Ihsan A. Badr

Corneal Ectasia in Vernal Keratoconjunctivitis

The type of corneal ectasia, the presence of breaks in Descemets membrane, and the success with contact lens wear or penetrating keratoplasty were studied in 61 patients with corneal ectasia and vernal keratoconjunctivitis. There were 53 patients with keratoconus, 5 with pellucid marginal corneal degeneration, 2 with keratoglobus, and 1 with superior corneal thinning. The high rate of hydrops and the corneal ectasia itself may be related to excessive eye rubbing. Success with contact lens wear or penetrating keratoplasty in vernal keratoconjunctivitis patients with keratoconus is less than in patients with keratoconus alone.

Contamination of donor cornea: postpenetrating keratoplasty endophthalmitis.

Nine cases (0.41%) of bacterial and fungal endophthalmitis developed out of a total of 2,210 consecutive penetrating keratoplasties performed between November 1983 and April 1989. Five of the nine cases (0.23%) had endophthalmitis related to donor tissue contamination. The donor tissue of these cases had a storage time of>5 days. A retrospective analysis of 1,399 consecutive corneoscleral rim cultures showed a contamination rate of 29%. The most common organisms isolated were Propionibacterium 26%, diphtheroids 24%, Staphylococcus epidermidis 22%, and fungi 9%. There is a statistically significant increase (p < 0.005) in the percentage of contaminated donor rims with a preservation time of more than five days. The risk of developing endophthalmitis is 12 times greater with a positive donor rim culture. Prolonged preservation of donor tissue can be a risk factor in developing endophthalmitis.

Extracapsular Cataract Extraction with or without Posterior Chamber Intraocular Lenses in Eyes with Cataract and High Myopia

PURPOSE To compare the results of insertion of low-power or zero-power posterior chamber intraocular lenses (PC IOLs) after cataract extraction in eyes with high myopia with leaving the eye aphakic. METHODS The outcome of extracapsular cataract extraction (ECCE) with low-power or zero-power PC IOLs in 184 consecutive highly myopic (axial length = 26.0 mm or longer) eyes was compared with 184 consecutive highly myopic eyes receiving ECCE without PC IOLs. Axial length, preoperative visual acuity, age, sex, and follow-up were similar between both groups. RESULTS In the pseudophakic eyes, there was a statistically significantly better visual outcome (P = 0.006), decreased incidence of posterior capsule opacification (13.6% versus 33.2%, P < 0.01), and decreased requirement for YAG capsulotomy (6.5% versus 17.9%, P < 0.01). There were two retinal detachments in the pseudophakic eyes compared with four in the aphakic eyes. There were no sight-threatening complications in 12 pseudophakic eyes after YAG capsulotomy. There were four sight-threatening complications (2 retinal detachments, 2 cases of uveitis with secondary glaucoma) in 33 aphakic eyes after YAG capsulotomy. CONCLUSIONS The use of PC IOLs may result in a lower complication rate and better visual outcome after ECCE in eyes with cataract and high myopia.

Heparin surface-modified intraocular lenses in patients with inactive uveitis or diabetes.

OBJECTIVE This study aimed to determine whether heparin surface-modified (HSM) intraocular lenses (IOLs) with a hydrophilic surface would reduce cell adherence and other postoperative changes compared with the conventional polymethylmethacrylate (PMMA) IOLs in patients with either diabetes mellitus or inactive uveitis. DESIGN The study design was a randomized, double-masked, clinical trial. PARTICIPANTS Twenty-five patients with bilateral cataracts, 14 with inactive anterior uveitis and 11 with diabetes, with an age range of 11 to 81 years (mean, 52.8 years) participated. INTERVENTION Bilateral cataract extraction with posterior chamber IOL implantation was measured, each patient receiving an HSM lens in one eye and a PMMA lens in the other. Pharmacia one-piece HSM and PMMA IOLs were used. Postoperative ocular changes were evaluated at regular intervals for 24 months in patients with inactive uveitis and for 6 months in patients with diabetes. Patients and physicians alike were unaware of which eye contained which lens until postoperative results were compiled. Records were kept by a study coordinator. MAIN OUTCOME MEASURES Comparisons of posterior synechiae, IOL cellular deposits, and posterior capsular fibrosis between PMMA and HSM IOLs were measured. RESULTS Using the chi-square test, no statistically significant difference was found between the HSM and PMMA IOLs in the number of cellular deposits found on the anterior IOL surface, the number of adhesions between the iris and IOL, or the incidence of capsular opacification. CONCLUSION The HSM and PMMA IOLs showed similar postoperative results in patients with inactive uveitis or diabetes mellitus.

EXCIMER LASER PHOTOTHERAPEUTIC KERATECTOMY FOR SHIELD ULCERS AND CORNEAL PLAQUES IN VERNAL KERATOCONJUNCTIVITIS

BACKGROUND Shield-shaped corneal ulcers and corneal plaques in vernal keratoconjunctivitis are associated with delayed epithelial healing, as well as the risks of infectious keratitis and sterile stromal ulceration. Significant visual impairment due to scarring and irregular astigmatism may result from central corneal lesions. METHODS Three eyes with central corneal lesions resulting from vernal keratoconjunctivitis were treated by excimer laser after active vernal keratoconjunctivitis was controlled and inflammatory plaque overlying the shield ulcers was removed. RESULTS All three eyes showed rapid reepithelialization within 1 week. Spectacle-corrected visual acuity of 20/30 or better was obtained in each eye. CONCLUSIONS In selected patients, excimer laser phototherapeutic keratectomy may be a useful adjunct in the treatment of shield-shaped corneal ulcers and plaques in vernal keratoconjunctivitis.

