Faculty Bibliography
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331
The effect of state legislation on eye donation
PURPOSE: Pennsylvania Act 102 implemented in March 1995 required all acute care hospitals in Pennsylvania to routinely refer all deaths to the Organ Procurement Organization for determination of suitability for organ/tissue donation. This study analyzed the effect of the law on eye donation. METHODS: Retrospective analysis of the total number of referrals and the actual number of eye donations from 62 hospitals in Pennsylvania to the Lions Eye Bank of Delaware Valley was performed for the years 1993 to 1998. Information gathered included donor's age, gender, race, cause of death, referring institution, and result of referral. RESULTS: From 1993 to 1998, the total numbers of referrals were 988, 1,647, 8,101, 21,123, 21,783, and 22,987, and the numbers of donors were 570, 574, 660, 644, 594, and 568, respectively. The increase in the number of donors after implementation of the law was not commensurate with the number of referrals. This was caused by a disproportionate increase in the number of referrals older than 70 years of age (from a mean of 33% to 52%), which exceeded the donor age limit of 69 years, and also to a lower family consent rate (from a mean of 48% to 24%). CONCLUSIONS: Well-designed state legislation with proper implementation greatly increased hospital referrals for eye donation. However, there was only a small increase in the number of eye donors because many of the referrals were beyond the acceptable upper age limit for eye donation. A small increase in the donor age limit would increase the number of eye donations without having to expand the potential donor pool. Education of the public may help to improve the family consent rate
PMID: 11413401
ISSN: 0277-3740
CID: 107502
Infectious crystalline keratopathy in an immunosuppressed patient [Case Report]
PURPOSE: To report a case of infectious crystalline keratopathy (ICK) in a patient with systemic malignancy on immunosuppressive chemotherapy. The patient wore frequent replacement contact lenses on an extended wear basis. METHODS: A 51-year-old female with carcinoma of the breast and systemic metastases was referred for a corneal ulcer. She received intravenous docetaxel, trastuzumab, and systemic dexamethasone. She wore frequent replacement Acuvue lenses on an extended wear basis. Her visual acuity was 20/200 in the right eye and 20/400 in the left eye. The right eye examination revealed diffuse superficial punctate keratopathy. In the left eye, there was a 3.8 x 4.5 mm corneal infiltrate with projecting crystalline processes. Corneal scrapings were performed for smears and cultures. Treatment with topical fortified cefazolin and fortified tobramycin every hour around the clock was initiated. RESULTS: Culture of the corneal scrapings grew Streptococcus anginosus and Staphylococcus aureus. There was a good response to medical therapy. When last seen after 4 weeks of treatment, the infiltrate measured about 1 mm and the visual acuity was 20/40 with pinhole. CONCLUSIONS: Systemic immunosuppression may be a predisposing factor for the development of ICK. This case suggests that debilitated patients may be at risk for unusual infections and should be discouraged from overnight wear of contact lenses
PMID: 11352447
ISSN: 0733-8902
CID: 107504
Trends in contact lens-related corneal ulcers
PURPOSE: To identify changes in number of contact lens-related corneal ulcers per year and the type of contact lenses involved. METHODS: Charts of 299 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from January 1, 1996, to June 30, 1999, were retrospectively reviewed. A corneal ulcer was defined as an infiltrate that was treated at least hourly with topical fortified antibiotics or fluoroquinolones. RESULTS: Of these 299 cases, 37 (12.4%) were related to contact lens use. Contact lens-related ulcers accounted for 10.7% of all corneal ulcers in 1996, 15.3% in 1997, 8.6% in 1998, and 18.2% in the first 6 months of 1999. The contact lenses most commonly associated with ulcers were conventional soft daily-wear contact lenses (33%). There were similar numbers of ulcers associated with extended wear (n = 16) and daily wear (n = 17) of soft contact lenses. In addition, the number of cases associated with conventional (n = 17) and disposable/frequent replacement (n = 16) lenses were similar. Corneal cultures were performed in 15 (40.5%) cases and were positive in 8. There has been a significant decrease in the number of contact lens-related ulcers treated at our institution compared with previous years (1988-1999, p < 0.01). CONCLUSIONS: The number of contact lens-related corneal ulcers in the past 4 years was significantly fewer than previous years at our institution. A similar number of ulcers were associated with conventional and disposable/frequent replacement lenses despite the commercial preponderance of the latter type of lenses
