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Purpose: To compare the incidence of herpes simplex virus (HSV) epithelial recurrence and graft survival after penetrating keratoplasty (PK) in patients with and without self-reported atopy., Design: Retrospective cohort comparative study., Setting: Cornea Service, Wills Eye Hospital., Study Population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004 and who underwent primary PK for ocular HSV at the Cornea Service. From the 58 patients invited, 49 patients (50 eyes) were included. Nine patients were ineligible in accordance with the exclusion criteria: no active classic HSV episode before PK, immunosuppression, less than one year of follow-up, previous history of PK before presentation at the Service. Eligible patients filled out a questionnaire regarding their history of atopic disease, considering: presence of allergic rhinitis, asthma, or atopic dermatitis. Ocular history was obtained through chart review. main outcome measures: Incidence of epithelial HSV recurrences and corneal graft survival in both groups., Results: Each group (atopic and nonatopic) included 25 eyes. The atopic patients had a mean incidence of 0.07 episode/eye year (SD +/- 0.9) compared with 0.12/eye year (standard deviation [SD] +/- 0.21) in the nonatopics (P = .002). At 10 years of follow-up, the survival rate in the atopics was of 92% and in the nonatopics was of 79% (P = .88)., Conclusions: Nonatopics had significantly more epithelial recurrences after PK compared to atopics; however, both groups presented low incidences of recurrences and high graft survival rates.

Purpose: To compare the efficacy of oral antiviral prophylactic treatment for herpes simplex virus (HSV) recurrences in patients with and without self-reported atopy., Design: Retrospective cohort comparative study., Methods: setting: Cornea Service, Wills Eye Hospital. study population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004. From 244 patients invited, 54 patients (58 eyes) were included. One hundred and ninety patients were excluded according to exclusion criteria: no active episode during follow-up, immunosuppression, less than one year of follow-up, or previous history of penetrating keratoplasty. The Questionnaire regarding history of atopic disease, considers: presence of allergic rhinitis, asthma or atopic dermatitis, and chart review of ocular history. main outcome measures: Incidence of all types of HSV recurrences with and without antiviral prophylaxis within each group and between groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis., Results: Atopic/nonatopic (P value): mean follow-up without prophylaxis 8.1 (+/- 8.2)/7.3 years (+/- 8.6) (P = .71); mean follow-up with prophylaxis 2.9 (+/- 2.3)/2.6 years (+/- 2.2) (P = .51); the effect of prophylaxis significantly reduced the all recurrences in both groups except in the inflammatory recurrences in the atopic group and in the mixed recurrences in both groups. Prophylaxis decreased infectious episodes by 44% in nonatopic and 76% in atopics and decreased inflammatory manifestations by 69% in the nonatopic group and 8% in the atopic group., Conclusion: Antiviral prophylaxis for HSV recurrences was more effective in reducing infections in atopics and less effective in reducing inflammatory episodes in atopics versus nonatopics.

Purpose: To compare the characteristics of ocular herpes simplex virus (HSV) in patients with and without atopy., Design: Retrospective cohort comparative study., Methods: Patients who presented at the Cornea Service, Wills Eye Hospital, between March 2003 and March 2004 who had been previously diagnosed in the same institution as having ocular HSV diagnosis or were just diagnosed as having the disease were asked to complete a study questionnaire that enabled categorization into atopic and nonatopic. In April 2005, 223 patients who agreed to be in the study had their charts reviewed, and 125 patients were excluded according to exclusion criteria: immunosuppression, follow-up less than one year, previous history of penetrating keratoplasty (PK) out of the Cornea Service, and no active HSV episode during follow-up., Main Outcome Measures: Incidence of all types of HSV recurrences., Secondary Outcome Measures: Bilaterality, visual loss, need for PK , and secondary bacterial infection in both groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis., Results: Ninety eight patients (110 eyes) were included in the study. Atopic/nonatopic (P value): the mean follow-up was 11.6 (+/- 10.6)/8.8 years (+/- 8.4) (P = .14); the mean incidence of HSV episodes per year of follow-up was: total episodes 0.32 (+/- 0.36)/0.28 (+/- 0.33) (P = .14), infectious 0.16 (+/- 0.22)/0.10 (+/- 0.14) (P < .01), inflammatory 0.11 (+/- 0.19)/0.11 (+/- 0.19) (P < .01), and mixed 0.09 (+/- 0.20)/0.07 (+/- 0.16) (P = .06); bilateral HSV was present in 9/3 patients (P = .22); the mean loss of vision was four lines of Snellen in both groups; PK was performed in 14 of 16 eyes (P = .45); secondary bacterial infection was present in two of four eyes (P = .26)., Conclusions: Atopic patients had considerably more infectious and fewer inflammatory episodes when compared with nonatopics.

Purpose: To evaluate the effect of trypan blue staining of expandable hydrophilic acrylic intraocular lenses (IOLs) on contrast sensitivity and glare., Setting: Department of Ophthalmology, Federal University, and Oculistas Associados, Rio de Janeiro, Brazil., Methods: Phacoemulsification with expandable hydrophilic IOL implantation was performed in 19 eyes. Group 1 (stained group) consisted of 12 eyes with the IOL unintentionally stained by trypan blue 0.1% solution during surgery; Group 2 (unstained group) consisted of 7 eyes with IOLs that were not stained because trypan blue was not used during surgery. The eyes were examined postoperatively for Snellen best corrected visual acuity (BCVA), contrast sensitivity BCVA, and glare vision. The examiners were masked to whether the IOL was stained by trypan blue. Inclusion criteria included a BCVA of 20/30 or better 1 month postoperatively. Patients who had other ocular pathology or previous ocular surgery were excluded from the study., Results: The mean postoperative BCVA was 20/24 in the stained group and 20/23 in the unstained group (P =.73). The mean contrast sensitivity visual acuity was 20/31 in the stained group and 20/26 in unstained group (P =.10). The mean glare visual acuity was 20/75 and 20/33, respectively (P =.03)., Conclusions: Patients with expandable hydrophilic acrylic IOLs stained with trypan blue performed significantly worse on a glare vision test than patients whose IOLs were not stained. Cataract surgeons should avoid using trypan blue with this IOL type.