Over-Treated Corneal Abscess May Be Toxic Keratopathy.

BACKGROUND/AIMS: Keratitis, especially when long-standing and unresponsive to common antimicrobial treatment, leads to a suspicion of fungal aetiology. METHODS: Photographically documented case report. RESULTS: A 65-year-old man with diabetes was referred for corneal abscess unresponsive to antibiotic and antifungal treatment lasting 6 weeks. Corneal biopsy was performed following a 72-hour washout for identification of bacteria and fungi. Previously administered drops were withdrawn and only preservative-free artificial tears were maintained. Neither bacteria nor fungi were cultured. After 2 weeks, the clinical situation had conspicuously improved. CONCLUSION: Over-treatment of corneal affections fearing mycosis may lead to toxic keratopathy.

The Topcon SP 1000 and Image-NET systems. A comparison of four methods for evaluating corneal endothelial cell density.

The objective of this study was to compare four methods of counting corneal endothelial cell density using the Topcon SP 1000 microscope and Image-NET digital graphic software. Two independent observers quantified cell density from 63 endothelial photomicrographs using the various standardized techniques. The first method was that suggested for use with Topcon SP 1000, employing five different reference grids to compare subjectively with the endothelial cell density of the unknown sample. The other three methods involved the automated, semiautomated, and manual procedures developed for use with the Image-NET system software. The manual Image-NET system is presently considered to yield accurate cell morphology data. Confidence limits and standard errors of mean differences between values obtained by different methods were used to evaluate agreement and reproducibility of computerized methods. Sensitivity and specificity were calculated for two different threshold limits of endothelial cell density. Results showed that the automated Image-NET system is not reliable for clinical use because of its poor agreement with other methods and its lack of sensitivity and specificity at the selected threshold limits of endothelial cell density. The comparative Topcon method of using reference grids, although inexpensive and accurate for 500 cell/mm2 increments, was considered too imprecise for most clinical situations. The semiautomated Image-NET system, in half the analysis time required by the manual method, provided endothelial cell count estimates that were not clinically different from those obtained with manual counting.

Vision screening of preschool children in Italy.

Vision screening of preschool children is designed and performed to identify those affected by amblyopia or related, predisposing visual defects. In order to determine the prevalence of preschool vision screening in Italy, a questionnaire was mailed to the 635 regional health offices in which the country's national health system was organized at the time of the study. Results of this survey demonstrated that in 61.3% of the regions which responded, some form of preschool vision screening is performed. However, individual, non-standardized methods are used by the physicians or health care professionals responsible in each regional program. It is evident from this study that standardized procedures for preschool vision testing are lacking in Italy, and that the existing European Community guidelines should be disseminated and applied on a greater scale for the development of such a program on the national and European level.

Low-molecular-weight sodium hyaluronate in the treatment of bacterial corneal ulcers.

A double-blind clinical trial was performed on 26 patients suffering from corneal ulcers of proven (i.e., culture-positive) bacterial etiology. After their recruitment, the subjects were randomly assigned to one of the following treatment protocols: (1) tobramycin (15 mg/ml) in saline applied at 1 drop/h or (2) tobramycin (15 mg/ml) in low-molecular-weight hyaluronic acid applied at 1 drop/h. The sample size was adjusted according to a type I error of 0.01 and type a II error of 0.05 for a minimal expected difference of 35%. The healing time was calculated from the beginning of treatment to the day on which a follow-up fluorescein test proved to be negative. The mean healing time (+/- SD) was 3.5 +/- 0.9 days in the sodium hyaluronate group and 5.9 +/- 1.5 days in the saline group (P less than 0.001). These results suggest that treatment with an antibiotic dissolved in low-molecular-weight sodium hyaluronate can further shorten the clinical course of a bacterial corneal ulcer.

[Corneal transplantation in Parma: a critical review of activities from 1983 to 1989]. / Il trapianto di cornea a Parma: revisione critica dell'attività svolta dal 1983 al 1989.

At the Institute of Ophthalmology of Parma 66 corneal transplants were performed from 1983 to 1989. In this period the number of grafts per year remarkably increased. Two therapeutic choices characterized corneal transplantation in Parma: a) a fresh donor cornea was used without any storage medium; b) the post-operative ambulatory follow-up of patients was particularly frequent in the first 12 months after surgery. The follow-up period ranged from 3 to 75 months (mean 25 months). The life table calculated using the Kaplan-Meier method shows a graft survival of 86% after 4 years. Graft failures were 8. The authors report all postoperative complications that appeared. In comparison with what reported in Literature, a higher percentage of graft survival and a better final visual acuity were observed in the patients who underwent corneal transplantation in the Eye Clinic of Parma.

Filaria conjunctivae.

A conjunctival neoformation, excised in a 44-year-old healthy Italian man, was histologically diagnosed as Dirofilaria conjunctivae, which is probably Dirofilaria repens, a natural parasite found in dogs of European countries. This parasite rarely infests man in subcutaneous tissues, palpebral, orbital or conjunctival regions. In this case, as in those described by others, the vector remained unknown.

Mesectodermal leiomyoma of the ciliary body extending into the anterior chamber.

A neoplasm of the ciliary body extending from the equator to the iris and the anterior chamber was observed in an 18-year old girl. Because the visual acuity was lost and the clinical diagnosis was uncertain the eye was enucleated. Both optic and electron microscopic investigations allowed the diagnosis of the mesectodermal type of leiomyoma of the ciliary body.

Unusual misdiagnosis of choroidal melanoma.

A papillary, white mass observed in a 45-year-old man was diagnosed as an optic nerve glioma. The histological examination revealed a juxtapapillary amelanotic choroidal malignant melanoma, extending over the optic disc and infiltrating the optic nerve. This clinical picture is quite infrequent in malignant melanoma of the choroid.

[Corneal staphyloma (author's transl)]. / Hornhautstaphylom.

In an otherwise completely normal newborn female a congenital monolateral corneal staphyloma was found. The macroscopic centrocorneal cicatricial ridges were compatible with a microscopic defective area in the epithelium, where a massive inflammatory reaction was observed. Bowman's and Descemet's membranes were absent. The ciliary body was hypoplastic and the ciliary processes were only rudimentarily developed. On one side there were some lenticular remnants. The posterior pole corresponded to the patient's age.

[Trial and temptation in the interpretation of accommodative paralysis as a psychosomatic manifestation]. / Tentative et tentation d'interpréter comme une manifestation psychosomatique une paralysie de l'accommodation.

An adolescent, presented during 24 months an intermittent bilateral accommodation palsy. All the clinical tests were negative; a few peculiar aspects of the patient's character incited us to carry out, in parallel, a psychological research. The young man proved to be a mixed introvert, with Oedipal and familial problems. The assumption that accommodation palsy could have a psychological--although objectively unprovable motivation--is not in contradiction with the psychological research.