Exposure keratopathy after cosmetic CO2 laser skin resurfacing.

PURPOSE: To report two cases of exposure keratopathy after cosmetic CO2 laser skin resurfacing. METHODS: Two patients presented with bilateral intrapalpebral epitheliopathy. They were examined, treated, and followed for several weeks. RESULTS: Nonsurgical treatment options, including a variety of lubricants, punctal plugs, and lid taping, did not lead to a complete resolution of symptoms. Surgical options were recommended. CONCLUSION: Exposure keratopathy should be recognized as a potential side effect of not only incisional lid surgery but also facial CO2 laser skin resurfacing procedures.

Stargardt's macular dystrophy--a patient's perspective.

PURPOSE: The purpose of this paper was to evaluate life experience, including disease characteristics, daily-living activities, employment, interactions with health care professionals, and support services in patients diagnosed with Stargardt's macular dystrophy. METHODS: More than 200 patients with Stargardt's disease responded to a 68-question survey. Results were analyzed using SAS Statistical Analysis Package. RESULTS: Of 203 responders, 142 (70%) were women. Early disease onset occurred in more than 60% of patients. Blurred vision (134, 66%) and glare (183, 90.1%) were the leading symptoms reported. Reading (116, 57.1%), driving (86, 42.4%), and recognizing faces (66, 32.5%) were daily-living activities most difficult to perform. Patients with early disease onset had worse vision at presentation (p = 0.001), faster progression of visual loss (p = 0.007), and were more often diagnosed with a non-physiological visual loss (p = 0.007). Patients with late disease onset had more difficulty with orientation and coping skills (p = 0.02). Sixty-five percent of evaluated adults (108 of 165) were employed. CONCLUSIONS: Although the study illustrates that patients with Stargardt's disease can contribute and function well in contemporary society, issues related to depression, and availability and quality of health care, are still major concerns for this patient population. The study shows differences in progression of visual loss between patients, with early versus late disease onset indicating that age at onset and visual acuity at presentation might be two important factors influencing patient's visual prognosis. Finally, the study suggests parallels in psychological profiles between late age at onset Stargardt's disease and age-related macular degeneration patients.

Risk factors in microbial keratitis leading to penetrating keratoplasty.

OBJECTIVE: To determine the characteristics of infectious corneal ulcers at the time of presentation to the cornea specialist associated with a favorable response to medical therapy versus a poor outcome manifested by the need for penetrating keratoplasty for therapy or visual rehabilitation. DESIGN: Retrospective, case-control study. PARTICIPANTS: A total of 162 patient records were reviewed, including the study group of 30 patients and the control group of 132 patients. INTERVENTION: A retrospective review of all cases of microbial keratitis presenting to the Cornea Service between January 1, 1989 and December 31, 1995 was conducted. The cases were divided into two groups. The study group consisted of patients with microbial keratitis who failed medical therapy and required penetrating keratoplasty. The control group included patients with infectious ulcers who responded to medical therapy alone. MAIN OUTCOME MEASURES: The influence of demographics, medical and ocular history, delay in presentation to the primary ophthalmologist or the corneal specialist, topical medications, and contact lens usage were compared. Visual acuity and ulcer characteristics were recorded. The statistical significance was evaluated by the chi-square test for independence and multiple logistic regression. RESULTS: Older age (P=0.001), delay in referral to the corneal specialist (P<0.03), and treatment with topical steroids prior to presentation (P<0.0001) were statistically significant factors associated with the need for penetrating keratoplasty. Steroid use and the delay in referral were correlated. A past history of ocular surgery (P=0.01), poor visual acuity at presentation (P<0.001), and ulcer characteristics, including central location (P<0.0001), large size (P<0.0001), presence of perforation or descemetocele (P<0.0001), limbal involvement (P<0.0001), and hypopyon (P=0.05), were all associated with the need for penetrating keratoplasty. CONCLUSIONS: Older age, delay in referral to the corneal specialist, topical steroid treatment, past ocular surgery, poor vision at presentation, large size, and central location of the ulcer are risk factors for poor outcome of microbial keratitis, as indicated by the need for penetrating keratoplasty.

Evaluation of triggers for corneal graft rejection.

BACKGROUND AND OBJECTIVE: To evaluate potential triggering factors contributing to corneal graft rejection. PATIENTS AND METHODS: A prospective, case control study was conducted over a five month period. All patients presenting with new onset corneal graft rejection were enrolled into the study group. Two patients with clear grafts who presented shortly after each enrolled study group patient served as controls. Groups were matched for age, preoperative diagnosis, and number of previous keratoplasties. Participating patients and examining ophthalmologists filled out questionnaires regarding infectious, environmental and immunologic exposures. RESULTS: 66 patients were enrolled into the study, of which 22 had new rejection episodes. The most prevalent diagnoses were keratoconus (36.6%) and herpes simplex keratitis (22.7%). Anterior chamber reaction (77.3%) and keratic precipitates (68.2%) were the most common signs of graft rejection. A history of prior rejection episodes was significantly more frequent in the study group population (p < 0.001). Factors such as sun exposure, stress, smoking and travel were more prevalent in the rejection group but not statistically significant. The history of recent vaccinations and allergic reactions were equally prevalent in both groups. CONCLUSIONS: The new onset of corneal graft rejection was highly associated with a prior history of graft rejection episodes (p < 0.001). Other analyzed factors were not significant triggering factors for rejection in this small series.

Parry-Romberg syndrome associated with intracranial vascular malformations.

We describe a 23-year-old woman with iridocyclitis, enophthalmos, facial hemiatrophy, and transient numbness of her contralateral upper and lower extremities. The patient was found to have white matter densities in the right hemisphere in magnetic resonance T2-weighted images and vascular malformations involving right vertebral, right carotid, and right anterior cerebral arteries. Histopathologic evaluation of a biopsy specimen of anterior orbital fat and lacrimal gland revealed fibrosis and chronic inflammation. These findings were consistent with the diagnosis of progressive facial hemiatrophy (Parry-Romberg syndrome) in association with iridocyclitis and intracranial vascular malformations.