Gonococcal Keratoconjunctivitis in Adult

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.

Gonococcal Keratoconjunctivitis in Adult

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.

Clinical Analysis of Congenital Exotropia

Constant exotropia is uncommon during the first year of life.We investigated characteristics, surgical outcome and associated ocular abnormalities in patients who had an exodeviation during the first year of life. The charts of 18 patients who were diagnosed as congenital exotropia before 1 year old were reviewed.We etrospectively analyzed 10 healthy patients who did not have associated systemic or ocular abnormalities and were followed for at least 3 months after surgery. The mean follow-up period was 1.2 years[range, 3 months to 3.5 years]and all of them had an exodeviation of 25 prism diopter[PD]or more[mean, 37.5PD, SD 10.6PD].Preoperative DVD and inferior oblique muscle overaction were found in 1 patient respectively. Surgery was performed in 9 cases and botulinum toxin was injected in 1 case.Seven patients[70%]showed stable alignment within 10PD with one operation and one patient required reoperation.Postoperative dissociated vertical deviation and inferior oblique muscle overaction were found in each 1 patients. Congenital exotropia has large deviation and may be associated with inferior oblique muscle overaction or dissociated vertical deviation as infantile esotropia and has stable alignment with single operation.But unlike infan-tile esotropia, nystagmus is extremely rare.

Consecutive Esotropia after Surgery for Intermittent Exotropia

We evaluated retrospectively the clinical characteristics of 10 esotropic patients following surgery for intermittent exotropia. The nonoperative group(NG) comprised of 5 patients with esodeviation under 16PD and the operative group(OG) of 5 patients with the angle of 18PD or more. The associated condition was one case of myopic anisometropia in the NG. In the OG, there were inferior oblique overactions in three cases and high myopia or amblyopia in two cases. The mean esodeviation at early stage was 11.8PD and 7.8PD at final stage in the NG. 4 of 5 patients showed good alignment within 10PD. In the OG, the mean early esodeviation and final deviation were 11.6PD and 19.2PD respectively. Three patients showed orthotropia in the early stage, and 2 patients revealed orthotropia in the final stage. There were no significant differences in achieving fusion and steropsis between the two groups. The results suggest that the degree of deviation and associated ocular conditions will influence the choice of therapy. We think that there will be no problem in the recovery of binocular visual function after surgery for consecutive esotropia.

Intraoperative Subconjunctival Injection of Mitomycin C in Trabeculectomy

A single intraoperative application of mitomycin C(MMC) has been used to improve the surgical outcome of glaucomatous eyes. But this soaking method has a few disadvantages, including difficulty in controlling amount. The purpose of this study is to evaluate the effectiveness of intraoperative subconjunctival injection of MMC to overcome this problem. In a retrospective analysis, 29 eyes of 24 consecutive patients, who were phakic primary glaucoma, who underwent primary trabeculectomy with subconjunctival injection of MMC (0.04 mg/ml, 0.05ml) were reviewed. All patients were followed for a periods of 3 months to 1 year. Preoperative mean intraocular pressure(IOP) was 33.9 +/- 9.3mmHg. The mean IOPs after 1, 3, and 6 months were 16.4 +/- 7.0, 16.1 +/- 7.5 and 16.9 +/- 5.8 mmHg, respectively. Twenty two eyes(76%) achieved an IOP of less than 21mmHg without antiglaucoma medication. Postoperative complications were transient hyphema in 3 eyes(20%), shallow anterior chamber in 2 eyes(7%), conjunctival wound leakage in 1 eye(3%), and hypotony maculopathy in 1 eye(3%). There were 4 cases (14%) of avascular cystic bleb and 8 cases (28%) of nonfunctional fibrotic bleb. We suggested that intraoperative subconjunctival injection of MMC could control concentration and amount of MMC.

Experimental Studies on the Retinal Responses to Subretinal Perfluorocarbon Liquids

Perfluorocarbon liquids are frequently used intraoperatively in repair of complicated retinal detachments. One complication of their use is prfluorocarbon liquids entering the subretinal space via a retinal break or an iatrogenic retmotomy since these liquids are much heavier than water, We evaluated the response to subretinal perfluorophenanthrene (VitreonR) on the rabbit retina ophthalmoscopically and microscopically. Twenty eight rabbit eyes underwent subretinal injection of 50-100 ml of perfluorophenanthrene via the vitreous space. The same volume of balanced salt solution was injected into control eyes. Eyes were monitored by indirect ophthalmoscopy and examined by light and electron microscopy. Progressive retinal detachments with newly formed retinal breaks in the inferior quadrants developed in 24 of 28 eyes. In the remaining 4 eyes, small retinal bleb, from 0.5 to 3DD size, occurred in inferior peripheral retina. The photoreceptor outer and inner segments were lost and receptor cell nuclei began to deplete within 1-3 days. In addition, marked vacuole formation in the retinal fiber layers as well as in inner and outer nuclear layers were seen. The photoreceptor outer and inner segments had a1most dlsappeared and the number of nuclei in irulei and outer nuclear layers was markedly decreased from 1 to 3 months. The control eyes reattached and healed spontaneously within 3-5 days. Our findings suggest that all subretinal perfluorophenanthrene should be carefully removed from the eyes at the end of the surgery.

Experimental Studies on the Retinal Responses to Subretinal Perfluorocarbon Liquids

Perfluorocarbon liquids are frequently used intraoperatively in repair of complicated retinal detachments. One complication of their use is prfluorocarbon liquids entering the subretinal space via a retinal break or an iatrogenic retmotomy since these liquids are much heavier than water, We evaluated the response to subretinal perfluorophenanthrene (VitreonR) on the rabbit retina ophthalmoscopically and microscopically. Twenty eight rabbit eyes underwent subretinal injection of 50-100 ml of perfluorophenanthrene via the vitreous space. The same volume of balanced salt solution was injected into control eyes. Eyes were monitored by indirect ophthalmoscopy and examined by light and electron microscopy. Progressive retinal detachments with newly formed retinal breaks in the inferior quadrants developed in 24 of 28 eyes. In the remaining 4 eyes, small retinal bleb, from 0.5 to 3DD size, occurred in inferior peripheral retina. The photoreceptor outer and inner segments were lost and receptor cell nuclei began to deplete within 1-3 days. In addition, marked vacuole formation in the retinal fiber layers as well as in inner and outer nuclear layers were seen. The photoreceptor outer and inner segments had a1most dlsappeared and the number of nuclei in irulei and outer nuclear layers was markedly decreased from 1 to 3 months. The control eyes reattached and healed spontaneously within 3-5 days. Our findings suggest that all subretinal perfluorophenanthrene should be carefully removed from the eyes at the end of the surgery.

The Factors Affecting Consecutive Exotropia with Angle of 20 Prism Diopters or More following Surgery for Esotropia

The purpose of this study is to evaluate the factors that may have a role in the development of postoperative exotropia with the angle of 20 prism diopters (PD) or more. The study group was subdivided into three groups depending on the amount of deviation for consecutive exotropia; group A is the angle of 20PD or more, group B is between 10PD and 18PD, and group C is orthophoria. Comparing group A with C, the presence of amblyopia(p<0.05), postoperative limitation on adduction(p<0.01), postoperative binocular vision(p<0.05) and postoperative A or V pattern(p<0.05) were statistically significant. Among the factors of group A and B, the presence of postoperative limitation on adduction(p<0.05) and refractive error of 3D or more(p<0.05) were signifi cant. We suggest that these factors may have a role to develop large consecutive exotropia, therefore close observation is necessary when these factors are found.