Lulu L Cheng

A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium

Background: Mitomycin C (MMC) and limbal conjunctival autograft (LCAU) are two known useful adjuvants in the prevention of pterygial recurrence. This study was conducted to compare the outcome of these two treatments. Methods: Prospective study on consecutive cases of primary pterygium (February 2001 to March 2002) randomised into two adjuvant groups: (1) intraoperative 0.02% MMC for 5 minutes or (2) LCAU. Patients were followed for recurrence (defined as fibrovascular tissue invading the cornea >1.5mm) and complications for a period of one year. Results: 115 eyes in 114 patients who completed the study were randomised to receive MMC (n = 63) and LCAU (n = 52). There were 10 recurrences (15.9%) in the MMC group and only one recurrence (1.9%) in the LCAU group. There was a statistically significant difference in the recurrence rate between the two groups (p = 0.04). There were a total of three conjunctival cysts, three symblephara, one granuloma, and one dellen. No other visually significant complications were encountered in either group. Conclusion: Although LCAU resulted in better one year success rates, it is technically more difficult and inapplicable in cases with previous limbal disturbance. Simple excision followed by MMC or LCAU are both safe and acceptable adjuvants for pterygium excision. Choice of adjuvant should be carefully made based on assessment of recurrence risk, local practices, and surgeon’s expertise.

The use of autologous serum tears in persistent corneal epithelial defects

AbstractPurpose Persistent corneal epithelial defects (PED) present a very challenging problem to anterior segment surgeons. Autologous serum tears had been demonstrated to be beneficial in the treatment of PED. The current study was conducted to review the local spectrum of indications and to examine the outcome of autologous serum tear usage.Methods All cases of PED treated with autologous serum tears at a tertiary referral centre for the period August 1999 – July 2001 were identified and reviewed.Results A total of 10 eyes from 10 patients were identified (5OD : 5OS). The gender ratio was 7M : 3F and the mean age was 36.8 (range 17–73) years old. The mean duration of PED before the usage of autologous serum tears was 22.4±69.6 days. Six eyes healed within 2 weeks, but two eyes failed to heal after 1 month of treatment and two patients defaulted follow-up. No adverse effects were observed with the addition of autoserum tears.Conclusions The results of the current study correlated well with previous reported studies. Autologous serum tears may be considered as a valuable adjunct in the management of recalcitrant cases of PED.

Orthokeratology Lens-related pseudomonas aeruginosa Infectious Keratitis

Purpose. To report a case of orthokeratology lens-related Pseudomonas corneal ulcer in an adult. Methods. Case report. Results. A 37-year-old man presented with a 1-day history of painful red eye. He was a soft contact lens wearer before he started on nocturnal orthokeratology lens wear of 8 to 10 hours per night 9 months ago. Corneal scraping sent for culture revealed a heavy growth of Pseudomonas aeruginosa. The patient was treated with intensive topical fortified tobramycin and ceftazidime drops. The ulcer healed with a residual paraxial corneal scar. Although his best-corrected visual acuity (BCVA) recovered from finger counting (8/200) at presentation to 20/30, he suffered visual loss from a premorbid BSCVA of 20/15. His contrast sensitivity (Vector Vision CSV 1000 test) performance was also worse than his fellow eye. Conclusion. Nocturnal orthokeratology lens wear may be associated with an increased risk of infection.

Endolaser around macular hole in the management of associated retinal detachment in highly myopic eyes.

Purpose: To analyze the role of endolaser around macular hole in managing associated retinal detachment in patients with high myopia. Methods: Review of medical records of 25 consecutive eyes of 25 patients with at least 5.00 diopters of myopia who underwent primary pars plana vitrectomy and fluid‐gas exchange. In the first half of the study period, one row of contiguous argon green endolaser was routinely applied over the retinal edge of the macular hole (EL group). In the second half of the study period, endolaser was not applied around any macular hole (NEL group). Demographic information, intraoperative and postoperative complications, and final visual acuities and retinal reattachment rates were studied. Results: The mean (±SD) refractive error was ‐11.8 ± ‐3.5 diopters (D) for the EL group and ‐11.6 ± ‐5.4 D for the NEL group. The mean axial length was 29.0 ±1.8 mm for the EL group and 28.3 ± 1.7 mm for the NEL group. The primary anatomic success was 62.5% (10/16) and 77.8% (7/9) in the EL and NEL groups, respectively. No statistically significant difference was found in preoperative, postoperative, or change in best‐corrected visual acuities between the two groups. Conclusion: Endolaser around the macular hole after pars plana vitrectomy and internal gas tamponade may not affect the anatomic or visual outcome in primary retinal detachment secondary to a highly myopic macular hole. RETINA 20:439‐444, 2000

Graft-vs-host-disease-associated conjunctival chemosis and central serous chorioretinopathy after bone marrow transplant.

PURPOSE To describe bilateral conjunctival chemosis and central serous chorioretinopathy in a patient with graft-vs-host disease after bone marrow transplant. DESIGN Interventional case report. METHODS A 45-year-old Chinese woman developed blurring of vision 16 days after bone marrow transplant for multiple myeloma. She had graft-vs-host disease 11 days after bone marrow transplantation. On examination, vision was 0.6 in the right eye and 0.3 in the left eye. Bilateral conjunctival chemosis and multiple central serous chorioretinopathy were present. RESULTS Treatment of graft-vs-host disease with high-dose systemic corticosteroid and cyclosporin led to the resolution of the conjunctival chemosis and central serous chorioretinopathy 3 months later. Visual acuity improved to 0.8 in both eyes. CONCLUSION Choroidal infiltrate in graft-vs-host disease may contribute to choroidal hyperpermeability, which leads to the development of central serous chorioretinopathy in postbone marrow transplant patients.

