Subject(s)
Corneal Diseases/diagnostic imaging , Cysts/diagnostic imaging , Descemet Membrane/diagnostic imaging , Tomography, Optical Coherence , Adolescent , Aged , Corneal Diseases/diagnosis , Corneal Diseases/surgery , Cysts/diagnosis , Cysts/surgery , Descemet Membrane/pathology , Descemet Membrane/surgery , Female , Fuchs' Endothelial Dystrophy/complications , Fuchs' Endothelial Dystrophy/diagnostic imaging , Fuchs' Endothelial Dystrophy/surgery , Humans , Keratoplasty, Penetrating , Male , Osteogenesis Imperfecta/complications , Osteogenesis Imperfecta/diagnostic imaging , Osteogenesis Imperfecta/surgeryABSTRACT
Iatrogenic corneal ectasia is a rare but devastating complication after refractive surgery. While its incidence appears to be declining, it has not been eliminated. Its cause is probably related to a combination of an intrinsic predisposition to ectasia and an additional anatomical destabilising effect from the refractive surgery. Determining which eyes are intrinsically "weak" and exactly how much additional "weakening" an eye can withstand before developing progressive thinning and protrusion are both difficult tasks. The essentially universal availability of corneal topography and the increasing use of corneal tomography have significantly improved our ability to preoperatively diagnose early forms of corneal ectasias, especially keratoconus and pellucid marginal degeneration. Advanced software algorithms have also enhanced the sensitivity and specificity of these technologies. Newer technologies, such as measuring corneal biomechanics and corneal epithelial distribution, will hopefully continue to help us to differentiate normal from abnormal corneas preoperatively. In addition to abnormalities in anterior and posterior corneal curvature, a number of other risk factors for the development of post-refractive surgery ectasia have been proposed, including younger patient age, thinner central corneal thickness, thinner residual stromal bed thickness and high myopia. If the percentage of altered tissue is > 40â%, this is an extremely accurate predictor of corneal ectasia after refractive surgery. While there are a number of effective treatments for iatrogenic corneal ectasia, such as contact lenses, corneal crosslinking, intracorneal rings and corneal transplantation, prevention should be the goal. With newer and better corneal imaging technology to help screen out patients with abnormal corneas along with an improved understanding of exactly how much weakening a given cornea can take, we should be able to minimize this vision threatening complication.
Subject(s)
Corneal Diseases/diagnosis , Corneal Diseases/therapy , Corneal Topography/methods , Refractive Surgical Procedures/adverse effects , Tomography, Optical Coherence/methods , Corneal Diseases/etiology , Corneal Diseases/pathology , Diagnosis, Differential , Early Diagnosis , Evidence-Based Medicine , Humans , Iatrogenic Disease/prevention & control , Treatment OutcomeABSTRACT
PURPOSE: To determine the characteristics of patients with anterior scleritis at a tertiary care eye center and determine which factors in these patients were associated with the need for systemic immunosuppressive therapy. PATIENTS AND METHODS: Retrospective study. Fifty patients with anterior scleritis presenting to the Cornea Service at Wills Eye Hospital from August 1996 to August 2001 were reviewed and divided into two groups. The control group included 35 patients who responded to oral non-steroid anti-inflammatory drugs (NSAIDs) and/or systemic steroids. The study group consisted of 15 patients who required additional treatment with systemic immunosuppressive agents. The influence of demographics, type of scleritis, bilateral disease, and ocular complications were analyzed. The presence of a systemic autoimmune disease, the best corrected visual acuity (BCVA), medications, and complications related to treatment were recorded. The statistical significance was evaluated by Student's t test for independence samples and Fisher's exact test; P<0.05 was considered significant. RESULTS: After a mean follow-up of 19.3 +/- 24.9 months, an associated systemic autoimmune disease was present in 17 patients (34%). Scleritis was the first manifestation of the systemic disease in 10 out of 17 patients (59%). Patients who required immunosuppressive treatment had more frequent ocular complications (80% versus 26%, P=0.0004) than did patients who responded to oral NSAIDs and/or steroids. CONCLUSIONS: Scleritis may be the sign of presentation of a systemic autoimmune disease. The presence of ocular complications, in particular corneal involvement, may be associated with the need for systemic immunosuppressive therapy.
