Neisseria gonorrhoeae keratoconjunctivitis

Clinical and laboratory findings of 47 patients with ocular infections secondary to Neisseria gonorrhoeae during a 5 1/2-year period were reviewed. In 16 patients (34%), corneal involvement was noted. Six of these patients had a severe ulcerative keratitis resulting in permanent visual loss and five required surgery for a corneal perforation. Patients with corneal involvement were older and presented later in the course of their disease than patients with isolated conjunctival involvement (P less than 0.005). An out-patient regimen of intramuscular antibiotics (either penicillin, cephalosporin, or spectinomycin [Trobicin]) appeared to be effective for infections limited to the conjunctiva in adults. If a topical antibiotic ointment is used in addition to parenteral antimicrobial agents, the authors' laboratory sensitivities suggest that erythromycin may be the drug of choice.

Branhamella catarrhalis keratitis

Branhamella catarrhalis, formerly known as Neisseria catarrhalis, has structural similarities to Neisseria gonorrhoeae, but is generally considered to be nonpathogenic. We studied the clinical and laboratory data of four previously reported cases and six additional cases of B. catarrhalis keratitis. All patients had a predisposing ocular or systemic condition, or both. There were various clinical characteristics, but in most cases the infiltrate occurred in the central or paracentral cornea. A prompt response to treatment with a cephalosporin and aminoglycoside antibiotic was noted in all cases. Two patients had corneal perforations, which probably resulted from a delay in treatment. Gram-negative diplococci from corneal scrapings may not necessarily represent N. gonorrhoeae.

Pseudomonas corneoscleritis

We evaluated three cases of Pseudomonas aeruginosa corneoscleritis, one associated with the use of contaminated eyedrops; another in an elderly, debilitated patient; and the third in a patient who had previously undergone penetrating keratoplasty. In the first two cases, control of the infection was achieved by intensive antibiotic therapy alone. The third case required evisceration of the eye following spontaneous perforation at the site of scleral involvement. Histopathologic findings showed persistence of the organism in the sclera despite intensive antibiotic therapy for six days.

Overcoming difficulties in trephining donor corneas for penetrating keratoplasty

The complication of the donor button becoming trapped inside the barrel of the trephine blade can become a frustrating situation for the surgeon who is trying to recover it. The use of a sterile medicine dropper to apply slight suction to the epithelial side of the button allows for easy and secure removal of the trapped button without the risk of distortion or direct trauma to the endothelium as could occur with other methods.

Corneal ulcer due to Listeria monocytogenes

We present a patient with a corneal ulcer due to Listeria monocytogenes, which has not previously been considered to be a feature of human listeriosis. The ulcer responded to topical and subconjunctival gentamicin and cephaloridine. Subsequent management was complicated by the development of a fibrinous pupillary membrane leading to pupillary block requiring iridotomy and later vitrectomy with trabeculectomy. Listeria monocytogenes may be confused with diphtheroid contaminants seen in corneal ulcer scrapings and is probably underreported as a cause for microbial keratitis.

Comparison of low- and high-volume irrigation-aspiration systems for extracapsular cataract extraction

A low-volume irrigation-aspiration system with a 1-mm tip (0.3-mm aspiration port) has been developed for extracapsular cataract extraction. This autoclavable system uses approximately 36% less irrigating fluid during the irrigation and aspiration of cortical material when compared to currently available models. The time required for cortical aspiration is also shortened by 33%. After three years of clinical experience with the low-volume system at the Miami Veterans Administration Medical Center, where almost all extracapsular cataract surgery is now performed with the new system, there have been no adverse effects and subsequent capsulotomy has rarely been necessary.

Ulcerative keratitis associated with contact lens wear

A review of 573 cases of ulcerative keratitis cultured at the Bascom Palmer Eye Institute from January 1977 through September 1982 showed that 118 cases (21%) were associated with contact lens wear; of these, 64 were culture-positive. Of these culture-positive cases, 50 (78%) were caused by gram-negative bacteria, nine (14%) by gram-positive organisms, and two (3%) by fungal organisms. Of the 264 culture-positive ulcers not associated with contact lens wear, 119 (45%) were caused by gram-negative bacteria, 74 (28%) by gram-positive organisms, and 63 (24%) by fungal organisms. These statistically significant differences suggested that the organisms associated with ulcerative keratitis within our geographic region are modified by contact lens use. Pseudomonas was the organism most frequently isolated from ulcers associated with contact lenses and was responsible for nearly two thirds of the culture-positive cases.

Snailtracks of the corneal endothelium

An unusual pattern of corneal endothelial cell alterations has been observed at the slitlamp in eyes following intraocular surgery. Because of their appearance, we have called these changes "snailtracks". We have commonly seen these snailtracks following extracapsular cataract extraction. Similar changes have been noted in cadaver corneas stored in McCarey-Kaufman (M-K) medium. This study presents information which suggests that these changes represent corneal endothelial cell damage.

Inferior rectus paresis after secondary blepharoplasty

A 52-year-old woman underwent a secondary cosmetic blepharoplasty for repair of residual dermatochalasis. After this procedure vertical diplopia was noted. Ultrasound examination and the findings at operation were consistent with trauma to the inferior rectus muscle. We present this as an additional complication of cosmetic blepharoplasty.

Neisseria gonorrhoeae conjunctivitis. An outbreak during an epidemic of acute hemorrhagic conjunctivitis

Ten patients with gonococcal conjunctivitis were examined during an epidemic of acute hemorrhagic conjunctivitis (AHC). Eye cultures in all cases demonstrated Neisseria gonorrhoeae, and seven also had isolates of N gonorrhoeae in genital specimens. All patients responded well to antimicrobial therapy. The patients had used a folk remedy in which they had applied urine to their eyes to treat the symptoms of AHC.