Keratitis induced by skin polish.
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Adult↗
Biomedical subjects
M J Mannis
Publications and source records attributed to M J Mannis.
Corneal fistulas and their management.
We reviewed three representative cases of chronic corneal fistula formation and provide a systematic approach to the assessment and therapeutic alternatives for this problem. In two of our patients, the fistula was managed surgically. The third patient developed endophthalmitis, which resulted in loss of light perception. Chronic corneal fistulization is a rare clinical entity resulting from malapposition of corneal tissue after traumatic, surgical, or infectious perforation. Fistulas may result in prolonged or recurrent hypotony, peripheral anterior synechia formation, or endophthalmitis. Accurate assessment of the risks associated with corneal fistula formation takes into account the type of fistula, its location in the cornea, and the condition of the ocular adnexae. We reviewed the risk factors that will determine the urgency and type of therapy used.
Aged↗
Uses of thrombin in ocular surgery. Effect on the corneal endothelium.
Thrombin is a hemostatic factor that induces platelet aggregation and catalyzes the conversion of fibrinogen to fibrin. The potential for its increasing application to a variety of anterior and posterior segment surgery led us to investigate the in vitro effect of thrombin on the corneal endothelium in a sheep model. We examined freshly excised sheep corneas stained with alizarin red and trypan blue after exposure to two different concentrations of thrombin for four hours. The structure of the corneal endothelium appeared to be intact even after prolonged exposure to thrombin at concentrations of 100 and 1000 U/mL. Thrombin appears to be nontoxic to the corneal endothelium in this experimental model.
Adult↗
The effect of fluorouracil on the corneal endothelium.
The utility of the antiproliferative agent fluorouracil has been demonstrated recently in glaucoma-filtering surgery and in the management of proliferative vitreoretinopathy after vitrectomy. Because of the potential for contact with the corneal endothelium, its toxicity to the endothelium is an important consideration. The effect of fluorouracil on corneal endothelial integrity in an in vitro animal model was studied. Freshly excised sheep corneal buttons were exposed to increasing concentrations of fluorouracil for four hours and were subsequently evaluated microscopically using vital staining with alizarin red and trypan blue. Exposure to normal saline and chlorhexidine gluconate was used to establish negative- and positive-staining controls. Corneal buttons exposed to normal saline or to 1.0 mg/mL or less of fluorouracil had intact endothelial monolayers that completely excluded trypan blue. Corneal buttons exposed to chlorhexidine gluconate or to 10 mg/mL of fluorouracil, however, had severely or totally disrupted endothelial monolayers in which the remaining cells, if any, all had blue-staining nuclei. These results suggest that the threshold concentration for fluorouracil toxicity to corneal endothelium lies between 1 and 10 mg/mL when exposure time is four hours.
Animals↗
Contrast sensitivity after epikeratophakia.
Epikeratophakia is a rapidly evolving surgical procedure for the refractive correction of aphakia. Even when Snellen acuity after epikeratophakia is normal, patients often report a subjective degradation of the visual image through the surgically corrected eye. To further define visual performance in the patient with optically successful epikeratophakia, we examined contrast sensitivity in two patients surgically corrected for monocular aphakia. Contrast thresholds were measured over a range of spatial frequencies using both computer-generated sinusoidal gratings and a commercially available wall chart system. The eye with epikeratophakia in each case was compared with the opposite normal eye with comparable acuity. One patient was also tested prospectively in the same eye both before and after surgery. Data demonstrate a depression of the contrast sensitivity function in the middle and high spatial frequencies induced by the placement of an epikeratophakia lenticule when compared with the normal eye or contact lens-corrected, preoperative aphakic eye with comparable good acuity. These findings may explain the subjective experience of epikeratophakia patients.
Adult↗
Making sense of contrast sensitivity testing. Has its time come?
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Humans↗
Personality trends in keratoconus. An analysis.