Subject(s)
Immunosuppressive Agents/therapeutic use , Scleritis/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Case-Control Studies , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVE: To evaluate clear corneal wound infections after phacoemulsification. MATERIALS AND METHODS: The medical records of 7 patients with clear corneal wound infections after phacoemulsification were reviewed retrospectively. Data that were reviewed included patient age, sex, onset of symptoms and signs after surgery, possible risk factors for infection, concomitant ocular disease, use of perioperative prophylactic antibiotics and steroids, culture and antibiotic sensitivity results, treatment regimen, and outcome. RESULTS: The median onset of signs and symptoms after surgery was 10 days (range, 4-60 days). Corneal cultures yielded methicillin-resistant Staphylococcus aureus in 2 cases, Streptococcus pneumoniae in 1 case, and Staphylococcus epidermidis in 1 case. Cultures yielded no microorganisms for 1 patient. Corneal cultures were not obtained in 2 patients. In 3 of the 4 culture-positive cases, the isolated microorganisms were resistant to the perioperative prophylactic antibiotics (fluoroquinolones and tobramycin) that were used. No possible risk factors were noted except use of topical steroids 4 times a day without antibiotic coverage for iritis before referral in one of our patients. Six of these 7 wound infections healed with topical antibiotic therapy. One of the patients required lamellar keratectomy and conjunctival flap for complete healing. In 4 of the 7 cases, best-corrected visual acuity at the last follow-up visit was better than 20/40. CONCLUSIONS: Clear corneal wound infection after phacoemulsification is a serious complication of cataract surgery. Infections are caused by gram-positive organisms sensitive to bacitracin and the combination of trimethoprim-sulfamethoxazole but often resistant to aminoglycosides and/or fluoroquinolones.
Subject(s)
Cornea/microbiology , Corneal Ulcer/etiology , Eye Infections, Bacterial/etiology , Phacoemulsification/adverse effects , Staphylococcal Infections/etiology , Streptococcal Infections/etiology , Surgical Wound Infection/etiology , Aged , Aged, 80 and over , Anti-Bacterial Agents , Cornea/surgery , Corneal Ulcer/diagnosis , Corneal Ulcer/drug therapy , Drug Therapy, Combination/therapeutic use , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Female , Humans , Male , Methicillin Resistance , Middle Aged , Retrospective Studies , Risk Factors , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus/isolation & purification , Staphylococcus epidermidis/isolation & purification , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pneumoniae/isolation & purification , Surgical Wound Infection/diagnosis , Surgical Wound Infection/drug therapy , Visual AcuityABSTRACT
PURPOSE: To report a rare complication in which the patient accidentally removed the laser in situ keratomileusis corneal flap. METHODS: Interventional case report. A 35-year-old woman underwent uncomplicated laser in situ keratomileusis surgery. Ten days after surgery, she inserted a soft contact lens into the right eye to improve her vision. She tried to remove the contact lens, but had pain and bleeding. She was referred 10 days later with a diagnosis of loss of flap. RESULTS: On examination, she had a best-corrected visual acuity of 20/70 in the right eye. The right eye examination revealed no corneal flap, mild corneal edema, and significant haze. A central epithelial defect was found. CONCLUSION: Accidental corneal flap removal can rarely follow laser in situ keratomileusis surgery. This complication provides insight into the weak adhesion of the flap onto the stromal bed after laser in situ keratomileusis surgery and, hence, the inherent risk of traumatic flap dislocation or amputation, which needs to be explained to the patient.
Subject(s)
Amputation, Traumatic/complications , Corneal Stroma/injuries , Keratomileusis, Laser In Situ , Surgical Flaps , Adult , Corneal Edema/diagnosis , Corneal Edema/etiology , Corneal Opacity/diagnosis , Corneal Opacity/etiology , Corneal Stroma/surgery , Epithelium, Corneal/pathology , Female , Humans , Myopia/surgery , Visual Acuity , Wound HealingABSTRACT
PURPOSE: To describe an unusual and possibly new keratopathy in human immunodeficiency virus (HIV)-positive patients. DESIGN: Retrospective observational case series. PARTICIPANTS: : Six HIV-positive patients at four centers. METHODS: A complete medical history was obtained and a thorough ophthalmic examination was performed on each of the patients. RESULTS: Each patient had bilaterally symmetrical keratopathy consisting of variably pigmented round and reticular posterior intracorneal precipitates at the level of Descemet's membrane. The precipitates were diffuse, but larger and more prominent near the limbus and finer toward the central cornea. None of the eyes were inflamed, and all had normal vision. No patient had uveitis on presentation or any history of cytomegalovirus retinitis. CONCLUSION: These patients have a unique posterior keratopathy, which requires further investigation.
