Faculty Bibliography
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332
Conjunctival autograft for pterygium surgery: how well does it prevent recurrence?
BACKGROUND AND OBJECTIVE: The efficacy of the surgical management of pterygium with conjunctival autograft was evaluated. PATIENTS AND METHODS: In a retrospective survey, the records of 94 consecutive patients who underwent surgery for pterygium between 1984 and 1993 were reviewed. Only the first pterygium procedure for each patient performed at Wills Eye Hospital was included. The statistical technique of survival curve analysis by the Kaplan-Meier product limit was used to analyze the results separately after the removal of primary and recurrent pterygia. RESULTS: Thirty-one patients with primary pterygium underwent simple excision. Forty patients had conjunctival autografts. The recurrence rates estimated at 1 year were 40% and 16%, respectively (P= .031). In both groups, patients who were 50 years old or younger were more likely to have a recurrence (P = .029). All 23 patients with recurrent pterygium had conjunctival grafts, and the estimation of recurrence at 1 year was 25%. No serious complications occurred in any group. * CONCLUSION: Conjunctival autograft decreases the recurrence rate for primary pterygium compared with simple excision
PMID: 9054479
ISSN: 1082-3069
CID: 107546
Infantile ulcerative keratitis secondary to congenital entropion [Case Report]
Congenital entropion is a rare eyelid anomaly that can cause chronic corneal erosions or ulceration. The diagnosis may be easily overlooked by both the pediatrician and the ophthalmologist, particularly when the lids are tightly closed in the crying child. We present three cases of congenital entropion associated with corneal ulceration. Each patient underwent a complete ophthalmologic examination. Examination under anesthesia, including corneal scrapings for culture and photography, was performed before surgical repair of the entropion. There were two cases of lower lid entropion and one case of upper lid entropion. In all three cases symptoms were present since birth, and the diagnosis was overlooked by the treating pediatrician. Corneal ulceration ultimately developed in all three cases. Cultures revealed Staphylococcus aureus in one case, and coagulase negative Staphylococcus in another case. Cultures were negative in one case. In all three patients the ulcers healed rapidly after surgical entropion repair. Congenital upper or lower lid entropion is an uncommon condition that does not spontaneously improve and is an important cause of corneal ulceration in infants. Recognition of this condition is often difficult, and early surgical intervention to repair the lid deformity may help to avoid permanent corneal scarring and visual loss
PMID: 8985631
ISSN: 0277-3740
CID: 107547
A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis - The epithelial keratitis trial
Objective: To evaluate the efficacy of oral acyclovir in preventing stromal keratitis or iritis in patients with epithelial keratitis caused by herpes simplex virus (HSV). Methods: Patients with HSV epithelial keratitis of 1-week or less duration were treated with topical trifluridine and were randomly assigned to receive a 3-week course of oral acyclovir, 400 mg 5 times a day (hereafter referred to as the acyclovir group), or placebo (hereafter referred to as the placebo group). The development of HSV stromal keratitis or iritis was assessed during 12 months of follow-up. Results: Stromal keratitis or iritis developed in 17 (11%) of the 153 patients in the acyclovir group and in 14 (10%) of the 134 patients in the placebo group, Compared with the placebo group, the adjusted rate ratio for the development of stromal keratitis or iritis in the acyclovir group was 1.16 (95% confidence interval, 0.56-2.43). The development of stromal keratitis or iritis was more frequent in patients with a history of HSV stromal keratitis or iritis than in those without such a history (23% vs 9%; P = .01). Conclusions: For patients with HSV epithelial keratitis treated with topical trifluridine, no apparent benefit of a 3-week course of oral acyclovir in preventing HSV stromal keratitis or iritis was seen during the subsequent year. The 1-year rate of development of stromal keratitis or iritis was lower than previously reported in the literature, except in patients with a history of HSV stromal keratitis or iritis. $$:
ISI:A1997XD99400001
ISSN: 0003-9950
CID: 107699
"Corneal thickness measurements by ultrasound biomicroscopy (UBM), ultrasound pachymetry and histopathology" [Meeting Abstract]
ISI:A1997WN18600631
ISSN: 0146-0404
CID: 107700
Indications for penetrating keratoplasty and associated procedures, 1989-1995 [Meeting Abstract]
ISI:A1997WN21500819
ISSN: 0146-0404
CID: 107701
Methods of disinfecting contact lenses to avoid corneal disorders
The contact lens industry has grown rapidly over the past four decades due to the wide-spread demands of the American population for a convenient alternative to spectacle wear for the correction of myopia. Unfortunately, many people who wear contact lenses are not aware of the potential risks associated with them, and consumer education about lens care has not been adequate. This article reviews the role of disinfection in contact lens wear, summarizes the current available contact lens disinfection systems, and provides recommendations for safe contact lens use
