摘要:

Purpose.To evaluate the efficacy and risks of complications of topical mitomycin C (MMC) for small-size conjunctival intraepithelial neoplasia (CIN).Methods.Eight patients with clinically diagnosed CIN <8 mm were included in the study. Patients received topical drops of MMC, 0.02–0.04%, 4 times daily for 14 days. Retreatment was done when lesions were not eliminated or recurred after the first treatment.Results.Three patients remained disease free after one course of MMC application. Retreatment was done in four patients because of lesions that decreased in size but were not eliminated, and for regrowth in one case. After retreatment, the lesions were eradicated in four patients, whereas in one patient, the treatment failed, and the lesion was surgically excised. The complications of MMC use included mild conjunctival hyperemia in two patients and mild allergy in one patient, which resolved after discontinuation of the treatment.Conclusion.Application of topical MMC is an effective treatment for most but not all cases of small-size CIN.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.To review the indications and patient characteristics for penetrating keratoplasty (PKP).Methods.Retrospective review of records at the Pathology Service, Department of Ophthalmology, University of Toronto from 1964 to 1997.Results.The 6,222 records were reviewed. The leading indications for PKP were regraft, keratoconus (KC), pseudophakic bullous keratopathy (PBK), Fuchs' dystrophy, viral infections, and trauma, in that order. During the second half of the 1980s, PBK replaced KC as the leading indication for transplantation. The average age of patients increased from 49 (±19) years during the second half of the 1960s to 63 (±20) years at the first half of the 1990s. Gender differences (M/F ratio) were significant for KC, viral keratopathy, trauma, PBK, aphakic bullous keratopathy (ABK), edema of unspecified etiology, interstitial keratitis, rheumatoid arthritis, and Fuchs' dystrophy. Diagnostic category differences between all patients for PKPs and regrafts were significant for autoimmune keratolysis, congenital opacities, PBK, ABK, edema of unspecified etiology, scarring, Fuchs' dystrophy, and KC.Conclusion.Indications are in accordance with the literature with the exception of regraft, which was higher. An increase in the average age of patients corresponded with the PBK epidemic. The high male-to-female ratio among patients with KC was different from that previously reported for the prevalence of this condition. Sex distribution among patients with PBK and ABK showed a female predominance. Differences in the underlying disease distributions between regrafted patients and the rest of the series coincide with prognostic classifications for PKP.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.Asking the family of a deceased patient to consider eye donation is one of the most difficult aspects of the donation process. The aim of this prospective study was to describe the content of interviews with the families of potential donors and to analyze their reactions to improve the process of eye donation.Methods.We consecutively met with 151 families of suitable corneal donors at the Rouen University Hospital. All interviews with donor families were analyzed using a preestablished questionnaire.Results.In only 17.9% of cases was the family aware of the potential donor's last will. In 77.7% of these cases, the patient wished to donate. Procurement rate was 71.5%. This acceptance was mostly facilitated by the awareness and motivation of the hospital staff, the experience of the physician, and the 13.3-h period of time allowed after the donor's death. The commitment on the part of the ophthalmologist to carry out optimal anatomical restoration was a very important point for 32% of families who accepted donation. Twenty-one percent of families asked for a delay for reflection. This delay helped to obtain a positive response in 72.7% of cases and even sometimes helped families to reconsider a previously negative position (14% of initial refusals).Conclusion.We demonstrate that a high positive response (71.5%) can be obtained from the donor's family when a trained and motivated group manages the post-mortem cornea donation request.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.To evaluate the use of ultrasound biomicroscopy (UBM) in examining the status of anterior-segment structures in eyes with corneal opacification.Methods.Evaluation with UBM was performed between 1 and 2 weeks before surgery in 21 patients (21 eyes) with corneal opacities who were scheduled for penetrating keratoplasty. UBM findings were correlated with the findings noted during penetrating keratoplasty. The efficacy of UBM evaluation was calculated in terms of positive and negative predictive values (PPVs and NPVs) for the presence or absence of each finding.Results.Seventeen eyes had either aphakic or pseudophakic bullous keratopathy (ABK or PBK). UBM findings of anterior synechiae, peripheral anterior synechiae, posterior synechiae, peripheral and sector iridectomies positively correlated with those observed during surgery in five (55.6%) of nine locations, 19 (73.1%) of 26 locations, 12 (80%) of 15 locations, eight (88.9%) of nine locations) and six (85.7%) of seven