Faculty Bibliography

We reviewed the records of 22 patients whose corneal ulcers were associated with therapeutic soft contact lens wear. The patients required hospitalization on the Cornea Service at Wills Eye Hospital between January 1, 1978 and September 1, 1988. A majority of the ulcers were associated with pseudophakic or aphakic bullous keratopathy (9 of 22 cases; 41%); neurotrophic/exposure keratitis was the second most common diagnosis (7 of 22; 32%). Most patients used topical antibiotics (15 of 22; 68%) and/or corticosteroids (13 of 22; 59%). Cultures were positive in 15 of 22 cases (68%). Gram-positive organisms were isolated in 60% the culture-positive cases (9 of 15). Streptococcus was the most common organism isolated (6 of 15 culture positive-cases; 40%). Gram-negative organisms were found in four of 15 culture-positive ulcers (27%). There was only one Pseudomonas infection in the series. Uncommon organisms--including Candida, atypical mycobacteria, Achromobacter, Acinetobacter and Micrococcus--were isolated in five cases. Therapeutic soft contact lens wearers are at risk for developing corneal ulcers; most often these are caused by gram-positive bacteria, especially streptococci, and uncommon organisms

Contact lens (CL) fitting carries the risk of transmitting infectious agents, including adenovirus and Pseudomonas. Therefore, a number of precautions must be observed to ensure safety in the office. Paramount among these is hand washing, both immediately after contact with a patient's eyes and again between patients. Equally important is that all trial lenses and CLs removed from patients be disinfected before reuse. Low-water-content soft CLs can be heat disinfected; high-water-content CLs require chemical treatment. A combination of surfactant cleaning with a chlorhexidine-containing agent and hydrogen peroxide disinfection is preferred for rigid lenses to guarantee destruction of human immunodeficiency virus (HIV). The proper use of lens care solutions is also necessary to minimize the risk of their becoming contaminated with pathogenic organisms. Only commercially prepared solutions should be used, preferably in small-volume bottles that are frequently replaced. Preservative-free solutions should be discarded after 1 day's use, whereas preserved solutions may be used for up to 2 weeks. Sterile saline rather than tap water is recommended for rinsing rigid lenses. Finally, part of the clinician's responsibility in running a safe office is to educate patients about these hygienic practices

Nd:YAG laser cyclophotocoagulation (CPC) of the ciliary body is a promising cyclodestructive treatment for the management of refractory glaucoma following penetrating keratoplasty. Twenty-eight eyes (27 patients) were treated between August 1985 and September 1987 and followed 6 to 24 months (median, 18 months). The mean intraocular pressure (IOP) was initially 39 mm Hg (range, 30 to 70 mm Hg) on maximally tolerated medications. The Lasag Microrupter 2 was used in the free-running thermal mode with a mean pulse energy of 4.13 J. The laser was retrofocused 3.6 mm from the conjunctival surface and 30 to 50 applications per treatment (mean, 37.5) were given 2 to 3 mm from the limbus for 360 degrees (71%) or 180 degrees (29%). Multiple treatments were necessary in 13 eyes (46%). After CPC, IOP fell to 22 mm Hg or below in 18 eyes (64%) at 3 months, in 20 of 27 eyes (74%) at 6 months, and in 16 to 24 eyes (67%) at 1 year. Inadequate IOP control in four of 28 eyes necessitated cyclocryotherapy in three patients and a Schocket procedure in one other. Of the 14 clear pre-CPC grafts six (43%) became edematous during follow-up. All of the failed grafts had undergone multiple CPCs

Disposable contact lenses were developed to reduce the complications associated with cosmetic extended wear contact lenses. We describe two cases of Pseudomonas corneal ulcers that developed in patients wearing disposable soft contact lenses. Patients wearing these lenses remain at risk for infection

Unlike Corynebacterium diphtheriae and Propionibacterium acnes, the pleomorphic gram-positive rods known as diphtheroids are generally regarded as nonpathogenic contaminants of the human external eye. We reviewed five years of microbiology records at Wills Eye Hospital and studied a series of eight cases of apparently infectious keratitis associated with heavy growth of diphtheroids on cultures of ulcer scrapings. All of these cases included indolent ulcers that occurred almost exclusively in elderly patients (mean age, 72 years; range, 11 to 92 years). All patients had preexisting ocular conditions that compromised the corneal surface such as exposed corneal sutures, eyelid surgery, aphakic extended wear contact lenses, viral keratitis, and diabetes mellitus. No other pathogens were isolated. All infections responded well to antibiotic therapy with all organisms sensitive to cefazolin and all but one sensitive to gentamicin

We reviewed the preoperative clinical indications and associated surgical procedures for 2,299 penetrating keratoplasties performed at our institution from 1983 through 1988. Pseudophakic bullous keratopathy was the most common indication overall, accounting for 526 cases (23%). A marked increase was noted in the incidence of pseudophakic bullous keratopathy as an indication for penetrating keratoplasty beginning in 1985. The association of anterior chamber intraocular lenses in eyes with pseudophakic bullous keratopathy undergoing penetrating keratoplasty increased from 19 of 43 cases (44%) in 1983 to 79 of 108 cases (73%) in 1988. The incidence of intraocular lens exchange at the time of penetrating keratoplasty in cases of pseudophakic bullous keratopathy increased from six of 43 (14%) in 1983 to 63 of 108 (58%) in 1988. Other major indications for penetrating keratoplasty included Fuchs' dystrophy (375 cases, 16%), keratoconus (348 cases, 15%), aphakic bullous keratopathy (331 cases, 14%), and regraft (233 cases, 10%). Cataract extraction, with or without intraocular lens implantation, was combined with penetrating keratoplasty in 397 of 1,532 phakic eyes (26%). The incidence of triple procedure (penetrating keratoplasty, cataract extraction, and intraocular lens implantation) increased from 27 of 248 phakic eyes (11%) in 1983 to 68 of 258 phakic eyes (26%) in 1988

We prepared an attractive and effective poster using a Macintosh computer and Laserwriter and Imagewriter II printers. The advantages of preparing the poster in this fashion were increased control of the final product, decreased cost, and a sense of artistic satisfaction. Although we employed only the above mentioned computer, the desktop publishing techniques described can be used with other systems