ABSTRACT
Diagnosis and management of Acanthamoeba chronic ulcerative keratitis is difficult. Two cases of Acanthamoeba keratitis at Wills Eye Hospital were diagnosed within several months of each other during 1983. Corneal transplantation was necessary for diagnosis and therapy in these cases. Another two cases were diagnosed when histopathologic specimens from penetrating keratoplasties done between 1974 and 1983 were reviewed retrospectively. There has been no evidence of recurrent disease in any of our cases during follow-up periods averaging two years (range, 12 to 40 months). The diagnosis of Acanthamoeba keratitis must be considered in cases of chronic progressive corneal ulceration unresponsive to medical therapy.
Subject(s)
Amebiasis , Keratitis/etiology , Adolescent , Adult , Cornea/surgery , Female , Humans , Iris/surgery , Keratitis/diagnosis , Keratitis/pathology , Keratitis/surgery , Male , Middle Aged , Visual AcuityABSTRACT
Thirty-four patients with herpes simplex dendritic keratitis were randomized into three treatment categories: Group A had débridement alone; group B, trifluridine (trifluorothymidine) alone; and group C, débridement and trifluridine. Patients treated with débridement alone had a statistically higher failure rate than did the other two groups. No statistically significant difference was observed between trifluridine treatment alone and débridement combined with trifluridine treatment, with regard to healing time. Our results suggest that débridement alone is suboptimal therapy for herpes simplex dendritic keratitis and that débridement combined with trifluridine appears to offer no advantage over trifluridine alone.
Subject(s)
Debridement , Keratitis, Dendritic/drug therapy , Thymidine/analogs & derivatives , Trifluridine/therapeutic use , Adolescent , Adult , Aged , Combined Modality Therapy , Female , Humans , Keratitis, Dendritic/surgery , Male , Middle AgedABSTRACT
We reviewed the experience with ulcerative keratitis associated with contact lens wear at Wills Eye Hospital, Philadelphia, from Jan 1, 1978 through July 1, 1983. Of the 322 cases of ulcerative keratitis, 56 cases (17%) were associated with the use of contact lenses. Twenty-nine (52%) of the 56 cases of contact lens-associated ulcers were culture positive. Pseudomonas was the most common isolate, occurring in 13 (23%) of the 56 cases. Staphylococcus species were the second most common, occurring in 11 (20%) of the 56 cases. In this series, contact lens-associated ulcers were seen frequently in those wearing soft lenses (48/56 cases or 86%) and in those wearing aphakic lenses (32/56 cases or 57%). Contact lens use is an increasingly important risk factor for the development of corneal ulcers. Prompt, appropriate, and intensive treatment is necessary to prevent visual loss.
Subject(s)
Contact Lenses/adverse effects , Corneal Ulcer/etiology , Adolescent , Adult , Aged , Contact Lenses, Extended-Wear/adverse effects , Contact Lenses, Hydrophilic/adverse effects , Corneal Ulcer/microbiology , Female , Humans , Male , Middle Aged , Pseudomonas Infections/microbiology , Staphylococcal Infections/microbiologyABSTRACT
Twenty patients with a total of 22 chalazia unresponsive to conservative medical treatment were randomized for treatment with either intralesional triamcinolone acetonide or placebo. Eight of 12 lesions treated with triamcinolone acetonide resolved. In all ten of those treated with normal saline injection, treatment failed to achieve a clinical cure. Nine of the normal saline treatment failures were then injected with triamcinolone acetonide. Eight of nine in this group achieved clinical resolution. When the two treatment groups were combined, a total of 16 of 21 chalazia (76%) resolved with intralesional steroid therapy. Intralesional steroid therapy can be used successfully to treat chalazia, and its effect is not merely due to a mechanical disruption of the lesion. Pain and discomfort from intralesional injections is a common complaint.
