1: Cornea. 2010 Aug;29(8):941-3. 

Paederus-induced keratitis.

Huang FC, Chen WJ, Shih MH.

From the Department of Ophthalmology, National Cheng Kung University Hospital,
Tainan, Taiwan.

PURPOSE:: To report the clinical picture and management of 4 cases of presumed
paederus-induced keratitis. METHODS:: The clinical characteristics of the
anterior segment and periocular area were presented. The outcomes and healing
course of the corneal lesions were recorded. RESULTS:: Each patient sustained an
accidental eye injury from a beetle while riding a motorcycle. Three cases were
complicated by periocular dermatitis. All patients had diffuse punctate
epithelial erosions or large epithelial defects on the unilateral cornea.
Prolonged corneal epithelialization was noted after lubrication with artificial
tears and wearing a contact lens. Reepithelialization was promoted after topical
supplementation with 20% autologous serum. All 4 patients had good visual
outcomes. Two patients healed with a faint corneal scar. CONCLUSIONS::
Paederus-induced keratitis could result in extensive involvement of the corneal
surface. Keratitis with a large epithelial defect mimicking the corrosive lesion
of a chemical burn requires aggressive therapy, such as autologous serum
combined with a bandage contact lens. Avoiding contact with the crushed body of
the beetle while rubbing the eye is mandatory to prevent this type of keratitis.

PMID: 20657212  [PubMed - in process]

2: Cornea. 2010 Jul 15; [Epub ahead of print] 

Morphometry of Corneal Epithelial Cells on Normal Eyes and After Anterior
Lamellar Keratoplasty.

Gaujoux T, Touzeau O, Laroche L, Borderie VM.

From the Department of Ophthalmology, Centre Hospitalier National
d'Ophtalmologie des XV-XX, Universite Pierre et Marie Curie, Paris, France.

PURPOSE:: To analyze morphometry of corneal epithelial cells in normal eyes and
after anterior lamellar keratoplasty (ALK) using confocal microscopy. METHODS::
This retrospective comparative case series included 29 eyes of patients who had
undergone ALK (ALK group) and 29 subjects before refractive surgery with normal
corneas (control group). The Heidelberg Retina Tomograph II with the Cornea
Module was used. Images were recorded and analyzed with Image J software.
Morphometric parameters used to analyze epithelial cells were cell area,
coefficient of variation of cell area, perimeter, circularity, and Feret
diameter. RESULTS:: Confocal microscopy was performed between 3 and 70 months
after surgery. For basal epithelial cells, no significant differences between
right eyes and left eyes were found in normal eyes for all morphometric
parameters (P < 0.05 and rs > 0.40). The mean epithelial cell area increased
during central and vertical migration (migration of epithelial cells from the
basal stratum to the outermost layer) (P < 0.001). The mean basal cell area in
the central zone was significantly higher (P < 0.001) after ALK in the ALK group
than that in the control group. After ALK, the mean basal cell area decreased
with postoperative time (rS = -0.78; P < 0.001) and returned to normal 24 months
after transplantation (P = 0.27). Comparison of both groups showed significant
differences in cell perimeter, circularity, and Feret diameter of basal cells
and intermediate cells (P PMID: 20639742  [PubMed - as supplied by publisher]

3: Cornea. 2010 Jul 12; [Epub ahead of print] 

Proposed Diagnostic Criteria for Seborrheic Meibomian Gland Dysfunction.

Arita R, Itoh K, Maeda S, Maeda K, Furuta A, Tomidokoro A, Amano S.

From the *Itoh Clinic, Saitama, Japan; daggerDepartment of Ophthalmology,
University of Tokyo School of Medicine, Tokyo, Japan; and double daggerMaeda
Ophthalmic Clinic, Fukushima, Japan.

PURPOSE:: To compare clinical findings between patients with seborrheic
meibomian gland dysfunction (MGD) and normal controls and to propose diagnostic
criteria for seborrheic MGD. METHODS:: Thirty eyes of 30 patients [13 men and 17
women; age (mean +/- SD) 73.9 +/- 9.9 years] diagnosed with seborrheic MGD and
60 eyes of 60 healthy volunteers (22 men and 38 women; age: 71.0 +/- 9.3 years)
as a control group were included in this study. Ocular symptoms were scored from
0 to 14 according to the number of symptoms present. Lid margin abnormality was
scored from 0 to 4 depending on the number of abnormalities present. Meibomian
gland changes were scored from 0 to 6 on the basis of noncontact meibography
(meiboscore). Superficial punctate keratopathy was scored from 0 to 3. Tear film
production was evaluated by Schirmer test. Receiver operating characteristic
curves with calculations of the area under the curve were used to describe the
accuracy of each parameter to differentiate patients with seborrheic MGD from
normal eyes. RESULTS:: Ocular symptom score and lid margin abnormality score
were significantly higher in the seborrheic MGD group than in the control group
(P < 0.0001 for both scores). Area under the curve values indicated that the lid
margin abnormality score had the highest diagnostic power as a single parameter
followed by the ocular symptom score. When the diagnosis for seborrheic MGD was
made on the basis of the 2 scores (ocular symptom score and lid margin
abnormality score) being abnormal, the sensitivity was 100% and the specificity
was 98.3%. CONCLUSIONS:: On the basis of these findings, we recommend that
physicians use ocular symptom score and lid margin abnormality score in the
diagnosis of seborrheic MGD. Seborrheic MGD should be considered very likely
when both of the 2 scores are abnormal.

