摘要:

Purpose.To investigate the efficacy of postoperative 5-fluorouracil (5-FU) in halting recurrence of pterygium.Methods.Early recurrence of pterygium was detected in six eyes of six patients aged 40 to 66 years that, over a 3-year period, had undergone pterygium excision in our institution, using the “bare sclera” technique. Each of the hyperemic fibrovascular tissues was found to override the cornea by 1.5 mm or less in length. Five of these eyes had undergone a primary excision and one, a second operation (with intraoperative mitomycin C). Upon diagnosis, each eye was treated with two to four injections of 5-FU, administered into the dome of the fibrovascular tissue. The dose of 5-FU per injection was 1 to 3 mg (mean, 2.1 ± 0.8 mg). Of all 126 eyes that underwent pterygium surgery during that 3-year period, pterygium recurred in nine additional eyes but was found to be 2 mm or more in length in each. These eyes were not treated by 5-FU.Results.In five of the six treated eyes, the pterygium became clinically atrophic and the recurrence process was stopped. No renewal of the recurrence process was detected after 12 months or more of follow-up. No major complications were related to the use of 5-FU.Conclusion.This pilot study suggests that when early recurrence of pterygium is already evident, 5-FU treatment into the dome of the fibrovascular tissue may be beneficial in halting its progression, by rendering it atrophic. A prospective, randomized, controlled study is required to confirm the efficacy of this approach.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.This study examines the safety, efficacy, and complications of 0.02% intraoperative daunorubicin in the prevention of the recurrence of pterygium after excision.Methods.Sixty patients with primary pterygium were included in this prospective, randomized clinical study and were randomly divided into two groups: the treatment group and the control group. Pterygium was excised under a microscope in all patients. The treatment group received intraoperative single application of 0.02% daunorubicin for 3 minutes, whereas the control group received distilled water for the same duration. Recurrence of pterygium and postoperative complications were prime areas of interest.Results.A recurrence rate of 6.67% was seen in the treatment group and was33% in the control group. Chemosis of conjunctiva and delayed epithelization were the only complications noticed after a mean follow-up of 15 months.Conclusion.Initial results indicate that a single intraoperative application of 0.02% daunorubicin for 3 minutes appears to be a safe and effective adjunct therapy to prevent the recurrence of pterygium. However, a much larger cohort study over a considerable number of years will eventually demonstrate the safety.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To compare the efficacy and safety of ofloxacin 0.3% ophthalmic solution with ciprofloxacin 0.3% ophthalmic solution in patients with culture-positive bacterial keratitis.Methods.Patients with a microbiologic diagnosis of bacterial keratitis were included in this double-masked, parallel-group study and were randomized to treatment with either ofloxacin 0.3% or ciprofloxacin 0.3% ophthalmic solution. One drop of the study medication was instilled during the daytime according to the following schedule: every half-hour on study day 1, every hour on days 2 through 4, and every 2 hours on days 5 through 21. Healing, the primary outcome measure, was defined as complete reepithelialization, accompanied by nonprogression of stromal infiltrate for 2 days. Secondary outcome measures included signs and symptoms of infection. Patients were monitored throughout the study period for any adverse events.Results.A total of 217 patients completed the study: 112 were treated with ofloxacin and 105 were treated with ciprofloxacin.Streptococcus pneumoniaewas the most commonly encountered pathogen in all patients. Complete corneal reepithelialization occurred in 85% of those treated with ofloxacin and in 77% of those treated with ciprofloxacin (p= 0.32). The average time to corneal ulcer healing was 13.7 days in those treated with ofloxacin and 14.4 days in those treated with ciprofloxacin. Both treatments were well tolerated with no patient discontinuing the study because of side effects.Conclusion.Ofloxacin 0.3% and ciprofloxacin 0.3% ophthalmic solutions are effective and safe in the treatment of patients with culture-positive bacterial keratitis.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.The conventional treatment ofNocardiakeratitis is with topical sulfonamides. Recently, topical trimethoprim and sulfamethoxazole (Bactrim) has been suggested as treatment. This study compares the in vitro efficacy againstNocardia asteroidesof Bactrim and various ratios of trimethoprim and a sulfonamide.Methods.Antibiotic disks were soaked with various ratios of trimethoprim and sulfacetamide sodium. They contained trimethoprim alone, sulfacetamide sodium alone, and both trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5. Disks containing Bactrim were also prepared. Each disk was placed on blood agar plates streaked withN. asteroides. The plates were incubated at 37°C for 72 hours and then examined.Results.Trimethoprim alone showed minimal effect. Sulfacetamide sodium alone had a clearance zone of 12 mm. The plates of trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5 had clearance zones of 14 mm, 17 mm, and 27 mm, respectively. Bactrim had a clearance zone of 70 mm.Conclusion.Trimethoprim or sulfacetamide sodium alone is not as effective as both drugs together. As the ratio of the two drugs was changed, potency differed againstNocardiaorganisms. Bactrim was the most effective antibiotic againstNocardiaorganisms. It should be the recommended agent for the treatment ofNocardiakeratitis.