ABSTRACT
Six patients had Acanthamoeba keratitis that manifested an unusual type of subepithelial corneal infiltrate late in the course of the disease. These infiltrates occurred in the anterior corneal stroma, often in a location removed from the site of infection. In four of these patients the infiltrates occurred with no other clinical signs of inflammation. Two patients had mild foreign-body sensation that resolved despite the persistence of the subepithelial infiltrates. The infiltrates resolved with topical corticosteroid therapy in three patients; however, in two of these three patients the infiltrates recurred when corticosteroid therapy was tapered or discontinued. The subepithelial infiltrates appeared and behaved similarly to those associated with viral and chlamydial corneal infections. An immunologic mechanism may be responsible for these unusual delayed-in-onset infiltrates.
Subject(s)
Acanthamoeba Keratitis/pathology , Acanthamoeba/isolation & purification , Acanthamoeba Keratitis/drug therapy , Adolescent , Adult , Animals , Anti-Inflammatory Agents/therapeutic use , Antiprotozoal Agents , Contact Lenses/adverse effects , Corneal Stroma/pathology , Epithelium/pathology , Female , Humans , Steroids , Visual AcuityABSTRACT
A retrospective analysis was undertaken of the clinical diagnoses of 1594 eyes that underwent penetrating keratoplasty performed in a private-referral corneal practice over a 9-year period, 1980-1988. The seven most common indications for surgery were keratoconus (24.0%), pseudophakic or aphakic bullous keratopathy (21.2%), corneal scarring (13.9%), Fuchs' endothelial dystrophy (12.5%), regraft (8.1%), and herpetic keratitis (5.3%). Keratoconus was the leading indication from 1980 to 1985. From 1985 to 1988, pseudophakic bullous keratopathy became the leading indication and correlates well with known complications associated with closed-loop anterior chamber lenses, which were widely used during the early 1980s. Less frequent indications for penetrating keratoplasty included the following: infectious (nonviral) keratitis (3.5%); acute or chronic ulcerative keratitis (2.7%); interstitial keratitis (1.8%); mechanical trauma (1.5%); other (non-Fuchs') corneal dystrophies (1.4%); congenital opacities (0.8%); and chemical burns (0.5%).
Subject(s)
Corneal Diseases/surgery , Keratoplasty, Penetrating , Aphakia/surgery , Corneal Diseases/diagnosis , Fuchs' Endothelial Dystrophy/surgery , Humans , Incidence , Keratitis, Dendritic/surgery , Keratoconus/surgery , Lenses, Intraocular , Preoperative Care , Reoperation , Retrospective StudiesABSTRACT
A 29-year-old man developed anterior uveitis unresponsive to intensive topical and systemic therapy. He had recently completed a course of chemotherapy with apparent response and resolution of metastasis from a mixed germ cell tumor (embryonal carcinoma and seminoma). Anterior chamber paracentesis was nondiagnostic on two occasions for metastatic cells. At the time of his second paracentesis a tumor marker, human chorionic gonadotropin-beta subunit, was used to confirm the diagnosis of anterior chamber metastasis to the eye.
Subject(s)
Anterior Chamber , Chorionic Gonadotropin/blood , Dysgerminoma/diagnosis , Eye Neoplasms/diagnosis , Peptide Fragments/blood , Teratoma/diagnosis , Adult , Anterior Chamber/analysis , Body Fluids/analysis , Chorionic Gonadotropin, beta Subunit, Human , Dysgerminoma/blood , Dysgerminoma/secondary , Eye Neoplasms/blood , Eye Neoplasms/secondary , Humans , Liver Neoplasms/secondary , Lung Neoplasms/secondary , Male , Suction/methods , Teratoma/blood , Teratoma/secondaryABSTRACT
Filamentary keratitis is a problem associated with a wide variety of ocular conditions. Of 114 patients receiving penetrating keratoplasty, 31 (27.2%) were noted to have filaments. Those patients receiving transplants for keratoconus were noted to have the highest incidence (12 of 31, 39%), while transplants following herpetic scars were not associated with filaments (0 of 11) in this series. Suturing technique or relation of donor button-to-graft site were not apparently important factors in the development of postoperative filamentary keratitis.