PMID: 20628302  [PubMed - as supplied by publisher]

4: Cornea. 2010 Jul 12; [Epub ahead of print] 

Comparison of Corneal Thickness Measurements Using Galilei, HR Pentacam, and
Ultrasound.

Jahadi Hosseini HR, Katbab A, Khalili MR, Abtahi MB.

From the Department of Ophthalmology, Poostchi Ophthalmology Research Center and
Binagostar eye center, Shiraz University of Medical Sciences, Shiraz, Iran.

PURPOSE:: To assess the degrees of agreement in measuring corneal thickness in
normal eyes between 2 noncontact systems based on the dual Scheimpflug system
(Galilei; Ziemer) and rotating Scheimpflug imaging (HR Pentacam; Oculus) and
also between each of these methods and the gold-standard method of ultrasound
pachymetry. METHODS:: In a prospective study, measurement agreement was assessed
in 47 eyes of 47 healthy subjects. All eyes were examined with each of the 3
devices. Measurements made with the Galilei and HR Pentacam were compared with
those made with ultrasound. The central corneal thickness (CCT) and thinnest
pachymetry of the Galilei and HR Pentacam were also compared. RESULTS:: The mean
values of CCT obtained from Galilei, HR Pentacam, and ultrasound were 560.57 +/-
29.10, 542.31 +/- 30.50, and 548.61 +/- 29.92 mum, respectively. The 95% limits
of agreement of each of these devices with ultrasound were -11.03 and +34.94 mum
for the Galilei and -33.67 and +20.74 mum for the Pentacam. The 95% limits of
agreement of Galilei with Pentacam in measurement of central and thinnest
corneal thickness were -3.39 and +33.11 and -10.40 and +27.29 mum, respectively.
Although CCT measurements made with the HR Pentacam were thinner (P < 0.001),
and those obtained with Galilei were thicker (P < 0.001) than those made with
ultrasound, there were significant correlation between Galilei and ultrasound (r
= 0.92; P < 0.0001) and between HR Pentacam and ultrasound (r = 0.89; P <
0.0001). The central and thinnest corneal thickness measurements made with the
HR Pentacam were thinner (P < 0.0001) than those made with Galilei, but there
was a significant correlation between Galilei and HR Pentacam in measuring CCT
(r = 0.96; P < 0.0001) and thinnest corneal thickness (r = 0.95; P < 0.0001).
Bland-Altman plots showed good agreement between these methods. CONCLUSIONS::
Although differences between the devices were statistically significant, there
was good correlation and agreement between Galilei and Pentacam in measuring
central and thinnest corneal thickness. The corneal thickness measurements made
with the HR Pentacam and Galilei also showed good correlation and agreement with
those made with ultrasound.

PMID: 20628301  [PubMed - as supplied by publisher]

5: Cornea. 2010 Jul 12; [Epub ahead of print] 

Anyone for Leftovers? A Simple Method for Teaching Corneal Graft Suturing.

Gurbaxani A, Decock R.

Kent and Canterbury Hospital,Canterbury, UK.

PMID: 20628300  [PubMed - as supplied by publisher]

6: Cornea. 2010 Jul 12; [Epub ahead of print] 

Photorefractive Keratectomy With Mitomycin C After Penetrating and Lamellar
Keratoplasty.

Forseto AS, Marques JC, Nose W.

From the *Eye Clinic Day Hospital, Sao Paulo, Brazil; and daggerFederal
University of Sao Paulo-Paulista School of Medicine, Sao Paulo, Brazil.

PURPOSE:: To assess the safety and efficacy of photorefractive keratectomy with
mitomycin C (PRK-MMC) to correct refractive errors after corneal
transplantation. METHODS:: This was a prospective and noncomparative study of 36
eyes that underwent PRK-MMC after penetrating (n = 34) or lamellar (n = 2)
keratoplasty. After mechanical epithelial removal and photoablation, a sponge
with mitomycin C 0.02% was applied to the stromal bed for 1 minute. The
uncorrected and best-corrected visual acuities, refraction, and complications
were assessed. RESULTS:: The average follow-up was 16.27 +/- 8.38 months (range,
6-30.5 months). The spherical equivalent decreased from -3.95 +/- 4.11 to -1.07
+/- 1.45 diopters (D) postoperatively (P < 0.001). The mean preoperative
astigmatism was 4.42 +/- 1.69 D (range, 1.00-7.25 D); however, surgical
correction was limited to 6.00 D. Vector analysis of astigmatic correction
showed an index of success of 55%. At the last follow-up, 41.7% (n = 15) and
61.1% (n = 22) of the eyes were within +/-0.50 and +/-1.00 D of emmetropia,
respectively. Nineteen eyes (52.8%) achieved an uncorrected visual acuity of
20/40 or better. The best-corrected visual acuity remained within 1 line of the
preoperative values in 26 cases (72.2%), improved in 8 (22.2%), and decreased in
2 (5.6%). Endothelial cell decompensation was observed in 1 eye (2.8%) 11 months
postoperatively, and haze developed in 3 cases (8.3%). CONCLUSIONS:: PRK-MMC may
be an option to correct refractive errors after keratoplasty. A low preoperative
endothelial cell count and haze may affect the safety outcomes.

