Jose M. Vargas

Short term oral minocycline treatment of meibomianitis

Aim: To evaluate the clinical impact, aqueous tear parameters, and meibomian gland morphology in patients with primary meibomianitis before, during, and 3 months after a course of oral minocycline. Methods: 16 patients were prospectively enrolled, 11 male and five female (mean age 69 years old). Each patient received routine clinical evaluations before, after 3 months therapy, and at 6 month study follow up visit. The clinical appearance, tear volume, flow and turnover, evaporation, Schirmer I test, meibomian gland dropout, lissamine green staining, and bacteriology wer evaluated. Results: Improvement was observed in clinical signs of meibomianitis at the second and third visits. Microbial culture findings improved. Decreased aqueous tear volume and flow, and increased evaporation rate range at 35–45% relative humidity (RH) (p<0.05) were also detected. Other related tear parameters did not change. Meibomian gland dropout showed no improvement. Conclusions: 3 months of oral minocycline resulted in clinical improvements in all meibomianitis signs that persisted for at least 3 months after discontinuation despite decreased aqueous tear volume and flow with increased evaporation (35–45% RH). However, there was improvement in the turbidity of secretions. Short term minocycline therapy probably has efficacy in the management of meibomianitis that extends beyond eradication of bacteria.

OPHTHALMIC EXAMINATION OF THE CAPTIVE WESTERN LOWLAND GORILLA (GORILLA GORILLA GORILLA)

Abstract This study examined the captive western lowland gorilla (Gorilla gorilla gorilla) eye as compared and contrasted with the human eye. Bilateral ophthalmic examinations of western lowland gorillas (n = 5) while under general anesthesia were performed opportunistically, including slit-lamp biomicroscopy, dilated fundus examination, cycloplegic retinoscopy, Schiotz tonometry, corneal diameter and thickness measurements, A-scan and B-scan ultrasonography, keratometry, and cultures of the eyelid margins and bulbar conjunctiva. Mean spherical equivalent refractive error by cycloplegic retinoscopy was +1.20 ± 0.59 diopters. Mean intraocular pressure by Schiotz tonometry was 12.0 ± 4.3 mm Hg. Mean optic nerve head cup to disc ratio was 0.42 ± 0.11. Mean horizontal corneal diameter was 13.4 ± 0.8 mm, and mean vertical cornea diameter was 12.7 ± 0.8 mm. Mean central corneal thickness by ultrasound pachymetry was 489 ± 52 μm. Mean axial length of the eye by A-scan was 22.75 ± 0.71 mm. Mean lens thickness by A-scan was 4.23 ± 0.34 mm. Mean anterior chamber depth by A-scan was 4.00 ± 0.26 mm. Mean keratometry reading was 44.38 ± 1.64 diopters. Eyelid margin and bulbar conjunctival cultures isolated Candida sp. (n = 5), Staphylococcus aureus (n = 4), Staphylococcus epidermidis (n = 3), Staphylococcus saccharolyticus (n = 3), and Micrococcus sp. (n = 3). This study suggests important similarities between western lowland gorilla and human eyes. These similarities may allow diagnostics, techniques, and equipment for human eye surgery, such as those used for cataract extraction and intraocular lens implantation, to be successfully utilized for gorillas.

Use of Intraocular Videoendoscopic Examination in the Preoperative Evaluation of Keratoprosthesis Surgery to Assess Visual Potential

PURPOSE To determine the clinical utility of intraocular videoendoscopy examination for the evaluation of the retina and optic nerve in patients being considered for a Boston type I keratoprosthesis (KPro). DESIGN Interventional case series study. METHODS Ten patients with a history of corneal blindness caused by failed penetrating keratoplasty (PK) and inability to accurately assess visual potential were included in this study. Ophthalmologic examination, B-scan ultrasonography, and pars plana videoendoscopy were carried out to assess the retina and optic nerve before KPro. RESULTS Posterior segment examination was successfully used to evaluate the retina and optic nerve of all patients with opaque corneas. Out of 10 patients that underwent endoscopic examination, 3 (30%) were considered to be adequate candidates for KPro surgery and 7 (70%) were not. This was based on visualized retinal disease and/or optic nerve pathology. Of the 3 patients that underwent KPro surgery, all of them had a significant improvement of vision, including counting fingers to 20/100, hand motion to 20/5, and light perception to 20/80, as suggested by the endoscopy preoperative examination. No complications of the endoscopy procedure were observed. CONCLUSIONS This report demonstrates the successful use of intraocular videoendoscopy to rule out threats to a good visual outcome for patients being considered as candidates for KPro. Direct visualization of the posterior segment can be part of the preoperative algorithm in the decision process of performing a KPro surgery in patients when visual potential is questionable.

Effect of phacoemulsification on corneal thickness

PURPOSE To determine the immediate effect on corneal thickness of cataract extraction using phacoemulsification. DESIGN Prospective consecutive nonrandomized humans undergoing standard small-incision phacoemulsification and intraocular lens insertion. METHODS Corneal thickness was measured immediately preoperative and postoperatively in 58 consecutive patients undergoing phacoemulsification in the absence of other ocular abnormalities. Corneal thickness was determined centrally and in the midperiphery of four quadrants. The last 17 eyes were also evaluated for the effect of pressure from a Honan balloon on corneal thickness. SETTING Faculty practice in medical school and university hospital. The cornea thinned in all five of the measured locations, with statistical significance being reached only in the four midperipheral quadrants. Pressure from the Honan balloon resulted in a negligible increase in corneal thickness preoperatively. CONCLUSIONS Corneas were found to have thinned statistically significantly immediately after phacoemulsification; however, the degree of thinning has doubtful clinical significance and does not represent a significant dehydration of the cornea during the surgical procedure.