Band-shaped and whorled microcystic dystrophy of the corneal epithelium.

OBJECTIVE: To report the clinical, histopathologic, and electron microscopic features of band-shaped and whorled microcystic corneal epithelial dystrophy. DESIGN: Two interventional case reports. PARTICIPANTS: Two patients, two eyes. INTERVENTION: The involved area of corneal epithelium was scraped from each cornea. RESULTS: Histopathologic examination showed microscopic vacuoles in the epithelial cytoplasm in both cases. Electron microscopic examination revealed mainly empty cytoplasmic vacuoles with scant nonspecific osmophilic material. The process recurred clinically in one patient. Changes in corneal topography are documented in one patient. CONCLUSION: Clinical findings and pathologic studies seem nearly identical to those in the original report. No pattern of systemic disorder or medication use was found. The cause of this condition remains unknown.

Technique for repair of Descemet membrane detachment.

PURPOSE: To demonstrate a successful repair of an intractable Descemet membrane detachment. METHODS: Case report. We used transcorneal mattress sutures to fixate Descemet membrane to the cornea in combination with intracameral air injection. RESULT: This technique resulted in reattachment of Descemet membrane and a substantial visual acuity improvement after complete resolution of corneal edema. CONCLUSIONS: Surgical repair may be needed in cases of large Descemet membrane detachment. This technique provides an additional surgical alternative to repair intractable Descemet membrane detachment without causing excessive anterior chamber disruption; it may also prevent the need for a penetrating keratoplasty.

The effects of donor age on the outcome of penetrating keratoplasty in adults.

OBJECTIVE: The purpose of the study is to determine whether there is a higher incidence of complications in adult patients receiving corneas from pediatric donors compared to those receiving corneas from adult donors. DESIGN: The design is a follow-up of two matched cohorts. PARTICIPANTS: The outcome of penetrating keratoplasty in 29 adult patients (age 20 years of age and older) receiving pediatric donor corneas (range, 0-5 years) was compared to that of 29 control patients matched for recipient age and diagnosis who received adult donor corneas (range, 40-70 years). INTERVENTION: Chart review was performed. MAIN OUTCOME MEASURES: Graft rejection, postoperative keratometry, postoperative refractive cylinder, postoperative intraocular pressure, and graft failure due to rejection were measured. RESULTS: One or more allograft reactions occurred in 11 (37.9%) of 29 patients who received pediatric donor corneas compared to 2 (6.9%) of 29 patients who received adult donor corneas (P = 0.005, chi-square). There were a total of 20 rejection episodes in patients receiving pediatric donor corneas compared to a total of 5 rejection episodes in patients receiving adult donor corneas. The average postoperative keratometry was 46.1 diopters for the pediatric donor group and 44.0 diopters for the adult donor group (P = 0.03). There was no statistically significant difference in average refractive cylinder (P = 1.0), intraocular pressure (P = 0.26), or the incidence of graft failure due to rejection (P = 1.0) between the two groups. The average follow-up time for clear grafts was 58.3 months in the pediatric donor group and 59.9 months in the adult donor group. CONCLUSIONS: The incidence of allograft reactions and the postoperative corneal curvature is greater in adult eyes undergoing penetrating keratoplasty with young donor corneas compared to those undergoing penetrating keratoplasty with older donor corneas. There was no difference in the incidence of graft failure due to rejection between the two groups.

The role of topical corticosteroids in the management of Acanthamoeba keratitis.

PURPOSE: To clarify the role of topical corticosteroids in the management of Acanthamoeba keratitis. METHODS: The records of 38 patients diagnosed with Acanthamoeba keratitis at three institutions were retrospectively reviewed. RESULTS: After medical therapy alone, patients diagnosed within 1 month of symptom onset had an increased likelihood of being cured (p = 0.02) and attaining visual acuity of 20/60 or better (p < 0.01). Fourteen (73.7%) of 19 patients treated with topical corticosteroids at any time were cured after antiamoebal therapy alone, whereas five (26.3%) patients required penetrating keratoplasty for either persistent infection (n = 3) or perforation (n = 2). The mean antiamoebal therapy duration, excluding duration after keratoplasty if applicable, was 38.5 weeks. Thirteen (76.5%) of 17 patients treated with antiamoebal therapy without topical corticosteroids were medically cured, whereas four (23.5%) required penetrating keratoplasty for either persistent infection (n = 2) or perforation (n = 2). The mean antiamoebal therapy duration was 20 weeks. Although the mean antiamoebal therapy duration in the steroid-treated group was significantly longer than that in the non-steroid-treated group (p = 0.02), outcome after medical therapy between the groups was not significantly different. CONCLUSIONS: Topical corticosteroids were not associated with a higher rate of medical treatment failure in patients with Acanthamoeba keratitis. Rather, poor outcome was significantly related to diagnostic delays. Therefore prudent use of corticosteroids in selected patients with severe pain not responsive to analgesics or severe corneal or anterior chamber inflammation appears justified.

