueous ofloxacin concentration was 793 +/- 516 ng/ml (range, 143-2,400 ng/ml). A significant correlation between time from last dose and aqueous humor concentration was found (r = 0.39, p = 0.025). The mean ofloxacin concentration was greater in those patients who received their last dose >1 h before aqueous aspiration (957 +/- 559 ng/ml versus 554 +/- 338 ng/ml, p = 0.02). From a best-fit scatter plot of concentration versus time, the maximal aqueous concentration of 1,000 ng/ml occurs at approximately 2h after topical administration.

The role of systemic cyclosporine dosing schedule on corneal allograft survival in the rat model.

We evaluated the role of preoperative versus postoperative systemic Cyclosporin A (CsA) on corneal allograft survival in the rat model. All treatment regimens were administered by daily intramuscular injection until rejection. In the preoperative group (n = 9), CsA (7.5 mg/kg/day) was started ten days preoperatively. In the postoperative group (n = 9), CsA (7.5 mg/kg/day) was started immediately postoperatively. In the injectable control group (n = 7), injections of 0.9% normal saline with olive oil began the day of surgery. A masked observer performed alternate day slit lamp evaluations of graft opacity, edema, and vascularity. The median rejection times [days (range)] for the injection control, preoperative and postoperative groups were: 11 (10-17), 17 (12-53), and 28 (12-53), respectively. The grafts in the postoperative and preoperative treatment groups survived longer than the control (p = 0.003 and p = 0.005 respectively). There was no statistical difference between the preoperative and postoperative groups (p = 0.3). Preoperative systemic administration of CsA may offer no significant benefit in prolonging allograft survival over treatment beginning the day of surgery.

Periocular FK-506 delays allograft rejection in rat penetrating keratoplasty.

FK-506 is a new immunosuppressant with the ability to inhibit activation of T-lymphocytes that would be cytolytic to an allograft. We studied periocular injection of FK-506 in a rat penetrating keratoplasty model. Corneas were transplanted from Brown Norway rats into Lewis rat recipients. The transplanted rats received periocular injection of either 0.5 mg/kg FK-506 or an equivalent volume of FK-506 vehicle only. Injections were given 1 day before, at keratoplasty, and every other day after keratoplasty until allograft rejection. The group receiving FK-506 had a significant delay in allograft rejection (p < 0.05). The FK-506 group rejected 12-20 days postkeratoplasty with a mean rejection time (MRT) of 14.3 days, compared with 8-14 days (MRT 11.1 days) for the control group. We conclude that periocular administration of FK-506 is effective in prolonging allograft survival in the rat penetrating keratoplasty model.

Experimental autoimmune pinealitis in the rat: ultrastructure and quantitative immunocytochemical characterization of mononuclear infiltrate and MHC class II expression.

Lewis rats immunized with Peptide M (an oligopeptide epitope of the S-antigen protein) developed experimental autoimmune uveoretinitis (EAU) and experimental autoimmune pinealitis (EAP). Temporal changes in mononuclear infiltrate to the pineal gland were quantitated by computer image analysis of sections immunostained with monoclonal antibodies to specific mononuclear populations. T helper/inducer cells (W3/25+) and monocyte/macrophages (OX-42+) were elevated during the early phases of inflammation (day 15) while cytotoxic/suppressor T cells (OX-8+) were elevated at days 15 and 21. Expression of MHC class II (OX-6) was markedly enhanced on pineal glia, but was not present on vascular endothelia during EAP. Ultrastructurally, many capillaries exhibited thickenings of the endothelia and basal lamina. EAP had little effect on the fine structure of pinealocytes and glia and there was little evidence of cellular destruction by day 21, in contrast to the extensive retinal destruction resulting from EAU. These findings suggest fundamental differences between EAU and EAP related to mechanisms of antigen processing/recognition in autoimmune diseases. Our study further indicates the importance of EAP as a model to investigate neuroendocrine-immune interactions.

Tight lens syndrome associated with a 24-hour disposable collagen lens: a case report.

Tight lens syndrome occurred 8 hours after a 24-hour Bio-Cor bandage collagen lens (Bausch & Lomb, Inc.) was placed on the eye of a 19 year old female patient with a history of Stevens-Johnson syndrome and recurrent corneal abrasions. Because collagen bandage contact lenses share some physical and fitting properties with hydrophilic lenses, they should be used with caution in patients at high risk for a tight lens.

Continued contact lens wear in patients with giant papillary conjunctivitis.

We performed a six-year retrospective evaluation of 47 contact lens patients with a documented history of giant papillary conjunctivitis (GPC). The relationships between specific symptoms, contact lens history, treatment regimens, and clinical responses were studied. Specifically, we sought to determine the number of patients forced to discontinue contact lens wear due to GPC. Our study indicated two important preconditions to be associated with the onset of symptoms: the continued use of aging lenses and suboptimal lens care. For those patients treated and followed-up for at least 4 months, 79% obtained total resolution of their symptoms. Though the numbers are too small to make any significant conclusions about treatment methods it seems that lens discontinuance alone does not appear to be an adequate treatment for this condition and may serve better as adjunct to other therapy.

Surgical treatment for a case of postoperative Pseudallescheria boydii endophthalmitis.

Pseudallescheria boydii (P. boydii) is an uncommon ocular pathogen which previously has been identified in only 10 of 905 fungal isolates identified by the Sid Richardson Microbiology Laboratory at the Cullen Eye Institute of Baylor College of Medicine. Furthermore, only one case of postoperative P. boydii endophthalmitis and four cases of endogenous P. boydii endophthalmitis have been reported. Three of the four patients with endogenous endophthalmitis died within 4 weeks of diagnosis. We describe a second case of postoperative endophthalmitis due to this fungus. The infection was successfully eradicated following vitrectomy, corneoscleral resection, and patch graft, in addition to intraocular, topical, and oral antifungal medication. Although in vitro sensitivities are variable, P. boydii is known to be relatively resistant to amphotericin B. This points to the importance of proper cultures and sensitivities when treating cases of suspected fungal endophthalmitis. Unfortunately, the patient's eye became phthisical 6 months following the initial intervention.