[Incidence of tumors and tumor-like lesions in the conjunctiva and the cornea]

Incidence of tumors and tumor-like lesions in conjunctiva and cornea seen at Juntendo University during the 13-year period from 1980 to 1992 was analysed histopathologically. There were 126 cases including 116 benign (92.1%) and 10 malignant lesions (7.9%). Pigmented nevi (32 cases) were most frequently found, accounting for 27.6% of the benign tumors and tumor-like lesions, half of which were compound nevi (16 cases). Nevi were closely followed by cysts (24 cases, 20.7%) and dermoids (15 cases, 12.9%). Carcinoma in situ (3 cases) was most frequently found, accounting for 30% of the malignant tumors (10 cases), closely followed by malignant lymphoma (2 cases), squamous cell carcinoma (2 cases), mucinous carcinoma (1 case), sebaceous gland carcinoma (1 case) and metastatic tumor (1 case). The ratio of males to females was 4:6. Age distribution of the patients was 47-92 years.

Corneas for the Kikiyu: procurement of tissue in East Africa

1. By introducing a viable donor tissue procurement, the International Eye Bank has increased the supply of corneal tissue for Kikiyu Mission Hospital's Eye Unit. 2. Tissue procurement can be realistically handled in off-peak times in the United States. 3. The use of modern communication, an excellent surgical staff and well-maintained surgical equipment, and the generosity of medical volunteers and pharmaceutical suppliers have made this project successful.

Changing indications for penetrating keratoplasty

The indications for penetrating keratoplasty have changed over the past several years. One hundred and eighty cases of penetrating keratoplasty performed in the Department of Ophthalmology, Naestved Centralsygehus, Denmark, from January 1984 to December 1993, were analysed. Overall pseudophakic bullous keratopathy was the most common indication for penetrating keratoplasty (28.3%). This was followed by keratitis (13.9%), Fuchs' dystrophy (13.9%), regraft (11.1%), aphakic bullous keratopathy (10.0%) and keratoconus (6.7%). Pseudophakic bullous keratopathy was the most common indication for penetrating keratoplasty in 1989 and in each year from 1991 to 1993. Before 1989 the most common indications were keratitis (18.0%) and aphakic bullous keratopathy (14.8%). The emergence of pseudophakic bullous keratopathy, as the most common indication for penetrating keratoplasty, correlates well with the dramatic increase in the number of cataract extractions with intraocular lens implantation performed since the early 1980s. Especially semiflexible, closed-loop anterior chamber lenses used in our department in the early years of the period, have been the cause of subsequent corneal edema.

The relationship between cataract and climatic droplet keratopathy in Mongolia

This study evaluated the association between cataract, the commonest single blinding disorder worldwide, and climatic droplet keratopathy which was taken as an indicator of high exposure to ultraviolet sunlight. A sample of 4344 persons from rural Mongolia (1991-92) provided 8634 eyes for analysis of the relationship between cataract and climatic droplet keratopathy. Right and left eyes were combined (paired into matched sets), and analysed using a random-effects regression model. The results indicated an inverse association between cataract and climatic droplet keratopathy in person aged 55 years or older, whereby eyes with more advanced climatic droplet keratopathy had lower prevalence of cataract (age-adjusted odds ratio 0.53, p = 0.047). In the younger group of persons aged 40-54 years, the reverse was found, whereby cataract prevalence was higher in eyes that have climatic droplet keratopathy (age-adjusted odds ratio 13.19, p = 0.046). However, only a small proportion (4%) of all the cataracts occurred in this younger age stratum where the prevalence of cataract was 0.5%, compared to prevalence of 17% in eyes of persons aged 55 years or older. These findings cast further doubts upon the current thesis that lifetime exposure to high levels of ultraviolet sunlight is a major cause of cataract in developing countries.

