Keratometry measurements in preterm and full term newborn infants.

AIM: To evaluate the relation between postconceptional age and birth weight with keratometric values in preterm and full term infants. METHODS: A prospective cross sectional study was performed. The cohort included 99 infants (198 eyes) admitted to the Neonatal and Neonatal Intensive Care Units at Schneider Children's Medical Center of Israel from February to September 2002. Keratometry in the horizontal and vertical meridians was performed in both eyes of each infant by two ophthalmologists using an autokeratometer. The results were evaluated according to: postconceptual age (<32 weeks, 32-36 weeks, >36 weeks) and birth weight (<1500 g, 1501-2500 g, >2501 g). RESULTS: Corneal curvature measurements decreased progressively with both postconceptual age and birth weight. At <32 weeks, mean (standard deviation) readings were 63.3 (3.2) diopters (D) for the horizontal meridian and 57.3 (2.6) D for the vertical meridian; corresponding values at >36 weeks were 54.0 (3.0) D and 50.7 (2.4) D. In the <1500 g group, mean (SD) readings were 61.3 (3.9) D for the horizontal meridian and 56.0 (2.9) D for the vertical meridian; corresponding values in the >2501 g group were 51.3 (2.1) D and 48.6 (1.8) D. CONCLUSIONS: There is an inverse relation of horizontal and vertical keratometric values with both postconceptional age and birth weight. Highest readings were noted in the babies with the lowest birth weight and youngest postconceptional age. The decrease in corneal dioptric power to normal values is linear and is apparently part of the normal ocular maturation.

Primary pterygium recurrence time.

BACKGROUND: The time to recurrence after surgical removal of primary pterygium (pterygium) and the association between the rate of recurrence and the postoperative interval remain unclear. OBJECTIVES: To determine the amount of follow-up time needed to identify recurrence in patients after surgical removal of pterygium. METHODS: We reviewed the files of 143 patients (143 eyes) with recurrent pterygium to determine the interval from surgery to recurrence. RESULTS: Almost all (91.6%) of the recurrences appeared by 360 days after surgery. CONCLUSIONS: One year is the optimal follow-up time to identify recurrence of pterygium.

[Corneal infection in wearers of contact lenses: causes, effect on visual acuity and prevention].

This is a 5-year retrospective survey of corneal infection in wearers of optical contact lenses (OCL). 23 of the 61 patients (38%; Hasharon Hospital) with positive cultures wore OCL. Visual acuity improved in 15 (65%), no change was noted in 4 (17.5%) and there was deterioration in 4 (17.5%), as compare with status on admission. Pseudomonas aeruginosa was the most common cause of infections among OCL wearers. The improvement in visual acuity expected due to wearing OCL was affected by infections. Those after Staphylococcus albus infections had the highest rate (100%) of improvement in visual acuity and after Ps. aeruginosa the lowest rate (57.2%) of improvement, as well as the highest rate of deterioration (42.8%) found following recovery. OCL wearers are at higher risk for damage to visual acuity following corneal infection, and highly virulent infections in OCL wearers are responsible for a high risk of damage to visual acuity.

Pterygium-induced corneal astigmatism.

BACKGROUND: Previous work has suggested an association between increasing size of pterygium and increasing degrees of induced corneal astigmatism. OBJECTIVES: To assess the quantitative relation between pterygium size and induced corneal astigmatism using a computerized corneal analysis system (TMS II) and slit-lamp beam evaluation of pterygium size, and to conclude whether corneal astigmatism is an early indication for surgical intervention. METHODS: We evaluated 94 eyes of 94 patients with unilateral primary pterygium of different sizes, using TMS II and slit-lamp beam measurements of the size of the pterygium (in millimeters) from the limbus to assess parameters of pterygium size with induced corneal astigmatism. Best corrected visual Snellen acuity was performed. RESULTS: Primary pterygium induced with-the-rule astigmatism. Pterygium extending > 16% of the corneal radius or 1.1 mm or less from the limbus produced increasing degrees of induced astigmatism of more than 1.0 diopter. Significant astigmatism was found in 16.16% of 24 eyes with pterygium of 0.2 up to 1.0 mm in size, in 45.45% of 22 eyes with pterygium of 1.1 up to 3.0 mm in size (P < or = 0.0004), and in 100% of 3 eyes with pterygium of 5.1 up to 6.7 mm in size (P = 0.0005). We found that visual acuity was decreased when topographic astigmatism was increased. CONCLUSIONS: When primary pterygium reaches more than 1.0 mm in size from the limbus it induces with-the-rule significant astigmatism (> or = 1.0 diopter). This significant astigmatism tends to increase with the increasing size of the lesion. Topographic astigmatism tends to be improved by successful removal of the pterygium. These findings suggest that early surgical intervention in the pterygium may be indicated when the lesion is more than 1.0 mm in size from the limbus.

