Sarah M. Nehls

Beauveria keratitis and biopesticides: case histories and a random amplification of polymorphic DNA comparison.

Purpose: The purposes of this study were to describe 2 contact lens-associated Beauveria keratitis cases and to compare the isolates of 3 contact lens-associated Beauveria keratitis cases with Beauveria-based biopesticides using random amplification of polymorphic DNA (RAPD). Methods: A 55-year-old diabetic woman from New Mexico and a 31-year-old healthy woman from southern Wisconsin developed soft contact lens-related corneal ulcers unresponsive to topical moxifloxacin and prednisolone acetate drops. Their corneal cultures grew B. bassiana. These isolates, an isolate from a third soft contact lens-related Beauveria keratitis case, and Beauveria-based biopesticides sold in the United States were analyzed using morphological features, DNA sequencing, and RAPD. A PubMed, Cochrane Library, OVID, UpToDate, and Google search using the term “Beauveria” found only 9 reported Beauveria keratitis infections. Results: Patient 1 responded to topical natamycin, ketoconazole, and 200 mg oral ketoconazole twice daily before developing a secondary bacterial infection requiring penetrating keratoplasty. After subsequent cataract surgery, the best-corrected visual acuity was 20/20. Patient 2 was treated with topical natamycin, topical amphotericin, and 200 mg oral voriconazole twice daily for 1 month with residual scarring and a best-corrected visual acuity of 20/25. RAPD showed that all isolates were unrelated. Conclusions: Although earlier reported Beauveria keratitis cases occurred after corneal injury in patients who did not wear contact lenses, 3 recent patients wore soft contact lenses and denied trauma, mirroring a changing trend in microbial keratitis. RAPD analysis showed that the Beauveria isolates were unrelated to one another and to Beauveria-based biopesticides. In Patient 2, oral voriconazole worked well.

Patient satisfaction and clinical outcomes with laser refractive surgery performed by surgeons in training.

Purpose To evaluate the refractive error quality of life (RQL) improvement, patient satisfaction, and clinical results of laser refractive surgery performed by residents or fellows. Setting Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA. Design Case series. Methods This study reviewed the clinical results of consecutive refractive surgery cases performed between March 2010 and February 2012 by ophthalmology residents or fellows. One‐year postoperative analysis of the RQL and patient satisfaction in a subgroup of patients was completed using the National Eye Institute Refractive Error Correction Quality of Life‐42 instrument (NEI RQL‐42), and a comparison with NEI published normative data and post‐refractive data was performed. Results Data were obtained from 138 eyes that had laser in situ keratomileusis and 4 eyes that had photorefractive keratectomy. The 1‐year postoperative analysis of the RQL and patient satisfaction was completed in 34 patients. After 6 months postoperatively, the mean uncorrected distance visual acuity was 0.01 logMAR (95% confidence interval [CI], −0.012 to 0.023). The mean postoperative residual refractive error spherical equivalent was −0.20 diopter (D) (95% CI, −0.26 to −0.13). No eye lost corrected distance visual acuity. Equivalent or better satisfaction in the RQL was found in all but 1 of the 13 scale scores of the NEI RQL‐42 compared with previously published NEI data. Conclusions Laser refractive surgery performed by residents and fellows showed high patient satisfaction and an improved RQL 1‐year postoperatively. Clinical outcomes validated the safety and efficacy of refractive surgery performed by surgeons in training. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Safety and efficacy of autologous serum eye drop for treatment of dry eyes in graft-versus-host disease.

Abstract Purpose: To evaluate the treatment of autologous serum eye drops (ASED) on dry eyes in patients with graft-versus-host disease (GVHD). Methods: A retrospective chart review of 35 patients with a history of ocular GVHD following hematopoietic stem cell transplantation that used ASED to alleviate dry eye symptoms was performed. Patients were categorized into three different groups. If patients had available ophthalmic data before and after starting treatment was group 1 (n = 14), had available ophthalmic data after starting treatment in group 2 (n = 10) and had available ophthalmic data before treatment or did not have any data after starting treatment in group 3 (n = 11). Data were collected on patient’s age, gender, primary diagnosis, visual acuity and fluorescein corneal staining were collected on individual eyes in order to evaluate the efficacy of the ASED on alleviating dry eye-related signs and symptoms. Results: No adverse ocular effect from the ASED was found in our series (except one fungal keratitis). All patients reported either improvement (55%) or stability (45%) in their ocular symptoms upon the use of ASED. In patients with available data before and after starting treatment, the corneal staining score improved by a median of 1 (p = 0.003) and the LogMAR visual acuity had a non-significant improvement. Conclusion: In our study, ASED used by patients with ocular GVHD were both safe and effective. ASED should be considered in patients with GVHD who suffer from dry eyes.

