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Purpose The purpose of this study was to report the clinical course and outcome of patients with refractory ocular mucous membrane pemphigoid (MMP) treated by repository corticotropin injection (RCI). Methods Patients with biopsy-proven ocular MMP treated with RCI from 3 tertiary medical centers were evaluated. Medical records between January 2013 and January 2021 were reviewed and deidentified to retrieve relevant disease-related data. Primary outcome measures included conjunctival inflammatory activity, change in Foster clinical conjunctival scarring staging after RCI treatment, and the development of ocular and systemic complications. Results Included were 15 patients (10 women and 5 men; 36-95 yrs of age) with a mean follow-up of 4.5 years. Most of the patients (80%) had Foster stage 3 at presentation, and all patients had active MMP. Each patient had failed to respond to at least 1 immunomodulatory drug during the follow-up, and 9 (60%) patients had treatment failure of at least 2 other agents before the use of RCI. The mean duration of RCI treatment was 21 months (range, 3-54 mo). Foster stage did not change in any of the 15 patients at the last follow-up. Nine patients continued RCI therapy at the last follow-up, and in all of them, the disease activity of MMP was well controlled. No serious adverse events because of RCI were documented during the follow-up in any treated patient. Conclusions RCI may serve as an alternative or an adjunctive treatment in patients with severe and refractory ocular MMP. Treatment with RCI seems to be safe and well-tolerated.

Purpose To report an outbreak of Fusarium keratitis in contact lens (CL) wearers in the northeastern United States. Methods Over a 41-month period, all cases with culture-proven corneal ulceration secondary to Fusarium at 2 tertiary care eye centers were identified through the microbiology departments of each institution, and a retrospective review of charts was performed. Statistical analyses were performed to evaluate a possible association of Fusarium keratitis with specific CL and CL solution brands. Results Fifteen cases of Fusarium keratitis were reported at the 2 tertiary centers between July 2005 and May 2006 (16.4 cases/yr) compared with 6 cases over the previous 30 months from January 2003 to June 2005 (2.4 cases/yr). All 15 of the more recent cases were CL users, and none had a history of trauma. All 15 patients claimed use of ReNu brand contact lens solution when they developed keratitis. Twelve (80.0%) of 15 patients were Acuvue soft contact lens users. Ten (66.7%) of 15 patients used tap water to rinse their contact lens cases. Six (40.0%) of 15 cases have thus far required corneal transplantation. Conclusions The incidence of corneal ulceration secondary to Fusarium has increased sevenfold over the reported 11-month period at 2 tertiary eye care centers in the northeastern United States compared with the previous 30 months. There seems to be an association between the recent outbreak of Fusarium keratitis among CL users and the use of ReNu contact lens solution. Medical treatment of Fusarium keratitis may be ineffective, and emergent penetrating keratoplasty (PKP) may be required in some patients. CL users and their physicians should reconsider the risks of CL use and discuss proper lens care techniques.

We present 2 cases of spontaneous corneal perforation in patients with keratoconus. The first patient developed a corneal scleral fistula 1 year after her initial diagnosis of hydrops. We conclude that adequate eye care education, allergy prophylaxis, and fall precautions may be necessary in patients with keratoconus to prevent corneal perforations. Medical and surgical treatments are both viable first-line treatments for corneal perforations.

PURPOSE To report a case in which corneal autograft and allograft were performed in a 10.5-month-old, ex 24-week, premature boy with bilateral corneal opacities from infectious keratitis. METHODS Case report based upon chart review. RESULTS At 3 years, the corneal autograft is clear without vascular ingrowth. After transplantation, the clarity of the autograft improved markedly and unexpectedly from its pretransplantation appearance. The child fixes and follows and has central steady maintained fixation at near with a spectacle correction of +11.00 diopters. The allografted cornea is opaque with 360 degrees of vascular ingrowth. This eye is phthisical with no response to light. CONCLUSIONS In circumstances in which a viable cornea is available from the patient's worse prognosis eye, a corneal autograft is a potential treatment option.