[Corneal infection, cause and effect on vision].

We conducted a retrospective 5-year survey of corneal infections treated in the ophthalmology ward of Hasharon Hospital. The most frequent type of corneal infection was corneal abscess; the most frequent cause was Staphylococcus albus, although this bacterium is not reported as a frequent cause of corneal infections. There was improvement in visual acuity in 69.2% and no change in 15.4%. Corneal infection by Pseudomonas aeruginosa was the most frequent cause of worsening of corneal acuity (23.08%). The greatest improvement of visual acuity was in those with corneal ulcers. The worst visual acuity was in those with corneal abscesses. Pseudomonas aeruginosa was the main cause of infection in contact-lens wearers. In the world medical literature, Staphylococcus albus is considered of very low virulence. This bacterium was the most frequent cause of corneal infections in our study so it may have greater virulence in Israel.

Diclofenac sodium, 0.1% (Voltaren Ophtha), versus sodium chloride, 5%, in the treatment of filamentary keratitis.

PURPOSE: To compare the efficacy and short-term safety of diclofenac sodium, 0.1% (Voltaren Ophtha; Ciba-Vision) and of sodium chloride, 5% ophthalmic solution, in the treatment of filamentary keratitis (FK) in patients with dry-eye syndrome due to secondary Sjögren's syndrome. METHODS: Thirty-two patients (64 eyes) with dry-eye syndrome due to secondary Sjögren' syndrome were enrolled in a randomized study (patients and authors were aware of which medication was being used). All patients had FK. Sixteen patients were treated with sodium chloride, 5% drops, and 16 patients received diclofenac sodium, 0.1% eyedrops. Treatment regimen included instillation of 1 drop, 4 times a day for 28 days, for both groups. Clinical assessment was performed once a week during the study period. Data on the efficacy and safety of the different therapeutic regimens were collected and compared. RESULTS: Both medications achieved disappearance of filaments at the end of the study. Treatment with diclofenac sodium, 0.1%, revealed a significantly more rapid improvement of the clinical symptoms as compared with sodium chloride, 5%. No significant adverse effects were observed in both groups. CONCLUSION: Diclofenac sodium, 0.1%, may be an effective and safe topical therapy in patients with FK caused by secondary Sjögren's disease.

The combination of topical ceftazidime and aminoglycosides in the treatment of refractory pseudomonal keratitis.

BACKGROUND: Pseudomonal keratitis is a serious and potentially blinding infection. METHODS: We treated 12 patients with culture-positive fulminant pseudomonal keratitis with a topical combination of ceftazidime ophthalmic solution (50 mg/ml) and aminoglycosides (14 mg/ml). None of these patients had responded to the standard initial therapy with topical fortified gentamicin or tobramycin (14 mg/ml) combined with cefazolin (50 mg/ml). RESULTS: Substitution of cefazolin by ceftazidime achieved a remarkable clinical improvement during the first 24-48 h of administration in all cases. The average time of healing after initiation of the combination of ceftazidime and fortified aminoglycosides was 21+/-15 days. No serious side effects accompanied ceftazidime administration. In vitro susceptibility testing showed resistance to gentamicin or tobramycin in 33% of cases (4/12) and sensitivity to ceftazidime in all cases. CONCLUSIONS: The combination of ceftazidime, in a 5% solution, and fortified aminoglycosides (1.4%) may be a useful, safe and effective topical therapy for the treatment of pseudomonal keratitis resistant to aminoglycosides.

Comparative study of tear substitutes and their immediate effect on the precorneal tear film.

Dry eye patients present with instability of the precorneal tear film which breaks up much earlier than normally. The instability of the precorneal tear film leads to dry eye symptoms such as the sensation of sand in the eye, recurrent blurred vision, itching, smartness, and the sensation of dryness. The stability of the precorneal tear film can be evaluated by the break-up-time test (BUT). The aim of treatment of dry eye is to increase the precorneal tear film stability. Tear substitutes are the most frequent medication for dry eye patients, who request life-long treatment. Therefore, we estimated the influence of tear substitutes on the precorneal tear film stability. The influence of unpreserved artificial tear substitute containing 0.1% sodium hyaluronate (Healon 0.1%) was compared with that of 7 different available tear substitute preparations containing preservatives. The results of the present study show that Healon 0.1% has the best influence on the precorneal tear film stability. These data were found to be independent of the viscosity property of Healon 0.1%.

