Quality of vision following clinically successful penetrating keratoplasty

PURPOSE: To evaluate visual function following clinically successful penetrating keratoplasty (PKP). SETTING: Department of Ophthalmology, Ege University, School of Medicine, Izmir, Turkey. METHODS: Patient group (PG) included 9 patients (12 eyes) who had clinically successful PKP in our department. The control group (CG) included 12 people (18 eyes) who had no ocular disease other than refractive errors. Those with a visual acuity level less than 20/25 were not included in the study. Contrast sensitivity levels and light threshold values of the central retina were measured; scanning-slit corneal topography-pachymetry and aberrometric analysis were performed. RESULTS: There were no statistical difference in terms of age (32.55 years +/- 9.25 (SD) in PG, 36.75 +/- 5.85 years in CG; P =.53), cylinder power in plus form (2.60 +/- 1.25 diopter (D) in PG, 2.79 D +/- 2.51 D in CG; P =.88), and spherical equivalent of refractive errors (-3.66 +/- 3.57 D in PG, -5.52 +/- 3.37 D in CG; P =.29) between the PG and CG. Cambridge low-contrast grating scores were 96.5 +/- 41.1 in grafted eyes and 148 +/- 27.7 in CG (P =.004). Central retinal light sensitivity was measured as 29.91 +/- 2.39 db in PG and 33.08 +/- 1.56 db in CG (P =.001). In corneal topographic analysis, mean kappa intercept was 0.69 +/- 0.37 mm in PG and 0.55 +/- 0.24 mm in CG (P =.20). Lower-order Zernike root mean squares (RMS) were 7.30 +/- 3.89 microm for PG and 8.58 +/- 3.46 microm for CG (P =.37). However, higher-order Zernike RMS were 2.15 +/- 0.78 in PG and 0.38 +/- 0.10 in CG, which is a statistically significant difference (P<.001). CONCLUSIONS: Even though the clinically successful PKP patients have correctable amount of spherocylindrical refractive errors with spectacle lenses, they still have reduced visual quality because of the significantly high amount of higher- order aberrations when compared with naturally occurring refractive errors.     

Actinomycotic canaliculitis: resolution following surgery and short topical antibiotic treatment

Purpose: This study aimed to study the incidence and clinical characteristics of patients diagnosed with actinomycotic canaliculitis in Iceland. Methods: We present a nationwide, retrospective case series for which cases were identified by searches of hospital diagnostic registries and pathology databases. Case histories were reviewed and histopathological analysis repeated to confirm the diagnosis. Results: Nine cases of actinomycotic canaliculitis were diagnosed in Iceland during 1988–2007. Subjects included six women and three men and represented 16% of all patients diagnosed with actinomycosis in the country. The incidence was 0.16 cases/100 000 inhabitants/year. Age‐specific incidence rates were 0.59 cases/100 000 inhabitants/year for the 40–59‐year‐old age group and 1.37 cases/100 000 inhabitants/year for individuals aged 60–79 years. All patients underwent a three‐way snip procedure and 1 week of topical antibacterial therapy. Conclusions: Actinomycotic canaliculitis is an uncommon condition which frequently eludes diagnosis. Topical antibiotics for 1 week may be sufficient following surgery, a finding which contrasts with previous reports.     

陕西省活动性沙眼快速评估调查研究

目的:对陕西省沙眼高发流行疑似区活动性沙眼流行情况进行基线评估,为沙眼的预防和治疗提供依据.方法:采用世界卫生组织沙眼简化分级系统,于2013-10-12/2014-01-26由陕西省防盲办公室组织流调队在榆林佳县坑镇、延安延长、汉中南郑县及商洛市商州区4个沙眼高发流行疑似区,抽取年龄6~8岁小学生共计200人,进行沙眼快速评估调查.结果:受检小学生200人中,未检出活动性沙眼病例.结论:在调查区域,未发现活动性沙眼流行区;活动性沙眼在陕西省内不再属于公共卫生问题.     