PMID: 20628299  [PubMed - as supplied by publisher]

7: Cornea. 2010 Jul 12; [Epub ahead of print] 

Epithelial Downgrowth After Descemet Stripping Automated Endothelial
Keratoplasty.

Gorovoy MS, Ratanasit A.

From the Private Practice at Gorovoy MD Eye Specialists, Fort Myers, FL.

PURPOSE:: To report the clinical and histological findings of a single patient
who developed late epithelial downgrowth of donor origin after Descemet
stripping automated endothelial keratoplasty (DSAEK). METHODS:: A 70-year-old
woman underwent uneventful DSAEK for Fuchs dystrophy in the right eye. The donor
had a thickened graft edge for 2 clock hours laterally. She recovered 20/40
vision by 3 months after operation and was maintained on daily prednisolone
acetate drops. Three years postoperatively, a routine examination revealed signs
of an asymptomatic epithelial downgrowth exhibited by synechiae and ectropion
uvea at the area of the thickened donor edge. Six months later, a faint
retrocorneal membrane limited to the donor periphery and contiguous with the
thick edge was noted. Visual acuity and intraocular pressure remained unchanged.
She was followed for the next 15 months, without intervention until the
retrocorneal membrane grew centrally, resulting in graft edema. The iris
synechiae remained unchanged. Repeat DSAEK, without iridectomy, was performed
with confirmation of epithelial downgrowth of donor origin. Six months
postoperatively, the patient has done well without sequela of residual
downgrowth. RESULTS:: Histopathological evaluation showed epithelial downgrowth,
emanating from thickened donor edge onto the posterior graft surface. The
anterior donor surface (interface) was devoid of downgrowth. X and Y DNA
analysis confirmed the downgrowth of male origin (donor) in this female patient.
CONCLUSIONS:: Donor-derived epithelial downgrowth can occur after DSAEK.
Although it can result in graft failure, it behaves much less aggressively than
expected and observation may be indicated until symptomatic graft edema occurs.
Repeat DSAEK, not penetrating keratoplasty, may be curative.

PMID: 20628298  [PubMed - as supplied by publisher]

8: Cornea. 2010 Jul 12; [Epub ahead of print] 

Severe Keratopathy in Patients With AIDS With Undiagnosed Lagophthalmos.

Nunez Perez J, Romera Becerro MA, Gracia Martinez J, Bulnes OA.

From the Ophthalmology Department, Hospital Parc Tauli, Institut Universitari
Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.

PURPOSE:: To report 2 cases of severe keratopathy in patients with AIDS with
delayed diagnosis of lagophthalmos. METHODS:: Observational case report.
RESULTS:: The first patient presented with a corneal abscess attributed to old
trauma. He responded poorly to topical treatment and suffered corneal
penetration. Penetrating keratoplasty was performed, but persistent epithelial
defects appeared. Finally, occult lagophthalmos was discovered. Topical ocular
lubrication, eye occlusion, and lateral tarsorrhaphy were insufficient, and the
graft became conjunctivalized. The second patient had corneal opacity and severe
pannus in his right eye and mild punctate keratopathy in his left eye. The left
cornea worsened despite treatment with lubricants. In an examination 2 weeks
later, we detected a subtle lagophthalmos, which was complicated by upper eyelid
retraction in the right eye. A bilateral upper blepharotomy improved the
keratopathy. CONCLUSIONS:: Patients with AIDS with severe weight loss can
present with lagophthalmos because of adipose and muscular atrophy in the
so-called wasting syndrome. Lagophthalmos in patients with AIDS can be difficult
to detect. Clinically significant lagophthalmos is associated with ocular
surface lesions in patients with AIDS with wasting syndrome.

PMID: 20628297  [PubMed - as supplied by publisher]

9: Cornea. 2010 Jul 12; [Epub ahead of print] 

In Vivo Imaging of the Cornea in a Patient with Lecithin-Cholesterol
Acyltransferase Deficiency.

Palmiero PM, Sbeity Z.

Department of Ophthalmology, Westchester Medical Center, New York Medical
College, Valhalla, New York, Department of Ophthalmology, Evangelic Hospital
Mulheim-Ruhr, University of Dusseldorf, Dusseldorf, Germany.

PMID: 20628296  [PubMed - as supplied by publisher]

10: Cornea. 2010 Jul 12; [Epub ahead of print] 

Interstitial Keratitis Secondary to Severe Hidradenitis Suppurativa: A Case
Report and Literature Review.

Alzaga Fernandez AG, Demirci H, Darnley-Fisch DA, Steen DW.

From the Department of Ophthalmology, Henry Ford Health System, Detroit, MI.

