Use of infant donor tissue for endokeratoplasty.

Endokeratoplasty using an infant donor cornea was performed in an 81-year-old man with Fuchs' endothelial dystrophy, corneal decompensation, and a history of cystoid macular edema in the left eye. The patient reported minimal discomfort after surgery, and the best spectacle-corrected visual acuity improved from 20/400 to 20/100 by the second postoperative month with resolution of the corneal edema. Endokeratoplasty using an infant cornea is a viable alternative to penetrating keratoplasty for corneal endothelial decompensation, and infant corneas may provide a new and potentially healthier source of tissue for corneal transplantation.

A randomized, double-masked trial of topical ketorolac versus artificial tears for treatment of viral conjunctivitis.

OBJECTIVE: To determine if topical ketorolac 0.5% relieves the symptoms and signs of viral conjunctivitis better than artificial tears. DESIGN: Randomized, controlled trial. PARTICIPANTS: One hundred seventeen patients with a clinical diagnosis of viral conjunctivitis were randomized to the treatment group or control group. METHODS: Physicians and patients were masked to treatment. Patients in the treatment group received topical ketorolac 0.5% four times daily. Patients in the control group received artificial tears four times daily. Symptom and sign scores were recorded on the day of recruitment and at the time of a follow-up examination 3 to 4 days later. MAIN OUTCOME MEASURES: Change in six symptoms of conjunctivitis (overall discomfort, itching, foreign body sensation, tearing, redness, and lid swelling) and four signs of conjunctivitis (conjunctival injection, conjunctival chemosis, conjunctival mucus, and lid edema). Adverse effects were also studied. RESULTS: A total of 105 patients returned for their 3- to 4-day follow-up. Both the artificial tear and ketorolac groups showed improvement in all symptom scores at their 3- to 4-day follow-up visit. There was no statistically significant difference between the change in symptom scores between the treatment group and control group in any symptom category except redness. Patients in the control group were more likely to report improvement in redness than those in the treatment group, P = 0.012. There was no statistically significant difference between the change in sign scores between the treatment and control groups. Ketorolac 0.5% was more likely to produce stinging than artificial tears, 59.2% versus 18.8%, P < 0.001. CONCLUSIONS: Topical ketorolac 0.5% used four times daily is no better than artificial tears at relieving the symptoms or signs of viral conjunctivitis and produces more stinging than artificial tears.

Traumatic hyphema: outcomes of outpatient management.

OBJECTIVE: This study aimed to compare the outcomes of outpatient and inpatient management of layered hyphema. DESIGN: The charts of all patients with traumatic layered hyphema treated in the Massachusetts Eye and Ear Infirmary Emergency Ward between January 1991 and November 1995 were analyzed retrospectively. Patients with a diagnosis of microscopic hyphema, ruptured globe, or posterior segment injury other than commotio retinae on their initial emergency department visit were excluded. The study patients were compared with an historic control group of patients with hyphema who had been treated at the same institution from July 1986 to February 1989. PARTICIPANTS: A total of 154 patients met the study criteria. These were compared with 119 patients in the historic control group. INTERVENTION: Of the study patients, 5% were admitted on the day of presentation, 95% were treated initially as outpatients, and 4% subsequently were admitted. All of the patients in the historic control group were treated with initial hospital admission. MAIN OUTCOME MEASURES: The rebleed rates of the study and control groups were compared. The final recorded visual acuity and causes of best-corrected visual acuity worse than 20/30 were analyzed for the study group. RESULTS: The rebleed rates of the study group and the historic control group were 4.5% and 5.0%, respectively (P > 0.05). The rebleed rates of the study patients initially treated as outpatients and the historic control group were 3.4% and 5%, respectively (P > 0.05). The rebleed rates of study patients who did not receive aminocaproic acid and the subset of historic control patients who received aminocaproic acid were 3.3% and 4.8%, respectively (P > 0.05). Ninety-six percent of study patients achieved a final best-corrected visual acuity of 20/30 or better. Causes of a final documented visual acuity worse than 20/30 included loss of patient follow-up before resolution of the hyphema, traumatic cataract, macular hole, and macular degeneration. CONCLUSIONS: In the authors' predominantly white patient population, close outpatient follow-up of traumatic hyphemas appears to be safe and effective. Hospitalization for hyphema does not appear to decrease the rate of rebleeding. Decreased vision in the setting of traumatic hyphema generally results from comorbidities not affected by inpatient management.

Cardiovascular effects of commonly used ophthalmic medications.

Eye disease and cardiovascular disease frequently coexist. As a result, cardiologists and ophthalmologists often treat the same patients. Among ophthalmologists it is well known that topical ophthalmic medications are capable of producing serious cardiovascular effects, including congestive heart failure, arrhythmias, and death. However, cardiologists may not be aware of these potential complications. This article reviews the cardiovascular effects of commonly prescribed topical ocular medications and describes important contraindications to their use in patients with cardiovascular disease. Cardiologists, by making themselves and their patients more aware of the cardiovascular effects of topical ocular medications, may be able to avoid the adverse and potentially fatal complications of these agents.