Management of alkali burns : an 11-year retrospective review.

OBJECTIVE: To review the spectrum of patients with alkali burns admitted over an 11-year period and to assess the clinical outcomes after the introduction of a standard alkali burn treatment protocol. DESIGN: Retrospective nonrandomized comparative study. PATIENTS AND INTERVENTIONS: A total of 121 patient records with alkali burns (n = 177 eyes) admitted to a tertiary hospital between 1987 and 1998 were reviewed. Eyes treated with a standard alkali burn treatment protocol, which included intensive topical steroids, ascorbate, citrate, and antibiotics, were compared with eyes treated by conservative management with antibiotics, and a short course of steroids. MAIN OUTCOME MEASURES: Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed. RESULTS: The standard protocol tended to delay corneal reepithelialization by one day (P: = not significant) in eyes with grade 1 burns (n = 76) and by 2 days (P: = 0.04) in grade 2 burns (n = 52), with no difference in final visual outcome. There were 37 eyes with grade 3 burns. Those treated with the standard protocol showed a trend toward more rapid corneal reepithelialization. Twenty-seven of 29 (93%) eyes with grade 3 injuries achieved a final best-corrected visual acuity of 20/40 or better compared with 3 of 6 (50%) eyes not treated according to the standard protocol (P: = 0.02). Eyes with grade 4 burns (n = 12), whether treated with the standard protocol or not, required 10 to 12 weeks for corneal reepithelialization. There was no statistically significant difference in final visual acuity. CONCLUSIONS: On the basis of our findings, a number of recommendations can be made for the management of alkali injuries. Patients with a grade 1 or 2 injury do not require routine admission and do not benefit from the use of intensive treatment with ascorbate and citrate. A trend toward more rapid healing and a better final visual outcome were apparent in grade 3 burns, but our standard protocol made no difference in grade 4 burns.

Lattice corneal dystrophy: epithelial macroerosions in clear corneal grafts.

Two sisters, aged 33 and 35, underwent uncomplicated penetrating keratoplasty for lattice corneal dystrophy type 1. Both patients, as well as their younger brother, had experienced frequent recurrent epithelial erosions prior to undergoing corneal grafting. Each sister has subsequently experienced painful, corneal epithelial macroerosions in the corneal graft, in the absence of any signs of recurrence of the lattice corneal dystrophy in the grafted tissue. With treatment each episode of macroerosion has resolved without complication. To our knowledge, this is the first report of epithelial erosions in a corneal graft without clinical evidence of recurrent lattice corneal dystrophy.

Excimer laser correction of astigmatism with multipass/multizone treatment. The Melbourne Excimer Laser Group.

PURPOSE: To evaluate the accuracy of excimer laser correction of myopic astigmatism by multipass/multizone photoastigmatic refractive keratectomy (PARK). SETTING: Tertiary referral ophthalmic hospital with an associated private laser facility. METHODS: This study comprised a consecutive series of 332 eyes of 289 patients who were followed for 6 months. All patients were 18 years or older, had stable myopic astigmatism (up to a -19.0 diopters [D] spherical equivalent [SE] at the spectacle plane), and had a best corrected visual acuity of at least 20/60 in both eyes. All eyes were treated with a VISX Twenty-Twenty excimer laser. The correction was divided between ablation zones using a multipass/multizone treatment paradigm based on the amount of myopia and astigmatism. Patients were examined 1 week, and 1, 3, and 6 months after surgery. RESULTS: Analysis of the mean percentage of spherical correction across the range of myopic preoperative SEs treated demonstrated 90% correction for most amounts of myopic astigmatism. Eyes with low myopia (mean preoperative SE < or = -5.0 D) treated with < or = -1.0 diopter cylinder (DC) of astigmatism achieved a mean percentage of spherical correction of 91% versus 93% in eyes with high myopia (> -5.0 D mean preoperative SE). Eyes with low myopia treated with > -1.0 DC of astigmatism achieved a mean percentage spherical correction of 90% versus 89% in eyes with high myopia. The differences between the two groups were not statistically significant. Patients with high relative cylinder (> 80% of total sphere treated) achieved comparable results. Analysis of the astigmatic component of the treatment, independent of the spherical result, showed a trend toward overcorrection in the high myopia group with less than -1.0 DC and a mean astigmatic correction of 89 and 98%, respectively, in the low and high myopic astigmatism groups. The mean angle of error was +2.0 degrees. CONCLUSION: Multipass/multizone PARK for myopic astigmatism demonstrated a high degree of predictability and stability with desirable results for low and high levels of astigmatism across the range of myopic astigmatism treated by surface ablation.

