Melvin I. Roat

Conjunctival epithelial cell hypermitosis and goblet cell hyperplasia in atopic keratoconjunctivitis.

Atopic diseases that include eczema (atopic dermatitis), asthma, and seasonal and perennial rhinoconjunctivitis are common manifestations of abnormal immediate hypersensitivity. Ocular involvement, such as atopic keratoconjunctivitis, characteristically includes conjunctival and corneal inflammation, and in a severe form, conjunctival scarring, symblepharon, corneal epitheliopathy, and visual loss. To examine the conjunctival cellular abnormalities in atopic keratoconjunctivitis, we studied the in vivo differentiation and tissue-culture growth characteristics of conjunctiva from normal subjects and patients with severe atopic keratoconjunctivitis. We examined conjunctival biopsy specimens to determine epithelial mitotic rate and goblet cell frequency, and we studied conjunctival explants to determine the latent period for fibroblast outgrowth and fibroblast doubling time. The mitotic rate for atopic keratoconjunctivitis, 6.7% +/- 2.1% (11 patients), was statistically significantly greater than for normal subjects, 2.0% +/- 0.63% (seven subjects) (P = .05). Also the goblet cell frequency for atopic keratoconjunctivitis, 14.6% +/- 3.4% (11 patients), was statistically significantly greater than for normal subjects, 4.8% +/- 0.92% (seven subjects) (P = .02). The latent period for fibroblast outgrowth and the fibroblast doubling time for atopic keratoconjunctivitis were not statistically significantly different from normal control subjects. Therefore, atopic keratoconjunctivitis was associated with conjunctival epithelial hypermitosis, goblet cell hyperplasia, and normal fibroblast tissue-culture growth. These characteristics may be useful in the diagnosis of atopic keratoconjunctivitis. We previously studied another disease characterized by chronic conjunctival inflammation and scarring, cicatricial pemphigoid, which also demonstrated conjunctival epithelial hypermitosis, but in contrast there was near absence of goblet cells, and the fibroblasts were hyperproliferative. These differences may be used to distinguish atopic keratoconjunctivitis from cicatricial pemphigoid.

Rapid Diagnostec Test for Ocular Adenovirus

A new, direct, enzyme immunoassay test (Adenoclone, Cambridge BioScience, Hopkinton, MA) was evaluated for the rapid diagnosis of ocular adenovirus infections. In 36 culture-proven cases of adenovirus ocular infection, direct Adenoclone testing of conjunctival swabs was positive in 24 of 31 patients (77%) tested within 1 week of onset of symptoms, and in one of five patients (20%) who presented after 1 week (P less than 0.02). Overall sensitivity was 69%, whereas specificity was 100%. The authors conclude that a positive Adenoclone test is reliable in the rapid diagnosis of early adenovirus ocular infections.

Epikeratophakia for control of pediatric bullous keratopathy

ABSTRACT A child who had had a congenital cataract phacoemulsified at age four months became contact lens intolerant, and at age two years had an implantation of a Worst metal‐looped iris‐clip intraocular lens. He developed painful pseudophakic bullous keratopathy three years later. Since the child remained with dense deprivation amblyopia and contact lens intolerance, when the IOL was removed an epikeratophakia graft was applied. The bullous keratopathy resolved and the patient has remained asymptomatic for 22 postoperative months. The proposed mechanism for relief of the bullous keratopathy is to increase tissue thickness and resistance, thus reducing fluid volume transferred to the subepithelial space.