PURPOSE:: To report a patient who presented with bilateral interstitial
keratitis in association with severe hidradenitis suppurativa. METHODS:: Case
report. RESULTS:: An 18-year-old African American woman with severe active
hidradenitis suppurativa of the axillae and groin presented with a 2-week
history of bilateral blurry vision. On examination, best-corrected visual acuity
was counting fingers in the right eye and 20/70 in the left eye. Slit-lamp
examination revealed diffuse vascularization of the corneal stroma with
surrounding infiltrates bilaterally. In the left eye, corneal thinning and an
epithelial defect were present in an area of infiltrate. Our clinical impression
at that time was bilateral interstitial keratitis with secondary bacterial
keratitis in the left eye. Topical therapy, prednisolone acetate 1% in the right
eye, and ofloxacin in the left eye, was instituted. A systemic workup, including
antinuclear antibody, rheumatoid factor, Lyme titer, cytoplasmatic staining
antineutrophil cytoplasmic antibodies, perinuclear staining antineutrophil
cytoplasmic antibodies, erythrocyte sedimentation rate, Venereal Disease
Research Laboratory, rapid plasma reagin, basic metabolic panel,
angiotensin-converting enzyme level, and a chest x-ray was negative. Topical
steroids were used in the left eye after resolution of the bacterial keratitis.
The interstitial keratitis responded to topical steroids and remained in
remission after steroid taper. However, bilateral interstitial keratitis
recurred coincident with a severe flare of hidradenitis suppurativa within 1
month of discontinuing the topical steroids. A course of subcutaneous adalimumab
injections (40 mg/mL every 2 weeks) for hidradenitis suppurativa was
implemented. Both her dermatological and ocular conditions responded to this
therapy and have remained in remission through 7 months of follow-up.
CONCLUSIONS:: Hidradenitis suppurativa is a rare cause of bilateral interstitial
keratitis. Patients may experience simultaneous exacerbations of both
dermatological and ocular manifestations. Systemic treatment with adalimumab can
improve both dermatological and ocular conditions.

PMID: 20628295  [PubMed - as supplied by publisher]

11: Cornea. 2010 Jul 12; [Epub ahead of print] 

In Vivo Imaging of the Cornea in a Patient With Lecithin-Cholesterol
Acyltransferase Deficiency.

Lisch W, Saikia P.

Department of Ophthalmology, Klinikum Hanau, Hanau, Hessen, Germany.

PMID: 20628294  [PubMed - as supplied by publisher]

12: Cornea. 2010 Jul 9; [Epub ahead of print] 

Castroviejo Lecture 2009: 40 Years in Search of the Perfect Contact Lens.

Cavanagh HD, Robertson DM, Petroll WM, Jester JV.

From the *Department of Ophthalmology, University of Texas Southwestern Medical
Center, Dallas, TX; and daggerDepartment of Ophthalmology, University of
California School of Medicine at Irvine, Irvine, CA.

PURPOSE:: To identify the pathophysiological changes produced by contact lens
wear that predispose the cornea to infection and search for prospective
modifiable risk factors that could reduce the incidence of this critical
complication in millions of patients worldwide. METHODS:: Significant
experimental and clinical publications are reviewed, and the results of ongoing
studies are presented. RESULTS:: Pseudomonas aeruginosa (PA) is the most common
pathogen causing lens-related infectious keratitis over 3 decades. Contact lens
wear can increase the risk of infection by increasing surface cell PA binding,
thereby promoting invasion between broken tight junctions and initiating direct
intracellular invasion mediated by lens-induced membrane lipid rafts. Prevention
of upregulation of specific surface-binding receptors for PA with concomitant
increase in infection risk is a zero damage game where independent interactions
among lens type, mode of wear, oxygen transmissibility, polymer, and toxic
effects of associated care solutions ideally should collectively produce no
increased ability for PA to attach and/or to invade, thus minimizing the risk
for lens-associated infections. The specific hypothesis tested is, "no increased
epithelial surface damage...no increased PA binding or invasion...no increased
risk for infection." Testing of this new paradigm has been performed in vitro
and in animal and human clinical trials and correlated clinically with relative
risk results from robust current epidemiological studies. Results to date
clearly support the use of lens-related increases in PA binding (bench) as a
noninvasive clinical predictor of risk for lens-related infection in subsequent
large-scale population studies (bedside). Currently, results suggest that use of
common commercial multipurpose lens care solutions with soft lenses may alone
significantly increase infection risk by enhancing lens-related PA binding as
compared with use of nonpreserved solutions (hydrogen peroxide). Clinical
testing also shows that only peroxide solutions show significant disinfection
capability against amoebic cysts. Further case-control studies to examine
relative risk for infection by lens type and lens care solution are urgently
needed. CONCLUSIONS:: Millions of patients are dependent on contact lenses for
vision worldwide; over 3 decades, lens use has increased, although risk for
lens-related infection has remained stubbornly unchanged. Unfortunately, recent
introduction of a new generation of hyper-oxygen transmissible lenses used with
traditional multipurpose lens care solutions has not lowered overall risks for
lens-related infections; however, similar lenses used with nonpreserved care
solutions (peroxide) recently demonstrated no significant increases in PA
binding in a 1-year clinical trial. Collectively, these findings along with the
urgent need for amoebic cysticidal disinfection have led to a current
recommendation to patients to use nonpreserved (hydrogen peroxide) care
solutions in soft lens wear.