Subject(s)
Corneal Diseases/etiology , Descemet Membrane/pathology , Eye Infections, Viral/etiology , HIV Seropositivity/complications , Adult , Antiviral Agents/therapeutic use , Corneal Diseases/diagnosis , Eye Infections, Viral/diagnosis , HIV Seropositivity/drug therapy , Humans , Male , Middle Aged , Retrospective Studies , Visual AcuityABSTRACT
OBJECTIVE: This document describes intrastromal corneal ring segments (Intacs) inserts technology and examines the evidence to answer the key question about whether the treatment is safe and effective in correcting low myopia. METHODS: A literature search that was conducted in September 2000 retrieved 13 relevant citations, and the reference lists of these articles were consulted for additional citations. Panel members reviewed this information and articles were rated according to the strength of evidence. RESULTS: Prospective multicenter phase II and III clinical trials (Level II evidence rating) of Intacs inserts for myopia of -1.00 to -3.00 diopters (D), with a maximum of +1.00 D of astigmatism, enrolled a total of 452 subjects, with a total of 454 surgical attempts. The results from phase II and phase III were pooled for much of the analysis. At 1 year, 97% of patients who completed follow-up had 20/40 or better uncorrected visual acuity (UCVA). Seventy-four percent of patients had 20/20 or better UCVA. Ninety-two percent of eyes were within +/-1 D of intended refractive correction, and 69% were within 0.5 D of intended refractive correction. At 3 months, 90% of patients had less than 1.0 D of change from the previous examination performed at 1 month. The ocular complication rate, which was defined as clinically significant events but not resulting in permanent sequelae, was 11% at 12 months. The adverse event rate was 1.1%, defined as a serious event if untreated. Nearly 9% of patients requested to have their inserts removed and a total of 3.8% of patients required a secondary surgical intervention. CONCLUSIONS: To date, evidence suggests that low myopia (-1 to -3 D) in a well-defined group of patients who have a stable manifest refraction and less than +1.0 D of astigmatism can be treated with Intacs inserts with a reasonable assurance of safety and effectiveness. Additional clinical research is needed to determine the long-term effectiveness of treatment and the comparative safety, effectiveness, and costs with other treatment modalities, including laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).
Subject(s)
Corneal Stroma/surgery , Myopia/surgery , Ophthalmology , Prostheses and Implants , Prosthesis Implantation , Technology Assessment, Biomedical , Academies and Institutes , Clinical Trials as Topic , Device Removal , Humans , United States , Visual AcuityABSTRACT
PURPOSE: To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients. METHODS: In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up. RESULTS: Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 +/- 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 +/- 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant ( p = 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid. CONCLUSION: Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only minor complications.
Subject(s)
Corneal Diseases/surgery , Eyelids/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Treatment Outcome , Wound HealingABSTRACT
PURPOSE: To report three cases of seemingly unilateral dystrophy indistinguishable from type I classic lattice corneal dystrophy. METHODS: Case study of three patients. Three patients, a 31-year-old man, a 44-year-old woman, and a 41-year-old man had multiple lattice lesions in one eye and an apparently healthy fellow eye. Two of these patients underwent penetrating keratoplasty because of poor vision. RESULTS: Histopathologic examination of the excised corneal button of patient 2 showed amyloid deposits consistent with lattice. In the third patient, lattice lesions were noted in the other eye nearly 13 years after he was first examined. CONCLUSIONS: Lattice corneal dystrophy is rarely unilateral. Lattice, even in unilateral cases, may cause significant vision loss to warrant penetrating keratoplasty. Lattice lesions may develop in the fellow eye many years later. This possibility should be explained to all patients with apparently unilateral lattice corneal dystrophy.
