Ocular injuries from paintball pellets.

OBJECTIVE: To evaluate the ocular effects of blunt trauma due to injury from a paintball pellet. DESIGN: Noncomparative case series. PARTICIPANTS: Thirteen patients who suffered ocular injury from paintballs are described. The patients presented to six different civilian and military emergency departments in tertiary care medical centers. INTERVENTION: Patients were treated for the ocular injury. MAIN OUTCOME MEASURES: Patients were evaluated for initial and final visual acuity. The reason for persistent loss of vision was delineated. RESULTS: There were 12 males and 1 female with an average age of 21 years (range, 12-33 years). Eleven of the 13 had no ocular protection at the time of the ocular injury. On initial examination, nine patients had a hyphema, nine had a vitreous hemorrhage, six had a retinal tear or detachment, three had corneal or corneal-scleral ruptures, and one had traumatic optic neuropathy. The final visual acuity was 20/40 or better in two patients, 20/50 to 20/150 in three patients, and 20/200 or worse in eight patients. CONCLUSION: Injuries due to paintball pellets can result in severe ocular damage and significant loss of vision. Eyecare professionals should be aware of the risks of this sport and must strongly advise participants to wear adequate protection when involved in this activity.

The role of cultures in the management of ulcerative keratitis.

PURPOSE: To ascertain the importance of routine cultures and gram stains in the management of ulcerative keratitis. METHODS: We retrospectively reviewed 119 consecutive corneal ulcers seen at Sinai Hospital of Baltimore. Cultures were obtained of the corneal ulcer and of the lids and conjunctivae of both eyes. Gram stains were performed by the hospital microbiology department on corneal scrapings from each ulcer. RESULTS: Positive corneal cultures were obtained from 56 eyes (47.1%). Initial antibiotic therapy was changed based on culture results in 14.3% of culture-positive eyes that demonstrated a worsening clinical course. Gram stains were negative in all cases. The sensitivity and specificity of the lid and conjunctival cultures were determined. CONCLUSIONS: Corneal cultures are important in the management of ulcerative keratitis. Lid and conjunctival cultures have low sensitivity and specificity.

Intraoperative corneal pachymetry in eyes having radial keratotomy.

We prospectively studied 45 eyes that had radial keratotomy for correction of myopia to determine whether significant changes in corneal thickness occurred during the surgical procedure and which paracentral corneal region was the thinnest consistently. We used a standard bidirectional technique with a diamond knife. The inferotemporal paracentral region was the thinnest most frequently (38% of eyes) both pre-incision and post-incision. However, each of the other paracentral regions measured the thinnest in a smaller percentage of eyes: temporal (28% pre-incision and post-incision); inferior (19% pre-incision, 21% post-incision); nasal (11% pre-incision, 9% post-incision); superior (4% pre-incision and post-incision). A statistically significant reduction in corneal thickness occurred intraoperatively in all regions.

Nd:YAG laser photo-induced adhesion of the corneal epithelium.

We retrospectively studied eight patients with recurrent corneal erosions treated with the Nd:YAG laser using 0.4- to 0.5-mJ pulses applied to the region of Bowman's layer through an intact epithelium. All eight patients had resolution of their symptoms after treatment. Mean follow-up time was 21.2 months (range, 12.6 to 36.6 months). A patient who was scheduled for diagnostic enucleation for a posterior choroidal mass consented to undergo this laser treatment with varied energy settings six days before his enucleation. His cornea was studied with specular microscopy, light microscopy, and transmission electron microscopy. Light microscopy of the cornea disclosed rare 100-microns defects in Bowman's layer with subjacent compaction of the anterior stromal lamellae. Electron microscopy showed minute foci of disruption in Bowman's layer with new collagen formation. Fine fibrils connected the basal epithelial cells to the new collagen. Nd:YAG laser photo-induced adhesion of the corneal epithelium may represent an effective treatment alternative for patients with recurrent corneal erosions.

Comparison of topical ciprofloxacin to conventional antibiotic therapy in the treatment of ulcerative keratitis.

We evaluated the efficacy of ciprofloxacin (3 mg/ml) as the sole topical antibiotic used to treat infectious keratitis in 14 patients. We compared the ciprofloxacin-treated group to a retrospective control group of 30 consecutive culture-positive patients treated with conventional therapy in which cefazolin (50 mg/ml) and fortified gentamicin sulfate (9.1 mg/ml) solutions were used. We found no remarkable difference between the control group and the ciprofloxacin-treated group regarding patient age, risk factors, need for hospitalization, and virulence of organism isolated. The average time to healing in culture-positive ciprofloxacin-treated patients was 34 +/- 33 days vs 45 +/- 71 days in the control group and this difference was not statistically significant. The duration of antibiotic therapy in the culture-positive ciprofloxacin-treated group was 27 +/- 15 days vs 33 +/- 50 days in the control group. Four of the 30 control patients required modification of their antibiotic regimen, whereas no ciprofloxacin-treated patient required a change. Ciprofloxacin appears to be an effective single agent in the treatment of ulcerative keratitis.

