Kathleen A. McClellan

Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluoroquinolones and gentamicin plus cephalothin

Purpose:  Patients presenting with presumed infective keratitis were studied to determine predisposing factors, the current susceptibilities of the bacterial isolates to a range of relevant antibiotics, the success rate of topical antibiotic treatment of keratitis and predictors of failure of topical therapy.

Six‐year review of Acanthamoeba keratitis in New South Wales, Australia: 1997–2002

Aim: To assess the incidence and risk factors for Acanthamoeba keratitis (AK), the diagnostic interval, and the efficacy and outcome of current treatment among the population of New South Wales, Australia.

Long-term follow-up results of lamellar keratoplasty as a treatment for recurrent pterygium and for scleral necrosis induced by beta-irradiation.

PURPOSE To evaluate the efficacy and safety of lamellar keratoplasty (LK) in the treatment of recurrent pterygium and of scleral necrosis induced by beta-irradiation. METHODS A retrospective review of patients who, between 1988 and 2001, underwent LK for the above indications. Recurrence rates, tectonic outcomes, pre- and postoperative visual acuities, and complications were analyzed. RESULTS In the recurrent pterygium group, LK was performed on 68 eyes. The mean age (mean +/- SD) at presentation was 45.1 +/- 13.7 years (range 17 to 77). The recurrence rate following LK was 5.9%, with a mean time to recurrence of 6.2 +/- 2.9 months (range 3 to 10). In all cases, the recurrence occurred above or below the lamellar grafts, and a second LK prevented any further recurrence. The mean length of follow-up was 27.1 +/- 26.6 months (range 3 to 132). The best-corrected visual acuity (BCVA) improved or remained unchanged in 65 of the 68 eyes (95.6%) but was reduced in the remaining three eyes (4.4%). In the scleral radionecrosis group, LK was performed on 30 eyes. The mean age at presentation was 67.7 +/- 10.3 years (range 37 to 85). Tectonic restoration was achieved in all patients. The mean length of follow-up was 49.0 +/- 45.1 months (range 8 to 120). The BCVA improved or remained unchanged in all patients. No significant complications were identified. CONCLUSION Lamellar keratoplasty is a safe and effective treatment option for both recurrent pterygium and beta-irradiation-induced scleral necrosis. In our opinion, LK is the treatment of choice for multiple or aggressive recurrences of pterygium and a successful management option for scleral radionecrosis.

Long-term Fundus Changes Due to Fundus Albipunctatus Associated With Mutations in the RDH5 Gene

Report of a Case. A 56-year-old woman had a 2-month history of decreased vision and mild discomfort in the left eye. She had a history of penetrating injuryat theageof8years that led to traumatic cataract and corneal scarring in her left eye. Two years before we saw her, she had undergone uncomplicatedcombinedcataractextraction and lens implantation with penetrating keratoplasty elsewhere. There had been a satisfactory convalescence, but the visual acuity OS remained counting fingers at 1 m. Amblyopia was therefore suspected. At our first examination of her, the visual acuity was 6/9 OD and hand motion in the left eye. Full ophthalmological workup revealed a graft rejection and a subtotal retinal detachment with a peripheral retinal tear at the 6-o’clock position in the left eye. Intraocular pressure was 22 mm Hg OD and 18 mm Hg OS. In the right eye there was early nuclear cataract formation, but otherwise all findings were normal. No signs of pseudoexfoliation were noted and the cup-disc ratio was 0.3. The patient was admitted and the graft rejection was successfully treated with intensive topical steroids. After the corneal graft inflammation settled, the patient underwent a left pars plana vitrectomy with endolaser and silicone oil filling under retrobulbar anesthesia. No systemic atropine was used. Postoperatively the patient was positioned facedown. The retina was flat under silicone oil on day 1 and the pressure was 40 mm Hg in the eye that had undergone surgery. Systemic treatment with oral dorzolamide hydrochloride reduced the pressure to 27 mm Hg. On day 3 the patient complained about severe pain in the right (fellow) eye. The visual acuity had dropped to 6/60 OD. On examination, acute angle closure with very shallow anterior chamber and angle grade 0 (Schaffer) was found. The intraocular pressure was 45 mm Hg despite continued treatment with dorzolamide hydrochloride, 250 mg 4 times a day, since day 1 after surgery and additional intravenous 20% mannitol (300 mL over 1 hour). Right eye YAG laser iridotomies were performed and the intraocular pressure dropped as the anterior chamber deepened. Pressures remained within normal limits after withdrawal of all systemic and topical treatment. The visual acuity returned to 6/12 OD. Gonioscopy 2 months later showed a grade 2 (Schaffer) anterior chamber angle in the right eye with small patent laser iridotomies at the 11and 2-o’clock positions. The axial length was measured at 22.79 mm. A reliable A-scan was not possible in the left eye because of the silicone oil filling.

