ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

To ascertain the importance of routine cultures and grain stains in the management of ulcerative keratitis. Methods. We retrospectively reviewed 119 consecutive corneal ulcers seen at Sinai Hospital of Baltimore. Cultures were obtained of the corneal ulcer and of the lids and conjunctivae of both eyes. Gram stains were performed by the hospital microbiology department on corneal scrapings from each ulcer. Results. Positive corneal cultures were obtained from 56 eyes (47.1%). Initial antibiotic therapy was changed based on culture results in 14.3% of culture-positive eyes that demonstrated a worsening clinical course. Gram stains were negative in all cases. The sensitivity and specificity of the lid and conjunctival cultures were determined. Conclusions. Corneal cultures are important in the management of ulcerative keratitis. Lid and conjunctival cultures have low sensitivity and specificity

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. To evaluate the long-term graft survival and complications of flexible, open-loop anterior-chamber intraocular lenses in patients with penetrating keratoplasty for pseudophakic or aphakic bullous keratopathy. Methods. We reviewed charts of all consecutive patients who underwent penetrating keratoplasty for pseudophakic or aphakic bullous keratopathy combined with implantation of a flexible, open-loop, anterior-chamber intraocular lens at our institution between 1983 and 1988. One-hundred one eyes of 99 patients were evaluated. Graft-survival rates were calculated by using the Kaplan-Meier actuarial method. Results. Mean follow-up was 49.8 months (range, 1–144). The probability of graft survival at 1, 2, 4, 6, and 8 years was 93, 87, 78, 65, and 65%, respectively. A total of 25 (24.8%) grafts failed. Progressive corneal edema without signs of rejection was the most common finding in patients with failed grafts (10 eyes, 40%). The most frequent complication observed was newly diagnosed or worsening of preexisting glaucoma (46 eyes, 45.5%). Conclusions. Our long-term results support flexible, open-loop anterior-chamber intraocular lenses as a reasonable option, at the time of penetrating keratoplasty, in patients with pseudophakic and aphakic bullous keratopathy.

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. Ganciclovir is a broad-spectrum virustatic agent. Its efficacy and safety after ocular application have been demonstrated in studies of herpetic keratitis in rabbits. Two strengths of ganciclovir gel (0.05 and 0.15%) were compared with 3% acyclovir ointment in the treatment of superficial herpes simplex keratitis in humans. Methods. Two multi-center randomized clinical trials were carried out in Africa (Trial 1) and Europe (Trial 2). Sixty-seven patients (Trial 1) and 37 patients (Trial 2) from herpetic ulceration were recruited. Results. The results showed no statistically significant difference between the treatment groups, although the healing rates tended to be better in the group receiving 0.15% ganciclovir gel, with healing rates of 85% (Trial 1) and 83% (Trial 2) as compared with 72% (Trial 1) and 71% (Trial 2) in the group receiving acyclovir ointment. Local tolerance was found to be superior with the gel formulation of ganciclovir with fewer complaints of discomfort (stinging, burning) or blurred vision after application of the drug. Systemic absorption of the drug was low. No hematologic changes were detected. Conclusions. These findings support the efficacy of ganciclovir gel in the treatment of ulcerative herpes simplex keratitis and demonstrate its superior local tolerance when compared with acyclovir ointment

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. To determine whether there are quantitative or qualitative differences in the ocular flora of patients with acquired immunodeficiency syndrome (AIDS) compared with human immunodeficiency virus (HlV)-negative patients. Methods. Forty patients with AIDS and 42 HIV-negative controls were sex and age matched. All subjects had a detailed anterior segment examination, including Schirmer's test, rose bengal staining, and quantitative cultures of the conjunctiva and lids. Statistical evaluation of the relation between AIDS, keratoconjunctivitis sicca (KCS), and ocular flora was performed. Results. No differences were observed in the types or numbers of organisms isolated from the conjunctiva or lids of patients with AIDS and HIV-negative subjects. Ocular flora was not influenced by use of systemic antibiotics, level of immunosuppression as measured by CD4 lymphocyte counts, KCS, or other ocular-surface disease. One AIDS patient was colonized by large numbers ofHaemophilus influenzaeOU with minimal clinical signs of inflammation or infection.Conclusion.There do not appear to be any differences in the ocular flora of HIV-negative patients and patients with AIDS. Presence of KCS and level of immunosuppression do not appear to affect the ocular flora in patients with AIDS.

