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Biomedical subjects

W T Driebe

Publications and source records attributed to W T Driebe.

At least 19 recordsLinked to original sources
PubMed2001

Diagnosis of hemophilia made after intraoperative bleeding during attempted penetrating keratoplasty in an elderly patient.

PURPOSE: To report an unusual case where the diagnosis of hemophilia was made after attempted penetrating keratoplasty in an elderly patient. METHODS: A 75 year old white male with a full-thickness corneal scar in the visual axis and a visually significant cataract OD was to undergo penetrating keratoplasty and cataract extraction with lens implantation for visual rehabilitation. There was no history of bleeding diathesis given. RESULTS: During placement of the Flieringa ring, a progressively enlarging 360 degrees subconjunctival hemorrhage was observed. Given the unusual bleeding,the procedure was aborted and the patientwas referred to the hematology service for further evaluation. Laboratory studies revealed a diagnosis of atypical hemophilia of mild severity. CONCLUSIONS: The initial diagnosis of hemophilia in any elderly patient is unusual. This case is even more unusual asthe diagnosis of a bleeding disorder was first considered after excessive subconjunctival hemorrhage developed during attempted penetrating keratoplasty.

Aged↗
PubMed2001

Fungal keratitis in a daily disposable soft contact lens wearer.

PURPOSE: To report the first case of fungal keratitis in a patient wearing daily disposable soft contact lenses. METHODS: Case Report. A 20-year-old white female in good health developed a corneal ulcer in her lefteye associated with daily disposable soft contact lens wear. There was no history of trauma to the left eye, and she denied overnight wear. Corneal scrapings were taken, and the patient was started on intensive tobramycin 14 mg/mL and cefazolin 50 mg/mL topical therapy for suspected bacterial keratitis. After 3 days of antibacterial therapy, the ulcer worsened. The cultures were negative as were the Gram stain and Gomori's methenamine silver stain. Initial cultures and stains were then repeated with the addition of a culture for herpes simplex virus. The developing clinical picture was suspicious for fungal keratitis. The patient was then started on intensive vancomycin 2%, natamycin 5%, and continued on fortified tobramycin. Three days after the second corneal scrapings were performed, a positive fungal culture was obtained for Fusarium sp. Vancomycin and tobramycin were then discontinued and amphotericin B 0.15% was added to natamycin 5% with the continuation of intensive topical therapy. RESULTS: The patient's keratitis was successfully treated with intensive double antifungal therapy. CONCLUSIONS: Infectious keratitis in daily disposable soft contact lens wear is an unusual occurrence. To our knowledge, there is no previous case of fungal keratitis occurring in patients wearing daily disposable lenses. This case emphasizes the importance of considering fungus in the differential diagnosis for keratitis even in daily disposable contact lens wearers.

Adult↗
PubMed2001

Fungal ring infiltrates in disposable contact lens wearers.

PURPOSE: To report two cases of ring infiltrates in disposable contact lens wearers resembling Acanthamoeba keratitis but later identified as fungus. METHODS: We report two patients with histories of disposable soft contact lens use, who, on initial presentation, were found to have corneal ring infiltrates and were treated for presumed Acanthamoeba keratitis. Microbiological studies, which included Gram stain and Gomori methenamine silver stain, as well as blood agar, chocolate agar, thioglycolate broth, Sabouraud agar, nonnutrient agar with Escherichia coli overlay, and Lowenstein-Jensen plates, were performed. RESULTS: Microbiological studies revealed fungi in both cases. CONCLUSIONS: Fungal keratitis is an uncommon complication of disposable soft contact lens use, but it should be considered in the differential diagnosis of corneal ring infiltrates.

Adult↗
PubMed2000

Mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal.

PURPOSE: To report a case of Mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal. METHODS: Case report. A 36-year-old white woman in good health developed a paracentral keratitis in her right eye 1 month after bilateral laser in situ keratomileusis. Initial treatment included topical steroids and then intensive Ocuflox (ofloxacin ophthalmic solution; Allergan, Inc, Irvine, California) without success. Cultures were negative. The keratitis worsened, and she was referred to our institution. Interface infiltration was noted, and the flap was lifted to obtain adequate laboratory studies. Cultures were positive for M chelonae. RESULTS: The keratitis was treated with intensive topical amikacin sulfate 1%, topical clarithromycin 1%, and Ciloxan (ciprofloxacin HCL; Alcon Laboratories, Inc, Fort Worth, Texas) with minimal improvement in her clinical condition. She developed a toxic reaction to amikacin 1%. In order to improve antibiotic penetration, the hazy, ulcerated corneal flap was removed. The keratitis then resolved with intensive topical clarithromycin 1% and Ocuflox over 5 weeks. The patient now has visual acuity without correction of 20/50, despite superficial corneal haze. CONCLUSION: M chelonae is a rare and insidious cause of infection after laser in situ keratomileusis. Diagnosis can be difficult and is often delayed. Aggressive medical management, with flap removal, if needed, may lead to resolution of infection.

