Phototherapeutic keratectomy for anterior scarring in an epikeratophakia lenticule.

PURPOSE: To present a case of anterior scarring in an epikeratophakia lenticule and its partially successful treatment with the excimer laser. METHODS: Excimer laser phototherapeutic keratectomy (PTK) was used to reduce corneal scarring in an epikeratophakia lenticule. RESULTS: Visual acuity improved after two sessions of PTK. CONCLUSIONS: PTK is an alternative to epikeratophakia lenticule removal.

Recurrent subepithelial corneal opacities after excimer laser phototherapeutic keratectomy.

PURPOSE: To report the recurrence of presumed post-viral conjunctivitis subepithelial corneal opacities after excimer laser phototherapeutic keratectomy (PTK). METHOD: Case report. RESULTS: A 33-year-old ophthalmic technician developed recurrence of opacities after treatment of presumed post-viral keratitis subepithelial corneal opacities with the excimer laser. CONCLUSIONS: Post-viral keratitis subepithelial corneal opacities may recur after removal by excimer laser PTK. Recurrence of these opacities in anterior corneal stroma previously unaffected by opacities before laser treatment suggests the presence of viral antigen in deeper corneal tissue than that occupied by the original subepithelial opacities. The recurrence also suggests likely routes of corneal antibody penetration in the formation of these opacities. Intensive topical steroid treatment may play a role by increasing the depth of viral particle penetration into corneal stroma.

Comparison of 1.0-, 1.5-, and 2.0-pitch abdominal helical computed tomography in evaluation of normal structures and pathologic lesions.

RATIONALE AND OBJECTIVES: The authors performed a comprehensive prospective clinical trial comparing 1.0-, 1.5-, and 2.0-pitch abdominal helical computed tomography (CT) in the evaluation of normal and pathologic structures/lesions. METHODS: Seventy-five consecutive patients were randomized by computer into one of three equal groups: helical CT pitch 1.0, 1.5, and 2.0. The imaging parameters and contrast enhancement of all 75 patients were kept constant. The 75 studies were masked, placed into a randomized order, and evaluated by five separate experienced radiologists who rated visualization of 25 normal structures and up to five pathologic findings per patient using a scale of 1 (not seen) to 5 (very well seen/very sharp margins). RESULTS: There were no statistical differences in 1.0- and 1.5-pitch abdominal CT scans when assessing the display of normal and pathologic lesions. In addition, helical pitch 1.0 and 1.5 studies were equivalent for both normal and pathologic structures/lesions, whereas equivalency was not demonstrated for helical pitch 2.0 studies. Overall study assessment questions again found equivalency between helical 1.0- and 1.5-pitch studies. CONCLUSIONS: Abdominal CT performed with pitches of 1.0 and 1.5 are equivalent. Because of its advantages, we advocate the routine use of an extended pitch (1.5) in routine abdominal CT. Further studies are required to evaluate the usefulness of the helical 2.0-pitch technique.

Antimicrobial prophylaxis for ophthalmic surgery.

Preoperative, intraoperative, and postoperative antibiotic agents have been used by ophthalmic surgeons routinely as prophylaxis for postoperative endophthalmitis. The rationale for such prophylaxis and the evidence which supports its efficacy are well founded. The optimal choice of antibiotic agent--from the standpoint of efficacy, route of delivery, adverse reactions, and cost--is far less established. This review considers these issues, as well as the role of topical disinfectants, including povidone-iodine, in preoperative prophylaxis.

In vivo scanning slit confocal microscopy of Acanthamoeba keratitis. A case report.

A 29-year-old woman presented with clinical signs and symptoms of Acanthamoeba keratitis. Scanning slit confocal microscopy revealed a 26-mu-diameter object, resembling an Acanthamoeba cyst, in the anterior stroma. Numerous ovoid objects (possibly inflammatory cells, trophozoites, or altered keratocytes) were present. Normal keratocyte nuclei and the anterior corneal mosaic, readily imaged by scanning slit confocal microscopy of the normal cornea, were noticeably absent. Subsequent corneal biopsy confirmed the diagnosis of Acanthamoeba keratitis.

