Epithelial herpetic simplex keratitis recurrence and graft survival after corneal transplantation in patients with and without atopy.

PURPOSE: To compare the incidence of herpes simplex virus (HSV) epithelial recurrence and graft survival after penetrating keratoplasty (PK) in patients with and without self-reported atopy. DESIGN: Retrospective cohort comparative study. SETTING: Cornea Service, Wills Eye Hospital. STUDY POPULATION: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004 and who underwent primary PK for ocular HSV at the Cornea Service. From the 58 patients invited, 49 patients (50 eyes) were included. Nine patients were ineligible in accordance with the exclusion criteria: no active classic HSV episode before PK, immunosuppression, less than one year of follow-up, previous history of PK before presentation at the Service. Eligible patients filled out a questionnaire regarding their history of atopic disease, considering: presence of allergic rhinitis, asthma, or atopic dermatitis. Ocular history was obtained through chart review. main outcome measures: Incidence of epithelial HSV recurrences and corneal graft survival in both groups. RESULTS: Each group (atopic and nonatopic) included 25 eyes. The atopic patients had a mean incidence of 0.07 episode/eye year (SD +/- 0.9) compared with 0.12/eye year (standard deviation [SD] +/- 0.21) in the nonatopics (P = .002). At 10 years of follow-up, the survival rate in the atopics was of 92% and in the nonatopics was of 79% (P = .88). CONCLUSIONS: Nonatopics had significantly more epithelial recurrences after PK compared to atopics; however, both groups presented low incidences of recurrences and high graft survival rates.

Comparative study of ocular herpes simplex virus in patients with and without self-reported atopy.

PURPOSE: To compare the characteristics of ocular herpes simplex virus (HSV) in patients with and without atopy. DESIGN: Retrospective cohort comparative study. METHODS: Patients who presented at the Cornea Service, Wills Eye Hospital, between March 2003 and March 2004 who had been previously diagnosed in the same institution as having ocular HSV diagnosis or were just diagnosed as having the disease were asked to complete a study questionnaire that enabled categorization into atopic and nonatopic. In April 2005, 223 patients who agreed to be in the study had their charts reviewed, and 125 patients were excluded according to exclusion criteria: immunosuppression, follow-up less than one year, previous history of penetrating keratoplasty (PK) out of the Cornea Service, and no active HSV episode during follow-up. MAIN OUTCOME MEASURES: Incidence of all types of HSV recurrences. SECONDARY OUTCOME MEASURES: Bilaterality, visual loss, need for PK , and secondary bacterial infection in both groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS: Ninety eight patients (110 eyes) were included in the study. Atopic/nonatopic (P value): the mean follow-up was 11.6 (+/- 10.6)/8.8 years (+/- 8.4) (P = .14); the mean incidence of HSV episodes per year of follow-up was: total episodes 0.32 (+/- 0.36)/0.28 (+/- 0.33) (P = .14), infectious 0.16 (+/- 0.22)/0.10 (+/- 0.14) (P < .01), inflammatory 0.11 (+/- 0.19)/0.11 (+/- 0.19) (P < .01), and mixed 0.09 (+/- 0.20)/0.07 (+/- 0.16) (P = .06); bilateral HSV was present in 9/3 patients (P = .22); the mean loss of vision was four lines of Snellen in both groups; PK was performed in 14 of 16 eyes (P = .45); secondary bacterial infection was present in two of four eyes (P = .26). CONCLUSIONS: Atopic patients had considerably more infectious and fewer inflammatory episodes when compared with nonatopics.

Ocular copper deposition associated with monoclonal gammopathy of undetermined significance: case report.

To report a case of ocular copper deposition in both eyes at the level of Descemet's membrane associated with a monoclonal gammopathy of undetermined significance (MGUS). A 49-year-old white woman had golden-brown metallic dust-like deposits on Descemet's membrane of both eyes. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin and a normal level of total protein. Serum protein electrophoresis demonstrated a single peak (M-spike) in the gamma region (M-protein in serum = 11 g/l). Flow cytometric analysis of the marrow aspirate identified a monoclonal plasma cell population that represents approximately 2% of the total marrow cells consistent with the diagnosis of monoclonal gammopathy of undetermined significance. Copper deposits at the level of Descemet's membrane may be a finding in a patient with monoclonal gammopathy of undetermined significance.

Ocular copper deposition associated with monoclonal gammopathy of undetermined significance: case report

Relatar um caso de depósito corneano de cobre em ambos os olhos a nível da membrana de Descemet associado a gamopatia monoclonal de significância indeterminada (GMSI). Paciente feminina, 49 anos, leucodérmica, apresentando depósito corneano de aspecto marrom-ouro a nível da membrana de Descemet em ambos os olhos. Exame sistêmico revelou cobre sérico elevado, ceruloplasmina sérica normal, e proteína total normal. Eletroforese de proteínas séricas demonstrou um pico único na região gama (proteína M = 11 g/l). Análise citométrica de aspirado medular evidenciou uma população de células plasmáticas monoclonais de aproximadamente 2% do total de células medulares consistente com o diagnóstico de gamopatia monoclonal de significância indeterminada. Depósitos de cobre a nível da membrana de Descemet podem ser encontrados em pacientes com gamopatia monoclonal de significância indeterminada.

Ceratoplastia penetrante no tratamento da ceratopatia causada pelo vírus varicela-zoster / Penetrating keratoplasty for varicella-zoster virus keratopathy

Objetivo: Apresentar e analisar os resultados cirúrgicos de ceratoplastias penetrantes realizadas em olhos apresentando seqüelas corneanas devido à infecção prévia pelo vírus varicela-zoster. Local: Serviço de Córnea, Doenças Externas Oculares e Cirurgia Refrativa do Wills Eye Hospital (Philadelphia, USA). Métodos: Estudo retrospectivo no qual foram analisadas as informações contidas nos prontuários dos pacientes submetidos à ceratoplastia penetrante entre janeiro de 1989 e dezembro de 1998, devido a seqüelas corneanas relacionadas à infecção prévia pelo vírus varicela-zoster, no Serviço de Córnea do Wills Eye Hospital, Philadelphia (PA). Resultados: Quinze pacientes (15 olhos) foram transplantados no intervalo de tempo pesquisado, 12 deles apresentavam ceratopatia causada por episódio prévio de herpes zoster ocular e três devido à varicela. Doze pacientes eram do sexo feminino e apenas três do sexo masculino. A idade média encontrada foi de 57 anos (4-83 anos). Em quatro olhos realizou-se tarsorrafia lateral associada à ceratoplastia penetrante. Três olhos apresentaram quadro de rejeição do tipo endotelial no pós-operatório e foram tratados com êxito através do uso tópico de soluções de prednisolona. Um dos pacientes evoluiu com falência primária do enxerto após a primeira cirurgia, sendo reoperado e, novamente, apresentou falência primária do enxerto devido à ceratopatia neurotrófica. Outros três casos submetidos a um segundo transplante após falência do primeiro enxerto apresentavam enxertos transparentes na última avaliação realizada. Após um período médio de acompanhamento pós-operatório de 50 meses, 13 enxertos (86,7 por cento) encontravam-se transparentes e em oito olhos (53,3 por cento) a acuidade visual corrigida era igual ou superior a 20/100. Cinco olhos apresentavam enxerto transparente e acuidade visual final inferior a 20/100 devido a alterações no segmento posterior ocular. Conclusão: Resultados cirúrgicos favoráveis podem ser obtidos em transplantesde córnea realizados em olhos apresentando ceratopatia relacionada à infecção prévia pelo vírus varicela-zoster. Para isso são fundamentais um cuidadoso acompanhamento pós-operatório e a proteção constante da superfície ocular através de lubrificação freqüente e, se necessário, tarsorrafia lateral

Complications associated with soft contact lens use

A retrospective study of 246 consecutive patients fit with daily and extended wear soft contact lenses was undertalken to determine the incidence and range of lens related problems is cosmetic, aphakic, and keratoplasty patients in a cornea service setting. Adequate data for inclusion in the study were available from 212 patients, who were folloowed for a minimum of six months (range 6-42 months; memdian 30 months). Approximately half (105 of 212; 50%) of the patients demonstrated problems. The most common problem was corneal neovascularization (61 of 212; 29%), which was greater than 1mm in 10% (22 of 212). Seious complications were infrequent. Two aphakic graft patients developed suture abscesses and three had rejection episodes. Overall, extended wear lens patients were significantly more likely to have complications (62 of 85; 73%) thandaily wear lens patients (43 of 127; 34%) (P < 001). Cosmetic lens patients were significantly less likely to have problems (34 of 98; 35%) than aphakic patients (35 of 50; 70%) (P , 001). Our data suggest that problems (including peripheral neovascularization, deposits, and chemical reactions related to soft lens wear) are common, but serious, visiontion, deposits, and chemical reactions related do soft lens wear) are common, but serious, visionthreatening complications (including corneal ulcers) are infrequent when lenses are fit carefully and patients are repeatedly instructed regarding lens use