Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction.

OBJECTIVE: To investigate the efficacy of topical cyclosporine A 0.05% (tCsA) (Restasis, Allergan Pharmaceuticals) in the treatment of meibomian gland dysfunction (posterior blepharitis). METHODS: Thirty-three patients with symptomatic meibomian gland dysfunction were randomized in a prospective study to either tCsA or placebo (Refresh Plus preservative-free artificial tears), 2 times daily for 3 months. They were evaluated at baseline and at 1, 2, and 3 months for subjective symptoms and objective signs including meibomian gland inclusions, lid margin vascular injection, tarsal telangiectasis, fluorescein staining, tear breakup time, and Schirmer scores. RESULTS: Twenty-six patients completed the study. All patients were tested for ocular symptoms, lid margin vascularity, tarsal telangiectasis, meibomian gland inclusions, tear breakup time, and fluorescein staining. At the 3-month visit, the tCsA group showed a greater improvement in ocular symptoms than the placebo group, but this difference was not statistically significant. At the 3-month visit, several objective examination findings were statistically significantly (P < 0.05) improved in the tCsA group compared with the placebo group. These differences included lid margin vascular injection, tarsal telangiectasis, and fluorescein staining. The most significant finding (P = 0.001) was the greater decrease in the number of meibomian gland inclusions in the tCsA group compared with the placebo group. CONCLUSIONS: Topical CsA may be helpful in the treatment of meibomian gland dysfunction (posterior blepharitis). Topical CsA did not induce an improvement in the symptoms, but it did decrease the number of meibomian gland inclusions in patients with meibomian gland dysfunction.

Childhood onset of pterygia in twins.

PURPOSE: To report a case of childhood onset of pterygia in twins. METHODS: Twelve-year-old male twins had nasal lesions on the left eye of twin A and on the right eye of twin B. Both lesions were excised with superior conjunctival autograft. RESULTS: Histopathologic examination showed the lesions to be pterygia. Other pedigrees of familial pterygia have been described. However, to the authors' knowledge, this young age at onset has not been documented with histopathology in twins. CONCLUSIONS: This case report documents the youngest age at onset of pterygia in twins, with histologic confirmation. It suggests a genetic or developmental cause for pterygium formation.

Flap folds after femtosecond LASIK.

PURPOSE: To report a case of bilateral flap folds after a laser-assisted in situ keratomileusis (LASIK) procedure in which the flap was created by the femtosecond laser. METHODS: Retrospective chart review. RESULTS: A 43-year-old white woman underwent bilateral simultaneous LASIK. The corneal flap was created with the femtosecond laser. Postoperatively, the patient noted significantly decreased visual acuity, glare, and haloes. She was diagnosed with corneal flap striae, which were treated unsuccessfully with a lifting and stretching procedure, but responded to subsequent bilateral flap suturing. CONCLUSIONS: Despite the increased accuracy in flap creation with the femtosecond laser, large flap folds may develop.

Chryseobacterium meningosepticum keratitis.

PURPOSE: To describe a case of a corneal ulcer caused by Chryseobacterium meningosepticum in an eye without significant comorbidities. DESIGN: Interventional case report. METHODS: Retrospective case review. RESULTS: A 48-year-old man presented with a corneal ulcer in his right eye and was treated with ofloxacin and fortified bacitracin ophthalmic solution. Cultures grew C. meningosepticum, and the infection resolved. Two previous case reports in the literature have described ocular infections with this bacterium, both in postoperative patients with significant ocular comorbidities. CONCLUSIONS: This is the first report of ocular infection with C. meningosepticum in an eye with no significant comorbidities.