PMID: 11322418
ISSN: 0277-3740
CID: 107505
Human immunodeficiency virus p24 antigen testing in cornea donors [Case Report]
PURPOSE: Testing for the p24 antigen of the human immunodeficiency virus (HIV) may detect early HIV infection in the seronegative window; however, falsely reactive results may occur in cadaver specimens. Although neither the Food and Drug Administration (FDA) nor the Eye Bank Association of America requires p24 testing of cornea donors, many tissue banks using other organs from cornea donors do perform this assay, and the FDA requires that eye banks reject corneal tissue if a reactive p24 assay is reported. We investigated the impact of p24 testing on eye banking and corneal transplantation. METHODS: Two clinical cases and records from the Lions Eye Bank of Delaware Valley (LEBDV) were reviewed retrospectively. RESULTS: Two corneas from the LEBDV were transplanted before the reporting of p24 reactivity by other tissue banks. In one case, because of the young age of the recipient, the surgeon elected to replace the cornea with new tissue hours after the original transplant, and later polymerase chain reaction (PCR) testing was negative. In the other case, there was not enough specimen to perform Western blot or PCR confirmatory testing. The patient was followed with periodic serologic testing for HIV and has remained seronegative. To avoid such problems in the future, the LEBDV initiated testing of all donors with p24 and other nonrequired screening tests. Over a 2-month period, 22 corneas (from 11 donors) were discarded because of these tests: 4 donors had reactive p24 tests, 6 were reactive for antibody to hepatitis B core antigen, and 1 had a reactive syphilis test. CONCLUSIONS: Results from p24 assays by other tissue banks may cause difficult clinical situations when the results are received after transplantation of the tissue, but the use of the p24 assay in the screening of cornea donors may result in excessive waste of donor tissue. Further guidance is needed regarding the management of positive results from this and other nonrequired screening tests
PMID: 11322416
ISSN: 0277-3740
CID: 107506
Predictive factors in visual outcome of infectious keratitis [Meeting Abstract]
ISI:000168392100182
ISSN: 0146-0404
CID: 107685
Predictors of recurrent herpes simplex virus keratitis
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. $$:
ISI:000167178900001
ISSN: 0277-3740
CID: 107683
Penetrating keratoplasty in iridocorneal endothelial syndrome
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
PMID: 11248814
ISSN: 0277-3740
CID: 107507
Use of autologous limbal epithelial cells cultured on amniotic membranes for unilateral stem cell deficiency
PMID: 11198702
ISSN: 0003-9950
CID: 107508
Additional factors linking corneal melting to topical nonsteroidal anti-inflammatory drugs - In reply [Letter]
ISI:000169780200023
ISSN: 0003-9950
CID: 107684
The role of glaucoma therapy in the need for repeat penetrating keratoplasty
PURPOSE: To evaluate the effects of medical and surgical therapy for glaucoma in patients requiring repeat penetrating keratoplasty (PK) for endothelial failure. METHODS: Retrospective review of the charts of all patients undergoing repeat PK at the Cornea Service at Wills Eye Hospital between January 1, 1989 and December 31, 1995. Study end-points were time to first rejection episode, number of rejection episodes, time to endothelial failure, and time to regraft. RESULTS: During the study period, 156 patients underwent repeat PK for irreversible endothelial failure. Ninety-four (60.3%) patients had a concomitant diagnosis of glaucoma. Of these 94, 27 (28.7%) underwent glaucoma surgery. The surgically treated group had a significantly higher percentage of patients with at least one rejection episode (55.6%) than those without glaucoma (32.8%; p = 0.04). Similarly, a significant difference existed in the percentage of both medically and surgically treated glaucoma patients having at least one rejection episode (50%) when compared with patients without glaucoma (32.8%; p = 0.04). Rejection episodes occurred sooner in the glaucoma patients than in the nonglaucoma group (18 months vs. 32 months; p = 0.01), irrespective of glaucoma therapy. Grafts in glaucoma patients failed 12 months earlier than those in patients without glaucoma. CONCLUSION: In a selected group of patients who required repeat PK for endothelial graft failure, a majority of patients were found to have a history of glaucoma. Among regraft patients, surgical therapy for glaucoma was found to increase the risk of rejection episodes when compared to patients without glaucoma. The patients with glaucoma were found to be at increased risk for early rejection and failure compared to patients without glaucoma
PMID: 11095048
ISSN: 0277-3740
CID: 107509