Adult↗
PubMed2000

Fungal keratitis after laser in situ keratomileusis: a case report.

PURPOSE: To report a case of fungal keratitis resulting after laser in situ keratomileusis (LASIK). METHODS: A 38-year-old white man in good health developed a corneal infiltrate with laboratory confirmation of fungal keratitis after LASIK. Corneal scrapings were taken. Silver stain was positive for hyphae. Culture was positive for Curvularia sp. The patient was started on intensive natamycin 5% and amphotericin 0.15% topical therapy. RESULTS: The patient's keratitis was successfully treated with intensive antifungal therapy. CONCLUSIONS: Infectious keratitis is a rare but a serious potential complication after LASIK. To our knowledge, no previous case of fungal keratitis after LASIK has been reported. This case emphasizes the importance of surveillance for infection after LASIK.

Adult↗
PubMed1999

Patient with lichen planus and conjunctival immunopathologic features of lupus erythematosus.

PURPOSE: To report a case of severe cicatricial conjunctivitis in a patient with lichen planus, which is known to affect the skin and mucous membranes. The conjunctival immunopathologic features were consistent with lupus erythematosus rather than with lichen planus. METHOD: Oral mucosal and skin biopsies were performed with histopathologic and immunofluorescent studies consistent with lichen planus. The patient later had a biopsy of cicatrized conjunctiva with histopathologic and immunofluorescent findings consistent with lupus erythematosus. Evaluation by rheumatology and dermatology consultants demonstrated no evidence of active systemic lupus erythematosus or discoid lupus erythematosus. RESULTS: The patient was treated with topical and systemic immunosuppressives and her disease eventually stabilized. CONCLUSION: The case demonstrates two coexisting autoimmune disease entities: lichen planus of the skin and oral mucosa and a cicatricial conjunctivitis consistent with lupus erythematosus.

Biopsy↗
PubMed1998

Alcaligenes xylosoxidans keratitis post penetrating keratoplasty in a rigid gas permeable lens wearer.

PURPOSE: We report a case of Alcaligenes xylosoxidans keratitis following penetrating keratoplasty in a rigid gas permeable (RGP) lens wearer. METHODS: A 61 year old RGP lens wearer with a history of nonresponsive keratitis of the right eye which involved the graft margin was referred to us for treatment. Corneal cultures revealed growth of a gram-negative rod on the fifth day and the organism was subsequently identified as Alcaligenes xylosoxidans, which was resistant to most antibiotics and sensitive only to Bactrim, Timentin, and imipenem. RESULTS: Clinical improvement was observed within 24 hours after treatment with the use of topical i.v. Bactrim and topical i.v. Timentin 2% alternating every 30 minutes. Complete resolution of the infection with mild scarring was observed 6 weeks after treatment. CONCLUSIONS: Alcaligenes xylosoxidans is a potential cause of bacterial keratitis which should be considered in cases of nonresponsive gram-negative keratitis. The addition of topical Bactrim or Timentin may need to be considered in such cases.

Administration, Topical↗
PubMed1995

Diagnosis and successful medical treatment of Acanthamoeba keratitis.

OBJECTIVE: To identify the methods that result in timely diagnosis and effective treatment of Acanthamoeba keratitis. METHODS: We retrospectively reviewed the medical records of 12 consecutive patients whom we treated for culture-proved Acanthamoeba keratitis in 14 eyes. RESULTS: Contact lenses were worn in 13 of 14 affected eyes and substandard methods were often used to care for them. The diagnosis was established in all patients by laboratory analysis of corneal scrapings; corneal biopsies were not required. Acanthamoeba organisms were identified on smears from 12 of 14 eyes with use of standard, nonfluorescent stains and recovered in culture from all patients by inoculating scrapings on nonnutrient agar overlaid with Escherichia coli. Eleven of 14 eyes were medically cured with a combination of antiamebic drugs, most commonly propamidine isethionate, neomycin sulfate, and clotrimazole. Topical corticosteroids were used in only one patient. Two of the three eyes that required therapeutic keratoplasty were not treated before surgery according to our usual protocol; the third required keratoplasty for treatment of a severe bacterial superinfection. Twelve of 14 eyes recovered 20/50 or better visual acuity. Bacterial superinfections were a serious problem, with a total of six superinfections occurring in three treated eyes. CONCLUSION: With timely diagnosis and medical treatment with a combination of antiamebic drugs and avoidance of topical corticosteroids, most cases of Acanthamoeba keratitis can be cured, with an excellent prognosis for visual recovery.

