Bupivacaine and lidocaine retrobulbar anesthesia. A double-blind clinical study.

Bupivacaine 0.75% with epinephrine and/or hyaluronidase and lidocaine 2% with epinephrine and hyaluronidase were compared as to onset and duration of surgical anesthesia and akinesia in a prospective, randomized, double-blind study in 111 patients undergoing 128 elective intraocular surgical procedures. There was no significant difference in onset time to adequate surgical anesthesia among any of the drug groups at 15 minutes following retrobulbar injection, but the bupivacaine with epinephrine group lagged for akinesia. Mean duration of akinesia was 11 hours for the bupivacaine groups compared to four hours for lidocaine. During the eight hours following surgery, 70-90% of the patients receiving bupivacaine required no postoperative analgesia compared to less than 40% of the lidocaine group. There were no drug-related complications.

Ultrastructural and histochemical studies of conjunctival concretions.

Ultrastructural and histochemical studies were performed on conjunctival concretions (yellow spots in the tarsal conjunctiva) from two patients who had associated atopic keratoconjunctivitis and posttrachomatous degeneration. By electron microscopy, these concretions were composed of finely granular material and membranous debris accumulating in the conjunctival subepithelium. Histochemically, concretions stained strongly positive for phospholipid and elastin, weakly positive for neutral polysaccharides and lipid, and were negative for amyloid, collagen, glycogen, iron, mucopolysaccharides, RNA, and DNA. In view of the absence of both calcium and phosphate in the accumulated material, the use of the term "lithiasis" is misleading and should be avoided. These findings support a hypothesis that concretions that follow chronic conjunctivitis represent products of cellular degeneration.

Treatment of herpes simplex keratitis with idoxuridine and vidarabine: a double-blind study.

A double controlled clinical study comparing idoxuridine (IDU) and vidarabine (ara-A) in the treatment of uncomplicated herpes simplex keratitis was carried out with 10 patients. No statistically significant differences occurred in the healing time between IDU (6.8 days) and ara-A (8.0 days). Two moderately adverse reactions to IDU were observed, but no demonstrable ocular toxicity was noted with ara-A.

Pediculosis ciliaris.

Pediculosis ciliaris, though not as common as in the past, is still not a rare disorder. Infestation has become more prevalent among adolescents within the past few years. Severe itching, irritation, secondary conjunctivitis, and preauricular adenopathy may accompany the louse infestation. A brief review of the etiology and treatment of pediculosis ciliaris has been presented. Every physician should be aware of this disorder and be adequately prepared to treat it.

Aspergillus flavus keratitis.

Corneal infection due to the species Aspergillus flavus is rare and often destructive. This report describes a case of Aspergillus flavus corneal ulcer that failed to respond to amphotericin B, pimaricin, and clotrimazole. The eye subsequently became phthisical. The rational approach to the management of fungal corneal infection is to culture or perform sensitivity tests on the isolated organism. Early surgical intervention should be done if the infection fails to respond to medical treatment, and if the disease process extends deep into the stromal tissue and anterior chamber. Fungal malignant glaucoma requires excisional keratoplasty, lens extraction, and anterior vitrectomy.

Corneal perforation due to Helminthosporium and Mima polymorpha.

This apparently is the first reported case of corneal perforation due to a mixed infection of Helminthosporium species and Mima polymorpha. These 2 organisms separately rarely cause ocular infection and when present together could produce serious damage to the eye. In long-standing diseases of the cornea, mixed infection should be suspected when the infection fails to respond to conventional medical therapy. Thorough laboratory evaluation should be done. Selection of appropriate antibiotics should be based on clinical impression, initial Gram stain findings and final cultural results.

Treatment of vernal keratoconjunctivitis with topical cromolyn sodium.

This paper presents five cases of steroid resistant vernal keratoconjunctivitis which were treated with cromolyn sodium. Four of the five patients had an associated punctate keratitis which cleared in this treatment. Topical application of cromolyn in the form of 4%aqueous solution appears to be an effective means for treating vernal keratoconjunctivitis .The drug is well tolerated and is without significant ocular side effects. The drug may be used in conjunction with topical corticosteroids without ill effect. More importantly, cromolyn may significantly reduce the need for topical corticosteroids.

Ocular involvement in Yersinia enterocolitica infection presenting as Parinaud's oculoglandular syndrome.

Ocular involvement in Yersinia enterocolitica infection presenting as a Parinaud's oculoglandular syndrome occurred in a 77-year-old woman with diabetes. Yersinia enterocolitica was recovered from cultures of the conjunctiva, cornea, fistula tract, and blood. The patient responded to parenteral and topical administration of gentamicin and a corneal transplant. While hospitalized, she developed peritonsillar inflammation and enlarged, tender lymph nodes in the preauricular, submaxillary, and submandibular areas. The combination of the unilateral granulomatous conjunctivitis and enlarged regional lymph nodes was consistent with the diagnosis of Parinaud's oculoglandular syndrome. Yersinia enterocolitica may be another cause of Parinaud's oculoglandular syndrome.

Adenine arabinoside in idoxuridine unresponsive and intolerant herpetic keratitis.

Twenty-two patients with active herpes simplex dendritic keratitis, in whom topical idoxuridine was unsuccessful in controlling their disease, were treated with topical adenine arabinoside (ara-A), a purine analogue effective against many DNA viruses. This drug was an effective antiviral agent in these patients. No signs of ocular or adnexal toxicity were noted.

Clinical experience with the therapeutic hydrophilic contact lens.

Hydrophilic contact lenses were prescribed for 62 patients with a variety of corneal diseases. The lens was must successful for relief of pain in bullous keratropathy and in the healing of recurrent erosions. Its value in improving vision in bullous keratopathy depends on the stage of corneal edema and is not impressive in long-standing edema with scarring. The lens may be of value in patients with sterile indolent ulcers and in alkali-burned corneas with large epithelial defects after conventional therapy has failed. Caution is advised in fitting patients with the dry eye syndromes. Patients with minimal corneal scars due to keratoconus may benefit from a soft lens. Complications related to the use of hydrophilic lenses in this group of 62 patients are also discussed.

Keratomycosis in Wisconsin.

Candida albicans was the most common fungus responsible for mycotic keratitis in our series from a northern climate, as opposed to southern climates where other fungi were more common. Pimaricin was effective in our patients with Candida infections and in one patient with Aspergillus infection that had been unresponsive to previous amphotericin B.