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Alison D Early, Sarah Adelson, Craig J Miller, Thomas F Mauger Department of Ophthalmology, The Ohio State University Havener Eye Institute, Columbus, OH, USA Objective: To evaluate smoking and alcohol use as risk factors for higher-grade dysplasia in a population of patients with histopathologically proven ocular surface squamous neoplasia. Materials and methods: This is a retrospective chart review of data extracted from a database comprising demographic information and medical diagnosis information based on International Classification of Disease codes. Outcome measures were analyzed using the Wilcoxon two-sided test, a non-parametric t-test. Results: Database review yielded 35 patients with ocular surface squamous neoplasia lesions proven by histopathologic analysis. The mean age was 64.51 years with SD 17.54 years. Patients were 28.57% female and 71.43% male. Nearly all patients were White (88.57%), and 5.71% were African American, 2.86% Hispanic, and 2.86% Other. There was no significant difference in dysplasia grade between smokers and non-smokers (P=0.7044), those who used alcohol vs did not use alcohol (P=0.2470), those who used tobacco and alcohol vs those who did not (P=0.5117), and those who used either tobacco or alcohol vs those who did not (P=0.8259). Conclusion: No statistically significant relationship was found between high-grade dysplasia and cigarette smoking, alcohol use, or both cigarette smoking and alcohol use. Keywords: ocular surface squamous neoplasia, corneal dysplasia, conjunctival dysplasia, carcinoma in situ, squamous cell carcinoma, ocular surface tumors

Tyler D Oostra,1 Thomas F Mauger2 1Havener Eye Institute, Department of Ophthalmology, The Ohio State University Wexner Medical Center, Columbus, OH 43212, USA; 2West Virginia University Eye Institute, Department of Ophthalmology, West Virginia University, Morgantown, WV 26506, USA Purpose: The purpose of this study is to examine the cost effect of surgeon and patient discretion in regard to cataract surgery and how this affects population health care costs.Methods: A model of cataract progression was created from preexisting published data and combined with mortality data and Medicare cataract statistics to estimate the effect of mortality on decreasing the rate of cataract surgery if surgery was delayed until any cataract progression occurred.Results: Five-year cataract progression rates were determined for a given patient age, sex, and type of cataract. Combined with 5-year death rates, delaying surgery until progression occurred resulted in a 1.1% decrease in surgery for nuclear sclerosis at age 45 that increased to a 33.8% decrease by age 90; a 1.5% decrease in surgery for cortical cataract at age 45 that increased to a 51.1% decrease by age 90; and a 1.6% decrease in surgery for posterior subcapsular at age 45 that increased to a 59.7% decrease by age 90. The effect of this decrease in surgical volume on Medicare was estimated to result in a 13% overall decrease in cataract surgery annually at a cost of ~$660 million dollars per year.Conclusion: Overall, we conclude that surgeon and patient discretion in regard to cataract surgery has a substantial cost effect with the potential to reduce surgical volume by as much as 13% by the decision to delay surgery as a result of patient mortality. Keywords: cataract surgery, cataract progression, cost effect, health care costs

Thomas Mauger, Eric QuartettiHavener Eye Institute, Department of Ophthalmology, The Ohio State University, OH, USAPurpose: To analyze the levels of ß-glucuronidase during prolonged (14 day) corneal preservation with epithelialized (EPI) and deepithelialized (DEP) corneas and the effect of supplemental hydrocortisone (HCT) on these levels.Methods: Thirty-six freshly excised bovine corneas were preserved in Optisol solution (4°C) for 14 days with the following conditions EPI/no supplemental HCT, DEP no supplemental HCT, EPI/10-8 M HCT, and EPI 10-4 M HCT. ß-glucuronidase activity levels were measured at the end of this period.Results: ß-glucuronidase levels (nmol/mL/h) for each group were found to be: EPI – No HCT: 4.302, SEM 0.586; DEP – No HCT: 2.178, SEM 0.271; EPI – 10-8 M HCT: 4.472, SEM 0.435; EPI – 10-4 M HCT: 2.072, SEM 0.437. The EPI – No HCT and EPI – 10-8 M HCT were not significantly different as were the DEP – No HCT and EPI – 10-4 M HCT groups. The EPI – No HCT group and the EPI – 10-8 M HCT group were independently significantly different from the DEP – No HCT and the EPI – 10-4 M HCT groups.Conclusions: The corneal epithelium contributes significantly to the formation of the lysosomal enzyme, ß-glucuronidase, during preservation. The addition of 10-4 M HCT decreases the production of ß-glucuronidase during corneal preservation in this model.Keywords: ß-glucuronidase, preservation

