Kenneth C. Chern

Corneal Anesthetic Abuse and Candida Keratitis

PURPOSE Topical corneal anesthetic abuse is a self-inflicted injury, causing profound corneal morbidity. Superimposed infection is an important complicating factor. The authors report four patients with confirmed topical anesthetic abuse of the cornea, in whom Candida keratitis developed. METHODS A retrospective review of the medical records of four patients with confirmed topical corneal anesthetic abuse and fungal keratitis. RESULTS A 21-year-old woman, two 28-year-old women, and a 35-year-old man were included in the study. All these patients sustained a corneal injury, prompting the chronic use of topical anesthetics (0.5% proparacaine hydrochloride in 3 patients, and 0.5% tetracaine hydrochloride and 0.4% benoxinate hydrochloride in the other). Corneal findings included epithelial defects in all patients, focal infiltrate in one patient, and ring-shaped stromal infiltrate in three patients. Topical anesthetic was discontinued, all patients initially were treated empirically with antibacterial agents, and three patients received topical corticosteroids. Subsequent corneal cultures grew Candida spp, Candida albicans specifically in three patients, and local and systemic antifungal therapy was started. Corneas in two patients re-epithelialized; a conjunctival flap was performed on another patient with a descemetocele; and the remaining patient was lost to follow-up, although repeat fungal cultures yielded no growth. CONCLUSIONS Corneal superinfection with Candida may occur during topical anesthetic abuse. Therapy includes discontinuation of the anesthetic and institution of antifungal therapy.

The Efficacy of Topical Metronidazole in the Treatment of Ocular Rosacea

PURPOSE The purpose of the study is to investigate the efficacy of metronidazole topical gel in the treatment of ocular rosacea. METHODS Ten patients with ocular rosacea were treated prospectively with lid hygiene and topical metronidazole applied to the lid margin in one eye and lid hygiene alone in the fellow eye. The treatment period was 12 weeks. A masked observer graded the ocular findings at the initial visit and at the conclusion of the treatment period. Pretreatment scores were compared with post-treatment scores with respect to ocular surface, eyelid margin, and combined eyelid plus ocular surface. RESULTS Eight of ten treated eyes improved, whereas only five of ten control eyes improved. There was a statistically significant improvement in the eyelid score in both the treated and control groups (P = 0.003, P = 0.025, respectively), but no significant improvement in the ocular surface score in either group. When the pretreatment and post-treatment eyelid and ocular surface scores were combined, there was a significant improvement in the treated eyes but not in the control eyes (P = 0.022, P = 0.10, respectively). No adverse effects of the metronidazole treatment were encountered in this study. CONCLUSION Metronidazole topical gel may be a safe and effective means of treating rosacea blepharitis.

Small-diameter, Round, Eccentric Penetrating Keratoplasties and Corneal Topographic Correlation

PURPOSE The purpose of the study is to report the outcome and postoperative topographic analysis of seven patients who underwent small-diameter, round, eccentric penetrating keratoplasty. METHODS Seven patients underwent small-diameter, round, eccentric penetrating keratoplasty for a variety of corneal disorders (cataract wound necrosis and dehiscence or fistula, three patients; penetrating keratoplasty wound infection, two patients; corneal rheumatoid melt and perforation, one patient; localized fungal keratitis, one patient). Full-thickness corneal transplants ranged in size from 3.0 to 5.5 mm. The graft wound and sutures spared the visual axis in all cases. Patients were observed for 7 to 42 months (mean, 21 months). All patients had postoperative topographic analysis. One of these also had preoperative analysis. RESULTS All grafts tectonically were effective in treating the intended condition. Best-corrected visual acuity was 20/30 or better in the four patients without pre-existing corneal transplants or dry eyes; 20/60 and 5/200 in the patients with previous central penetrating keratoplasties; and 20/40 in the patient with rheumatoid melt. There was no clinically significant regular or irregular astigmatism induced centrally by the eccentric graft in the four patients where visual acuity was 20/30 or better. Irregular astigmatism was noted in the other three patients. CONCLUSION Small-diameter, eccentric penetrating keratoplasties may be used successfully to treat various peripheral corneal disorders. In some cases, this can be performed without inducing high or irregular astigmatism or both centrally.

Disappearance of crystals in Schnyder's crystalline corneal dystrophy after epithelial erosion.

PURPOSE A 40-year-old woman with Schnyders crystalline corneal dystrophy had two episodes of epithelial erosion. METHODS We reviewed the patients medical record and photographic file. RESULTS In the areas underlying the epithelial erosion, the crystalline opacities disappeared. The crystals recurred in the subsequent five years but were not as dense. CONCLUSIONS Crystals in the subepithelial or Bowmans layer may lead to epithelial destabilization and corneal epithelial erosion. Disappearance of the crystalline opacities may occur after disruption of the epithelium.

Bacterial contamination of anaerobic vitreous cultures: using techniques employed for endophthalmitis

PURPOSE To investigate the occurrence of contaminated cultures of vitreous specimens from non-infected eyes obtained using anaerobic techniques employed for endophthalmitis. METHODS Vitreous specimens were obtained using meticulous sterile techniques employed for endophthalmitis from seventeen patients undergoing pars plana vitrectomy for non-infective indications: vitreous hemorrhage (12 eyes), retinal detachment (3), Coats disease (1), and congenital dislocated lens(1). Vitreous specimens were inoculated in the operating room onto an anaerobic blood agar plate and into thioglycolate broth. Bacterial growth occurring before 10 days was considered positive. RESULTS Three organisms were isolated from three separate eyes. One colony of Staphylococcus species was isolated on an anaerobic blood agar plate on day 3. A single colony of Propionibacterium acnes grew on an anaerobic blood agar plate on day 6. Alpha-hemolytic streptococci grew from thioglycolate broth on day 10. CONCLUSIONS Growth as detected in this study might represent contaminating rather than an infecting organism in an eye suspected of having endophthalmitis.

American Uveitis Society Meeting October 30, 1995 Marriott Marquis Hotel, Atlanta, GA, USA.

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