Subject(s)
Cornea/pathology , Corneal Dystrophies, Hereditary/diagnosis , Adult , Amyloid/metabolism , Amyloidosis/diagnosis , Cornea/metabolism , Cornea/surgery , Corneal Dystrophies, Hereditary/metabolism , Corneal Dystrophies, Hereditary/surgery , Female , Humans , Keratoplasty, Penetrating , MaleABSTRACT
PURPOSE: To describe a post-LASIK patient with decreased vision and a chalazion of the upper eyelid. METHODS: A 46-year-old man was referred with decreased vision of 1 month's duration. He underwent bilateral uncomplicated LASIK for myopic astigmatism 1.5 years and bilateral enhancements 1 year previously. He had 20/20 uncorrected vision in both eyes after those procedures. He developed a chalazion of his right central upper eyelid 1 month prior with simultaneous blurring of vision. On our examination, his uncorrected visual acuity was 20/60 in the right eye. Complete eye examination including refraction, computerized corneal topography, and pachymetry were done. RESULTS: With a manifest refraction of +1.25 +0.50x80, the visual acuity in the right eye improved to 20/20. Computerized corneal topography revealed circular central corneal flattening in both eyes, much greater in the right eye than the left eye. The location of the chalazion with the right eye closed corresponded to the area of central corneal flattening. The central power from the corneal topography was 39.4 D OD and 40.8 D OS. He was diagnosed as having acquired hyperopia associated with chalazion-induced central corneal flattening of the right eye. Chalazion-induced hyperopic change on topography disappeared, and his uncorrected vision improved to 20/20 in the left eye as the chalazion resolved completely. CONCLUSION: In post-LASIK patients with decreased vision and topography changes late after surgery, periocular masses should be considered in the differential diagnosis. Decreased corneal thickness and rigidity after LASIK might be a predisposing factor to external compression-induced curvature changes.
Subject(s)
Chalazion/complications , Hyperopia/etiology , Keratomileusis, Laser In Situ , Postoperative Complications , Vision Disorders/etiology , Astigmatism/surgery , Corneal Topography , Humans , Male , Middle Aged , Myopia/surgery , Visual AcuityABSTRACT
Excimer laser phototherapeutic keratectomy (PTK) is an important tool in the management of superficial corneal pathology. It works well in the treatment of anterior corneal dystrophies and degenerations, but we are learning that it may have a role in the treatment of certain patients with deeper corneal pathology. Indications also are being expanded to treat much less common conditions and also to treat children. Irregular astigmatism, which is not treated very well with current PTK techniques, may be addressed better with newer approaches, such as selective zonal ablation and the use of BioMask. As current PTK techniques are improved and newer methods are developed, this procedure will continue to be an excellent option for certain patients with superficial corneal problems.
Subject(s)
Cornea/surgery , Corneal Diseases/surgery , Photorefractive Keratectomy , Humans , Lasers, ExcimerABSTRACT
PURPOSE: Pennsylvania Act 102 implemented in March 1995 required all acute care hospitals in Pennsylvania to routinely refer all deaths to the Organ Procurement Organization for determination of suitability for organ/tissue donation. This study analyzed the effect of the law on eye donation. METHODS: Retrospective analysis of the total number of referrals and the actual number of eye donations from 62 hospitals in Pennsylvania to the Lions Eye Bank of Delaware Valley was performed for the years 1993 to 1998. Information gathered included donor's age, gender, race, cause of death, referring institution, and result of referral. RESULTS: From 1993 to 1998, the total numbers of referrals were 988, 1,647, 8,101, 21,123, 21,783, and 22,987, and the numbers of donors were 570, 574, 660, 644, 594, and 568, respectively. The increase in the number of donors after implementation of the law was not commensurate with the number of referrals. This was caused by a disproportionate increase in the number of referrals older than 70 years of age (from a mean of 33% to 52%), which exceeded the donor age limit of 69 years, and also to a lower family consent rate (from a mean of 48% to 24%). CONCLUSIONS: Well-designed state legislation with proper implementation greatly increased hospital referrals for eye donation. However, there was only a small increase in the number of eye donors because many of the referrals were beyond the acceptable upper age limit for eye donation. A small increase in the donor age limit would increase the number of eye donations without having to expand the potential donor pool. Education of the public may help to improve the family consent rate.
Subject(s)
Eye Banks/legislation & jurisprudence , State Government , Tissue Donors/legislation & jurisprudence , Tissue and Organ Procurement/legislation & jurisprudence , Adolescent , Adult , Aged , Child , Cornea , Eye Banks/statistics & numerical data , Female , Humans , Male , Middle Aged , Mortality/trends , Pennsylvania , Retrospective Studies , Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/statistics & numerical dataABSTRACT
PURPOSE: To determine the benefit of bilateral penetrating keratoplasty with regard to binocular vision. METHODS: We compared patients who underwent corneal transplantation bilaterally with patients who had successful corneal transplantation in one eye and corneal disease in the other eye. Specifically, changes in fusion, stereopsis, and binocular vision function were analyzed. A questionnaire regarding performance of daily tasks was given. RESULTS: Patients with bilateral keratoplasty performed better in all the analyzed functions. Fusion was achieved by 81.25% in the unilateral group versus 100% in the bilateral group (p = 0.15). Stereopsis was present more in the bilateral group (100% vs. 62.5%, p = 0.008) and the quantity of stereopsis was significantly better in the bilateral group (121 seconds of arc vs. 1,284 seconds of arc, p = 0.014). 88.8% of the patients subjectively improved in daily activities after second eye surgery. CONCLUSION: There are objective and subjective improvements after bilateral penetrating keratoplasty.
