Journal Contents
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Cornea and External DiseaseSUSCEPTIBILITY OF CORNEAL AND CONJUNCTIVAL PATHOGENS TO CIPROFLOXACIN Knauf HP. Silvany R. Southern PM. Risser RC. Wilson SE. Cornea. 15(1):66-71, 1996 Jan. Ciprofloxacin 0.3% ophthalmic solution has been shown to be effective in the treatment of bacterial keratitis and conjunctivitis, and many physicians use ciprofloxacin as sole therapy in these conditions. In this retrospective study, we found seven of 84 isolates from corneal and conjunctival cultures that were resistant to ciprofloxacin. All of the resistant organisms were gram positive. Six of the isolates (Staphylococcus aureus, Staphylococcus hominis, and four isolates of the Streptococcus viridans group) were from corneal cultures, and one (Staphylococcus aureus) was from a conjunctival culture. Yearly records of systemic isolates from 1988 to 1993 (n = 35,308) demonstrated a statistically significant decrease in susceptibility for several organisms that are common pathogens in the conjunctiva and cornea: Pseudomonas aeruginosa (95-90%, p = 0.001); Staphylococcus aureus (96-87%, p < 0.0001); Staphylococcus spp, coagulase negative (97-81%, p < 0.0001): Enterococcus spp. (92-79%, p < 0.0001); Acinetobacter anitratus (97-77%, p = 0.0006); and Enterobacter cloacae (100-96%, p = 0.03). Although the susceptibility of corneal and conjunctival isolates in this series remained relatively high (91.7%), a much larger series of systemic isolates that are common ocular pathogens revealed a statistically significant increase in resistance to ciprofloxacin over the preceding 5 years.
Cornea and External DiseasePrimary Corneal Graft Failure: A National Reporting System Wilhelmus KR, Stulting RD, Sugar J, Khan MM. Arch Ophthalmol 113(12):1497-1502, 1995 Over a 3 year period, between January of 1991 and December of 1993, 147 cases of primary graft failure were reported to the Eye Bank Association of America (EBAA) from member eye banks in 33 states within the US and one Canadian province. The male-to-female recipient ratio was approximately equal. The mean recipient age was 62.5 years (+/-19.8 years). The mean donor age was 50.2 years (+/- 17.1 years). Specular microscopy was performed on 64 eyes (43.5%), and these were found to have and average central endothelial density of 2685 cells/mm2. Roughly 90% of the corneas were stored in Optisol or Optisol GS, and 9% were stored in Dexol. The mean death-to-preservation time was 6.6 hours (range 0.5 to 19 hours). The mean preservation-to-surgery time was 4.1 days (range 0.5 to 15 days). Of the 147 donor eyes, 38 (26%) were imported from outside the local eyebanks region. Imported corneas were more likely to be stored for longer than 7 days, and to come from donors 70 years and older. Primary graft failure occured in both recipients from the same donor in 15% of the eyes. These corneas also tended to be stored longer than 7 days. There was no correlation between donor age and primary graft failure. Although on a statistical basis no single factor correlated with the occurrence of primary graft failure, there was some evidence that suggested that prolonged corneal storage (greater than 7 days), and advanced donor age (70 years or greater) may increase the risk of primary graft failure.
Cornea and External DiseaseAnalysis of 100 Explanted One-piece and Three-piece Silicone Intraocular Lenses Auffarth GU, Wilcox M, Sims JCR, Mccabe C, Wesendahl TA and Apple DJ. Ophthalmology , 102(8):1144-1150, 1995 Aug. 100 explanted silicone IOLs (63 three-piece and 37 one-piece plate lenses) were examined and reasons for explantation were looked at. The most frequent reason for explantation of all IOLs in this study was decentration and dislocation (42%). This was followed by inflammation (27%), and incorrect IOL power calculation (8%). The results show that there is no substantial difference between silicone and polymethylmethacrylate (PMMA) lenses in terms of reasons for explantation. Instead, the data suggests that clinical outcome is not as dependent on the type of lens selected as it is on the quality of surgery. The study also suggests that there are no major differences between three-piece IOLs with polypropylene haptics and one-piece plate haptic lens designs in terms of incidence of decentration or inflammation requiring explantation. Of interest is that YAG laser damage (sometimes extensive) was detected on the optic surfaces of 20 IOLs, many of which were mistaken by the ophthalmologist as pigment deposits. Some of these patients actually underwent extra and unnecessary YAG laser treatment for surface polishing. In summary, the results show that the most important factor ensuring safety and efficacy of foldable silicone IOLs is in-the-bag implantation using modern "capsular" surgical techniques.