Background: The ability to view the posterior segment in keratoprosthesis (Kpro) implanted patients is limited. The purpose of this retrospective, observational study was to investigate the use of ultra-wide field (UWF) scanning laser ophthalmoscopy imaging and its utility for serial evaluation of the retina and optic nerve in patients with either a Boston type I or II Kpro., Methods: A retrospective chart review was performed for patients with a Boston type I or II Kpro seen at The Ohio State University Wexner Medical Center. Images were graded for quality by two masked observers on a defined four-point scale ("Poor", "Fair", "Good", or "Very good") and assessed for visible posterior segment anatomy. Interobserver agreement was described using the Kappa statistic coefficient (κ) with 95% confidence intervals., Results: A total of 19 eyes from 17 patients were included in this study. Eighteen eyes had a type I Kpro, while one eye had a type II Kpro. UWF imaging from 41 patient visits were reviewed by two observers. Interobserver agreement between the two graders was fair for image quality (κ = 0.36), moderate for visibility of the macula with discernible details (κ = 0.59), moderate for visibility of the anterior retina with discernable details (κ = 0.60), and perfect agreement for visibility of the optic nerve with discernible details (κ = 1.0). In 6 eyes, UWF imaging was performed longitudinally (range 3-9 individual visits), allowing for long-term follow-up (range 3-46 months) of posterior segment clinical pathology., Conclusions: UWF imaging provides adequate and reliable visualization of the posterior segment in Kpro implanted patients. This imaging modality allowed for noninvasive longitudinal monitoring of retinal and optic nerve disease in this selected patient population., (© 2022. The Author(s).)

Purpose: To compare the incidence of pseudophakic cystoid macular oedema (CME) in patients who receive intracameral cephalosporin versus intracameral vancomycin during cataract surgery. Methods: A retrospective chart review was conducted on subjects with the diagnosis of CME between January 1 2010 and July 31 2017. Inclusion criterion was the documentation of CME after cataract extraction. Exclusion criteria were intraoperative complication, prior history of macular oedema, epiretinal membrane, uveitis, other pre-existing retinal pathology, or other post-operative pathology including other ocular surgery in the post-operative period. Results: The final analysis included 89 eyes with optical coherence tomography (OCT) proven CME. The incidence of pseudophakic CME in our population of 10,165 cataract surgeries after applying the above-stated exclusion criteria was 0.88%. The incidence of pseudophakic CME in subjects who received intracameral cephalosporin was 0.87% (mean age in years 69 ± 11; 31 male [39%], 48 female [61%]). The incidence of pseudophakic CME in subjects who received intracameral vancomycin was 0.96% (mean age in years 66 ± 13; 4 male [40%], 6 female [60%]). Pearson's chi-square test demonstrated no significant difference between these groups ( p  = 0.7705). Conclusions: There was no statistical difference in the incidence of pseudophakic CME in subjects who received intracameral cephalosporin versus intracameral vancomycin during cataract surgery.

Purpose: The purpose of this study was to examine the outcomes of conjunctival flaps performed at our institution., Methods: The medical records of all patients who underwent a total or partial conjunctival flap surgery over the course of a 6-year period from 2010 to 2015 were reviewed to identify the ocular diagnoses and perform a retrospective review of the preoperative and postoperative course., Results: Thirty-five patients received a conjunctival flap during the 6-year period, 20 partial flaps and 15 total flaps. Infectious keratitis or corneal ulceration accounted for 25 (71.4%) of the cases. The remaining flaps were performed for corneal perforation, graft rejection, bullous keratopathy, and secondary corneal edema. Seven patients had recession of their flap postoperatively, and 14 went on to have further surgical intervention. Conjunctival flap surgery successfully stabilized the patient's ocular surface in 97.1% of the cases., Conclusion: Conjunctival flap surgery is an important and useful surgical option in the treatment of ocular surface disease, especially recalcitrant infectious keratitis and corneal ulcers.