Combined intravenous pulse methylprednisolone and oral cyclosporine A in the treatment of corneal graft rejection: 5-year experience.

Purpose To report the mid-term results of a treatment strategy using topical steroids, intravenous pulse methyl prednisolone and oral cyclosporine A (CSA) for the treatment of acute corneal graft rejection.Methods Noncomparative, interventional case series. Treatment of corneal graft rejection included 1% prednisolone eye drops, intravenous infusion of 500 mg methyl prednisolone, and oral CSA in two regimens—standard dose was 15 mg/kg/day for 2 days, 7.5 mg/kg/day for 2 days, then adjusted to maintain trough blood levels of 100–200 μg/l; low dose was 2 mg/kg/day with no loading dose.Results Outcome in 34 eyes of 34 patients (21 M;13 F) aged 60 ± 17.7 years (range 9–83 years), who presented after an average duration of 6.6 ± 6.3 days (range 0–30 days) following acute corneal graft rejection, are reported. Twenty-five patients received standard dose CSA while nine patients received the low dose regimen. Mean duration of treatment before reversal of graft rejection was 13.6 ± 12.1 days (range 3–54 days). Treatment was successful in reversing the graft rejection in 32/34 (94%) eyes. Irreversible graft failure occurred in one eye in each group. During a mean follow-up period of 19.2 ± 16.7 months (range 1–55 months), further episodes of graft rejection were seen in 1/32 (3%) eyes. Complications due to treatment included: duodenal ulcer in one patient that responded to medical treatment, and transient elevation in serum creatinine levels in three patients, which returned to normal after decrease in dosage or cessation of oral CSA.Conclusion Our 5-year experience with the use of oral CSA in the treatment of acute corneal graft rejection has shown this treatment approach to be safe and effective in reversing the rejection process. This approach may also protect the graft from subsequent episodes of allograft rejection. A randomised controlled trial to further delineate the role of CSA in reversing acute graft rejection seems warranted.

Assessment of pupil size under different light intensities using the Procyon pupillometer

PURPOSE: To study the relationship between pupil size and light intensity using the Procyon pupillometer. SETTING: University based clinic. METHODS: In this retrospective study, 20 consecutive patients had pupil size assessment with the Procyon pupillometer under 3 different light conditions—4, 0.4, and 0.04 lux. Correlation was established using the log unit of the light intensity and pupil size. RESULTS: The correlation coefficient for the association between pupil size and log unit of light intensity in all eyes was significant (P<.001). The mean correlation coefficient for the association between pupil size and log unit of light intensity in all patients was 0.968 ± 0.089 (SD) in the right eye and 0.970 ± 0.031 in the left eye. CONCLUSION: The linear relationship between the pupil size and the log unit of the light intensity showed a tight correlation in all cases. These results can be useful in the comparing pupil size with pupillometers that work under different light conditions.

Confocal microscopy of posterior polymorphous endothelial dystrophy

Purpose: To report the in vivo confocal microscopic findings of posterior polymorphous endothelial dystrophy (PPED). Methods: Four patients with PPED from 2 unrelated families and 2 asymptomatic children of an index patient were included in this observational case series. The eyes of the 6 subjects were examined by confocal light microscopy. Results: Confocal microscopy demonstrated craters, streaks, and cracks over the corneal endothelium surface. Pleomorphism and polymegathism were present in eyes with PPED. Guttae and clusters of abnormal endothelial cells were also identified in corneas of these PPED patients. These findings were absent in eyes without clinical manifestations of PPED. Conclusions: In vivo confocal microscopy is potentially useful for excluding suspected cases of subclinical PPED. Abnormalities in the Descemet membrane and endothelium were observed.

Topical 0.03% tacrolimus ointment in the management of ocular surface inflammation in chronic GVHD.

Topical 0.03% tacrolimus ointment in the management of ocular surface inflammation in chronic GVHD

Prospective study on the safety and efficacy of combined conjunctival rotational autograft with intraoperative 0.02% mitomycin C in primary pterygium excision.

Purpose: To describe the novel use of combined conjunctival rotational autograft (CRA) and intraoperative 0.02% mitomycin C (MMC) in the treatment of primary pterygium and to evaluate its safety and efficacy. Methods: Prospective interventional case series comparing with historical controls was conducted. Patients with primary pterygium underwent pterygium excision, MMC was applied to the scleral bed after the surface conjunctiva was harvested, and the CRA was sutured back with a 180-degree rotation. Patients were followed for a minimum of 1 year. Results: Sixty-seven eyes from 67 patients participated in the study, of which 31 (46.3%) were men and 36 (53.7%) were women. The mean age was 58 ± 10.6 years, (range 36-79 years). There were 2 recurrences (3%), one occurring at month 3 and the other at month 9. Compared with historical controls, CRA-MMC resulted in significantly fewer recurrences than MMC alone (P = 0.005) when adjusted for age and was equally effective when compared with limbal-conjunctival autografts. The main postoperative problem was graft injection, which was noted in 41 eyes (61%) at 1 year. Conclusions: To the best of our knowledge, this was the first study on the combined use of CRA and MMC in the treatment of primary pterygium. CRA with MMC was found to be effective in the prevention of recurrence. Although injection remained as a cosmetic concern, it was a safe alternative to limbal-conjunctival autograft in cases where mobilizing autologous conjunctival tissue would not be feasible.