Keratoplasty suturing hard contact lens.

A suturing hard contact lens used intraoperatively for penetrating keratoplasty helps stabilize the donor tissue and maintains a controlled anterior chamber. It offers improved tissue control during suturing of the graft. This minimizes manipulation of the donor tissue and protects the endothelium from contact with intraocular structures.

Descemetocele after intraocular lens implantation.

A persistent central corneal epithelial defect progressing rapidly by stromal ulceration to descemetocele formation was observed in five elderly patients soon after cataract surgery with intraocular lens implantation. The ulceration occurred in the absence of active inflammation or infection in otherwise clear cornea. Topically applied artificial tears, antibiotics, and corticosteroids failed to control the ulceration although bandage soft contact lens therapy and conjunctival flap helped stabilize the cornea in one case each. Spontaneous perforation in two cases necessitated penetrating keratoplasty.

Papanicolaou cytology in the diagnosis and management of external ocular tumors.

Papanicolaou smear cytology is a simple diagnostic procedure for the evaluation and management of external ocular lesions. A variety of benign and neoplastic lesions are examined for correlation of clinical, cytologic, and histologic impressions. Accurate correlation in 38 of 41 eyes substantiates the reliability of Papanicolaou smear cytology to differentiate benign from neoplastic ocular lesions. Cytology proved useful in the preoperative evaluation of squamous cell carcinoma and related tumors of the conjunctiva, and malignant melanoma of the conjunctiva. Cytology also was valuable in the detection of tumor recurrence in squamous cell carcinoma and carcinoma-in-situ of the conjunctiva, and in Meibomian gland carcinoma of the eyelid. The accessibility of ocular tumors makes them particularly well suited for cytologic examination.

Cataract following radial keratotomy.

An intumescent cataract developed 16 weeks after radial keratotomy in a 31-year-old man. Corneal perforation was documented at the time of surgery, but no direct injury was noted to the lens capsule. Visual acuity decreased to hand motions during a four-month course. Successful extracapsular cataract extraction occurred seven months following the original radial keratotomy. Soft contact lens correction of aphakia recovered a visual acuity of 6/6.

Corneal crystalline deposits associated with dysproteinemia. Report of two cases and review of the literature.

Two patients had multiple, fine, polychromatic corneal crystals on ocular examination. Peripheral corneal biopsies and electron microscopic studies demonstrated that the crystals, which were located solely within the cytoplasm of keratocytes, exhibited an internal periodicity of 10 nm and developed within dilated cisternae of rough-surfaced endoplasmic reticulum. Histochemical studies of the corneal crystals confirmed their proteinaceous nature (immunoglobulin crystals). Serum protein analysis showed that both patients had a monoclonal gammopathy with an elevated IgG level and increased K light chains. The associated proteinopathy was unsuspected in both patients until the nature of the crystals was established. Both patients had a neoplastic process; one had a previous diagnosis of Hodgkin's disease, and multiple myeloma developed in the other on follow-up studies. Clinicians should be aware of the possibility of a malignant disorder in patients with corneal crystal-line deposits.

Chronic conjunctivitis associated with 'floppy eyelids'.

The floppy eyelid syndrome represents a chronic conjunctivitis characterized by a triad of (1) a loose upper lid that readily everts on elevating the lid, (2) a soft rubbery tarsus that can be folded on itself, and (3) a diffuse papillary conjunctivitis. Seven cases of this condition are reported, all involving men, and four involving obese patients.

Posterior corneal pigmentation in melanosis oculi.

A 5-year-old girl was seen with findings consistent with melanosis oculi and notably decreased vision secondary to dense corneal pigmentation. A penetrating keratoplasty was performed without complications. Light microscopy disclosed dense pigment granules layered in deep stroma just anterior to Descemet's membrane. Electron microscopy revealed these to be melanocytes, without evidence of phagocytic activity. The corneal pigmentation may have resulted from a misdirection of melanocytes in embryogenesis. To our knowledge, the finding of visually notable corneal pigmentation has not been previously reported in association with the syndrome of melanosis oculi.

Psychosocial characteristics of candidates for the prospective evaluation of radial keratotomy (PERK) study.