Human immunodeficiency virus type 1 and type 2 seroprevalence in cornea donors

Routine screening of cornea donors for human immunodeficiency virus type 1 (HIV-1) has been established and has reduced the risk of HIV-1 transmission to a minimum. Screening for HIV-2 is less common. We evaluated 100 cornea donors for HIV-2 and 166 cornea donors for HIV-1 according to our routine screening procedure. Enzyme-linked immunosorbent assays (ELISAs) with high sensitivity were used to detect antibodies in donor blood. HIV-2 seroconversion was not found in any of the 100 cases tested, whereas HIV-1 seroconversion was detected in 4 of 166 cases; consecutive Western-blot analysis showed only 1 positive result. Thus, 1 of 166 cases (0.6%) had to be considered infected with HIV-1. Our findings of HIV-1 seroprevalence are comparable with those obtained in studies carried out in Europe and the United States. Data are lacking for comparison with our results concerning HIV-2 seroprevalence. Because of the epidemiologic situation of HIV-2 in Europe, different seroprevalence rates would be expected. Routine screening of potential cornea donors for HIV-2 in Germany may be necessary only if the seroprevalence rises in the population.

A study of the complications induced by conventional and disposable contact lenses

We reviewed the charts of 23,068 patients (45,580 eyes) who were prescribed contact lenses in order to investigate the incidence of corneal complications in Japan. This population of patients included wearers of various types of conventional contact lenses as well as disposable extended wear lenses and daily disposable lenses. The rate of corneal complications and 95% confidence interval for each lens group were: polymethylmethacrylate (PMMA) lenses, 15.8% (358 of 2,267 eyes, 14.3-17.3%); rigid gas permeable lenses, 10.5% (3,191 of 30,459 eyes, 10.2-10.8%); acrylelastomer lenses, 7.2% (nine of 124 eyes, 2.7-11.7%); HEMA lenses 8.5% (534 of 6,261 eyes, 7.8-9.2%); high water content lenses, 4.0% (103 of 2,591 eyes, 3.6-4.4%); weekly disposable lenses, 4.9% (146 of 2,985 eyes, 4.1-5.7%); and daily disposable lenses, 2.5% (22 of 893 eyes, 1.5-3.5%). PMMA lenses had a significantly higher rate of corneal complications compared with other lenses, whereas the daily disposable lens had a significantly lower rate for the same. The majority of corneal complications for all types of lenses consisted of superficial punctate keratopathy, and there were no cases of corneal ulcers.

Do topical antibiotics help corneal epithelial trauma?

Topical antibiotics are routinely used in emergency rooms to treat corneal trauma, although no published evidence supports this treatment. In a noncomparative clinical trial, 351 patients with corneal epithelial injuries were treated without antibiotics. The infection rate was 0.7%, suggesting that such injuries can be safely and effectively managed without antibiotics. A comparative clinical trial is neither warranted nor feasible.

Exposure keratopathy in a mentally retarded adult population

BACKGROUND

Mentally retarded patients are often found to have exposure corneal disease. No study could be found that documented the prevalence of this corneal disorder among these patients.

METHODS

A retrospective study was conducted on a population of 210 mentally retarded adults to determine the prevalence of clinically significant exposure keratopathy.

RESULTS

17.6 percent of this population was found to have this disorder mostly due to incomplete blinking.

CONCLUSIONS

Exposure keratopathy was found to be a significant ocular health problem among this population. Since many of these people cannot verbalize their discomfort it is recommended that the optometrist tailor his or her examination so this disorder is not overlooked and untreated.

West Indian punctate keratopathy

We found corneal lesions of West Indian punctate keratopathy in 128 of 2,048 patients examined in a general eye clinic in Grenada, West Indies. Of these, 125 were Black, two were Indians (Hindu), and one a White female. The lesions occurred in asymptomatic persons with no history of trauma or recurrent erosions. Males were affected more than females, and older adults more than children. The condition was usually unilateral but occasionally bilateral, with one to four lesions in the intrapalpebral fissure in a paracentral location. The lesions were round, discrete, white to yellowish-gray dots 0.2-0.6 mm in size located at the level of the epithelial basement membrane and Bowman's layer. No vascularization nor other anterior membrane disorders were observed. Corneal biopsies of 11 patients were studied by histopathologic and immunoperoxidase techniques. Histopathology revealed areas of lipid positive material in Bowman's layer and adjacent corneal stroma. The epithelium showed basal cell edema, degeneration, and irregular thickening of the basement membrane. Immunoperoxidase studies did not contribute any new information about these lesions.

Evaluating the reproducibility of topography systems on spherical surfaces

Newly devised software was used to compare the ability of the Topographic Modeling System-1 (Computed Anatomy, New York, NY) and the Corneal Analysis System (EyeSys Laboratories, Houston, Tex) to reproduce power measurements on spherical surfaces. Reproducibility results were compared for spheres of 40.00, 42.50, and 44.00 diopters. The program determines the absolute difference in corneal power at defined keratoscope positions for paired examinations of the same eye. Four examinations of each sphere were obtained with each instrument. Individual points were sampled at specific keratoscope locations at 30 degrees-semimeridional intervals. The program compared variability of measurements at four defined ranges of distance from the vertex normal: within 0.60 mm, 0.61 to 1.5 mm, 1.51 to 2.5 mm, and 2.5 mm or greater. The Corneal Analysis System showed significantly greater variability of readings obtained within 0.60 mm of the vertex normal for all three spheres (P = .001 by Duncan's multiple comparison procedure), whereas the Topographic Modeling System-1 showed equally consistent readings within 0.60 mm as it did between 0.61 and 1.5 mm from the vertex normal.

Indications and techniques of penetrating keratoplasties, 1985-1988

Indications and surgical techniques for penetrating keratoplasties (PKs) were evaluated to determine present trends and suggest future directions for PK. Analyses were based on 3,941 PK cases, with questionnaires completed at the time of surgery by 638 surgeons receiving tissue through Tissue Banks International, Inc. between July 1, 1985, and December 31, 1988. The leading indications for PK were pseudophakic corneal edema (PCE) (23%), graft failure (17%), Fuchs' corneal dystrophy (13%), kerataconus (13%), keratitis/scar (12%), and aphakic corneal edema (10%). Indications for PK varied by age and sex. Anterior chamber (AC) lenses accounted for the majority (56%) of PCE cases. Penetrating keratoplasty for PCE occurred within 5 years of cataract surgery for 81% of patients with PC lenses and only 52% of patients with AC lenses. Intraocular lens exchange was performed in most AC and iris-fixed lens PCE cases (65% and 77%, respectively), but less frequently in PC lens cases (17%). A PC lens was placed in 29% of all PCE lens exchange cases. These data have confirmed and expanded observations from smaller studies about leading indications and surgical techniques for PK. Therefore, eye bank data may be useful in describing and monitoring future indications and trends for PK because they provide a broader base of information than that obtained through a single institution.

Changing trends in the indications for penetrating keratoplasty

The indications for penetrating keratoplasty have changed over the past several years. Nine hundred ninety-nine penetrating keratoplasty specimens from 1981 through 1990 were analyzed. Overall, keratoconus was the most common indication for penetrating keratoplasty (24.2%). This was followed by pseudophakic bullous keratopathy (23.0%), regraft (13.1%), scarring (8.2%), and Fuchs' endothelial dystrophy (5.8%). Pseudophakic bullous keratopathy was the most common indication for penetrating keratoplasty in each year from 1984 through 1989 with a peak in 1987 (33%). Since 1987, the number of pseudophakic bullous keratopathy cases has decreased; and in 1990, keratoconus (33.1%) surpassed pseudophakic bullous keratopathy (24.1%) as the most common indication for penetrating keratoplasty. This decreasing incidence of pseudophakic bullous keratopathy may reflect the discontinued use of closed-looped anterior chamber and iris-plane intraocular lenses most commonly associated with this complication.