Subject(s)
Keratoplasty, Penetrating , Vision, Binocular/physiology , Activities of Daily Living , Adult , Aged , Aged, 80 and over , Cornea/physiopathology , Cornea/surgery , Corneal Diseases/physiopathology , Corneal Diseases/surgery , Depth Perception/physiology , Female , Humans , Male , Middle Aged , Recovery of Function/physiology , Vision Disparity , Visual Acuity/physiologyABSTRACT
PURPOSE: To report a case of infectious crystalline keratopathy (ICK) in a patient with systemic malignancy on immunosuppressive chemotherapy. The patient wore frequent replacement contact lenses on an extended wear basis. METHODS: A 51-year-old female with carcinoma of the breast and systemic metastases was referred for a corneal ulcer. She received intravenous docetaxel, trastuzumab, and systemic dexamethasone. She wore frequent replacement Acuvue lenses on an extended wear basis. Her visual acuity was 20/200 in the right eye and 20/400 in the left eye. The right eye examination revealed diffuse superficial punctate keratopathy. In the left eye, there was a 3.8 x 4.5 mm corneal infiltrate with projecting crystalline processes. Corneal scrapings were performed for smears and cultures. Treatment with topical fortified cefazolin and fortified tobramycin every hour around the clock was initiated. RESULTS: Culture of the corneal scrapings grew Streptococcus anginosus and Staphylococcus aureus. There was a good response to medical therapy. When last seen after 4 weeks of treatment, the infiltrate measured about 1 mm and the visual acuity was 20/40 with pinhole. CONCLUSIONS: Systemic immunosuppression may be a predisposing factor for the development of ICK. This case suggests that debilitated patients may be at risk for unusual infections and should be discouraged from overnight wear of contact lenses.
Subject(s)
Corneal Ulcer/microbiology , Eye Infections, Bacterial , Immunosuppression Therapy , Staphylococcal Infections , Staphylococcus aureus/isolation & purification , Streptococcal Infections , Streptococcus/isolation & purification , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Cefazolin/therapeutic use , Contact Lenses , Cornea/microbiology , Corneal Ulcer/diagnosis , Corneal Ulcer/drug therapy , Drug Therapy, Combination/therapeutic use , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Female , Humans , Middle Aged , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , Tobramycin/therapeutic use , Visual AcuityABSTRACT
PURPOSE: Testing for the p24 antigen of the human immunodeficiency virus (HIV) may detect early HIV infection in the seronegative window; however, falsely reactive results may occur in cadaver specimens. Although neither the Food and Drug Administration (FDA) nor the Eye Bank Association of America requires p24 testing of cornea donors, many tissue banks using other organs from cornea donors do perform this assay, and the FDA requires that eye banks reject corneal tissue if a reactive p24 assay is reported. We investigated the impact of p24 testing on eye banking and corneal transplantation. METHODS: Two clinical cases and records from the Lions Eye Bank of Delaware Valley (LEBDV) were reviewed retrospectively. RESULTS: Two corneas from the LEBDV were transplanted before the reporting of p24 reactivity by other tissue banks. In one case, because of the young age of the recipient, the surgeon elected to replace the cornea with new tissue hours after the original transplant, and later polymerase chain reaction (PCR) testing was negative. In the other case, there was not enough specimen to perform Western blot or PCR confirmatory testing. The patient was followed with periodic serologic testing for HIV and has remained seronegative. To avoid such problems in the future, the LEBDV initiated testing of all donors with p24 and other nonrequired screening tests. Over a 2-month period, 22 corneas (from 11 donors) were discarded because of these tests: 4 donors had reactive p24 tests, 6 were reactive for antibody to hepatitis B core antigen, and 1 had a reactive syphilis test. CONCLUSIONS: Results from p24 assays by other tissue banks may cause difficult clinical situations when the results are received after transplantation of the tissue, but the use of the p24 assay in the screening of cornea donors may result in excessive waste of donor tissue. Further guidance is needed regarding the management of positive results from this and other nonrequired screening tests.
