Epidemiological characteristics, predisposing factors and microbiological profiles of infectious corneal ulcers: the Portsmouth corneal ulcer study.

AIM: The aim of the study was to identify the epidemiological characteristics, predisposing factors, and the clinical and microbiological diagnosis of infectious corneal ulcers in a population based in southern England. METHODS: A retrospective review was undertaken of the medical records of patients presenting with infectious corneal ulcers at the eye casualty department of Queen Alexandra Hospital, Portsmouth, UK, between January 1997 and December 2003. RESULTS: A total of 1786 patients presented with infectious corneal ulcers, with a mean age of 45 years and female predominance (54.5%). Contact lens wear was the main predisposing factor in 554 patients (31%). Corneal scrapes from 1254 patients grew positive cultures in 800 patients. Gram-positive bacteria accounted for 696 (71.1%) of the total 979 bacterial isolates, while Gram-negative bacteria accounted for 283 (28.9%) with the predominance of Pseudomonas aeruginosa. Nine out of 11 patients with Acanthamoeba keratitis were contact lens wearers. The majority of patients 1728 (96.8%) sought medical help more than once and 34 patients (1.9%) had poor visual outcome. Follow-up was completed in 1633 patients (91.4%) with an average of 11.5 days. CONCLUSIONS: Wearing contact lenses remains the most important risk factor for infectious corneal ulcers. Reduction of the rate and severity of infectious keratitis requires continuous education of patients, and of professionals.

Endophthalmitis following extracapsular cataract surgery: a review of 32 cases.

Thirty two cases of endophthalmitis following extracapsular cataract surgery that had occurred within our department and had undergone intraocular diagnostic tap between May 1982 and May 1991 were reviewed. An infectious agent was identified in 20 cases (62.5%). The commonest organism was Staphylococcus epidermidis (11 cases) (55%). Proteus was the only gram negative organism identified (four cases) (20%). Both of these organisms were associated with a favourable visual outcome. In the culture positive subgroup 15 eyes (75%) achieved a final acuity of 6/60 or better with 10 eyes (50%) gaining 6/12 or better. Thirteen (65%) of the culture positive cases were managed without vitreal intervention. Of these 11 (85%) achieved 6/60 or better with eight (62%) gaining 6/12 or better. It appears that when an endophthalmitis follows uncomplicated extracapsular cataract surgery delivery of antibiotic by the 'conventional' routes (topical, subconjunctival and systemic) is consistent with a favourable visual result in many cases. A modified anterior chamber diagnostic tap technique is described.

How clean is your capsule?

Proliferation of residual lens epithelial cell is believed to be the major cause of posterior capsule opacification following extracapsular cataract extraction. During surgery these cells can be visualised with appropriate illumination facilitating their mechanical removal with the McIntyre cannula. When flat preparations of the anterior capsule are examined by light microscopy, the areas 'cleaned' of cells in this way appear transparent but scanning electron microscopy reveals tufts of remaining debris which may represent points of cellular attachment to the capsule. Control of lens epithelial cell proliferation is important for the future development of cataract surgery.

Accuracy of routine intraocular lens power calculation in a district general hospital.

To assess the accuracy of routine preoperative biometry we reviewed all cases of extracapsular cataract extraction with posterior chamber implant performed at Queen Alexandra Hospital in 1985. Of 471 eyes included in the survey 67.9% were within 1.0 D of the expected refraction and 90.7% within 2.0 D. Factors influencing accuracy are discussed. The necessity of routine preoperative biometry is emphasised.

Oxygen dissociation curve in Eales's disease.

The oxyhaemoglobin dissociation curve (ODC) was investigated in 15 patients with Eales's disease and 11 controls to test the hypothesis that Eales's disease is caused by retinal hypoxia secondary to impaired oxygen release from the blood. Patients with the peripheral form of Eales's disease did not have any significant difference in the P50 values when compared with the controls. However, the P50 values were significantly lower (P < 0.005) for the patients with mixed retinopathy. This degree of increased oxygen affinity is not physiologically significant but may reflect an intrinsic abnormality of the red cells in these cases.

Spinal arachnoiditis in Jamaica

Ten cases of spinal arachnoiditis with either complete or partial myelographic block are presented. The importance of surgical exploration in all these cases is emphasized. The difficulty of recognizing spinal arachnoiditis at operation and the value of corticosteroid therapy in these patients are discussed (AU)

Results of closed vitrectomy.

The results of 101 closed vitrectomy operations are reported. The cases were classified on morphological grounds, and analysis showed that eyes with anterior segment or pure gel pathology responded favourably to surgery, while those with associated retinal disease had a poorer prognosis.

Slipping of the upper femoral epiphyses in patients with intracranial tumours causing hypopituitarism and chiasmal compression.

Four cases of slipped upper femoral epiphyses in patients with intracranial tumours causing hypopituitarism and chiasmal compression are presented. Detailed endocrine studies in three cases showed severe deficiencies of growth hormone as well as of gonadotrophin and sex hormones. The literature is reviewed and the aetiology is discussed with special reference to Harris's hypothesis that an increase in growth hormone relative to oestrogen predisposes to slipping of the upper femoral epiphysis in humans, which these cases do not seem to support. In all cases the slip was bilateral, and it is emphasised that surgical treatment can provide only temporary fixation because fusion is dependent on correct hormonal therapy.