Intraoperative pachometry during automated lamellar keratoplasty: a preliminary report.

BACKGROUND: The hinge technique greatly improves the results of automated lamellar keratoplasty but makes it impossible to measure the thickness of the corneal cap with a micrometer. We developed a technique of measuring cap and stromal disc thickness with a pachometer and compared the results with those obtained with a micrometer. METHODS: Measurements of the thickness of the stromal disc and/or corneal cap were taken with the Mitutoyo micrometer and the Chiron Corneo-Gage System III pachometer in five myopic and three hyperopic cases undergoing automated lamellar keratoplasty with complete cap resection. The intended postoperative refraction was plano. Postoperative refractions were taken at two months. RESULTS: In most cases, the corneal cap measured thinner while the stromal disc measured thicker by the micrometer than by the pachometer because of the hydration status of the stromal bed. In both myopic and hyperopic cases, the thickness measurements taken with the pachometer correlated better with the postoperative spherical equivalent values than those taken with the micrometer. CONCLUSIONS: The thickness measurement of corneal resections by both micrometry and pachometry is greatly influenced by tissue hydration status. When hydration is similar, the pachometer provides more accurate thickness readings than does the micrometer, as determined by correlations with intended refractive results.

Ocular involvement in an outbreak of herpes gladiatorum.

An epidemic of herpes simplex virus type 1 occurred in 60 of 175 wrestlers (34%) attending a four-week intensive training camp. Five of these 60 patients (8%) developed ocular involvement that included follicular conjunctivitis, blepharitis, and phlyctenular disease. Cultures of the conjunctiva and eyelid vesicles were positive for herpes simplex virus type 1 in four of the five patients with ocular disease. The viral isolates were compared by restriction-endonuclease analysis, which disclosed that three of the four isolates were the same strain. None of the patients had corneal involvement and there has been no evidence of viral recurrence to date. Herpes simplex virus type 1 is a health risk for wrestlers, and ocular infections are part of the clinical spectrum. Prompt diagnosis and appropriate management of the outbreak may reduce the severity of the outbreak transmission.

En bloc resection in upper eyelid blepharoplasty.

Upper eyelid blepharoplasty as traditionally performed may fail to adequately debulk the eyelids especially in the middle age or older patient. A technique used by the senior author for the past 10 years is described. The en bloc resection of redundant upper eyelid tissue can be readily combined with other procedures.

An outbreak of herpes gladiatorum at a high-school wrestling camp.

BACKGROUND AND METHODS: Herpes simplex virus type 1 (HSV-1) has been identified as a cause of cutaneous or ocular infection among athletes involved in contact sports; in this context it is known as herpes gladiatorum. In July 1989, we investigated an outbreak among 175 high-school wrestlers attending a four-week intensive-training camp. Cases of infection were identified by review of medical records, interview and examination of the wrestlers, and culture of skin lesions. Oropharyngeal swabs were obtained for HSV-1 culture, and serum samples for HSV-1 serologic studies. HSV-1 isolates were compared by restriction-endonuclease analysis. RESULTS: HSV-1 infection was diagnosed in 60 wrestlers (34 percent). The lesions were on the head in 73 percent of the wrestlers, the extremities in 42 percent, and the trunk in 28 percent. HSV-1 was isolated from 21 wrestlers (35 percent), and in 39 (65 percent) infection was identified by clinical criteria. Five had conjunctivitis or blepharitis; none had keratitis. Constitutional symptoms were common, including fever (25 percent), chills (27 percent), sore throat (40 percent), and headache (22 percent). The attack rate varied significantly among the three practice groups, ranging from 25 percent for practice group 1 (lightweights) to 67 percent for group 3 (heavyweights). Restriction-endonuclease analysis identified four strains of HSV-1 among the 21 isolates. All 10 isolates from practice group 3 were identical (strain A), and 5 of 7 isolates from practice group 2 (middleweights) were identical (strain B), which suggested concurrent transmission of different strains within different groups. HSV-1 was not isolated from any oropharyngeal swabs. CONCLUSIONS: Herpes gladiatorum may cause substantial morbidity among wrestlers, and it is primarily transmitted by direct skin-to-skin contact. Prompt identification and exclusion of wrestlers with skin lesions may reduce transmission.