Propionibacterium acnes endophthalmitis after intracapsular cataract extraction.

The authors report a case of Propionibacterium acnes endophthalmitis after intracapsular cataract extraction with implantation of an anterior chamber intraocular lens. The patient's chronic inflammation persisted for 5 years after cataract surgery despite treatment with pars plana vitrectomy, intraocular lens removal, topical and oral steroids, and topical fortified antibiotics. Fluctuations in the inflammation were paralleled by changes in the size and appearance of a white plaque on the posterior corneal surface. Anterior chamber tap cultures were positive for P. acnes after 8 days of incubation under anaerobic conditions. The inflammation was not controlled until the posterior corneal plaque, which was the presumed nidus of the chronic infection, was removed and the patient was treated with intravitreal and oral antibiotics.

.008% timolol ophthalmic solution. A minimal-effect dose in a normal volunteer model.

A double-masked, randomized, placebo-controlled, rising-dose, single-dose study was undertaken to assess the effect of low concentrations of timolol maleate ophthalmic solution (0.008%, 0.025%, 0.08%, and 0.25%) on intraocular pressure and its diurnal variation in healthy, normal volunteers. A single dose of 0.008% timolol exhibits a definite but minimal-effect on intraocular pressure in this normal volunteer model, causing a significant peak mean decrease in intraocular pressure from its value immediately predose. This decrease was 1.8 mm Hg (a peak mean percent decrease of 12.8%) at 2 hours postdose compared with an increase of 0.1 mm Hg (+2.5%) during a pre-study curve due to normal diurnal variation. One drop of 0.008% solution represents a single dose of approximately 2.5 micrograms of timolol. A slight contralateral ocular hypotensive effect appears to be present for 0.25% timolol at 2 hours postdose although it just failed to reach statistical significance.

Symmetry of refractive and visual acuity outcome in the Prospective Evaluation of Radial Keratotomy (PERK) study.

In the Prospective Evaluation of Radial Keratotomy (PERK) study, the symmetry of refractive and visual acuity outcome was analyzed in 269 patients with bilateral radial keratotomy with a single operation in each eye. Patients were required to wait 1 year after surgery on the first eye before having surgery on the second eye. At 1 year after surgery on the second eye, 98% of patients had 3.00 diopters or less difference between their two eyes in the spherical equivalent of the cycloplegic refraction (100% before surgery), and 96% of patients had 3.00 D or less difference between their two eyes in the amount of refractive power in the vertical meridian (100% before surgery). Thus, surgically induced refractive anisometropia was not a major complication in the PERK study. However, 14% of patients had four to eight Snellen lines difference in the uncorrected visual acuity between their two eyes (1% before surgery), emphasizing that induced asymmetry of refraction is a potential clinical problem for some patients.

Ocular toxoplasmosis and visual field defects.

We studied 34 patients with peripapillary lesions secondary to toxoplasmosis. All patients had visual field defects corresponding to interruption of the nerve fiber layer of the retina. The extent of visual field loss increased with proximity to the disk.

Melanocytic lesions of the eyelid skin.

We described the three histogenetic forms of cutaneous melanoma--lentigo maligna melanoma, superficial spreading melanoma, and nodular melanoma. The first two forms have a flat spreading component or radial growth phase in the epithelium as well as in the invasive or vertical growth phase. Formerly these two lesions may have been confused with one another. Nodular melanoma has only the vertical growth phase. Examples of lentigo maligna melanoma and superficial spreading melanoma were found in eyelid lesions involving both the skin and conjunctiva. The distinctive histopathology of the cutaneous lesion was retained in the conjunctiva.

Malignant melanomas of the conjunctiva.

A retrospective study of 23 conjunctival melanomas using the Clark classification revealed that the three most common forms of melanoma described in the skin--lentigo maligna melanoma (Hutchinson's freckle with melanoma), superficial spreading melanoma, and nodular melanoma--can be recognized in the conjunctiva. As in the skin, lentigo maligna melanoma appears to be associated with a good prognosis compared to the prognosis associated with superficial spreading melanoma. These two forms of melanoma are both associated with an intraepithelial stage and had previously been grouped under one designate, cancerous melanosis. They can be distinguished histologically although definite clinical differentiation will be determined in the future. Some melanomas with an intraepithelial stage, however, cannot be definitely classified. Relating all conjunctival cancerous melanoses to Hutchinson's melanotic freckle is no longer justified.

Endogenous Aspergillus endophthalmitis occurring after kidney transplant.

Two months after renal transplantation, a 26-year-old man developed pneumonia that was recalcitrant to antibiotic therapy and proved by biopsy to be due to cytomegalovirus and Aspergillus fumigatus. Ten days later while on amphotericin B therapy, he developed an endophthalmitis proved by smear and culture of a vitreous aspiration to be caused by A. fumigatus. Despite intravitreous and systemic amphotericin B the vision deteriorated and the eye was enucleated. Microscopic examination disclosed an intense endophthalmitis with vitreous and retinal abscesses. The second patient was a 29-year-old woman who developed severe hypertension and graft rejection one month after renal transplant, despite massive immunosuppressive therapy with prednisone, azathioprine, and cobalt 60 irradiation. She developed pneumonia, meningitis, and died. A postmortem examination revealed disseminated aspergillosis. A single choroidal abscess due to Aspergillus with an associated retinal hemorrhage was observed in the left eye.