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Corneal infiltration after recurrent corneal epithelial erosion
stained tissue sections, the acid-fast stains, and a polymerase chain reaction to amplify type-specific sequences of diverse mycobacteria should be used to this order to differentiate these granulomatous inflam matory diseases. — Thomas J. Liesegang * Department of Pathology, Laboratory of Environmental and Respiratory Pathology, University of Graz, Medical School, Auenbruggerplatz 25, A-8036 Graz, Austria.
• Corneal infiltration after recurrent corneal epi thelial erosion. Ionides ACW, Tuft SJ*, Ferguson VMG, Matheson MM, Hykin PG. Br J Ophthalmol 1997;81:537-540.
T
HE AUTHORS REVIEWED THE RECORDS OF PATIENTS
who were examined and treated for recurrent corneal epithelial erosions (approximately 5,800 pa tient episodes over a 4-year period) and found 11 patients who presented again with signs suggestive of a microbial keratitis. Patients with a history of contact lens wear or herpetic keratitis were excluded. One of the 11 patients presented with similar signs on two occasions. There was typically a paracentral epithelial defect >2 mm in diameter with an associated stromal infiltrate and an intense anterior uveitis. Three patients had a hypopyon and four developed a subepithelial ring infiltrate. Samples were taken for microscopy and bacterial culture, with a positive isolate from two (16%) of 12 episodes. Treatment with topical antibiotics and topical corticosteroids resulted in rapid reepithelialization and a reduction of inflammation. There was good visual outcome for all eyes, with a recurrence or symptoms of epithelial erosion in only one eye after a mean follow-up period of 18 months. The authors conclude that corneal infiltrates are an uncommon complication of recurrent corneal epithe lial erosion. Despite the intensity of the infiltration, the majority are culture-negative, using established techniques. There is typically rapid resolution and a good visual outcome, with a tendency for the episode to mark the end of further symptoms of epi thelial erosion. The authors propose that the stromal infiltrate may be an immune response to bacterial antigens analogous to "sterile" marginal corneal infil trates. — Thomas J. Liesegang. *Moorfields Eye Hospital, London EC1V 2PD UK.
870
• Endothelial metaplasia in the iridocorneal endo thelial syndrome. Howell DN*, Damms T, Burchette JL Jr, Green WR. Invest Ophthalmol Vis Sci 1997:38:1896-1901.
T
HE IRIDOCORNEAL ENDOTHELIAL (ICE) SYNDROME IS
a group of progressive ocular disorders whose common features encompass abnormalities of the cornea, iris, and iridocorneal angle. Included in the spectrum of ICE syndrome are Chandler syndrome, iris nevus syndrome, and essential iris atrophy. The authors tested the hypothesis that the aberrant, cytokeratin-expressing cells that replace endothelium in the ICE syndrome are of endothelial origin. Corneas from four patients with Chandler syndrome and three with essential iris atrophy were examined by two-color immunofluorescence for simultaneous ex pression of cytokeratins and two markers of endothe lial lineage: vimentin and the antigen recognized by the antiendothelial monoclonal antibody 2B4.14.1. In six corneas, unequivocal endothelial staining for cytokeratins was present; in each of these, cells coexpresssing cytokeratins and the two endothelial markers were clearly identifiable. In the remaining corneas, weak cytokeratin staining that colocalized with vimentin was present. The authors conclude that there is strong support for the hypothesis that the epithelial-like endothelial cells in ICE syndrome are cells of endothelial lineage rather than heterotopia of epithelial cells; these cells probably arise through a metaplastic transformation of preexisting endotheli um. There was no pattern variability between Chan dler syndrome and essential iris atrophy. The findings militate against the alternative hypothesis that the cells represent embryonic rests or heterotopia of true epithelial cells. — Thomas J. Liesegang *Pathology and Laboratory Medicine Service (113), VA Medical Center, 508 Fulton St, Durham, NC 27705.
• Effectiveness of topical diclofenac in relieving photophobia after pupil dilation. Chitakara DK*, Jayamanne DGR, Griffiths PG, Fsadni MG. J Cata ract Refract Surg 1997;23:740-744.
P
RIOR AUTHORS HAVE SHOWN THAT DICLOFENAC
significantly reduces pain, burning, and light sensitivity in eyes after excimer laser photorefractive
AMERICAN JOURNAL OF OPHTHALMOLOGY
DECEMBER 1997
• Corneal infiltration after recurrent corneal epi thelial erosion. Ionides ACW, Tuft SJ*, Ferguson VMG, Matheson MM, Hykin PG. Br J Ophthalmol 1997;81:537-540.
T
HE AUTHORS REVIEWED THE RECORDS OF PATIENTS
who were examined and treated for recurrent corneal epithelial erosions (approximately 5,800 pa tient episodes over a 4-year period) and found 11 patients who presented again with signs suggestive of a microbial keratitis. Patients with a history of contact lens wear or herpetic keratitis were excluded. One of the 11 patients presented with similar signs on two occasions. There was typically a paracentral epithelial defect >2 mm in diameter with an associated stromal infiltrate and an intense anterior uveitis. Three patients had a hypopyon and four developed a subepithelial ring infiltrate. Samples were taken for microscopy and bacterial culture, with a positive isolate from two (16%) of 12 episodes. Treatment with topical antibiotics and topical corticosteroids resulted in rapid reepithelialization and a reduction of inflammation. There was good visual outcome for all eyes, with a recurrence or symptoms of epithelial erosion in only one eye after a mean follow-up period of 18 months. The authors conclude that corneal infiltrates are an uncommon complication of recurrent corneal epithe lial erosion. Despite the intensity of the infiltration, the majority are culture-negative, using established techniques. There is typically rapid resolution and a good visual outcome, with a tendency for the episode to mark the end of further symptoms of epi thelial erosion. The authors propose that the stromal infiltrate may be an immune response to bacterial antigens analogous to "sterile" marginal corneal infil trates. — Thomas J. Liesegang. *Moorfields Eye Hospital, London EC1V 2PD UK.
870
• Endothelial metaplasia in the iridocorneal endo thelial syndrome. Howell DN*, Damms T, Burchette JL Jr, Green WR. Invest Ophthalmol Vis Sci 1997:38:1896-1901.
T
HE IRIDOCORNEAL ENDOTHELIAL (ICE) SYNDROME IS
a group of progressive ocular disorders whose common features encompass abnormalities of the cornea, iris, and iridocorneal angle. Included in the spectrum of ICE syndrome are Chandler syndrome, iris nevus syndrome, and essential iris atrophy. The authors tested the hypothesis that the aberrant, cytokeratin-expressing cells that replace endothelium in the ICE syndrome are of endothelial origin. Corneas from four patients with Chandler syndrome and three with essential iris atrophy were examined by two-color immunofluorescence for simultaneous ex pression of cytokeratins and two markers of endothe lial lineage: vimentin and the antigen recognized by the antiendothelial monoclonal antibody 2B4.14.1. In six corneas, unequivocal endothelial staining for cytokeratins was present; in each of these, cells coexpresssing cytokeratins and the two endothelial markers were clearly identifiable. In the remaining corneas, weak cytokeratin staining that colocalized with vimentin was present. The authors conclude that there is strong support for the hypothesis that the epithelial-like endothelial cells in ICE syndrome are cells of endothelial lineage rather than heterotopia of epithelial cells; these cells probably arise through a metaplastic transformation of preexisting endotheli um. There was no pattern variability between Chan dler syndrome and essential iris atrophy. The findings militate against the alternative hypothesis that the cells represent embryonic rests or heterotopia of true epithelial cells. — Thomas J. Liesegang *Pathology and Laboratory Medicine Service (113), VA Medical Center, 508 Fulton St, Durham, NC 27705.
• Effectiveness of topical diclofenac in relieving photophobia after pupil dilation. Chitakara DK*, Jayamanne DGR, Griffiths PG, Fsadni MG. J Cata ract Refract Surg 1997;23:740-744.
P
RIOR AUTHORS HAVE SHOWN THAT DICLOFENAC
significantly reduces pain, burning, and light sensitivity in eyes after excimer laser photorefractive
AMERICAN JOURNAL OF OPHTHALMOLOGY
DECEMBER 1997