Tomy Starck

Conjunctival autograft for primary and recurrent pterygia : Surgical technique and problem management

The surgical technique and postoperative problem management of conjunctival autograft transplantation for advanced primary and recurrent pterygium are reviewed. Problems such as graft edema, corneoscleral dellen, and epithelial inclusion cysts infrequently occur. Corneal astigmatism, Tenons granuloma, retraction and/or necrosis of the graft, and muscular disinsertion are even less frequently encountered. Limbal-conjunctival autograft for recalcitrant recurrent cases is proposed.

Clinical and histopathologic studies of two families with lattice corneal dystrophy and familial systemic amyloidosis (Meretoja syndrome).

Lattice corneal dystrophy associated with familial systemic amyloidosis (Meretoja syndrome) has rarely been described other than in patients of Finnish origin. The authors report two North American patients with this disease who manifest blepharochalasis, lattice corneal dystrophy, open-angle glaucoma, and cranial neuropathy. In one patient, a corneal intraepithelial and subepithelial pseudodendrite was managed by superficial keratectomy, and this same patient benefited from surgical brow suspension for facial muscular weakness. In the second patient, penetrating keratoplasty was complicated by a neurotrophic persistent epithelial defect. Corneal tissue from both superficial keratectomy and penetrating keratoplasty exhibited ultrastructurally characteristic amyloid filaments and associated elastoid material. Transmission electron microscopy of conjunctiva and skin biopsies similarly revealed amyloid deposits associated with most basement membranes, the perineurium and endoneurium of most peripheral nerves, and the intima and media of arteries. By immunoperoxidase staining, the corneal amyloid deposits were positive for the amyloid P-component protein but negative for the nonimmunoglobulin amyloid A protein and prealbumin. Serum prealbumin and amyloid A related protein were normal.

Penetrating Keratoplasty and Anterior Segment Reconstruction for Severe Ocular Trauma

The principles for management of acute ocular trauma are also applicable to the subsequent reconstruction of the anterior segment. As with the primary repair of ocular trauma, meticulous anatomical restoration during reconstructive surgery minimizes secondary complications and enhances the visual prognosis. Anterior segment reconstruction may then involve procedures such as stripping of corneal pannus, removal of lens and vitreous remnants, iris and angle reconstruction, intraocular lens implantation, and penetrating keratoplasty. A total of 39 consecutive cases of severe ocular trauma, which had undergone penetrating keratoplasty and anterior segment reconstruction, were evaluated for visual outcome, graft survival, and secondary complications. Post-operatively, 49% of eyes achieved > 20/100 as compared with 10% before surgery, and 72% improved by at least two Snellen lines. In all, 31 (80%) initial keratoplasties remained clear, as did all 4 subsequently regrafted corneas, for an overall keratoplasty success rate of 90%. Elevated intraocular pressure occurred postoperatively in 18 eyes (46%), and among these, 10 of 13 eyes (77%) had preoperative glaucoma, whereas 8 of 26 (31%) did not (P < 0.015). Peripheral anterior synechiae could be anatomically corrected at surgery in 80% of cases (24 of 30 eyes). Thus, despite major trauma and a high prevalence of glaucoma, both the visual and the anatomical improvements were highly satisfactory and without severe complications.

Positive polymerase chain reaction and histology with borderline serology in Parinaud's oculoglandular syndrome.

Purpose. To report a case of Parinauds oculoglandular syndrome (POS) in which, despite a borderline serology, polymerase chain reation (PCR) testing for a conjunctival biopsy was positive for Bartonella henselae, a source of cat-scratch disease. A Steiner silver stain demonstrated the organism. Methods. Case Report. Results. A 65-year-old man was seen for a foreign body in his left eye (OS) associated with chemosis and a preauricular node. Conclusion. B. henselae is a known cause of POS. This gram-negative pleomorphic rod has been more frequently discovered in connection with this syndrome due to improved diagnostic testing such as indirect immunofluorescence antibody and PCR testing. Frequently, serology is positive if the organism is present. This report describes a patient with clinical findings of POS who, despite borderline serology, had pleomorphic rods on Steiner silver stain and positive PCR testing compatible with Bartonella henselae.

Xylene keratopathy: a case report and review of the literature.

Purpose. To report a case of direct contact xylene-related vacuolar keratopathy. Methods. Interventional case report and review of the literature. Results. Xylene keratopathy is a distinct clinical entity characterized by significantly decreased visual acuity, increased corneal thickness, and the presence of corneal epithelial and stromal vacuoles on a diffuse gray stromal background. The vacuoles are diffusely scattered, subtle, and clear on slit-lamp examination. Occasionally, white, round, denser areas can also be observed. Xylene keratopathy disappeared gradually over 4 weeks with topical steroid treatment and did not cause permanent sequelae. Conclusions. Xylene exposure should be considered as possible etiologic agent of vacuolar epithelial and stromal keratopathy. Exposure may occur directly as a splash of liquid or through its vapors.

Surgical Treatment of Human Bites of the Upper Eyelid

Human bites of the upper eyelid are extremely rare. Few reports have been published on the surgical management of such injuries, and they have dealt mainly with those cases in which the avulsed tissue segment is available for reconstructive surgery. This article reports on a case of human bite injury of the upper eyelid with more than 50% full-thickness loss of tissue, in which the missing segment was not available for reconstruction.