Faculty Bibliography

PURPOSE: This study was designed to determine how patients with pellucid marginal corneal degeneration (PMCD) are managed in a tertiary corneal practice. METHODS: A retrospective chart review of 45 patients with PMCD from a corneal referral practice was performed. Information collected from the medical records included demographic data, best-corrected visual acuity, videokeratography, contact lens use, and surgical procedures. RESULTS: Forty-five patients (85 eyes; 30 males, 15 females) with PMCD were included in this study. They were followed-up for an average of 4.7 years (standard deviation (SD), +/-8.7). Seventy-five eyes (88.2%) were managed nonsurgically with spectacles in 31 eyes (36.4%) or contact lenses in 44 eyes (51.8%). Contact lens management was initially attempted in 51 eyes (60%); however, 7 eyes failed contact lenses. Visual acuity of 0.5 (20/40) or better was noted in 34 eyes (75.5%) after contact lens fit. Ten eyes (11.8%) underwent penetrating keratoplasty with an average postoperative follow-up of 9 years (SD, +/-8.2; 1.5-20.5). Clear grafts were present in all 10 eyes at the end of the study (average, 9 years; SD, +/-82). CONCLUSIONS: Nonsurgical management of PMCD continues to play a predominant role in the management of this disorder. Poor best-corrected visual acuity at presentation of 0.2 (20/100) or worse and long follow-up (8 years or more) were significantly associated with surgery

To report a case of ocular copper deposition in both eyes at the level of Descemet's membrane associated with a monoclonal gammopathy of undetermined significance (MGUS). A 49-year-old white woman had golden-brown metallic dust-like deposits on Descemet's membrane of both eyes. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin and a normal level of total protein. Serum protein electrophoresis demonstrated a single peak (M-spike) in the gamma region (M-protein in serum = 11 g/l). Flow cytometric analysis of the marrow aspirate identified a monoclonal plasma cell population that represents approximately 2% of the total marrow cells consistent with the diagnosis of monoclonal gammopathy of undetermined significance. Copper deposits at the level of Descemet's membrane may be a finding in a patient with monoclonal gammopathy of undetermined significance

PURPOSE: To analyze the frequency of contact lens-related corneal ulcers and its relationship to the type of contact lens and care. METHODS: Charts of 376 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from July 1, 1999 to December 31, 2002 were retrospectively reviewed. All patients with contact lens-related corneal ulcers were identified, and information regarding cultures, lens type, usage, and cleaning was obtained. RESULTS: Of the 376 cases, 113 (30%) were related to contact lens use. The contact lens history was recorded in 83 of 113 cases (73%). The soft daily wear frequent replacement lens was the most common lens type associated with corneal ulcers (n = 36/83, 43%). Corneal cultures were performed in 71 of 113 cases (63%) and were positive in 51 of 71 cases (72%). The most common microorganism involved was Pseudomonas aeruginosa (n = 17/51, 33%). The frequency of contact lens-related corneal ulcers from 1999-2002 (n = 113/376, 30%) was significantly greater than that from years 1996-1999 (n = 37/299, 12%) at our institution (P < 0.05). CONCLUSION: There was a significant increase in the number of contact lens-related corneal ulcers between 1999 and 2002 compared with previous years (P < 0.05). The contact lens type most frequently associated with corneal ulcers was the soft daily-wear frequent-replacement contact lens (43%). Contact lens-related corneal ulcers continue to be a serious problem despite a shift in the market to the use of frequent-replacement daily-wear contact lenses and advances in contact lens technology

PURPOSE: To evaluate the complications associated with anterior basement membrane dystrophy (ABMD) after laser in situ keratomileusis (LASIK). SETTING: Cornea Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. METHODS: In this noncontrolled retrospective case series, the medical records of all patients with LASIK complications seen in the Cornea Service at Wills Eye Hospital from January 1, 1998, to December 31, 2002, were reviewed. All patients who presented with ABMD changes after LASIK were included in the study. Patients with a history of trauma before or after surgery were excluded. RESULTS: Thirty-five eyes of 18 patients were included. The mean age was 46.2 years. Thirteen eyes (37.1%) had a flap-lift procedure to remove epithelial ingrowth or for an enhancement. The most common reason for the visit was visual complaints, which were seen in 77.8% of patients. Seven patients (38.9%) had visual complaints alone; 27.8% had visual complaints associated with recurrent erosions and 11.1%, with dry eyes. Four patients (22.2%) had recurrent corneal erosions with no visual complaints. On examination, the most common finding was negative staining with fluorescein dye within the LASIK flap, which was seen in all patients. In addition to the ABMD changes, 25.7% had some degree of epithelial ingrowth and 45.7%, irregular astigmatism. CONCLUSIONS: Anterior basement membrane dystrophy changes post LASIK were associated with visual complaints and/or recurrent erosions. Patients should be carefully screened for ABMD. Those who have ABMD signs or symptoms may not be ideal candidates for LASIK

PURPOSE: To address the primary causes of the congenital corneal opacities seen on the Cornea Service at Wills Eye Hospital (Philadelphia, PA), the associated systemic anomalies and their management. METHODS: Retrospective review of the medical records of all patients with the diagnosis of congenital corneal opacities seen at the Cornea Service from January 1, 1992 to June 30, 2003. Children 12 years old or younger at the first visit to our department were included in the study. We classified the location and extent of corneal pathology. We divided the management into medical and surgical. RESULTS: Seventy-two eyes of 47 patients were included in the study. The mean follow-up time from the first to the last visit was 33.1 months. The most common primary cause of congenital corneal abnormalities was Peters anomaly (40.3%), followed by sclerocornea (18.1%), dermoid (15.3%), congenital glaucoma (6.9%), microphthalmia (4.2%), birth trauma, and metabolic disease (2.8%). Seven eyes (9.7%) were classified as idiopathic. Ten patients had systemic abnormalities associated with their ocular condition. The management was medical in 38 eyes (52.7%). Twenty-four eyes (32.4%) underwent only 1 penetrating keratoplasty (PK). Only 1 eye received a regraft during the follow-up period. Eight grafts failed during the follow-up period. CONCLUSION: The importance of this study is to share our experience with this rare entity, congenital corneal opacities, describing their clinical presentation and their management