Faculty Bibliography

We report our experience using specular microscopy to perform endothelial cell counts in a series of 16 patients with bilateral, uncontrolled, primary open-angle glaucoma undergoing argon laser trabeculoplasty (ALT). Trabeculoplasty was performed in 20 eyes of these 16 patients. Untreated fellow eyes in 11 patients were used as controls for this series. Endothelial specular microphotographs and pachymetry were done using a Pocklington specular microscope (Keeler-Konan) before ALT and again approximately one and four months later. The endothelial cell densities were normal in all of the affected eyes before treatment and in the control eyes. No statistically significant differences between the pretreatment and posttreatment cell densities and pachymetry values relative to the controls were observed during the course of this study

Mononuclear cells in the lacrimal (exorbital) glands of five germ-free, five ex-germ-free, and five age-matched conventional rats were counted by light microscopy. Tissues from these rats were also examined by electron microscopy. IgA-containing plasma cells were counted by immunofluorescence microscopy in the lacrimal glands of five germ-free and five conventional rats. The median number (and range) of mononuclear cells per ten high-power fields was 25 (14-28) in germ-free rats, 33 (32-43) in ex-germ-free rats, and 41 (36-50) in conventional rats. The median number (and range) of IgA-containing plasma cells per ten high-power fields was two (0-5) in germ-free and 44 (29-72) in conventional rats. The differences in the numbers of mononuclear cells in the lacrimal glands of germ-free as compared with ex-germ-free and with conventional rats were statistically significant (P less than 0.004). The difference between the numbers of IgA-containing plasma cells in germ-free as compared with conventional rats was also statistically significant (P less than 0.004). Electron microscopy revealed that the mononuclear cells in all groups of rats consisted of macrophages and lymphocytes. These observations suggest that the number of mononuclear cells, and particularly IgA-containing plasma cells, in the rat lacrimal gland can be increased by systemic and/or local immunologic stimulation

We conducted a randomized, double-masked, placebo-controlled study to evaluate the efficacy of topical interferon in the treatment of adenoviral conjunctivitis. The study was designed to determine the efficacy of plasmid-derived alpha-2 interferon treatment with regard to the duration of clinical disease, virus shedding, and the occurrence of bilateral infection and subepithelial infiltrates. Interferon therapy was not found to have a statistically significant effect with regard to these factors in the 14 patients who completed 14 days of treatment in the study with interferon or a placebo. Interferon therapy was, however, associated with a tendency toward asymptomatic infection in the second eye when compared to the controls

We reviewed the experience with ulcerative keratitis associated with contact lens wear at Wills Eye Hospital, Philadelphia, from Jan 1, 1978 through July 1, 1983. Of the 322 cases of ulcerative keratitis, 56 cases (17%) were associated with the use of contact lenses. Twenty-nine (52%) of the 56 cases of contact lens-associated ulcers were culture positive. Pseudomonas was the most common isolate, occurring in 13 (23%) of the 56 cases. Staphylococcus species were the second most common, occurring in 11 (20%) of the 56 cases. In this series, contact lens-associated ulcers were seen frequently in those wearing soft lenses (48/56 cases or 86%) and in those wearing aphakic lenses (32/56 cases or 57%). Contact lens use is an increasingly important risk factor for the development of corneal ulcers. Prompt, appropriate, and intensive treatment is necessary to prevent visual loss

Although cosmetic extended-wear contact lenses are generally safe, they can be associated with a number of complications. A review of 124 cases of corneal ulcers treated between Jan. 1, 1982, and June 1, 1983, disclosed six cases in otherwise healthy patients (four women and two men, ranging in age from 15 to 41 years) who wore extended-wear contact lenses for correction of myopia. In five of the six, the contact lenses had undergone recent manipulation. Two patients had changed their contact lenses without proper disinfection procedures. Five of the six had been treated with antibiotics before corneal scrapings were cultured and three had been treated with corticosteroids. The cultures grew gram-negative rods (in three cases Pseudomonas organisms and in one case Serratia organisms); both patients whose cultures grew no organisms had received antibiotics. Vigorous treatment with tobramycin and cefazolin eyedrops and cycloplegics produced final corrected visual acuities of 20/20, 20/30, 20/60, 20/20, and 20/50. In the sixth case, the final uncorrected visual acuity was counting fingers at 1 foot

We conducted a retrospective study of 107 penetrating keratoplasties in 99 eyes (99 patients) performed from 1970 to 1979 at the Wills Eye Hospital. The follow-up periods ranged from one to 12 years (median, three years). Overall, 86 of the 107 transplants (80%) remained clear and 63 eyes (59%) achieved good to excellent visual acuities (20/60 or better). Preoperative vascularization was not a significant prognostic factor with regard to final visual outcome, graft clarity, or graft rejection. Herpes simplex keratitis was inactive at the time of corneal transplantation in 100 of the eyes (93%). The overall rate of recurrent dendritic keratitis after transplantation for herpes was 19%

Twenty patients who had iridoplasties performed at the time of penetrating keratoplasty were followed for a minimum of nine months. Although 12 patients had peripheral anterior synechiae (PAS) preoperatively, only four developed progressive PAS and secondary angle closure glaucoma postoperatively. Our experience suggests that iris suturing, by producing a mechanically rigid iris diaphragm, may prevent postoperative anterior synechiae and appositional angle closure