Fusarium keratitis and endophthalmitis associated with lens contact wear.

INTRODUCTION: Fusarium keratitis is a severe corneal infection that is usually seen in tropical and subtropical countries after a corneal trauma. In 2005-2006, an epidemic of Fusarium keratitis, occurring predominantly among contact lens wearers, was observed in several countries. CASE REPORT: We describe the clinical course of a Fusarium keratitis which failed to respond to systemic and local voriconazole treatment, and experienced a progression to a severe keratitis with endophthalmitis, requiring early therapeutic keratoplasty ("à chaud"). After 8 months of follow up, the vision recovered to 20/50. DISCUSSION: After the 2005-2006 worldwide epidemics, case-control studies pointed out that a new lens care solution, ReNu with MoistureLoc (Bausch & Lomb), was likely responsible of numerous cases. Complementary studies underlined that this infection mostly concerned non-compliant patients, i.e., those reusing the solution several times, since this results in a decrease of the antifungal activity due to the uptake of the biguanides into the lens. CONCLUSION: Fusarium endophtalmitis can result in a devastating disease with a poor visual outcome. An initial antifungal dual therapy may control the infection. In case of failure, an early keratoplasty may be mandatory. For contact lens wearers, education on sanitary good practice is necessary to avoid new epidemics in the future.

[The effects of medications on the eyes]. / Oeil et médicaments.

The visual system is very sensitive to side effects of medicines, either regarding systematic complications of eye drops or ocular complications following oral or intravenous treatments. For the latter, ophthalmologic regular monitoring is mostly the best preventive measure since most of iatrogenic abnormalities are reversible after ruling out the treatment. However, some ocular complications are poorly reversible, as for example with antimalarial drugs or vigabatrin. Concerning systemic complications of ocular treatments, their risk is often underestimated, while the passage of drugs in the blood can sometimes reach similar rates than those observed after an oral administration, as it is the case with some beta-blockers ophthalmic solutions. It is also advisable to distrust overdoses, or accidental oral ingestions, of parasympatholytic mydriatics which can induce neurological and cardiac complications in children or in elderly.

Low-dose proton beam therapy for circumscribed choroidal hemangiomas.

OBJECTIVE: To evaluate the efficacy and safety of proton beam therapy for complicated circumscribed choroidal hemangiomas. METHODS: The study was a retrospective nonrandomized investigation. Seventeen consecutive patients, referred to the Institut Gustave-Roussy, Villejuif, France, for circumscribed choroidal hemangioma associated with serous retinal detachment were studied. Each eye received a total dose of 20 cobalt gray equivalents (CGEs) delivered in 15-second fractions of 5 CGEs over 4 days. Functional tests included the initial and final best-corrected visual acuity, slitlamp examination, intraocular pressure, fundus examination, fluorescein angiography, and indocyanine green angiography. Tumor thickness was determined on B-scan ultrasonography. RESULTS: The macula was involved in 7 eyes and the lesion was juxtapapillary in 2 eyes. The mean (SD) tumor thickness was 3.06 (9.0) mm. The mean initial tumor diameter was 6.82 mm (range, 3.2-12.1 mm). The right eye was involved in 7 cases and the left eye in 10 cases. The mean (SD) follow-up period was 52 (58) months (range, 36-90 months). Retinal reattachment was obtained in all cases after a mean period of 2 months (range, 1-12 months; median, 1 month). Tumor regression was obtained in all cases. One recurrence occurred 1 year after the initial treatment in an undertreated area. After re-treatment, however, resolution of the retinal detachment occurred, and flattening of the choroidal lesion was obtained. Final visual acuity improved to 2 Snellen lines or more in 16 eyes (94%), was stable in 1 eye, and attained 20/40 or more in 12 eyes (70.6%). No radiation therapy complications occurred during follow-up. CONCLUSIONS: Proton beam therapy for choroidal hemangiomas seems to be an effective and safe alternative option. A total dose of 20 CGEs delivered in 4 daily 15-second fractions of 5 CGEs seems adequate for local control of both the tumor and serous retinal detachment.

Corneo-conjunctival autograft transplantation for pterygium surgery.

PURPOSE: To evaluate the efficacy of surgical management of pterygium with corneo-conjunctival autograft transplantation. SETTING: Ophthalmology Department, Bicêtre Hospital, University Paris XI and the Assistance Publique Hôpitaux de Paris, France. METHODS: The records of 104 patients (114 eyes), comprising 40 women and 64 men, who underwent corneo-conjunctival autograft transplantation for primary (104 eyes) and recurrent (10 eyes) pterygia between 1992 and 1998, were reviewed in a retrospective survey. Follow-up ranged from 12 to 78 months (mean 22.5 months). RESULTS: All grafts were planted promptly and donor sites re-epithelialized with no excessive scar tissue formation. No recurrence was noted. Improvement of visual acuity was achieved in 24 patients and stabilization was achieved in 76 patients. The main complication was progression of corneal astigmatism exceeding 4 dioptres in two patients. CONCLUSION: These results indicate that corneo-conjunctival autograft transplantation is an effective treatment for pterygia.

Phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear.

PURPOSE: To evaluate phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear. METHOD: The records of 20 patients with cataract after silicone oil repair of retinal detachment with giant retinal tear or complicated by proliferative vitreoretinopathy were reviewed. All eyes underwent phacoemulsification, posterior capsulorhexis, aspiration of silicone oil with an irrigation-aspiration hand piece, and intraocular lens implantation into the capsular bag. Lens calculation was based on the fellow eye. The mean follow-up period after cataract surgery was 15.4 months. RESULTS: There were three recurrences of retinal detachment (15%). Transient corneal edema was noted in two eyes. Unpredictable refraction was the main problem, but the myopic refractive error was <4.5 diopters in all cases. CONCLUSION: Cataract extraction combined with silicone oil removal is an effective technique.

Non-preserved 1% lidocaine solution has less antibacterial properties than currently available anaesthetic eye-drops.

PURPOSE: Some anaesthetics inhibit bacterial growth, and thus may lead to low rates of positive cultures from bacterial keratitis. Antibacterial properties of lidocaine were compared with those of oxybuprocaine or tetracaine, either in current commercial eye lotions or in extemporaneous solutions. METHODS: Forty-eight bacterial strains were used to determine the minimum inhibitory and bactericidal concentrations of four commercial eye lotions containing oxybuprocaine or tetracaine, of a non-ophthalmic 1% lidocaine commercial solution and of extemporaneously prepared solutions of oxybuprocaine, tetracaine, lidocaine and benzalkonium. RESULTS: Most strains had their growth inhibited by 0.2% oxybuprocaine or 0.4% tetracaine, which corresponds to a 1/2 dilution of the commercial eye-drops. Bacterial growth was still observed with a 1% lidocaine solution. CONCLUSIONS: Currently available anaesthetic eye-drops that are used before corneal specimen collection may lead to false-negative bacterial cultures. Conversely, a non-preserved 1% lidocaine solution might be more appropriate in corneal specimen collection.