Long-term follow-up study of scleroplasty using autogenous periosteum.

Autogenous periosteum was used to reinforce scleral thinning, perforation, or corneoscleral wound dehiscence in four eyes of three patients with necrotizing scleritis or peripheral ulcerative keratitis associated with advanced rheumatoid arthritis. All grafts have remained intact during an average follow-up interval of 36 months (range, 19-52 months). The postoperative visual acuity ranged between 20/30-20/60. Two eyes exhibited age-related macular degeneration, and one eye had an epiretinal membrane postoperatively. No systemic complications occurred following surgery.

Pneumococcal endophthalmitis after corneal transplantation: control by modification of harvesting techniques.

Between January and September 1986, 61 patients underwent corneal transplantation at a university hospital, and three (4.9%) of the patients developed endophthalmitis. Cultures of the donor cornea were positive for Streptococcus pneumoniae. The transplant program was stopped and an investigation begun. Review of corneal transplants in 1985 showed that S pneumoniae was recovered from only 1 (1.5%) of 66 donor corneas compared with 6 (9.8%) of 61 in 1986 (P = 0.045; Fisher's exact test). Investigation showed that major changes had occurred in the corneal transplant program in 1986 as a result of a new state law. Coroner's cases had become the source of most corneas; younger donors were available, and corneas, instead of whole eyes, were collected in the coroner's office, often by part-time technicians. All of the infected corneas had been harvested by part-time technicians, instead of the regular eye bank technician, and came from younger donors (mean age 11.8 years v 27.2; P less than or equal to 0.02). Based on these observations, collection techniques were modified to reduce contamination of corneas during harvesting. This included the use of surgical drapes and gloves, collecting the cornea without interruption, saline irrigation of the eye, and inversion of the eye chamber to ensure complete contact of the cornea with the antibiotic-containing media. The program was restarted, and there were no corneal infections with S pneumoniae during a one-year follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Ophthalmia nodosa caused by tarantula hairs.

A young woman presented with ocular discomfort after handling her pet tarantula. Multiple fine hairs were detected on the eyelids, in the palpebral and bulbar conjunctiva, and in the corneal epithelium and stroma. In addition, foreign body granulomas were found in the conjunctiva. Six months later, peripheral chorioretinal lesions were seen. The clinical and histologic findings in this case closely resemble the findings in ophthalmia nodosa caused by caterpillar hairs.

Arachidonic acid metabolism to eicosanoids in herpes virus-infected rabbit cornea.

The metabolism of the polyunsaturated fatty acid, arachidonic acid (20:4, n-6) in rabbit cornea with varying severities of herpes simplex viral infection was investigated. The results indicate an active synthesis of the lipoxygenase and cyclooxygenase reaction products of arachidonic acid in central cornea and corneal-scleral rim. Stimulation of 12-hydroxyeicosatetraenoic acid (12-HETE) production in herpes-infected cornea was correlated positively with the severity of infection. Other eicosanoids were increased maximally in moderately infected corneas. The stimulation of eicosanoid synthesis was more evident in central cornea as compared to corneal-scleral rim. Herpes infection also caused a decline in the incorporation of radiolabeled arachidonic acid into membrane glycerolipids. These data indicate that the production of eicosanoids from arachidonic acid is stimulated in herpes-infected cornea. The stimulation may reflect the presence of phagocytic cells in the infected cornea, an enhanced capacity of the cornea itself to produce eicosanoids, or a combination of these effects. Decreased acylation of membrane lipids may be the result of infection-induced activation of fatty acid release mechanisms, which would lead to degradation of cell membranes. The presence of lipoxygenase reaction products in the herpes-infected cornea introduces a new factor for consideration in the design of therapeutic regimens for this disease.

Choroideremia in a genotypically normal female. A case report.

