Clinical course of epidemic keratoconjunctivitis: evaluation by in vivo confocal microscopy.

PURPOSE: To describe, by in vivo confocal microscopy, the structural changes occurring during the course of adenovirus epidemic keratoconjunctivitis (EKC), from the onset of the disease up to 24 weeks of follow-up. METHODS: Eight patients (age, 8-57 years) with clinical evidence of EKC were examined and photographed in vivo with a Heidelberg Retina Tomograph II, Rostock Cornea Module. RESULTS: At 1 week, confocal microscopy revealed clusters of hyperreflective cells in the basal epithelial cell layer. In these sites, we observed subepithelial accumulations of dendritic cells, located mainly at the level of the Bowman layer. Underneath in the anterior stroma, we detected clusters of highly reflective, irregularly shaped cells. At 2 weeks, all patients presented follicular conjunctivitis, focal keratitis, and subepithelial infiltrates. At this point, confocal microscopy revealed persistent clusters of hyperreflective basal epithelial cells intermingled with roundish cells that probably represent leukocytes. Underneath, dendritic cells had formed an intricate network and, in the anterior stroma, we detected a hyperreflective cellular plaque that corresponded to the subepithelial infiltrate. At 24 weeks after onset of the symptoms, density and dimension of dendritic cell clusters were decreased, but we now detected stromal hyperreflectivity in the midstroma. CONCLUSIONS: In vivo confocal microscopic examination of subepithelial infiltrates appearing during EKC suggests that the innate immune system, as represented by the dendritic cells, is highly active early on. Nonetheless, the inflammatory component in both epithelium and stroma is massive and, in deeper stromal layers, long standing.

Outcomes of coaxial microincision cataract surgery versus conventional coaxial cataract surgery.

PURPOSE: To compare the outcomes of coaxial microincision cataract surgery (MICS) with those of conventional coaxial cataract surgery. SETTING: University Eye Clinic, Geneva, Switzerland. METHODS: In a prospective study, 50 eyes of 50 patients with nuclear or corticonuclear cataract (grades 2 to 4 on the Lens Opacities Classification System III) were randomly selected to have cataract extraction through a temporal clear corneal incision using 1 of 2 techniques: coaxial MICS (25 eyes) or conventional coaxial cataract surgery (25 eyes). Coaxial MICS was performed through a 1.6 mm incision and conventional coaxial cataract surgery, through a 2.8 mm incision. In all cases, a flexible hydrophobic acrylic intraocular lens (Lentis L-303, WaveLight GmbH) was implanted. Intraoperative parameters were ultrasound time, surgical time, and total volume of balanced salt solution used. The best corrected visual acuity, corneal thickness, and endothelial cell count were evaluated preoperatively and postoperatively. RESULTS: There were no relevant clinical differences between groups or perioperative complications in either group. The only statistically significant differences between the 2 groups were ultrasound time (P = .0002) and surgical time (P = .005). CONCLUSIONS: Coaxial microincision cataract surgery was a safe and effective technique. Although ultrasound and surgical time were significantly higher with coaxial MICS than with conventional coaxial cataract surgery, the postoperative results in the 2 techniques were comparable.