Acanthamoeba↗
PubMed1994

The clinical management of keratoconus: a 6 year retrospective study.

We conducted a retrospective analysis of the management of 118 eyes of 66 new patients presenting with keratoconus at the University of Florida from 1987 through 1992. Eyes were ultimately managed by one of three methods: glasses or no correction; contact lenses; or penetrating keratoplasty. The outcome of each management method was determined by evaluating initial and final vision and keratometry for each group. Twenty-one eyes received glasses or required no correction. Rigid gas permeable lenses, Dura-T style PMMA lenses, and specialty design gas permeable lenses were used to successfully fit 63 eyes. Twenty-eight eyes underwent penetrating keratoplasty (PK), and an additional six eyes were PK candidates. Factors associated with the need for PK included best corrected initial visual acuity of 20/40 or worse, average keratometry > 55 D, and the presence of apical scarring (P < 0.001).

Adolescent↗
PubMed1993

Results of therapeutic penetrating keratoplasty.

PURPOSE: To determine the anatomic and visual results of therapeutic penetrating keratoplasty (PK) and its role in the management of corneal disease. METHODS: The authors reviewed the records of all of their patients who had undergone therapeutic PK over the past 9 years and evaluated each for the following criteria: cure of disease, graft clarity, and visual acuity. Patients were divided into seven categories: (1 and 2) bacterial and fungal keratitis, (3 and 4) herpetic keratitis, with and without inflammation, (5) acanthamoebic keratitis, (6) perforations due to keratoconjunctivitis sicca, and (7) other causes of perforation. RESULTS: In microbial keratitis, therapeutic PK eradicated the disease in all cases. Seventy-three percent of grafts for bacterial keratitis and 60% for fungal keratitis remained clear. A higher percentage of clarity was achieved when grafts were 9.0 mm or less. Seven patients with secondary endophthalmitis were cured with a surgical approach including therapeutic PK. In herpetic keratitis with active inflammation, only 36% of grafts remained clear, and inflammation recurred in 36%. All perforations due to post-herpetic persistent epithelial defects in "quiet" eyes were grafted successfully. In patients with severe keratoconjunctivitis sicca, eyes were anatomically stabilized in 83%, but all grafts failed because of complications from ocular surface disease. CONCLUSIONS: Therapeutic PK is valuable in the management of microbial keratitis that does not respond to antimicrobial therapy. Results are poorer for patients with herpetic keratitis, although selected patients respond to therapeutic PK when other methods of management have failed. Patients with perforations due to keratoconjunctivitis sicca have a uniformly poor prognosis for graft clarity.

Acanthamoeba Keratitis↗
PubMed1993

Juvenile xanthogranuloma of the corneoscleral limbus.

A 10-year-old boy had a slowly enlarging left limbal mass, extending into the corneal stroma, but not into the anterior chamber. The lesion was excised by lamellar sclerokeratectomy and subsequently confirmed histopathologically as a juvenile xanthogranuloma. Though rare, juvenile xanthogranuloma of the corneoscleral limbus should be considered in the differential diagnosis of limbal mass lesions extending into the cornea. Total resection is usually curative.

Child↗
PubMed1993

Drainage tube implants in the treatment of glaucoma following penetrating keratoplasty.

A retrospective review was undertaken to compare outcomes in 26 eyes that underwent penetrating keratoplasty (PKP) and drainage tube surgery (Molteno double-plate implant or Schocket procedure). Drainage tube surgery was performed either before PKP (10 eyes), after PKP (7 eyes), or at the same time as PKP (9 eyes). Mean follow up was 22 months. The average preoperative intraocular pressure (IOP) for all of the eyes was 31 mm Hg; 96% of them achieved a final IOP of less than 18 mm Hg (average, 14 mm Hg on a mean of 0.8 medications). Graft failure occurred in 11/26 (42%). Eight of these eyes were regrafted, and six of these eight have remained clear at a mean follow up of 22 months after regrafting. The overall PKP success rate, including the eyes that underwent repeat PKP, was 81%. Visual acuity remained stable or improved in 70% of the eyes.

Adolescent↗
PubMed1992

Indications for and results of intraocular lens explantation.