Purpose: Pterygia are much more common nasally than temporally. Ultraviolet (UV) radiation is a major risk factor. Coroneo proposed that the nasal preference is caused by the "peripheral light focusing effect," (PLF), in which UV at an oblique angle passes through temporal cornea and is concentrated on and damages nasal limbal stem cells. This study evaluates whether the PLF is sufficient to explain the nasal preference., Methods: Whereas Coroneo and colleagues derived the maximum PLF intensity gain (UV concentration factor) as a function of incident angle (i.e., different nasal limbal positions were used for different incident angles) the current analysis derived intensity gain at a fixed position such at the nasal corneo-limbal junction (CLJ). This provided a measure of the total PLF irradiation at this position, which was compared to total direct irradiation of nasal and temporal limbus at the corresponding positions (e.g., CLJs). In Part 1, analysis was performed like that of Coroneo, using horizontally incident UV; in Part 2, the analysis was extended to include incident rays above and below the horizontal., Results: In both part 1 and part 2 of the study, the limbal UV irradiation of the nasal limbus from the PLF was not sufficient to explain the strong nasal location preference of pterygia., Conclusions: The analysis calls into question the PLF explanation of nasal location preference. Other explanations of the nasal preference, and of pterygium pathogenesis, should be considered, such as temporal to nasal tear flow carrying substances such as cytokines to the nasal limbus.

Importance: Determining factors associated with endothelial cell loss after Descemet stripping automated endothelial keratoplasty (DSAEK) could improve long-term graft survival., Objective: To evaluate the associations of donor, recipient, and operative factors with endothelial cell density (ECD) 3 years after DSAEK in the Cornea Preservation Time Study., Design, Setting, and Participants: This cohort study was a secondary analysis of data collected in a multicenter, double-masked, randomized clinical trial. Forty US clinical sites with 70 surgeons participated, with donor corneas provided by 23 US eye banks. Individuals undergoing DSAEK for Fuchs dystrophy or pseudophakic/aphakic corneal edema were included., Interventions: The DSAEK procedure, with random assignment of a donor cornea with a preservation time of 0 to 7 days or 8 to 14 days., Main Outcomes and Measures: Endothelial cell density at 3 years as determined by a reading center from eye bank and clinical specular or confocal central endothelial images., Results: The study included 1090 participants (median age, 70 years) with 1330 affected eyes (240 bilateral cases [22.0%]), who underwent DSAEK for Fuchs dystrophy (1255 eyes [94.4%]) or pseudophakic/aphakic corneal edema (PACE) (75 eyes [5.6%]). Of these, 801 eyes (60.2%) belonged to women and 1207 (90.8%) to white individuals. A total of 749 participants (913 eyes; 164 [21.9%] bilateral cases) had functioning grafts with acceptable endothelial images preoperatively and at 3 years postoperatively and were included in this analysis. Factors associated with a lower ECD at 3 years (estimated effect with 99% CI) in the final multivariable model included donors with diabetes (-103 [-196 to -9] cells/mm2), lower screening ECD (-234 [-331 to -137] per 500 cells/mm2), recipient diagnosis of PACE (-257 [-483 to -31] in cells/mm2), and operative complications (-324 [-516 to -133] in cells/mm2). Endothelial cell loss (ECL) from a preoperative measurement to a 3-year postoperative measurement was 47% (99% CI, 42%-52%) for participants receiving tissue from donors with diabetes vs 43% (99% CI, 39%-48%) without diabetes; it was 53% (99% CI, 44%-62%) for participants diagnosed with PACE vs 44% (99% CI, 39%-49%) for those diagnosed with Fuchs dystrophy, and 55% (99% CI, 48%-63%) in participants who experienced operative complications vs 44% (99% CI, 39%-48%) in those who did not. No other donor, recipient, or operative factors were significantly associated with 3-year ECD., Conclusions and Relevance: Donor diabetes, lower screening ECD, a PACE diagnosis in the recipient, and operative complications were associated with lower ECD at 3 years after DSAEK surgery and may be associated with long-term graft success. While causation cannot be inferred, further studies on the association of donor diabetes and PACE in recipients with lower 3-year ECD warrant further study.