Eye lesions, blindness and visual impairment in the Taraba river valley, Nigeria and their relation to onchocercal microfilariae in skin

2876 persons in fourteen communities in the Taraba River Valley, Nigeria were examined for eye lesions and tested for visual acuity using the 'tumbling E'. The individuals were also examined for microfilaria of Onchocerca volvulus. More than one-tenth of the population were blind, while another 16.1% had visual impairment. The prevalence of blindness was in excess of 20% in six communities, with one community recording 71.9% blindness rate. All forms of visual involvement increased with age but were similar between sexes. Eye lesions were related to the level of vision. Both eye lesions and vision deteriorate with increase in age. Vision seems to worsen with increase in prevalence and intensity of O. volvulus. Large microfilarial loads were associated with severe eye damage and blindness. These findings indicate that the Taraba river valley could be one of West Africa's worst foci of onchocercal blindness.

Incidence of ocular surface epithelial dysplasia in metropolitan Brisbane. A 10-year survey

The ocular histologic records of all hospital and private pathologic laboratories in metropolitan Brisbane, Australia, were surveyed from 1980 through 1989. One hundred thirty-nine cases of histologically proven dysplasia, carcinoma in situ, and invasive carcinoma of the cornea and conjunctiva were identified. The incidence of these conditions in the area surveyed is estimated to be 1.9 per 100,000 per year averaged for 10 years.

The long-term effects of visible light on the eye

The relationship between exposure to sunlight and senile cataract, age-related macular degeneration, pterygium, and climatic droplet keratopathy was examined in 838 watermen who work on the Chesapeake Bay. The presence and severity of lenticular, corneal, and macular changes were assessed by either clinical examination or from stereo macular photographs. From detailed exposure histories, ocular exposure was estimated for three bands of visible radiation-violet (400 to 450 nm), blue (400 to 500 nm), or all visible (400 to 700 nm)-as well as for UV-A (320 to 340 nm) and UV-B (290 to 320 nm). The results with each band of visible radiation were similar. Neither cortical nor nuclear cataract was associated with ocular exposure to blue or all visible radiation, but pterygium and climatic droplet keratopathy were more common with higher exposures. Compared with age-matched controls, patients with advanced age-related macular degeneration (geographic atrophy or disciform scarring) had significantly higher exposure to blue or visible light over the preceding 20 years (odds ratio, 1.36 [1.00 to 1.85]) but were not different in respect to exposure to UV-A or UV-B. These data suggest that high levels of exposure to blue or visible light may cause ocular damage, especially later in life, and may be related to the development of age-related macular degeneration.

Climatic droplet keratopathy, exfoliation syndrome, and cataract

During a countrywide survey we assessed the prevalence of climatic droplet keratopathy (CDK) in a randomised sample of 2446 subjects representative of the population of the Republic of Djibouti. The investigation of the relationship between CDK and two diseases considered to be related to exposure to ultra-violet light--namely, exfoliation syndrome and cataract--was planned as a case control study. In the rural area prevalence of CDK was five times higher than in the urban one (2.8% vs 0.5%) and varied according to districts. The highest rates were observed where the inhabitants' activities were related to the sea. The case control study revealed that the opacification of the lens was about three times commoner in patients with CDK than in patients without CDK (p = 0.03) and that the exfoliation syndrome was about six times commoner in patients with CDK than in controls of similar age, sex, climatic conditions, and lens status (p = 0.02). Moreover, we noticed that the sequelae of corneal perforations were about 30 times commoner in patients with CDK than in controls of similar age (p less than 0.00001).

[Clinical analysis and epidemiological investigation of proteinoid corneal degeneration]

A series of corneal degeneration similar to Labrador keratopathy occurring in the Mongol nationalities is reported. Epidemiological survey indicated the incidence to be 8.11%, mostly among people over 30 years, and to increase with age. The majority of cases were bilateral and asymptomatic, showing proteinoid guttate opacities in the superficial layers and lower quadrants of the cornea. The etiology was believed to be related to altitude, cold windy and dusty environment, and probably alcohol.

