摘要:

Purpose.Determinants of the natural history of recurrent herpes simplex virus (HSV) keratitis have not been consistently established. We assessed how previous HSV eye disease affects the risk of recurrent HSV keratitis and evaluated whether demographic and other variables play any predictive role.Methods.Three hundred forty-six patients in the placebo group of the Herpetic Eye Disease Study's Acyclovir Prevention Trial who had experienced an episode of HSV eye disease in the previous year were followed up for 18 months. Recurrences were categorized according to the type of involvement. Relative rates of recurrence were compared for categories of demographic variables, types and number of previous ocular HSV episodes, previous nonocular HSV infection, and month of the year.Results.Fifty-eight (18%) of the 346 patients developed epithelial keratitis and 59 (18%) developed stromal keratitis during the 18 months of follow-up. Previous epithelial keratitis did not significantly affect the risk of epithelial keratitis (p= 0.84). In contrast, previous stromal keratitis increased the risk of stromal keratitis 10-fold (p< 0.001), and the risk was strongly related to the number of previous episodes (p< 0.001). Age, gender, ethnicity, and nonocular herpes were not significantly associated with recurrences, and no seasonal effects were observed.Conclusion.Among patients who experienced active ocular HSV disease in the previous year, a history of epithelial keratitis was not a risk factor for recurrent epithelial keratitis. In contrast, previous, especially multiple, episodes of stromal keratitis markedly increased the probability of subsequent stromal keratitis.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To determine overall 2-and 5-year corneal graft survival rates and to identify risk factors for corneal graft failure in our patient population.Methods.A retrospective chart review of 696 patients undergoing corneal transplantation performed by a single surgeon at The Toronto Western Hospital over a 7.5-year period.Results.A total of 468 eyes met the inclusion criteria for this study. Overall, the 2-and 5-year graft survival rates were 78.8% and 64.5%, respectively. In a univariate analysis, patient age, gender, history of glaucoma, preoperative diagnosis, type of operative procedure, and postoperative factors all were shown to be significantly associated with graft survival. In a multivariate analysis, six independent predictors of graft failure were identified: preoperative diagnosis, neovascularization of the graft, the presence of peripheral anterior synechiae, gender, occurrence of one or more rejection episodes, and age of the recipient at the time of corneal transplantation.Conclusions.Risk of graft failure can vary substantially within a population of patients receiving a corneal transplant. The outcomes of this study concur with the risk factors for corneal graft failure in the literature and can be used as prognostic guidelines for both surgeons and patients.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate the clinical outcome of penetrating keratoplasty (PK) in iridocorneal endothelial (ICE) syndrome.Methods.Clinical charts of patients who underwent penetrating keratoplasty for ICE syndrome between 1985 and 1999 were reviewed retrospectively. Glaucoma control, best corrected visual acuity pre-and post-PK, graft clarity, graft rejection episodes, improvement in pain, and additional procedures were analyzed.Results.Fourteen cases were reviewed with an average follow-up of 58 months after PK. Initial grafts failed in seven patients (50%), in six cases because of rejection, and one owing to endothelial failure without signs of rejection. Repeat PKs were performed in six patients. At final follow-up, 12 grafts were clear. Glaucoma was controlled pre-and post-PK (average intraocular pressure, 16 mmHg for both eyes). Pre-PK, eight patients were using glaucoma medicines and nine had had glaucoma surgery. At the end of the follow-up, seven patients were using glaucoma medicines; six patients required glaucoma surgery after their initial PK. At the final follow-up visit, visual acuity in three patients (21%) was 20/40 or better, it ranged from 20/50 to 20/100 in four patients (29%) and 20/200 to 20/400 in five patients (36%), and in two patients with failed grafts (14%) it was counting fingers or worse.Conclusion.Clear grafts were achieved in 12 cases, although six patients (43%) underwent repeat PKs. All patients had glaucoma, which was controlled before and after PK by medical treatment and surgical procedures. Favorable outcomes can be achieved in patients with ICE syndrome but may require multiple corneal and glaucoma procedures.