Leiomyoma of the Lower Eyelid

Figure 2. A, Microscopic examination demonstrates conjunctival tissue with an area of haphazard smooth muscle bundles (hematoxylin-eosin, original magnification ×40). B, Higher magnification reveals fascicles composed of fusiform cells with cigar-shaped end nuclei (arrow) (hematoxylin-eosin, original magnification ×400). C, Cytoplasmic staining with muscle-specific actin immunohistochemistry stain is observed (original magnification ×400).

Postoperative visual acuity in patients with fuchs dystrophy undergoing descemet membrane-stripping automated endothelial keratoplasty: correlation with the severity of histologic changes.

OBJECTIVE To investigate a correlation between the severity of histologic changes of the Descemet membrane in patients with Fuchs endothelial dystrophy and the best-corrected visual acuity (VA) after Descemet membrane-stripping automated endothelial keratoplasty (DSAEK). METHODS In a retrospective study design, we created a histologic grading system based on common characteristics observed histologically among 92 DSAEK specimens sent to the University of Wisconsin Eye Pathology Laboratory with a clinical diagnosis of Fuchs dystrophy from 3 separate corneal surgeons. Cases were graded as mild, moderate, or severe on the basis of guttae dispersion, presence of a laminated Descemet membrane, presence of embedded guttae, and density of guttae. Regression models were built to study the relationship among preoperative VA, histologic findings, and best-corrected VA 6 months and 1 and 2 years after DSAEK. RESULTS No correlation was found between the severity of histologic changes of Descemet membrane and preoperative VA. However, a correlation was noted between the preoperative and final VA. Cases with a laminated Descemet membrane but no embedded guttae (n = 8) appeared to be less responsive to DSAEK. Otherwise, the severity of histologic changes of Descemet membrane observed in patients with Fuchs corneal dystrophy after DSAEK did not show a statistically significant correlation with final VA. CONCLUSIONS Our analysis fails to show an inverse relationship between the severity of histologic changes of the Descemet membrane and the best-corrected VA of at least 20/40 after DSAEK for Fuchs endothelial dystrophy. However, in a subset of patients with Fuchs dystrophy who develop a laminated Descemet membrane without embedded guttae, the visual recovery after DSAEK is less than expected. The laminated architecture of Descemet membrane without embedded guttae may facilitate separation between the membrane layers and, thus, incomplete removal of the recipients Descemet membrane during DSAEK, which may then limit the postoperative visual outcome.

Use of Topical Insulin to Treat Refractory Neurotrophic Corneal Ulcers

Purpose: To report the clinical course of 6 patients with refractory neurotrophic corneal ulcers that were treated with topical insulin drops. Methods: Retrospective chart review of patients who had neurotrophic corneal ulcers or epithelial defects refractory to standard medical and surgical treatment. Insulin drops, prepared by mixing regular insulin in artificial tears with a polyethylene glycol and propylene glycol base at a concentration of 1 unit per milliliter, were prescribed 2 to 3 times daily. Results: Six patients, aged 2 to 73 years, developed neurotrophic corneal ulcers refractory to a range of medical and surgical treatments, including bandage contact lens, amniotic membrane grafting, and permanent tarsorrhaphy. Each patient was administered topical insulin drops with complete corneal reepithelialization within 7 to 25 days. Conclusions: Topical insulin may be a simple and effective treatment for refractory neurotrophic corneal ulcers. Further study is required to determine the clinical efficacy and side effect profile of insulin drops.

