Lid flora in blepharitis.

The microbiologic evaluations of 332 consecutive patients with the primary diagnosis of chronic blepharitis were reviewed and compared to those of 160 control patients. The most commonly isolated organisms from lids with blepharitis were Staphylococcus epidermidis (95.8%), Propronibacterium acnes (92.8%), Corynebacterium sp. (76.8%), Acinetobacter sp. (11.4%), and Staphylococcus aureus (10.5%). Compared to controls, S. epidermidis (p less than 0.01), P. acnes (p less than 0.02), and Corynebacterium sp. (p less than 0.001) were present significantly more often. S. aureus and the isolation of more than one microbial species were not more common in blepharitis patients. Quantitatively, heavy growth, by total and individual species, was significantly more common in blepharitis patients (total, p less than 0.001; S. epidermidis, p less than 0.001, P. acnes, p less than 0.001). These data demonstrate that patients with blepharitis are more likely to have normal skin bacteria on their lids and in greater quantities than nonblepharitis patients.

Continuous tear capsulotomy and phacoemulsification cataract extraction combined with penetrating keratoplasty.

Continuous tear capsulotomy, or capsulorhexis, permits secure and precise placement of a posterior chamber intraocular lens. This technique can be used open sky during triple procedures combining penetrating keratoplasty with cataract extraction and intraocular lens insertion. Expression of the nucleus through a continuous tear capsulotomy can be difficult. Incisions in the anterior capsule facilitate nucleus expression but can extend, obviating the advantages of continuous tear capsulotomy. With phacoemulsification using low irrigation and adequate ultrasound power, the nucleus can be completely emulsified or fragmented into easily removable pieces. This permits continuous tear capsulotomy to be part of triple procedure surgery.

Porcine collagen corneal shield treatment of persistent epithelial defects following penetrating keratoplasty.

Treatment of persistent epithelial defects following penetrating keratoplasty (PK) can be difficult. The use of a 24-hour porcine collagen corneal shield (Bausch & Lomb) to promote epithelialization of these cases was compared to the use of the hydrophilic bandage soft contact lens (Bausch & Lomb, plano O4). Twenty-three consecutive patients treated for persistent epithelial defect following PK were reviewed. Sixteen of 22 (73%) treated with a bandage soft contact lens healed completely. None of seven patients with persistent epithelial defect treated with collagen shield therapy healed. Six of these seven patients were subsequently treated with a bandage soft contact lens; five (83%) healed with this therapy. These data suggest that the 24 hour collagen corneal shield is not useful in treating persistent epithelial defect following PK and that a bandage soft contact lens is significantly more effective (P less than 0.01) in these cases.

Acridine orange and Gram stains in infectious keratitis.

Two hundred thirty consecutive cases of presumed infectious keratitis were reviewed. Cultures were positive in 49.5% (114 of 230). Acridine orange stain sensitivity (81%) was significantly greater than gram stain sensitivity (65%) (p less than 0.002). Gram stain specificity was 92%, and acridine orange specificity was 89%. In keratitis with low or moderate growth, acridine orange was positive in 73% (61 of 84) as compared with Gram stain 53% (45 of 84), (p less than 0.001). In cases of heavy microbial growth, Gram stain was positive in 97% (29 of 30), acridine orange in 100% (30 of 30). This study demonstrates that both Gram stain and acridine orange stain are excellent in cases of infectious keratitis with heavy microbial growth, but that acridine orange is significantly better than Gram stain in cases with low amounts of organisms.

Chronic vitritis with macrophagic inclusions. A sequela of treated endophthalmitis due to a coryneform bacterium.

A 75-year-old woman was treated successfully for endophthalmitis due to a coryneform bacterium contracted from a contaminated corneal graft. We were able to study the involved eye histologically when the patient died unexpectedly 5 1/2 weeks after treatment. The vitreous contained a moderate number of macrophages filled with PAS-positive particles. Ultrastructurally, the PAS-positive particles corresponded to degenerating bacterial cell walls. The striking resemblance of the macrophages in this case to macrophages in Whipple's disease is intriguing because Corynebacterium has been the most frequently implicated bacterial genus in the pathogenesis of Whipple's disease.

Corneal manifestations of scleromyxedema.

Bilateral superficial corneal deposits and scleromyxedema, an uncommon dermatosis caused by the accumulation of acid mucopolysaccharide in the skin often associated with a benign monoclonal gammopathy developed in a 71-year-old man. A biopsy specimen of the cornea showed that the deposits stained strongly positive for IgG and lambda chains. Ultrastructurally, the deposits consisted of amorphous granular material. Scleromyxedema should be considered in the differential diagnosis of noninflammatory superficial keratopathies associated with benign gammopathies.

Outpatient treatment of microbial corneal ulcers.

