Changes in astigmatism after ptosis surgery measured by corneal topography.

A computerized topographic analysis system (EyeSys [EyeSys Technologies, Houston, TX, U.S.A.]) was used to evaluate corneal astigmatic changes (central corneal power and astigmatic axis) after blepharoptosis surgery on 29 eyelids (22 patients). Fifteen nonoperated eyelids of study patients undergoing unilateral ptosis repair were used as controls. All patients were evaluated preoperatively and again 6 weeks after surgery. Fifteen operated eyelids and five controls were also examined 12 months after surgery to evaluate the stability of these measurements. In 72.4% of operated eyes, corneal topography demonstrated increased with-the-rule astigmatism 6 weeks after surgery, 13.8% of surgical eyes showed increasing against-the-rule astigmatism, and in 13.8%, no change was noted from preoperative measurements. None of the 15 control eyes demonstrated any change in corneal astigmatic axis or significant change in central corneal power. By 12 months after surgery, all of the operated eyes showed a regression toward the amount and pattern of preoperative astigmatism. Only two of 15 eyes maintained a difference of > 0.3 D of central corneal power greater than their preoperative measurement at 1 year. These data suggest that corneal topography may be altered by changes in eyelid position, although the changes appear to be temporary in most patients.

Patient tolerance and ocular surface staining characteristics of lissamine green versus rose bengal.

PURPOSE: To determine patient tolerance and ocular surface staining characteristics of 1% lissamine green versus 1% rose bengal solutions in patients with dry eye and in those with normal ocular surfaces by comparison of subjective sensation and objective staining scores. METHODS: Twelve patients with keratoconjunctivitis sicca and eight subjects with no ocular surface disease recorded their symptoms on a graded scale (0-5) and the duration of symptoms after instillation of one drop of 1% lissamine green and 1% rose bengal on two different occasions in different order. Lissamine green and rose bengal staining patterns were recorded on a graded scale (0-4) by one of the authors. RESULTS: For patients with keratoconjunctivitis sicca mean sensation score with lissamine green (2.42) was significantly lower (P = 0.00006) than with rose bengal (4.58). The duration of symptoms was significantly longer (P = 0.0007) after rose bengal instillation as well. For subjects with no ocular surface disease, mean sensation score with lissamine green (1.375) was significantly lower (P = 0.01) than with rose bengal (2.5). In this group, duration of symptoms also was significantly longer (P = 0.001) after rose bengal instillation. In both groups, there was no difference in objective staining scores. CONCLUSION: Lissamine green is better tolerated than rose bengal by patients and is equally as effective as rose bengal in evaluating the ocular surface in keratoconjunctivitis sicca.

Cytomegalovirus keratitis after penetrating keratoplasty.

We report the development of cytomegalovirus (CMV) keratitis in the penetrating keratoplasty of a 59-year-old human immunodeficiency virus-negative woman after uncomplicated corneal transplantation. Immunosuppression with topical cyclosporine A 2% in corn oil and topical prednisolone acetate 1% suspension was used postoperatively. The 15-month postoperative course was complicated by multiple episodes of endothelial rejection, medically controlled elevated intraocular pressure, polymicrobial bacterial (coagulase-negative staphlococcus and alpha-hemolytic streptococcus) keratitis, and endothelial plaque formation with associated hypopyon and epithelial defect. The graft failed and penetrating keratoplasty was repeated. Cytomegalovirus infection of superficial keratocytes in a region of scarring was identified in histological sections stained with hematoxylin and eosin and confirmed using mouse monoclonal anti-cytomegalovirus antibodies. Excision of the diseased corneal button with no additional treatment appears to have been curative. Low-grade keratitis was the only manifestation of the CMV infection, and it has not recurred 6 months postoperatively.