PMID: 20622672  [PubMed - as supplied by publisher]

13: Cornea. 2010 Jul 9; [Epub ahead of print] 

Phototherapeutic Keratectomy in Pediatric Patients in India.

Rathi VM, Vyas SP, Vaddavalli PK, Sangwan VS, Murthy SI.

From the *Cornea and Refractive Surgery Services, L V Prasad Eye Institute,
Hyderabad, Andhra Pradesh, India; and daggerCornea and Refractive Surgery
Services, Choithram Netralaya, Indore, Madhya Pradesh, India.

PURPOSE:: To study the outcome of phototherapeutic keratectomy (PTK) in children
younger than 16 years, with corneal scars, dystrophies, and band-shaped
keratopathy. METHODS:: Records of 18 eyes of 14 patients younger than 16 years
who had undergone PTK were retrospectively reviewed. Pre- and post-PTK visual
acuity, corneal clarity, and need for additional surgery were noted. Flying spot
and broad beam laser machines were used for PTK. RESULTS:: PTK was performed on
18 eyes of 14 patients; PTK was performed to treat scars (n = 8 eyes),
band-shaped keratopathy (n = 5 eyes), and granular dystrophy (n = 5 eyes) for
reduced vision. In addition, 1 patient had irritation, watering, and
photophobia. All these patients had a clear visual axis after PTK. Refraction
was possible only in 6 eyes before PTK; with increased clarity of the visual
axis, it was possible in 15 patients after PTK. Before PTK, mean best-corrected
logarithm of minimum angle of resolution visual acuity (Snellen equivalent) was
1.13 (20/250) and SD 0.92 (20/160); after PTK, it was 0.47 (20/60) and SD 0.37
(20/50) (P = 0.001). The primary disease recurred in 3 patients: granular
dystrophy in 2 eyes, and scar along with Salzmann nodular degeneration in 1 eye.
PTK was repeated in all 3 with good visual and symptomatic outcomes. None of
these patients had infection or raised intraocular pressure. CONCLUSIONS:: PTK
is a safe and effective procedure in children. After PTK, corneal clarity is
enhanced, facilitating accurate refraction and leading to improved visual acuity
in most eyes. PTK can be safely repeated in case of recurrence.

PMID: 20622671  [PubMed - as supplied by publisher]

14: Cornea. 2010 Jul 9; [Epub ahead of print] 

Impression Cytologic Analysis After Corneal Collagen Cross-Linking Using
Riboflavin and Ultraviolet- A Light in the Treatment of Keratoconus.

Renesto AD, Barros JD, Campos M.

From the Vision Institute, Department of Ophthalmology, Federal University of
Sao Paulo, Sao Paulo, Brazil.

PURPOSE:: To report impression cytologic (IC) results after corneal
cross-linking (CXL) using riboflavin and ultraviolet-A light in the treatment of
keratoconus and compare the data with those from a group of subjects with the
same disease. METHODS:: Forty eyes were distributed into 2 groups: patients in
group 1 underwent CXL, whereas patients in group 2 received riboflavin 0.1%
eyedrops for 1 month of topical use. IC specimens were obtained from all eyes
before treatment and 1 and 3 months after treatment. RESULTS:: Patients in group
1 showed a decrease in goblet cell density on the superior conjunctiva after CXL
(P = 0.008) but no difference on the temporal conjunctiva or in the cornea.
Patients in group 2 demonstrated improvement in cell-to-cell contact of
epithelial cells and reduced keratinization on the temporal conjunctiva after
treatment (P = 0.003 and P = 0.034, respectively) but no changes on the superior
conjunctiva or in the cornea. Fisher exact test comparison of IC total scores
after treatment revealed no difference between groups. CONCLUSIONS:: Despite
changes in goblet cell density after corneal CXL in the superior conjunctiva and
an improvement in the morphology of epithelial cells after the use of riboflavin
eyedrops, comparison of total IC scores showed no difference between groups.

PMID: 20622670  [PubMed - as supplied by publisher]

15: Cornea. 2010 Jul 9; [Epub ahead of print] 

Management of Nontraumatic Corneal Perforation With Tectonic Drape Patch and
Cyanoacrylate Glue.

Khalifa YM, Bailony MR, Bloomer MM, Killingsworth D, Jeng BH.

From the *Department of Ophthalmology, University of California, San Francisco,
CA; daggerDepartment of Ophthalmology, San Francisco General Hospital, San
Francisco, CA; double daggerFrancis I. Proctor Foundation, University of
California, San Francisco, CA; section signMedical College of Georgia, Augusta,
GA; and paragraph signVeterans Affairs Medical Center, Augusta, GA.

PURPOSE:: To report a case of nontraumatic corneal perforation managed with a
tectonic drape patch. METHODS:: Interventional case report. RESULTS:: A
60-year-old patient with a corneal scar in his left eye likely secondary to
herpes simplex virus interstitial keratitis underwent laser peripheral iridotomy
for narrow angles. He developed progressive thinning of the cornea overlying the
scar that led to a descemetocele and then ultimately a 1.2- x 1.7-mm
perforation. Intraoperatively, several attempts were made to seal the
perforation with cyanoacrylate glue, but the wound continued to leak. Sterile
plastic drape that was on the surgical field was fashioned into a 2-mm-diameter
patch, and the peripheral edge of the tectonic drape patch was glued over the
perforation, successfully sealing the cornea. One week later, the drape patch
was intact without leak, and a penetrating keratoplasty was carried out without
complication. CONCLUSIONS:: Tectonic drape patch technique for nontraumatic
corneal perforations in which there is tissue loss is a viable temporizing
option when cyanoacrylate glue alone fails and when there is no corneal tissue
or amniotic membrane available to close the wound.

