摘要:

Purpose.To review the changing epidemiology of herpes simplex disease and correlate it with the epidemiology of ocular herpes simplex disease.Method.A review of pertinent reports in the world literature about the epidemiology of herpes simplex and specifically about ocular herpes simplex.Results.In developed countries, many individuals are reaching adolescence and adulthood without prior herpesvirus infection. Herpes simplex genital infection is increasing at a rapid rate in sexually active adolescents and adults, with about one in six adults now infected in the United States. Similar statistics are confirmatory worldwide in developed countries. Active herpes simplex infection is a risk factor for acquisition of human immunodeficiency virus. The Herpetic Eye Disease Study, as well as prior studies from Moorfields Eye Hospital and the Mayo Clinic in Rochester, Minnesota, provides us with the epidemiology of ocular herpes simplex. Recent studies suggest an older age of onset and perhaps overall more severe ocular disease as compared with the older literature.Conclusions.Herpes simplex is a significant health concern at present with genital infections increasing in epidemic proportions. This is also reflected in a rise in the incidence of neonatal herpes. Herpes simplex virus type 1 (HSV-1) infection is being acquired for the first time in an older age group. A significant and increasing proportion of genital herpes is caused by HSV-1. Serologic studies are no longer as useful in distinguishing orofacial herpes from genital herpes. More acute retinal necrosis syndrome cases are associated with HSV-2. Speculation about the future of ocular herpes is made based on this changing epidemiology.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate the immediate postoperative corneal topography after the deep lamellar endothelial keratoplasty procedure.Methods.Eight eye bank eyes underwent deep lamellar endothelial keratoplasty through a 9.0-mm limbal incision replacing the central 7.0 mm of posterior stroma and endothelium through the lamellar pocket wound. Orbscan topography was performed before and after surgery, and simulated keratometry readings and central corneal diopter power were recorded. The change in astigmatism and corneal power from preoperative to postoperative readings was then determined.Results.The net change in corneal astigmatism averaged 0.4 ± 0.5 diopters (range, −0.1 to 1.1 diopters). The net change in corneal power averaged −0.2 ± 0.4 diopters of flattening (range, −0.9 to +0.2 diopters). Neither the astigmatism nor the corneal power levels after this surgery were significantly different from the preoperative topography (p= 0.22 and 0.27, respectively).Conclusions.The deep lamellar endothelial keratoplasty procedure, with its absence of corneal surface incisions or sutures, has no significant effect on immediate postoperative corneal topography. The potential advantages of this procedure over penetrating keratoplasty in the treatment of endothelial dysfunction are considerable.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.Recent advances aimed at preventing and treating complications after keratoprosthesis surgery have improved prognosis, but it has been suspected that various preoperative diagnoses may carry substantially different postoperative outcomes. This article attempts to clarify the ranking of prognostic categories for patients undergoing keratoprosthesis surgery.Methods.A retrospective review of the outcome in a recent series of 63 patient eyes operated at the Massachusetts Eye and Ear Infirmary between 1990 and 1997 and followed up for a minimum of 21 months. Anatomic retention of the device and the loss of vision caused by complications were recorded. The patients were divided into four categories according to preoperative cause.Results.Anatomically, one keratoprosthesis extruded spontaneously. Another 10 were permanently removed because of complications. Of the 63 eyes, 10 never achieved a visual acuity of at least 20/200 vision because of preexisting retinal or optic nerve damage. The remaining 53 had a visual acuity of 20/200 to 20/20 as follows: Stevens–Johnson syndrome (n= 7), after 2 years: 33%, after 5 years: 0%; chemical burn (n= 17), after 2 years: 64%, after 5 years: 25%; ocular cicatricial pemphigoid (n= 20), after 2 years: 72%, after 5 years: 43%; graft failure in noncicatrizing conditions (dystrophies, degenerations, or bacterial or viral infections) when a repeat graft was expected to have a poor prognosis (n= 19), after 2 years: 83%, after 5 years: 68%. The difference in outcome between the Stevens–Johnson syndrome outcome group and the graft failure group or the ocular cicatricial pemphigoid group was statistically significant. In the group of 53 eyes, visual acuity was restored to 20/200 to 20/20 for a cumulative total of 138 years.Conclusion.Outcome of the keratoprosthesis surgery varied markedly with preoperative diagnosis. Most favorable was graft failures in noncicatrizing conditions, whereas Stevens–Johnson syndrome was the worst. Ocular cicatricial pemphigoid and chemical burns occupied a middle ground. The difference between the groups seemed to correlate with the degree of past preoperative inflammation.