Sustained Gentamicin Release by Presoaked Medicated Bandage Contact Lenses

Current therapeutic regimens for external ocular infections require instillation of antibiotics up to every quarter of an hour in concentrations higher than those commercially available. As an alternative to topically applied gentamicin eye drops, the possibility of sustained gentamicin release by bandage contact lenses was investigated. Ten hydrogel bandage contact lenses (61.4% HEMA and 38.6% water content) were soaked overnight in a 0.5% solution of sterile, unpreserved, commercially available gentamicin, and fitted thereafter on ten eyes of healthy adult volunteers. Gentamicin concentrations in the tear film were determined 10, 30, and 60 minutes, and 4, 8, 24, 48, 72, and 96 hours after fitting, using agar diffusion bioassay. Bactericidal concentrations (>1.6 µg/ml) were found up to 3 days after contact lens fitting in all subjects. No toxic topical or systemic effects were seen. © 1988, American Academy of Ophthalmology, Inc. All rights reserved

Is Chronic Intraocular Inflammation after Lens Implantation of Bacterial Origin?

In an effort to better understand the cause of chronic intraocular inflammation after intraocular lens (10L) implantation, both scanning and transmission electron microscopy were used to compare 1 anterior chamber, 1 irisfixated, and 3 posterior chamber IOLs removed for this condition between 2 and 16 months after implantation with 8 IOLs explanted for other reasons (decentration in 4 cases, bullous keratopathy in 4 cases). Colonization with nonslime-producing, as well as slime-producing bacteria (1 case) in the presence of a thin membranous structure of cellular origin (multinucleated giant cells and macrophage-like cells) was demonstrated on all of the 5 IOLs explanted from inflamed eyes. Neither bacteria nor membranous structures could be identified on the IOLs removed because of dislocation or from eyes with bullous keratopathy. These observations indicate that bacterial colonization and the consequent host response may be characteristic features of many otherwise unexplained cases of intraocular inflammation after IOL implantation. © 1991, American Academy of Ophthalmology, Inc. All rights reserved

Bacterial Growth Is Significantly Enhanced on Foldable Intraocular Lenses

Analyssis of in vitro bacterial growth on intraocular lenses of different materials (silicone, polymethyl methacrylate , hydrogel

Automated corneal topography: Computerized analysis of photokeratoscope images

The analysis of corneal topography has recently become popular, mainly as a consequence of the rapid development of refractive surgery techniques. To date, computer-assisted evaluation of photokeratoscope pictures has been the most popular method used to assess corneal topography. The processing system described previously by other authors requires hand-digitizing of the photokeratoscope pictures and therefore the constant presence of an operator for a considerable amount of time. We have introduced the use of a video camera to digitize the photokeratoscope images, making the processing automatic and quicker. Moreover, precision glass spheres have been used to calibrate the system in order to minimize the intrinsic errors even further. The data obtained from the computerized analysis are presented in three different ways. Besides having the numerical values in diopters, corneal maps with various shades of grey are used, together with the quantitative, three-dimensional representation of corneal astigmatism. An automated system for the analysis of corneal topography was tested for both experimental models and clinical conditions. It was easy to use and showed high precision (less than 1â\u80° error when processing photographs of precision glass spheres). © 1989 Springer-Verlag

Leukoplakia of the cornea presenting as fingerprint epithelial lines: A case report

Opacities in association with fingerprint patterns of the epithelium were seen in the upper half of the right cornea of a 52-year-old patient complaining of decreased vision. Removal of the corneal epithelium from the involved area resulted in visual improvement and normalization of corneal appearance. Histological examination of the removed epithelium failed to reveal the typical intraepithelial formation of basement membrane invaginations even in the areas corresponding to the fingerprint patterns. Moderate to severe degree of atypia were seen in the epithelial cells. No abnormalities were observed in 3 conjunctival specimens excised at the time of epithelial removal. The diagnosis of corneal dysplasia (leukoplakia) was made. Our report is the first description of epithelial fingerprint patterns of the cornea associated with leukoplakia. © 1991 Kluwer Academic Publishers

Intraocular lens removal from eyes with chronic low-grade endophthalmitis

Intraocular lenses (IOLs) were removed from 11 eyes with chronic low-grade endophthalmitis after cataract extraction to restore useful vision and prevent recurrence. One anterior chamber lens, one iris-supported lens, and nine posterior chamber lenses were removed. In the eyes with posterior chamber lenses, the posterior capsule was intact; total (n = 7) or partial (n = 2) capsulectomy was performed in these eyes. Aqueous humor specimens obtained at surgery were positive for bacteria in five eyes, but scanning electron microscopy showed bacteria on all removed IOLs and capsular bags. Final best corrected visual acuity was 20/40 or better in seven eyes. Reduced visual acuity, between 20/50 and 20/400 in three eyes and counting fingers in one eye, was related to retinal detachment (n = 2) and age-related macular degeneration (n = 2). Transient hyphema was seen in one eye. With a mean follow-up of 21 months (range 10 to 31 months), no recurrence of inflammation was observed. The results show that negative cultures do not preclude a bacterial cause for infection and that primary IOL removal with partial or total capsulectomy provides a surgical approach to the treatment of chronic low-grade endophthalmitis not responsive to medical therapy. © 1995, American Society of Cataract and Refractive Surgery. All rights reserved. All rights reserved