PMID: 20622669  [PubMed - as supplied by publisher]

16: Cornea. 2010 Jul 9; [Epub ahead of print] 

Intraductal Meibomian Gland Probing Relieves Symptoms of Obstructive Meibomian
Gland Dysfunction.

Maskin SL.

From the The Dry Eye and Cornea Treatment Center, Tampa, FL. 33609.

PURPOSE:: To perform a retrospective evaluation of a new treatment for
obstructive meibomian gland dysfunction (O-MGD) using invasive orifice
penetration and intraductal probing. SETTING:: Office-based ophthalmology
private practice. METHODS:: Medical charts of 25 consecutive patients with O-MGD
(based on presence of lid margin or tarsal hyperemia, lid margin telangiectasia,
thickening or irregularity, and meiboman gland orifice metaplasia) plus lid
tenderness or symptoms of lid margin congestion were reviewed to evaluate the
effect of probing on tenderness and congestion. RESULTS:: Twenty-four of 25
patients (96%) had immediate postprobing relief, whereas all 25 patients (100%)
had relief of symptoms by 4 weeks after procedure. Twenty patients (80%) only
required 1 reatment and had an average of 11.5-month follow-up. Five patients
(20%) had retreatment at an average of 4.6 months. All patients had symptom
relief at time of last follow-up. Of 56 symptomatic and treated lids, 42 (75%)
were upper lids. Patients frequently reported improvement in newly recognized
but previously subclinical symptoms. CONCLUSIONS:: Invasive orifice penetration
and intraductal probing seems to provide lasting rapid symptom relief for
patients with O-MGD. Probing findings in this study frequently included (1) mild
resistance upon orifice penetration, (2) proximal duct gritty tactile and aural
sensation suggestive of keratinized cellular debris, and (3) focal variable
resistance deeper within the duct, which may be relieved with the probe,
suggestive of fibrovascular tissue. Taken together, these findings may offer
probing characteristics that may allow for a grading system for duct
obstruction. The postprobing improvement of symptoms not previously appreciated
supports the notion that meibomian gland disease exists subclinically.

PMID: 20622668  [PubMed - as supplied by publisher]

17: Cornea. 2010 Jun 30; [Epub ahead of print] 

Combined Phototherapeutic Keratectomy and Amniotic Membrane Grafts for
Symptomatic Bullous Keratopathy.

Mannan R, Pruthi A, Rampal U.

>*Department of Ophthalmology Baba Deep Singh Charitable Hospital Amritsar,
Punjab, India; daggerGovernment Medical College Amritsar, Punjab, India.

PMID: 20595900  [PubMed - as supplied by publisher]

18: Cornea. 2010 Jun 30; [Epub ahead of print] 

In Vitro Susceptibility Patterns of Methicillin-Resistant Staphylococcus aureus
and Coagulase-Negative Staphylococcus Corneal Isolates to Antibiotics.

Elsahn AF, Yildiz EH, Jungkind DL, Abdalla YF, Erdurmus M, Cremona FA, Rapuano
CJ, Hammersmith KM, Cohen EJ.

From the *Department of Ophthalmology, Cornea Service, Wills Eye Institute; and
daggerDepartments of Pathology, Anatomy and Cell Biology, Jefferson Medical
College, Thomas Jefferson University, Philadelphia, PA.

PURPOSE:: To determine the in vitro susceptibility of methicillin-resistant
Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative
Staphylococcus (MRCNS) isolates to various antibiotics. METHODS:: All cases of
bacterial keratitis caused by Staphylococcus species during 2006 and 2007 were
identified. The isolates were divided according to species and susceptibility to
methicillin into 4 groups: methicillin-susceptible S. aureus,
methicillin-susceptible coagulase-negative Staphylococcus, MRSA, and MRCNS.
Routine susceptibility testing for Staphylococcus species to methicillin and 19
other antibiotics was performed using the MicroScan POS Breakpoint Combo Panel
Type 20. RESULTS:: One hundred fifty-seven isolates were identified. Forty
isolates were S. aureus, including 21 MRSA, and 117 isolates were
coagulase-negative Staphylococcus, including 29 MRCNS. All MRSA isolates were
susceptible to gentamicin, linezolid, rifampin, tetracycline, and vancomycin and
were resistant to penicillin, cefazolin, cefepime, azithromycin, erythromycin,
and ofloxacin. Ninety percent of MRSA isolates were resistant to
fourth-generation fluoroquinolones. All MRCNS isolates were susceptible to
vancomycin, chloramphenicol, linezolid, and rifampin and were resistant to
penicillin, cefazolin, cefepime, and azithromycin. Sixty-five percent of the
MRCNS isolates were susceptible to fourth-generation fluoroquinolones and
gentamicin. CONCLUSIONS:: All MRSA and MRCNS isolates were sensitive to
vancomycin, linezolid, and rifampin. MRSA isolates were generally sensitive to
gentamicin and tetracycline and resistant to fourth-generation fluoroquinolones.
MRCNS isolates were not consistently sensitive to gentamicin, tetracycline, or
fourth-generation fluoroquinolones.

PMID: 20595899  [PubMed - as supplied by publisher]

19: Cornea. 2010 Jun 30; [Epub ahead of print] 

Combined Amniotic Membrane Transplantation With Phototherapeutic Keratectomy for
Symptomatic Bullous Keratopathy.

Vyas S, Rathi V.

*Choithram Netralaya; daggerL.V. Prasad Eye Institute Hyderabad, India.

PMID: 20595898  [PubMed - as supplied by publisher]

20: Cornea. 2010 Jun 30; [Epub ahead of print] 

New Treatment Option for Adult-Onset Limbal Xanthogranuloma.

Mocan MC, Bozkurt B, Orhan D, Kuzey G, Irkec M.

*Department of Ophthalmology, Hacettepe University, School of Medicine, Ankara,
Turkey; daggerDepartment of Ophthalmology, Selcuk University, Konya, Turkey;
Departments of double daggerPediatrics and section signPathology, Hacettepe
University, School of Medicine, Ankara, Turkey.

PMID: 20595897  [PubMed - as supplied by publisher]

21: Cornea. 2010 Jun 30; [Epub ahead of print] 

Juvenile Xanthogranuloma of the Corneal Limbus. Report of 2 Cases and Review of
the Literature.

Hermel M, Donner A, Remky A.

*Department of Ophthalmology and daggerInstitute of Pathology, RWTH Aachen
University, Aachen, Germany.

PMID: 20595896  [PubMed - as supplied by publisher]

22: Cornea. 2010 Jun 30; [Epub ahead of print] 

Nerve Growth Factor in the Developing and Adult Lacrimal Glands of Rat With and
Without Inherited Retinitis Pigmentosa.

Muzi S, Colafrancesco V, Sornelli F, Mantelli F, Lambiase A, Aloe L.

From the *Institute of Neurobiology and Molecular Medicine, National Research
Council (CNR), Rome, Italy; daggerIRCCS-Bietti Foundation, Rome, Italy; and
double daggerDepartment of Ophthalmology, University of Rome "Campus
Bio-Medico," Rome, Italy.

PURPOSE:: In the present study, we investigated lacrimal function and presence
of the neurotrophin nerve growth factor (NGF) and its receptors in the lacrimal
gland (LG) of normal rats and rats with inherited retinitis pigmentosa (IRP).
MATERIALS AND METHODS:: After anesthesia, modified Schirmer tests were performed
on IRP rats and Sprague Dawley (SD) rats to measure tear function. LGs of
developing and adult IRP and SD rats were removed and used for histological,
immunohistochemical, and biochemical analyses. RESULTS:: The results showed that
basal tear secretion is reduced in IRP rats as compared with SD rats. NGF and
NGF receptors are expressed in the LG of both rat strains. In SD rats, these NGF
markers are low during early life and more elevated in adult life. Conversely in
rats with IRP, NGF and its receptors decreased in adult life. CONCLUSIONS:: The
role of NGF in maintaining ocular surface integrity is well known. The
observations of this study further support the hypothesis that neurotrophins
play a role in modulating tear secretion and probably in preventing the
deleterious effects of dry eye. This hypothesis is presented and discussed.

PMID: 20595895  [PubMed - as supplied by publisher]

23: Cornea. 2010 Jun 30; [Epub ahead of print] 

Four Cases of Acanthamoeba Keratitis Treated With Phototherapeutic Keratectomy.

Kandori M, Inoue T, Shimabukuro M, Hayashi H, Hori Y, Maeda N, Tano Y.

From the Department of Ophthalmology, Osaka University Medical School, Suita,
Japan.

PURPOSE:: To report 4 cases of Acanthamoeba keratitis treated with excimer laser
phototherapeutic keratectomy (PTK) and to discuss the clinical efficacy of this
procedure. METHODS:: Four cases with early stage Acanthamoeba keratitis
resistant to medical amoebic therapy for at least 1 week and with an enlarged
abscess underwent PTK. RESULTS:: After PTK, the infected corneal lesions were
removed and the clinical symptoms rapidly resolved in all cases. Another 40-mum
ablation was required as a result of the 1-week delay in performing PTK. There
was no recurrence during the postoperative period. CONCLUSION:: When lesions are
limited to about one third of the superficial corneal stromal layer, PTK could
be the most beneficial option for treating Acanthamoeba keratitis, resistant to
medical amoebic therapy using chlorhexidine or polyhexamethylene biguanide,
because of direct removal of resistant amoebic cysts and better visual recovery
without irregular astigmatism.

PMID: 20595894  [PubMed - as supplied by publisher]

24: Cornea. 2010 Jun 30; [Epub ahead of print] 

Comparison of Accuracy of Intraocular Lens Calculations Using Automated
Keratometry, a Placido-Based Corneal Topographer, and a Combined Placido-Based
and Dual Scheimpflug Corneal Topographer.