PMID: 8970238
ISSN: 0039-6257
CID: 107548
Management of coexisting corneal disease and glaucoma by combined penetrating keratoplasty and trabeculectomy with mitomycin-C
BACKGROUND AND OBJECTIVE: The management of coexistent corneal disease and uncontrolled glaucoma continues to be a challenging clinical situation. The purpose of this study is to evaluate the results of combined penetrating keratoplasty and trabeculectomy with mitomycin-C. PATIENTS AND METHODS: A retrospective study was undertaken to review the records of nine patients who had corneal edema and high intraocular pressure managed by simultaneous penetrating keratoplasty and trabeculectomy with mitomycin-C. RESULTS: The nine patients had an average pre-operative intraocular pressure of 26 mm Hg (range 17 to 41 mm Hg) and associated corneal edema. The average postoperative intraocular pressure at last follow-up was 19 mm Hg (range 5 to 53 mm Hg). Three patients needed additional procedures. Six of nine patients had intraocular pressures judged to be adequately controlled (11 +/- 5 mm Hg, range 5 to 18 mm Hg) throughout the postoperative period (average follow-up 16 months). Grafts remained clear in seven patients. The grafts failed in two cases in which additional glaucoma surgery was necessary. CONCLUSION: Combined penetrating keratoplasty and trabeculectomy with mitomycin-C should be considered for selected patients with uncontrolled glaucoma and corneal disease who have sufficient conjunctiva for a filtering procedure
PMID: 8938797
ISSN: 1082-3069
CID: 107549
Trends in contact lens-associated corneal ulcers
Charts of 320 patients with corneal ulcers seen on the Cornea Service of Wills Eye Hospital from July 1, 1992, to June 30, 1995, were reviewed retrospectively. Of these cases, 96 (30%) were associated with contact lens use. Ulcers in contact lens users accounted for 36% of cases in the last 6 months of 1992 and all of 1993, 20% of cases in 1994, and 29% in the first 6 months of 1995. The contact lenses most commonly associated with ulcers were disposable extended-wear lenses. They were used in 33% of contact lens-associated ulcers in 1992, 27% in 1993, 39% in 1994, and 44% in 1995. Pseudomonas was the predominant organism prior to 1993 (1-4). From 1993 to 1995, however, the number of Pseudomonas ulcers steadily decreased. Two or three Acanthamoeba infections continue to be treated each year. There has been a significant decrease in the number of contact lens-related ulcers treated at our institution compared with previous years (p < 0.01) (3, 4)
PMID: 8899267
ISSN: 0277-3740
CID: 107550
The rate of visual recovery after penetrating keratoplasty for keratoconus
PURPOSE: We performed a retrospective study of 68 patients who underwent penetrating keratoplasty (PK) for keratoconus during the years of 1988 and 1989. The purpose of this study was to determine the speed of visual recovery, final best corrected visual acuity, and rate of rejection episodes. METHODS: The visual acuity, type of correction, and complications were recorded at 3, 6, 12, 18, 24, 36, and 48 months. RESULTS: The average final best corrected visual acuity was 20/23, and all patents achieved 20/30 or better vision (range: 20/15 to 20/30). The best vision was achieved at 16.5 +/- 8.7 months. Thirty-one percent of the patients were corrected with contact lenses. Factors associated with best corrected vision were preoperative vision, combined suture technique, and a donor/host size disparity of 0.25 mm (P < 0.005). Thirty-one percent of the patients had at least one episode of graft rejection. The use of contact lenses was not associated with an increased risk of rejection. CONCLUSIONS: PK for keratoconus yields an excellent visual result, but this study shows the need for long-term careful follow-up to achieve optimal visual rehabilitation
PMID: 8906385
ISSN: 0733-8902
CID: 107551
Recurrent keratopathy after penetrating keratoplasty for aniridia [Case Report]
Corneal lesions in aniridia include peripheral pannus and epithelial abnormalities that may advance centrally, resulting in the need for penetrating keratoplasty. Three patients with aniridia who underwent repeated corneal surgical procedures (one keratectomy and six penetrating keratoplasties) are described herein. A clinicopathological correlation was performed. In all three patients there was evidence of recurrent pannus and epitheliopathy on histopathological examination, which correlates with the clinical findings. These findings suggest that the pathophysiology of recurrent aniridia keratopathy may be related to a primary abnormality in the stem cells of the recipient corneal limbus. Aniridic pannus and epitheliopathy recur in grafts after penetrating keratoplasty and threaten the transplanted cornea. The risk of recurrent keratopathy should be considered when recommending a surgical procedure to patients with aniridia
PMID: 8862921
ISSN: 0277-3740
CID: 107552
