Long Term Follow-Up of Epikeratophakia in the Pediatric Aphakia

We performed 3 cases of epikeratoplasties on two pediatric aphakic patients who were intolerable to contact lenses & spectacles. These epikeratoplasties were performed in accordance with the Kaufman-McDonald Epikeratophakia Method using the commercially available frozen and dried Kerato-Lens (Allergan Medical Optics), the lenticule of which was rehydrated at the time of surgery. The cataract extractions were performed at 3 months after birth on both eyes of the congenital cataract & at 18 months after birth on the traumatic cataract that had developed at 14 months after birth. The epikeratoplasties for the eyes with congenital cataract were performed at 24 months on the right eye and at 16 months after birth on the left eye respectively. The epikeratoplasty for the traumatic cataract eye was performed at 28 months after birth. The 3 grafts have remained successful over the follow-up period of 4 to 6 years. The right eye of congenital cataract case had myopic shift of 3.75D and best corrected visual acuity of 0.2 during 5-year of follow-up period and the other left eye had myopic shift of 4.75 D and best corrected visual acuity of 0.7 during 6-year of follow-up period. The traumatic cataract case had myopic shift of 1.0 D and best corrected visual acuity of 0.05 during 4-year of follow up period. In view of this, it is considered that the epikeratoplasty is of an effective treatment in correcting the refractive error in the pediatirc aphakia patients who intolerable to contact lens and in whom difficulty exists in determining whether an intraocular lens implantation is appropriate or not.

The Neonatal Conjunctivitis

Conjunctivitis of the newborn is the term for any conjunctivitis with discharge occurring during the first 28 days of life. We had retrospective study of the microbiologic culture of the 113 cases of neonatal conjunctivitis. We evaluated causative organisms, difference of the causative organisms between two delivery methods, and antibiotic sensitivities. We studied the used agents, time of application, and patients of the prophylactic methods in 199 hospitals. Organisms were isolated in 101(89.3%) cases of the 113 neonatal conjunctivitis patients. S aureus was the most common infectious cause of conjunctivitis of the newborn, with 52(46%) isolates, followed by coagulase- negative staphylococci, E. coli, H. influenzae but N. gonorrhoea was isolated in only one case(0.9%). Species of the frequently isolated organisms were not significantly different between the cases of the casarean section delivery method and the normal vaginal delivery methods(p=0.11). The S. aureus, the most commonly isolated organism, was low sensitive to penicillin(14.6%), tetracycline(6.7%), and erythromycin(14.6%). Ocular prophylaxis is practiced in 181(91%) hospitals. The most commonly used method was tetracycline in 86(43.2%) hospitals, followed by erythromycin in 27(13.6%) hospitals, AgNO3 in 24(12%) hospitals. The neonatal conjunctivitis is a easily treated benign disease but the most of causative organisms are infected during the neonatal care so that these infections could be minimized by improving methods of infection control. Also the incidence of the nenatal conjunctivitis would be reduced by the agent that have not evidence of bacterial resistance because of the Gram positive bacterias are highly resistant to erythromycin and tetracyclined.

Occurrence of A Miller Fisher Syndrome After Insect Bite

Miller Fisher syndrome is characterized by ophthalmoplegia, ataxia and areflexia and usually develops after respiratory tract viral infection. Other various events that precede neurologic symptoms are GI tract infection, vaccination, digitalis intoxication, insect bite, and delivery. The clinical course is usually benign with complete recovery. Miller Fisher syndrome is rare and occurred after insect bite is even more rare. The authors experienced a case of Miller Fisher syndrome in 7-year-old female who had the sudden onset of ophthalmoplegia, ataxia and areflexia. These symptomes developed after insect bite.