ABSTRACT
Objetivo: Caracterizar el diagnóstico de infección ocular por virus herpes simples (HSV) en un grupo de niños chilenos, mediante el estudio clínico y de laboratorio virológico. Métodos: La población estudiada comprendió niños menores de 15 años, con diagnóstico clínico de herpes ocular, que fueron atendidos por los autores y un grupo de oftalmólogos entrenados especialmente para el estudio. Junto con detallar el tipo de infección herpética, a todos los pacientes se les tomaron muestra para estudio virológico que incluyó estudio de cultivos celulares y posteriormente técnica de reacción en cadena de polimerasa (PCR), con el fin de tipificar las cepas y características genómicas del virus infectante. Resultados: El estudio enroló 18 niños, cuyas edades fluctuaron entre los 40 días y 13 años, con una media de 6 años. De las formas clínicas observadas, la más frecuentes fueron la blefaritis y la queratitis dendrítica constituyendo en 27 y 22 por ciento de los casos, respectivamente. El diagnóstico de HSV fue confirmado en 15 de 18 pacientes, constituyendo un 83 por ciento de positividad. 14 de 15 casos correspondieron a HSV tipo 1, y en un niño se diagnóstico infección por HSV tipo 2. Los antecedentes clínicos de este caso confirmaron que se trataba de una infección perinatal, lo que permitió instaurar el tratamiento en forma oportuna. El estudio permitió identificar un caso de excreción ocular viral asintomática, lo que sumando a un cuadro de recurrencias múltiples obligó a indicar terapia profiláctica permanente con aciclovir. Conclusiones: La blefaritis y queratitis herpética constituyeron en conjunto el 70 por ciento de los casos. El rendimiento celular y PCR fue elevado en los casos con alto índice de replicación viral, como la queratitis y blefaritis. En los casos con menor replicación, como queratitis estromal o conjuntivitis, el estudio PCR demostró una mayor sensibilidad que el estudio en cultivo celular. La presencia de un caso de infección perinatal por HSV-2 pudiera ser indicativo de un aumento en la frecuencia de esta forma de presentación.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Genome, Viral , Keratitis, Herpetic/classification , Keratitis, Herpetic/diagnosis , Keratitis, Herpetic/epidemiology , Keratitis, Herpetic/virology , Simplexvirus/isolation & purification , Simplexvirus/genetics , Blepharitis/virology , Chile , Polymerase Chain Reaction , Keratitis, Dendritic/virology , Corneal Ulcer/virologyABSTRACT
BACKGROUND: Herpes simplex virus (HSV) infection of the cornea is a leading cause of blindness in occidental countries and a common recurrent manifestation of it is the immune stromal keratitis (ISK). However, it is not known whether active viral replication occurs during the acute phase of the disease, because isolation of the virus by conventional culture techniques has not been accomplished. AIM: To establish the presence of HSV in patients with ISK. MATERIAL AND METHODS: Fourteen corneal swabbing samples, from active diseased eyes of patients with clinical diagnosis of ISK, were submitted to Herpchek and PCR for the identification of HSV antigens and genome. RESULTS: All ISK samples were negative by both techniques. CONCLUSIONS: It was not possible to identify HSV antigens nor their genome by the methodology used. It is likely that, they can't be detected in corneal superficial layers or probably there is no viral replication at this stage of the disease, so antiviral therapy should be reconsidered.
Subject(s)
Keratitis, Herpetic/virology , Simplexvirus/genetics , Simplexvirus/immunology , Acute Disease , Adolescent , Adult , Antigens, Viral/analysis , Child , Child, Preschool , Chronic Disease , Corneal Stroma/virology , Female , Genome, Viral , Humans , Male , Middle Aged , Polymerase Chain Reaction , Severity of Illness IndexABSTRACT
BACKGROUND: Herpetic keratitis is the main infectious cause of corneal opacity. The existence of effective antiviral agents underscores the need of an early diagnosis. AIM: To correlate clinical features of herpetic keratitis with virological studies. PATIENTS AND METHODS: Forty one patients with a clinical diagnosis of herpetic keratitis were studied. Viral isolation, polymerase chain reaction (PCR) and typification were done in a sample taken by swabbing the ocular lesion. RESULTS: Twenty six patients (31% female) had epithelial keratitis, that was mild or moderate in 88% of cases and acute in 77% of them. In 20 patients (77%), viral isolation and PCR were positive (HSV-2 in one case). Fifteen patients (67% female) had stromal keratitis, 93% of cases were moderate or severe and 53% were acute. Viral isolation was negative in all cases and in 20% PCR was positive. CONCLUSIONS: Viral isolation and PCR were equally sensitive in epithelial keratitis, but in stromal keratitis only PCR could detect the virus. Moderate acute dendrite was the predominant clinical manifestation. The higher proportion of women with stromal keratitis supports its possibly autoimmune etiology. HSV-2 is seldomly isolated and possibly associated to vertical transmission.
Subject(s)
Keratitis, Herpetic/virology , Simplexvirus/isolation & purification , Acute Disease , Adolescent , Adult , Aged , Child , Child, Preschool , Chronic Disease , Female , Humans , Infant , Keratitis, Herpetic/diagnosis , Male , Middle Aged , Polymerase Chain Reaction , Predictive Value of Tests , Simplexvirus/geneticsABSTRACT
Fifty-five consecutive patients had cataract extraction with a 6 mm no-stitch frown incision and implantation of a 6 mm optic three-piece posterior chamber lens. Vector analysis calculations of diopters (D) of mean induced keratometric astigmatism for this incision were 0.70 D at one day, 0.76 D at one week, 0.50 D at one month, and 0.50 D at three months. The Naeser's polar value showed a mean with-the-rule astigmatism of +0.42 D at one day and -0.08 D against-the-rule astigmatism at three months. The results suggest that the 6.0 mm no-stitch frown incision induces a low postoperative astigmatism and provides a stable incision.