Epithelial Interface Cysts after Epikeratophakia

Background: Epithelial interface cysts have been occasionally observed after lamellar keratoplasty. The authors report the incidence, clinical significance, and management of this complication in epikeratophakia patients. Methods: From August 1987 to January 1991,108 consecutive patients undergoing epikeratophakia entered a prospective study aimed at evaluating both clinical results and changes in corneal physiologic parameters. After an average hospitalization of 6 days, all patients underwent complete ophthalmologic examinations at regular intervals after surgery. All postoperative complications, including the development of epithelial interface cysts, were recorded and photographed. Results: Over a 3-year period, epithelial interface cysts were observed in 8 eyes, with an overall incidence of 7.4%. All cysts originated under the periphery of the epilens. In five patients, the cysts enlarged centripetally but eventually ceased to grow, causing no visual impairment. In two patients, after an initial increase in size the cysts slowly regressed and finally disappeared. In only one patient, a cyst migrated over the visual axis, thus necessitating surgical removal. The cyst did not recur during an observation time of 18 months after debridement, allowing full recovery of visual acuity. Conclusions: The incidence of epithelial interface cysts after epikeratophakia is relatively high. Because of their peripheral location and self-limited growth, the clinical significance of this complication is low. The possibility of spontaneous regression of the cysts supports a conservative approach, as long as the visual axis is not affected. Surgical removal is possible without compromising the epi-lens and is compatible with an excellent visual outcome. © 1993, American Academy of Ophthalmology, Inc. All rights reserved

Mycotic infection of the capsular bag in postoperative endophthalmitis

A case of mycotic infection after uncomplicated extracapsular cataract extraction with implantation of a posterior chamber modified C-loop intraocular lens (IOL) is reported. Severe postoperative intraocular inflammation, diagnosed by aqueous cultures as secondary to Staphylococcus aureus endophthalmitis, did not respond to antibiotic therapy. Despite IOL and capsular bag removal and further antibiotic treatment, the inflammation persisted and phthisis followed. Retrospective electron microscopic examination of the explanted material demonstrated the presence of abundant fungal elements in the capsular bag and spores on the IOL surface. Vitreous taps performed at the time of explantation were negative for bacteria and fungi, confirming the localized nature of the mycotic infection. To our knowledge this report represents the first observation of a mycotic infection confined to the capsular bag after cataract surgery with implantation of a posterior chamber IOL. © 1991, American Society of Cataract and Refractive Surgery. All rights reserved

Long-term Results after Removal of Dislocated Intraocular Lenses from the Retinal Surface through a Limbal Approach

Background: The authors describe the use of a limbal approach for removing dislocated intraocular lenses (IOLs) from the retinal surface to minimize surgical trauma and optimize visual outcome. Methods: Thirteen consecutive patients underwent removal of a dislocated posterior chamber IOL (PC IOL) from the retinal surface through a limbal approach. The surgical technique used in all patients included a limbal incision from the 3- to 9-o'clock positions; open-sky vitrectomy, grasping the IOL at the angle between loops and optics with an iris hook; and IOL removal through the corneoscleral opening. In all except one patient, who had high-degree myopia, an IOL was re-implanted during the same surgical procedure (free sulcus fixation of a PC IOL over remnants of the capsular bag, 7 patients; sulcus fixation of a PC IOL over remnants of the capsular bag combined with 1 transscleral suture, 3 patients; and implantation of an anterior chamber IOL, 2 patients). Results: No retinal or corneal complications secondary to IOL removal and re-im-plantation through a limbal approach could be detected over an average follow-up period of 22.3 months (range, 17-27 months). Best-corrected visual acuity was 20/40 or better in seven patients, between 20/50 and 20/400 in three, and less than 20/400 in three. Visual outcome worse than 20/40 was related to pre-existing macular degeneration in five patients and retinitis pigmentosa in an additional one. Conclusions: The use of a limbal approach allows removal of an lOL from the retinal surface and secondary IOL implantation in the preferred site during the same surgical procedure. Because no special instrumentation is needed, this technique also is suitable for primary removal if dislocation occurs intraoperatively. The visual outcome and the long-term absence of complications recorded in our series indicate that a limbal approach may offer a reasonable alternative in managing IOLs luxated onto the retinal surface. © 1994, American Academy of Ophthalmology, Inc. All rights reserved

Complications of Sulcus-supported Intraocular Lenses with Iris Sutures, Implanted during Penetrating Keratoplasty after Intracapsular Cataract Extraction

In a retrospective study, the authors analyzed visual results and postoperative complications in a series of 14 consecutive patients who had undergone penetrating keratoplasty and implantation of a posterior chamber intraocular lens (PC IOC) in the absence of the posterior capsule. Seven patients suffered from aphakic bullous keratopathy and seven from pseudophakic bullous keratopathy. Postoperative follow-up was 7.6 months on the average. Bestcorrected postoperative visual acuity was 20/60 or better in four cases and 20/200 or better in eight. Glaucoma was present before surgery in four eyes, which persisted in all cases and developed in four new cases. Results of gonioscopic examination showed the postoperative development of goniosynechiae in four eyes. Pseudophakodonesis of various extent was present in ten eyes. Preoperatively, cystoid macular edema was diagnosed angiographically in one case. It did not improve after surgery and was seen in three additional eyes postoperatively. Causes for postoperative visual acuity lower than 20/200 were cystoid macular edema in three cases, graft rejection in one case, central retinal scar in one case, and optic nerve atrophy in one case. A distortion of the pupil was seen in three eyes in miosis and in four additional eyes in mydriasis. Corneal thickness as well as anterior chamber depth were within normal limits. Fluorophotometric evaluation of the blood-aqueous barrier showed values comparable with those obtained after intracapsular cataract extraction and implantation of an iris-fixated IOL. Despite the relatively good visual results, the high postoperative incidence of cystoid macular edema and/or glaucoma may discourage the use of this technique. © 1990, American Academy of Ophthalmology, Inc. All rights reserved