Gram-negative corneal ulcers in elderly aphakic eyes with extended-wear lenses.

We report 13 cases of corneal ulcers caused by gram-negative bacteria. These cases occurred in aphakic eyes wearing hydrophilic contact lenses on an extended-wear basis. The risks for infection in the elderly aphakic eye with extended-wear hydrophilic lenses are increased by delay in removal of the lens. Caution in the use of these lenses is urged. The ability of either the patient or an attendant to remove the lens as soon as redness, diminished vision, or pain presents itself is essential in minimizing the risks for serious infection.

Endophthalmitis following penetrating keratoplasty.

To determine the incidence of infectious endophthalmitis in the early postoperative period following penetrating keratoplasty, and the type and origin of the causative organisms, all cases of penetrating keratoplasty performed at the Emory University affiliated hospitals between January 1977 and March 1982 were reviewed. Four (0.2%) of the 1,876 cases developed infectious endophthalmitis. In all four, evidence of infection developed within 72 hours, and in three the donor rim culture grew the same organism as was obtained from the anterior chamber or vitreous. The causative organisms were Streptococcus pneumoniae, Staphylococcus aureus, group D Streptococcus-enterococcus, and Pseudomonas aeruginosa. Eyes with positive donor rim cultures had a 22-fold increased incidence of endophthalmitis.

Autosomal dominant central pigment epithelial and choroidal degeneration.

Eight of nine individuals of a four-generation family had autosomal dominant central pigment epithelial and choroidal degeneration, which was not entirely consistent with previously described central retinal and choroidal degenerations. The early loss of the choriocapillaris with a relative sparing of the sensory retinal and pigment epithelial function is similar to central areolar choroidal degeneration. Ophthalmoscopically, however, the disease resembled the dominant progressive foveal degenerations; except that our patients additionally had multiple peripheral yellow-white lesions. An exceptional finding in our patients was the preservation of good visual acuity despite marked atrophy of the choriocapillaris.

Cost-effectiveness in eyebanking.

The current operating budget for American eyebanks is more than $5 million per year, and an increasing portion of this expense is being paid by third-party payers. American eyebanks were surveyed to determine what a reasonable cost per transplant tissue might be and to see if recommendations could be made that would help optimize cost-effectiveness in American eyebanking. Most well-run eyebanks needed between $222 to $464 to process each donor cornea for transplantation. This cost-effective goal was most often met if the bank provided at least 150 corneas annually and if there was a full-time professional staff using modern tissue preservation techniques. An eyebank unable to meet these goals should consider obtaining its tissue from the nearest cost-effective eyebank, allowing the redirection of charitable contributions to other more cost-effective eye care-related community activities.

Extended-wear contact lenses in patients with corneal grafts and aphakia.

Extended-wear contact lenses (EWCL) were fitted successfully on 61 aphakic eyes with penetrating corneal grafts. In two- to 32-months follow-up there were 26 eyes that had varying amounts of superficial neovascularization of the grafts and one Staphylococcus epidermidis corneal graft ulcer. There were five homograft rejections, all occurring in severely diseased eyes. Variable vision and visual acuity less than that with hard contact lenses or aphakic spectacles were the most frequent problems. Both were due to the high corneal astigmatism present in many patients. The results indicate that EWCLs may be used safely by patients with penetrating corneal grafts and aphakia, particularly if there is no host corneal edema, scarring, or vascularization, if these are no synechias to the graft wound, and if the astigmatism is less than 3.0 diopters.

Fundus flavimaculatus and subretinal neovascularization.

A 52-year-old woman had clinical findings of fundus flavimaculatus and a subretinal neovascular membrane that had involuted into a fibrous nodule beneath the foveola. Chronic destructive changes accompanying any disease involving the retinal pigmented epithelium may secondarily cause a lesion in Bruch's membrane, predisposing to subsequent subretinal neovascularization is a rarely observed manifestation in dystrophic diseases, which are usually slowly progressive.

Bayes' theorem in ophthalmologic computer diagnosis.

Computers are being investigated as diagnostic aids in many fields of medicine. Models employing Bayes' theorem, a statistical formula, commonly are used to supply valuable information on the likelihood of each disease in the differential diagnosis to help the clinician make the diagnosis. However, knowledge of elementary decision analysis is beneficial to help understand the current and potential uses of these models. We discussed Bayes' theorem as an introduction to decision analysis. Moreover, we described a Bayesian model for the differential diagnosis of leukocoria to illustrate the application of computers to ophthalmologic diagnosis.

The mitogenic effects of methyl sterculate on aortic smooth muscle cells.