Oral bromhexine has no effect on tear and lysosyme secretion in healthy subjects.

The purpose of the present study was to determine whether bromhexine (Solvex) affects the rate of tear secretion or the concentration of lysosyme in the tear fluid in healthy subjects. The rate of tear secretion and lysosyme concentration in tear fluid were estimated in 56 healthy volunteers before and after 3 weeks of oral administration of placebo (tablets of vitamin C, 200 mg per day) followed by bromhexine tablets, 32 mg per day. Shirmer's test I was performed to evaluate the tear secretion, and the lysosyme plate method was used to detect lysosyme concentration. Shirmer's test showed similar results before and after placebo and bromhexine administration. In conclusion, oral bromhexine was found to have no effect on the rate of tear secretion, nor on the concentration of lysosyme in the tear fluid of healthy subjects.

[Effect of pterygium excision on keratometric readings].

A pterygium is a triangular, fibrovascular connective tissue overgrowth of bulbar conjunctiva onto the cornea. A pterygium may grow into the visual axis and thus obstruct vision. It may also have an effect on corneal curvature and cause irregular astigmatism or formation of dellen. No study of these effects after surgical treatment has been published, to the best of our knowledge. In this study an attempt was made to find out whether corneal curvature is affected as a result of the surgery. The results of 28 pterygium operations performed between 1989-1990 were analyzed as regards k-readings before and 4 months after operation (1 month after discontinuance of thiotepa drops). It was found that excision of the pterygium by the bare sclera technique, together with the use of steroids and thiotepa drops, had no effect on the corneal k-readings made 4 months after operation.

[Coincidence of uveitis, dental pulpitis and gingivitis].

The coincidence of uveitis, dental pulpitis and gingivitis is reported. The patients were 2 women, 21 and 50 years old, respectively, and a man aged 36. All were cured by systemic antibiotic treatment. As uveitis is often found in otherwise healthy patients with no apparent focus of infection, it has been suggested that such a focus might be of dental origin. In a tooth abscess the seat of infection in the bone tissue is subject to pressure and irritation from chewing. This can cause bacteria from infected root canals to be pumped into the blood stream and lymphatics. The causes we describe demonstrate the importance of systemic, wide-spectrum antibiotic treatment in such cases.

Effect of I-Scrub on signs and symptoms of chronic blepharitis.

To assess the effect of I-Scrub (Spectra Pharmaceutical Services), a new detergent eyelid scrub, on the subjective symptoms and objective clinical signs of chronic blepharitis, 20 patients with this disease were treated for three weeks. None of them yielded positive cultures for virulent bacteria from the eyelids and conjunctiva. Most of the patients reported significant reduction in the subjective symptoms and in the severity of the clinical signs as well. No adverse effects were observed. The results of our study suggest that this product is of value as a detergent eyelid scrub in the treatment of chronic blepharitis.

Unilateral congenital ptosis due to plexiform neurofibroma, causing refraction error and secondary amblyopia.

An 8-year-old boy with congenital ptosis of the right upper eyelid due to plexiform neurofibroma was operated on because of a rapidly worsening of his ptosis. Only partial removal of the tumor was possible. A hypermetropic astigmatism of the right eye was caused by the condition of the upper lid, with secondary amblyopia. This finding suggests that in cases of congenital ptosis the presence of a lid tumor must be suspected. Such a tumor causes ptosis and this can lead to refraction error and amblyopia.

[Hyperviscosity syndrome and eye involvement].

10 patients with serum hyperviscosity syndrome of different etiologies were examined by fluorescein angiography of the ocular fundus. There was no exact correlation between the pathological findings in the fundus of cases with plasma cell dyscrasia and blood viscosity. Only papilledema and retinal venous engorgement were improved by lowering serum viscosity by plasmapheresis. The abnormal circulating immunoglobulins are an important factor in the genesis of the pathological changes in the retina of patients with plasma cell dyscrasia.

[Epiphora as an expression of dry eye].

One of the most common ophthalmic disorders in the elderly is epiphora, a watery eye with overflow of tears. In some patients it appears in a paradoxical form: dry eye indoors and tearing outdoors. We present a 76-year-old man and a 58-year-old woman with this disorder. Despite diagnosis of dry eye, confirmed by several tests, they complained of epiphora. This ceased after treatment with tear substitutes, bromhexine and occlusion of the lacrimal puncti. The possibility that tearing may be an expression of the dry eye state should always be considered.