Which is better? One or two? A randomized clinical trial of single-plate versus double-plate Molteno implantation for glaucomas in aphakia and pseudophakia.

PURPOSE: Previous studies have suggested that primary double-plate Molteno implantation may be beneficial. Therefore, the authors performed a randomized clinical trial to evaluate the relative effectiveness and safety of single- versus double-plate Molteno implantation. METHODS: From March 1988 to February 1990, 132 patients who underwent Molteno implantation for medically uncontrollable non-neovascular glaucomas in aphakia or pseudophakia were randomly assigned to receive either single- or double-plate implants. RESULTS: The 1- and 2-year life-table success rates (success [survival] defined as 6 mmHg < or = final intraocular pressure [IOP] < or = 21 mmHg without additional glaucoma surgery or devastating complication) were 55% and 46% with single-plate implantation and 86% and 71% with double-plate implantation, respectively. The final postoperative visual acuities were within one line of the preoperative visual acuities or had improved in 73% and 80% of patients, respectively. Choroidal hemorrhages and/or effusions, corneal decompensation, flat anterior chambers, and phthisis bulbi were more common in the patients who had undergone double-plate Molteno implantation; however, transient elevations of IOP during the first few postoperative months were more common in the patients who had undergone single-plate Molteno implantation. CONCLUSIONS: Double-plate Molteno implantation more frequently affords IOP control than single-plate Molteno implantation; however, double plates are associated with greater risks of choroidal hemorrhages and/or effusions, corneal decompensation, flat anterior chambers, and phthisis bulbi.

Infectious keratitis in Baltimore.

One hundred thirty cases of ulcerative keratitis occurring from 1985 to 1989 at Sinai Hospital of Baltimore were reviewed. Positive corneal cultures were obtained from 40% of cases. The most common isolates were Staphylococcus epidermidis (28%), S. aureus (16%), and Pseudomonas aeruginosa. P. aeruginosa was the most common in contact lens wearers. Antibiotic pretreatment did not affect the rate of positive cultures significantly. Bilateral conjunctival and eyelid margin cultures also were examined. An association was found between corneal and ipsilateral conjunctival isolates (P = .05). Gram stains were consistently negative. Most patients were treated successfully as outpatients. The value of simultaneous conjunctival and eyelid margin cultures and Gram stains was questioned.

A limited comparison of apraclonidine's dose response in subjects with normal or increased intraocular pressure.

We performed a multicentered, placebo-controlled, randomized, crossover study comparing the efficacy of 0.5% and 1.0% apraclonidine hydrochloride in 15 normal volunteers and 17 subjects with increased intraocular pressure. Apraclonidine 1% produced a maximum 30.4% +/- 14.0% (4.7 +/- 2.4 mm Hg) decrease in mean intraocular pressure in normal eyes and a 31.3% +/- 16.5% (7.6 +/- 4.2 mm Hg) decrease in eyes with increased pressure. Apraclonidine 0.5% produced a maximum 25.8% +/- 9.7% (4.0 +/- 1.7 mm Hg) decrease in mean intraocular pressure in normal eyes and a 27.4% +/- 16.0% (6.8 +/- 4.5 mm Hg) decrease in eyes with increased pressure. There was no statistically significant difference in mean percent intraocular pressure lowering effect between the 0.5% and 1.0% apraclonidine concentrations. Most subjects treated with apraclonidine had a greater than or equal to 20% reduction in intraocular pressure from baseline. Twelve hours after instillation of apraclonidine, nine of the normal volunteers had an intraocular pressure of 10 mm Hg or less. Apraclonidine produced the same percent intraocular pressure decrease regardless of the initial level of intraocular pressure.

The safety and efficacy of topical 1% ALO 2145 (p-aminoclonidine hydrochloride) in normal volunteers.

We prospectively evaluated the efficacy and safety of the twice-daily application of 1% ALO 2145 (p-aminoclonidine hydrochloride, a topical alpha 2-agonist) in 21 normal volunteers for one month. Criteria measured included intraocular pressure (IOP), basal tear secretion, pupillary size, corneal sensitivity, heart rate, and blood pressure; urinalysis and blood chemistry studies were also performed. The mean (+/- SD) IOP fell 38.7%, from 17.5 +/- 3.9 mm Hg to 10.7 +/- 3.4 mm Hg, in five hours. The mean IOP remained between 23% and 30% below the pretreatment level when checked 12 hours after the last drop's instillation from day 8 through day 28 of the study. No clinically significant changes in mean systolic blood pressure, blood chemistry values, urinalysis results, basal tear secretion, or corneal sensitivity were noted. The mean heart rate and diastolic blood pressure were each significantly decreased at only one of nine time intervals. Dry mouth was noted at some time in 52% of volunteers. ALO 2145 seems to be effective in lowering IOP in normal volunteers, without marked cardiovascular effects.