Subject(s)
Astigmatism/etiology , Cataract Extraction/adverse effects , Suture Techniques/adverse effects , Adult , Aged , Aged, 80 and over , Cataract Extraction/methods , Female , Humans , Lenses, Intraocular , Male , Middle AgedABSTRACT
Excessive eye elongation can be induced in experimental animals by visual deprivation. A tendency toward myopic refraction or shift in pediatric aphakia has been recorded in some children. In this report, we present the case of an 18-year-old patient who had developmental cataracts treated at seven years of age with bilateral cataract extraction and implantation of an intraocular lens in one eye only. Axial length of the eye with a contact lens increased compared with the eye with the intraocular lens.
Subject(s)
Aphakia, Postcataract/pathology , Cataract Extraction , Eye/pathology , Lenses, Intraocular , Adolescent , Female , Humans , Hypertrophy , Sensory Deprivation , Visual AcuityABSTRACT
Between 1980 and 1990, 42 eyes of 34 patients (age range: 18 months to 18 years) were implanted with an intraocular lens, with 29 being primary implantations and 13 secondary. The primary implantation group comprised patients with congenital, developmental, and traumatic cataracts. Patients in the developmental and traumatic cataract groups achieved the best visual acuity. Those with congenital cataracts had the poorest visual outcome. Follow-up ranged from a minimum of three months to more than ten years. Overall the patients demonstrated an improvement in visual acuity and the psychological advantage of enhanced visual function without spectacles or contact lenses. We conclude that with proper case selection and a controlled, skilled surgical approach, the use of an intraocular lens for visual rehabilitation in the pediatric age group is a feasible approach.
Subject(s)
Cataract Extraction , Cataract/physiopathology , Lenses, Intraocular , Visual Acuity/physiology , Adolescent , Cataract/congenital , Cataract/genetics , Child , Child, Preschool , Eye Injuries/complications , Follow-Up Studies , Humans , Infant , Longitudinal Studies , Treatment OutcomeABSTRACT
We conducted a retrospective review of 79 patients who had intraocular lens (IOL) explantation and exchange over a 12-year period. Seventy-nine eyes of 40 males and 39 females from 17 to 94 years of age were followed from three months to more than 12 years. Sixty-one percent (61%) were posterior chamber lenses and 39% were anterior chamber lenses replaced by 76% posterior chamber and 24% anterior chamber lenses. The indications for lens exchange were eccentric or displaced IOL (41.7%), endothelial decompensation (27.7%), incorrect IOL power (12.6%), and uveitis-glaucoma-hyphema syndrome (10.0%). Analysis of the clinical results revealed that 72% of the cases had postoperative visual acuity better than or equal to 20/30, and 8% had a loss of one or more lines of visual acuity. Among the complications occurring after IOL exchange were retinal detachment, glaucoma, corneal decompensation, and anisometropia.
Subject(s)
Cataract Extraction , Lenses, Intraocular/adverse effects , Vision Disorders/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Anterior Chamber/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Treatment Outcome , Visual AcuityABSTRACT
Microphthalmos is a developmental disorder of the eye consisting of a smaller than normal eye. This disorder can present as an isolated condition or associated with other systemic alterations. It is not uncommon for patients with microphthalmos to have congenital cataracts along with other ocular and systemic abnormalities. This paper reports the experience with 11 microphthalmic eyes of seven patients who had primary or secondary intraocular lens (IOL) implantation over a six-year period from 1985 to 1991. In all cases the IOL had a 13.5 mm or 14.0 mm overall diameter and a 6.0 mm or 6.5 mm optic. It was difficult to obtain documentation of objective visual improvement in many of these cases because of the associated nystagmus. However, all patients reported subjective improvements. These results suggest that with proper technique and lens selection microphthalmic patients should be considered for IOL implantation with relative safety and success.
Subject(s)
Lenses, Intraocular , Microphthalmos/surgery , Adolescent , Adult , Cataract Extraction , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Treatment Outcome , Visual AcuityABSTRACT
One hundred and twelve primary posterior chamber intraocular lens implants from a series of 560 eyes operated on at the Eye Service of Hospital Salvador in Santiago, Chile, were analyzed to determine the postoperative visual acuity. The follow up time varied between 3 and 26 months. Lenses were implanted by experienced ophthalmologists and residents in training. Visual acuity was 0.5 or better in 79.5% of cases. The postoperative visual acuity varied with age, being worse in patients over 70 years old.
Subject(s)
Cataract Extraction/methods , Lenses, Intraocular , Adult , Age Factors , Aged , Aged, 80 and over , Cataract Extraction/statistics & numerical data , Chile , Female , Follow-Up Studies , Hospitals, Teaching , Humans , Male , Middle Aged , Prognosis , Sex FactorsABSTRACT
Between June 1983 and September 1987, 2799 disability pensions were given in the East Santiago Area, population 676,269. Of them, 222 (7.9%) were due to ophthalmological causes. Blindness as defined by the WHO was present in 57 cases. It was caused by myopia (33%), glaucoma (21%), diabetic retinopathy (9.8%), retinal detachment, cataract and optic atrophy (5.2%) and ocular trauma (3.5%).