locations, respectively. The NPVs for these findings were 100%, six (54.5%) of 11 locations), 10 (71.4%) of 14 locations, 12 (100%) of 12 locations, and 14 (100%) of 14 locations, respectively. Correlation for findings pertaining to the posterior capsule (PC) were presence of PC/PC remnants [PPV, 13 (92.9%) of 14 locations; NPV, two (66.7%) of three locations], presence of central PC tears [PPV, two (66.7%) of three locations], intactness of PC [PPV, six (85.7%) of seven locations], and PC thickening [PPV, 13 (81.25%) of 16 locations; NPV, four (100%) of four locations]. For vitreous in the anterior chamber, the PPV was eight (100%) of eight locations, and NPV was 12 (92.3%) of 13 locations. Pseudophakos-related information in eyes with PBK showed a PPV of 100% for presence, centration, and anatomic location (seven of seven, four of four, and seven of seven locations, respectively).Conclusion.In eyes with corneal opacity, UBM determines the status of various anterior-segment structures. It is thus a useful adjunct in the preoperative planning and prognostication of patients requiring penetrating keratoplasty.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.To evaluate and compare the efficacy of the four adjunctive agents to facilitate recipient bed intralamellar dissection in cases of lamellar keratoplasty.Methods.Forty eyes with partial-thickness corneal opacities were recruited for this prospective, randomized clinical trial. The cases were divided into four groups per the intralamellar injection (i.e., air [group I], 2% hydroxypropyl methylcellulose [HPMC] [group II], balanced saline solution [BSS] [group III], and no adjunct [group IV] used to facilitate recipient intralamellar dissection). The intraoperative parameters evaluated were initial preparation time, dissection time, and total time. At each follow-up, visual acuity, refractive status, keratometry, and endothelial cell counts were also analyzed.Results.Initial preparation time, dissection time, and total time were significantly decreased with the use of an adjunct (p< 0.05) and were found to be least with the use of BSS. No difference in these time frames was noted between group I and group II. Corneal haze and incomplete air insufflation were seen in group I, and difficulty in injection of 2% HPMC and its incomplete spread were noted in group II. The mean spherical equivalent, astigmatism, endothelial cell counts, and visual acuity did not show any significant difference between any group.Conclusion.Hydrodelamination with BSS is easy to perform and should be undertaken routinely to facilitate recipient intralamellar dissection.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.To describe the epidemiology ofVibrioeye infections.Method.We reviewed the records of a patient from our institution withV. vulnificuskeratitis and conducted a literature search for other cases of ocular infections withVibriospecies.Results.A 39-year-old fisherman was struck in his left eye with an oyster shell fragment, developed suppurativeV. vulnificuskeratitis, and was successfully treated with combined cefazolin and gentamicin. Including our patient, 17 cases of eye infections withVibriospp. have been reported, and 11 (65%) involved exposure to seawater or shellfish. Of the seven cases due toV. vulnificus(six keratitis and one endophthalmitis), six had known exposure to shellfish or seawater along the U.S. coast of the Gulf of Mexico. Of five cases ofV. alginolyticusconjunctivitis, three had been exposed to fish or shellfish. Three infections withV. parahaemolyticus(one keratitis and two endophthalmitis) were reported; two of these occurred in people exposed to brackish water on or near the Gulf Coast. Two cases of postsurgical endophthalmitis, one withV. albensisand one withV. fluvialis,also were reported.Conclusions.In addition to septicemia, gastroenteritis, and wound infections, halophilic noncholeraVibriospecies can cause sight-threatening ocular infections. Ocular trauma by shellfish from contaminated water is the most common risk factor forVibrioconjunctivitis and keratitis. Nearly one half of reportedVibrioinfections of the eye occurred along the U.S. coast of the Gulf of Mexico.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.Although conjunctival rhinosporidiosis is endemic in India, associated scleral melting and staphyloma formation are quite rare. We report clinical features and management in three patients with this unusual presentation.Methods.Retrospective review of case records of three patients with conjunctival rhinosporidiosis.Results.Infection occurred in young, healthy adults and was localized to the forniceal conjunctiva in all patients. The affected conjunctiva had numerous grey–white spherules, but a polyp-like lesion was not present in any patient. Diagnosis was based on clinical features and examination of scrapings from the involved conjunctiva. Treatment was surgical, with excision of infected conjunctival tissues and staphyloma repair with homologous sclera or autogenous periosteum. Failure to recognize the conjunctival pathology in one patient resulted in recurrence of the staphyloma.Conclusion.Conjunctival rhinosporidiosis can be associated with scleral staphyloma in young, healthy, adults. Differentiating this entity from idiopathic scleral ectasia requires knowledge of the clinical features of conjunctival rhinosporidiosis and a high index of clinical suspicion.