The National Eye Institute Prospective Evaluation of Radial Keratotomy (PERK) Study is a multicenter clinical trial for the evaluation of radial keratotomy. This article describes the questionnaire data collected on PERK patients and compares them with a similar group of myopic persons studied during the Rand Health Insurance Experiment (heretofore referred to as the Rand study). The PERK patients are young, white myopes who dislike being dependent on corrective lenses but perceive themselves to be more visually impaired than do comparable Rand study myopes. Most female subjects and a plurality of the male subjects have tried contact lenses and quit wearing them mainly because use of the lenses was inconvenient or bothersome. There is no evidence that patients are psychologically or socially deviant. Both male and female subjects expressed a fear of being without vision and cited impatience with the lenses as their major motivation for wanting surgery.

Bacterial endophthalmitis following cutting of sutures after cataract surgery.

Bacterial endophthalmitis developed in four patients after cataract surgery sutures were cut. Wound dehiscence was present in three cases, but in one the wound remained intact. Vitreous cultures identified Streptococcus viridans in two cases and Staphylococcus aureus and St. epidermidis in one case each. Antibiotic therapy was administered by intraocular, periocular, topical and systemic routes and three patients underwent vitrectomy. Visual function recovered to 20/50 in two cases and to 20/100 in a third. Retinal detachment in the fourth case resulted in loss of all visual function.

Bacterial endophthalmitis resulting from radial keratotomy.

Staphylococcus epidermis endophthalmitis developed nine days after surgery in a 47-year-old man who underwent a 16-incision radial keratotomy during which the cornea was inadvertently perforated. The anterior chamber showed marked cellular reaction and flare and there was a 5% hypopyon inferiorly. There was also a marked cellular reaction in the vitreous, which contained many fluffy white balls. Visual acuity decreased to counting fingers at 1 foot. A pars plana vitrectomy and intraocularly, periocularly, intravenously, and topically administered antibiotics resulted in recovery of the visual acuity to 6/9 (20/30).

Hypopyon iridocyclitis associated with extended-wear soft contact lenses.

Two patients had corneal erosions and hypopyon iridocyclitis associated with continuous wear of aphakic soft contact lenses. Both patients were treated with cycloplegia and patching without antibiotics or corticosteroids. Both patients fully recovered.

Acanthamoeba keratitis associated with soft contact lenses.

Three patients (a 13-year-old girl, a 25-year-old man, and a 22-year-old woman) who used daily-wear soft contact lenses, sterilized with saline made from distilled water and salt tablets, developed Acanthamoeba keratitis. Acanthamoeba was cultured from the contact lens solution of one patient. This patient, in whom the diagnosis was made by corneal biopsy early in the clinical course, was successfully treated with topical neomycin-polymyxin, miconazole, and propamidine isethionate. The other two patients underwent penetrating keratoplasty. One of these patients, who received a graft early in the clinical course, developed a recurrence of disease in the graft, whereas the other, who received the graft 18 months after the initial symptoms, has maintained a clear corneal transplant with useful vision.

Mycobacterium keratitis after laser in situ keratomileusis.

PURPOSE: The authors report two cases of Mycobacterium keratitis following LASIK. METHODS: The case reports are based on a retrospective review of clinical history and associated findings. RESULTS: Two patients developed infectious keratitis after undergoing laser in situ keratomileusis (LASIK). In case #1, the infection developed after manipulation of the lamellar flap to remove epithelium from the stromal bed. In case #2, prior radial keratotomy may have been a contributing factor to development of the infection. Corneal infiltrates appeared as focal, white, stromal deposits. Cultures isolated Mycobacterium fortuitum from case #1 and Mycobacterium chelonae from case #2. Topical fortified amikacin, clarithromycin, tobramycin, and ciprofloxacin eventually controlled the infection. Topical prednisolone acetate and bandage contact lenses were necessary to control inflammation and pain. Infiltrates were slow to resolve until focal necrosis eroded through the flaps leading to rapid clearing of the infiltrates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited in the second. CONCLUSIONS: Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recognition of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.

A retrospective review of endophthalmitis due to coagulase-negative staphylococci.

