Faculty Bibliography

Moraxella corneal ulcers are uncommon but may be complicated by marked inflammation and corneal perforation. In a series of eight cases treated over a period of 6 years, despite appropriate antibiotic therapy, descemetoceles and/or perforations developed in four cases, resulting in loss of the eye in two cases. In our series, the final visual acuity was count fingers or less in most patients (six of eight; 75%). Ulcers not only occurred in patients with systemic diseases, including alcoholism and malnutrition, but also in patients with various pre-existing ocular surface diseases. It is important to be aware of the potential of Moraxella ulcers to result in loss of vision and the eye

We reviewed the records of 41 patients who underwent penetrating keratoplasty for a corneal opacity caused by trauma between Jan. 1, 1983, and Dec. 31, 1988. Most of the patients were young males whose average age was 35 years. Common tools accounted for many injuries (14 of 41, 34%). Sixteen injuries (39%) were work-related. Thirty-six patients (88%) had corneal scars from a perforating injury, four patients (10%) had corneal edema, and one patient (2%) required emergency penetrating keratoplasty for extensive tissue loss. Of the 39 patients with one year of follow-up, 31 (82%) maintained clear corneal grafts. Rejection occurred in nine of 39 patients (23%) and only three (33%) of the rejections resolved. Visual outcome was favorable with 20 patients (51%) attaining best-corrected postoperative visual acuity of 20/20 to 20/40, nine patients (23%) attaining visual acuity of 20/50 to 20/100, and ten patients (26%) attaining visual acuity of 20/200 or worse. Preoperative retinal disease (six of 39, 15%), astigmatic errors (five of 39, 13%), graft failures (four of 39, 10%), and postoperative glaucoma (12 of 39, 31%) adversely influenced the outcome. Although the prevalence of postoperative complications is relatively high, good visual results can be obtained in patients who undergo penetrating keratoplasty after ocular trauma

We reviewed data on 150 repeat corneal transplants performed between 1983 and 1988 at Wills Eye Hospital. Minimal postoperative follow-up was six months. The most common diagnoses before regraft were pseudophakic bullous keratopathy (29 of 150), aphakic bullous keratopathy (28 of 150), Fuchs' dystrophy (21 of 150), failed graft (17 of 150), and keratoconus (14 of 150). Herpes simplex keratitis, interstitial keratitis, chemical burns, traumatic scars, and corneal dystrophies accounted for most of the remaining regrafts. Of the 150 regrafts, 39 (26%) failed during the study period. Almost half of the regraft failures occurred within six months, and over four fifths occurred within 18 months. Of the 111 eyes with clear grafts, final visual acuity data were available for 68 eyes (minimal follow-up, two years; mean, 3.3 years). A best-corrected visual acuity of 20/20 to 20/40 (22 of 68) or 20/50 to 20/100 (27 of 68) was achieved in most patients

Anterior stromal puncture has recently been proposed as a new treatment for recalcitrant cases of recurrent corneal erosion. Concerns about the risks of corneal perforation and scarring, as well as doubts regarding its efficacy have prevented many patients from benefiting from this procedure. We introduce a new, inexpensive, commercially available instrument designed to standardize this technique, minimize scarring, and prevent corneal perforation. In a clinical trial involving 25 consecutive patients with recurrent erosions resistant to vigorous conservative treatment, the first 11 patients underwent stromal puncture in which a straight tuberculin needle was used; the following 14 were treated with a newly designed prototype needle. All patients in this series remained free of erosions after completion of stromal puncture, except for one woman with marked diffuse anterior basement membrane dystrophy, who went on to develop spontaneous bilateral erosions. Follow-up ranged from 2 months to 30 months (mean, 13 months). There were no complications of stromal puncture, and subjective and objective evaluations revealed no significant postoperative glare. Microscopic analysis of eye bank eyes subjected to anterior stromal puncture procedures demonstrated that the new prototype needle provided shallower penetration and thus less likelihood of perforation or excessive scarring than the straight needle. Also, postoperative discomfort and scarring appeared to be significantly less in patients treated with the prototype needle

The authors review four cases of Kaposi's sarcoma that were presented to the Foot Clinics of New York and affiliated North General Hospital during a 1-year period from the fall of 1987 to the fall of 1988. The authors conclude that it is sometimes difficult to diagnose Kaposi's sarcoma and to differentiate between the acquired immunodeficiency (AIDS) form and the classic form. Guidelines for diagnosis and a profile of the AIDS-related and non-AIDS-related Kaposi's sarcoma patient are discussed

Familial and environmental factors may play a role in the development of conjunctival intraepithelial neoplasia (CIN). Nineteen patients with biopsy-proven CIN completed a questionnaire to evaluate possible predisposing factors. Nineteen age-matched and sex-matched controls completed questionnaires and received slit-lamp examinations. Factors associated with a relatively increased risk of developing CIN included exposure to petroleum products, heavy cigarette smoking, light hair and ocular pigmentation, and family origin in the British Isles, Austria or Switzerland. Non-office and nonprofessional workers were more likely to develop conjunctival intraepithelial neoplasia (p = .05), as were those who were not college graduates (p = .07)

Bacterial endophthalmitis has been recognized as a significant cause of chronic, delayed-onset inflammation following extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation. The diagnosis of chronic postoperative bacterial endophthalmitis should be suspected in any case of chronic, refractory inflammation following ECCE. Although successful treatment may require surgical intervention in some cases, others may respond to antibiotic therapy alone

We studied personality traits of patients with keratoconus in a controlled prospective study using the Minnesota Multiphasic Personality Inventory (MMPI). Whereas four of 16 (25%) control patients with herpes simplex keratitis had scores indicative of psychological abnormality, 15 of 28 (54%) keratoconus patients had scores indicative of abnormality (P less than .05). Keratoconus patients who had undergone penetrating keratoplasty had a lower rate of abnormal scores (3 of 9; 33%) than unoperated keratoconus patients (12 of 19; 63%) (P less than .05). Patients who considered themselves moderate or severely limited by their eye condition were more likely to have abnormal scores (7 of 8; 87%) than patients who thought they were mildly affected (8 of 20; 40%) (P less than .05)