We reviewed the medical records of 97 patients who had 101 consecutive intraocular lens (IOL) explantation procedures, with or without exchange, at the University of Florida Eye Center from January 1, 1983, to December 31, 1987. The majority of the removed IOLs were anterior chamber styles (53.9%), followed by iris-fixated lenses (33.7%). The most common indications for surgery included pseudophakic bullous keratopathy (PBK)--69%, uveitis-glaucoma-hyphema (UGH) syndrome--9%, and IOL instability--7%. The best visual outcome was seen in patients with IOL instability; 50% achieved 20/40 or better visual acuity. Forty one percent of patients with PBK, who had IOL explantation/exchange combined with penetrating keratoplasty, achieved 20/40 or better visual acuity. The poorest visual outcome was seen in patients with the UGH syndrome; 83% had a final acuity of 20/200 or worse. However, these patients achieved resolution of their pain and inflammation and better control of their intraocular pressure as a result of the surgery. Complications leading to IOL explantation tended to occur months to years after the original surgery in patients with closed-loop, semi-flexible anterior chamber lenses and iris-fixated lenses. Posterior chamber lenses were most often removed because of complications unrelated to the implant.

Aged↗
PubMed1992

The effect of diclofenac sodium ophthalmic solution on intraocular pressure following cataract extraction.

Ninety-two nonglaucomatous patients undergoing extracapsular cataract extraction with implantation of a posterior chamber intraocular lens by residents at a Veterans hospital were randomized in double-masked fashion to receive either a topical nonsteroidal antiinflammatory agent, diclofenac sodium 0.1%, or a placebo consisting of vehicle only. One drop of placebo or diclofenac sodium 0.1% was administered on an inpatient basis by trained staff every 6 hours for three doses, starting the afternoon prior to surgery. A further drop was given at 90, 60, 30, and 15 minutes before the operation. Starting 24 hours after surgery, all patients received diclofenac sodium 0.1%. All patients remained hospitalized for 72 hours postoperatively. Mean baseline intraocular pressure (IOP) was 14.0 and 14.1 mm Hg in the diclofenac and placebo groups, respectively. IOP rose 8.6 mm Hg in both groups at 6 hours after surgery. At 24 hours, the mean IOP elevation from baseline was 11.3 mm Hg in the diclofenac group and 9.6 mm Hg in the placebo group (P = .47). Within the first 24 hours, IOP spiked more than 10 mm Hg in 57% (26/46) of the diclofenac patients and in 54% (25/46) of the placebo patients. These results suggest that diclofenac sodium 0.1% drops affect neither the incidence nor the height of IOP elevation following cataract surgery.

Aged↗
PubMed1990

Xerophthalmia and cystic fibrosis.

We treated two infants with failure to thrive who presented with clinical evidence of conjunctival and corneal xerosis. One patient was referred with possible infectious corneal ulcer thought to exist because there were deep peripheral ulcerations of the cornea and associated hypopyon. The other patient was initially thought to have a nasolacrimal duct obstruction because of excessive tearing. Xerophthalmia secondary to vitamin A deficiency was suspected and led to the diagnosis and treatment of cystic fibrosis in each case. Therapy with vitamin A promptly resolved the xerosis, but it also caused a transient rise in intracerebral pressure. Xerophthalmia can still be a problem in developed countries when underlying disorders, such as cystic fibrosis, lead to vitamin A malabsorption.

Cystic Fibrosis↗
PubMed1990

Recurrent postoperative endophthalmitis.

We treated five patients for postoperative endophthalmitis who demonstrated an initially good response to intravitreal management of their infection and then suffered a later recurrence. Four of the five patients received a single intravitreal injection of antibiotics as the only intravitreal therapy, and the fifth patient received a single antibiotic injection in addition to a partial vitrectomy. All recurrent infections occurred between 10 and 21 days after the original intravitreal injection of antibiotics. At the time of the recurrence, all five patients remained culture positive with the same organism that was initially isolated. The bacterial species isolated were S. epidermidis, group D streptococcus, P. acnes, P. mirabilis, and P. aeruginosa. All patients were ultimately sterilized with repeated intravitreal injections of antibiotics, vitrectomy, and/or intraocular lens removal. Factors that were related to recurrent infection were marginal susceptibility of the organism to the originally injected antibiotics, infection with a slowly replicating organism, and infection with a gram-negative bacillus. A single intravitreal injection of antibiotics may only partially treat bacterial endophthalmitis. Patients should be observed for at least 3 weeks following treatment of endophthalmitis for recurrence of their infection, and aggressive management, including vitrectomy and repeated intravitreal injections of antibiotics, should be used to treat recurrent infections.

Aged↗