Faculty Bibliography
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332
Penetrating keratoplasty for varicella-zoster virus keratopathy
PURPOSE: To examine and report the results of penetrating keratoplasty performed in patients with varicella-zoster virus keratopathy. METHODS: The authors retrospectively reviewed the records of 15 patients who had penetrating keratoplasty for varicella-zoster virus keratopathy from January 1989 through December 1998 on the Cornea Service at Wills Eye Hospital. RESULTS: Twelve patients had a preoperative diagnosis of herpes zoster ophthalmicus, and three, of varicella. Four eyes had lateral tarsorrhaphies performed in conjunction with penetrating keratoplasty. Three eyes had endothelial rejection episodes that responded well to treatment with topical steroids. One eye had a regraft 1 month after primary failure, and this second graft also failed because of recurrent neurotrophic keratopathy. Three eyes that had repeated penetrating keratoplasty for graft failure had clear grafts at the last examination. At an average follow-up time of 50 months, 13 (86.7%) grafts remained clear, and the best corrected visual acuity was 20/100 or better in eight (53.3%) eyes. Five patients had decreased visual acuity because of retinal diseases. CONCLUSION: Although varicella-zoster virus keratopathy is an uncommon indication for penetrating keratoplasty, effective visual rehabilitation can be achieved in these patients. Careful postoperative management, frequent lubrication, and lateral tarsorrhaphies to protect the corneal surface are major factors in the successful outcome of these cases
PMID: 10746442
ISSN: 0277-3740
CID: 107519
Mycobacterium chelonae infection in a corneal graft [Case Report]
PMID: 10676805
ISSN: 0003-9950
CID: 107521
Management of small corneal infiltrates in contact lens wearers [Editorial]
PMID: 10676796
ISSN: 0003-9950
CID: 107522
Oral acyclovir for herpes simplex virus eye disease - Effect on prevention of epithelial keratitis and stromal keratitis
Objectives: To investigate the effect of oral acyclovir therapy for recurrences of herpes simplex virus (HSV) epithelial keratitis and stromal keratitis and to determine if certain patients derive differential benefit. Design: This randomized, double-masked clinical trial enrolled 703 immunocompetent patients with prior HSV eye disease within the preceding year, assigned 357 patients to receive oral acyclovir, 800 mg/d, and 346 to receive placebo; and followed up patients during a 12-month treatment period for the development of HSV eye disease. Results: The cumulative probability of a recurrence of any type of ocular HSV disease during the 1-year treatment period was 19% in the acyclovir group compared with 32% in the placebo group. Sixteen patients in the acyclovir group and 30 in the placebo group had more than 1 recurrence. A benefit was seen for preventing both epithelial keratitis (rate ratio, 0.62; 95% confidence interval, 0.39-0.97) and stromal keratitis (rate ratio, 0.57; 95% confidence interval, 0.36-0.89). Although a relative benefit of treatment on preventing any type of recurrence was present in most subgroups, the magnitude of absolute benefit tvas greatest among patients with the highest number of prior episodes of ocular HSV disease. The benefit in preventing stromal keratitis was seen solely among patients with a history of stromal keratitis. Conclusions: Long-term suppressive oral acyclovir therapy reduces the rate of recurrent HSV epithelial keratitis and stromal keratitis. Acyclovir's benefit is greatest for patients who have experienced prior HSV stromal keratitis. $$:
ISI:000088702700001
ISSN: 0003-9950
CID: 107686
Human immunodeficiency virus p24 antigen testing in cornea donors [Meeting Abstract]
ISI:000086246702356
ISSN: 0146-0404
CID: 107687
Psychological stress and other potential triggers for recurrences of herpes simplex virus eye infections
Objective: To assess psychological stress and other factors as possible triggers of ocular herpes simplex virus (HSV) recurrences. Design: A prospective cohort study nested in a randomized, placebo-controlled, clinical trial. Setting: Fifty-eight community-based or university sites. Participants: Immunocompetent adults (N = 308), aged 18 years or older, with a documented history of ocular HSV disease in the prior year and observed for up to 15 months. Exposure Variables: Psychological stress, systemic infection, sunlight exposure, menstrual period, contact lens wear, and eye injury recorded on a weekly log. The exposure period was considered to be the week before symptomatic onset of a recurrence. Main Outcome Measure: The first documented recurrence of ocular HSV disease, with exclusion of cases in which the exposure week log was completed late after the onset of symptoms. Results: Thirty-three participants experienced a study outcome meeting these criteria. Higher levels of psychological stress were not associated with an increased risk of recurrence (rate ratio, 0.58; 95%;, confidence interval, 0.32-1.05; P=.07). No association was found between any of the other exposure variables and recurrence. When an analysis was performed including only the recurrences (n=26) for which the exposure week log was completed late and after symptom onset, there was a clear indication of retrospective overreporting of high stress (P =.03) and systemic infection (p=.01). Not excluding these cases could have produced incorrect conclusions due to recall bias. Conclusions: Psychological stress does not appear to be a trigger of recurrences of ocular HSV disease. If not accounted for, recall bias can substantially overestimate the importance of factors that do not have a causal association with HSV infection. $$:
ISI:000165738800001
ISSN: 0003-9950
CID: 107688
Indications for penetrating keratoplasty and associated procedures, 1996-1999 [Meeting Abstract]
ISI:000086246704927
ISSN: 0146-0404
CID: 107689
The effect of state legislation on eye donations [Meeting Abstract]
ISI:000086246704984
ISSN: 0146-0404
CID: 107690
Efficacy of fluoroquinolones in the treatment of corneal infiltrates and ulcers [Meeting Abstract]
ISI:000086246701364
ISSN: 0146-0404
CID: 107691
Trends in contact lens-related corneal ulcers [Meeting Abstract]
ISI:000086246700397
ISSN: 0146-0404
CID: 107692
