Long-term graft survival in patients with Down syndrome after penetrating keratoplasty.

Purpose: To determine graft survival and long-term visual outcome after penetrating keratoplasty (PK) for keratoconus in patients with Down syndrome.

Methods: The records of all patients with Down syndrome who received PK by the same provider were reviewed. A retrospective analysis was performed to determine long-term graft survival, incidence of graft failure, and complication rate.

Dominant familial congenital entropion with tarsal hypoplasia and atrichosis.

Background: Congenital entropion and atrichosis of the lower eyelids associated with tarsal hypoplasia is a rare condition, with isolated reports in the literature and without previous pathologic examination.

Methods: Case report. A father and son with mild entropion, lower eyelash atrichosis, and tarsal hypoplasia are described.

Warm balanced salt solution for clearing tear film precipitation during cataract surgery.

Adequate anterior segment visualization during cataract surgery can be hindered when excessive tear film secretions precipitate on the corneal surface before the initial corneal incision is made. In most cases, room-temperature balanced salt solution applied to the corneal surface clears the debris. However, in cases in which tear film precipitates persist after the use of room-temperature balanced salt solution, the application of warm balanced salt solution can provide rapid and sustained dispersion of the precipitates.

Analysis of anterior and posterior corneal curvature changes using Orbscan technology in radial keratotomy eyes exposed to hypoxia.

Purpose: To study the changes in anterior and posterior corneal curvatures in radial keratotomy (RK) and normal eyes exposed to hypoxia using Orbscan (Bausch & Lomb) technology.

Setting: Department of Ophthalmology, Madigan Army Medical Center, Tacoma, Washington, USA.

Methods: At sea level, 11 RK subjects and 10 control subjects were exposed to ocular surface hypoxia in 1 eye by filtering humidified, compressed 100% nitrogen (0% oxygen) through an airtight goggle system for 2 hours.

Refractive changes caused by hypoxia after laser in situ keratomileusis surgery.

Objective: To determine whether hypoxia induces refractive changes in subjects who have had laser in situ keratomileusis (LASIK) refractive surgery.

Design: Prospective paired eye clinical trial.

Participants: There were 20 LASIK subjects (40 eyes) and 20 myopic non-LASIK controls (40 eyes).

Visual field defect associated with laser in situ keratomileusis.

Purpose: To report a case of visual field defect associated with laser in situ keratomileusis.

Methods: Case report. A 28-year-old woman with high myopia (-10D) and a family history of normal tension glaucoma underwent bilateral laser in situ keratomileusis keratorefractive surgery.

Monocanalicular intubation for dacryostenosis in oculo-auriculo-vertebral dysplasia (hemifacial microsomia) with congenital corneal anesthesia.

Purpose: To present a case of oculo-auriculo-vertebral dysplasia associated with corneal anesthesia and ipsilateral dacryostenosis that was successfully treated with monocanalicular lacrimal intubation.

Methods: Case report.

Results: Previous neurotrophic corneal ulcers in a child with hemifacial microsomia had become secondarily infected from a stagnant tear lake, resulting in significant corneal scarring and visual loss.

Infectious crystalline keratopathy caused by Candida guilliermondii.

Purpose: To describe the manifestations of infectious crystalline keratopathy caused by Candida guilliermondii in a corneal transplant performed for pseudophakic bullous keratopathy.

Method: Case report.

Results: Candida guilliermondii was identified as the causative organism of an indolent infectious crystalline keratopathy.

Juvenile xanthogranuloma of the iris in an adult.

Juvenile xanthogranuloma is a self-limited skin disorder of young children that uncommonly affects the eye. Juvenile xanthogranuloma has been described in adults, but reported intraocular involvement is extremely rare. We report a case of juvenile xanthogranuloma diagnosed in a 25-year-old man who was seen with nontraumatic hyphema and iridocyclitis.

The etiology of refractive changes at high altitude after radial keratotomy. Hypoxia versus hypobaria.

Objective: Refractive changes at high altitude that occur after radial keratotomy (RK) may be caused by hypoxia or hypobaria.

Design: A prospective study was performed to evaluate the effects of hypoxia on RK and non-RK corneas.

Participants: There were 20 RK and 20 control eyes.

Refractive changes during 72-hour exposure to high altitude after refractive surgery.

Purpose: The authors prospectively analyzed refractive and pachymetric parameters during exposure to high altitude after radial keratotomy (RK) and photorefractive keratectomy (PRK).