A 10-year-old girl demonstrated advanced choroideremia. She had decreased visual acuity, high myopia, and characteristic fundus findings of choroideremia. Her ERG, dark adaptation, visual fields, and fluorescein angiogram were all abnormal; the results were consistent with choroideremia. Her chromosome studies revealed that she was a genotypically normal female. Her parents were examined ophthalmologically and found to be normal.

Acyclovir in the treatment of herpetic stromal disease.

Seventeen patients (ten women and seven men, 23 to 72 years old) with stromal herpetic disease were treated with topical and oral acyclovir for 14 days. Of the 12 patients with disciform edema, five showed minimal improvement, four showed no change, and three showed worsening of their disease. Of the five patients with necrotizing stromal keratitis, one improved, one showed no change, and three became worse. The patients who had been treated with corticosteroids previously had a statistically significantly worse outcome than those who had not been so treated. One patient with necrotizing stromal keratitis showed virus particles in tissue specimens obtained by superficial lamellar keratectomy. Thus, acyclovir was not effective in the treatment of disciform edema or necrotizing stromal keratitis. Further studies are needed to ascertain whether the drug is therapeutically ineffective or whether acyclovir did not reach the stroma in amounts sufficient to affect the course of stromal disease in the human eye.

Surgical management of peripheral fungal keratitis (keratomycosis).

Keratomycosis often follows ocular trauma caused by vegetable matter. Medical management sometimes is unsuccessful, and surgical intervention is required. Débridement, penetrating keratoplasty, and lamellar keratoplasty in conjunction with an inlay conjunctival flap have all been proved effective. Three case reports illustrate the usefulness of lamellar keratoplasty and conjunctival flaps in the management of peripheral corneal fungal ulcers.

Differences in natural and recombinant interferon for herpes keratitis in two animal models.

Natural human leukocyte interferon (natural HuIFN-alpha) and recombinant leukocyte A interferon (recombinant A HuIFN-alpha) were tested for prophylactic and/or therapeutic effects in reducing the severity of keratitis in rabbit and monkey eyes infected with McKrae strain herpesvirus. The results showed that the two interferons acted differently in the rabbit eye; combined prophylactic and therapeutic administration of natural interferon mitigated the disease, while recombinant interferon had no effect. In monkeys, the two interferons acted similarly. Combined prophylactic and therapeutic administration reduced disease findings, while therapeutic administration alone had no effect. Thus, studies in rabbits are not accurate predictors of primate study results; whether or not nonhuman primate results can be extrapolated to humans remains to be seen.

Soccerball-induced eye injuries.

We report a series of 24 confusion eye injuries resulting from soccerball impact. Hyphema (50%), vitreous hemorrhage (29%), corneal abrasion (21%), angle recession (8%), and retinal tear (4%) were experienced. When compared with a combined hyphema series and with hockey and racquet sports, our group had fewer serious injuries and no permanent visual acuity loss resulted. Although the incidence of eye injuries is low and the use of eye protectors may be inconvenient, we strongly recommend protective eyewear be worn in competitive sports involving large and small projectiles.

Late ocular hypotony following intracapsular cataract extraction: probable relation to premature resorption of polyglactin 910 sutures.

We have recently had a series of seven patients who developed late ocular hypotony, flat anterior chambers, and choroidal detachments following cataract surgery. In each case, there was evidence of premature dissolution of the polyglactin 910 sutures that were used for closure. From this experience we propose steps that can be taken to minimize such problems.

Atropine toxicity in identical twins.

Two cases of atropine toxicity in monozygotic twins presented with the usual systemic manifestations: hyperpyrexia, agitation, mydriasis, tachypnea, tachycardia, decreased gastrointestinal motility, anhydrosis, and skin flush. Intravenous physostigmine, the treatment of choice, was used to resolve the toxic crisis. Physostigmine counteracts atropine's anticholinergic effects at the postganglionic nerve synapses of the autonomic nervous system. The chance of atropine toxicity occurring with ophthalmic usage may be lessened by careful parental instruction about dosages and about the warning signs of its systemic toxicity.