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. Patients frequently have ocular pain, photophobia, foreign-body sensation, and burning/stinging after radial keratotomy. This study was a prospective, randomized, double-masked, multicenter, fellow-eye comparison of diclofenac sodium (Voltaren Ophthalmic, 0.1% solution) and placebo for controlling these ocular symptoms after bilateral radial keratotomy. Methods. Patients who were pain free in both eyes before surgery were randomly assigned to treatment with diclofenac sodium in one eye and placebo in the other. One drop of each masked trial medication was administered 30–60 min before surgery, 5 min and 6 h after surgery, at bedtime on the day of surgery, and four times daily for 2 additional days. Patients evaluated ocular symptoms in each eye 0.5, 1, 2, 4, 6, 24, and 48 h after surgery and provided a global evaluation 6, 24, and 48 h after surgery. For each assessment, the difference in scores between eyes was analyzed by using a pairedttest. Results. Diclofenac sodium was significantly (p< 0.001) superior to placebo in controlling each ocular symptom at each interval after surgery and for patient global assessments 6, 24, and 48 h after surgery.Conclusion.Diclofenac sodium 0.1% ophthalmic solution is clinically effective in controlling adverse ocular symptoms occurring after bilateral radial keratotomy

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. To examine the leading indications for penetrating keratoplasty. Methods. We retrospectively performed a chart review of 904 cases of penetrating keratoplasty over a 10-year period (1986–1995). Where possible, the clinical indication was corroborated by the pathological report. Results. Leading indications included pseudophakie bullous keratopathy (PBK; 28.5%), regraft (22.4%), keratoconus (10.0%), Fuchs' dystrophy (7.6%), aphakic bullous keratopathy (ABK; 6.1%), herpetic keratopathy (4.2%), bacterial infection (4.2%), physical trauma (4%), interstitial keratitis (3.7%), and corneal scarring (2.8%). The most common type of intraocular lens found in patients with PBK was the anterior-chamber lens [AC IOL, 71.6%; posterior-chamber lens (PC IOL), 16%; iris-plane IOL (IP IOL; 12.5%]. In our series, we noted decreasing trends in the incidences of ABK (p< 0.001 ) and PBK (p< 0.04) and an increasing trend in the incidence of regraft (p< 0.0083). Our data do not show statistically significant changes in the incidences of Fuchs' dystrophy and keratoconus. Gender differences were present for Fuchs' dystrophy with female exceeding male patients by a 3:1 ratio (p< 0.001). Male exceeded female patients by 2:1 for keratoconus (p< 0.001). Male exceeded female patients by 3:1 for trauma (p< 0.001). Conclusions. In this series, the leading indications for penetrating keratoplasty were found to be generally in agreement with the data reported in recent literature. Variations may reflect the wide variations in practice and referral patterns

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. Fluoroquinolone solutions are widely used in therapy of bacterial keratitis. These drugs are sate, and their ocular side effects are mild and not serious in nature. The most frequent untoward effect associated with ciprofloxacin therapy has been a white crystalline deposit. This deposit has not been reported after using the other commercially available quinolones, ofloxacin and norfloxacin. Methods. We present three cases of norfloxaein deposits after treatment of bacterial keratitis. Results. In the three cases, the norfloxacin was substituted for another antibiotic effective against the bacteria, and the precipitate spontaneously resolved in all cases within a few days with no untoward ocular effect.Conclusion.Crystalline corneal deposits can develop during topical norfloxaein therapy. The exact factors contributing to the formation are unknown, although the differences in the tear pH/solubility could be involved. Clinicians should be aware of this ocular side effect

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. We present the clinicopathologic correlations of two cases and two other clinical cases of topical anesthetic abuse keratopathy that were originally diagnosed asAcanthamoebakeratitis because of ring keratitis presentation and characteristic history. Methods. Four patients who were referred to us with suspectedAcanthamoebakeratitis are included. Each was initially treated for amoebic keratitis, by using established protocols, and only later was the true origin (topical anesthetic abuse) uncovered. The clinical and surgical histories, pathologic analysis of the corneal specimens, and follow-up of ≤4 years are included. Results. Our four cases show another cause for ring infiltration of the cornea. Two cases resulted in corneal transplantation and multiple other medical or surgical treatments in an attempt to restore vision but had poor outcomes of finger-counting vision. Two other cases responded to intensive medical treatments with return of useful vision. Evaluation of the surgical specimens revealed a previously unpublished finding of near total cell death within the corneal stroma.Conclusion.Topical anesthetic abuse resulting in sight-threatening keratitis may be seen as a masquerade syndrome in many cases. Because of the often poor outcome, we must be aware of this entity, prevent abuse, and be vigilant in our prohibition of topical anesthetic for any therapeutic use

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. To identify the relationship between epidermal growth factor (EGF) concentrations in human tears and clinical tear-flow parameters and how these vary with age and gender. Methods. Tear samples were collected with minimal stimulation from 68 healthy and asymptomatic adults (33 men, 35 women), aged 21–88 years. EGF concentrations were determined by sandwich enzyme-linked immunosorbent assay (ELISA) in 65 cases. Schirmer tests were performed without anesthesia, and the clearance of fluorescein from the tear film assessed. The Tear Function Index (TFI) was calculated from these values. Results. There were approximately equal numbers of male and female subjects with a similar age distribution for each gender (48±3 and 51±3 years, mean ± SEM, respectively). Ninety percent of tear EGF concentrations were between 0.75 and 7.1 ng/ml. Tear EGF level correlated significantly with Schirmer I value, but not with age. Schirmer I value correlated with tear clearance [LN(TCR)] but not with age. Tear EGF concentrations were significantly higher for men (3.4±0.3 ng/ml) than for women (2.4±0.3 ng/ml;p= 0.043). Conclusions. EGF concentrations in tear samples from normal humans were found to correlate with gender and Schirmer I value but not with tear clearance

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID