Giant papillary conjunctivitis associated with an extruded scleral buckle. Case report.
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Conjunctivitis↗
Biomedical subjects
J B Robin
Publications and source records attributed to J B Robin.
Corneal allograft rejection in a pregnant woman.
We report a case of corneal allograft rejection that occurred in a gravid woman 1 year following transplantation. This is the first report, to our knowledge, of corneal allograft rejection occurring in a pregnant woman.
Acanthamoeba↗
Post-traumatic and postoperative endophthalmitis: a comparison of visual outcomes.
We retrospectively studied 50 consecutive cases of exogenous endophthalmitis treated between 1972 and 1985. Twenty-two of these cases occurred after penetrating ocular trauma and the remaining 28 followed ocular surgery. Thirty-two (64%) of the cases were culture-positive. A wide variety of organisms were identified in the post-traumatic cases, while the isolated agent in the majority of postoperative cases was Staphylococcus epidermidis. Twenty-nine of the 50 patients received treatment with vitrectomy and intraocular antibiotics; of these, 14 (48%) achieved final visual acuities better than or equal to 20/400. Of the 21 patients who were treated with parenteral, topical, and subconjunctival antibiotics alone eight (38%) reached this same final visual acuity. Culture-negative cases, postoperative cases, and cases treated with vitrectomy and intraocular antibiotics were associated with improved visual outcomes.
Adolescent↗
Reevaluation of human alpha interferons against herpesvirus infection of the rabbit eye.
Because of reported differences in potency, recombinant DNA-derived human alpha interferons (IFNs) were reevaluated for use against acute Herpes Simplex Virus type 1 (HSV-1) infection of the rabbit eye. The IFNs used topically were IFN-alpha 2, (IFN-alpha 2) and a consensus of known human IFN-alpha s, designated IFN-alpha Con1. Prophylactic treatment with IFN-alpha Con1 at 1 or 15 X 10(6) U/eye/day beginning 48 hours before HSV-1 inoculation and therapeutic treatment with 5 or 15 X 10(6) U/eye/day beginning 4 hours after inoculation with either IFN-alpha Con1 or IFN-alpha 2 appeared to prevent or significantly reduce the development of corneal epithelial involvement. The effects were dose dependent with no evidence for decreased activity at the higher dose. The duration of HSV-1 shedding into tear film was not significantly reduced.
Acute Disease↗
Intentional reactivation of latent ocular herpes infection during BVDU therapy.
Sixteen adult New Zealand white rabbits with previously confirmed herpes simplex virus type 1 (HSV-1) infections were stimulated by iontophoresis of 6-hydroxydopamine into the cornea and were followed-up by topical epinephrine treatment to confirm latency. A total of 224 ocular cultures were obtained, of which 73 were positive for HSV during the seven day cycle. Twenty-seven of the 32 eyes (84%) had at least one positive culture. Animals were randomly divided into two treatment groups. Upon repeat stimulation (Cycle 2), concurrent with oral and topical bromovinyl-deoxyuridine (BVDU) therapy, only 3/104 ocular cultures were HSV positive, while 24/112 ocular cultures from placebo-treated animals were positive. Anti-HSV serum titers were comparable before and after BVDU therapy and the HSV isolates from BVDU treated animals did not develop drug resistance (i.e., ED-50 values were approximately 0.1-0.2 ug/ml both before and after therapy). It was concluded that BVDU had a demonstrable therapeutic effect on the recovery of HSV-1 from ocular cultures during intentional reactivation, but the latent ganglionic infection was not eliminated.
Animals↗
Lectins for the identification of ocular bacterial pathogens.
In a preliminary in vitro investigation, fluorescein-conjugated lectins were used in the identification of bacteria commonly involved in ocular infections. Clinical isolates of Staphylococcus aureus, Staph. epidermidis, Streptococcus pneumoniae, Strep. pyogenes, Pseudomonas aeruginosa, Hemophilus influenzae, and Proteus mirabilis were incubated with each of eleven lectins using a slide technique. Bacterial fluorescence was readily observed with a fluorescence microscope. All clinical isolates bound wheat germ agglutinin. The Gram-positive isolates bound Concanavalin A, while the Gram-negative isolates did not, with rare exceptions. Streptococcal species isolates reacted with Dolichos biflorus agglutinin, while staphylococcal species isolates did not. Lectins may be useful in furthering the initial identification of causative organisms in bacterial ocular infections.
Bacterial Infections↗
Fluorescein-conjugated lectin identification of a case of human keratomycosis.
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Adult↗
The clinical characteristics and course of adult gonococcal conjunctivitis.
We studied 21 cases of adult conjunctivitis caused by Neisseria gonorrhoeae, confirmed by either Gram's stain or culture, that were seen between 1972 and 1986. The patients, typically young men, had irritation or pain, a copious purulent discharge, and marked conjunctival inflammation. Keratitis, anterior chamber inflammation, periocular edema and tenderness, gaze restriction, and preauricular lymphadenopathy were common. All patients were hospitalized and treated with high doses of parenterally administered antibiotics. Two patients had severe ulcerative keratitis at initial examination, which ultimately resulted in light-perception visual acuity, despite antibiotic therapy and keratoplasty. In the remainder of the patients, corneal involvement was milder and transient, and treatment with parenteral penicillin and topical antibiotics was uniformly effective in reversing the course of the infection and preventing significant visual loss. Careful ophthalmologic and microbiologic monitoring is suggested to prevent possible complications caused by penicillin-resistant strains.
Adolescent↗
Mycobacterium chelonei keratitis after radial keratotomy.
Two patients who had undergone radial keratotomy developed delayed postoperative infectious keratitis. Both patients had surgery at the same outpatient facility, and their procedures had been performed by the same surgeon. The corneal lesions appeared similar in both cases, consisting of white irregular infiltrates with radiating projections and fluffy, indistinct margins. Although they were found at all levels, the lesions were most concentrated in the mid-to-deep stroma and were associated with overlying epithelial defects. In both cases, Mycobacterium chelonei was isolated from corneal biopsy specimens. Both patients were treated with topical fortified amikacin; in one there was complete resolution of the corneal infiltrates with medical therapy alone. Although the other patient's lesions initially appeared to resolve with medical therapy, she eventually required corneal transplantation because of recurrence of the infiltrates. Histopathologically, the infiltrates consisted of myriads of acid-fast bacteria with rare inflammatory cell infiltrations.
Adult↗
Anaerobic endophthalmitis caused by Propionibacterium acnes.
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Bacitracin↗
An update of the indications for penetrating keratoplasty. 1979 through 1983.
We performed a retrospective analysis of the clinical and pathologic diagnoses of 497 corneal buttons that had been submitted to the Estelle Doheny Eye Pathology Laboratory, Los Angeles, during the five-year period 1979 through 1983. The leading indications, in order of decreasing frequency, were pseudophakic bullous keratopathy (17.5%), regrafts (15.1%), aphakic bullous keratopathy (10.9%), corneal trauma (9.3%), and Fuchs' endothelial dystrophy (9.1%). The emergence of pseudophakic bullous keratopathy as the most common cause for penetrating keratoplasty correlates well with the dramatic increase in the number of cataract extractions with intraocular lens implantations performed since the mid-1970s. Less frequent indications for penetrating keratoplasty included the following: corneal scars (6%); active ulcerative keratitis (7%); keratoconus (6%); keratitis secondary to virus (5%); non-Fuchs' corneal dystrophies (3%); congenital corneal opacities (3%); interstitial keratitis (2%); and chemical burns (1%).
Adolescent↗
Radial keratoneuritis as a presenting sign in Acanthamoeba keratitis.
Three myopic patients who wore soft contact lenses developed unilateral Acanthamoeba keratitis that presented with unusual infiltrates that appeared to be located along the corneal nerves. These infiltrates were found in the midstroma, beginning paracentrally, and extending to the limbus in a radial pattern. The epithelium overlying these infiltrates was intact. In two patients, the central epithelium had a stippled, almost dendritiform appearance leading to the misdiagnosis of herpes simplex keratitis. Cultures from corneal scrapings of two patients and cultures of a corneal biopsy from one patient, which included an area of presumed neural involvement, grew Acanthamoebae. All three patients used homemade saline solutions (salt tablets dissolved in distilled water). In one patient, Acanthamoebae were found in the contact lens case solution. In our recent experience, Acanthamoebae have also been found in the distilled water bottle and the saline solution made from distilled water and salt tablets in two additional patients with A. keratitis. Distilled water, which is not sterile, has proven to be one potentially avoidable source of A. keratitis in contact lens wearers.
Adult↗
Rapid visualization of three common fungi using fluorescein-conjugated lectins.
The feasibility of using fluorescein-conjugated lectins to visualize and differentiate three fungi commonly involved in ophthalmic mycoses was evaluated. Using a panel of fluorescein-conjugated lectins, Candida albicans, Aspergillus fumigatus, and Fusarium solani were rapidly and reproducibly visualized in in vitro culture isolates, as well as in tissue samples and fixed histopathologic specimens taken from experimental mycoses. Additionally, Aspergillus and Fusarium were consistently differentiated from Candida. The binding affinities of the different lectins corresponded well with the individual sugar composition of the fungal cell walls.
Animals↗
Progressive herpetic corneal endotheliitis.
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Acyclovir↗
The histopathology of corneal neovascularization. Inhibitor effects.
With the use of a previously described model of corneal neovascularization induced by thermal cautery, we examined the effects of inhibitors on both the incidence of corneal neovascularization and the degree of inflammatory cell response. Three known inhibitors of corneal neovascularization, 1% prednisolone acetate, indomethacin, and 0.3% flurbiprofen, were studied and the results were compared with those in saline-treated controls. As expected, corneal neovascularization, preceded by conjunctival and corneal polymorphonuclear leukocyte (PMNL) infiltration, occurred in all control animals. Corneal neovascularization did not occur in any of the inhibitor-treated eyes. Histopathologically, both conjunctival and corneal PMNL counts in the treated eyes were markedly reduced compared with controls. These findings are consistent with the hypothesis that inflammatory cells, particularly PMNLs, are closely associated with the initiation of corneal neovascularization.
Animals↗
In vivo transillumination biomicroscopy and photography of meibomian gland dysfunction. A clinical study.
Meibomian gland transillumination biomicroscopy and infrared photography were performed on 18 patients with clinically evident meibomian gland dysfunction (MGD) and dermatologic rosacea, 22 patients having MGD without evidence of dermatologic rosacea, and 15 unaffected individuals who served as controls. All patients having clinical signs of MGD demonstrated morphologic abnormalities of their meibomian glands by transilluminated biomicroscopy. Patients without dermatologic rosacea were noted to have varying degrees of gland distortion. Moreover, infrared photography documented a loss of the normal grape-like clusters of dark spots that represent the gland, suggesting a loss of glandular acini. Patients with dermatologic rosacea had more severe alterations, including marked distortion and loss of normal gland anatomy. There were no such abnormalities in clinically unaffected individuals. These data demonstrate that transilluminated biomicroscopy and infrared photography have the ability to identify a spectrum of morphologic alterations of the meibomian glands in MGD patients. The authors suggest that these techniques could be used to classify clinical MGD based upon the presence or absence of identifiable meibomian gland abnormalities.
Eyelid Diseases↗
Anti-myelin basic protein antibody in experimental allergic optic neuritis and encephalomyelitis.
We produced demyelinating optic neuritis and encephalomyelitis in juvenile strain 13 guinea pigs by sensitization with optic nerve myelin. Three distinct clinical courses were noted: a severe, acute optic neuritis associated with a rapidly fatal encephalomyelitis; a mild, chronic optic neuritis with a nonfatal encephalomyelitis; and an initially mild disease followed by an acute exacerbation of optic neuritis and fatal encephalomyelitis. Clinically mild disease was associated with elevated levels of anti-myelin basic protein antibody, while severe disease was associated with extremely low antibody levels.
Animals↗
Human alpha and gamma interferon analogs in rabbits with herpetic keratitis.
Complete gene synthesis methods have been used to construct analogs of human interferons (IFNs): these include a consensus of the known human IFN-alpha S, designated IFN-alpha Con1 and a variant of human IFN-gamma, designated IFN-gamma 4A. These interferons, in purified form, were used topically against herpes simplex virus type 1 (HSV-1) induced ocular keratitis in rabbits. Eyes pretreated with IFN-alpha Con1 had decreased signs of infection and a lower incidence of HSV-1 positive trigeminal ganglia (3 of 14 positive) compared to the placebo treated (10 of 14 positive). IFN-alpha Con1 was as effective as natural IFN-alpha subtypes on a units basis, despite the very high specific activity of this analog. IFN-gamma 4A used under similar conditions do not result in beneficial effects with treatments beginning 24 or 48 hr before or 4 hr after virus inoculation. Rabbits with confirmed latent HSV infection were treated topically with IFN-alpha Con1 (10(6) units per eye each day) either before or before and after attempts to intentionally reactivate the infection by bilateral iontophoresis of 6-hydroxydopamine plus topical epinephrine treatment of the corneas. These IFN-alpha Con1 treatment regimens along with intentional reactivation during latency did not: (1) lessen the frequency of inducible ocular shedding episodes; (2) alter the mean time of 3-5 days between attempts to reactive latent infection and the appearance of HSV in tears; or (3) significantly change the incidence of HSV-positive trigeminal ganglia (83-100% HSV positive).
Administration, Topical↗