Glistening Intraocular Lens

Author Contributions: Conception and design: Skaat, De Moraes, Bowd, Sample, Girkin, Medeiros, Ritch, Weinreb, Zangwill, Liebmann Data collection: Skaat, De Moraes, Bowd, Sample, Girkin, Medeiros, Ritch, Weinreb, Zangwill, Liebmann Analysis and interpretation: Skaat, De Moraes, Weinreb, Zangwill, Liebmann Obtained funding: Not applicable Overall responsibility: Skaat, De Moraes, Bowd, Sample, Girkin, Medeiros, Ritch, Weinreb, Zangwill, Liebmann Abbreviations and Acronyms: AD 1⁄4 African descent; ADAGES 1⁄4 African Descent and Glaucoma Evaluation Study; bPPA 1⁄4 beta-zone parapapillary atrophy;

Ciliary Body Medulloepithelioma in a 10-Year-Old Boy

gen activator impairs blood-brain barrier integrity during ischemic stroke. Nat Med. 2008;14(7):731-737. 22. Klettner A, Roider J. Comparison of bevacizumab, ranibizumab, and pegaptanib in vitro: efficiency and possible additional pathways. Invest Ophthalmol Vis Sci. 2008;49(10):4523-4527. 23. Faure C, Macrez R, Vivien D, Sahel JA, Bonnel S. Interaction study between rtPA and bevacizumab. Br J Ophthalmol. 2011;95(5):743-744. 24. Verheul HM, Lolkema MP, Qian DZ, et al. Platelets take up the monoclonal antibody bevacizumab. Clin Cancer Res. 2007;13(18, pt 1):5341-5347. 25. Jackson TL, Antcliff RJ, Hillenkamp J, Marshall J. Human retinal molecular weight exclusion limit and estimate of species variation. Invest Ophthalmol Vis Sci. 2003; 44(5):2141-2146. 26. Heiduschka P, Fietz H, Hofmeister S, et al; Tubingen Bevacizumab Study Group. Penetration of bevacizumab through the retina after intravitreal injection in the monkey. Invest Ophthalmol Vis Sci. 2007;48(6):2814-2823. 27. Kamei M, Misono K, Lewis H. A study of the ability of tissue plasminogen activator to diffuse into the subretinal space after intravitreal injection in rabbits. Am J Ophthalmol. 1999;128(6):739-746. 28. Takeuchi A, Kricorian G, Yao XY, Kenny JW, Marmor MF. The rate and source of albumin entry into saline-filled experimental retinal detachments. Invest Ophthalmol Vis Sci. 1994;35(11):3792-3798.

Urethane as an inhibitor of the firefly light reaction

A study has been made to test the hypothesis that general anesthetics such as urethane are able to inhibit light from a firefly reaction mixture. Urethane was found to reduce light emission in a dose-dependent manner, the minimal effective concentration being about 20 mM. Dixon plots gave a Ki value in the range of 175 to 215 mM. Lineweaver-Burk plots showed that urethane increases the apparent Km for ATP and reduces Vmax for the reaction. This is taken to mean that urethane acts as both a competitive and non-competitive inhibitor of the firefly light reaction (mixed-type inhibition).

Changes in the Corneal Architecture Following Corneal Hydrops.

Originally received: May 9, 2015. Final revision: August 14, 2015. Accepted: August 19, 2015. Available online: September 23, 2015. Manuscript no. 2015-750. 1 Departments of Ophthalmology and Quality, Kaiser Permanente, Walnut Creek, California. 2 Division of Research, Kaiser Permanente Northern California, Oakland, California. 3 Department of Ophthalmology, Kaiser Permanente, Fresno, California. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Supported by the Kaiser Foundation Research Institute Community Benefit Program (Oakland, CA); and the National Eye Institute, National Institutes of Health, Bethesda, Maryland (grant no.: R21 EY022989). Dr. Herrinton has had a research contract in the past 3 years with Medimmune (Mountain View, CA) that does not bear on the present topic. Author Contributions: Conception and design: Shorstein, Liu, Analysis and interpretation: Shorstein, Liu, Waxman, Herrinton Data collection: Shorstein, Liu, Herrinton Obtained funding: Shorstein Overall responsibility: Shorstein, Herrinton