Papanicolaou Cytology in the Diagnosis and Management of External Ocular Tumors

•nicolaou smear cytology is a simple diagnostic procedure for the evalevaluatiouationment of external ocularsions. A variety of benign and neoplastic lesions are examined for correlationclinical, cytolhistologic impressions. Accurate correlation in 38 of 41 eyes substantiates the reliability of Papanicolaou smear cytology to differentiategn from neoplastic ocular lesions. Cytology proved useful in the preoperative evaluation of squamous cell carcinoma and related tumors of the conjunctiva,gnant melanoma of the conjunctiva. Cytology also was valuable in the detection of tumor recurrence in squamous cell carcinoma and carcinomain-situ conjunctiva, and in Meibomian gland carcinoma of the eyelid. The accessibility of ocular tumors makes them particularly well suited for cytologic examination

Bacterial Endophthalmitis Resulting from Radial Keratotomy

Staphylococcus epidermidis endophthalmitis developed nine days after surgery in a 47-year-old man who underwent a 16-incision radial keratotomy during which the cornea was inadvertently perforated. The anterior chamber showed marked cellular reaction and flare and there was a 5% hypopyon inferiorly. There was also a marked cellular reaction in the vitreous, which contained many fluffy white balls. Visual acuity decreased to counting fingers at 1 foot. A pars plana vitrectomy and intraocularly, periocularly, intravenously, and topically administered antibiotics resulted in recovery of the visual acuity to 6/9 (20/30)

Management of Infectious Endophthalmitis

Diagnostic anterior chamber and vitreous aspiration confirmed an infectious etiology in 78 of 140 eyes (56%) with suspected endophthalmitis. In 27 eyes the vitreous aspirate was positive, while the anterior chamber aspirate was negative. Intraocular antibiotics were used in 88 eyes including 50 which underwent therapeutic vitrectomy. Vision of 20/20 to 20/400 was achieved in 57% of recently operated, culture-positive eyes treated with intraocular antibiotics, and in 59% of those treated with combined vitrectomy and intraocular antibiotics

Late Onset Endophthalmitis Associated with Filtering Blebs

Thirty-six cases of late onset endophthalmitis in patients with filtering blebs are presented. Onset of endophthalmitis ranged from 4 months to 60 years after bleb formation. Possible contributing factors could be identified only in a minority of patients. Aqueous, vitreous or both were cultured in all cases. Eighty-three percent of eyes were culture positive. Streptococci were the most frequent causative organisms, isolated from 57% of culture positive eyes. Twenty-three percent of eyes grew Hemophilus influenzae. Only two cases were caused by staphylococci. In general, the visual outcome was poor, probably primarily due to the virulence of the infecting organisms. Endophthalmitis remains a risk even many years after creation of a filtering bleb. The microbiologic spectrum in this clinical setting is considerably different from that of recent postoperative endophthalmitis. Based on the bacteriology and clinical course of the patients presented, recommendations for management are discussed

Chronic Conjunctivitis Associated With 'Floppy Eyelids'

• The floppy eyelid syndrome represents a chronic conjunctivitis characterized by a triad of (1) a loose upper lid that readily everts on elevating the lid, (2) a soft rubbery tarsus that can be folded on itself, and (3) a diffuse papillary conjunctivitis. Seven cases of this condition are reported, all involving men, and four involving obese patients

Corneal Ulcer Due to Listeria monocytogenes

We present a patient with a corneal ulcer due to Listeria monocytogenes, which has not previously been considered to be a feature of human listeriosis. The ulcer responded to topical and subconjunctival gentamicin and cephaloridine. Subsequent management was complicated by the development of a fibrinous pupillary membrane leading to pupillary block requiring iridotomy and later vitrectomy with trabeculectomy. Listeria monocytogenes may be confused with diphtheroid contaminants seen in corneal ulcer scrapings and is probably underreported as a cause for microbial keratitis

Snailtracks of the Corneal Endothelium

An unusual pattern of corneal endothelial cell alterations has been observed at the slitlamp in eyes following intraocular surgery. Because of their appearance, we have called these changes “snailtracks.” We have commonly seen these snailtracks following extracapsular cataract extraction. Similar changes have been noted in cadaver corneas stored in McCarey-Kaufman (M-K) medium. This study presents information which suggests that these changes represent corneal endothelial cell damage

Results of the Prospective Evaluation of Radial Keratotomy (PERK) Study One Year After Surgery

The Prospective Evaluation of Radial Keratotomy (PERK) study is a nine-center, self-controlled clinical trial of a standardized technique of radial keratotomy in 435 patients who had physiologic myopia with a preoperative refraction between −2.00 and −8.00 diopters. The surgical technique consisted of eight incisions using a diamond micrometer knife with blade length determined by intraoperative ultrasonic pachymetry and the diameter of central clear zone determined by preoperative refraction. At one year after surgery, myopia was reduced in all eyes; 60% were within ±1.00 diopter of emmetropia; 30% were undercorrected and 10% were overcorrected by more than 1.00 diopter (range of refraction, −4.25 to +3.38 D). Uncorrected visual acuity was 20/40 or better in 78% of eyes. The operation was most effective in eyes with a refraction between −2.00 and −4.25 diopters. Thirteen percent of patients lost one or two Snellen lines of best corrected visual acuity. However, all but three eyes could be corrected to 20/20. Ten percent of patients increased astigmatism more than 1.00 diopter. Disabling glare was not detected with a clinical glare tester, but three patients reduced their driving at night because of glare. Between six months and one year, the refraction changed by >0.50 diopters in 19% of eyes