Progression of active trachoma to scarring in a cohort of Tanzanian children

Risk factors for the incidence of scarring are needed to inform trachoma control programs in countries hyperendemic for this blinding disease. A cohort of pre-school children with constant, severe trachoma, and an age, sex, and neighborhood matched cohort of children without constant severe trachoma were followed for seven years to determine the incidence of scarring. The incidence of scarring in the children with constant severe trachoma was 29.2% versus 9.6% in the comparison group. In a model adjusting for multiple factors, significant predictors of scarring were increasing age, female, and constant severe trachoma (OR = 4.85, 95% CL = 2.05, 11.40). Infection with C. trachomatis at follow up was also associated with scarring in both groups of children. It is likely that these children have a different host response to infection, and represent a subgroup at high risk for the blinding complications of trachoma. Reducing exposure to infection in the community through antibiotics and changes in hygiene practices is still the most promising control strategy.     

Progression of active trachoma to scarring in a cohort of Tanzanian children

Risk factors for the incidence of scarring are needed to inform trachoma control programs in countries hyperendemic for this blinding disease. A cohort of pre-school children with constant, severe trachoma, and an age, sex, and neighborhood matched cohort of children without constant severe trachoma were followed for seven years to determine the incidence of scarring. The incidence of scarring in the children with constant severe trachoma was 29.2% versus 9.6% in the comparison group. In a model adjusting for multiple factors, significant predictors of scarring were increasing age, female, and constant severe trachoma (OR = 4.85, 95% CL = 2.05, 11.40). Infection with C. trachomatis at follow up was also associated with scarring in both groups of children. It is likely that these children have a different host response to infection, and represent a subgroup at high risk for the blinding complications of trachoma. Reducing exposure to infection in the community through antibiotics and changes in hygiene practices is still the most promising control strategy.     

Expression of growth factors in the conjunctiva from patients with active trachoma

PURPOSE: The blinding complications of trachoma are associated with progressive conjunctival fibrosis due to excessive accumulation of extracellular matrix (ECM) components. We studied the processes involved in the regulation of fibrosis in trachoma by investigating the expression of the fibrogenic and angiogenic connective tissue growth factor (CTGF) and basic fibroblast growth factor (bFGF), the angiogenic vascular endothelial growth factor (VEGF), the angiogenesis-associated endothelial cell marker CD105 (endoglin), and the ECM protein tenascin in the conjunctiva. METHODS: Conjunctival biopsy specimens from six patients with active trachoma, and six control subjects were studied by immunohistochemical techniques using monoclonal and polyclonal antibodies directed against CTGF, bFGF, VEGF, CD105, and tenascin. RESULTS: In the normal conjunctiva, weak immunoreactivity for VEGF was observed in epithelial cells. There was no immunoreactivity for the other antibodies. In all trachoma specimens, immunoreactivity for CTGF and bFGF was localized in monocytes/macrophages, positive for the CD68 marker. Strong immunoreactivity for VEGF was observed in epithelial cells and on vascular endothelial cells. CD105 immunoreactivity was observed on vascular endothelial cells. Immunoreactivity for tenascin was noted in the upper substantia propria. CONCLUSIONS: These findings suggest that macrophages play an active role in conjunctival scarring, upregulated local production of CTGF, bFGF, and VEGF contributes to both fibrous tissue growth and angiogenesis, vascular endothelial cells are activated and are undergoing active angiogenesis, and deposition of tenascin reflect remodelling of the conjunctiva in trachomatous conjunctivitis.     