Outpatient and inpatient management of culture-proved microbial corneal ulcers was evaluated. Twenty-six consecutive patients were reviewed. Twenty had been managed as outpatients, six as inpatients. All ulcers were treated with intensive topical antimicrobial therapy, and all steadily healed, as evidenced by epithelialization and resolution of infiltrate. None progressed to extreme stromal thinning, descemetocele, or perforation. Inpatients and outpatients did not differ in terms of healing time, although this can vary considerably for the same causative organism. Complete epithelialization took two to 56 days. Pseudomonas ulcers healed in seven to 42 days (mean, 22 days), which is similar to previously published reports of inpatient therapy. This study suggests that with careful patient selection and follow-up, infectious corneal ulcers can be successfully managed on an outpatient basis.

Central corneal endothelial cell density after argon laser trabeculoplasty.

We report our experience using specular microscopy to perform endothelial cell counts in a series of 16 patients with bilateral, uncontrolled, primary open-angle glaucoma undergoing argon laser trabeculoplasty (ALT). Trabeculoplasty was performed in 20 eyes of these 16 patients. Untreated fellow eyes in 11 patients were used as controls for this series. Endothelial specular microphotographs and pachymetry were done using a Pocklington specular microscope (Keeler-Konan) before ALT and again approximately one and four months later. The endothelial cell densities were normal in all of the affected eyes before treatment and in the control eyes. No statistically significant differences between the pretreatment and posttreatment cell densities and pachymetry values relative to the controls were observed during the course of this study.

Penetrating keratoplasty following the use of a temporary keratoprosthesis during pars plana vitrectomy.

The Landers-Foulks temporary keratoprosthesis provides an excellent way to perform pars plana vitrectomy and retinal detachment repair in eyes with opaque corneas. For the most part, these eyes have previously been inoperable. The procedure described in this paper permits this device to be used in conjunction with larger, more routine sized penetrating keratoplasties.

New thoughts on ocular neovascularization: a neurally controlled regenerative process?

Although the final common pathway of ocular neovascularization has been produced by a variety of stimuli in various locations in the eye, a specific unifying mechanism has not been generally accepted. Regeneration in lower vertebrates is a phenomenon that closely parallels new vessel growth in the eye, especially in its ontogenic potential and may give clues to its pathogenesis. The importance of a neural factor in regeneration has been demonstrated using several models. Interestingly, ocular tissues such as the iris, lens, and neural retina exhibits some of the most remarkable evidence for this regenerative mechanism. This article explores, through various developmental associations and clinical observations, the concept of ocular neovascularization as a neurally mediated regenerative process. Recent research utilizing a model of corneal denervation has added further support to this association.

The effect of corneal trephination on neovascularization.

In order to investigate a neural influence on corneal neovascularization, we attempted to induce new vessel growth within a denervated zone produced by trephination. The stimulus for vascularization was cauterization central to the trephined margin. We demonstrated that in corneas denervated and stimulated in this manner neovascularization did not occur. This finding supports our hypothesis of a neural influence on neovascularization.

Ipsilateral rotating autokeratoplasty.

Ipsilateral rotating autokeratoplasty may be indicated when a nonprogressive central scar is present in an otherwise clear and normal cornea. By rotating an eccentric corneal button, the scar can be displaced peripherally and clear cornea brought into the visual axis. Ten cases of ipsilateral rotating autokeratoplasty were done in the Cornea Service at Wills Eye Hospital, Philadelphia, between 1975 and 1980. The technique is comparable to routine penetrating keratoplasty. There were no intraoperative or postoperative complications. Postoperative astigmatism was not a serious problem. All grafts remained clear and satisfactory; visual results were obtained in the majority of the patients.

Conjunctival hyperemia and corneal infiltrates with chemically disinfected soft contact lenses.

For three cosmetic soft contact lens wearers who chemically disinfected their lenses, conjunctival hyperemia and anterior stromal infiltrates of the cornea developed. When the conjunctival hyperemia and corneal infiltrates resolved, two of the three patients were challenged with their chemically disinfected soft contact lenses, with reappearance of the conjunctival and corneal reactions. Bacterial cultures of the conjunctiva, lids, lens cases, lens solutions, and eye cosmetics were not helpful. Conjunctival cultures for adenovirus and chlamytdial titers were negative. Giemsa stain of conjunctival scrapings showed a few mononuclear cells, polymorphonuclear leukocytes, and rare eosinophils but no inclusion bodies. Occlusive patch tests and intradermal tests showed positive delayed hypersensitivity reactions to the chemical disinfectants in all three patients. Occlusive patch tests with thimerosal suggested that this preservative was responsible for the reactions. Delayed hypersensitivity to thimerosal may play a role in the development of the conjunctival hyperemia and corneal infiltrates described in these patients.