- Email: [email protected]
A cluster of cases of mycobacterium Szulgai Keratitis that occurred after laser-assisted in situ keratomileusis
7.88 letters; high-contrast entrance visual acuity, 9.03 ⫾ 8.40 letters; low-contrast entrance visual acuity, 9.43 ⫾ 7.88 letters; spherical equivalent refractive error, 3.15 D ⫾ 3.84 D; and refractive cylinder power, 1.55 D ⫾ 1.42 D. Twenty-one percent of the keratoconus patients had corneal scarring in only one eye. There is an association between patient-reported unilateral eye rubbing and greater asymmetry in corneal curvature and between a history of unilateral eye trauma and greater asymmetry in corneal curvature and refractive error, with the rubbed/ traumatized eye being the steeper eye most of the time. The authors believe that the findings support the observation that keratoconus can be very asymmetric at the time of presentation.—Michael D. Wagoner
● Novel mutations in the MYOC/GLC1A gene in a large group of glaucoma patients. Michels-Rautenstrauss K, Mardin C, Wakili N, Ju¨ nemann AM, Villalobos L, Mejia ¨ zbey S, Naumann GOH, Reis C, Soley GC, Azofeifa J, O A, Rautenstrauss B.* Hum Mutat 2002;20:479 – 480.
M
UTATIONS OF THE MYOCILIN (MYOC) GENE WITHIN
Myocilin mutations in a population-based sample of cases with open-angle glaucoma: the Rotterdam study. Hulsman CAA, de Jong PTVM, Lettink M, van Duijn CM, Hofman A, Bergen AAB.* Graefes Arch Clin Exp Ophthalmol 2002;240:468 – 474.
the GLC1A locus have been identified in 2% to 4% of patients with open-angle glaucoma (OAG). In this study, 682 persons were screened for MYOC mutations. The first group consisted of 453 patients from a long-term clinical study who were diagnosed with either OAG, juvenile OAG, primary OAG, ocular hypertension or normal-tension glaucoma (NTG), plus 22 patients with secondary glaucoma. This group, along with 83 healthy controls, is part of a long-term study with repeated clinical examinations. An additional sample of 124 glaucoma patients or patients at risk for glaucoma were included in the mutation screening. Five novel mutations, namely Gly434Ser, Asn450Asp, Val251Ala, Ile345Met, and Ser393Asn, could be identified as the cause of primary OAG, juvenile OAG, and normaltension glaucoma. Myocilin mutations were identified at a rate of 11 of 341 (3.2%) of patients, similar to previous studies.—Hans E. Grossniklaus
T
*Bernd Rautenstrauss, Institute of Human Genetics, Friedrich-Alexander University of Erlangen-Nurnberg, Schwabachanlage 10, D-91054, Erlangen, Germany.
*Karla Zadnik, OD, PhD, The Ohio State University, College of Optometry, 338 West Tenth Street, Columbus, OH 43210-1240; E-mail: [email protected]
●
HIS STUDY INVESTIGATED THE PREVALENCE OF MYOCI-
lin (MYOC) mutations in a population with openangle glaucoma (OAG) and described a family with both juvenile- and adult-onset OAG caused by a mutation in MYOC. Myocilin was screened in cases derived from the Rotterdam Study. Definite OAG was defined as glaucomatous optic neuropathy together with a glaucomatous visual field defect. Upon identification of the Asn480Lys mutation in one case, seven additional family members were studied. The haplotypes of MYOC flanking markers D1S2851, D1S242, D1S218 and D1S1165 were compared to test for a founder effect. Seven sequence alterations in MYOC were found in 14 of 47 OAG cases; 6 of these were also found in controls. In 1 case, an Asn480Lys mutation was found. In relatives of the latter patients, the phenotype ranged from a glaucomatous optic neuropathy without visual field defect in a 70-year-old patient to severely affected optic disks and a remaining temporal remnant in a 34-year-old patient. Those without the mutation had no signs of OAG. Haplotype analysis suggested a different origin of the mutation. The prevalence of MYOC mutations (2.2%) was similar to that found in hospital-based studies. Although mutations in MYOC are rare, relatives carrying this mutation run a high risk of developing the disease. Instead of submitting all members of a family with the Asn480Lys mutation to frequent follow-up, medical care may be restricted to those carrying the mutation.—Hans E. Grossniklaus
A cluster of cases of Mycobacterium szulgai keratitis that occurred after laser-assisted in situ keratomileusis. Holmes GP,* Bond GB, Fader C, Fulcher SF. Clin Infect Dis 2002;34:1039 –1046.