Purpose: To associate donor, recipient, and operative factors with graft success 3 years after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS)., Design: Cohort study within a multicenter, double-masked, randomized clinical trial., Participants: One thousand ninety individuals (1330 study eyes) with a median age of 70 years undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE; 6% of eyes)., Methods: Eyes undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (n = 675) or 8 to 14 days (n = 655). Donor, recipient, and operative parameters were recorded prospectively. Graft failure was defined as regraft for any reason, a graft that failed to clear by 8 weeks after surgery, or an initially clear graft that became and remained cloudy for 90 days. Failure in the first 8 weeks was classified further as primary donor failure or early failure, in the absence or presence of operative complications, respectively. Proportional hazards and logistic regression models were used to estimate risk ratios (RR) and 99% confidence intervals (CIs) for graft failure., Main Outcome Measures: Graft success at 3 years., Results: One thousand two hundred fifty-one of 1330 grafts (94%) remained clear at 3 years and were considered successful. After adjusting for PT, tissue from donors with diabetes (RR, 2.35; 99% CI, 1.03-5.33) and operative complications (RR, 4.21; 99% CI, 1.42-12.47) were associated with increased risk for primary or early failure. Preoperative diagnosis of PACE (RR, 3.59; 99% CI, 1.05-12.24) was associated with increased risk for late failure by 3 years after surgery compared with Fuchs dystrophy. Graft success showed little variation among other factors evaluated, including donor age (RR, 1.19 per decade; 99% CI, 0.91-1.56 per decade), preoperative donor endothelial cell density (RR, 1.10 per 500 cells; 99% CI, 0.74-1.63 per 500 cells), graft diameter (RR, 1.22 per 1 mm; 99% CI, 0.39-3.76 per 1 mm), and injector use for graft insertion (RR, 0.92; 99% CI, 0.40-2.10)., Conclusions: Descemet stripping automated endothelial keratoplasty success in the early and entire postoperative period is more likely when the donor did not have diabetes and was without operative complications and in the long-term postoperative period in recipients with Fuchs dystrophy compared with those with PACE. Mechanisms whereby diabetic donors and PACE recipients reduce the rate of graft success after DSAEK warrant further study., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

A 45-year-old female with history of contact lens wear presented with a persistent corneal ulcer that was unresponsive to topical moxifloxacin. The patient's exam was concerning for fungal keratitis. Cultures were obtained, and the patient was started on fortified amphotericin B drops and oral voriconazole. The cultures identified Candida dubliniensis as the causative organism. The patient's exam worsened despite treatment, and the decision was made for surgery. At the time of surgery, her cornea was found to have unexpectedly perforated. She underwent cryotherapy; tectonic penetrating keratoplasty; anterior chamber tap; intracameral voriconazole, amphotericin B, and cefuroxime; and a partial conjunctival flap. Pathology from the cornea showed GMS and PAS stains positive for fungal forms. C. dubliniensis is a yeast closely related to Candida albicans that was first described in 1995 as a cause of oral candidiasis in patients with AIDS. There are a few published cases of endophthalmitis due to C. dubliniensis in the ophthalmology literature, but to our knowledge, no cases of fungal keratitis due to this organism have been reported. C. dubliniensis is a novel cause of fungal keratitis that can be difficult to identify and treat but is felt to be less virulent than C. albicans and generally susceptible to available anti-fungal therapies.

Purpose: To report 2 cases of ocular chemical burns associated with the use of a swim goggle antifog agent and to review the literature for this and similar antifog products., Methods: Case reports and systematic review of the medical literature, material safety data, product safety reports, and consumer reviews., Results: Two males, one 46 years and the other 41 years, were referred to our clinic with chemical burns of the ocular surface after using the same goggle antifog agent while swimming in a triathlon. Both sustained significant epithelial defects. Fortunately, with prompt treatment, both of our patients returned to their baseline vision within a few weeks without suffering sight-threatening complications., Conclusions: These are the first cases of ocular chemical burn secondary to use of an eyewear antifog agent to be reported in the medical literature. Similar reports found in consumer forums suggest that our cases are not isolated and these products may have the potential to cause vision-threatening chemical burns.

We report on the theory and design of adaptive objective lens for ultra broadband near infrared light imaging with large dynamic optical depth scanning range by using an embedded tunable lens, which can find wide applications in deep tissue biomedical imaging systems, such as confocal microscope, optical coherence tomography (OCT), two-photon microscopy, etc., both in vivo and ex vivo. This design is based on, but not limited to, a home-made prototype of liquid-filled membrane lens with a clear aperture of 8mm and the thickness of 2.55mm ~3.18mm. It is beneficial to have an adaptive objective lens which allows an extended depth scanning range larger than the focal length zoom range, since this will keep the magnification of the whole system, numerical aperture (NA), field of view (FOV), and resolution more consistent. To achieve this goal, a systematic theory is presented, for the first time to our acknowledgment, by inserting the varifocal lens in between a front and a back solid lens group. The designed objective has a compact size (10mm-diameter and 15mm-length), ultrabroad working bandwidth (760nm - 920nm), a large depth scanning range (7.36mm in air) - 1.533 times of focal length zoom range (4.8mm in air), and a FOV around 1mm × 1mm. Diffraction-limited performance can be achieved within this ultrabroad bandwidth through all the scanning depth (the resolution is 2.22 μm - 2.81 μm, calculated at the wavelength of 800nm with the NA of 0.214 - 0.171). The chromatic focal shift value is within the depth of focus (field). The chromatic difference in distortion is nearly zero and the maximum distortion is less than 0.05%.

Purpose: To describe the clinical features of a familial abnormality of the corneal stem cells and to investigate the role of PAX6 mutations in the affected family members., Methods: A family with multiple generations of peripheral keratopathy was evaluated. Because of the corneal phenotypic similarity to aniridia-related keratopathy, it was hypothesized that the affected patients might have a dominantly inherited mutation of PAX6 on chromosome 11. Commercial sequencing of germline DNA from 1 affected family member did not identify any PAX6 mutations in the exons or intron-exon boundary regions. Because the commercial analysis is not designed to identify PAX6 deletions, germline DNA was collected from 5 unaffected and 2 additional affected family members. DNA repeat markers in the region of PAX6 were analyzed to determine whether this chromosomal region segregates with the disease phenotype., Results: Affected family members with this autosomal dominant peripheral corneal abnormality showed evidence of progressive corneal stem cell dysfunction. Several individuals demonstrated corectopia, and 1 individual had ectropion uvea but no other iris or ocular abnormalities associated with aniridia. Genotyping data of affected and unaffected family members demonstrated that the PAX6 region does not segregate with the disease phenotype., Conclusions: The features of this autosomal dominant abnormality show some similarity to aniridia, although the classic characteristics of severe iris hypoplasia and macular hypoplasia are absent. Mutational screening and genotyping could not conclusively clarify a role for PAX6 in this disease phenotype, suggesting that it is a distinct clinical and genetic disease entity, not a variant of aniridia.

Objective: To study the epidemiology, clinical observations, and microbiologic characteristics of fungal keratitis at tertiary eye care centers in the United States., Design: Retrospective multicenter case series., Participants: Fungal keratitis cases presenting to participating tertiary eye care centers., Methods: Charts were reviewed for all fungal keratitis cases confirmed by culture, histology, or confocal microscopy between January 1, 2001, and December 31, 2007, at 11 tertiary clinical sites in the United States., Main Outcome Measures: Frequency of potential predisposing factors and associations between these factors and fungal species., Results: A total of 733 cases of fungal keratitis were identified. Most cases were confirmed by culture from corneal scraping (n = 693) or biopsies (n = 19); 16 cases were diagnosed by microscopic examination of corneal scraping alone; and 5 cases were diagnosed by confocal microscopy alone. Some 268 of 733 cases (37%) were associated with refractive contact lens wear, 180 of 733 cases (25%) were associated with ocular trauma, and 209 of 733 cases (29%) were associated with ocular surface disease. No predisposing factor was identified in 76 cases (10%). Filamentous fungi were identified in 141 of 180 ocular trauma cases (78%) and in 231 of 268 refractive contact lens-associated cases (86%). Yeast was the causative organism in 111 of 209 cases (53%) associated with ocular surface disease. Yeast accounted for few cases of fungal keratitis associated with refractive contact-lens wear (20 cases), therapeutic contact-lens wear (11 cases), or ocular trauma (21 cases). Surgical intervention was undertaken in 26% of cases and was most frequently performed for fungal keratitis associated with ocular surface disease (44%). Surgical intervention was more likely in cases associated with filamentous fungi (P = 0.03). Among contact lens wearers, delay in diagnosis of 2 or more weeks increased the likelihood of surgery (age-adjusted odds ratio = 2.2; 95% confidence interval, 1.2-4.2)., Conclusions: Trauma, contact lens wear, and ocular surface disease predispose patients to developing fungal keratitis. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with trauma or contact lens wear, whereas yeast is most frequently the causative organism in patients with ocular surface disease. Delay in diagnosis increases the likelihood of surgical intervention for contact lens-associated fungal keratitis., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population., Design: Retrospective, multicenter case series., Participants: Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007., Methods: Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research., Main Outcome Measures: Quarterly number of fungal keratitis cases and fungal species., Results: We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P < 0.0001)., Conclusions: The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear., (Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the repeatability and reliability of IOLMaster (Carl Zeiss Meditec, Inc., Dublin, CA) axial length and keratometry measurements (K readings) with a soft contact lens on normal eyes. The method is designed for eyes with corneal irregularities or after endothelial keratoplasty., Methods: Biometry was performed on 20 healthy right eyes of volunteer subjects with mean age, 27.3 +/- 4.9 years; axial length, 24.77 +/- 1.04 mm; and K reading, 43.48 +/- 1.69 D. Axial length and keratometry were measured and repeated with -0.5 D SofLens38 (Bausch & Lomb, Rochester, NY) and Acuvue2 (Johnson & Johnson, New Brunswick, NJ) soft contact lenses. Repeatability and reliability were evaluated. Contact lens thickness was measured directly by corneal optical coherence tomography (OCT)., Results: Axial lengths increased 59 +/- 10 microm with SofLens38 and 134 +/- 13 microm with Acuvue2, and these changes correlated with the OCT contact lens thicknesses (P = 0.995). The axial length variability remained constant (P = 0.18), measuring 24 +/- 10 microm for SofLens38 and 23 +/- 8 microm for Acuvue2 compared with 20 +/- 7 microm with no lens. K readings of 43.08 +/- 1.66 D with SofLens38, 42.79 +/- 1.57 D with Acuvue2, and 43.48 +/- 1.69 D with no lens corresponded to differences of -0.40 +/- 0.12 D with SofLens38 and -0.69 +/- 0.19 D with Acuvue2. The K-reading variability increased slightly from 0.04 to 0.09 D with either lens., Conclusions: Low-power soft contact lenses enable reliable and repeatable IOLMaster axial length and K-reading measurements. Correcting for the measurable lens thickness and lens effects, a <0.5-D error in the Sanders-Retzlaff-Kraff (SRK) II power formula is predicted.

Purpose: To describe whether a technique of treatment of a combined acanthamoeba-stenotrophomonas keratitis with a conjunctival flap followed by a penetrating keratoplasty is successful., Methods: A case of chronic ring-shaped keratitis in which Stenotrophomonas maltophilia was isolated with corneal scrapings, and acanthamoeba cysts were found with a corneal biopsy. The infection was resistant to conventional medical treatment. It was treated with a conjunctival flap combined with corneal cryo treatment, followed by a penetrating keratoplasty 6 months later., Results: The patient achieved immediate pain relief after the conjunctival flap. All medications were tapered off over 3 months. A penetrating keratoplasty was performed after 6 months. The cornea remained clear and the best-corrected visual acuity is 20/25 2 years after surgery., Conclusions: A combined acanthamoeba-stenotrophomonas keratitis, which is resistant to medical therapy, can be treated successfully with a conjunctival flap followed by a penetrating keratoplasty.

Povidone iodine (PI) is a common preoperative antiseptic for eyelid and conjunctival preparation. The corneal endothelium may theoretically be exposed to PI during intraocular surgery or during the repair of a corneal laceration. This study explores the changes in corneal endothelial cell density following exposure to 1%, 2%, and 5% concentrations of PI in a porcine model. Four groups of excised porcine corneas were exposed to 1% (group A), 2% (group B), and 5% (group C) PI and balanced salt solution (BSS, Alcon Labs, Fort Worth, TX) (group D) for a 1-minute exposure. Specular microscopy was used to measure endothelial cell density pre- and post-exposure. Group A (1% PI) had reduction of endothelial cell density from 3870 cells/mm2 to 3604 cells/mm2, group B (2%) 3634 preexposure to 3115 postexposure, group C (5%) 3582 preexposure to 2948 postexposure, and group D (BSS) endothelial cell density was 3639 preexposure to 3741 postexposure. A graded increase in endothelial cell loss is seen with increased povidone iodine concentrations.

The intraocular pressure (IOP), anterior chamber depth (ACD), and axial length (AL) were measured in 38 eyes of 19 subjects before and after intravenous mannitol injection (12.5 g). Intraocular pressures dropped over the initial 30 min then rose back to baseline by 2 hr. Time 0 min:14.2 mmHg, 15 min:12.7 mmHg, 30 min:11.4 mmHg, 60 min:12.0 mmHg, 90 min, 13.2 mmHg, 120 min:14.1 mmHg. Sitting and supine ACD and AL did not change following mannitol injection. This study supports an ocular hypotensive effect of mannitol without reducing vitreous volume using a relatively low dose of mannitol (12.5 g). This finding has important implications for its use in ocular surgery at this dosage.

Objective: To determine whether water handling in patients receiving haloperidol decanoate (HD) was impaired., Design: Prospective, controlled trial of water handling in patients without symptomatic hyponatremia receiving HD. Eligibility for study inclusion required that patients had received HD for at least 4 months, were not taking any medication reported to cause inappropriate antidiuretic hormone secretion or hyponatremia (excluding haloperidol), and would agree to participate in the study. An age- and gender-matched healthy control subject was enrolled for each study patient. Baseline laboratory values were obtained within 48 hours prior to the standard water-loading test to screen for abnormalities in electrolytes, kidney function, and liver function. A 20-mL/kg water-load test was administered to each patient. Urine volume and osmolality were measured every hour for 4 hours., Setting: A community mental health (CMH) outpatient psychiatric facility for the patients receiving HD and Saint Mary's Health Services for the controls., Participants: Fifteen patients receiving HD from the CMH facility and 15 age- and gender-matched control subjects were enrolled., Main Outcomes Measures: Impaired water handling was defined as a failure to dilute urine to less than 100 mmol/kg or a failure to excrete more than 65% of a water load in 4 hours., Results: Five patients receiving HD were excluded because of protocol refusal or violation. Five of 10 evaluable patients receiving HD had abnormal water handling. Two of these could not lower their urine osmolality to less than 100 mmol/kg, 2 could not excrete more than 65% of the water load, and 1 did not meet either criteria. None of the healthy volunteers had abnormal free water handling. The difference between the study patients and the control subjects was statistically significant (p = 0.0097)., Conclusions: Fifty percent of our study patients receiving HD had abnormal free water handling. This finding, combined with our clinical observations of symptomatic hyponatremia in other patients receiving the drug, suggests the need to investigate the incidence of hyponatremia and to design a useful screening tool to identify patients at risk. In the meantime, clinicians should be aware of the potential for impaired water handling in patients receiving HD.

In vitro, iris contractions after muscarinic agonists were measured in mg of tension change and the concentration producing 50% of the response was expressed as EC50 mumol/l. Although the average EC50 value of carbachol in the iris sphincter of the donors with diabetes or Parkinson's disease did not change significantly when compared with the control, the maximum contraction of the tissue from the diseased state was increased significantly. Thus, in addition to the well known denervation supersensitivity of the iris-dilator, the iris-sphincter also develops adaptive sensitivity changes. Antimuscarinic drug treatment in some Parkinson's patients interfered with the estimation of supersensitivity in vitro studies. The enhanced response of carbachol at the low temperatures or the relative potency of carbachol and pilocarpine in the tissue obtained from the diseased donors was not significantly different from that of controls. Based on EC50 values, the potency of arecoline on the iris was 1/3 that of carbachol. Significantly lower EC50 values of carbachol were found in irides which were in contact with open loop type anterior chamber lens implants compared with those in contact with the closed loop anterior chamber lens implants. Maximum responses of irides to carbachol were less when the tissue was in contact with open loop lens compared with those in contact with closed loop anterior chamber implants. Irides from many donors having unilateral or bilateral replacement of the artificial lenses responded with EC50 of carbachol which was approximately equal to that of the contralateral eye. The maximum difference between EC50 values of the left and right iris was less than 5 fold.(ABSTRACT TRUNCATED AT 250 WORDS)

A one-month-old infant boy was examined early in life because his mother had bilateral retinoblastoma and his father had bilateral microphthalmia. The ophthalmologist found his right eye was normal size with a coloboma of the iris, choroid, and retina. The left eye was microphthalmic with a coloboma of the uveal tract and retina. A vascularized fluffy white mass in the posterior pole was diagnosed clinically as a retinoblastoma. The tumor regressed with radiation. When the patient was four years of age, a large tumor was found in the region of the pineal recess, causing hydrocephalus and seizures. A biopsy showed an undifferentiated malignant neuroepithelial neoplasm. The patient died within three months of diffuse central nervous system tumor. The unusual findings of a retinoblastoma in a microphthalmic eye with bilateral colobomas and a neuroepithelial neoplasm of the pineal gland are discussed.

The rate of corneal epithelial healing was determined as a function of the oxygen level present at the tear-cornea interface. Oxygen levels of 1.77, 2.3, 5.3, 8.55, 10.12, and 16.45% were created over the rabbit cornea with tarsorrhaphy and various contact lenses. Full depth epithelial defects of 4.5 mm diameter were created in 6 animals for each test condition with the fellow eye serving as a control and healing in air (21.09% oxygen). The defect (radius) was measured at 24-h intervals until healing occurred. Statistically significant (p less than 0.05, paired Student t-test) delays in healing were found with oxygen levels of 8.55% and below. These delays were most profound over the initial 24 h. The healing rate with tarsorrhaphy, at the 1.77% oxygen level, over the first 24 h was 5.2 microns/h radius, only 15.2% of the paired control, 34.0 microns/h radius, healing in air (21.09% oxygen). Healing rates over the initial 24 h under contact lenses allowing 2.3, 5.3, 8.55, 10.12, and 16.45% oxygen were 6.1, 23.5, 26.5, 43.0, and 45.0 microns/h in radius, respectively.