Question mark ear: a method for repair.

We present a rare case of bilateral question mark ears together with our method to correct the deformity. We discuss the developmental theory of this anomaly, and review the literature. We describe our technique to correct this deformity using advancement-rotation flaps taken from both sides of the ear cleft.

Corneal and conjunctival infections.

Recent advances in the field of infectious conjunctivitis and keratitis include new diagnostic methods, the identification of new pathogens, and novel therapeutic agents. Tandem confocal microscopy has been used to diagnose Acanthamoeba keratitis, and polymerase chain reaction has proven to be a rapid and sensitive technique for detecting specific viral antigens, particularly in cases where cultures yield no growth. Two new antiviral agents, ganciclovir and carbocyclic oxetanocin G, have been shown to be as effective as acyclovir in treating herpetic epithelial disease. The fluoroquinolones, especially ofloxacin, have become the antimicrobial agents of choice in the initial management of selected cases of bacterial keratitis.

Adiposis dolorosa (Dercum's disease): 10-year follow-up.

Adiposis dolorosa is a disease characterized by painful, subcutaneous fatty tumors. This disorder usually occurs in obese, postmenopausal women and is associated with weakness and mental disturbances such as depression, confusion, lethargy, and dementia. The cause is unknown, and there is no specific treatment. Pain may be relieved by steroids, intravenous lidocaine, or analgesics. Surgical treatment consists of excision or liposuction of the painful masses. We present two cases of adiposis dolorosa in men, with a follow-up of more than 10 years.

Activated suppressor cell function in severely disabled patients with multiple sclerosis.

Defective suppressor cell function has previously been demonstrated in patients with multiple sclerosis (MS) with progressive disease and moderate degrees of disability. In the present study activated suppressor cell function was assessed in patients with documented progressive disease who, at the time of study, had experienced severe disability (Kurtzke score greater than or equal to 6.5) for at least 2 years. We found that mean suppressor levels were significantly increased in this patient group compared with the suppressor levels in the MS patient group with progressive disease but only moderate disability (Kurtzke score of less than or equal to 6.0 within 2 years of study) (59 +/- 8% vs 19 +/- 7%, respectively, p less than 0.01). The mean value in the latter group was significantly reduced compared with the mean value for normal control subjects (47 +/- 4%, p less than 0.01), a finding consistent with previous reports. The results of this study indicate that suppressor cell function, as measured by our assay system, need not be defective in MS patients who have become severely disabled from the progressive form of the disease. Whether the patients who are now severely disabled from progressive MS passed through a phase of disease associated with the same suppressor defects as found in the progressive patients currently with moderate disability will remain speculative until long-term longitudinal studies are performed.

Nobecutane spray as a temporary dressing of skin graft donor sites.

Various methods have been used for managing split-thickness skin graft donor sites. Open and closed techniques have been suggested by various authors with the purpose of achieving smooth and rapid healing of the wound. There is growing evidence to suggest that the site and quality of the healing is improved when the wound is protected from dehydration and further mechanical trauma. A recent method is the spraying of Nobecutane Spray on the donor site. Nobecutane sprayed on a wound forms a plastic film which serves as a dressing material. It contains specially modified acrylic resin in an organic solvent (ethyl acetate) and TMTD (tetramethylthiuram disulphide) which is strongly bactericidal and fungicidal. We employed this method on 50 patients and found it to be effective in achieving rapid and painless healing. The dressing is transparent, permits easy follow-up of healing in the donor site, protects the wound against infection, and does not inconvenience the patient. The treatment is simple, economical, and does not require special skills. The dressing peels off spontaneously after epidermal regeneration of the wound is completed. No complications or allergic reaction were observed with this treatment.