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate the efficacy and safety of low-dose intraoperative mitomycin C (MMC) during bare sclera procedure and to compare the rates of pterygium recurrence between recurrent pterygium patients treated with adjuvant MMC and those reconstructed with a conjunctival autograft.Methods.We studied the recurrence of pterygium, 12-month pterygium-free survival rates, final appearance, and postoperative complications in 96 eyes of 92 patients who received either intraoperative 0.02% MMC for 30 seconds or conjunctival autografting after pterygium excision. Patients were divided into three groups: group 1 included 38 eyes with primary pterygium undergone intraoperative MMC; group 2, 26 eyes with recurrent pterygium treated with intraoperative MMC; and group 3, 32 eyes with recurrent pterygium treated with pterygium excision and conjunctival autografting.Results.Pterygium recurred in 3 (7.9%) of 38 eyes in group 1, 5 (19.2%) of 26 eyes in group 2, and 2 (6.3%) of 32 eyes in group 3. Despite the higher recurrence rate in group 2 compared with that of group 3, the difference between the two was not statistically significant (p= 0.22). The cumulative probabilities of success were 91.6 ± 4.6%, 80.8 ± 7.7%, and 92.3 ± 5.4% at 12 months for groups 1, 2, and 3, respectively. Final appearance of the pterygium excision area was satisfactory in nearly two-thirds of the MMC-treated patients, 71.1% and 65.4% for groups 1 and 2, compared to 75.1% of patients who had undergone conjunctival autografting. No patients experienced severe complications during a mean postoperative follow-up of 27.3 ± 4.1 months, 29.9 ± 3.9 months, and 40.9 ± 19.1 months for groups 1, 2, and 3, respectively.Conclusions.A single intraoperative application of 0.02% MMC for 30 seconds after pterygium excision is associated with minimal complication and effectively reduces the recurrence rates after excision of primary or recurrent pterygium. In comparison with conjunctival autografting, low-dose application of MMC after bare sclera procedure is less efficacious in preventing recurrence of pterygium, but simpler and produces a similar proportion of patients with satisfactory final appearance.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate tear secretion and corneal sensitivity after laser in situ keratomileusis (LASIK) for the correction of myopia.Methods.In a prospective study, 48 consecutive eyes (24 patients) underwent LASIK to correct myopia ranging from −3.5 to −12.25 diopters. Tear secretion tested by the tear function index and corneal sensitivity tested using the Cochet-Bonnet esthesiometer were evaluated preoperatively and 1 week and 1, 3, 6, and 9 months postoperatively.Results.Tear secretion and corneal sensitivity after LASIK were reduced during the first 3 months after surgery (p< 0.001). Tear secretion returned to its preoperative values only after 9 months. Tear secretion and corneal sensitivity were more depressed in long-term contact lens wearers preoperatively and 6 months after surgery (p< 0.05).Conclusion.In the correction of myopia, tear secretion was depressed after LASIK during the first 6 months after surgery.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate the intraocular pressure (IOP) with three different instruments, Goldmann applanation tonometer (GAT), noncontact tonometer, and Tono-Pen after photorefractive keratectomy (PRK) for myopia.Methods.A prospective case series study to evaluate preoperative and postoperative IOP measurements of 149 eyes at 12 months. We performed GAT, noncontact tonometry, Tono-Pen central, and Tono-Pen temporal periphery measurements. We also performed measurements of the central corneal thickness (CCT) by ultrasonic pachymetry and keratometry. Preoperative IOP reading served as control for all studies.Results.After PRK, IOP reading was significantly reduced in the treated eyes when compared with the control measurements (11.87 ± 1.73 vs. 13.37 ± 1.52 mmHg,p< 0.0001 with GAT; 12.07 ± 1.6 vs. 13.51 ± 1.59 mmHg,p< 0.0001 with noncontact tonometer; 12.18 ± 1.6 vs. 13.48 ± 1.55 mmHg,p< 0.0001 with Tono-Pen central; 13.48 ± 1.65 vs. 13.71 ± 1.56 Hg,p< 0.0104 with Tono-Pen temporal periphery). There was also a significant correlation between IOP reading changes measured by GAT, noncontact tonometer, Tono-Pen central, and change of CCT and between reduction of IOP reading and keratometry (r2> 0.39,p< 0.0001 for each). The correlation between IOP reading change by Tono-Pen temporal periphery and CCT was also significant but r2value was only 0.034. Tono-Pen temporal periphery postoperative IOP measurements had the best correlation with preoperative GAT IOP (r2= 0.57,p< 0.0001).Conclusions.PRK reduced IOP reading as measured by GAT, noncontact tonometer, and Tono-Pen central; less so when measured by Tono-Pen temporal periphery. Early detection of glaucoma and IOP follow-up in glaucoma patients may be done best by peripheral Tono-Pen measurements over the nonablated cornea.