L
ASER-ASSISTED IN SITU KERATOMILEUSIS (LASIK) IS A
ABSTRACTS
221
*Arthur A.B. Bergen, The Netherlands Ophthalmic Research Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands; E-mail: [email protected]
VOL. 136, NO. 1
●
common ophthalmic procedure for the correction of refractive errors. When two patients developed keratitis caused by Mycobacterium szulgai after they underwent LASIK, the authors conducted a retrospective cohort study of LASIK procedures performed at a single clinic during a 4.5-month period. Seven patients had compatible symptoms and signs, five of whom had confirmed M. szulgai keratitis. Five cases occurred among 30 procedures performed by one surgeon, and there were no cases among 62 procedures performed by another surgeon (approximate relative risk, 12.0; 95% confidence interval, 1.6 – 679.0; P⫽.29). The first surgeon had chilled syringes of saline solution in ice for intraoperative lavage, the only factor that was different from the second surgeon. Cultures of samples from the source ice machine’s drain identified M. szulgai; the strain was identical to isolates recovered from all confirmed cases and differed from standard M. szulgai strain, as determined by pulsed-field gel electrophoresis. Intraoperative contamination from ice water
apparently led to M. szulgai keratitis in these patients. —Hans E. Grossniklaus
By the 1940s, appointments were often made as early as the junior year of medical school. Hospitals thus had little information about students’ performance, and students frequently had to make a final decision to accept or reject an offer without knowledge of other potential offers. From 1945 through 1951, efforts were made to enforce a uniform date for accepting offers. However, students were still faced with offers having very short deadlines, compelling them to accept or reject offers without knowledge what other offers might be forthcoming. Hospitals often had to scramble for available students, since if an offer was rejected, it was often too late for them to reach their next preferred candidate. A centralized clearinghouse was developed as a way of alleviating this chaos and allowing a larger role to the preference of both students and hospitals. The Boston Pool algorithm was equivalent to a “deferred acceptance” algorithm, which can be interpreted as one in which hospitals made offers to applicants, starting at the top of each hospital’s rank-order list, and each applicant held on to the best offer he or she received thus far but could later reject it if a better offer was forthcoming. The Boston Pool algorithm produced outcomes that were stable, in the sense that no applicant and hospital that were not matched with one another preferred each other to their assigned matches. The most recent redesign of the algorithm, the Roth-Peranson algorithm, yields a match as favorable as possible to the applicants while producing a stable outcome that accommodates contemporary requirements of residencies. The algorithm continues to be updated to take into account contemporary issues, such as growth in the couples match.—Hans E. Grossniklaus
*Gary P. Holmes, Scott and White Memorial Hospital and Clinic, 2401 S. 31st St., Temple, Texas 76508; E-mail: [email protected]
●
Herpes simplex type 2 membraneous conjunctivitis in acquired immune deficiency syndrome. Charles NC,* Akhtar S. Ophthalm Prac 2002;20:342–344.
H
ERPETIC OPHTHALMIC INFECTIONS ALMOST ALWAYS
represent herpes zoster ophthalmicus (varicella-zoster virus) or herpes simplex virus type-1 blepharitis and keratitis. Herpes simplex virus type 2 infections usually originate in the anogenital area and occur uncommonly in the ocular region. Infection by human pathogens in atypical sites occur in immunosuppressed patients. The authors describe the occurrence of a focal tarsal conjunctival plaque in a man with acquired immunodeficiency syndrome. Histopathologic examination of an excised fibrin membrane showed a mixed inflammatory infiltrate, including bizarre, multinucleated epithelial cells that stained positively with herpes simplex virus type 2 viral antibody.—Hans E. Grossniklaus
*Norman C. Charles, MD, Eye Pathology Laboratory, NYU Medical Center, NB5-N-20, 550 First Ave, New York, NY 10016; E-mail: [email protected]
●
The origins, history, and design of the resident match. Roth AE.* JAMA 2003,289:909 –911.
