Corneal Problems Research Articles

The diagnosis and management of the superior rectus suspension syndrome.

The diagnosis and management of patients having had superior rectus suspension procedures for the correction of blepharoptosis can be quite difficult. Patients who have had these procedures frequently present with a syndrome which included 1) history of an unknown type of ptosis surgery performed at least ten years ago, 2) good eyelid excursion, 3) minimal lid lag associated with marked lagophthalmos, 4) hypotropia, and 5) corneal scarring. One must evert the upper eyelid to demonstrate the pathognomonic adhesion between tarsus and the superior rectus muscle. The correct management of this condition is virtually impossible until the diagnosis is made. To correct the corneal and motility problems that result from superior rectus suspension procedures, the adhesion between the superior rectus muscle and the upper eyelid must be released. It is very easy to overlook this syndrome if one is unaware of its presentation. We present five patients who illustrate the superior rectus suspension syndrome.

'Silicone rubber' lenses in aphakia.

Tesicon, one of the commercially available 'silicone rubber' lenses, was used in the correction of aphakic patients. In 74% of cases the lenses were considered successful for a daily wear regimen by the patient. Furthermore, a small number of patients could wear this lens without interruption for 3 to 6 days at a time. Despite this good acceptance by patients, corneal problems (mainly staining) and lens problems (dry surfaces) were frequently encountered.

Corneal complications after closed vitrectomy through the pars plana.

A retrospective study of 150 patients who underwent closed vitrectomy through the pars plana evaluated the incidence and character of postoperative corneal complications. Corneal changes developed in 43% of patients. Thirty patients had significant corneal complications, half of which resolved with treatment. Fourteen patients had complications that necessitated corneal surgery or resulted in loss of useful vision. Diabetic patients were at greatest risk for corneal problems, particularly postoperative epithelial defects. Intraoperative lensectomy was the only other factor that increased the corneal complication rate. The importance of early recognition and therapy for corneal changes after vitrectomy becomes apparent.

Lens glide in implant surgery.

The lens glide is a disposable, sterile piece of Silastic that is designed to make insertion of intraocular lenses safer and simpler. Since the use of the lens glide has become part of our routine surgical procedure in implant surgery, there has been a notable reduction in vitreous loss and in postoperative corneal problems.

External Diseases of the Eye

The child presenting a red, tearing eye can pose a dilemma for the pediatrician. A good history and a careful systematic examination using good light and magnification should lead the physician to the proper diagnosis. The child with no complaints other than discharge probably has a conjunctivitis, while the child with photophobia and a scratchy sensation should make one search for either a foreign body or a corneal problem. Fluorescein dye is invaluable in outlining a corneal scratch, abrasion, dendritic ulcer, or bacterial ulcer; and the use of smears and cultures can help pinpoint the exact cause of the patient's difficulties and help in choosing the proper medication. The care of the patient with a red eye may be difficult; but when properly done, it can be a source of great satisfaction to both the patient and the physician.

Hydrophilic lenses for "continuous" wear in aphakia: definitive fitting and the problems that occur.

Patients have been very satisfied with these lenses (78% wearing at the end of six months), not the least those with reduced function of the macula. The problems of infection have been discussed, and apart from improvement in lens materials patient selection is of paramount importance. The problem of deposits is presented, but theri elimination will depend on more research into their nature and development, improvement of the material's resistance to this form of attack, and improved lens design to overcome corneal and tear flow problems.

Trabeculectomy for Glaucoma-Reply

In Reply. —We appreciate Dr Back's interest in our article. His letter raises two points. The first is in regard to the need to localize exactly the Schlemm canal and the trabecular meshwork. Our point was that since a trabeculectomy works by filtration and not by having aqueous pass through the cut ends of the Schlemm canal, it is not necessary to have the Schlemm canal in the excisional space. However, we agree with Dr Back that one should be in the general area of the filtration meshwork. If one's dissection is too far toward the posterior side, the ciliary body may be encountered with bleeding, vitreous loss, or an inadvertent cyclodialysis as complications. If it is too far anteriorly, corneal problems may develop. In response to his second point, our usual scleral flap is about 5 mm × 5 mm and the tissue excised is usually a 1 mm×4

Current Concepts in Ophthalmology

Current Concepts in Ophthalmology is a series of reviews averaging 10 to 20 pages per review on clinical and paraclinical subjects. The book contains 26 chapters, each written on the favorite subject of 26 different authors who, at the time of writing, were all members of the Department of Ophthalmology at the University of Iowa. There is no recognizable theme, other than the gathering together of reviews of interest to the members of this Department of Ophthalmology. Various aspects of corneal problems, glaucoma, malignant melanoma, a long section on echography, and an interesting potpourri of other subjects are contained. The diversity of subjects is impressive. While the current forefront in clinical ophthalmological developments is not comprehensively studied, this book contains reviews on many interesting clinical developments. The book is easy to read and has excellent, large, helpful illustrations. The shortness of the chapters invites one to pick up the book

Management of Corneal Problems by Hydrophilic Contact Lenses: A Report of 30 Cases

Management of Corneal Problems by Hydrophilic Contact Lenses: A Report of 30 Cases

The Cornea World Congress.

Those interested in the cornea will find in this volume, current to October 1964, references to most controversial corneal problems presented by 78 panelists from all over the world. The symposium method for rapid dissemination of knowledge in a special field is probably the best one presently available. No less important than the formal papers is the opportunity for informal discussion among colleagues. We are grateful to Dr. King for providing this useful reference volume and hope that, at suitable times, similar meetings can be held and appropriately reported.

Observations on herpetic keratitis and keratoconjunctivitis.

Herpetic keratitis has always been a major problem. In 1936 Gundersen 1 wrote that in New England dendritic keratitis was the most frequent corneal infection recognizable on an etiologic or morphologic basis. In 42 months he found it in 221 patients at the Massachusetts Eye and Ear Infirmary. During the same period there were 97 cases of serpent ulcer, 52 cases of phlyctenular keratitis, and 184 cases of interstitial keratitis. This experience was paralleled in most parts of the United States in the prewar years. During the war the disease was extremely troublesome, constituting, in our experience, the major military corneal problem. Since the war it has become an even more serious source of disability; not only are there relatively more cases but they seem also to have increased in severity and in the frequency with which both eyes become involved. The following analysis of 200 cases of herpetic keratitis