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.There have been no reported cases of hepatitis C virus (HCV) transmission by corneal transplantation. Previous studies have also shown no correlation between HCV seropositivity and the presence of HCV RNA in the corneal tissues. This study aims to investigate such correlation and to provide further evidence to the possible transmissibility of HCV via corneal grafts.Methods.Of the 1,619 potential corneal donors to the Eye Bank of Canada over a 1-year period, 15 tested HCV-positive by the second-generation Abbott HCV enzyme immunoassay (EIA) 2.0 assay. Their sera were further tested with second-generation radio-immunoblot assay (RIBA-II), and their corneas (29 altogether) were processed for identification of HCV RNA using polymerase chain reaction (PCR).Results.Of the 29 corneas from seropositive donors, HCV RNA was detected in 7 (24.1%).Conclusion.This is the first study in the literature that demonstrates a significant correlation between HCV seropositivity and the presence of HCV in the corneas. Routine HCV serologic testing for all potential corneal donors and rejection of corneal tissues based on HCV seropositivity is certainly justifiable.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.To measure real time intraocular pressure (IOP) during keratomileusis and to determine variability of corneal flap thickness by using different suction ring pressure settings.Methods.Eight human cadaver eyes, two groups of four each, were used. The suction ring of the UniversalKeratome was applied to each eye, the same as for a standard automated lamellar keratoplasty (ALK) or laser in situ keratomileusis (LASIK) procedure, to create a lamellar corneal flap. The pressure of the suction ring on each eye was raised to one of two different levels, four eyes to 488 and the remaining four to 600 mmHg. IOP was continuously recorded by manometer, from application of the suction ring through the end of the passage of the microkeratome. Central corneal thickness was measured, both before and after each procedure.Results.IOP increased by >90 mmHg after application of the suction ring at a pressure of either 488 mmHg or 600 mmHg. Corneal flaps performed under a suction ring pressure of 488 mmHg measured 159.98 ± 5 &mgr;m, whereas flap thickness for the 600-mmHg group varied 1.4–266.2 &mgr;m. Two flaps exhibited irregular configurations.Conclusions.Real time IOP can be measured during keratomileusis. The results demonstrated a significant increase in IOP during the procedure. Suction ring pressure setting is an important variable in determining consistent corneal flap thickness during the keratomileusis procedure.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate the effect of intraoperative mitomycin C (MMC) on corneal light scattering after excimer laser keratectomy.Methods.Phototherapeutic keratectomy (PTK) was performed in 24 rabbit eyes. After 40-&mgr;m epithelial ablation, animals were divided into three groups. In group 1, filter paper discs soaked with MMC (group 1A, 0.5 mg/mL; group 1B, 0.25 mg/ml) were applied for 1 minute. In group 2, annular filter papers soaked with MMC (group 2A, 0.5 mg/mL; group 2B, 0.25 mg/mL) were applied for 1 minute. Controls received vehicle only (group 3). Six-millimeter diameter 100-&mgr;m deep PTK was performed. Corneal light scattering was measured weekly from 1 to 6 weeks, at 10 weeks, and at 8 and 13 months using a scatterometer. A corneal light scattering index (SI) ranging from 0 to 10 was calculated; SI of 1 represents normal scattering.Results.A statistically significant decrease in mean SI was noted in group 2A (annular MMC 0.5 mg/mL;p< 0.05) as compared with the control group at 2 weeks. At 10 weeks, SI approached baseline levels in group 2 and the control group but showed significant increase in group 1 (MMC disc;p< 0.05). At 8 and 13 months, SI showed no statistical differences between groups.Conclusions.Controlled application of 0.5 mg/mL MMC in the corneal midperiphery transiently reduces corneal light scattering after excimer keratectomy in this rabbit model.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To demonstrate the capability of a standard, commercially available optical coherence tomography device (originally designed to measure retinal thickness) to image the human cornea in vivo and to measure central corneal thickness (CCT) in normal and edematous corneas. The intrapatient precision and interpatient variability of this novel application was compared to standard ultrasonic pachymetry. Also, the correlation of both methods was investigated.Methods.CCT measurements using optical coherence tomography (OCT) and ultrasonic pachymetry (PACH) were obtained in 36 normal eyes and 16 eyes with corneal edema.Results.Direct in vivo imaging of the cornea and measurements of CCT by OCT could be performed in all eyes. In normal subjects, CCTOCTwas 530 ± 32 &mgr;m and CCTPACHwas 581 ± 34 &mgr;m. The two methods showed a highly significant correlation with a standardized regression coefficient of 0.988. The difference between both methods was constant over the range of CCT (mean difference, 49.4 ± 5.9 &mgr;m). The mean intrapatient SD of CCT measurements was 4.90 &mgr;m and 4.96 &mgr;m for OCT and PACH, respectively. In patients with corneal edema, mean CCTOCTwas 601 ± 59 &mgr;m, and mean CCTPACHwas 667 ± 68 &mgr;m. The difference between the two techniques increased slightly with increasing corneal edema (mean difference, 66.9 ± 10.9 &mgr;m).Conclusion.Imaging of the human cornea can be performed by a standard retinal OCT device, and OCT measurement of CCT shows excellent correlation to values obtained by PACH, giving similar readings separated by a constant difference. In corneal edema, the difference between the two methods is additionally increased, but continues to demonstrate excellent consistency.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID