Cytomegalovirus as a cause of recurrent corneal endotheliitis in the Canadian population.

OBJECTIVE: To report the clinical manifestations, response to antiviral treatment, and long-term visual outcomes of cytomegalovirus endotheliitis in a Canadian population. DESIGN: Retrospective case series. PARTICIPANTS: A total of 9 eyes of 7 patients referred to a cornea subspecialty clinic in a major Canadian centre with corneal endotheliitis. METHODS: A retrospective review of all patients presenting with corneal endotheliitis to 1 corneal surgeon was completed. Patients underwent anterior chamber biopsy with positive cytomegalovirus polymerase chain reaction. All patients received systemic valganciclovir for a minimum of 3 months. Primary outcomes included visual acuity, intraocular pressure control, medication dependence, and corneal status. RESULTS: The average follow-up was 76.4 ± 11.8 months. Two patients had bilateral disease. Corneal manifestations included linear, disciform, and circinate patterns of endotheliitis. Best-corrected visual acuity improved from a mean of 0.48 ± 0.19 logMAR at presentation to 0.24 ± 0.11 logMAR at last follow-up. Intraocular pressure decreased from a peak of 35 ± 3.1 mm Hg to 14.2 ± 4.3 mm Hg. Antiglaucoma medications were reduced from 2.6 ± 0.45 to 0.89 ± 0.29 agents. Two eyes required endothelial transplantation. Valganciclovir therapy was well tolerated by all patients; at the time of last follow-up, all patients were stable on low-dose valganciclovir at an average dose of 1395 mg per week. CONCLUSIONS: Cytomegalovirus is an uncommon but clinically significant cause of corneal endotheliitis that must be considered in the differential diagnosis of corneal endotheliitis, even in the immunocompetent population. Our results support prior findings that this entity responds robustly to oral valganciclovir and demonstrate for the first time the efficacy of chronic low-dose antiviral maintenance therapy.

Sural nerve graft for neurotrophic keratitis: early results.

OBJECTIVE: To report our center's experience in treating neurotrophic keratitis (NK) through corneal neurotization using nerve transfers and sural nerve grafts in the adult population. DESIGN: Prospective observational case series, single center study. METHODS: Six consecutive patients (5 males and 1 female) with severe NK were evaluated. All patients had complete corneal anaesthesia in the neurotrophic eye. Three patients had unstable epithelial disease with recurrent breakdowns despite maximal medical and standard surgical management; three presented with dense scarring of their cornea. These patients were surgically treated using nerve transfers and sural nerve grafts for neurotization of the neurotrophic eye. Subjects were evaluated for corneal sensation, epithelial breakdown, and visual acuity. RESULTS: Mean participant age was 57 years (SD 19) with a mean denervation time before the procedure of 23 months (SD 20). Patients were followed up for a minimum of 6 months following the procedure, with a mean follow up time 12 months (SD 4.2). All patients had improved corneal sensation within half a year following the procedure. Five patients (83%) demonstrated improved visual acuity. Of these patients, three (50%) had improved visual acuity with no further surgical intervention. One patient underwent cataract extraction 13 months after neurotization and another underwent amniotic membrane grafting 17 months after neurotization. CONCLUSIONS: Our experience suggests that corneal neurotization using nerve transfers and sural nerve grafts for patients suffering from deteriorating neurotrophic keratitis is a safe procedure in adults. It successfully restored corneal sensation in all patients and improved visual acuity in most patients.

Comparison of nonlaser nonendoscopic endonasal dacryocystorhinostomy with external dacryocystorhinostomy.

OBJECTIVE: To compare the success rate of nonlaser nonendoscopic dacryocystorhinostomy (EN-DCR) with that of externalDCR(EX-DCR). DESIGN: Retrospective chart review. PARTICIPANTS: Eighty-eight patients that underwent 102 consecutive EN-DCR or EX-DCR between November 1, 1995, and September 1, 2003. METHODS: All DCRswere performed by a single ophthalmologist. The surgical protocol remained constant, and surgical success was defined as a lack of symptoms that indicated DCR or normal canalicular irrigation. RESULTS: Eighty-eight patients were reviewed, equating to 102 cases ofDCR (56 EX-DCRand 46 EN-DCR). The average age of patients was 63.2±18.2 years old (range, 19-93 years), and the average duration of surgery was 32.1 minutes for EX-DCR and 23.3 minutes for ENDCR (p < 0.0001). Three cases of intraoperative bleed requiring nasal packing were documented in EX-DCR and 2 cases in EN-DCR. The success rates were 89.8% and 90.2% for EX-DCR and EN-DCR, respectively. There was no statistical difference between these 2 numbers. The average follow-up time was 12.8 months (median, 5 months; range, 2-97 months). CONCLUSIONS: We found that the endonasal approach to DCRs was quicker than the external approach and the success and complication rates of both methods were comparable.