Whole globe enucleation versus in situ corneal excision: a study of tissue trauma and contamination.

Twenty-four pair of eyes donated to the Minnesota Lions Eye Bank were studied to determine the effect of corneal procurement methods on tissue quality. Eyes studied were ineligible for transplantation because of a preexisting medical condition other than sepsis or age of > 75 years. The procurement technique was randomized for each donor. One cornea was procured in situ (IS), whereas the fellow eye was enucleated and processed in the laboratory (EN). Procurement protocols were standard Eye Bank Association of America methods. Tissue characteristics were scored according to standard eye bank protocols. Cultures were performed at the time of tissue procurement and following storage for 7 days in Dexol media. With the exception of endothelial striae, no statistical difference was found between groups for any tissue characteristics. The average score for endothelial striae in the IS group was greater than twice that of the EN group. Initial cultures were positive in 10 of 24 in the IS group and four of 24 in the EN group. Each group had three positive end-storage cultures. These results demonstrate superior tissue decontamination after initial processing and less endothelial cell trauma with standard enucleation when compared to in situ corneal excisions.

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.

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.