Unexpected corneal endothelial cell decompensation after intraocular surgery with instruments sterilized by plasma gas.

PURPOSE: Ten cases of unexpected corneal endothelial cell decompensation occurring after routine intraocular surgery using instruments sterilized with a new plasma gas protocol are described. DESIGN: A retrospective observational case series with 1 year of follow-up was conducted. RESULTS: All patients had corneal decompensation and nonreactive pupils after surgery. Six patients required penetrating keratoplasty. Three patients partially recovered pupillary function. Visual acuity at 1 year ranged from 20/20 to hand motion (HM). One patient with an anterior chamber intraocular lens (ACIOL) experienced optic atrophy and HM vision despite resolution of corneal edema. CONCLUSIONS: Toxic corneal endothelial cell destruction syndrome was associated with the introduction of plasma gas sterilization protocols.

Recurrent corneal ulcerations associated with smokeable methamphetamine abuse.

PURPOSE: We studied a case of chronic, recurrent, bilateral, corneal ulcerations associated with smokeable methamphetamine abuse, commonly known as "ice," in an otherwise healthy 31-year-old woman. METHODS: Every few months the patient had recurrent corneal ulcerations. Each time, she was hospitalized and treated successfully with topical antibiotics. RESULTS: Even though she had undergone numerous formal attempts at drug rehabilitation, she continued to have relapses, and ulceration recurred only during periods of smokeable methamphetamine abuse. CONCLUSION: Illicit use of smokeable methamphetamine may result in corneal ulceration.

Cystic hydrops and spontaneous perforation in Fuchs' superficial marginal keratitis.

PURPOSE: We studied a case of Fuchs' superficial marginal keratitis in which cystic corneal hydrops developed in one eye, and spontaneous corneal perforation occurred in the fellow eye. METHODS: The patient underwent bilateral annular corneoscleral lamellar patch grafts for tectonic support. RESULTS: The patient had an uncomplicated postoperative course and visual acuity of 20/25 bilaterally. CONCLUSION: Stromal loss in Fuchs' superficial marginal keratitis may be severe enough to result in cystic corneal hydrops. Patients with this disorder should be counseled regarding the possibility of corneal perforation.

Penetrating keratoplasty and transscleral fixation of posterior chamber lens.

We reviewed the outcome in 115 patients who underwent penetrating keratoplasty and transscleral fixation of a posterior chamber lens. One patient died soon after surgical procedures, and nine patients were lost to follow-up, leaving a cohort of 105 patients. Mean follow-up time was 26.8 months (range, six to 43 months). Visual acuity of 20/40 or better was found in 29 patients (27.6%) and 20/50 to 20/200 in 37 patients (35.2%). Reasons for poor visual outcome included cystoid macular edema in ten patients (9.5%), age-related macular degeneration in six patients (5.7%), and retinal detachment in four patients (3.8%). None of the patients developed lens decentration. There were no instances of hyphema and only one patient had a perioperative limited suprachoroidal hemorrhage. New-onset increase in intraocular pressure developed in 20 of 66 patients (30.3%). Analysis of the 39 patients with preoperative increase in intraocular pressure that required medical treatment demonstrated an improvement in 13 patients (33.3%), worsening in 12 patients (30.8%), and unchanged status in 14 patients (35.9%). The exposed haptic suture was covered by using one of the following three alternative methods: a conjunctival flap, a scleral flap, or a corneal tissue button. Exposure of the haptic suture through the conjunctiva was a complication in 21 patients (20%). Of these 16 (76.1%) occurred in the group with a conjunctival covering, five (23.8%) occurred in the group with a scleral flap, and none occurred in the corneal tissue button group. This study demonstrated that transscleral fixation of a posterior chamber lens is a viable option in the treatment of patients undergoing penetrating keratoplasty and intraocular lens implantation with absent capsular support.

Posterior infectious crystalline keratopathy with Staphylococcus epidermidis.

Two cases of infectious crystalline keratopathy located in the posterior stroma after penetrating keratoplasty are presented. Topical steroids and suture removal were risk factors in both cases. In the first case, a moderate anterior chamber reaction was present. Crystalline infiltrates persisted on topical and systemic steroid therapy. In the second case, deep corneal ulceration, hypopyon, and vitreitis were noted. A vitreous aspirate showed rare gram-positive cocci in pairs. The corneal ulceration and crystalline keratopathy persisted despite intravitreal and topical antibiotics. Therapeutic penetrating keratoplasty was performed in both cases. Staphylococcus epidermidis sensitive to vancomycin was isolated from corneal tissue. Light microscopy documented aggregates of gram-positive bacteria anterior to Descemet's membrane, with an overlying keratitis. Electron microscopy in the second case showed all bacteria within stromal keratocytes. No clinical recurrence was seen using topical vancomycin. As demonstrated in the cases presented, infectious crystalline keratopathy can occur exclusively in the deeper layers of the cornea. Isolation of S. epidermidis, associated inflammation, and intraocular spread of organisms are rare findings.

Histologic study of eyes with transsclerally sutured posterior chamber intraocular lenses.

We studied the postmortem histologic characteristics of two eyes that had undergone penetrating keratoplasty and transscleral suturing of a posterior chamber intraocular lens for bullous keratopathy. The eyes were studied three days postoperatively in a 79-year-old man with pseudophakia and six months postoperatively in an 83-year-old man with aphakia. We also removed a posterior chamber intraocular lens in a 73-year-old woman who had an epithelial downgrowth three months postoperatively. In the first two cases, only one of four haptics was successfully positioned in the sulcus. Histologic study disclosed a thin fibrous capsule surrounding the haptics at their attachment site, no inflammation around the transscleral portion of the suture, and exposure of a suture tip externally. In the third case, the intraocular lens fell back into the vitreous cavity after the fixation sutures were cut externally at the time of surgical removal. Stability of the lens in all three cases was primarily a result of intact transcleral sutures and not fibrous encapsulation or ciliary sulcus placement of haptics.

Traumatic air blast injury with intracranial, bilateral orbital, and mediastinal air.

Air at 75 lbs/sq in from an air compressor hose struck a 19-year-old man in his right eye. Injected through a superior conjunctival laceration, the air entered subcutaneous, mediastinal, and bilateral orbital and intracranial spaces. High-resolution computed tomography scanning of the head and orbits revealed air adjacent to the right optic nerve throughout the orbit. We hypothesize that air was injected intracranially, but extradurally, through the superior orbital fissure. The patient suffered no visual loss.

A temperature-dependent choice in cell differentiation.

Ascension of the cell mass during culmination was observed to be temperature-sensitive in strain HH31 of the cellular slime mold Dictyostelium discoideum. A sequence of additional developmental abnormalities was also observed both preceeding and succeeding culmination. Slugs reared at the restrictive temperature (27 degrees C), in contrast to those reared at the permissive temperature (22 degrees C), were deficient in the expression of six prespore markers and elevated in the production of four prestalk markers. Following attempted culmination at the restrictive temperature, the majority of cells were stalk cells according to fluorescence, phase contrast, electron microscopic, biochemical, and plating efficiency criteria. These findings were correlated with a general diminution of staining of slug cell Membrane extracts on polyacrylamide gels with FITC-wheat germ agglutinin. The effect of the higher temperature was readily reversible prior to terminal differentiation. An interdependence of several of the changes was suggested by the observation that in two derivative strains the temperature-dependence of these changes was coordinately altered. In summary, a large fraction of the slug cells of HH31 appear to be temperature-dependent in their choice of pathways of cell differentiation, this change is related to a modification of the cell surface, and the choice made in the slug is remembered by cells as they terminally differentiate.