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.We report an unusual type of corneal change in some communities mesoendemic for onchocerciasis in Kaduna State of Northern Nigeria.Methods.Thirty-four villages with an overall average microfilarial skin snip positivity rate of 71% and a total population of about 10,000 were included in a controlled trial of ivermectin for onchocerciasis. Detailed slit lamp examination of 806 persons within this population revealed at least 27 individuals with these lesions. There were 11 women and 16 men, aged between 5 and 70 years with a mean age of 45 years and a SD of 15 years. Drawings and photographs of 22 of these individuals were available for assessment.Results.The lesions were peripheral, silvery white, and of two main types: the first group's lesions wereflaky, refractile, and crystalline in appearance; the second group's lesions were more cylindrical in outline and were crisscrossed, giving alattice-like pattern. There were indeterminate forms in between these polar topographies. Of the 25 subjects who had skin snips performed, 23 were microfilaria-positive. There was no accompanying inflammation and the posterior segments showed no evidence of crystalline deposits or retinitis pigmentosa, as is found in Bietti's dystrophy. The lesions coexisted with typical sclerosing keratitis in six individuals, and changes noted in the posterior pole of ten individuals were typical of onchocercal chorioretinitis. The evidence for consanguinity was not compelling. Differences between and similarities to Bietti's and Schnyder's crystalline corneal dystrophy, which are known to be composed of cholesterol crystals, are discussed. The lesions are also compared with lattice dystrophy known to be composed of amyloid. These lesions may be related to onchocercal infection.Conclusions.We describe some unusual peripheral corneal changes in individuals living within areas of Northern Nigeria mesoendemic for onchocerciasis. These changes take the form of flaky crystals or lattice within the anterior stroma and are common in middle-aged individuals. This may be related to onchocercal infection.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To present a cluster of four patients with primary graft failure (PGF) who consecutively underwent a penetrating keratoplasty (PKP) during a period of 17 days in one institution. PKP was performed for reasons unrelated to herpes simplex infection. Herpes simplex virus type 1 (HSV-1) is presented as the possible cause of these PGFs.Methods.Viral culture of conjunctival swabs and of a bandage contact lens was performed on VERO, MRC-5, and Hep-2 cells. The four patients underwent subsequent regrafting. Polymerase chain reaction (PCR) for HSV-1 was carried out on aqueous humor and on a sample of iris and cornea with primers. Aqueous humor specimens were pretreated by boiling, and a qiagen extraction was performed according to the instructions of the manufacturer on biopsies of iris and cornea. Immunohistopathology was performed with polyclonal antibodies directed against HSV-1 and -2.Results.Culture of a conjunctival swab in three patients and culture of a bandage contact lens in the fourth patient were positive for HSV-1. In three of the four patients, PCR was positive for HSV-1 on aqueous humor and corneal graft tissue. PCR on iris tissue was positive in all patients. In three patients, culture for HSV-1 of aqueous humor and of iris tissue could not be carried out because of insufficient sample. Viral culture of the iris tissue in one patient and of the corneal graft in the four patients were negative. Immunohistopathologic examination was positive for HSV-1 in three cases.Conclusion.These case reports strongly support the hypothesis that HSV-1 can be the cause of PGF.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To compare the topical effects of tetracaine, lidocaine, and bupivacaine on corneal sensitivity in normal eyes.Methods.Corneal touch sensitivity was measured with a Cochet-Bonnet anesthesiometer before and at 2.5-minute intervals after instillation of the anesthetic agent, until baseline levels had been reestablished. Seventeen healthy volunteers were randomized into five groups. Group 1 included 0.5% tetracaine (n= 6); group 2, 4% lidocaine (n= 8); group 3, 0.75% bupivacaine (n= 8); group 4, 0.5% tetracaine + 4% lidocaine (n= 5); and group 5, 0.5% tetracaine + 0.75% bupivacaine (n= 7).Results.The duration of anesthesia showed no differences between groups 1, 3, and 5. Although there was no difference between groups 2 and 4, both groups demonstrated significantly longer effects than groups 1, 3, and 5 (p< 0.005).Conclusion.The application of 4% lidocaine results in a significantly prolonged topical anesthetic effect when compared with tetracaine and bupivacaine.