ABSTRACT
PURPOSE: To report a corneal nevus, without conjunctival involvement, that clinically simulated a metallic foreign body. METHODS: Case report with clinicopathologic correlation. RESULTS: A 22-year-old man developed a superficial pigmented lesion of his left cornea. It was suspected to be a chronically retained foreign body, but a melanocytic neoplasm could not be excluded. The lesion was removed by lamellar keratectomy and proved histopathologically to be a compound nevus of the cornea, without conjunctival involvement. CONCLUSIONS: Melanocytic nevus can rarely occur in the cornea. Involvement of the cornea by a melanocytic lesion does not necessarily imply a malignant melanoma.
Subject(s)
Corneal Diseases/diagnosis , Eye Foreign Bodies/diagnosis , Eye Neoplasms/diagnosis , Nevus, Pigmented/diagnosis , Adult , Cornea/pathology , Corneal Diseases/surgery , Diagnosis, Differential , Eye Foreign Bodies/surgery , Eye Neoplasms/surgery , Humans , Male , Nevus, Pigmented/surgeryABSTRACT
Nd:YAG laser cyclophotocoagulation (CPC) of the ciliary body is a promising cyclodestructive treatment for the management of refractory glaucoma following penetrating keratoplasty. Twenty-eight eyes (27 patients) were treated between August 1985 and September 1987 and followed 6 to 24 months (median, 18 months). The mean intraocular pressure (IOP) was initially 39 mm Hg (range, 30 to 70 mm Hg) on maximally tolerated medications. The Lasag Microrupter 2 was used in the free-running thermal mode with a mean pulse energy of 4.13 J. The laser was retrofocused 3.6 mm from the conjunctival surface and 30 to 50 applications per treatment (mean, 37.5) were given 2 to 3 mm from the limbus for 360 degrees (71%) or 180 degrees (29%). Multiple treatments were necessary in 13 eyes (46%). After CPC, IOP fell to 22 mm Hg or below in 18 eyes (64%) at 3 months, in 20 of 27 eyes (74%) at 6 months, and in 16 to 24 eyes (67%) at 1 year. Inadequate IOP control in four of 28 eyes necessitated cyclocryotherapy in three patients and a Schocket procedure in one other. Of the 14 clear pre-CPC grafts six (43%) became edematous during follow-up. All of the failed grafts had undergone multiple CPCs.
Subject(s)
Glaucoma/surgery , Keratoplasty, Penetrating/adverse effects , Light Coagulation , Follow-Up Studies , Glaucoma/etiology , Humans , Intraocular Pressure , Postoperative CareABSTRACT
We describe how use of the Gass hook allows safer placement of the lateral rectus stay suture for inferior rectus recession through an inferotemporal cul-de-sac incision.
Subject(s)
Oculomotor Muscles/surgery , Surgical Instruments , Humans , Sclera , Suture TechniquesABSTRACT
To investigate the contribution of endothelial dystrophy to the subsequent development of pseudophakic bullous keratopathy, we retrospectively reviewed the clinical records and histopathologic specimens of pseudophakic patients who had undergone penetrating keratoplasty for corneal decompensation. Conclusive evidence of endothelial dystrophy was found in a majority (18 of 27, 67%) of patients who developed pseudophakic bullous keratopathy following implantation of a posterior chamber intraocular lens. By contrast, the incidence in a comparable group of 51 pseudophakic bullous keratopathy patients with anterior chamber intraocular lenses was low (six of 51, 12%) (P less than 0.01). In analyzing the relative risk of post-surgical corneal decompensation, one cannot implicate a particular intraocular lens without considering pre-existing endothelial dystrophy.
Subject(s)
Corneal Diseases/etiology , Corneal Dystrophies, Hereditary/complications , Lenses, Intraocular/adverse effects , Anterior Chamber , Corneal Dystrophies, Hereditary/pathology , Corneal Transplantation , Humans , Retrospective StudiesABSTRACT
Topical administration of sodium citrate reduces the incidence of corneal ulceration and perforation following an alkali burn to the eye. The specific mechanism by which sodium citrate prevents the ulceration is not understood, although citrate does inhibit the infiltration of polymorphonuclear leukocytes (PMNs) into the cornea following an alkali burn. In the present study, the effects of sodium citrate and another calcium chelator, ethylene glycol bis (beta-aminoethylether)-N,N'tetraacetic acid (EGTA), upon PMN oxygen consumption and lysosomal enzyme release were determined. Oxygen consumption was measured polarographically using a Clark-type oxygen electrode, and lysosomal enzyme release was determined by intra- and extra-cellular measurements of myeloperoxidase activity. Opsonized zymosan and N-formylmethionylleucylphenylalanine (FMLP) were used to stimulate neutrophil oxygen consumption and lysosomal release. Both sodium citrate and EGTA inhibited PMN oxygen consumption and lysosomal enzyme release in response to opsonized zymosan. In contrast, neither sodium citrate nor EGTA reduced PMN oxygen consumption or lysosomal enzyme release in response to FMLP. Therefore, the ability of sodium citrate (and EGTA) to inhibit PMN stimulation is dependent upon the choice of stimulus. Until the inflammatory mediators involved in the ulcerative process following an alkali burn to the eye are delineated, the impact of sodium citrate upon PMN stimulation in vivo cannot be resolved.
Subject(s)
Citrates/pharmacology , Egtazic Acid/pharmacology , Ethylene Glycols/pharmacology , Neutrophils/drug effects , Burns, Chemical/drug therapy , Burns, Chemical/immunology , Citric Acid , Eye Burns/chemically induced , Eye Burns/drug therapy , Humans , Lysosomes/metabolism , N-Formylmethionine Leucyl-Phenylalanine/pharmacology , Neutrophils/immunology , Neutrophils/metabolism , Oxygen Consumption , Zymosan/pharmacologyABSTRACT
Polymorphonuclear leukocytes (PMNs) are considered to play a central role in the corneal ulceration process subsequent to an alkali burn. We have described the time course of PMN infiltration into the ocular tissues following an alkali burn. In addition, we examined the effect of sodium citrate upon the accumulation of PMNs in the alkali burned cornea. The accumulation of PMNs into the cornea and iris-ciliary body was quantified by measuring myeloperoxidase (MPO), an enzyme marker for these inflammatory cells. Leukocytes in aqueous humor aspirates and corneal washes were counted directly under a microscope. In the alkali burned cornea, we found an initial transient, yet substantial, infiltration of PMNs, peaking at about 12-24 hr and limited to the peripheral cornea; this subsided by about 72 hr. By 14 days, the MPO activity, and hence the number of leukocytes, had risen again, and by 21 days the level had increased by several fold. Qualitatively similar biphasic patterns of leukocyte infiltration were observed in the iris-ciliary body and aqueous humor. Leukocyte numbers in corneal washes only increased between 4-24 hr following the alkali burn. The exceptionally high degree of leukocyte infiltration into the cornea at 21 days corresponded with the presence of ulceration. Topical administration of sodium citrate (10%) inhibited the early and late phase of PMN accumulation in the alkali burned cornea, i.e. at 24 hr (-63%) and 21 days (-92%). The inhibition of PMN infiltration by sodium citrate correlates with the reduced corneal ulceration observed following treatment with this compound.
