Primary graft failure associated with epithelial downgrowth: a case report

BACKGROUND: Epithelial downgrowth is a rare complication of ocular surgery. While the features of epithelial downgrowth following corneal transplantation are well described, its association with primary graft failure has only been reported once previously. We report a case of primary corneal graft failure (PGF) associated with retrocorneal epithelial cell ingrowth. CASE PRESENTATION: A 59 year-old male underwent an uncomplicated penetrating keratoplasty for Fuchs' corneal dystrophy. The patient developed PGF, and a second transplant was performed 5 weeks after the initial surgery. The initial host corneal button and the failed corneal graft were examined with light microscopy. Histopathologic examination of the excised corneal button demonstrated multilaminar epithelial cells on the posterior corneal surface and absence of endothelial cells. DNA extraction and polymerase chain reaction (PCR) for herpes simplex virus (HSV) DNA was performed on the failed corneal graft. Polymerase chain reaction performed on the failed corneal graft was negative for HSV DNA, which has been implicated in selected cases of PGF. Three years following repeat penetrating keratoplasty, there was no evidence of recurrent epithelial ingrowth. CONCLUSION: This is only the second report of PGF associated with epithelialization of the posterior corneal button, which most likely developed subsequent to, instead of causing, the diffuse endothelial cell loss and primary graft failure

Body Shaping and Volume Restoration: The Role of Hyaluronic Acid

Driven by the rising popularity of minimally invasive techniques, the demand for cosmetic procedures is increasing. Cosmetic body-shaping procedures can be categorized into those that remove tissue and those that add volume. This review focuses on the latter of these categories, particularly on the use of resorbable hyaluronic acid gels specifically developed for minimally invasive volume enhancement. Pilot studies of hyaluronic acid involving its injection to contour various body deformities and its recent use in female breast augmentation are discussed. Injectable hyaluronic acid is effective and well tolerated. It represents an attractive treatment option for volume restoration or augmentation by providing predictable long-lasting results after minimally invasive administration. Alternative treatment options for volume enhancement also are summarized including fat transfer, silicone implants, and the use of injectable nonresorbable products such as silicone, polyalkylimide, and polyacrylamide gels. As patients continue to opt for nonsurgical procedures that offer predictable results, the development of minimally invasive products such as hyaluronic acid is increasingly important

Medication Lists for Elderly Patients: Clinic-Derived Versus In-Home Inspection and Interview

OBJECTIVE: To determine how often the lists of regular medications derived in geriatric clinics by examination of “medication bags” and interview matched those found during in-home inspections and interviews. DESIGN: Prospective cross-sectional study. SETTING: Geriatric clinics at three university-affiliated hospitals. PARTICIPANTS: Consecutive community-dwelling outpatients 65 years or older who were newly referred. METHODS: The in-home medication inspection used a semistructured interview followed by a room-to-room search. The medications identified in the home were compared with the medication list derived in clinic by examination of the “medication bag” and interview. MAIN RESULTS: Fifty patients with a mean age of 78.9 years participated. The mean number of regular medications (prescription and nonprescription) was 6.3, and the mean number of regular prescription medications was 3.6. A comparison of clinic versus in-home medication lists revealed that 48% (95% confidence interval [95% CI], 34% to 62%) of patients had at least 1 omission of any regular medication and 19% (95%, CI 10% to 32%) of patients had at least 1 omission of a regular prescription medication. CONCLUSION: The clinic-derived medication list resulted in a complete listing of all regular medications in only 52% taking regular medications. More specific instructions to patients to bring all prescription and nonprescription medications and all vitamins, herbal, and natural remedies, and more directed questions by physicians may result in more complete clinic medication lists