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.Discussion of four cases of congenital corneal anesthesia with varied systemic associations and modes of presentation. Classification and systemic associations of congenital corneal anesthesia along with the importance of multi-specialty evaluation of such patients.Methods.Clinical examination of all four cases and corneal sensation assessment with Cochet–Bonnet esthesiometer. Thorough systemic examination and investigations including serum bio-chemical analysis, roentgenography, ultrasonography, nerve conduction studies, and CT scan of the patients to identify systemic associations.Results.All four patients proved to have bilateral congenital corneal anesthesia with Cochet–Bonnet esthesiometry confirming corneal anesthesia. Systemic examination revealed associated congenital mesenchymal anomalies in the first case. The second case had generalized reduction in pain sensitivity confirmed by nerve conduction studies. The third case was an isolated bilateral congenital corneal anesthesia, while the fourth was a case of congenital trigeminal nerve anesthesia involving all three divisions of both trigeminal nerves. Other causes of corneal anesthesia and self-inflicted corneal injuries were ruled out by clinical multi-specialty evaluation and appropriate investigations. Correct diagnosis and symptomatic treatment aided speedy relief of symptoms of all the patients.Conclusion.Congenital corneal anesthesia is a rare condition and is often a diagnostic dilemma. Although more common conditions that cause corneal anesthesia can mislead the clinician, the congenital variant should be kept in mind in any case of intractable corneal ulceration in children. Early diagnosis, symptomatic treatment and measures to prevent further corneal damage will immensely help in retaining useful vision for the affected children.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To examine the role of epithelial cells in inducing the differentiation of keratocytes into myofibroblasts and to determine whether this effect may be inhibited by amniotic membrane matrix.Methods.In vivo, a 9-mm diameter, partial-thickness corneal flap was created in 12 rabbit eyes (6 rabbits), which were equally subdivided into three groups. The first group was implanted with one layer of a 6-mm diameter human amniotic membrane, from which the epithelium had been removed by dispase. The second group received an implantation of dispase-treated amniotic membrane with cultured rabbit corneal epithelial cells. The third group received the same implantation as the second group except that the cultured corneal epithelial cells were sandwiched between two layers of membrane. All corneas were removed 2 weeks later and were subjected to Masson trichrome staining and immunofluorescence staining with monoclonal antibodies to &agr;-smooth muscle (&agr;-SM) actin for myofibroblasts and cytokeratins for epithelial cells. In vitro collagen gels impregnated with different types of human ocular surface fibroblasts were seeded with or without rabbit corneal epithelial cells before testing for gel contraction.Results.Positive staining of &agr;-SM actin was noted only in keratocytes adjacent to corneal epithelial cells at the incision site and those grown on the basement membrane side of the amniotic membrane. Negative staining was noted when epithelial cells were removed by dispase or when cultured corneal epithelial cells were sandwiched between two layers of membrane. Gel contraction by fibroblasts was significantly promoted when epithelial cells were seeded on the gel. In the latter situation, positive staining of &agr;-SM actin was noted in fibroblasts subjacent to epithelial cells but not in those impregnated in the gel.Conclusion.Epithelial cells are capable of inducing the differentiation of adjacent fibroblasts into myofibroblasts; such an induction requires a close epithelial–mesenchymal contact. Amniotic membrane alone does not induce this effect and can help block such induction by epithelial cells.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate the usability of Eurosol, a new medium-term corneal storage medium without components of bovine origin.Methods.Ten pairs of human donor corneas were placed in tissue culture at 31°C for 7, 14, 21, 28, or 35 days. One cornea of each pair was cultivated in conventional storage medium on Earls' minimum essential medium base containing 2% fetal bovine serum; the other one was stored in Eurosol. Corneas were examined with inverse light microscopy; corneal thickness was measured; and scanning electron microscopy was performed.Results.No significant difference in corneal thickness and endothelial cell count was found at any time. Scanning electron microscopy showed a complete endothelial cell layer on all corneas.Conclusion.The findings indicate a potential clinical applicability of the tested serum-free medium-term storage medium, offering a safer alternative to conventional media containing fetal bovine serum.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID