Prevalence of pinguecula and pterygium in a general population in Spain.

PURPOSE: To determine the prevalence of pinguecula and pterygium and to investigate their associations in a general adult population in North-Western Spain. METHODS: An age-stratified random sample of 1155 subjects ≥ 40 years was selected in O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (SD): 63.4 (14.5) years, range: 40-96 years, 37.0% males). An interview to collect history of systemic diseases and lifestyle details and a comprehensive ophthalmic evaluation in which pinguecula and pterygium were recorded was carried out. The prevalence of pinguecula and pterygium and their relationship with lifestyle factors and ocular and systemic diseases was investigated. RESULTS: The prevalence of pinguecula was 47.9% (95% confidence interval (CI): 43.9-51.9). This prevalence increased significantly with aging (P = 0.002) and was higher in men (56.4%; 95% CI: 50.0-62.7) than in women (42.7%; 95% CI: 37.8-47.8) (P=0.001). The prevalence of pterygium was 5.9% (95% CI: 4.3-7.9). This prevalence also increased significantly with aging (P = 0.005) and was 4.8% (95% CI: 2.6-8.4) in men and 6.5% (95% CI: 4.5-9.3) in women (P = 0.346). After controlling for age and sex, pinguecula was associated with alcohol intake (adjusted odds ratio (OR(a)): 3.08; 95% CI: 1.60-5.95), pterygium with fluorescein staining (OR(a): 2.64; 95% CI: 1.08-6.46) and both disorders with outer activity (OR(a): 2.07; 95% CI: 1.36-3.15 and 2.28; 95% CI: 1.04-4.98, respectively). CONCLUSIONS: Pinguecula is far more common than pterygium. Alcohol consumption is strongly associated with pinguecula. Fluorescein staining is highly prevalent in subjects with pterygium. Both disorders increase with age and are associated with outer activity.

[Limbal transplantation: multicenter retrospective case series analysis]. / Estudio multicéntrico retrospectivo sobre trasplante de limbo.

PURPOSE: To report the results of limbal transplantation (LT) in patients with limbal stem cell deficiency (LSCD) in the context of ocular surface diseases. MATERIALS AND METHODS: A multicenter (5 centers) retrospective case series analysis of patients who underwent LT between 1996 and 2004 was performed. Data were collected by the same researcher using a customized database. Success was defined by the absence of a persistent corneal epithelial defect, on-going inflammation or recurrence of a pterygium. RESULTS: Data from 72 LT performed in 61 patients (65 eyes) with a mean follow-up of 20.8 months (SD 23.5; range, 3-115) were analyzed. There were 33 males and 28 females with a mean age of 55.8 years (SD: 15.6; range, 20-89). Fifty-eight (80.6%) LT were autografts (40 pterygia, 12 alkali burns, 3 iatrogenic cases, 2 viral infections, 1 neoplasia case) and 14 (19.4%) were allografts from cadaveric donors (7 immune-based disorders, 6 alkali burns, 1 iatrogenic case); all patients receiving allografts also received systemic immunosuppression. Of the total number of LT, 48 (66.7%) were successful. This proportion increased to 81.0% (47/58) when autografts were used. However, only 7.1% (1/14) of all allografts were successful. The success rate was higher (80.0%) when performed for a pterygium and lower when done for immune-based inflammation (14.3%). CONCLUSION: Autograft tissue for LT is always preferable to allografts to surgically treat LSCD, as clinical success is significantly higher, and systemic immunosuppression is avoided. As expected, immune-based disorders are the most difficult cases to treat. LT has been shown to be an excellent option for recurrent pterygium, although prospective studies need to be performed to further corroborate these results.

Adherence of Acanthamoeba to unworn conventional and disposable soft contact lenses.

PURPOSE: To compare the adherence of Acanthamoeba trophozoites and cysts to two types of unworn conventional and disposable contact lenses included in groups 1 and 4 of the Food and Drug Administration and to assess the adherence to the center and edge of the lenses. METHODS: We used 10 conventional and 10 disposable contact lenses belonging to groups 1 and 4 of the Food and Drug Administration. Each lens was divided into four segments. A human corneal isolate of Acanthamoeba suspended in saline (1x 105 amoebae/mL) was used. Lens segments were exposed to Acanthamoeba cysts and trophozoites for 2 hours. After removal, the count was made with an optical microscope at 100x magnification. Three fields at the center and three fields at the edge were read on each segment. RESULTS: Acanthamoeba adhered to both types of contact lenses, with a proportion of trophozoites to cysts between 6:4 and 7:3. There was a significantly higher adherence to disposable (8.14 +/- 3.57 organisms/mm(2)) than to conventional (4.94 +/- 2.33 organisms/mm(2)) (p < 0.0001) contact lenses. We also found that the greatest adherence was to the edge of the conventional (12.05 +/- 4.03 organisms/mm(2)) and disposable (26.10 +/- 7.84 organisms/mm(2) (p < 0.0001) contact lenses. CONCLUSIONS: This study shows that Acanthamoeba has varying adherence affinity for different new hydrogel contact lenses. The affinity for disposable lenses (etafilcon A) is significantly higher than that for conventional lenses (polymacon). This adherence is greater for ionic material and high water content. The use of low water content, nonionic contact lenses may reduce the adherence of Acanthamoeba. Finally, the edge may play an important role as an Acanthamoeba vector.

