Recurrent endogenous Candida.

We report a 61-year-old who developed candidemia following pancreatic tumor surgery, and presented with bilateral multifocal chorioretinitis and vitritis. Chorioretinal lesions regressed with fluconazole therapy. Pars plana vitrectomy was performed with resultant improved visual acuity, but vitritis recurred with the next chemotherapy session. With the cessation of chemotherapy, vitritis regressed without any systemic treatment.

Topical N-acetylcysteine reduces interleukin-1-alpha in tear fluid after laser subepithelial keratectomy.

PURPOSE: To evaluate the effect of topical N-acetylcysteine (NAC) on interleukin 1-alpha (IL-1alpha) levels in tear fluid after myopic laser subepithelial keratectomy (LASEK) and its possible role in modulating corneal wound healing. METHODS: Twenty-six eyes of 13 patients who underwent myopic LASEK were divided into 2 groups. Group 1 (n=10 eyes) was used as a control group. All patients received topical lomefloxacin and dexamethasone postoperatively. Additionally, patients in Group 2 received topical NAC for 1 month postoperatively. Tear fluid samples were collected with microcapillary tubes preoperatively, on the first and on the fifth postoperative day, and the release of IL-1alpha in tear fluid was calculated. Haze grading and confocal microscopic examination were performed at 1 and 3 months postoperatively. RESULTS: The mean IL-1-alpha release values were 0.285-/+0.159 pg/min in Group 1 and 0.235-/+0.142 pg/min in Group 2 preoperatively. In Group 1, the values were 0.243-/+0.155 pg/min on day 1 and 0.164-/+0.125 pg/min on day 5. In Group 2, the mean IL-1alpha release values were 0.220-/+0.200 pg/min on day 1 and 0.080-/+0.079 pg/min on day 5. The difference between the groups was significant only for day 5 (p<0.05). Mean corneal haze score and grey scale value in confocal microscopy were significantly higher (p<0.05) in Group 1 at 1 month. However, at 3 months there was no difference between groups (p>0.05). CONCLUSIONS: NAC seems to have an additive effect to steroids in suppressing IL-1alpha levels in tear fluid and may be clinically advantageous in modulating corneal wound healing during the early postoperative period after LASEK.

Long-term success rate of perforated punctal plugs in the management of acquired punctal stenosis.

PURPOSE: To give the long-term success rates of punctal dilatation with insertion of perforated punctal plugs (PPP) for the management of acquired punctal stenosis. METHODS: A series of 44 eyes of 26 patients who underwent PPP implantation for the management of acquired punctal stenosis were retrospectively evaluated in terms of the severity of acquired punctal stenosis, associated eyelid disorders, implantation technique of PPP, and long-term success rate of PPP for the treatment of epiphora. In all patients, punctal dilation was performed prior to the insertion of plugs. Patients demonstrating moderate or severe horizontal eyelid laxity underwent a lateral tarsal strip procedure before PPP implantation. Complete stenosis of the punctum was treated with the radiofrequency unit before PPP implantation. The plugs were extracted at 2 months in every patient. RESULTS: The mean age of the patients was 63.6 +/- 10.5 years. The median interval between the onset of epiphora and PPP implantation was 15 months. There were 14 complete stenoses, 29 partial punctal stenoses, and 1 squamous papilloma involving the inferior punctum causing epiphora. Associated eyelid laxity was detected in 14 of 44 eyes (31.8%), and 8 eyes underwent a lateral tarsal strip procedure before PPP implantation. The mean follow-up time was 19.0 +/- 13.4 months. Success was achieved in 37 of 44 eyes (84.1%), with relief of epiphora. Of the 7 eyes with continued epiphora, 3 eyes demonstrated recurrent punctal stenosis and 4 eyes demonstrated mild horizontal eyelid laxity. CONCLUSIONS: The long-term success rate of PPP implantation for the treatment of acquired punctal stenosis is satisfactory. Associated eyelid pathologies should be evaluated for their contribution to epiphora and be treated before PPP implantation.

Higher-order aberrations and visual acuity after LASEK.

BACKGROUND: To determine ocular higher-order aberrations (HOAs) in eyes with supernormal vision after myopic astigmatic laser subepithelial keratomileusis (LASEK) and to compare the findings with those in eyes with natural supernormal vision. METHODS: Ocular HOAs were measured after LASEK in 20 eyes of 12 myopic astigmatic patients with postoperative uncorrected visual acuity (UCVA) of >20/16 (group 1). Patients who were included in the study had no visual symptoms like glare, halo or double vision. The measurements were taken 8.3 +/- 3 months after LASEK surgery. In group 2 ocular HOAs were examined in 20 eyes of 10 subjects with natural UCVA of >20/16 as a control. Measurements were taken across a pupil with a diameter of 4.0 mm and 6.0 mm. Root-mean-square (RMS) values of HOAs, Z(3)-1, Z(3)1, Z(4)0, Z(5)-1, Z(5)1 and Z(6)0 were analyzed. RESULTS: The mean RMS values for each order were higher in group 1 when compared with group 2 at 4.0 mm and 6.0 mm pupil diameters. There was no statistically significant difference between groups in spherical and coma aberrations (P > 0.05). Mean RMS values for total HOAs were 0.187 +/- 0.09 microm at 4.0 mm and 0.438 +/- 0.178 microm at 6.0 mm pupil in group 1 and 0.120 +/- 0.049 microm at 4.0 mm and 0.344 +/- 0.083 microm at 6.0 mm pupil in group 2. The difference between groups in total HOAs was statistically significant at 4.0 mm and 6.0 mm pupil diameters (P < 0.05). CONCLUSION: Ocular HOAs exist in eyes with supernormal vision. After LASEK, the amount of HOAs of the eye increases under both mesopic and photopic conditions. However the amount of HOA increase does not seem to be consistent with visual symptoms.

A possible mechanism for transpupillary thermotherapy: nitric-oxide-related cellular damage.

BACKGROUND: To determine the oxidative stress markers on rabbit vitreous following transpupillary thermotherapy (TTT) application. METHODS: The pigmented rabbit eyes were divided into 3 groups, each containing 6 eyes. Group 1 was used as a control group. Twelve eyes underwent TTT with a power of 250 mW (group 2) and 800 mW (group 3), with a diameter of 3000 microm and duration of 60 s; 24 h after laser application, vitreous samples were collected. Nitric oxide (NO) and malondialdehyde (MDA) levels and superoxide dismutase (SOD) activities were determined in all groups. RESULTS: NO levels were statistically significantly higher in all groups when compared with the control group (p < 0.05). MDA levels were higher and SOD activities were lower in all groups when compared with the control group, but the differences were not significant statistically (p > 0.05). INTERPRETATION: Our results support the hypothesis that TTT application induces NO synthesis, which may lead to occlusion at choroidal neovessels. Because of the nonsignificantly increased levels of MDA and decrease of SOD activities there maybe only a weak relation between lipid peroxidation induced by free oxygen radicals and TTT-induced vascular damage.