Topical anesthetic abuse ring keratitis: report of four cases.

PURPOSE: We present the clinicopathologic correlations of two case and two other clinical cases of topical anesthetic abuse keratopathy that were originally diagnosed as Acanthamoeba keratitis because of ring keratitis presentation and characteristic history. METHODS: Four patients who were referred to us with suspected Acanthamoeba keratitis are included. Each was initially treated for amoebic keratitis, by using established protocols, and only later was the true origin (topical anesthetic abuse) uncovered. The clinical and surgical histories, pathologic analysis of the corneal specimens, and follow-up of < or = 4 years are included. RESULTS: Our four cases show another cause for ring infiltration of the cornea. Two cases resulted in corneal transplantation and multiple other medical or surgical treatments in an attempt to restore vision but had poor outcomes of finger-counting vision. Two other cases responded to intensive medical treatments with return of useful vision. Evaluation of the surgical specimens revealed a previously unpublished finding of near total cell death within the corneal stroma. CONCLUSION: Topical anesthetic abuse resulting in sight-threatening keratitis may be seen as a masquerade syndrome in many cases. Because of the often poor outcome, we must be aware of this entity, prevent abuse, and be vigilant in our prohibition of topical anesthetic for any therapeutic use.

Pseudophakic keratoplasty: posterior chamber lens implantation in the presence of ruptured capsule.

A technique is described for implantation of a posterior chamber intraocular lens during keratoplasty for bullous keratopathy when a large capsulotomy and vitreous prolapse are present. Seven cases of pseudophakic or aphakic bullous keratopathy with anterior chamber, iris-fixated, or no intraocular lens in place are reported. A completely intact posterior capsule is not necessary to support safely a sulcus-fixated posterior chamber lens. Anterior segment reconstruction, careful removal of existing intraocular lenses (except a posterior chamber lens), vitrectomy through the ruptured posterior capsule, and assessment of the remaining posterior capsule rim are important surgical objectives.