Comamonas acidovorans keratitis in a hydrogel contact lens wearer.

PURPOSE: To present an unusual case of keratitis in a patient who wears hydrogel contact lenses that are replaced on a monthly basis. The agent isolated was Comamonas acidovorans, a species of Pseudomonas. METHODS AND RESULTS: A 40-year-old patient who wears hydrogel contact lenses that are replaced on a monthly basis presented with a red eye. The patient reported that the eye had been red for 2 days. A peripheral corneal stromal infiltrate was found and Comamonas acidovorans was isolated in culture. The patient was initially treated with high-dose gentamicin. After the results of cultures and sensitivity studies were obtained, she was given ciprofloxacin, leading to the remission of the case. CONCLUSIONS: Comamonas acidovorans should be considered as a possible agent of keratitis in hydrogel contact lens wearers-a culture and sensitivity studies may be indicated.

Efficacy of subconjunctival cyclosporin-containing microspheres on keratoplasty rejection in the rabbit.

BACKGROUND: The purpose of this study was to evaluate microspheres of PLGA containing cyclosporin (CsA) as a subconjunctival drug delivery system and to test their efficacy in the prevention of corneal allograft rejection in the rabbit. METHODS: Rabbits were injected subconjunctivally with a solution of CsA (CsA-AR) (20 animals) or a microsphere suspension of CsA (CsA-MP) (20 animals), with equivalent drug concentrations (15 mg/ml). The concentration of CsA in the aqueous, cornea and blood was measured by radioimmunoassay at different times thereafter. In other rabbits, 40 allogeneic grafts were performed. Animals were divided into four groups that received the following subconjunctival treatments: group 1: AR solution (solvents of CsA-AR solution); group 2: CsA-AR solution; group 3: MP suspension (empty microspheres); group 4: CsA-MP suspension. RESULTS: Mean corneal levels of CsA were 1174+/-830, 918+/-179, 972+/-580, 268+/-182 and 243+/-162 ng/ml at 12, 24 and 48 h and 7 and 14 days after the injection of CsA-AR. For the CsA-MP suspension, corneal concentrations were 1195+/-321, 234+/-147 and 88+/-77 ng/ml at 12, 24 and 48 h but subsequently dropped to undetectable levels. Blood and aqueous levels were undetectable. Treatment with CsA significantly improved the survival time and survival rate of grafts in the CsA-treated groups (2, 4) over grafts in non-CsA-treated groups (1, 3). There was no significant difference in the graft survival curve between groups 2 and 4. CONCLUSION: CsA-containing microspheres might be a promising formulation in the prevention of corneal graft rejection. Since the levels of CsA in blood were undetectable, this treatment might avoid the problems associated with systemic side effects.

Repair of scleral perforation with preserved scleral and amniotic membrane in Marfan's syndrome.

To describe the surgical technique used in the repair of a large scleral perforation in a patient with Marfan's syndrome and a past history of various surgical interventions in both eyes. Scleral homograft and amniotic membrane transplant were used to reconstruct the large scleral defect present in his left eye. One month after surgical intervention, the patient showed excellent restoration of the scleral perforation without signs of inflammation or infection. The combination of scleral homograft and amniotic membrane transplant constitute an effective alternative to autologous scleral and conjunctival grafts when these cannot be used.

Aspergillus fumigatus scleritis.

We report a case of scleritis caused by Aspergillus fumigatus. The infection was successfully treated with antifungal drugs, cryotherapy and dura mater grafting. A 67-year-old man developed a scleral ulcer 2 months after suffering a trauma in his right eye caused by the branch of a tree. Diagnosis was made after biopsy of a scleral nodule. Scrapings showed hyphal fragments and cultures were positive for Aspergillus fumigatus. Although therapy with oral fluconazol and topical amphotericin B was begun, the scleritis continued to worsen, so cryotherapy and dura mater grafting were performed. The patient showed no signs of infection for 8 months after discontinuation of antifungal drugs.

Heparin inhibits Pseudomonas adherence to soft contact lenses.

Adherence of bacteria to the surface of contact lenses may play an important role in contact lens intolerance and corneal infections. To decrease the capability of bacteria to adhere to contact lenses we incubated two types of soft contact lenses with two strains of Pseudomonas aeruginosa (serotypes 0:11 and 0:8) at a concentration of 5 x 10(7) c.f.u./ml for 12 hours. When heparin was added to the medium at a concentration of 1000 IU/ml the numbers of bacteria adhering to the contact lenses were significantly fewer than in the controls (p < 0.005). Our results suggest that heparin, either included in contact lens solutions or bonded to the surface of the contact lens, may decrease contact-lens-related morbidity.

Crescentic resection for the treatment of pellucid corneal marginal degeneration.

The left eye of a patient with bilateral pellucid marginal corneal degeneration was treated by crescentic resection of the affected part. The treatment, while it has not been monitored over the long term, appears to have many advantages over penetrating keratoplasty.

Idiopathic lipid corneal degeneration.

Two patients with no history of eye disease or systemic disorder exhibited bilateral corneal lipid annular infiltrates, together with deep stromal vascularization. Penetrating keratoplasty was performed on one eye of each patient, and one patient presented with an acute graft rejection.