C
OMPETITION AMONG HOSPITALS FOR INTERNS AND
among medical students for good internships led to increasingly early offers of internships in the early 1900s.
222
AMERICAN JOURNAL
*Alvin E. Roth, PhD, Department of Economics, Harvard University, 183 Baker Library, Boston, MA 02163; E-mail: [email protected]
OF
OPHTHALMOLOGY
JULY 2003
● Novel mutations in the MYOC/GLC1A gene in a large group of glaucoma patients. Michels-Rautenstrauss K, Mardin C, Wakili N, Ju¨ nemann AM, Villalobos L, Mejia ¨ zbey S, Naumann GOH, Reis C, Soley GC, Azofeifa J, O A, Rautenstrauss B.* Hum Mutat 2002;20:479 – 480.
M
UTATIONS OF THE MYOCILIN (MYOC) GENE WITHIN
Myocilin mutations in a population-based sample of cases with open-angle glaucoma: the Rotterdam study. Hulsman CAA, de Jong PTVM, Lettink M, van Duijn CM, Hofman A, Bergen AAB.* Graefes Arch Clin Exp Ophthalmol 2002;240:468 – 474.
the GLC1A locus have been identified in 2% to 4% of patients with open-angle glaucoma (OAG). In this study, 682 persons were screened for MYOC mutations. The first group consisted of 453 patients from a long-term clinical study who were diagnosed with either OAG, juvenile OAG, primary OAG, ocular hypertension or normal-tension glaucoma (NTG), plus 22 patients with secondary glaucoma. This group, along with 83 healthy controls, is part of a long-term study with repeated clinical examinations. An additional sample of 124 glaucoma patients or patients at risk for glaucoma were included in the mutation screening. Five novel mutations, namely Gly434Ser, Asn450Asp, Val251Ala, Ile345Met, and Ser393Asn, could be identified as the cause of primary OAG, juvenile OAG, and normaltension glaucoma. Myocilin mutations were identified at a rate of 11 of 341 (3.2%) of patients, similar to previous studies.—Hans E. Grossniklaus
T
*Bernd Rautenstrauss, Institute of Human Genetics, Friedrich-Alexander University of Erlangen-Nurnberg, Schwabachanlage 10, D-91054, Erlangen, Germany.
*Karla Zadnik, OD, PhD, The Ohio State University, College of Optometry, 338 West Tenth Street, Columbus, OH 43210-1240; E-mail: [email protected]
●
HIS STUDY INVESTIGATED THE PREVALENCE OF MYOCI-
lin (MYOC) mutations in a population with openangle glaucoma (OAG) and described a family with both juvenile- and adult-onset OAG caused by a mutation in MYOC. Myocilin was screened in cases derived from the Rotterdam Study. Definite OAG was defined as glaucomatous optic neuropathy together with a glaucomatous visual field defect. Upon identification of the Asn480Lys mutation in one case, seven additional family members were studied. The haplotypes of MYOC flanking markers D1S2851, D1S242, D1S218 and D1S1165 were compared to test for a founder effect. Seven sequence alterations in MYOC were found in 14 of 47 OAG cases; 6 of these were also found in controls. In 1 case, an Asn480Lys mutation was found. In relatives of the latter patients, the phenotype ranged from a glaucomatous optic neuropathy without visual field defect in a 70-year-old patient to severely affected optic disks and a remaining temporal remnant in a 34-year-old patient. Those without the mutation had no signs of OAG. Haplotype analysis suggested a different origin of the mutation. The prevalence of MYOC mutations (2.2%) was similar to that found in hospital-based studies. Although mutations in MYOC are rare, relatives carrying this mutation run a high risk of developing the disease. Instead of submitting all members of a family with the Asn480Lys mutation to frequent follow-up, medical care may be restricted to those carrying the mutation.—Hans E. Grossniklaus
A cluster of cases of Mycobacterium szulgai keratitis that occurred after laser-assisted in situ keratomileusis. Holmes GP,* Bond GB, Fader C, Fulcher SF. Clin Infect Dis 2002;34:1039 –1046.
