Diffuse lamellar keratitis induced by trauma 6 months after laser in situ keratomileusis.

This case report illustrates an unusual presentation of diffuse lamellar keratitis triggered by a foreign body striking the eye 6 months after laser in situ keratomileusis (LASIK). The etiology of diffuse lamellar keratitis is unclear. The infiltrate within the plane of the flap after removal of the foreign body supports the theory that diffuse lamellar keratitis is an inflammatory reaction.

Linkage of posterior polymorphous corneal dystrophy to 20q11.

Posterior polymorphous dystrophy (PPMD) is an autosomal dominant disorder of the cornea that is clinically recognized by the presence of vesicles on the endothelial surface of the cornea. The corneal endothelium is normally a single layer of cells that lose their mitotic potential after development is complete. In PPMD, the endothelium is often multi-layered and has several other characteristics of an epithelium including the presence of desmosomes, tonofilaments, and microvilli. These abnormal cells retain their ability to divide and extend onto the trabecular meshwork to cause glaucoma in up to 40% of cases. A large family with 21 members affected with PPMD was genotyped with short tandem repeat polymorphisms distributed across the autosomal genome. Linkage was established with markers on the long arm of chromosome 20. The highest observed LOD score was 5.54 (theta = 0) with marker D20S45. Analysis of recombination events in four affected individuals revealed that the disease gene lies within a 30cM interval between markers D20S98 and D20S108.

Burkitt lymphoma presenting as a conjunctival mass.

PURPOSE: A sporadic Burkitt lymphoma, which presented as a primary conjunctival mass, demonstrates the approach to clinical diagnosis, staging, and current management of this rapidly growing malignant tumor, as well as newer concepts of its pathogenesis. PATIENT AND METHODS: A 16-year-old girl had rapid development of a conjunctival mass 6 weeks after an infectious mononucleosis-like illness, associated with a positive monospot test. A biopsy of the tumor was immunostained for lymphocyte markers. Additional clinical workup included computed tomographic scanning, nasopharyngeal biopsy, and studies of blood, bone marrow, and spinal fluid. In situ hybridization for Epstein-Barr virus (EBV)-encoded nuclear RNA was performed on the tumor and adenoidal tissue. RESULTS: The conjunctival biopsy showed a typical Burkitt lymphoma with markers positive for predominantly B lymphocytes. Computed tomographic scans indicated residual tumor in the anterior orbit. Biopsy of thickened adenoidal tissue showed only benign lymphoid hyperplasia. Evidence of EBV infection was found in the adenoidal tissue but not in the tumor cells. The patient was treated with combined chemotherapy on a Pediatric Oncology Group Study protocol for localized non-Hodgkin lymphoma, and is disease-free 4 1/2 years after diagnosis. CONCLUSIONS: A sporadic Burkitt lymphoma arising in the conjunctiva appears to be the first reported in this site. The lymphoma responded well to chemotherapy, which is now the usual course in stage 1 disease. A direct role for EBV in the oncogenesis of this sporadic tumor, similar to that in the endemic form, could not be supported because EBV-encoded nuclear RNA was absent in the tumor cells.

Calcific band keratopathy associated with the use of topical steroid-phosphate preparations.

OBJECTIVE: To report a possible adverse effect of topical steroid-phosphate preparations and to identify factors that may contribute to the development of this effect. DESIGN: The medical records of five patients who developed calcium deposition in the cornea were reviewed and analyzed for possible contributing factors. PATIENTS: Five cases of calcium deposition in the cornea associated with the use of topical steroid-phosphate preparations are described. Scrapings from the cornea and/or specimens obtained at keratoplasty were available in all cases. These cases had the following characteristics in common: use of steroid-phosphate preparations (n = 5); multiple topical drops (n = 5); penetrating keratoplasty (n = 3); presence of epithelial defects (n = 4); history of herpetic stromal keratitis (n = 3) [corrected]; and history of iritis (n = 3). A hypothesis explaining calcium deposition in association with steroid-phosphate preparations is presented. CONCLUSIONS: We recommend withdrawal of steroid-phosphate preparations in patients who develop band keratopathy.

Subconjunctival fibrosis after conjunctival autograft.

While largely successful, the use of a conjunctival autograft in the exposed scleral bed following a pterygium excision can result in postoperative complications. We report two cases of a previously undescribed complication: subconjunctival fibrosis at the harvest site of the graft. In one case, the fibrosis caused an asymptomatic, purely cosmetic defect; however, in the other case, the scar tissue constricted the extraocular movement with resultant diplopia. We call attention to this complication as it can affect visual function; we discuss its management and prevention.

Long-term outpatient treatment of CMV retinitis with ganciclovir in AIDS patients.

Cytomegaloviral retinitis was diagnosed in nine eyes of seven patients with acquired immune deficiency syndrome (AIDS) on the basis of the characteristic ocular findings and a positive culture for cytomegalovirus (CMV) obtained systemically. Treatment with ganciclovir was begun on a protocol which provided two weeks of inpatient therapy at daily doses of 2.5 to 10 mg/kg followed by outpatient therapy at a reduced dosage three to six days per week. Outpatient maintenance dosage ranged from 15 mg/kg per week to 30 mg/kg per week. In seven eyes of six patients the treatment decreased retinal inflammation and stabilised the margins of the lesions. Six patients have tolerated long term maintenance therapy for 10-30 weeks. Six of seven patients (85%) in this study developed side effects from ganciclovir which required periods of a reduction in dosage or interruption of therapy. The side effects from ganciclovir included neutropenia, thrombocytopenia, drug fever, and neuropathy. Physicians using ganciclovir in AIDS patients must watch for the signs of drug toxicity and adjust treatment accordingly. Ganciclovir appears to be a promising therapy for CMV retinitis, but further work is necessary to determine the best regimen for optimal efficacy with minimal side effects.

Postkeratoplasty crystalline deposits mimicking bacterial infectious crystalline keratopathy.

Three corneal transplant patients developed white, crystalline, anterior stromal lesions in their grafts while receiving long-term topical corticosteroid therapy. A presumed diagnosis of infectious crystalline keratopathy was made in each case. However, histologic examination of the lesions failed to show gram-positive cocci. A fungal infiltrate was present in the first two patients, and calcium deposits produced the lesion in the third patient.