The buffering capacity of tears collected from contact lens wearers was compared to that from non-contact lens wearers. Three groups of subjects were investigated: 6 subjects not wearing contact lenses, 3 subjects wearing rigid contact lenses, and 3 subjects wearing hydrogel contact lenses. Each of the 12 subjects provided, on 6 separate occasions, 100 microliters of tears. The pH of the tears was measured with a closed chamber, temperature stabilized micro-electrode system firstly on collection and then after titration with acid and base. In all, 28 titration steps across the acid-base spectrum were completed for each subject's tears on each occasion. These tear pH responses to acid-base challenge were compared to that of unbuffered distilled water for the same titration procedure. There was no statistically significant effect of contact lens wear on tear buffering capacity, but considerable inter-subject variability was noted.

Flare cells, and hypotony do not always signify uveitis, but may also be presenting symptoms of a retinal detachment. Unexpected, unusually good intraocular pressure control in a difficult case of glaucoma is less often a cause for rejoicing and more often a result of a retinal detachment.

The buffering capacity of tears collected from six young, healthy subjects was assessed using a microtitration technique. Each subject provided, on six separate occasions, about 100 microliter of tears, collected in small amounts and with minimal mechanical stimulation over several hours. The pH of the total stirred pool of tears from each subject was determined at the outset. This pool of tears was then divided into two equal volume aliquots, the pH of each being determined following each titration step of one of them with acid, and of the other with base. In all, 28 titration steps across the acid-base spectrum were completed for each patient pool collected. A total of 1044 tear pH measurements were made, all being done in a closed, temperature stabilized (36 degrees C) microelectrode chamber having an accuracy of within 0.04 pH units. For a comparative reference, an identical titration procedure was used on degassed, demineralized distilled water (348 pH determinations). Buffering capacity was found to show considerable intersubject variations, but in all cases the effect was more pronounced and more uniform following acid titration. Local zones of enhanced buffering across the pH spectrum could be identified, presumably reflecting the multiple buffering components (bicarbonate, protein and others) present in tear fluid.

A quantitative comparison is made of the effects of two of the most completely dissociating representatives from the pH spectrum, sodium hydroxide and hydrochloric acid, on oxygen uptake by the corneal epithelium. Based on initial observations, a 6 to 1 time ratio in the exposure period (acid, 60 seconds; base, 10 seconds) was found necessary to localize and define similar aerobic effects by the 2 agents on their concentration scales. A further dosage adjustment factor was required, a 5/1 concentration ratio of acid to base, to achieve near parity of the major depressive thresholds of those 2 agents, as well as to illustrate in the resulting graphical model several unique features of each in their aerobic effects on corneal tissue at lower concentrations.

A micropolarographic system was used as a quantitative means of monitoring the healing course of corneal epithelium following a 10 second exposure to 0.20 N sodium hydroxide solution. Concentrations of less than that strength produced inconsistent flux baselines due to incomplete damage to the epithelium, while higher concentrations commonly involved the stroma as well. Virtually complete epithelial destruction (down to the basement membrane) and reproducible flux baselines were found, however, with the 0.20 N induced lesion studied in detail here. The healing course following those exposures consisted of two well defined phases: an initial period of hypoflux lasting some 48 h before rising back up to the pre-lesion baseline, followed then by a period of hyperflux lasting about 7 days before decreasing once again down to the pre-lesion baseline. This oxygen flux sequence closely parallels certain sliding and mitotic phases of epithelial healing already established in the literature.

With the use of a micropolarographic system, the effects of a series of unbuffered sodium hydroxide concentrations on oxygen uptake by the corneal epithelium of rabbit were measured in vivo. Based on an exposure model of 10 sec. followed by a saline rinse, concentrations of greater than 0.10 N were found to cause an abrupt and severe decline in oxygen uptake, with oxygen flux responses associated with 0.13 N and greater being indistinguishable 10 min later from those of a cornea completely denuded of epithelium. Initial flux variations, characteristic of exposure responses to concentrations of 0.10 N or less, gradually diminished, however, stabilizing within 1 hr to levels not significantly different (P less than 0.01) from pre-exposure fluxes or those of saline controls.