Patients with keratoconus frequently are described as having peculiar personality characteristics, despite the lack of controlled studies in the ophthalmologic or psychiatric literature. We studied 109 subjects, using a standardized personality inventory (the Millon Clinical Multiaxial Inventory) that measures 20 personality scales-both normal and pathologic. Subjects were divided into three age-matched groups: (1) patients with keratoconus, (2) patients with other chronic eye diseases, and (3) normal controls. Results indicated that although chronic eye disease, including keratoconus, did have an impact on personality functioning in young and middle-aged adults, no specific complex of personality characteristics attributable to keratoconus could be identified. Patients with keratoconus differed from normal controls in much the same way as did patients with other chronic eye diseases, being less conforming and more passive-aggressive, paranoid, and hypomanic. They tended to more disorganized patterns of thinking and scored higher on substance abuse indicators. The influence of keratoconus on personality may be a function of the timing and nature of its onset in the context of the patient's psychosocial development.
Adolescent↗
Contrast sensitivity after penetrating keratoplasty.
Contrast sensitivity testing in the corneal transplant patient may enhance our assessment of visual performance, which is traditionally evaluated using Snellen acuity only. To evaluate contrast sensitivity function after penetrating keratoplasty, we studied 29 patients with anatomically successful corneal grafts and a best corrected visual acuity of 20/50 or better. Graft patients were compared with an age-matched control group including persons with comparable visual acuities without ocular disease. In addition to a complete ophthalmic examination, all subjects underwent contrast sensitivity testing using a computer-generated sinusoidal grating system as well as a commercially available contrast sensitivity wall chart. Data indicate that, despite comparable Snellen visual acuity, the contrast sensitivity curves for graft patients were depressed overall compared with those of normal subjects except at the lowest spatial frequency. However, comparison of grafted eyes to contralateral eyes with corneal disease in a small subset of patients with bilateral disease shows a trend toward higher contrast sensitivity values in the eyes that had been operated on. These data suggest that despite an improvement in contrast sensitivity with penetrating keratoplasty, an eye with a corneal transplant is not entirely normal from a visual standpoint. Nonacuity parameters may be important indexes for assessing real-world visual function in the graft patient, although the clinical role of these tests is not yet completely defined.
Adult↗
Rapid contrast sensitivity assessment in keratoconus.
Contrast sensitivity derangement may accompany keratoconus even in the presence of normal or near normal Snellen visual acuity. This has been demonstrated with computer-driven contrast sensitivity test devices. The purpose of this study was to evaluate the utility and efficacy of rapid screening devices for contrast sensitivity testing. However, such devices are often cumbersome and difficult to use clinically. We tested 12 patients with keratoconus on 2 simple chart systems designed to test contrast sensitivity in a rapid and clinically useful manner: the Vistech chart and the Regan multi-contrast visual acuity charts. Both devices detected the contrast sensitivity abnormalities present in early keratoconus, but some patients [with greater than or equal to 6/12 (20/40) visual acuity] were unable to respond to areas of the charts corresponding to high spatial frequency and/or low contrast tasks. Such simple wall charts may be useful in measuring the visual abnormalities in early keratoconus, in monitoring the progression of the disease, and in evaluating various treatment options.
Adult↗
Corneal epithelial healing after penetrating keratoplasty using topical Healon versus balanced salt solution.
The authors conducted a prospective study of 38 consecutive corneal transplant patients over a five-and-one-half month period in order to evaluate the effect of intraoperative hydration with topical Healon versus balanced salt solution on postoperative epithelial healing in the corneal graft. Eight independent variables, including patient age, sex, operating room time, donor age, donor time in McCarey-Kaufman media, intraoperative hydration with balanced salt solution versus Healon, and the amount of postoperative punctate epithelial keratitis measured on postoperative day 1, day 2, and at one week were compared using a multiple linear regression method. While the correlation between donor age (p = .060) and patient age (p = .088) with the amount of punctate epithelial keratitis at one week post graft approached statistical significance, only the Healon-treated group showed a high correlation to more complete graft healing one week postoperatively (p = 0.002). Topical Healon during keratoplasty may foster epithelial healing, but it also may present technical challenges of which the surgeon should be aware.