Linear IgA disease. The ocular manifestations.

The ocular history and examination of a 54-year-old Filipino woman with linear IgA disease is described. Results of the eye examination were consistent with chronic cicatricial conjunctivitis, showing subconjunctival fibrosis and symblepharon formation. Direct immunofluorescence of the conjunctiva was positive for IgA and C3 in a linear pattern along the epithelial basement membrane. The ophthalmologic and dermatologic findings in linear IgA disease are compared with those of dermatitis herpetiformis, bullous pemphigoid, and cicatricial pemphigoid. This is the first documented case report of the ocular manifestations of linear IgA disease in the American literature.

Acanthamoeba keratitis. A review of the literature.

Acanthamoeba is a free-living ubiquitous ameba that is responsible for a small but increasing number of cases of keratitis. The infection is associated with minimal corneal trauma and soft contact lens wear. It typically presents as a unilateral central or paracentral corneal infiltrate, often with a ring-shaped peripheral infiltrate. The lesion is often confused with fungal, bacterial, or herpetic keratitis. Successful therapy hinges on early recognition and aggressive therapy with appropriate topical antiamebic medication often in conjunction with penetrating keratoplasty. Thirty-five cases from the world literature are reviewed.

A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome.

A prospective evaluation of ophthalmologic findings in 26 patients (25 men and one woman) with the acquired immune deficiency syndrome disclosed that 19 patients had significant ocular abnormalities. These included isolated retinal hemorrhages, cotton-wool spots, cytomegalovirus retinitis, acute retinal necrosis, cranial nerve palsies, and orbital Kaposi's sarcoma. Hemorrhages and cotton-wool spots appeared and disappeared spontaneously. Cytomegalovirus retinitis and acute retinal necrosis were progressive and destructive. The fundus findings did not correlate with the patient's general clinical status.

Cytomegalovirus retinitis: a manifestation of the acquired immune deficiency syndrome (AIDS).

Two homosexual males with the "gay bowel syndrome' experienced an acute unilateral loss of vision. Both patients had white intraretinal lesions, which became confluent. One of the cases had a depressed cell-mediated immunity; both patients ultimately died after a prolonged illness. In one patient cytomegalovirus was cultured from a vitreous biopsy. Autopsy revealed disseminated cytomegalovirus in both patients. Widespread retinal necrosis was evident, with typical nuclear and cytoplasmic inclusions of cytomegalovirus. Electron microscopy showed herpes virus, while immunoperoxidase techniques showed cytomegalovirus. The altered cell-mediated response present in homosexual patients may be responsible for the clinical syndromes of Kaposi's sarcoma and opportunistic infection by Pneumocystis carinii, herpes simplex, or cytomegalovirus.

Prophylactic antibiotics for ophthalmic surgery.

Preoperative or immediately postoperative antibiotics have been used by ophthalmic surgeons routinely as prophylaxis for postoperative endophthalmitis. The rationale for such prophylaxis, as the evidence which supports its efficacy are well founded. The optimal choice of antibiotics, however, from the standpoints of efficacy, delivery (route, dosage, and frequency of administration), adverse reactions, and cost is far less well established. This review considers these issues in the context of a critical evaluation of the pertinent literature.

Vitamin A in experimental herpetic keratitis.

Systemic vitamin A palmitate at three dosage levels was evaluated for its effect on experimental herpes simplex virus (HSV) keratitis in corticosteroid-treated rabbits. High-dose vitamin A palmitate reduced the severity of herpetic keratitis, but the low or moderate doses did not, and none of the vitamin A treatments affected virus recovery. Vitamin A treatment, however, produced substantial weight loss in uninfected rabbits and in corticosteroid-treated, HSV-infected rabbits. Steroid treatment alone significantly increased the antibody response to HSV, but this effect was not enhanced by vitamin A. The slight beneficial effect on HSV keratitis could be attributed to the known effect of vitamin A on promoting epithelial healing rather than an enhancement of immunity. For this purpose, local application of vitamin A may be just as effective and much less toxic than administration for systemic effect.