Subject(s)
Cornea/virology , Corneal Transplantation , HIV Core Protein p24/analysis , HIV Seropositivity/diagnosis , Tissue Donors , Adolescent , Blotting, Western , Child, Preschool , Eye Banks/standards , HIV-1/genetics , HIV-1/immunology , Hepatitis B Core Antigens/analysis , Humans , Keratoconus/surgery , Male , Mass Screening , Middle Aged , Polymerase Chain Reaction , Reoperation , Retrospective Studies , Serologic Tests , United States , United States Food and Drug Administration/standardsABSTRACT
PURPOSE: To identify changes in number of contact lens-related corneal ulcers per year and the type of contact lenses involved. METHODS: Charts of 299 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from January 1, 1996, to June 30, 1999, were retrospectively reviewed. A corneal ulcer was defined as an infiltrate that was treated at least hourly with topical fortified antibiotics or fluoroquinolones. RESULTS: Of these 299 cases, 37 (12.4%) were related to contact lens use. Contact lens-related ulcers accounted for 10.7% of all corneal ulcers in 1996, 15.3% in 1997, 8.6% in 1998, and 18.2% in the first 6 months of 1999. The contact lenses most commonly associated with ulcers were conventional soft daily-wear contact lenses (33%). There were similar numbers of ulcers associated with extended wear (n = 16) and daily wear (n = 17) of soft contact lenses. In addition, the number of cases associated with conventional (n = 17) and disposable/frequent replacement (n = 16) lenses were similar. Corneal cultures were performed in 15 (40.5%) cases and were positive in 8. There has been a significant decrease in the number of contact lens-related ulcers treated at our institution compared with previous years (1988-1999, p < 0.01). CONCLUSIONS: The number of contact lens-related corneal ulcers in the past 4 years was significantly fewer than previous years at our institution. A similar number of ulcers were associated with conventional and disposable/frequent replacement lenses despite the commercial preponderance of the latter type of lenses.
Subject(s)
Contact Lenses/trends , Corneal Ulcer/epidemiology , Adolescent , Adult , Aged , Anti-Infective Agents/therapeutic use , Contact Lenses/adverse effects , Corneal Ulcer/etiology , Disposable Equipment , Eye Infections/drug therapy , Eye Infections/epidemiology , Eye Infections/etiology , Female , Fluoroquinolones , Humans , Male , Middle Aged , Philadelphia/epidemiology , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the clinical outcome of penetrating keratoplasty (PK) in iridocorneal endothelial (ICE) syndrome. METHODS: Clinical charts of patients who underwent penetrating keratoplasty for ICE syndrome between 1985 and 1999 were reviewed retrospectively. Glaucoma control, best corrected visual acuity pre- and post-PK, graft clarity, graft rejection episodes, improvement in pain, and additional procedures were analyzed. RESULTS: Fourteen cases were reviewed with an average follow-up of 58 months after PK. Initial grafts failed in seven patients (50%), in six cases because of rejection, and one owing to endothelial failure without signs of rejection. Repeat PKs were performed in six patients. At final follow-up, 12 grafts were clear. Glaucoma was controlled pre- and post-PK (average intraocular pressure, 16 mmHg for both eyes). Pre-PK, eight patients were using glaucoma medicines and nine had had glaucoma surgery. At the end of the follow-up, seven patients were using glaucoma medicines; six patients required glaucoma surgery after their initial PK. At the final follow-up visit, visual acuity in three patients (21%) was 20/40 or better, it ranged from 20/50 to 20/100 in four patients (29%) and 20/200 to 20/400 in five patients (36%), and in two patients with failed grafts (14%) it was counting fingers or worse. CONCLUSION: Clear grafts were achieved in 12 cases, although six patients (43%) underwent repeat PKs. All patients had glaucoma, which was controlled before and after PK by medical treatment and surgical procedures. Favorable outcomes can be achieved in patients with ICE syndrome but may require multiple corneal and glaucoma procedures.