The effect of successful contact lens wear on mucosal immunity of the eye

OBJECTIVE This study aimed to assess the effect of contact lens wear on the mucosal defenses of the outer eye against infection. DESIGN A case-controlled study of daily contact lens wearers in their initial 6 months of contact lens wear. PARTICIPANTS Contact lens wearers (mean age, 23.1 years; 47 subjects) were compared with age-matched control subjects (mean age, 24.7 years; 44 subjects). INTERVENTION Outer eye defenses were studied by assay of tear constituents and quantitative conjunctival microbiology. MAIN OUTCOME MEASURES Antimicrobial activity of tears was studied by assay of total immunoglobulin A (IgA), IgA isotype-specific antibodies reactive with Escherichia coli, Haemophilus influenzae, Staphylococcus epidermidis, albumin and lysozyme, and the ocular surface microbial load determined using quantitative microbiology of the conjunctival sac. RESULTS The IgA isotype-specific antibodies reactive with E. coli (P = 0.03) and S. epidermidis (P = 0.068) were lower in contact lens wearers, but antibody:albumin ratios were not significantly different in the two groups. Contact lens wear also had no significant effect on tear IgA, albumin, or lysozyme or its ratios with albumin. Bacterial numbers and colonization rates for coagulase-negative staphylococci were greater in contact lens wearers than in age-matched control subjects. Corynebacterium sp. and non-Enterobacteriaceae (P = 0.007) were isolated more frequently and in greater numbers from contact lens wearers. Colonization rates were increased for Corynebacterium sp., but non-Enterobacteriaceae were transient. In both daily contact lens wearers and age-matched control subjects, most conjunctival flora were transient rather than colonizing, and no subject developed an outer eye infection during the study. CONCLUSION These results suggest that daily contact lens wear does not significantly alter the mucosal defenses of the outer eye that function to eliminate organisms from the conjunctival sac and prevent outer eye infection.

Suppurative keratitis: A late complication of radial keratotomy

ABSTRACT A 21‐year‐old man who had radial keratotomy performed two years previously presented with a painful, red right eye. Suppurative keratitis was found in one of the eight radial incisions and Staphylococcus epidermidis was isolated by culture. Lack of stromal healing of the infected incision and the presence of epithelial cysts in four other incisions in the same eye suggest that the cause of the corneal infection was loss of the epithelial barrier function because of epithelial breakdown.

Microbiological and Histopathological Confirmation of Acanthamebic Keratitis

&NA; A healthy 42 yr‐old woman presented with a left keratitis which she had had for 3 months. No organisms could be grown by culture of corneal scrapings for bacteria and fungi, and the condition failed to respond to topical therapy. Amebic keratitis was diagnosed following corneal biopsy and cultures which grew Acanthamoeba of a species similar to, but not identical with, Acanthamoeba polyphaga. Medical treatment was continued for 6 mth. During this time the corneal infiltrate became less prominent but visual acuity remained impaired by both corneal opacity and cataract.

Nonabsorbable Suture Material in Cataract Surgery: A Comparison of Novafil and Nylon

We compared the performance of 10-0 Novafil (polybutester, Davis & Geck, American Cyanamid Company, New South Wales, Australia.) with that of 10-0 nylon (Alcon) in 60 patients undergoing extracapsular cataract extraction and implantation of a posterior chamber intraocular lens. A standard technique was used, and the incision was closed with interrupted sutures of either 10-0 Novafil or 10-0 nylon. Length of follow up ranged from 6 to 26 months (average, 15 months). We assessed the intraoperative handling qualities of the suture materials, as well as their effect on wound healing and inflammation. We also compared the surgically-induced astigmatism in the two suture groups over the first 3 postoperative months and then in long-term follow up (average, 15 months). Sutures removed at long-term follow up were examined by scanning electron microscopy (SEM). Both suture materials handled easily at operation and were well tolerated by all patients. There was no significantly different surgically-induced astigmatism in the two suture groups after 12 weeks (P = .962) or during longer follow up (P = .401). SEM confirmed more advanced biodegradation of nylon as compared with Novafil sutures after they had been in place an average of 18 months.

Long-term comparison of Novafil and nylon in corneoscleral sections

To compare the long-term degradation of Novafil (polybutester, American Cyanamid Company) and nylon suture material, we examined corneoscleral sections of nine rabbits 23 months after the placement of sutures. Only two nylon sutures remained, one in each wound of two rabbits; all the Novafil sutures were still present. However, examination of the Novafil sutures with scanning electron microscopy revealed signs of disintegration.

Late development of localized band keratopathy in relation to a Molteno tube.

We report a case in which, 6.5 years postoperatively, localized band keratopathy developed in relation to a Molteno tube. At no stage had direct contact been noted between the tip of the tube and the corneal endothelium. The mechanisms of development of corneal opacities in relation to anterior chamber drainage tubes are discussed and the implications for the placement of such tubes are examined.