Shirayama M, Wang L, Koch DD, Weikert MP.

From *Department of Ophthalmology, Baylor College of Medicine, Houston, TX; and
daggerDepartment of Ophthalmology, University of Tokyo, Tokyo, Japan.

PURPOSE:: To compare the accuracy of intraocular lens (IOL) power calculations
with automated keratometry, a Placido-based corneal topographer, and a combined
Placido-based and dual Scheimpflug corneal topographer. METHODS::
Retrospectively, 75 eyes of 62 patients who had phacoemulsification with
implantation of the SN60WF IOL were analyzed. Corneal powers were measured using
5 techniques: (1) automated keratometry (AutoK, IOL Master), (2) simulated
keratometry from the Placido-based corneal topographer (SimKP, Atlas), (3)
simulated keratometry from the combined Placido-based and dual Scheimpflug
corneal topographer (SimKP+DS, Galilei), (4) total corneal power of the steep
and flat meridians over a central 1.0-4.0 mm zone using ray tracing
(TCPMeridian, Galilei), and (5) TCP over the central 4.0-mm zone by ray tracing
(TCPCentral, Galilei). For each IOL implanted, prediction errors were determined
by comparing the predicted refractions calculated with the Holladay 1 formula to
the actual refraction that was obtained 3-4 weeks postoperatively. The surgeon
factor was optimized for each method of corneal power measurement. The accuracy
of IOL power calculation using these corneal powers was determined by
calculating the mean absolute prediction error (MAE) and the percentage of eyes
with prediction errors within 0.5, 1.0, and 1.5 diopters (D). RESULT:: The MAEs
were 0.37, 0.39, 0.39, 0.41, and 0.42 D for the AutoK, SimKP, SimKP+DS,
TCPMeridian, and TCPCentral methods, respectively. There were no significant
differences among groups. Over 93% of eyes had MAEs within 1.0 D for all methods
of corneal power measurement. CONCLUSIONS:: The accuracy of IOL power
calculation was comparable with AutoK, the Placido-based corneal topographer,
and the combined Placido-based and dual Scheimpflug corneal topographer.

PMID: 20595893  [PubMed - as supplied by publisher]

25: Cornea. 2010 Jun 30; [Epub ahead of print] 

Infectious Crystalline Keratopathy Treated With Intrastromal Antibiotics.

Khan IJ, Hamada S, Rauz S.

From the Academic Unit of Ophthalmology, School of Infection and Immunity,
College of Medical and Dental Sciences, University of Birmingham, Birmingham and
Midland Eye Centre, Birmingham, United Kingdom.

An 84-year-old white female with nonprogressive conjunctival scarring developed
infectious crystalline keratopathy (ICK) recalcitrant to topical therapy. After
determination of the causative organism's antibiotic sensitivities, superficial
keratectomy was performed with intrastromal corneal infiltration of cefuroxime
into the affected cornea. Postoperatively, the ICK resolved completely, leading
to an improvement in visual acuity and a reduction in ocular irritation. This
case highlights the importance of a surgical approach in ICK and also
demonstrates the possible benefit of a novel use of intracorneal antibiotics as
an adjunct.

PMID: 20595892  [PubMed - as supplied by publisher]

26: Cornea. 2010 Jun 30; [Epub ahead of print] 

A 10.0-mm Posterior Lamellar Graft for Bullous Keratopathy in a Buphthalmic Eye.

Unterlauft JD, Weller K, Geerling G.

From the University Eye Hospital, Julius-Maximilians-University Wuerzburg,
Wuerzburg, Germany.

PURPOSE:: To report a case of Descemet stripping endothelial keratoplasty (DSEK)
with a large posterior lamellar graft for the treatment of bullous keratopathy
secondary to congenital glaucoma. METHODS:: Bullous keratopathy secondary to
unilateral congenital glaucoma with buphthalmos in a 36-year-old man was treated
with DSEK. A Descemet endothelium lamella of 10-mm diameter was excised by
descemetorhexis. A regular sclerocorneal donor button of 12-mm diameter was
manually split using the Melles technique, and a 10-mm diameter donor graft was
punched. The graft was implanted as a folded "Taco" into the anterior chamber
using forceps and fixed to the host bed using an intracameral air bubble.
RESULTS:: Immediately after DSEK, the graft showed a small peripheral dehiscence
of 1 x 3 mm, which resolved within 2 days. During 30 months of follow-up, the
endothelial graft remained well centered, clear, and without any signs of graft
rejection. Visual acuity improved from perception of hand movement before
operation to 0.2 at 30 months after DSEK. Endothelial cell loss was 33% at 18
months, 44% at 24 months, and 47% at 30 months after operation. Maximum
intraocular pressure was 15 mm Hg preoperatively and 16 mm Hg at the last
follow-up. CONCLUSION:: DSEK using a corneal graft of 10.0-mm diameter obtained
from a normal-sized donor button can be performed safely and effectively in
cases of unilateral buphthalmos and secondary corneal decompensation, where a
large recipient cornea requires an equivalently sized graft and transplantation
of large amounts of donor endothelium.

PMID: 20595891  [PubMed - as supplied by publisher]