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Purpose To evaluate the efficacy of amniotic membrane in corneal ulcers refractive to conventional treatment and amniotic membrane with fibrin glue in corneal perforations. Methods Amniotic membrane transplantation (AMT) was performed in 33 eyes from 32 patients for corneal ulcers refractive to conventional treatment. Fourteen ulcers were perforated and received fibrin glue and amniotic membrane. Ulcers were divided into 3 groups: neurotrophic or exposure, autoimmune, and other etiology. Results Overall success was observed in 80% (27/33 eyes) of the cases, with success rates of 87.5% (14/16 eyes), 70% (7/10 eyes), 85.7% (6/7 eyes) in groups 1, 2, and 3, respectively. The ulcers healed in a mean time of 3.6 +/- 1.6 weeks and the follow-up was 14.8 +/- 9.9 months. Failure was noted in 6 eyes with severe neurotrophic keratitis, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and Acanthamoeba keratitis. Grafts with fibrin sealant showed a success rate of 92.9 % (13/14 eyes) compared to 73.7% (14/19 eyes) for amniotic grafts alone. In patients with severe limbal damage, a success rate of only 20% (1/5) was observed. Conclusions AMT is a viable option in the treatment of nonhealing corneal ulcers of various depth and etiologies. Perforations up to 3 mm can be safely managed by fibrin glue and AMT. These techniques lead to rapid reconstruction of the corneal surface and can give a good final functional result or allow keratoplasty to be done in more favorable conditions.

Objective To determine whether ocular cicatricial pemphigoid (OCP) may represent a distinct immunopathologic disease when it is pure ocular cicatricial pemphigoid (POCP) (e.g., only confined to the conjunctiva) or when it is associated with skin or extraocular mucous membrane lesions or both (OCP + ). Design Prospective, immunologic, and immunopathologic study with special emphasis on direct immunoelectron microscopy. Participants Six patients with POCP and seven patients with OCP + . Intervention After informed consent was obtained, a conjunctival biopsy was performed in all patients. Skin and extraocular mucosa biopsy specimens were harvested in selected cases only. Main outcome measures Results of direct immunofluorescence and direct immunoelectron microscopy without freezing on conjunctival and skin biopsy specimens, indirect immunofluorescence, and Western immunoblotting analysis were analyzed. Results Results of direct immunoelectron microscopic examination of the conjunctiva showed the presence of immune deposits in the upper lamina lucida of the basement membrane zone in the six patients with POCP, whereas the immune reactants were located in the lower part of the lamina lucida and in the lamina densa of the basement membrane zone (conjunctiva, buccal mucosa, and skin) in the seven patients with OCP + . Direct immunofluorescence was positive in the biopsy specimens of three patients with POCP (50%) and the seven patients with OCP + (100%). Results of indirect immunofluorescence study showed circulating autoantibody levels only in two patients with OCP + , and results of Western immunoblot analysis were negative. Conclusions Results of direct immunoelectron microscopic examination of the conjunctiva support the hypothesis that POCP may be a disease entity distinct from mucocutaneous cicatricial pemphigoid.

Optimizing the sensitivity of immunopathologic methods in detecting target antigens in immune-mediated cicatrizing conjunctivitis.Immunofluorescence was performed on normal and salt-split conjunctival biopsies in fifteen patients with clinical evidence of ocular cicatricial pemphigoid, and results were compared with immunoperoxidase, a technique thought to be more sensitive although more expensive and more difficult technically to perform.Ten of fifteen biopsies (67%) were positive when conventional and salt-split immunofluorescence results were combined. Four of eight patients with positive conventional immunofluorescence showed more marked immunofluorescence with the salt-split method. All patients were positive with immunoperoxidase (100%).Immunoperoxidase was more sensitive than conventional or salt-split immunofluorescence in detecting immunoreactant deposition along the basement membrane of the conjunctiva. Salt-split immunofluorescence demonstrated more intense staining of conjunctival samples when compared with conventional immunofluorescence, without however increasing the yield of positive biopsies. Finding solutions for the proper handling of conjunctival tissue in salt may improve the diagnostic yield of salt-split immunofluorescence.

* BACKGROUND AND OBJECTIVE: To evaluate the outcome of cataract surgery for patients with acquired immunodeficiency syndrome (AIDS) who underwent vitrectomy and silicone tamponade for viral retinitis-associated retinal detachment. * PATIENTS AND METHODS: The authors retrospectively reviewed the data of five AIDS patients (five eyes) who had cataract within a mean period of 4 months following vitrectomy and silicone oil tamponade for viral retinitis-associated retinal detachment. Phacoemulsification and implantation of a polymethylmethacrylate posterior chamber intraocular lens were performed. The mean postoperative followup was 3 months. * RESULTS: Neither silicone oil loss nor retinal redetachment were reported postoperatively. Visual acuity improved in two eyes and remained unchanged in one eye. Total blindness occurred in two eyes. * CONCLUSION: Although cataract surgery in these eyes is a relative easy procedure and does not interfere with the retinal status, visual outcome remains poor because of possible postoperative optic atrophy. [Ophthalmic Surg Lasers 1997;28:828-831.]

PURPOSE: To evaluate the accuracy of the Holladay Diagnostic Summary of the EyeSys Corneal Analysis System in predicting the corneal visual acuity potential in patients who have undergone penetrating keratoplasty (PKP). METHODS: Astigmatism patterns, refractive and topographic astigmatism, best spectacle-corrected visual acuity (BSCVA), and hard contact lens (HCL) visual acuity of 54 patients were analyzed 3 months after PKP and compared with the Potential Corneal Acuity (PCA) value predicted by the Holladay Diagnostic Summary. RESULTS: Qualitative patterns of astigmatism (p = 0.01) and refractive (p = 0.002) and topographic (p = 0.0002) astigmatism were significantly correlated with PCA values. Using HCL visual acuities to correct the BSCVA (HCL-corrected BSCVA) for noncorneal causes of reduced vision, we found that the PCA values of 48.1% of the patients were within one line of the HCL-corrected BSCVA; 81.5% were within two lines; and 93.0% were within three lines. CONCLUSION: The Holladay PCA measurement may be useful in the postoperative evaluation of the optical quality of the central corneal surface in patients who have undergone PKP.