Faculty Bibliography

PURPOSE: To report a case series of contact lens-related corneal ulcers in compliant patients with no apparent predisposing factors. DESIGN: Retrospective case series. METHODS: Charts of 70 patients with contact lens-related corneal ulcers from July 1999 to June 2002 were reviewed. Lens care hygiene and method of disinfection, as well as frequency of lens replacement, were recorded. Only patients who followed recommended guidelines for contact lens wear were included in the study. RESULTS: Of the 70 patients, 21 (30%) developed corneal ulcers despite being compliant with the guidelines for contact lens wear. All patients used multipurpose solutions for cleaning, disinfecting, and storing daily wear soft contact lenses. CONCLUSION: Standard lens care hygiene does not seem to be sufficient in preventing the development of corneal ulcers in patients using conventional and frequent replacement daily wear soft contact lenses

PURPOSE: To report two cases of Descemet membrane detachment associated with hemorrhage after alkali burn to the cornea. DESIGN: Observational case reports. METHODS: We describe two patients with detachment of Descemet membrane associated with hemorrhage after alkali burns to the cornea. RESULTS: Patient 1 received a splash of caustic soda to the face. Descemet membrane detachment with hemorrhage was present. An attempt at reattachment using intraocular gases failed. Patient 2 sustained a chemical burn secondary to an airbag injury. A thickened, detached Descemet membrane associated with a hyphema was evident. CONCLUSIONS: Detachments of Descemet membrane associated with alkali burns are often accompanied by irreversible endothelial cell damage

PURPOSE: To evaluate the presentation, treatment, and disease course of Thygeson's superficial punctate keratitis. DESIGN: Observational case series. PARTICIPANTS: Forty patients, diagnosed and managed with Thygeson's superficial punctate keratitis between January 1, 1992, and December 31, 2001, on the Cornea Service at Wills Eye Hospital. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Patient demographics, symptoms, visual acuity, ophthalmic examination, management, duration of disease, and length of follow-up. RESULTS: At the time of presentation, the mean patient age was 28.7 years. The most common presenting symptoms included photophobia, blurred vision, and irritation. Thirty of 38 patients without a history of decreased vision (78.9%) initially were seen with visual acuities in both eyes of 20/30 or better. The 8 (21.1%) remaining patients all had visual acuities between 20/40 and 20/50; improvement in vision with treatment was noted in all 3 observed at our institution. Six patients (16%) had unilateral disease, whereas another 2 patients had bilateral involvement develop after unilateral presentation. Thirty-nine patients (97.5%) were treated with topical steroids at some point in their disease course. The patient not managed with steroids was only seen once and was managed with artificial tears for mild symptoms. In addition to steroids, a patient was treated for recurrent episodes with extended-wear contact lens, and another patient was started on topical cyclosporine because of an inability to be tapered off topical steroids. The average duration of disease in the 15 patients who were observed for more than a single year was 11.1 years. CONCLUSIONS: Thygeson's superficial punctate keratitis is a potentially chronic condition, which might affect people of all ages for years to decades. Corticosteroids are the mainstay of treatment, with extended-wear contact lens and topical cyclosporine reserved as secondary agents

OBJECTIVE: To evaluate the effectiveness of more than 12 months of oral acyclovir therapy in reducing recurrences of ocular herpes simplex virus. METHODS: We retrospectively compared ocular herpes simplex virus recurrence in 2 groups of patients. In group 1, patients used oral acyclovir for at least 12 months and then discontinued the treatment. In group 2, patients received the treatment for at least 18 months. We compared recurrences when both groups were using acyclovir (period 1) and when only group 2 was receiving the drug (period 2). Statistical analysis was performed with the t test, chi2 test, and Kaplan-Meier method. RESULTS: Group 1 had 18 patients and a mean +/- SD follow-up of 45.2 +/- 22.2 months. Group 2 had 22 patients and a mean +/- SD follow-up of 42.4 +/- 30.2 months. Six patients (33%) in group 1 and 4 patients (18%) in group 2 had recurrence in period 1 (P =.3). In period 2, 14 patients (78%) in group 1 and 8 patients (36%) in group 2 had recurrence (P =.01). Mean +/- SD recurrence-free survival in period 2 was 15.3 +/- 5.5 months in group 1 and 37.3 +/- 6.3 months in group 2 (P =.001). CONCLUSIONS: Long-term oral acyclovir use seems to remain effective in decreasing the number of ocular herpes simplex virus recurrences beyond 12 months

PURPOSE: To describe a case of bilateral keratoconus occurring after LASIK in a keratoconus suspect. METHOD: Case report. RESULTS: A 33-year-old male presented to our institution for evaluation of poor vision 4 years after undergoing bilateral LASIK for the treatment of compound myopic astigmatism. Corneal topography examination showed marked bilateral inferior steepening, and a slitlamp examination revealed classic signs of keratoconus. A review of his preoperative corneal topography showed bilateral inferior steepening, but no other clinical signs of keratoconus were noted at the time of the operation. CONCLUSIONS: A finding of inferior steepening on corneal topography examination should be regarded as a contraindication to the LASIK procedure

PURPOSE: To present a case in which an RK4 lens was fitted for a patient who developed flap striae resulting from laser-assisted in situ keratomileusis (LASIK). METHODS: Case report. RESULTS: A 44-year-old man underwent uncomplicated LASIK procedure for bilateral myopia and astigmatism. Visually significant flap striae (OS>OD) were noted postoperatively. The flaps were relifted, refloated, and stretched twice in each eye. In addition, OD enhancement laser treatment was performed. Nevertheless, decreased best-corrected visual acuity (OS>OD) persisted. One month after LASIK, the patient was referred to our office for a second opinion and further evaluation. To avoid additional manipulation of the flaps, we used an RK4 lens fitting to achieve a final corrected visual acuity of 20/20 OU. CONCLUSIONS: Persistent, visually significant flap striae following flap, refloating, stretching, and smoothing techniques can make LASIK patients unhappy. An RK4 lens fitting is an alternative method for correcting postoperative irregular astigmatism and to achieve the best-corrected visual acuity