Radial keratotomy in the soldier-aviator.

Radial keratotomy (RK) is an ophthalmological procedure that alters the shape of the cornea, making it "flatter," causing the desired shift to farsightedness. Complications can be minor and "normal" in the immediate post-operative period, or can include problems that occur in many eyes, that persist but do not decrease best corrected visual acuity, or may include events that potentially or actually threaten vision and may produce blindness. At best, only 50% of patients can expect to have 20/20 uncorrected vision 2-3 years after surgery. Diurnal fluctuations in vision (two-five Snellen lines) can persist years after RK. Perhaps 1% of patients may have a two-three Snellen line loss of best corrected vision or ghost images that interfere with clear vision. Disabling glare can disrupt daily activities. Eyes that have undergone RK are at increased risk of corneal rupture after blunt eye trauma. The visual demands of the active duty military, and more dramatically the military aviator, are incompatible with RK. Therefore, RK should not be performed on active duty soldiers, nor should enlistees be accepted if they have undergone the procedure.

Treatment of scleromalacia perforans with dura mater grafting.

We describe, to our knowledge for the first time in the English literature, the successful use of cadaveric dura mater in reinforcing the sclera in a rheumatoid arthritis patient with scleromalacia perforans.

Prevention of sports-related eye injury.

Sports-related eye injury is an important cause of vision loss. Many eye injuries can be prevented through the supervision of play, the enforcement of game rules and the use of eye protective devices. State-of-the-art eye protective devices incorporate highly impact-resistant optical material, usually polycarbonate lenses, in a sturdy frame. Protective devices are available for use in racquet sports, baseball, basketball, football, ice hockey and other sports.

Abortive cryptophthalmos: a case report and a review of cryptophthalmos.

Cryptophthalmos is a rare, probably autosomal recessive condition in which the lid folds fail to separate in the embryo resulting in a continuous sheet of skin from the forehead to the cheeks covering the eyes. Cryptophthalmos has many variants and is usually associated with multiple other congenital anomalies. This article reports on an isolated case of "abortive cryptophthalmos" with multiple systemic anomalies. The surgical treatment is described and the general features of the cryptophthalmos syndrome and its variants are reviewed.

Contamination of K-Sol corneal storage medium with Propionibacterium acnes.

K-Sol is a widely used corneal preservation medium. It has an excellent record for corneal storage and no previous report of contamination. During September 1988, on five of our K-Sol-stored donor rims Propionibacterium acnes grew. Cultures of unopened K-Sol also yielded P acnes. This report reviews previous contaminations of corneal storage media and the special characteristics of P acnes that enabled it to survive precautions taken against infection. The detection of P acnes was not obvious, and we emphasize the need for appropriate culturing of all donors, both aerobically and anaerobically, and close scrutiny of delayed inflammation in postoperative patients.

Nocardia asteroides keratitis: a case associated with soft contact lens wear.

Ocular nocardiosis is rare. Most cases of nocardial keratitis have resulted from corneal trauma by objects contaminated with the organism. We describe the first case of Nocardia asteroides keratitis associated with an extended wear soft contact lens. We also describe its successful treatment with topical trimethoprim-sulfamethoxazole in combination sulfacetamide.

Postoperative astigmatism after central vs eccentric penetrating keratoplasties.

Six patients with markedly eccentric penetrating keratoplasties had severe corneal astigmatism (mean, 10.38 +/- 2.91 diopters). In four of these patients the flat meridian was lying in the direction of graft displacement. Laboratory experiments disclosed no statistically significant difference in diameter between the major and minor axes of the corneal buttons in the centrally and eccentrically trephined eyes and we could not elucidate the mechanism of the severe astigmatism. However, in the eccentrically trephined eyes the longer axis consistently lay in the direction of decentration whereas in the centrally trephined eyes the long axis was oriented randomly.

Penetrating keratoplasty for exogenous Paecilomyces keratitis followed by postoperative endophthalmitis.

Three patients developed Paecilomyces lilacinus keratitis while being treated with topical corticosteroids and antibiotics. The first patient, a diabetic man, suffered superficial ocular trauma while being treated for recurrent anterior uveitis related to an iris-fixated intraocular lens. The second patient developed keratitis while being treated for anterior segment inflammation associated with herpes zoster ophthalmicus. The third patient, a woman with chronic lymphoma in remission, was receiving topical antibiotics and corticosteroids for a corneal transplant performed one year previously. All three patients underwent penetrating keratoplasty after progression to perforation or failure of medical therapy. Two eyes (cases 1 and 2) eventually required enucleation. The fungal isolates demonstrated in vitro resistance to amphotericin and natamycin with greater sensitivity to imidazole derivatives. Thus, we recommend prompt and prolonged topical treatment with miconazole or other imidazole derivatives along with avoidance of penetrating keratoplasty and corticosteroids.

Results of penetrating keratoplasty for pseudophakic corneal edema with retention of intraocular lens.

We reviewed the records of 26 consecutive patients undergoing penetrating keratoplasty for pseudophakic corneal edema in which the original intraocular lens was retained. The average interval between lens implantation and penetrating keratoplasty was 31.5 months. Follow-up after keratoplasty ranged from 11 to 59 months, with an average of 24.5 months. Six patients had anterior chamber lenses; sixteen, iris or iridocapsular lenses; and four, posterior chamber lenses. A vitrectomy was performed in 14 (54%) patients. Of the 21 patients with clear grafts (80%), 8 (38%) had vision of 20/40 or better while 7 (33%) had acuities of 20/200 or worse. Visual acuity of 20/40 or better was attained by 3 of 4 (75%) patients with posterior chamber lenses but only 3 of 16 (19%) patients with iris-supported lenses. Cystoid macular edema was the principal cause of decreased acuity in 12 of the 13 patients with clear grafts and acuity less than 20/40. Angiographic confirmation was obtained in 7 of 12 patients. Overall, the results are similar to those reported for pseudophakic keratoplasty with intraocular lens removal. No adverse effect of retaining a securely fixated intraocular lens was demonstrated.

An unusual case of retinoschisis and retinal detachment.

An unusual case of retinoschisis and associated retinal detachment in a 61-year-old man is reported. The case involved a retinoschisis area with 22 outer-layer retinal holes and two inner-layer retinal holes in the superior nasal quadrant of the left eye. The retinal detachment extended posteriorly beyond the schisis area. The patient's condition was managed with a combination of cryotherapy and a scleral buckle. Postoperatively, the did well despite the presence of a choroidal detachment that resolved in one month. Cases previously reported have not precisely listed the number of retinal holes. This case is unusual in that there are an unusually large number of retinal holes.