We retrospectively reviewed 28 cases of postoperative endophthalmitis due to coagulase-negative staphylococci. There was an average delay between surgery and the acute presentation of 7 X 2 days (SD 3 X 3). All patients were treated with intraocular antibiotics (IOAB) or therapeutic vitrectomy with IOAB. In six of the 28 cases the organisms were resistant to gentamicin as measured by the Kirby-Bauer technique; none was resistant to cephalosporins. Isolates that had been stored by lyophilisation were reconstituted and tested by serial dilution; none was resistant to gentamicin, though two were borderline. The final visual acuity was 6/18 or better in 72% of the eyes.

Gentamicin-resistant Pseudomonas aeruginosa corneal ulcers.

Six cases are described of Pseudomonas aeruginosa ulcerative keratitis in which antibiotic sensitivity studies demonstrate organism resistance to gentamicin sulfate but sensitivity to other aminoglycosides such as tobramycin and amikacin. In four cases, community-acquired infections represent the source of these ulcers. This paper documents the emergence of aminoglycoside resistance among Pseudomonas aeruginosa keratitis within the general community.

Corneal ulcer due to Listeria monocytogenes.

We present a patient with a corneal ulcer due to Listeria monocytogenes, which has not previously been considered to be a feature of human listeriosis. The ulcer responded to topical and subconjunctival gentamicin and cephaloridine. Subsequent management was complicated by the development of a fibrinous pupillary membrane leading to pupillary block requiring iridotomy and later vitrectomy with trabeculectomy. Listeria monocytogenes may be confused with diphtheroid contaminants seen in corneal ulcer scrapings and is probably underreported as a cause for microbial keratitis.

Accuracy and reproducibility of KeraScanner analysis in PERK corneal topography. PERK Study Group.

The measurement of the corneal radius of curvature centrally and in the corneal periphery is exceedingly difficult because of variables in photography and data acquisition. We present a technique of Automated image scanning of corneal photographs which provides a more accurate and reproducible analysis of the paracentral corneal contour. We analyzed the sources of error of corneal topography measurement. CorneaScope photographs of calibration balls were generated by each Prospective Evaluation of Radial Keratotomy (PERK) Surgical Center. The 90% confidence intervals for individual ring-radial positions on the 8.00 and 10.00 mm balls were 7.91 to 8.09 mm and 9.89 to 10.11 mm respectively. Our isopter method of analysis for clinical comparison averages all eight radii of curvature for each CorneaScopef ring. This isopter technique reduces the corresponding 90% confidence intervals to 7.96 to 8.03 and 9.95 to 10.06 mm. The measurement variability of a 10 mm calibration ball decreased in the following order: calibration ball positioning, scanner personnel, photograph movement between scans, and nonrepositioned scanning. Photographs of calibration balls demonstrate +/- 4 microns of measurement resolution and patient corneal photographs may be evaluated to +/- 40 microns. This automated scanning system provides consistent data when digitizing keratographs.

Cytologic evaluation of ocular lesions.

Evaluation was made of ocular cytologic specimens from 59 patients with clinically suspicious lesions: 47 conjunctival scrapes, 10 vitreous fluid aspirates, 1 corneal scrape and 1 iris cyst aspirate. Tissue correlation was available for 30 of the 59 cases. A control group of 20 normal conjunctival scrapes was also evaluated. Cytomorphologic criteria for normal ocular specimens, inflammatory lesions, premalignant lesions and malignant lesions are presented. These lesions included dysplasia (seven cases), carcinoma in situ (four cases), squamous cell carcinoma (five cases), Meibomian gland carcinoma (three cases), basal cell carcinoma (two cases), metastatic adenocarcinoma (one case), melanoma (two cases) and retinoblastoma (one case). The remaining lesions were nonspecific inflammatory changes and normal variants. The results of this study indicate that cytologic examination of ocular specimens can be a valuable adjunct in the workup of suspected neoplastic eye lesions.

Lasiodiplodia theobromae panophthalmitis.

Lasiodiplodia theobromae is a rare ocular pathogen. We report a case of panophthalmitis caused by this fungus. The patient was a healthy 62-year-old janitor with no history of ocular trauma in whom keratitis developed. Cultures of corneal scrapings identified the fungus. Despite treatment with appropriate antimycotics the keratitis progressed to infectious scleritis and then spontaneous perforation of the globe, which necessitated enucleation. The ultrasonographic, microbiologic and histologic findings are discussed and the results of in-vitro sensitivity testing presented.