Microbiological profile of a shipboard environment and the flora on contact lenses of seamen.

PURPOSE: The purpose of this study was to culture and identify the spectrum of organisms (and their sensitivities) that contaminate the extended wear contact lenses of seamen in their working environment. A secondary aim was to identify the most appropriate first-line antibiotic regimen to be used on seamen who sustain contact lens-related corneal keratitis on board ship. METHODS: Twenty pairs of contact lenses of 20 seamen in one group and 24 pairs in another group wearing contact lenses were collected at the end of 1 week of extended wear. Groups one and two differed only in the way lenses were stored prior to culturing. All contact lenses were then brought to the microbiological lab within 24 hours for culture and sensitivity testing. RESULTS: The most common contaminants on the contact lenses in this study were Staphylococcus epidermidis and Staphylococcus aureus, organisms resident on the normal eyelids. Enterobacterand Pseudomonas species, present in a shipboard environment, were also identified as contaminants on the contact lenses. The organisms cultured from the contact lenses correlated well with those of normal lid flora as well as from the ship environment and are probably derived from these sources. Storage in saline-containing preservatives yielded significantly less positive bacterial cultures from the contact lenses in our study. All bacterial isolates were sensitive to ciprofloxacin whereas several bacteria resistant to cefazolin and gentamicin were identified. CONCLUSION: The most common contaminants on the contact lenses in this study were Staphylococcus epidermidis and Staphylococcus aureus, organisms resident on the normal eyelids. Enterobacter and Pseudomonas species, which are normally present in a shipboard environment, were also identified as contaminants on the contact lenses. Ciprofloxacin is effective against all organisms identified as contaminants on the contact lenses in this study. Of all the antibiotics tested, it is probably the most suitable agent against contact lensrelated keratitis under such shipboard circumstances and is thus recommended in these situations.

Capsular block syndrome: A case series.

Capsular block syndrome (CBS) or capsular bag distension syndrome has been described after cataract removal with in-the-bag placement of a posterior chamber intraocular lens in the presence of an anterior continuous curvilinear capsulorhexis. Features of CBS include shallowing of the anterior chamber and an unexpected myopic overrefraction; occasionally, there is a persistent uveitis. The patient may be mistakenly diagnosed with pupil block glaucoma or endophthalmitis. We report 9 cases of CBS and their initial diagnoses and management. In 1 case, the capsular bag distention and anterior chamber shallowing are illustrated by ultrasound biomicroscopy.

Refractive errors and strabismus in premature Asian infants with and without retinopathy of prematurity.

AIM: In Caucasian populations, premature infants with retinopathy of prematurity (ROP) have been reported to have higher risks of developing refractive errors and strabimus. The purpose of this study is to evaluate the rate of these complications in Asian premature infants with and without ROP. METHODS: A retrospective case review of all premature infants referred to the Singapore National Eye Centre for ophthalmology screening. These included all neonates born earlier than 34 weeks gestational age and less than 1500 grams in birth weight. Standardized ophthalmology examinations including cycloplegic refraction and fundus examination at regular intervals were performed to determine the presence of ROP, refractive errors, squints and other ocular abnormalities until the patients were 3 years old. RESULTS: During 1991 to 1993, a total of 113 neonates were reviewed. Of these, 16 (14.2%) developed ROP. The risk of ROP was higher with lower birth weights and earlier gestational ages. At 1-year follow-up, the rate of myopia was 33.3% in babies with ROP compared to 3.7% in babies with no ROP (p < 0.001). The higher rates of myopia in babies with ROP remained with longer follow-up (33.3% and 25% in ROP group versus 3.4% and 3.8% in no ROP group, at 2 and 3 years respectively). There was no difference in rates of astigmatism or hyperopia throughout the 3 years. At 1 year follow-up, the rate of strabismus was 20% in the ROP group compared to 4.9% in the no ROP group (p = 0.07). However, this difference in rates of strabismus was not significant at 2 and 3 years of follow-up. CONCLUSION: Premature babies with ROP had higher rates of myopia and strabismus than those without ROP. Long-term follow-up of these babies is important for early detection and treatment of these ocular problems.

Combined penetrating keratoplasty and limbal allograft transplantation for severe corneal burns.

The management of ocular surface disease presents a significant challenge to ophthalmologists. Recent advances in the etiology and pathophysiology of ocular surface diseases, such as chemical and thermal burns or Stevens-Johnson syndrome, include the concept of the limbal stem cell. Limbal stem cell theory suggests that the corneal limbus contains epithelial stem cells that are responsible for a continuous supply of corneal epithelial cells, which not only migrate from the deep to superficial epithelial layers, but also progress in a centripetal direction, inward from the limbus. Support for this concept is provided indirectly by the relatively poor prognosis for penetrating keratoplasty for these types of ocular surface diseases. In such cases, it is suggested that limbal damage and depletion is present and is a significant factor in loss of integrity of the ocular surface; therefore, conventional penetrating keratoplasty, which does not include limbal tissue, does not have a high success rate.