Prevalence and distribution of active trachoma in children of less than five years of age in trachoma endemic regions of Oman in 2005

BACKGROUND: Oman aims to achieve "Elimination of Blinding Trachoma" by 2010. For accreditation purposes, a trachoma survey was conducted in Oman in 2005, targeting children younger than five years. It was conducted in twenty wilayats (districts) of three trachoma endemic regions. The Omani children were surveyed at health institutions during a 'Polio Supplementary Immunization Campaign.' The authors present the outcome of this survey and recommend policies for trachoma control in the study area. METHODS: Eye health care supervisors examined Omani children sequentially in health centers. However, the timings and days of visit to these health centers were selected randomly. The presence of trachoma follicular (TF) was noted in the tarsal area. The prevalence of TF was calculated and its distribution was mapped. RESULTS: The coverage for the immunization of children of less than five years of age residing in the study area was greater than 97%. For trachoma evaluation, 4,205 children were examined. The prevalence of TF in children of less than five years of age was 0.59% (95% CI; 0.40-0.88). Sumail, Hamra and Izki wilayats of Dhakhiliya region and Barka and Al Awabi Wilayats of South Batinah region had a prevalence of TF greater than 1%. No wilayat of North Sharqiya region had > or =1% TF. The gender variation in TF was not significant. (RR = 0.97 [95% CI 0.46-2.05]). CONCLUSIONS: All the Wilayats of trachoma endemic regions of Oman seem to have a prevalence of TF lesser than 5%. The data on TF in children aged between six and ten will enable us to determine whether Oman has achieved the Ultimate Intervention Goals (UIGs) for the provision of antibiotic treatment for acute infection (the "A" component of the SAFE strategy for the "Elimination of Blinding Trachoma" for the year 2005). Such initiatives of trachoma screening during a supplementary vaccination campaign could prove a cost-effective approach for determining the trachoma status of a country.     

A case of vancomycin-resistant enterococcus conjunctivitis and its clinically successful topical treatment

PURPOSE: To describe what is, to our knowledge, the first documented case of vancomycin-resistant enterococcus (VRE) conjunctivitis and its successful topical treatment. METHODS: A 77-year-old white man with end-stage multiple myeloma was hospitalized for congestive heart failure and pneumonia. During hospitalization, the patient developed conjunctivitis. Cultures of the eye were directly plated into several media. The bacterium was tested for antibiotic minimum inhibitory concentration (MIC) with the Clinical and Laboratory Standards Institute (CLSI) method. RESULTS: Culture of the affected eye grew Enterococcus faecalis resistant to vancomycin. Topical treatment with moxifloxacin 0.5% (Vigamox; Alcon, Ft. Worth, TX) resulted in clinical resolution despite a MIC showing resistance. CONCLUSION: Clinical resolution of VRE conjunctivitis was shown with topical moxifloxacin therapy in this case. At the same time, we suggest the use of combined topical and systemic therapy for treatment of VRE in immunocompromised patients.     

Reduction of trachoma in the absence of antibiotic treatment: Evidence from a population-based survey in Malawi

PURPOSE. A survey was conducted in Chikwawa District, Malawi in order to compare the current prevalence of trachoma with a similar survey in 1983. METHODS. Using random cluster household sampling, children aged 1 to 6 and adults aged 50 or older were enumerated and examined for the presence of trachoma. RESULTS. Among the 1313 children enumerated, 1249 (95.1%) were examined and among the 1431 adults enumerated, 1221 (85.3%) were examined. The prevalence of active trachoma among the children was 13.9% (11.9–15.9%), 10.0% in males and 14.4% in females. The prevalence of active trachoma varied significantly among the 25 clusters, ranging from 3.9% to 38.2% with 5 clusters (20%) having a prevalence &gt;20%. Signs of trachomatous trichiasis were observed in 1.0% of adults examined. Active disease in 1999 was associated with a longer distance to the primary water source. CONCLUSIONS. Since 1983 there has been no mass antibiotic treatment programme in the district and little change in socioeconomic status. However, compared to the 1983 findings, active trachoma has been reduced by over 50% (p &lt; 0.001) and trachomatous trichiasis by over 80%. In the 16-year interim (especially in the past 7 years) health, water and hygiene programmes were initiated and we hypothesize that the reduction in active disease is likely due to these changes. Our findings suggest that sustained reductions in active trachoma can be achieved without community-based antibiotic distribution.