TWo Cases of Mycobacterium Chelonae Keratitis at the Interface after Laser in Situ Keratomileusis

PURPOSE: To describe two cases of bacterial keratitis with Mycobacterium chelonae after laser in situ keratomileusis (LASIK) METHODS: Two cases of non-tuberculous mycobacterial keratitis occurred in the interface between flap and stromal bed 8 and 15 days after LASIK. In both cases, we documented acid fast bacilli in intraoperative staining of the interfacial lesion and confirmed them with microbial culture. Appropriate medical therapies were followed. RESULTS: Mycobacterium chelonae were incubated in both cases. In the first case, stromal infiltration improved after 2 months of medical therapy, but in the course of tapering antibiotics, infiltration was reaggravated. Removal of the flap resulted in the improvement. In the second case which were developed in both eyes, stromal infiltration was much severe and poorly responded to medical therapy with more frequent initial postoperative steroid use. CONCLUSIONS: Mycobacterium chelonae should be considered as one of the causes of keratitis after LASIK and topical steroid may aggravate clinical course. Long-term medical treatment with oral and topical antibiotics for more than 2 months, and even excision of the flap may be required to control the infection.

The Surgical outcomes of combined Phacoemulsification, Posterior Chamber Lens Implantation and Trabeculectomy in Glaucoma Patients

PURPOSE: To access the surgical outcomes of combined cataract surgery and trabeculectomy in glaucoma patients. METHODS: Twenty one patients (23 eyes) with preoperative visual acuity over 0.3 treated by combined surgery in severance hospital from 1997 to 1999 were included in this study. We examined preoperative and postoperative visual acuity, intraocular pressure, number of ocular hypotensive eyedrops, visual field test retrospectively. RESULTS: A total of 21 patients (23 eyes) were observed. Mean preoperative intraocular pressure (IOP) were 18.62+/-2.58 mmHg and that of postoperative 1-year follow-up period were decreased to 15.43+/-2.04 mmHg (p<0.05). One, 2 and 3 years after surgery, 2 eyes (8%), 3 eyes (13%), 5 eyes (20%) were aggravated by Advanced Glauma Intervention Study (AGIS) scoring system, respectively. Although there was significant decrease in postoperative intraocular pressure (p<0.05), no significant change was observed in postoperative IOP, mean deviation (MD), and corrected pattern standard deviation (CPSD) between aggravated group and non aggravated group. CONCLUSIONS: The IOP was maintained under 21 mmHg following combined cataract surgery and trabeculectomy and AGIS score of some patients was aggravated during the follow up period. There were no significant difference in postoperative IOP, MD and CPSD between aggravated and non aggravated group, but rim volume and rim area decreased significantly in aggravated group at postoperative two years.

Effects of Dexamethasone on Mucins of Human Corneal Epithelial Cells

PURPOSE: To evaluate whether mucin gene expression is regulated by glucocorticoid hormone in cultured human corneal epithelial cells (HCECs). The effects of dexamethasone on the expression of MUC1 and MUC4, two known mucins produced by corneal epithelial cells, were determined. METHODS: HCECs were cultured in medium supplemented with dexamethasone. The modulations of MUC1 and MUC4 expression by dexamethasone were investigated by RT-PCR and Western blot analysis. RESULTS: The expression of MUC1 mRNA and its protein were enhanced in HCECs by dexamethasone. However, the treatment of HCECs with dexamethasone caused a decrease in MUC4 mRNA and its protein. These effects of dexamethasone on the MUC1 and MUC4 were abolished by a glucocorticoid antagonist (RU486). CONCLUSIONS: This study shows that dexamethasone is implicated in the expression of mucin in HCECs, and suggests that glucocorticoid receptor participates in the modulation of mucin production.