Methods: The authors measured manifest and cycloplegic refraction, keratometry, computed video keratography, and central and peripheral pachymetry in six subjects who have undergone RK (11 eyes), six who have undergone PRK (12 eyes), and nine with myopia (17 eyes) at sea level and on three consecutive days at 14,100 feet. All measurements were repeated 1 week after subjects returned to sea level.

Effects of simulated high altitude on patients who have had radial keratotomy.

Background: Previous studies documented diurnal myopic shifts in patients who have had radial keratotomy (RK). Recently, hyperopic shifts in these patients exposed to high altitude have been reported. A direct mechanical effect of reduced barometric pressure on surgically altered corneas has been theorized to cause this hyperopic shift.

Penetrating keratoplasty after radial keratotomy. A report of six patients.

Background: For more than 15 years, radial keratotomy has increased in popularity as an option for treating myopia in the United States. During this period of time, the procedure has been modified to improve results and decrease complications. Despite these changes, complications from radial keratotomy continue to occur.

Comparison of three corneal trephines for use in therapeutic penetrating keratoplasties for large corneal perforations.

Corneas with large perforations complicate penetrating keratoplasty due to the increased risk of anterior chamber collapse they pose. We hypothesize that suction trephines should produce more uniform corneal openings than non-suction trephines. Penetrating keratoplasties using Franceschetti-type freeblades, and Hanna and Hessberg-Barron suction trephines were performed on human eye bank eyes with large corneal perforations.

Refractive corneal surgery with the Draeger rotary microkeratome in human cadaver eyes.

Background: Instrumentation for performing a uniform lamellar keratoplasty has been undergoing various stages of refinement. Reliable reproduction and uniform thickness and diameter of lamellar resections is required before lamellar refractive keratoplasty can be considered safe and effective.

Methods: The authors used the Draeger rotary microkeratome with mechanical blade advance for lamellar dissections in 61 human cadaver eyes prepared by injecting Swinger-Kornmehl (SK) solution into the anterior chamber to a pressure of 35 to 40 mm Hg and by soaking for 30 minutes in SK solution.

Combined treatment of Acanthamoeba keratitis with propamidine, neomycin, and polyhexamethylene biguanide.

We developed an intensive treatment regimen of topical neomycin, propamidine, and polyhexamethylene biguanide that was tapered to a maintenance level over a 14- to 28-day period as toxicity developed. Since July 1991, we used this treatment on six eyes of five patients in whom Acanthamoeba keratitis was diagnosed clinically. All patients had positive cultures for microorganisms from their corneas or contact lens cases or had pathognomonic findings of pseudodendritic subepithelial infiltrates and radial keratone-uritis.

Peters' anomaly: a review of 26 penetrating keratoplasties in infants.

We reviewed the specimen records log of the McGee Eye Institute Histopathology Service from January 1979 to December 1990 for penetrating keratoplasty specimens submitted with a clinical diagnosis of Peters' anomaly. The records of the 19 cases thereby identified were reviewed for clinical outcome and visual rehabilitation, and the histopathology of all specimens was reviewed and correlated with the clinical diagnosis. Two specimens from the same patient were eliminated as histopathologically inconsistent with Peters' anomaly; one patient's data were not used because the patient was an adult when first grafted.

Treatment of alkali-injured rabbit corneas with a synthetic inhibitor of matrix metalloproteinases.

Healing of corneal alkali injuries remains a severe clinical challenge. The authors evaluated the effect of a new synthetic inhibitor of matrix metalloproteinases (GM6001 or N-[2(R)-2-(hydroxamido carbonylmethyl)-4-methylpentanoyl]-L-tryptophane methylamide) on preventing ulceration of rabbit corneas after alkali injury. Topical treatment of corneas with severe alkali injuries with 400 micrograms/ml or 40 micrograms/ml GM6001 alone prevented ulceration for 28 days, although 8 of 10 corneas treated with vehicle perforated.

Infectious endophthalmitis following sutureless cataract surgery.

Within the last 6 months, three cases of infectious endophthalmitis following sutureless cataract surgery have been referred to us. Two of these cases followed uncomplicated sutureless phacoemulsification with intraocular lens implantation. One case was complicated by a postoperative hyphema with additional surgery for clot removal 2 days following the initial procedure.

Does neuroretinitis rule out multiple sclerosis?

Neuroretinitis, a form of optic neuritis, is characterized by papillitis and a stellate macular exudate, or "macular star." The star implies the presence of a disc vasculopathy and secondary leakage of lipoproteinaceous material into the macula. Demyelinating optic neuritis would not be expected to produce a secondary macular exudate.