Delayed diffuse lamellar keratitis after laser in situ keratomileusis.

Two cases are reported of delayed diffuse lamellar keratitis after uneventful laser in situ keratomileusis. The first patient presented with an epithelial defect 6 weeks after laser in situ keratomileusis. Three days later the defect was healed but diffuse lamellar keratitis was noted. This was treated with topical dexamethasone and ketorolac with complete resolution of the diffuse lamellar keratitis over 3 weeks. The second patient presented with an epithelial defect and gross diffuse lamellar keratitis 10 weeks after laser in situ keratomileusis. Treatment was with topical dexamethasone and ciprofloxacin with gradual resolution of the diffuse lamellar keratitis. Common to both patients was a background of rosacea, implanted debris with no initial reaction, and epithelial defects leading to diffuse lamellar keratitis. It is suggested that these two cases represent epithelial defect associated corneal infiltration, which resembles classical diffuse lamellar keratitis with the spread of inflammatory cells through a path of least resistance.

Pigmentary retinopathy associated with the mitochondrial DNA 3243 point mutation.

Fourteen patients from four unrelated families were studied to determine the prevalence of retinal pigmentary abnormalities associated with the MELAS A to G 3243 point mutation. Neurologic and ophthalmic examinations, retinal photography, pattern shift visual evoked potentials, and electroretinography were performed in all patients. Eight of the 14 patients had retinal pigmentary abnormalities characterized by symmetric areas of depigmentation involving predominantly the posterior pole and midperipheral retina. None of the patients had optic atrophy and only one patient with pigmentary retinal abnormalities had impaired visual acuity. None of the diabetic subjects (n = 6) had signs of diabetic retinopathy. Fluorescein angiography demonstrated mottled hyper- and hypofluorescent areas indicating multiple window defects in the retinal pigmentary epithelium. Visual evoked potentials showed delayed P100 responses in four of the eight patients with retinal pigmentary abnormalities. We conclude that there is a high prevalence of retinal pigmentary abnormalities in patients with MELAS A to G 3243 point mutation. These abnormalities are usually asymptomatic and best detected by retinal photography.

Posterior amorphous corneal dystrophy. A new pedigree with phenotypic variation.

BACKGROUND: Posterior amorphous corneal dystrophy is a rare condition characterized by bilateral sheet-like opacification of the posterior stroma in association with corneal flattening and thinning. It has been reported in only four families, all from the United States. The authors report on a fifth family, the first from Britain, with nine affected individuals. METHODS: Slit-lamp photography, refraction, keratometry, pachometry, corneal topography, and specular microscopy were used to assess the family members. RESULTS: Two distinct forms of the disease were identified. All patients with the centroperipheral form were hypermetropic and had keratometry readings below 41.00 diopters and a central corneal thicknesses less than 0.50 mm. Those with the less severe peripheral form were less hypermetropic, some slightly myopic, and had keratometry readings above 41.00 diopters, but the central corneal thicknesses was similar to those with the centroperipheral form. No abnormalities of the endothelium were detected, and visual acuity was only mildly affected. The condition appears to be nonprogressive. CONCLUSION: Though the centroperipheral form of posterior amorphous corneal dystrophy is more likely to lead to presentation, most patients are asymptomatic. This dystrophy can be very subtle in its appearance and easily overlooked. This led the authors to suspect that the prevalence of this condition is higher than the few reports in the ophthalmic literature suggest.

The Valsalva DCR bubble test: a new method of assessing lacrimal patency after DCR surgery.

Objective confirmation of nasolacrimal patency following dacryocystorhinostomy is a desirable postoperative goal for both the surgeon and the patient. The authors describe a simple method to demonstrate dacryocystorhinostomy patency and present a study comparing the effectiveness of this novel test with Jones fluorescein testing in 32 cases seen consecutively at postoperative follow-up. The test consists of demonstrating reflux of air through the dacryocystorhinostomy as the patient performs the Valsalva maneuver. This reflux is most easily seen as bubbles rising through a drop of saline placed in the medial canthus. A high correlation was found between this test and Jones testing. The Valsalva dacryocystorhinostomy bubble test (VBT) appears to be a fast, safe, and accurate method of confirming dacryocystorhinostomy patency.

Langerhans' cell histiocytosis of the frontal bone.

Two cases of Langerhans' cell histiocytosis of the frontal bone are presented. This condition was previously known as eosinophilic granuloma and rarely involves the orbit but may be associated with widespread and life-threatening disease. Clinical, radiological and histopathological features are presented. A discussion of the light and electron microscopic appearances, investigation and management follows.

Spontaneous visual improvement in the presence of posterior capsule opacification.

We report a case of a patient who had reduced visual acuity due to posterior capsular opacification after extracapsular cataract extraction and posterior chamber lens implantation. Capsulotomy was not performed. Over the subsequent two years visual acuity returned spontaneously to normal.

Penetrating keratoplasty and raised intraocular pressure. A brief review of the problems and its management.

Postkeratoplasty glaucoma is a serious sight-threatening problem that is likely to remain with us for the foreseeable future. It is common yet unsatisfactory to deal with. It is only by meticulous assessment of patients and rigorous aftercare that the condition can be adequately managed. Modern surgical techniques may improve the prognosis in cases which are uncontrolled by traditional methods.

Post-keratoplasty glaucoma.

The incidence of post-keratoplasty glaucoma remains at about 30% of all grafts performed. Aphakic eyes, particularly those after intracapsular extraction, the elderly, traumatised eyes and eyes undergoing repeat corneal grafts appear to be at greatest risk. This paper also reviews the mechanisms and treatment of post keratoplasty glaucoma.