Subject(s)
Corneal Diseases/surgery , Endothelium, Corneal/surgery , Iris Diseases/surgery , Keratoplasty, Penetrating , Adult , Aged , Corneal Diseases/complications , Endothelium, Corneal/pathology , Female , Follow-Up Studies , Glaucoma/etiology , Glaucoma/surgery , Graft Survival , Humans , Intraocular Pressure , Iris Diseases/complications , Male , Middle Aged , Retrospective Studies , Syndrome , Treatment Outcome , Visual AcuityABSTRACT
PURPOSE: To evaluate the effects of medical and surgical therapy for glaucoma in patients requiring repeat penetrating keratoplasty (PK) for endothelial failure. METHODS: Retrospective review of the charts of all patients undergoing repeat PK at the Cornea Service at Wills Eye Hospital between January 1, 1989 and December 31, 1995. Study end-points were time to first rejection episode, number of rejection episodes, time to endothelial failure, and time to regraft. RESULTS: During the study period, 156 patients underwent repeat PK for irreversible endothelial failure. Ninety-four (60.3%) patients had a concomitant diagnosis of glaucoma. Of these 94, 27 (28.7%) underwent glaucoma surgery. The surgically treated group had a significantly higher percentage of patients with at least one rejection episode (55.6%) than those without glaucoma (32.8%; p = 0.04). Similarly, a significant difference existed in the percentage of both medically and surgically treated glaucoma patients having at least one rejection episode (50%) when compared with patients without glaucoma (32.8%; p = 0.04). Rejection episodes occurred sooner in the glaucoma patients than in the nonglaucoma group (18 months vs. 32 months; p = 0.01), irrespective of glaucoma therapy. Grafts in glaucoma patients failed 12 months earlier than those in patients without glaucoma. CONCLUSION: In a selected group of patients who required repeat PK for endothelial graft failure, a majority of patients were found to have a history of glaucoma. Among regraft patients, surgical therapy for glaucoma was found to increase the risk of rejection episodes when compared to patients without glaucoma. The patients with glaucoma were found to be at increased risk for early rejection and failure compared to patients without glaucoma.
Subject(s)
Corneal Diseases/surgery , Filtering Surgery/methods , Glaucoma/surgery , Graft Rejection/prevention & control , Keratoplasty, Penetrating , Corneal Diseases/complications , Corneal Diseases/pathology , Endothelium, Corneal/pathology , Female , Glaucoma/complications , Graft Rejection/etiology , Graft Rejection/pathology , Humans , Intraocular Pressure , Keratoplasty, Penetrating/pathology , Male , Middle Aged , Prognosis , Reoperation , Retrospective Studies , Risk Factors , Secondary PreventionSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cataract Extraction , Cornea/drug effects , Corneal Diseases/chemically induced , Diclofenac/adverse effects , Administration, Topical , Aged , Cornea/pathology , Corneal Diseases/pathology , Corneal Diseases/therapy , Corneal Transplantation , Female , Humans , Keratoplasty, Penetrating , Male , Ophthalmic Solutions/adverse effects , Rupture, Spontaneous/etiology , Rupture, Spontaneous/pathology , Rupture, Spontaneous/therapy , Tissue AdhesivesABSTRACT
PURPOSE: To report the surgical outcomes of treatment for ocular surface squamous neoplasms. METHODS: Retrospective review of squamous neoplasms of the ocular surface managed at a cornea center over a 15-year period. Surgical treatment was divided into two methods. The procedure was identical within each group. One group of patients was treated with simple excision of the lesion. The second group of patients was treated with excision followed by focal cryotherapy to the involved limbus and/or conjunctival margin. Follow-up is reported. RESULTS: A total of 28 lesions were reviewed. Included were 20 primary tumors and 8 recurrent tumors referred following initial treatment at other centers. Histopathologic diagnoses included 1 actinic keratosis, 7 dysplasias, 18 carcinomas in situ, and 2 invasive squamous cell carcinomas. The rate of recurrence for primary tumors was 28.5% with simple excision and 7.7% for excision combined with cryotherapy (p = 0.27). The rate of recurrence for recurrent tumors was higher: 16.6% for tumors treated with excision and cryotherapy and 50% (one in two) for lesions treated with simple excision (p = 0.46). CONCLUSION: Simple excision of ocular surface squamous neoplasms appears to result in a higher recurrence rate when compared to excision with adjunctive cryotherapy. Judicious cryotherapy to the involved limbus and conjunctival margins results in recurrence rates comparable with other, more extensive cryotherapy procedures. This technique of cryotherapy has very few adverse effects on the eye.