Trabeculectomy flap suture lysis with endolaser probe.

Enhancing filtration after trabeculectomy with scleral flap sometimes requires cutting of the nylon suture. A new use of the endolaser probe to cut the nylon suture through hemorrhagic and edematous conjunctiva and Tenon's capsule is described. The probe compresses the tissue so that it is close to the suture for delivery of the laser energy. This application of the endolaser probe as an "ecto-laser" succeeded in enhancing filtration, raising the conjunctival bleb, and lowering intraocular pressure.

Tetracyclines in ophthalmology.

Tetracycline and its congeners demonstrate antimicrobial activity against bacteria, Chlamydiae and Toxoplasma gondii. Ophthalmologists can use these drugs to treat bacterial and chlamydial infections, and also for ocular rosacea and similar disorders. Side effects associated with systemic tetracycline use are most commonly related to the gastrointestinal tract and to signs of yeast superinfection. Minocycline use may be limited by its vestibular toxicity. Temporary growth retardation and staining of erupting teeth may occur with oral use of tetracycline in children under 8 years; these drugs should not be given in pregnancy or to young children. Topical tetracycline application yields good tear and aqueous humor concentrations.

Wound healing of grafts in congenitally opaque infant corneas.

Wound healing, determined by uneventful suture removal, was evaluated in 28 corneal transplants (20 eyes) with congenital corneal opacities. Seven transplants in seven eyes with the typical central corneal opacities of Peters' anomaly had suture removal between 17 and 90 days postoperatively. All seven transplants remained transparent. Corneal grafts for sclerocornea or regrafts in sclerocornea healed much more quickly than those in eyes with Peters' anomaly (as early as four days postoperatively in the 13 most recent cases). In these corneas suture microabscesses and superficial neovascularization of the wound were signs indicating wound healing and also a host inflammatory response that led to graft rejection if the sutures were not removed.

Fuchs' adenoma affecting the peripheral iris.

An elevated, pigmented lesion of the peripheral iris developed in a 73-year-old woman. The lesion was believed to be a malignant melanoma and was excised at the time of routine cataract extraction. Pathologic examination disclosed a Fuchs' adenoma. These lesions are common in the elderly and are almost invariably clinically silent. This case, however, demonstrates that under rare circumstances a Fuchs' adenoma may induce cataractous changes or produce clinical findings that can mimic an iris melanoma.

Allergic and toxic reactions of soft contact lens wearers.

The allergic and toxic effects of preservatives found in soft contact lens solutions are reviewed. Thimerosal, a preservative commonly found in soft contact lens solutions, may cause ocular delayed hypersensitivity. Patients with delayed hypersensitivity to thimerosal may develop conjunctival hyperemia, corneal infiltrates and intolerance to lens wear with the use of soft contact lens solutions containing thimerosal. Delayed hypersensitivity to thimerosal can be demonstrated by an occlusive patch test or intradermal injection. Discontinuation of chemical disinfection with substitution of thermal disinfection using unit-dose, non-preserved saline causes resolution of signs and symptoms. Another cause of lens wear intolerance is contact lens-associated giant papillary conjunctivitis. Protein deposits on the lens may act as antigens and initiate an allergic condition which disappears when the lens is discontinued. Alternatively, the giant papillae may be the result of mechanical irritation induced by the contact lenses. The chemical preservatives that are found in soft contact lens solutions cause epithelial toxicity when applied to isolated rabbit corneas. However, corneal toxicity toxicity in a clinical setting has not been demonstrated.

Peripheral corneal ulcers, conjunctival ulcers, and scleritis after cataract surgery.

After undergoing uneventful cataract extractions, four patients developed an inflammatory reaction that included scleritis and peripheral corneal infiltrates and ulcers. Two of these patients also developed conjunctival ulcers. The inflammatory reaction in all four patients responded to topical corticosteroids.

Endophthalmitis after strabismus surgery.

We treated two cases of endophthalmitis caused by strabismus surgery. In one patient, a scleral perforation was recognized during surgery and treated with cryopexy. In the other, a scleral perforation was suspected but never confirmed. Despite intensive antibiotic and corticosteroid therapy, visual acuity decreased to light perception in Case 1 and to counting fingers in Case 2. The second eye was enucleated eight years later after it had become blind and painful.