Cornea and External DiseaseThe Indications for and Outcome in Pediatric Keratoplasty: A Multicenter Study Dana MR, Moyes AL, Schaumberg DA, Laibson PR, Holland EJ, Sugar A, Sugar J. Ophthalmology , vol 102(8);1129-1137, August 1995. This was a multicentered, nonrandomized, retrospective study of the results of pediatric keratoplasty (defined as keratoplasty in children 12 years of age or under) from four large academic centers in the US. During an 18 year period from 1975 to 1993, 164 keratoplasties were done in 131 eyes of 108 children. There was sufficient data to assess the final visual outcome in 84 eyes. All patients included in the study had a minimum of 6 months of postoperative follow-up. The mean postoperative follow-up was 45.4 months. Indications for keratoplasty were subdivided into three general categories: 1.)congenital opacities (64%) 2.)traumatic opacities (17%) 3.)acquired opacities (19%). Of all the eyes in the study, 55% had some form of neurocrestopathy (anterior segment dysgenesis), 16% had congenital hereditary endothelial dystrophy, 18% had a penetrating/lacerating corneal injury, and 21% had a corneal scar from some type of infectious keratitis. Sixty of the children (56%) presented with unilateral corneal opacities, while the remaining 48 presented with bilateral corneal opacities. The average preoperative visual acuity was 20/160 or better in 5%, 20/200 to counting fingers in 32%, less than counting fingers in 33%, able to fix and follow objects in 8%, and unknown in 22%. Of 131 eyes, 79% underwent a total of 1 keratoplasty, and 21 % had 2 or more keratoplasties. The age at first keratoplasty was 6 months or less in 47 eyes, 7 to 12 months in 10 eyes, with the remainder being fairly evenly distributed up to age of 12 years. Multiple preoperative, intraoperative, and postoperative variables were analyzed. At the time of last examination 19% of all keratoplasties were opaque, 19% were hazy, and 62% were clear. There was a correlation between loss of graft clarity and vitrectomy at the time of keratoplasty, and those eyes that had postoperative complications (corneal ulceration in particular). There was no correlation between loss of graft clarity and age or diagnostic category. The overall graft survival rate was 80.2% at 1 year, and 67.4% at 2 years (Kaplan-Meier survival curve). There was a significant association between decreased graft survival and vitrectomy, lensectomy, and the performanance of a third operative procedure. Eighty four eyes had adequate data to determine the visual outcome following surgery. Of the 84 eyes, 82% had vision equal to or better than preoperative levels, while 18% had worse vision. A total of 60% achieved ambulatory vision of counting fingers or better. Approximately one third of the eyes achieved 20/200 vision or better, and 21% of those eyes had 20/50 or better vision. Six eyes (7%) had no light perception, of which 4 eyes went on to develop phthisis bulbi. Poor visual outcomes were correlated with bilateral corneal disease, lack of optical correction postoperatively, vitrectomy, lack of amblyopia therapy, and associated postoperative complications.
Cornea and External DiseaseAllograft Conjunctival Transplantation for Bilateral Surface Ocular Surface Disorders. Kwitko S, Marinho D, Barcaro S, Bocaccio F, Rymer S, Fernandes S, and Neuman J. Ophthalmology , July 1995;102(7):1020-1025 This was a prospective study of 10 patients (12 eyes) that evaluated the efficacy of allograft conjunctival transplantation in severe ocular surface disease. The effect of class I & II HLA antigens on therapeutic success was evaluated retrospectively. Eight eyes received haplo-identical (50% match) HLA matched tissue (6 from siblings, 2 from parents), two eyes received HLA identical tissue from siblings, and two eyes received HLA incompatible tissue from a sibling. Therapeutic success was considered to be increased corneal clarity with decreased corneal vascularization judged by masked observers, improved visual acuity, and/or improved symptoms (ie. pain;photophobia). The surgical technique was a modification of that described by Kenyon & Tseng (Ophthalmol 96:709-723, 1989), and did not include limbal tissue. The average follow-up was 17.2 months (range: 4-22 months). Average time to complete reepithelialization was 7.8 days. Improved visual acuity, increased corneal clarity, and decreased vascularization was seen in 11 of 12 eyes (91.6%). Rejection was seen in three eye (25%) at 1, 6, & 12 months postop. Two of three cases of rejection occurred in HLA-incompatible grafts. The authors conclude that results from HLA identical and haplo-identical donor-recipient pairs were significantly better than HLA-incompatible pairs ( P = 0.022 Fisher's exact test).
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