Adult↗
HTLV-III screening by eye banks.
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Deltaretrovirus↗
Acanthamoeba sclerokeratitis. Determining diagnostic criteria.
Acanthamoeba infection of the cornea is an entity now recognized with increasing frequency. We saw two cases of Acanthamoeba sclerokeratitis in contact lens wearers in whom scleritis (anterior and posterior) played a central role in the clinical course of the disease. Scleritis is probably a more common component of Acanthamoeba infection than has generally been acknowledged. Posterior scleritis has not, to our knowledge, been reported previously in this disorder. The clinical diagnosis of Acanthamoeba infection has often been missed due to lack of a definition of the historical and clinical criteria by which this disease is characterized. We reviewed the 26 previously reported cases and suggest a set of criteria that can be used to establish an early diagnosis. Historical criteria include minor corneal trauma, exposure to soil or standing water, or contact lens wear. Clinical characteristics include severe pain, infiltrative (often ring-shaped) stromal keratitis, variable anterior uveitis, epithelial erosion, scleritis, standard bacterial culture negativity, chronicity, and lack of response to antimicrobial agents.
Adolescent↗
Fitting gas-permeable contact lenses after penetrating keratoplasty.
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Contact Lenses↗
Conjunctival transplantation. Autologous and homologous grafts.
Autologous conjunctival transplants have been used successfully for restoration of damaged ocular surfaces. Homologous (allogeneic) conjunctival grafts have been explored less systematically. We developed a nonhuman primate model for comparison of autologous and homologous conjunctival transplantation in order to assess the clinical viability and immunopathologic characteristics of these grafts. Autologous or homologous grafts were performed in nine adult rhesus monkeys. Both autologous and homologous grafts were compared for clinical viability and immunopathologic change. Clinical results suggest that, although homologous grafts incited a greater inflammatory and scarring response, there was minimal graft shrinkage and a normal surface epithelium. Immunopathologic studies using laminin, bullous pemphigoid antigen, and fibronectin indicate that, despite the increased inflammatory response seen in homografts, the epithelial surface is normal. With our increasing ability to modulate the immune response, conjunctival homografts may play a role in restoration of the ocular surface.
Animals↗
Cystic conjunctival masses as the presenting sign of disseminated lymphoma.
Systemic malignant lymphoma rarely presents as conjunctival masses. Biopsy of unusual cystic conjunctival masses from a 49-year-old woman showed malignant lymphoma. On subsequent examination, the patient was found to have disseminated systemic malignant lymphoma. Examination of possible predictive clinical features of the conjunctival lesions showed that these were of little value in diagnosing the systemic malignancy.
Antineoplastic Combined Chemotherapy Protocols↗
Contact thermal burns of the cornea from electric curling irons.
We treated four patients with corneal burns resulting from mishaps while using electric curling irons. In all cases, the burns were symptomatic with blurred vision, tearing, pain, and photophobia. Injury was limited to the corneal epithelium, and management included debridement, topical antibiotics, cycloplegia, and pressure patching. Burns resolved completely within 48 hours after debridement and patching.
Adult↗
The effect of penetrating keratoplasty on contrast sensitivity in keratoconus.
Complaints of visual distortion often precede a decrement in visual acuity in keratoconus. We studied seven patients with keratoconus who had undergone keratoplasty in one eye and whose Snellen visual acuity measurements were equal in the grafted and nongrafted eyes. Subjects were examined clinically; we then measured contrast thresholds for seven spatial frequencies of computer-generated sinusoidal gratings after optimal contact lens correction. Results indicate that nongrafted keratoconic eyes demonstrate abnormal contrast sensitivity, even with good visual acuity measurements. Eyes with clear corneal grafts and with visual acuities comparable to nongrafted eyes fell within the 95% confidence limits of the normal contrast sensitivity curve. The findings confirm that corneal distortion or opacity in the optimally corrected keratoconic eye may account for notable visual dysfunction and that keratoplasty improves not only Snellen visual acuity but contrast sensitivity as well.
Adult↗