Saul Ullman

Clinical evidence for hepatitis B transmission resulting from corneal transplantation.

Purpose Two cases of hepatitis B virus (HBV) infection after penetrating keratoplasty are presented. Methods An extensive clinical and serologic investigation of these two transplant recipients was performed. In addition, the medical histories, autopsy reports, and specimens of blood from the two deceased corneal tissue donors were retrieved and studied. Results Serum from both donors was positive for hepatitis B surface antigen; the clinical history and serologic testing of both recipients strongly suggest that the HBV infection in each case was acquired from donor corneal tissue. Conclusion To our knowledge, these are the first documented cases of HBV infection after corneal transplantation. Eye banks should continue to screen donors for HBV.

Bilateral Angle-Closure Glaucoma in Association with the Acquired Immune Deficiency Syndrome

Two homosexual men, 35 and 42 years old, had bilateral acute angle-closure glaucoma in association with the acquired immune deficiency syndrome. In one patient, the angle-closure attack was the initial manifestation of AIDS. Choroidal effusion with secondary anterior rotation of the ciliary body at the scleral spur appeared to be the pathophysiologic mechanism. Pupillary block, angle crowding, and inflammatory synechial angle closure must be differentiated from anterior rotation of the ciliary body as the mechanism of the angle closure to provide optimal treatment. Whereas primary angle closures are treated with miotics and iridectomy, secondary angle closure may be worsened with this treatment. Cycloplegics and, if necessary, drainage of suprachoroidal fluid may be curative in AIDS-related angle closure associated with a choroidal detachment. Both patients died before the long-term efficacy of this treatment could be assessed.

Corneal opacities secondary to Viscoat

ABSTRACT Viscoat® is a new viscoelastic solution of chondroitin sulfate and sodium hyaluronate dissolved in a phosphate buffer. Recent findings of postoperative corneal deposits in association with its use have been reported to Cilco. The corneal deposits are noted 18 to 48 hours postoperatively and are similar in appearance to calcific band keratopathy. The clinical characteristics and prognosis of this entity are reviewed. Possible methods of treatment and recommendations for prevention are discussed.

Necrotizing Keratitis Caused by Capnocytophaga ochracea

We studied three cases of Capnocytophaga keratitis that demonstrated stromal necrosis and a ring infiltrate. In all cases, the keratitis occurred in a previously diseased or traumatized cornea. One patient was treated with chronic antiamoebic therapy for presumed Acanthamoeba keratitis. Two cases resulted in corneal perforation. Laboratory isolation was difficult because of slow, fastidious growth. Capnocytophaga is not uniformly sensitive to commonly used topical antibiotics such as the cephalosporins and aminoglycosides, but may respond to treatment with topical clindamycin.

Fractionated Epibulbar 1-125 Plaque Radiotherapy for Recurrent Mucoepidermoid Carcinoma of the Bulbar Conjunctiva

PURPOSE/METHODS A patient with recurrent conjunctival mucoepidermoid carcinoma was treated successfully with surgical excision of the tumor and fractionated epibulbar I-125 plaque radiotherapy. RESULTS/CONCLUSIONS Local excision with fractionated epibulbar plaque radiotherapy is an effective means of eradication in select cases of recurrent mucoepidermoid carcinomas of the conjunctiva. This treatment may avoid more aggressive surgical treatment and preserve vision.

Descemet stripping automated endothelial keratoplasty for spontaneous descemet membrane detachment in a patient with osteogenesis imperfecta.

Purpose: To report the first use of Descemet stripping automated endothelial keratoplasty (DSAEK) for spontaneous Descemet membrane detachment in a patient with osteogenesis imperfecta (OI), keratoconus, and acute bullous keratopathy. Methods: A case report of a 25-year-old man with OI and symptomatic unilateral bullous keratopathy secondary to spontaneous Descemet membrane detachment is described. The patient presented with acute loss of vision in his right eye and was noted on slit-lamp examination to have a totally detached and taut Descemet membrane, spanning the anterior chamber. This diagnosis was confirmed with an anterior segment OCT (Visante; Carl Zeiss Meditec, Dublin, CA). Results: After an attempt to reattach the Descemet membrane with air bubbling was unsuccessful, the patient underwent successful DSAEK. Seven months postoperatively, his best spectacle–corrected visual acuity was 20/50 compared with his other eye, which was 20/40. There were some central folds in the donor noted immediately postoperatively that have persisted. Conclusions: To the best of our knowledge, this case is the first documented spontaneous Descemet membrane detachment in a patient with OI and probable keratoconus treated successfully with DSAEK. Unlike in classical keratoconus hydrops, medical management is unlikely to resolve a total Descemet membrane detachment. This unusual Descemet membrane detachment was tightly stretched across the anterior chamber without any obvious tear, making simple air or gas bubble apposition impossible. Attempts to tear the Descemet membrane and then bubble led to significant folds. DSAEK was successful in removing the detached Descemet membrane and replacing it with the donor tissue.

Cavernous hemangioma of the conjunctiva

Congenital hemangiomas of the conjunctiva are extremely rare. We report the clinical, histopathologic and ultrastructural findings in a child with an isolated cavernous hemangioma of the conjunctiva. the clinical and pathologic features which help distinguish this lesion from a lymphangioma or other conjunctival tumors are discussed. the importance of ultrastructural analysis as a diagnostic tool in these rare lesions is emphasized.

Anaphylactic reaction secondary to topical preoperative moxifloxacin

We report a case of anaphylactic shock following topical administration of moxifloxacin for endophthalmitis prophylaxis prior to cataract surgery. Immunoglobulin E (IgE) serology and IgE skin testing confirmed the anaphylactic etiology. Phacoemulsification with posterior chamber intraocular lens implantation was later performed with identical preoperative preparation except for the exclusion of moxifloxacin; no anaphylactic response occurred. To our knowledge, this is the first report of an anaphylactic response to topical moxifloxacin. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.

Use of the AMO SI-40NB Unfolder with the SI-55NB IOL in highly hyperopic eyes

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Coring-A Potential Source of Intraocular Contamination

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