Michelle K. Rhee

Bilateral keratoconjunctivitis associated with lichen planus.

Purpose To describe a case of bilateral keratoconjunctivitis in a patient with lichen planus. Methods Case report and review of the English literature. Results To our knowledge, this is the fourth reported case of keratoconjunctivitis associated with lichen planus. A 33-year-old Navajo man with lichen planus had recurrent and progressive keratoconjunctivitis that failed to improve on multiple topical medications. Tapered oral prednisone, 2% topical cyclosporin, and amniotic membrane transplantation pacified the acute exacerbation. Conclusions Our patient with lichen planus developed an ocular surface disease with cicatricial conjunctivitis, keratouveitis, keratoconjunctivitis sicca, punctate epithelial erosions, and persistent epithelial defects leading to noninfectious or infectious corneal ulceration. Amniotic membrane transplantation may play an adjunctive role in refractory cases of lichen planus–related keratoconjunctivitis. Topical cyclosporin may stabilize the ocular surface when combined with systemic immunosuppression in severe cases.

Clinical utility of cyclosporine (CsA) ophthalmic emulsion 0.05% for symptomatic relief in people with chronic dry eye: a review of the literature

To review the literature on the efficacy of cyclosporine (CsA) ophthalmic emulsion 0.05% on symptomatic relief in chronic dry eye disease. There is consistent evidence of objective improvements in chronic dry eye disease (Schirmer score, corneal and interpalpebral dye staining, and tear breakup time) with CsA, but variable results with symptomatic improvement, possibly due to patient tolerance of CsA, similar comforting effect with artificial tears and CsA vehicle, and the inherent subjective nature of symptom monitoring and analysis. This review explores the literature on CsA with special attention to symptomatic relief.

Cataract Drug Delivery Systems (Dropless vs. Nondropless Cataract Surgery).

Cataract surgery is the most commonly performed procedure in the world, estimated at >20 to 25 million in number annually. With the aging population growing, the volume will continue to rise. Although there have been advancements in technology, techniques, and training to increase the safety and efficacy of cataract surgery, there has not been a commensurate evolution in the prophylaxis against infectious postoperative endophthalmitis (IPOE) and inflammation. Although the incidence of IPOE is small and ranges from 0.04% to 0.36%, its devastating, sight-threatening potential requires constant vigilance and motivation to further minimize its occurrence. In addition, postoperative cystoid macular edema (CME) persists as a significant cause of suboptimal visual recovery, which is particularly important given the expanding population of diabetic patients. More recently, there has been growing interest and acceptance of ‘‘dropless’’ (eg, intracameral, transzonular, pars plana) alternatives to topical drops in the treatment of postoperative cataract patients. This interest has been enhanced by the development of a commercially available intracameral preparation of cefuroxime, as well as off-label, compounded use of moxifloxacin with or without dexamethasone, in addition to compounded transzonular and/ or pars plana triamcinolone acetonide, moxifloxacin, and vancomycin. We will review the published literature on prophylaxis against IPOE and inflammation in cataract surgery, and discuss the different drug delivery methods.