V. Senthil Maharajan

Amniotic membrane transplantation for ocular surface reconstruction: indications and outcomes

Background:  The amniotic membrane is a useful tool in the management of several ocular surface diseases. Despite numerous studies, standardization of the use of the membrane and of outcome measures is lacking. Herein, the authors’ results of amniotic membrane transplantation (AMT) in ocular surface reconstruction against defined outcome measures are reported.

Use of Lactophenol Cotton Blue Mounts of Corneal Scrapings as an Aid to the Diagnosis of Mycotic Keratitis

Lactophenol cotton blue (LPCB) mounts of corneal ulcer scrapings were assessed as a diagnostic tool in cases of mycotic keratitis over a period of 15 months. We investigated 568 cases of ulcerative keratitis by microbiological techniques consisting of direct microscopic examination of LPCB mounts and Gram-stained smears as well as culture of material scraped from the ulcer. Fungi were isolated in large numbers on multiple media from the corneal scrapings of 179 patients (culture-proven mycotic keratitis). Direct microscopic examination of LPCB mounts of corneal scrapings yielded positive results in 140 (78%) of 179 culture-positive patients and negative results in 371 (95%) of 389 culture-negative patients. There was a significant difference between the percentage of positive results obtained by LPCB mounts and by Gram-stained smears in the culture-positive cases. The LPCB mount was positive in greater than 80% of cases of keratitis due to Fusarium spp. and Aspergillus spp. The LPCB mount is strongly recommended as a simple, rapid, inexpensive, and sensitive diagnostic technique in cases of mycotic keratitis.

Diffuse Keratoconjunctival Proliferation: A Novel Clinical Manifestation

OBJECTIVE To report a previously unrecognized benign bilateral widespread conjunctival and corneal proliferative condition with a potential to affect vision. METHODS A gradually progressive diffuse conjunctival proliferation extending on the cornea was noted in 14 patients (28 eyes). These patients were followed up for a mean of 6 years for the site, extent, and progression of the condition. Six eyes had these lesions removed and studied histopathologically. RESULTS Patients included 6 men and 8 women (mean age, 57 years). Two patients had bilateral nasal lesions only, 1 patient had bilateral temporal lesions only, 6 patients had both nasal and temporal lesions, and 5 patients had lesions that extended circumferentially. Pathology reports showed dense collagenous tissue, a moderate number of active fibroblasts, numerous blood vessels, and no elastotic degeneration in 3 of the 6 eyes. Two eyes showed mild subepithelial elastotic degeneration, and 1 lesion was difficult to interpret because of excessive intraconjunctival hemorrhage. None showed any inflammatory activity. CONCLUSIONS The lesions appear to be a clinical variant of classic pterygium with the corneal encroachment being wider, irregular, and more extensive. Histologically, a noninflammatory nonelastotic collagenous accumulation appears to be a predominant feature unlike in classic pterygium where elastotic degeneration is the predominant feature.

Bilateral, acute angle-closure glaucoma associated with Guillain-Barré syndrome variant

A 55-year-old man presented with bilateral reduced visual acuity, limitation of extraocular movements, areflexia and ataxia. He was diagnosed with Miller Fisher Syndrome, precipitating bilateral simultaneous acute angle closure glaucoma due to autonomic dysfunction. He was subsequently treated for both conditions and made an excellent recovery.

Role of choroidal drainage in therapeutic keratoplasty

Purpose. To discuss the role of choroidal drainage in the management of positive vitreous pressure during therapeutic keratoplasty for patients with perforated corneal ulcers. Methods. Over a 2-year period, 8 of 36 (22%) consecutive patients with therapeutic grafts presented with a shallow anterior chamber during or immediately after surgery. These patients underwent choroidal drainage for formation of the anterior chamber. In 5 of them choroidal drainage was done intraoperatively when there was significant positive vitreous pressure and the anterior chamber could not be formed. Three patients had drainage within a week postoperatively for persistent shallow anterior chamber when ultrasonogram showed choroidal detachment. Results. Of the eight cases, seven drained fluid and the chamber could be reformed well. One was a dry tap and the chamber did not reform completely. Conclusion. Choroidal detachment (CD) is a previously unpublished cause for positive vitreous pressure in therapeutic keratoplasty for perforated corneal ulcers. In these situations suprachoroidal drainage can be considered as an option for the reformation of the anterior chamber. We recommend that a preoperative B-scan ultrasound be included in the workup of all corneal perforations and that intraoperative drainage of the fluid is considered in cases with significant positive vitreous pressure and confirmed CD.

Analysis of post-DSEK corneal profile and relationship to hyperopic shift

confidence interval 0.46 to 6.6 infections per 1000 patient-years) among surgeons who do not routinely remove the sutures. The between-group difference was statistically significant (P Z .02) (unpublished data). We agree with Hillier et al. that nonabsorbable corneal sutures must be removed after routine phacoemulsification surgery. We hope that our series of patients alongwith the suggestions fromHillier et al. will encourage others to have a heightened awareness of this problem and to consider changing their practice patterns if they do not routinely remove these sutures.dBrian J. Lee, MD, Scott D. Smith, MD, MPH, Bennie H. Jeng, MD