Ocular cicatricial pemphigoid, keratomycosis, and intravenous immunoglobulin therapy.

PURPOSE: To report the case of a patient developing fungal keratitis in the context of uncontrolled ocular cicatricial pemphigoid (OCP), which, despite intravenous immunoglobulin (IVIg) and other immunomodulatory therapy, progressed to end-stage pemphigoid, with corneal opacification, ankyloblepharon, and xerosis. Keratoprosthesis (KPro) restored functional vision for the patient. METHODS: A 39-year-old man presented with uncontrolled CP and corneal ulcer in the left eye. Conjunctival biopsy diagnosed OCP; corneal scraping and biopsy diagnosed the cause of the corneal ulcer. OCP was treated with systemic steroids, immunosuppressive drugs, and IVIg. Visual rehabilitation was accomplished with Ahmed valve and a type II Dohlman KPro. RESULTS: Immunohistology of the biopsied conjunctiva showed IgG at the epithelial basement membrane zone, confirming the clinical diagnosis of OCP. Microbiologic studies of the corneal biopsy specimen were negative for Acanthamoeba and herpes but positive for Aspergillus niger. The patient's keratomycosis resolved with topical antifungal therapy. Treatment with Dapsone, intravenous-pulse steroid, oral cyclophosphamide, and intravenous immunoglobulin (IVIg) failed to control the OCP, with resultant complete conjunctivization of the cornea. Keratoprosthesis improved the patient's visual acuity from hand movements to 20/20. CONCLUSIONS: Patients with uncontrolled OCP are at increased risk of corneal infection. The difficulty in diagnosing keratomycosis and the relatively rare occurrence of OCP explain the uniqueness of our reported case. OCP may progress to "end-stage" disease despite therapy. Keratoprosthesis can restore vision in selected otherwise seemingly hopeless cases.

AMO array multifocal lens versus monofocal correction in cataract surgery.

PURPOSE: To compare the functional capabilities of 15 patients (30 eyes) who had implantation of the Allergan Medical Optics (AMO) Array multifocal intraocular lens (IOL) with those of 13 patients (26 eyes) with an AMO monofocal IOL. SETTING: Department of Ophthalmology, The University of Western Ontario, Canada. METHODS: The objective capabilities of both groups were analyzed through visual acuity measurements for distance, near, and depth of focus. Subjective functionality was assessed through the use of a questionnaire that included the previously validated VF-14 index of visual function, a global measure of overall satisfaction with visual acuity, and questions related to the frequency of spectacle wear. RESULTS: Both groups had excellent corrected and uncorrected distance visual acuity postoperatively. The multifocal group had better acuity than the monofocal group at near with distance correction in place (70% versus 43% achieved J3 or better). The multifocal group also had significantly better depth of focus. Subjectively, both groups indicated high levels of satisfaction with visual function. However, the multifocal group indicated higher levels of satisfaction during the day, at night, and overall without spectacles. This result translated into less spectacle wear for both near and distance in the multifocal group. CONCLUSIONS: The results of this study indicate high patient satisfaction with the Array multifocal IOL and greater functional independence from spectacle wear, by objective and subjective patient measures, than with the monofocal IOL.

Ocular alkali burn associated with automobile air-bag activation.

Alkali burns of the eye can result in permanent visual impairment and are therefore potentially devastating. Immedicate diagnosis and treatment are essential to a good prognosis. The authors report the case of a 52-year-old woman who suffered alkali keratitis as the result of the activation of an automobile air bag. This type of injury will be seen more frequently as more cars are equipped with air bags and should be suspected in drivers and passengers involved in accidents in which air bags have been activated.

Frequency of ocular chlamydial infection among young adults.

Young adults are at particular risk for Chlamydia trachomatis infection. To determine whether there is a high rate of asymptomatic ocular chlamydial infection in this population, 131 eyes from 72 patients aged 18 to 30 years with no symptoms of conjunctivitis were tested for C. trachomatis by means of McCoy cell culture and a direct enzyme immunoassay. In addition, 51 of the patients underwent serologic testing to detect systemic chlamydial disease. Ocular chlamydial infection was not found in any of the patients, including the 26 with a positive result of serologic testing. We conclude that routine screening of young adults for ocular chlamydial infection would be of no benefit in detecting systemic chlamydial infection and its sequelae.

Leiomyoma of the iris.

A 77-year-old white woman presented with a lightly pigmented iris lesion assumed clinically to be an iris melanoma. Light microscopy of the excised tumour showed it to be a spindle-cell tumour. Electron microscopy confirmed the diagnosis of leiomyoma of the iris.

Effects of dimethyl sulfoxide on a model of corneal alkali injury.

The potential role of dimethyl sulfoxide in minimizing early structural damage to the eye following corneal alkali injury was examined. Corneal alkali injury was induced in rabbits and treated with topical applications of 20% dimethyl sulfoxide. At day 3 the rates of corneal opacification (p less than 0.01) and corneal ulceration (p less than 0.05) were significantly lower in the treatment group than in the control group, but this effect was not sustained during the rest of the study period. Further work is required to determine the therapeutic value of topical dimethyl sulfoxide in combination with other agents, such as cycloplegics, corticosteroids, ascorbic acid and citric acid, in corneal alkali injury.

Nocardia keratitis.

Unilateral keratitis developed in a 31-year-old man following superficial corneal injury with vegetable foreign material. The corneal inflammation progressed to perforation and endophthalmitis. Nocardia asteroides was eventually identified in an aspirate from the anterior chamber. Aggressive medical and surgical treatment resulted in salvage of the globe and a visual acuity of 6/15. Controversial aspects of the management of this problem are considered.