L
ASER-ASSISTED IN SITU KERATOMILEUSIS (LASIK) IS A
ABSTRACTS
221
*Arthur A.B. Bergen, The Netherlands Ophthalmic Research Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands; E-mail: [email protected]
VOL. 136, NO. 1
●
common ophthalmic procedure for the correction of refractive errors. When two patients developed keratitis caused by Mycobacterium szulgai after they underwent LASIK, the authors conducted a retrospective cohort study of LASIK procedures performed at a single clinic during a 4.5-month period. Seven patients had compatible symptoms and signs, five of whom had confirmed M. szulgai keratitis. Five cases occurred among 30 procedures performed by one surgeon, and there were no cases among 62 procedures performed by another surgeon (approximate relative risk, 12.0; 95% confidence interval, 1.6 – 679.0; P⫽.29). The first surgeon had chilled syringes of saline solution in ice for intraoperative lavage, the only factor that was different from the second surgeon. Cultures of samples from the source ice machine’s drain identified M. szulgai; the strain was identical to isolates recovered from all confirmed cases and differed from standard M. szulgai strain, as determined by pulsed-field gel electrophoresis. Intraoperative contamination from ice water
apparently led to M. szulgai keratitis in these patients. —Hans E. Grossniklaus
By the 1940s, appointments were often made as early as the junior year of medical school. Hospitals thus had little information about students’ performance, and students frequently had to make a final decision to accept or reject an offer without knowledge of other potential offers. From 1945 through 1951, efforts were made to enforce a uniform date for accepting offers. However, students were still faced with offers having very short deadlines, compelling them to accept or reject offers without knowledge what other offers might be forthcoming. Hospitals often had to scramble for available students, since if an offer was rejected, it was often too late for them to reach their next preferred candidate. A centralized clearinghouse was developed as a way of alleviating this chaos and allowing a larger role to the preference of both students and hospitals. The Boston Pool algorithm was equivalent to a “deferred acceptance” algorithm, which can be interpreted as one in which hospitals made offers to applicants, starting at the top of each hospital’s rank-order list, and each applicant held on to the best offer he or she received thus far but could later reject it if a better offer was forthcoming. The Boston Pool algorithm produced outcomes that were stable, in the sense that no applicant and hospital that were not matched with one another preferred each other to their assigned matches. The most recent redesign of the algorithm, the Roth-Peranson algorithm, yields a match as favorable as possible to the applicants while producing a stable outcome that accommodates contemporary requirements of residencies. The algorithm continues to be updated to take into account contemporary issues, such as growth in the couples match.—Hans E. Grossniklaus
*Gary P. Holmes, Scott and White Memorial Hospital and Clinic, 2401 S. 31st St., Temple, Texas 76508; E-mail: [email protected]
●
Herpes simplex type 2 membraneous conjunctivitis in acquired immune deficiency syndrome. Charles NC,* Akhtar S. Ophthalm Prac 2002;20:342–344.
H
ERPETIC OPHTHALMIC INFECTIONS ALMOST ALWAYS
represent herpes zoster ophthalmicus (varicella-zoster virus) or herpes simplex virus type-1 blepharitis and keratitis. Herpes simplex virus type 2 infections usually originate in the anogenital area and occur uncommonly in the ocular region. Infection by human pathogens in atypical sites occur in immunosuppressed patients. The authors describe the occurrence of a focal tarsal conjunctival plaque in a man with acquired immunodeficiency syndrome. Histopathologic examination of an excised fibrin membrane showed a mixed inflammatory infiltrate, including bizarre, multinucleated epithelial cells that stained positively with herpes simplex virus type 2 viral antibody.—Hans E. Grossniklaus
*Norman C. Charles, MD, Eye Pathology Laboratory, NYU Medical Center, NB5-N-20, 550 First Ave, New York, NY 10016; E-mail: [email protected]
●
The origins, history, and design of the resident match. Roth AE.* JAMA 2003,289:909 –911.
C
OMPETITION AMONG HOSPITALS FOR INTERNS AND
among medical students for good internships led to increasingly early offers of internships in the early 1900s.
222
AMERICAN JOURNAL
*Alvin E. Roth, PhD, Department of Economics, Harvard University, 183 Baker Library, Boston, MA 02163; E-mail: [email protected]
OF
OPHTHALMOLOGY
JULY 2003