Delayed sterile keratitis following radial keratotomy successfully treated with conjunctival flap.

BACKGROUND: A case of sterile keratitis involving three adjacent incisions and intervening stroma occurring 5 years after an eight-incision radial keratotomy is reported. METHODS: Multiple cultures showed no pathogens. Treatment with antibiotics, lubricants, patching, and bandage contact lenses failed to improve the condition. A conjunctival bridge flap was therefore performed. RESULTS: Total resolution of the keratitis occurred rapidly after performing the conjunctival bridge flap. CONCLUSIONS: Delayed keratitis following radial keratotomy has been reported in the past. Treatment in these cases has primarily been corneal transplantation. The present case presents an alternative treatment, conjunctival bridge flap, which was successful in this case of sterile keratitis following radial keratotomy.

Microbial keratitis associated with plano tinted contact lenses.

The use of plano contact lenses for cosmetic purposes is a recent phenomenon. We report five cases of severe microbial keratitis associated with the use of these lenses. This subpopulation of patients who possess no refractive error are at risk of developing severe complications from contact lens wear. We have identified several issues which should be addressed by eye care professionals and regulatory agencies.

Simultaneous bilateral conjunctival and orbital lymphoma presenting as a conjunctival lesion.

A 44-year-old man with the diagnosis of a conjunctival lymphoma in the left eye was also found on further evaluation to have a lymphoma in the opposite orbit. The patient had no systemic signs of the disease, and was treated with localized radiation therapy. Although simultaneous presentation of lymphoma affecting the conjunctiva in one eye and the orbit on the opposite side is rare, any patient with an isolated conjunctival lymphoma should have a careful evaluation of the opposite eye and orbit, including an orbital computed tomographic scan to rule out simultaneous involvement.

An analysis of semiflexible, closed-loop anterior chamber intraocular lenses.

We present the pathologic and scanning electron microscopic findings from 44 semiflexible, all polymethylmethacrylate, anterior chamber intraocular lenses (IOLs). These IOLs, which have round, small diameter, closed loops were removed following a variety of complications, including uveitis and/or the uveitis-glaucoma-hyphema syndrome, secondary glaucoma, pseudophakic bullous keratopathy, cystoid macular edema, erosion into uveal tissue (with and without oval pupil), and iris neovascularization. Over 200,000 of these lens styles have been implanted. Even though the number of these IOLs accessioned in our laboratory is small, we feel this analysis documents some of the problems that may be encountered with this IOL design. Many of the complications documented in our series resulted in severe visual loss. In addition to tissue damage that appeared secondary to the mechanical tissue-to-implant interface, other causes of complications included variations in surgical technique, implantation into eyes with preexisting disease (including eyes that had undergone previous surgery), and damage to tissue that occurred during IOL removal.

Fluorescein angiography of soft contact lens induced vascularization in penetrating keratoplasty.

Soft contact lenses after penetrating keratoplasty have become more popular as improved materials with high water content and high oxygen permeability have become available. However, aphakic patients who have undergone penetrating keratoplasty seem to be at high risk for development of graft vascularization when extended wear soft lenses are used for optical correction. This report, to our knowledge, is the first to use corneal fluorescein angiography to study contact lens induced vascularization. Corneal fluorescein angiography, in two cases, showed that vascularization was often more extensive than clinically apparent. Further, these "new" vessels, in both cases, were shown to be "leaky." This great degree of leak contributed to graft edema in both and possibly, in one case, to graft rejection. These findings suggest that care in fitting and careful follow-up is necessary in any graft patient fit with an extended wear lens and that delicate or problem patients may be better aided with other forms of optical correction. Further, this report shows the value of corneal fluorescein angiography as a useful tool in the study of vascularization of the cornea from any cause.

Pyogenic granulomas of the cornea.

Pyogenic granulomas are vasoproliferative, inflammatory lesions composed of granulation tissue, which occur on cutaneous or mucosal tissues, often arising secondary to other processes such as trauma or infection. Conjunctival pyogenic granulomas are not rare, but corneal involvement is very unusual and can occasionally lead to problems in the differential diagnosis of corneal masses. We report three cases of pyogenic granuloma involving the cornea. The clinicopathologic features of these cases and a review of the literature on the ocular manifestations of this condition are presented.

Combined penetrating keratoplasty and mechanical anterior vitrectomy.

Forty patients with aphakic bullous keratopathy undergoing combined penetrating keratoplasty and anterior vitrectomy using mechanical vitreous instruments were studied for a mean length of 36 months. Seventy percent of the grafts remained clear and thirty percent failed during the follow-up period. Fifty-three percent of those with clear grafts (15/28) obtained a visual acuity of 20/70 or better. In comparison to older methods of anterior vitrectomy, we have found that removal of vitreous with mechanical vitreous instruments offers more effective removal of solid and liquid vitreous, decreased surgical time, and decreased retinal traction. Further, it is easy to learn to use and handle these instruments.

Corneal changes in aniridia.

Nineteen patients with aniridia and one patient with bilateral iris colobomata from eight families were examined for corneal abnormalities. Thirty-six eyes revealed changes that are consistent with a progressive corneal dystrophy. These changes begin in the corneal periphery in the early years of life and progress to the corneal center with increasing age. This dystrophy has been staged into four typical clinical patterns. Central corneal scarring, and in some cases, ulceration may occur, which may be a significant threat to vision.