Spontaneous ophthalmic lesions in young Sprague-Dawley rats

Eight hundred eight Sprague-Dawley rats were examined for ophthalmic abnormalities during a pretest period in various preclinical safety assessment studies. Persistent pupillary membrane, corneal crystal, healed minor trauma, synechia, coloboma of the iris, lens luxation, cataract, persistent hyperplastic primary vitreous, vitreous hemorrhage, coloboma of the optic disc or choroid, remnant of hyaloid arterial system, retinal hemorrhage, retinal detachment, retinal folding and choroidal defect were observed. The incidences of corneal crystal, synechia, and nuclear cataract in this survey were higher than those reported previously. On the other hand, retinal folding in this survey was less common than that reported previously. These results suggest that background data of eye problems in albino rats should be accumulated in each own laboratory colony. In addition, since spontaneous eye problems are common in young albino rats, elimination of rats with ophthalmic abnormalities from study groups by an ophthalmic examination during a pretest period would facilitate to evaluate toxicity potential of test compounds in safety assessment studies.

Singapore General Hospital's experience in corneal grafting

This is a retrospective study of 56 corneal grafts that was done in the Singapore General Hospital (SGH) between 1980 and 1989. These cases were analysed and it was found that there was a male predominance of about 2:1. There was a rather even spread among the various age groups except for a slightly higher incidence in the 20-29 year age group. There was a drastic drop in the number of grafts done after the year 1987 and this was attributed to the reluctance to accept donor corneas from Sri Lanka as there was the danger of the AIDS transmission through the donor material. The most number of grafts were done for patients with infection as a cause for corneal opacities, followed closely by keratoconus. There was a high incidence of graft rejection as almost 20 out of the 56 developed rejection. However, the visual results proved to be good with 27 obtaining at least 6/12 vision post operatively. This article outlines the need for more stringent pre-operative evaluation of both the donor material as well as the host patient in order to reduce the incidence of graft rejection and, hence, increase the overall success rate.

Eye diseases in Siberian husky dogs

A full ophthalmic examination was performed on 40 Siberian husky dogs using direct and indirect ophthalmoscopy, gonloscopy and nasolacrimal cannulation. Eight (20%) of the dogs were found to have distichia, 10 (25%) had excessive medial caruncular hairs, 8 (20%) had absence, displacement, or narrowing of the nasolacrimal puncta, 2 (5%) had bilateral corneal crystalline opacities, and 2 (5%) had unilateral areas of lateral corneal lipidosis. Fifty percent of the dogs had some abnormality of the iridocorneal (drainage) angle. However, in only one of these was the deformity severe enough to require glaucoma prophylaxis. An association between blue iris colour and malformation of the iridocorneal angle was noted.

Corneal dystrophies among patients undergoing keratoplasty in Saudi Arabia

Diseases leading to corneal opacities are inflammations, infections, metabolic causes, trauma, or genetically determined diseases. Corneal dystrophies may lead to corneal blindness. A clinical and pathological review of 2,108 corneal specimens received from December 1983 to January 1988 revealed 86 (4%) corneal specimens with corneal dystrophies. Fifty-three (62%) patients had macular dystrophy, 11 (13%) had congenital hereditary endothelial dystrophy (CHED), 12 (14%) had Fuchs' corneal dystrophy, 5 (6%) had lattice corneal dystrophy, and 3 (4%) had granular dystrophy. Macular dystrophy appears to be the most common cause of corneal dystrophy in Saudi Arabia. Twenty-two (42%) patients with macular dystrophy and 10 (91%) patients with CHED were the result of consanguineous marriages. Genetic counseling is advisable among families who carry the trait of CHED or macular corneal dystrophy.

Changing indications for penetrating keratoplasty in Vancouver, 1978-87

Indications for penetrating keratoplasty (PK) were assessed by clinicopathological review of 659 corneal buttons submitted from 1978 to 1987 to the Ophthalmic Pathology Service in Vancouver. Leading indications for PK were bullous keratopathy (22.2%), keratoconus (17.1%), scarring with or without chronic inflammation (13.5%), graft failure (12.1%), scarring or active keratitis secondary to virus (9.0%) and Fuchs' dystrophy (8.3%). The principal factors responsible for graft failure were also judged by clinicopathological correlation. The authors compare their findings with those in other series.