Treatment of recurrent conjunctival epithelial neoplasia with topical mitomycin C.

PURPOSE: To study the effect of topical mitomycin C on conjunctival squamous neoplasia. METHODS: Three patients with recurrent conjunctival epithelial neoplasia were treated with topical mitomycin C 0.04%. RESULTS: Six to 9 months after treatment, no patient had clinical evidence of tumor recurrence. Conjunctival biopsy in two patients and cytology in one patient showed no evidence of tumor 1 to 4 months after treatment. One patient required short-term treatment for corneal edema and epithelial toxicity. CONCLUSION: Topical mitomycin C caused tumor regression without recurrence for 6 to 9 months after treatment.

Donor factors associated with epithelial defects after penetrating keratoplasty.

The records of 39 patients undergoing 40 consecutive penetrating keratoplasties were reviewed to identify donor factors that might correlate with the presence of an epithelial defect on the first postoperative day. Of the 40 transplanted corneas, 13 (32.5%) had no epithelial defect, 18 (45%) had some epithelial defect, and nine (22.5%) had a total epithelial defect 1 day postoperatively. The status of the epithelium was correlated with several donor factors. The only factor that had a statistically significant association with the degree of epithelial defect was the time interval from preservation to surgery (p = .001). Based on a logistic regression model, the probability of having an epithelial defect 1 day after penetrating keratoplasty increased with respect to longer storage times. These results may aid the surgeon in the selection of donor tissue, particularly when performing penetrating keratoplasty on patients with ocular surface disorders.

Familial bilateral perilimbal cystic benign melanosis with lipid keratopathy--a new entity?

We examined the clinicopathologic findings in two sisters with pigmented conjunctival lesions. Slit-lamp examination showed bilateral, circumferential cystic pigmented perilimbal lesion and prominent lipid keratopathy. The pigmented lesions were examined via biopsy, and histologic and ultrastructural examination of the biopsy specimens showed secondary melanosis of numerous conjunctival epithelial inclusion cysts. The two sisters have familial bilateral perilimbal cystic benign melanosis with lipid keratopathy, an idiopathic condition that requires no further surgical management.

Corneal endothelial deposits in patients with cytomegalovirus retinitis.

PURPOSE: We studied six patients with human immunodeficiency virus (HIV) who had cytomegalovirus retinitis and abnormal endothelial deposits in at least one eye, to characterize their corneal endothelial deposits. METHODS: The corneas of the six patients were examined by slit-lamp biomicroscopy and specular microscopy with morphometric analysis. The eyes of one patient with endothelial changes were obtained post mortem for histopathologic and ultrastructural examination. RESULTS: There were multiple diffuse, fine refractile, stellate-shaped deposits on the corneal endothelium in all affected eyes. The deposits were best seen with retroillumination. Two of six patients examined with specular microscopy showed severe abnormalities, which included marked areas of polymegathism and decreased endothelial cell counts. Examination of one eye obtained post mortem disclosed chains of dendritic macrophages and fibrin adherent to the apical surface of the corneal endothelium. There was no evidence of direct infection of the corneal endothelium by cytomegalovirus. CONCLUSIONS: Deposits on the corneal endothelium in patients with cytomegalovirus retinitis most likely result from an anterior uveitis. A preponderance of macrophages observed by histopathologic examination may be related to the inability of the immunodeficient patient to mount a normal T-cell response.

Dermatologic diagnosis and treatment of itchy red eyelids.

Distinguishing the cause of itching, red eyelids is often difficult. Pruritic, inflamed eyelids can reflect various etiologies and are a common clinical presentation to the office of a dermatologist or ophthalmologist. In this article, five of the more common causes of eyelid dermatitis (atopic dermatitis, contact dermatitis, contact urticaria, rosacea, seborrhea, and psoriasis) are reviewed in detail, with particular emphasis on the ocular and periocular features. Clinical clues, historical features, and patch testing in cases of eczematous eyelid dermatitis aid in differential diagnosis. In addition, pathogenesis and treatment are reviewed.

Bilateral herpes simplex virus type 2 keratitis: a clinicopathologic report with immunohistochemical and ultrastructural observations.

This report describes the clinical, histopathologic, ultrastructural, and immunohistochemical findings in two corneal buttons from a 13-year-old girl who developed bilateral progressive corneal stromal opacification during childhood. As determined by light microscopy, both corneal buttons were edematous with a chronic inflammatory infiltrate confined to the deep layers of the stroma. We detected intranuclear eosinophilic inclusions in some epithelial cells. We detected herpesvirus particles in stromal keratocytes and endothelial cells by transmission electron microscopy. Immunohistochemistry studies identified concurrent expression of specific herpes simplex virus type 2 antigen in corneal epithelial cells, in keratocytes in the deep layers of the stroma, and in endothelial cells. The cause of progressive bilateral stromal corneal opacification in this child was herpes simplex virus type 2 keratitis. This condition should be considered in the differential diagnosis of progressive, bilateral corneal opacification in children.