Changes in Higher-Order Aberrations After Phototherapeutic Keratectomy for Subepithelial Corneal Infiltrates After Epidemic Keratoconjunctivitis.

PURPOSE: To investigate how corneal aberrations change after phototherapeutic keratectomy (PTK) for subepithelial infiltrates after adenoviral keratoconjunctivitis. METHODS: The records of patients who underwent transepithelial PTK for subepithelial infiltrates were retrospectively reviewed. Preoperative best-corrected visual acuity (VA) and the results of slit-lamp biomicroscopy examinations were recorded. The PTK procedure was performed under topical anesthesia with an Amaris excimer laser. Patients' manifest refraction values, topographical examination results, and corneal aberrations before and after surgery were analyzed. RESULTS: Twenty-four eyes of 16 women (84.3%) and 3 men (15.7%) were treated. The mean follow-up time was 6.0 ± 2.5 (range: 3-12) months, and the mean ablation depth was 82.3 ± 1.0 (range: 80-88) µm. Postoperative median best-corrected VA increased from 0.6 (range: 0.4-1.0) logarithm of the minimum angle of resolution to 0.2 (range: 0.1-0.5) logarithm of the minimum angle of resolution (P = 0.048), coma decreased from 0.56 (range: 0.29-0.37) to 0.44 (range: 0.07-0.74), secondary astigmatism decreased from 0.45 (range: 0.12-1.9) to 0.17 (range: 0.03-0.49), and total higher-order aberrations decreased from 1.24 (range: 0.61-6.74) to 0.9 (range: 0.33-1.64) (P = 0.008, 0.0032, and 0.018, respectively). CONCLUSIONS: PTK is an effective method for treating corneal opacity after epidemic keratoconjunctivitis, which yields significant improvements in both VA and visual quality.

Infección por adenovirus en hospital de niños con enfermedades respiratorias crónicas / Adenovirus infection in a children's hospital with chronic pulmonary diseases

Introducción: Las infecciones por adenovirus se diseminan rápidamente en recintos cerrados causando brotes asociados a gran morbimortalidad. Objetivos: Identificar tasa de ataque (TA) de infección por adenovirus en hospital de niños con enfermedades respiratorias crónicas (ERC) y evaluar factores asociados que faciliten la infección. Pacientes y Método: Entre junio y octubre de 2010 se evaluaron 50 niños con ERC del Hospital Josefina Martínez. Ellos estuvieron expuestos durante el invierno a pacientes con infección respiratoria aguda baja. A los pacientes con ERC sintomáticos (fiebre y cambio en su signología respiratoria basal) se les realizó Inmunofluorescencia Directa (IFD) Viral. "Caso" fue definido como "paciente sintomático e IFD positiva para Adenovirus". Se evaluaron TA primaria, secundaria y global. Variables como género, edad, traqueostomía y gastrostomía fueron analizadas buscando asociación con los casos. Resultados: El 44 por ciento de los pacientes eran lactantes. El 68 por ciento tenía traqueostomía y 54 por ciento gastrostomía. El primer paciente con Adenovirus ingresó en junio y el caso primario apareció dos semanas después. Hubo 25 casos secundarios que representaron TA secundaria de 51 por ciento. La TA global fue 52 por ciento. No hubo fallecidos. Los lactantes tuvieron un riesgo tres veces mayor que los niños mayores de contraer la infección (OR 3,31 [IC95 por ciento 1,02-10,72; p = 0,046]). No hubo asociación significativa con traqueostomía, gastrostomía ni género. Conclusiones: La alta diseminación de la infección por adenovirus en recintos cerrados obliga a extremar las medidas de prevención de IAAS especialmente en lactantes.

Introduction: Intrahospital adenovirus infections spread rapidly in closed environments causing outbreaks associated with high morbidity and mortality. Objectives: To identify the attack rate (AR) of adenovirus in a hospital treating children with Chronic Respiratory Diseases (CRD) and to evaluate associated factors that facilitate infection. Patients and Methods: Fifty children with CRD were evaluated between June 2010 and October 2010 at Josefina Martinez Hospital. They were exposed to patients with acute lower respiratory infection during winter. Patients with CRD symptoms (fever and change in basal nasal mucus) underwent Viral Direct Immunofluorescence (DIF). The case was defined as "symptomatic patient with positive DIF for Adenovirus". Primary, secondary and global ARs were evaluated. Variables such as gender, age, tracheostomy and gastrostomy were analyzed looking for associations with the cases. Results: 44 percent of patients were infants; 68 percent of children had tracheostomy and 54 percent had gastrostomy. The first patient with Adenovirus was admitted in June and the primary case was reported two weeks later. 25 cases presented secondary AR corresponding to 51percent Global AR was 52 percent overall. No mortality was reported. The risk was three times higher in infants than older children (OR 3.31 [IC95 percent 1.02-10.72; p = 0.046]). No significant associations with tracheostomy, gastrostomy and gender were found. Conclusions: The rapid spread of adenovirus infection in closed environments requires extreme prevention measures especially regarding infants.

22q11.2 deletion syndrome with life-threatening adenovirus infection.

Adenovirus causes significant morbidity and mortality in immunocompromised children. We report how an infusion of HLA-matched sibling donor T lymphocytes rapidly eradicated life-threatening, high-level adenoviremia in a child with complete DiGeorge syndrome (22q11.2 deletion) who went on to reconstitute a diverse, donor-derived, postthymic T-cell repertoire.

Photorefractive keratectomy with mitomycin-C for the combined treatment of myopia and subepithelial infiltrates after epidemic keratoconjunctivitis.

PURPOSE: To report the use of photorefractive keratectomy (PRK) with mitomycin-C (MMC) to treat concomitant myopia and visually significant infiltrates associated with epidemic keratoconjunctivitis (EKC). SETTING: Ophthalmic Consultants of Long Island, Nassau University, Long Island, New York, USA. DESIGN: Interventional case series. METHODS: Consecutive patients with myopia and recalcitrant subepithelial infiltrates after EKC were treated with custom wavefront PRK (Visx S4 IR) and MMC with a target of emmetropia in all cases. RESULTS: The study evaluated 6 eyes of 3 patients. One year after treatment, all eyes attained an uncorrected distance visual acuity of 20/20 or better. There was no recurrence of infiltrates within the ablation zone in any eye. CONCLUSION: The use of topical MMC in conjunction with PRK to treat subepithelial infiltrates due to EKC provided good visual and refractive results.

Phototherapeutic keratectomy for the treatment of corneal opacities after epidemic keratoconjunctivitis.

PURPOSE: To assess visual results and compare methods of measuring central corneal thickness (CCT) and corneal opacity thickness (COT) in patients with corneal opacities induced by epidemic keratoconjunctivitis (EKC) and treated with phototherapeutic keratectomy (PTK) using low-dose mitomycin C (MMC). DESIGN: Prospective consecutive case series. METHODS: Patients with chronic adenoviral corneal opacity underwent transepithelial PTK with MMC 0.002% for 1 minute. The presence of photophobia, the best spectacle-corrected visual acuity (BSCVA), and the contrast sensitivity were evaluated. CCT measurements were obtained with ultrasound pachymeter (US), ultrasound biomicroscopy (UBM), Scheimpflug tomography (Pentacam Oculus), and optical coherence tomography (OCT Visante). COT measurements were obtained with UBM, Pentacam, and OCT. RESULTS: Thirty-one eyes of 23 patients, comprising 15 women (65.2%) and 8 men (34.8%), mean age 41.8 years, were enrolled in the study. Duration of visual disturbance was 19.1 ± 14 months. The number of patients with photophobia was reduced from 100% to 29% after surgery. BSCVA improved 2 or more lines in 78% of the patients at 12 months. A hyperopic shift of 1.52 ± 0.91 diopters was achieved. Contrast sensitivity improved in both photopic and mesopic conditions. For each of the instruments, the CCT postoperative mean was significantly smaller than the preoperative measurement (P < .0001) and COT values were significantly reduced in comparison to the preoperative values (P < .001). CONCLUSION: Improvements in photophobia, BSCVA, and contrast sensitivity were observed in patients treated using excimer laser PTK with low-dose MMC for subepithelial infiltrates.

[Phototherapeutic keratectomy (PTK) after epidemic keratoconjunctivitis]. / Phototherapeutische Keratektomie (PTK) nach Keratoconjunctivitis epidemica.

BACKGROUND: Persistent and recurrent nummuli after epidemic keratokonjunktivitis (EKC) often lead to reduced visual acuity and increased glare. In spite of long-term topical steroid therapy nummuli often recur. We tried to treat persistent nummuli with phototherapeutic keratectomy (PTK). PATIENTS: PTK with an excimer laser (193 nm) was performed in 13 eyes of 9 patients with nummuli. The nummuli were observed over 3-72 months (mean: 36 months). Preoperatively, the visual acuity was 0.1-0.9 (mean: 0.39 +/- 0.22) and the brightness acuity test (BAT) was 0.05-0.5 (mean: 0.25 +/- 0.15). Prior to PTK all eyes had been treated with local steroids several times for recurrent nummuli. RESULTS: During the follow-up from 15 to 56 months (mean: 33 +/- 11.5 ms), 11 eyes had an increase in visual acuity: 0.3-1.0 (mean: 0.63 +/- 0.26). The reduction of glare was especially beneficial for the patients: 0.3-0.9 (mean: 0.55 +/- 0.21). One patient had a recurrence of nummuli in both eyes 6 weeks after PTK. The subjective-induced spheric refractive change was -2.5 D to +2.0 D. The astigmatic error changed between -2.0 D to +1.5 D. CONCLUSION: PTK seems to be an effective method of treating persistent, recurrent nummuli after EKC. The low rate of recurrence of nummuli after PTK is remarkable.

Photorefractive keratectomy for myopia in the setting of adenoviral subepithelial infiltrates.

PURPOSE: To report a patient with persistent subepithelial corneal opacities 18 months after adenoviral keratoconjunctivitis who underwent photorefractive keratectomy for the correction of myopia. METHODS: Case report, review of medical literature, and slit-lamp photography. RESULTS: The patient underwent photorefractive keratectomy in each eye, 1 week apart, with ablation of central corneal opacities and resultant best-corrected visual acuity of BE, 20/20. Symptomatic subepithelial stromal infiltrates recurred in the peripheral but not the central cornea of each eye 3 months after laser treatment. CONCLUSIONS: Photorefractive keratectomy was successful in the correction of myopia and prevented the recurrence of adenoviral subepithelial corneal infiltrates within the laser-treated central cornea.