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To determine the leading indications for penetrating keratoplasty and to identify changing trends in these indications during the past 12 years.Methods.We retrospectively performed a chart review of the hospital records of all patients undergoing penetrating keratoplasty at the National Taiwan University Hospital during a 12-year period (1987–1999). When possible, the clinical indication was corroborated by the pathologic report.Results.A total of 770 corneal transplants were performed. The leading indications for penetrating keratoplasty, in order of decreasing frequency, were corneal scars (27.9%), regraft (21.0%), acute necrotizing and ulcerative keratitis (17.9%), pseudophakic or aphakic bullous keratopathy (17.6%), Fuchs' dystrophy (4.5%), and keratoconus (2.5%). A trend of increasing frequency of regraft and acute necrotizing and ulcerative keratitis, a decreasing frequency of corneal scar, and an initially decreasing then increasing frequency of pseudophakic and aphakic bullous keratopathy were found during the 12-year study period. Acute necrotizing and ulcerative keratitis was found to be the most frequent indication for regraft.Conclusion.In this series, corneal scars, regraft, and acute necrotizing and ulcerative keratitis were the leading indications for penetrating keratoplasty. A changing incidence of pseudophakic and aphakic bullous keratopathy noted during the study period was related to the type of intraocular lens implanted and the method of cataract surgery performed. This study found a comparatively high frequency of acute necrotizing and ulcerative keratitis and an extremely low frequency of keratoconus compared with previous reports.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To report three cases of limbal stem cell deficiency (confirmed by impression cytology) that followed multiple pterygium surgeries and therapeutic penetrating keratoplasty.Methods.The first case, after multiple pterygium surgeries, presented with corneal scarring and thickened epithelium with vascularization sparing the central cornea in the right eye and involving the entire cornea in the left eye. The second case presented with superficial scarring and extensive vascularization after failed therapeutic graft performed for a large perforated corneal ulcer. The third case was a clear graft performed for a progressing fungal ulcer with signs of conjunctivalization inferotemporally. Limbal stem cell deficiency was clinically suspected in all of these cases.Results.Goblet cells with mucin globules were found on the corneal surface by impression cytology in all three cases.Conclusions.We report three cases of limbal stem cell deficiency (proven by impression cytology) that followed multiple pterygium surgeries and therapeutic penetrating keratoplasty. Surgical insult to the limbus is the predisposing factor for stem cell damage in these cases. Involvement of the limbus by infection and use of intensive medications are probable contributing factors for stem cell damage in cases of therapeutic penetrating keratoplasty.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To study the incidence and prognosis of immunologic rejection of the central graft after limbal allograft transplantation (keratolimbal allograft transplantation [KLAT]) combined with penetrating keratoplasty (PKP).Methods.Endothelial rejection in central penetrating graft after simultaneous KLAT and PKP using the same donor cornea was retrospectively studied. Incidence, reversibility, prognosis, and changes in limbal grafts were examined.Results.Forty-five eyes underwent simultaneous PKP and KLAT. Endothelial rejection of the central graft was found in 16 eyes (35.6%). At last examination, 10 grafts (62.5%) restored clarity after immunosuppressive therapy. During rejection episodes, four eyes showed engorgement of vessels in limbal grafts, which existed before the episodes. Only one eye developed neovascularization with mild edema of the limbal grafts; however, no other limbal grafts showed abnormalities on biomicroscopy. No epithelial changes were noted, and 14 grafts (87.5%) were covered by corneal epithelium after the rejection.Conclusion.Approximately one third of eyes had endothelial rejection in the central graft after simultaneous KLAT and PKP. Abnormalities suggestive of rejection in the limbal grafts were seldom observed in these eyes, suggesting that immunologic response was different in central and limbal grafts.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To compare uncorrected visual acuity and refractive error in patients undergoing photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) between 1 week and 6 months after surgery.Methods.All eyes underwent PRK or LASIK with the VisX StarS2 excimer laser. We retrospectively analyzed data from 77 random eyes of 77 patients in the PRK group and 76 eyes of 76 patients in the LASIK group. All eyes had a low myopic refractive error (spherical equivalent range, −0.88 diopters (D) to −5.13 D; mean PRK, −2.8 ± 0.20 D; LASIK, −2.5 ± 0.22 D). Uncorrected visual acuity and manifest refractive error were evaluated 1 week, 1 month, and 6 months after surgery.Results.Each eye undergoing PRK was paired with an eye undergoing LASIK for a similar level of spherical equivalent. Mean uncorrected visual acuity after 1 week was 0.85 ± 0.06 (20/25, logMAR 0.12 ± 0.04) for the PRK group and 1.01 ± 0.06 (20/20, logMAR 0.01 ± 0.03) for the LASIK group (p< 0.001). Mean spherical equivalent after 1 week was 0.23 ± 0.12 D for the PRK group and −0.02 ± 0.07 D for the LASIK group (p= 0.02). Mean uncorrected visual acuity after 1 month was 1.03 ± 0.05 (20/20, logMAR 0.02 ± 0.03) for the PRK group and 1.05 ± 0.05 (20/20, −0.02 ± 0.03) for the LASIK group (p= 0.16). Mean