Cyclopropenoid compounds are derived from naturally occurring C19 long chain fatty acids which have been shown to increase mitosis in rat hepatocytes, to elevate serum cholesterol and to enhance atherosclerosis in hens. In order to study the direct effects of sterculi acid triglyceride on smooth muscle proliferation, sterculic acid triglyceride in Sterculia foetida seed oil extract was added to tissue culture media in concentrations of 2 x 10(-6) to 2 x 10(-3)mg/ml and tested on primary as well as subcultures of rabbit aorta smooth muscle cells. In stationary primary rabbit aortic smooth muscle cell cultures the outgrowth of explants treated with Sterculia foetida seed extract increased in diameter. This response was similar to the increase of cultures treated with hyperlipemic serum (which has been shown to stimulate smooth muscle cell proliferation in previous studies in this laboratory). Using autoradiography following a (3H) thymidine pulse, the percentage of labeled cells was increased in the sterculic acid triglyceride treated groups, as compared to controls. In trypsinized, subcultured rabbit aortic smooth muscle cells, Sterculia foetida seed oil extract resulted in an increased incorporation of (3H) thymidine per milligram of protein. These results, indicating increased cell proliferation, were significant at p less than 0.05.

Management and complications of bacterial periorbital and orbital cellulitis.

Forty-four patients with periorbital cellulitis or abscess were admitted to the hospital for treatment in a five-year period. Twenty-five patients were less than 5 years old; nine were more than 20 years old. Skin infection or trauma, upper respiratory tract infection, and sinusitis were the most common predisposing causes. Staphylococcus aureus was cultured in 13 patients and Haemophilus influenzae in nine patients. Ampicillin and methicillin were the chief antibiotics used. Ten patients required surgical drainage.

Combined detachments in Wegener's granulomatosis.

We report a case with limited Wegener's granulomatosis in which the eye findings were the initial and only evidence of the disease when the patient was first seen. The patient was unusual in that he developed bilateral combined choroidal and retinal detachments and severe necrotising scleritis, which led to bilateral globe perforations and loss of sight. We recommend a trial of cytotoxic agents in progressive ocular inflammatory diseases unresponsive to other medications before there is irreversible loss of vision.

Intraocular lens power formulas.

We have developed a FORTRAN digital computer program to evaluate intraocular lens power for any thin lens and combination of corneal curvature and axial length. Partial derivatives of the power with respect to cornea power, axial length, and lens position allow estimation of error in power of the lens. These derivatives are computed along with power of the lens for six far points which may be changed with the program running. The program is written for remote access so that an ordinary telephone and portable terminal provide the ability to compute lens power.

Platelet-induced retinal neovascularization in leukemia.

Retinal changes resembling those of background diabetic or hypertensive retinopathy commonly occur in leukemia, whereas retinal neovascularization is rare. When neovascularization does occur, it is usually the result of hyperviscosity caused by a greatly increased number of circulating leukocytes. A 42-year-old woman with diabetes mellitus developed chronic myelocytic leukemia and peripheral retinal neovascularization. The hyperviscosity leading to the neovascularization was probably caused by an increased number of circulating platelets.

Bilateral juxtapapillary subretinal neovascularization associated with pseudotumor cerebri.

A 32-year-old obese woman with hypertension and a three-year history of pseudotumor cerebri developed bilateral juxtapapillary subretinal neovascular membranes. To our knowledge, this is the first reported case of bilateral subretinal neovascular membranes complicating the course of this disease. The subretinal neovascular membrane in the left eye spontaneously involuted, but because the membrane in the right eye threatened the foveola, the patient underwent argon-laser photocoagulation. The subretinal fluid and hemorrhage progressively resolved, the membrane was replaced by fibrous tissue, and visual acuity improved. The pathogenesis of the subretinal neovascular membranes was presumably secondary to pressure deformity of the border of Bruch's membrane at the optic disk, creating a discontinuity of normal anatomic apposition of the chorioretinal layers. This anatomic dehiscence, coupled with hypoxia created by axonal tissue swelling and resultant impaired vascular perfusion of the tissues, led to the development of subretinal neovascular membranes.

Slit-lamp examination of the bedridden patient.

Slit-lamp examination of bedridden patients is facilitated by using a stretcher with the patient lying prone and holding the head erect.

Autosomal dominant Kearns-Sayre syndrome.

External ophthalmoplegia, retinal pigmentary degeneration, and heart block constitute the Kearns-Sayre syndrome. Skeletal muscle weakness, deafness, ataxia and endocrine disturbances also may occur. We examined 15 members in two generations of a family with autosomal dominant Kearns-Sayre syndrome. Seven had external ophthalmoplegia, six had electrocardiographic abnormalities, six had limb weakness nad six patients were normal. A deltoid muscle biopsy specimen from one patient contained typical "ragged-red fibers," abnormal lipid accumulation, and mitochondria increased in size and number, containing inclusions. The study demonstrated: (1) the marked variability in genetic expression; (2) the need to examine family members to discover asymptomatic patients and to establish an otherwise unrecognized hereditary pattern; and (3) the absence of specific and consistent biochemical abnormalities.

Ichthyosis hystrix (epidermal nevus syndrome) and Coats' disease.

A 4-year-old girl had the ichthyosis hystrix variant of the epidermal nevus syndrome with ocular fundus manifestations of Coats' disease. Her hearing was impaired because of serous otitis media and her visual acuity decreased because of hard yellow exudate in the macula as a result of decompensation and plasma leakage from the peripheral retinal vascular anomalies. Treatment of the vascular malformations with cryotherapy resulted in a reabsorption of the retinal edema and hard yellow exudate.