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.We sought to describe the clinical features, responsible pathogens, management, and prognosis of infectious scleritis after pterygium excision.Methods.A retrospective study through review of medical records of patients diagnosed with infectious scleritis after pterygium excision over a 10-year period at our institution.Results.A total of 16 cases of infectious scleritis after pterygium excision was identified. Among them, eight were associated with sclerokeratitis, and six had multifocal scleral nodules with subconjunctival abscesses. Culture results were positive in 15 (93.8%) cases.Pseudomonaswas isolated in 13 (81.3%) patients, fungus in three (18.8%), and two had a mixed growth (12.5%). Based on the in vitro susceptibility test, four (31%)Pseudomonasisolates were resistant to gentamicin, whereas all isolates were sensitive to amikacin. During the course of treatment, eight cases were complicated by vitreous opacity, four developed glaucoma, four had serous retinal or choroidal detachment, and two had secondary cataract. Scleral infection recurred in two patients after cessation of therapy. Among the nine patients treated with medical therapy, two eyes were enucleated, whereas only two attained a visual acuity of ≥2/200 at the end of the follow-up period. On the other hand, seven patients had combined antibiotic therapy and surgical debridement. The number of surgical debridement ranged from one to three, with an average of 1.4. In this combined-treatment group, only one patient required enucleation, and five cases attained a visual acuity of ≥2/200. The duration of hospitalization for patients with combined treatment was 21.2 ± 4.8 days compared with the 28.4 ± 5.0 days for those with medical treatment alone (p= 0.035).Conclusion.Surgical debridement in combination with appropriate antimicrobial therapy shortens the course of treatment and improves the visual outcome of severe infectious scleritis after pterygium excision.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.Late endothelial failure of penetrating keratoplasty can be defined as gradual decompensation (increasing thickness with loss of clarity) of a previously clear graft without apparent cause. This study examined the possibility that a chronic subclinical rejection process may be occurring in grafts that fail from late endothelial failure.Method.Six patients fulfilling the diagnostic criteria for late endothelial failure who underwent repeated keratoplasty were studied. The clinical course and results of specular microscopy were reviewed. The failed corneal graft for each patient was examined by light and electron microscopy.Results.Sequential specular microscopy demonstrated low initial postoperative endothelial cell density with continued decrease in density and increase in corneal thickness over the first 5 postoperative years. Electron microscopy revealed irregular-shaped cells of varying size with many abnormal features, lying on abnormal Descemet's membrane. Degenerating endothelial cells were commonly seen. There was no sign of acute or chronic inflammation.Conclusions.The pathologic findings are suggestive of an unstable and highly stressed endothelial cell population in late endothelial failure but are nonspecific. There was no evidence of acute or chronic rejection at the time of graft failure.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.To compare central and peripheral corneal endothelial cell morphometry in normal subjects and long-term contact lens wearers.Methods.Endothelial cell density (ECD), coefficient of variation of cell area (CV), and percentage of six-sided cells were measured by contact specular microscopy in the corneal center and temporal periphery of both eyes of 43 long-term contact lens wearers and in 84 normal subjects who had never worn contact lenses. The latter group included 43 age-and sex-matched controls for the contact lens wearers. ECDs were corrected for magnification changes due to corneal thickness.Results.Central ECD (2,723 ± 366 cells/mm2, mean ± SD) was significantly higher than peripheral ECD (2,646 ± 394 cells/mm2) for the normal group (p= 0.01) but not for the contact lens wear group (2,855 ± 428 cells/mm2central, 2,844 ± 494 cells/mm2peripheral,p= 0.84). Peripheral CV was significantly higher than central for normal subjects and contact lens wearers and was significantly higher in both center and periphery in contact lens wearers than in controls. Central percentage of six-sided cells was significantly higher than peripheral for normal subjects and contact lens wearers and was lower in both center and periphery in contact lens wearers than in controls.Conclusions.Central ECD was significantly higher by 3% than peripheral ECD in normal subjects, but not in contact lens wearers. The results suggest that contact lens wear causes a mild redistribution of endothelial cells from the central to the peripheral cornea. A reversal of this redistribution after contact lens wear is discontinued for refractive surgery could mask mild central endothelial damage from the refractive procedure.

ISSN:0277-3740    

出版商:OVID    

年代:2000

数据来源: OVID