Phototherapeutic keratectomy for macular corneal dystrophy.

PURPOSE To report a case of early intervention with phototherapeutic keratectomy for treatment of macular corneal dystrophy. METHODS We report a 21-year-old Saudi male with early macular corneal dystrophy, recurrent erosions, and decreased visual acuity, who underwent phototherapeutic keratectomy in the right eye and penetrating keratoplasty in the left eye with more than 2 years of follow-up. RESULTS Following phototherapeutic keratectomy, uncorrected visual acuity in the right eye improved from 20/80 to 20/30. Following penetrating keratoplasty in the left eye, uncorrected visual acuity deteriorated from 20/80 to 20/120 due to irregular astigmatism; the eye was not amenable to improvement with spectacle correction, and the patient declined contact lens therapy. In the right eye, there has been no anterior recurrence, although some mid- to deep stromal haze, which is not visually significant, has developed. CONCLUSIONS Early intervention for symptomatic, anterior macular corneal dystrophy with phototherapeutic keratectomy is relatively safe and preferable to observation or penetrating keratoplasty.

Chrysosporium parvum keratomycosis.

PURPOSE To report a case of corneal infection with Chrysosporium parvum, a filamentous fungus usually associated with pulmonary infections. METHODS A 43-year-old Saudi man had a corneal stromal infiltrate and perforation of his left eye. He was treated with a therapeutic penetrating keratoplasty and topical and systemic antifungal therapy. Corneal scrapings, microbiologic evaluation, and histopathologic examination of the surgical specimen were performed to establish the diagnosis. After the development of recurrent stromal keratitis at the graft-host junction, similar diagnostic and therapeutic maneuvers were performed. RESULTS Corneal scrapings and histopathologic examination were positive for numerous septate hyphae with endospores, consistent with a diagnosis of filamentous keratomycosis. Microbiologic isolation confirmed the diagnosis of Chrysosporium parvum. Similar diagnostic maneuvers for recurrent keratitis produced identical results. CONCLUSION To our knowledge, this is the first case of Chrysosporium parvum keratomycosis.

Wessely-type immune ring following phototherapeutic keratectomy

Abstract Immune rings following photorefractive keratectomy (PRK) have been reported but have not been described in detail. This case report describes an immune ring after phototherapeutic keratectomy (PTK) in a patient with long‐standing superficial corneal scars. A dense white ring formed in the peripheral cornea on the fourth day following surgery. The patient was treated with antibiotics until negative cultures were reported 48 hours later. A biopsy was taken and examined by light microscopy using hematoxylin‐eosin and Mason’s trichrome staining. The stroma showed focal keratocyte depopulation with nuclear fragments, occasional polymorphonuclear leucocytes, and an active fibroblastic reaction. No lymphocytes or plasma cells were seen. Clinically, the immune ring faded slowly and was still apparent 9 months after the PTK. Studies of similar cases are required to clarify the mechanisms responsible for this phenomenon.

Bacterial Keratitis Following Phototherapeutic Keratectomy

BACKGROUND Phototherapeutic keratectomy (PTK) is effective in the treatment of many superficial corneal disorders. The incidence of bacterial keratitis following PTK has not been assessed in a large, prospective clinical trial. METHODS We report three cases of bacterial keratitis that occurred in a prospective study of 258 consecutive PTK procedures at King Khaled Eye Specialist Hospital. RESULTS Three (1.2%) of 258 eyes developed bacterial keratitis during a period of follow up ranging from 1 to 24 months. All three cases were in 183 eyes (1.6%) with a diagnosis of climatic droplet keratopathy, while no cases were observed in 75 eyes with other anterior corneal disorders. Gram-positive species (Streptococcus pneumonia in two, coagulase-negative Staphylococcus in one) were the predominant species isolated from all three cases. Two of the cases were polybacterial. The final visual outcomes ranged from 20/125 to 20/400. CONCLUSIONS The risk of bacterial keratitis following treatment of superficial corneal disorders with PTK is low but its occurrence may adversely affect the final visual outcome.

Meesmann corneal epithelial dystrophy in a Saudi Arabian family

PURPOSE Meesmann corneal epithelial dystrophy is a dominantly inherited disorder that was originally reported in Germany and later in descendants of German immigrants to the United States. We report Meesmann corneal epithelial dystrophy in a family that cannot be traced to Germanic origin. METHODS A 17-year-old Saudi boy from the Al-Qahtani tribe of the Asir region of the kingdom came to the King Khaled Eye Specialist Hospital with classic clinical findings of Meesmann corneal epithelial dystrophy. We examined all members of the immediate family of the index case and members of five branches of the extended family. RESULTS Meesmann corneal epithelial dystrophy was present in the father and one sister of the index case. Four additional affected individuals were identified in three generations of one branch of the extended family. All but one of the seven affected individuals were aged 17 years or older. Our findings are consistent with previous reports of an autosomal dominant pattern of inheritance, with probable incomplete penetrance or delayed onset of phenotypic expression. CONCLUSION We report Meesmann corneal epithelial dystrophy in a family without German ancestry.