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Purpose: To report the results of imaging using high-resolution, Fourier domain anterior segment optical coherence tomography (AS-OCT) to evaluate patients with a type 1 Boston Keratoprosthesis (KPro). Methods: We performed a retrospective comparative study of patients in whom we implanted the Boston KPro. A total of 26 eyes of 23 patients from the Cornea Service at the University of California Davis Eye Center were included. Subjects were evaluated with the Spectralis AS-OCT (Heidelberg Engineering GmbH). Results: Preoperative diagnoses for KPro surgery included failed corneal transplant (69%), chemical burn (23%), and aniridia (8%). The average age of patients was 63.2 years (range, 17-88 years). Fifty-four percent of the patients were female. The mean duration between the KPro surgery and the acquisition of high-resolution AS-OCT imaging was 35.8 months (range, 2-90 months). The most commonly observed finding was retroprosthetic membrane formation, which we found in 77% of KPro eyes. In 65% of KPro eyes, we identified epithelium behind the front plate, and in 54%, we identified an epithelial lip over the anterior surface of the KPro front plate. In 31% of KPro eyes, we identified periprosthetic cysts, gaps or spaces, and thinning in the corneal carrier graft. Conclusions: Fourier domain AS-OCT is a useful noninvasive imaging technique in patients with a KPro and provides the ability to identify changes that are sometimes difficult to appreciate by clinical evaluation. The higher resolution Fourier domain systems may aid in the clinical diagnosis and management of pathology that might not be imaged with instruments of lower resolution. AS-OCT has the potential for monitoring the anatomic stability of an implanted KPro and may also help to monitor for complications. Moreover, highresolution imaging may enhance our understanding of periprosthetic anatomy.© 2013 by Lippincott Williams & Wilkins.

Infectious keratitis is a major cause of monocular blindness worldwide.1 Although fungal ulcers are relatively uncommon in developed nations, they occur frequently in developing countries, especially those in tropical regions. In South India, up to half of infectious ulcers are fungal.2 Fungal ulcers are notoriously difficult to treat compared with bacterial ulcers, and physicians frequently use combination therapy.3 Amphotericin B and natamycin are two commonly used topical agents to treat filamentous fungal keratitis.3 However, combination therapy may increase the risk of potential drug toxicity as well as the cost of therapy. Currently, there are no data on whether natamycin and amphotericin B interact synergistically in vitro against filamentous fungi. Here, we investigate whether amphotericin B and natamycin interact synergistically in vitro when tested against Fusarium and Aspergillus spp. isolated from patients with fungal keratitis. Ten Fusarium spp. and ten Aspergillus spp. isolates were randomly selected from 98 consecutive cases of culture-positive fungal keratitis treated at Aravind Eye Hospital in South India. All patients underwent cornea culture and were treated with natamycin, …

Role of randomised clinical trials in public health: distribution of mass antibiotics for trachoma control In this issue, Wright et al 1 discuss the role of randomised clinical trials (RCTs) in public health. They suggest that not all decisions can be based on evidence from RCTs, and they use the distribution of mass antibiotics for trachoma control as an example. The authors refer to several reports in which the prevalence of infection was dramatically lower after mass azithromycin distributions, but which had no control groups for comparison.2–5 They contend that a large RCT which randomised communities to different treatment strategies would be too difficult, too expensive and too unethical to conduct, and that treatment recommendations are needed immediately to prevent blindness. The particular example that the authors choose is an interesting one. Antibiotics are clearly effective in eliminating chlamydia.6–8 Infection has stayed low for months, if not years, after a single community-wide antibiotic distribution.2–4 But the long-term efficacy of mass treatment had not been rigorously shown in a group-randomised trial, at least not in time for a Cochrane Collaboration report on the topic (most recently updated in 2005).9,10 The report highlighted the fact that many studies have been uncontrolled and non-blinded. For an outcome, several have relied on clinical activity, which has never been shown to be a particularly good marker for ocular chlamydial infection.11–13 Those trials that did randomise by group typically included far too few …

CONTEXT: The World Health Organization recommends mass antibiotic distributions in its strategy to eliminate blinding trachoma as a public health concern. Some hypothesize that a single distribution is sufficient to control the ocular strains of chlamydia that cause trachoma. Others believe infection will inevitably return and periodic treatments or other measures are essential. OBJECTIVE: To determine whether ocular chlamydial infection returns to the community up to 24 months after a single mass antibiotic distribution in a hyperendemic region of Ethiopia. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study conducted March 2003 to March 2005 in the Gurage Zone of Ethiopia. Eight randomly selected villages were assessed for ocular chlamydial infection. Fifteen untreated villages were randomly chosen at 12 months to allow assessment of a secular trend. INTERVENTION: A single dose of oral azithromycin was offered to all residents of the 8 selected villages who were aged 1 year or older. MAIN OUTCOME MEASURE: Prevalence of ocular chlamydial infection in all children aged 1 to 5 years from each intervention village prior to treatment and 2, 6, 12, 18, and 24 months after mass antibiotic treatment, and also in untreated villages enrolled at 12 months. RESULTS: Five hundred fifteen children were examined for ocular chlamydial infection at baseline. For the follow-up examinations, the mean participation rate was 83%. The mean prevalence of infection in children aged 1 to 5 years decreased from 43.5% (95% confidence interval [CI], 35.0%-52.0%) to 5.1% (95% CI, 1.1%-9.2%) after treatment. On average, infection returned gradually over 24 months to 11.3% (95% CI, 4.5%-18.1%; P = .001). In 7 of 8 villages, infection was higher at 24 months than at 2 months. In the remaining village, no infection could be identified at any point after treatment. Villages enrolled at 12 months had significantly fewer infections than those enrolled 12 months earlier, suggesting a secular trend (P