spherical equivalent after 1 month was 0.19 ± 0.10 D for the PRK group and −0.02 ± 0.09 D for the LASIK group. This difference was statistically significant (p= 0.02), but was unlikely to be clinically significant. Mean uncorrected visual acuity after 6 months was 1.05 ± 0.06 (20/20, logMAR −0.01 ± 0.03) for the PRK group and 1.06 ± 0.05 (20/20, logMAR −0.14 ± 0.03) for the LASIK group (p= 0.41). Mean spherical equivalent after 6 months was 0.02 ± 0.08 D for the PRK group and 0.00 ± 0.08 D for the LASIK group (p= 0.35).Conclusion.Uncorrected visual acuity 1 week after surgery is significantly better in eyes undergoing LASIK than in eyes undergoing PRK. Both procedures provide functional vision by 1 week after surgery. The difference does not relate to refractive error, which was similar between the two groups, but to differences in healing of the epithelium. By 1 month after surgery, there is no difference in mean uncorrected visual acuity between eyes that undergo PRK or LASIK for low myopia.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To describe how laser-assisted in situ keratomileusis (LASIK) may induce recurrent corneal erosion (RCE) syndrome and the preventive measures for avoiding this complication.Methods.A case series was used.Results.We report the development of RCE syndrome in eight eyes of six patients after LASIK. In five cases, the RCE was triggered by epithelial trauma at the time of the LASIK procedure, as evidenced by the observation of RCE occurring at the same site as the initial epithelial disturbance. In case 6, RCE occurred with undiagnosed basement membrane dystrophy. The patients responded to treatment with ocular lubricants with one patient undergoing penetrating keratoplasty for RCE after LASIK.Conclusion.LASIK can induce or precipitate RCE, and RCE should perhaps be included as a potential complication in the informed consent process. It is important to minimize epithelial damage to prevent RCE after LASIK, and measures to reduce this include adequate irrigation of the corneal surface immediately before the microkeratome pass and careful attention to flap epithelium during flap replacement. Cases in which loose epithelium is noted after LASIK should be identified as potential RCE cases, and extra care should be taken for subsequent enhancement procedures or LASIK of the second eye.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To review ocular injuries secondary to airbag deployment that were seen in our institution and were reported in the literature.Methods.Patients examined at our institution between 1997 and 2000 were evaluated for ocular injuries caused by airbags. A review of the medical literature using Medline was performed. All reports involving ocular injuries secondary to airbags were included in this study.Results.Seven cases from our medical center were identified to involve airbag-related eye injuries. The ages of the patients ranged from 4 to 73 years. Ocular injuries included corneal abrasion, corneal decompensation, corneal alkali injury, hyphema, iris sphincter tears, vitreous hemorrhage, macular retinal pigment epithelium disruption, dislocated posterior chamber intraocular lens, and commotio retinae. A review of the medical literature showed 74 cases involving 80 eyes. The ages of the patients ranged from 2 to 81 years. Males slightly outnumbered females by a ratio of 1.1 to 1.0. The speed of the vehicles ranged from 0 to 65 miles per hour, with an average reported speed of 31 miles per hour. Reported injuries ranged from mild corneal abrasions to open globes.Conclusions.Ocular morbidity secondary to airbag deployment must be recognized as a significant risk for motor vehicle drivers and passengers. Improvements in airbag safety will include increased consumer awareness and manufacturer design modification.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate the presence of herpes simplex virus (HSV) and human papilloma virus (HPV) in pterygia and phenotypically normal conjunctiva and the possible relation between viral presence and clinical information.Methods.Fifty pterygia and respective conjunctival specimens were obtained. A personal and family history was recorded for each patient. HSV and HPV detection and typing were accomplished by polymerase chain reaction amplification of viral sequences. Results were statistically analyzed.Results.HSV (type 1) was detected in 11 (22%), HPV (type 18) in 12 (24%), and both HSV-1 and HPV-18 in 3 (6%) of pterygia. No conjunctival specimen displayed HSV, whereas HPV was detected in four (8%). Postoperative recurrence and history of conjunctivitis were significantly more common in patients with simultaneous detection of HSV and HPV.Conclusion.The fact that HSV was not detected in conjunctival specimens implies a more specific correlation with pterygium, as compared with HPV. The detection of potentially oncogenic viruses, such as HSV and HPV, supports the concept that pterygium can be considered a neoplastic condition. The correlation of postoperative recurrence and a history of conjunctivitis with the simultaneous detection of HPV and HSV, implies a possible viral cooperation affecting the clinical profile of pterygium.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID