An ocular model of adenovirus type 5 infection in the NZ rabbit.

Ocular adenoviral infections occur worldwide, and currently, there is no ocular animal model for evaluating new antivirals or studying pathogenesis. With a paired-eye design, an ocular model was developed in 32 New Zealand rabbits following topical and intrastromal inoculation with a clinical isolate of adenovirus type 5 (Ad5 McEwen). Clinical signs of infection--conjunctivitis, corneal edema, subepithelial infiltrates, and iritis--and seroconversion were evaluated. Replicating virus on the ocular surface was determined by serial ocular titers. Reproducible acute ocular infection was demonstrated in 32 of 32 infected eyes (100%), with mean viral replication lasting for 8.3 days. Peak ocular viral titers (10(3) plaque forming units/ml) were achieved on day three after inoculation and represented a 2 log increase (100 times) over day one. Ocular viral replication was associated with acute conjunctivitis (24/34 eyes, 75%), and delayed-onset presumed immune-mediated clinical disease was associated with: blepharoconjunctivitis (21/32 eyes, 66%), iritis (29/32 eyes, 91%), corneal edema (32/32 eyes, 100%), and subepithelial corneal infiltrates (30/32 eyes, 94%). Seroconversion was demonstrated in 26 of 31 rabbits (84%). The study concludes that a potentially useful animal model of adenoviral ocular infection can be attained.     

Reactivation of herpes virus after lamellar keratoplasty.

PURPOSE: To determine if lamellar keratoplasty in rabbits latently infected with herpes simplex virus type 1 (HSV-1) would stimulate graft recipients to shed virus and induce viral-specific corneal lesions. METHODS: Rabbits latently infected with HSV-1 received lamellar allografts in one eye from normal uninfected rabbits and the contralateral eyes served as unoperated controls. Normal rabbits received lamellar grafts from rabbits latently infected with HSV-1. For 1 week after surgery, slit-lamp examination and ocular swab sampling were performed daily to assess viral reactivation. RESULTS: The occurrence of positive swab cultures and corneal epithelial lesions after lamellar keratoplasty was significantly higher in operated eyes of latently infected rabbits when compared to the control eyes. Ocular shedding or recurrent lesions were not observed in the normal rabbits receiving corneal grafts from latently infected donors. CONCLUSIONS: These results indicated that lamellar keratoplasty induces HSV-1 shedding and recurrent epithelial lesions in the eyes of rabbits latently infected with HSV-1, which received lamellar grafts, but not in the eyes of normal rabbits given lamellar grafts from HSV-1 latently infected rabbits. It seems that the site of viral latency is not the anterior corneal stroma or the epithelium.     

The role of Brinzolamide 1% ophtalmic suspension in corneal edema

PURPOSE: The study is aimed at assessing the efficacy and safety of topical carbonic anhydrase inhibitor (IAC--i.e. ophthalmic suspension of brinzolamide 1%--Azopt) in the treatment of corneal edema. METHOD: For this purpose, we carried out an experimental, epidemiological-operational, randomised, placebo-controlled and double blind study, on three groups of laboratory animals (rabbits): group 1 (5 rabbits) included endothelial corneal injuries inflicted by ultrasound exposure by means of a phacoemulsification sound in both eyes group 2 (5 rabbits) included endothelial corneal injuries inflicted by direct trauma in both eyes group 3 (3 rabbits)--no endothelial corneal lesions (control group) In each group we instilled, all the animals, with ophthalmic suspension of brinzolamide 1% (Azopt), 1 drop t.i.d., in one eye for 14 days (starting the following day after infliction of endothelial injuries, when the corneal edema was evidenced by biomicroscopic examination) and placebo (saline solution 0.9% with the same osmolar and pH values as the Azopt) in the other eye. The assessment was performed throughout the following stages: To: preceding the infliction of corneal endothelial injuries, resorting to: biomicroscopic examination ultrasound pahimetry direct specular microscopy T1: the following day after infliction of corneal endothelial injuries, resorting to: biomicroscopic examination (the assessment of corneal edema) ultrasound pahimetry (measurement of corneal thickness and, hence edema) direct specular microscopy (cell density and endothelial ultrastructure evaluation: cellular polimegetism, pleiomorphism) T2: in the wake of 14 days therapy (after eye removal), adding to the previous examinations: indirect specular microscopy (with the same aim as the direct examination, yet examination carried out from the endothelial side) pathologic examination (using hematoxilin-eosin dye and Van-Gieson dye).     

白内障术后局部滴眼诱发药源性角膜病变的临床研究

目的:分析白内障术后滴妥布霉素地塞米松滴眼液对眼表的毒性作用,探讨妥布霉素地塞米松滴眼液所致药源性角膜病变的临床特征、治疗效果。方法:对临床所见的14例18眼白内障术后滴妥布霉素地塞米松滴眼液诱发的药源性角膜病变的临床资料进行回顾性分析。结果:患者14例18眼,均于白内障超声乳化术后使用妥布霉素地塞米松滴眼液点眼≥1wk;临床表现:眼部刺激症状:眼磨、流泪、畏光、视力下降。体征:眼部睫状充血,点状角膜糜烂11眼,弥漫性角膜上皮混浊6眼,角膜基质浸润1眼。其中合并有糖尿病病史者5眼,抗青光眼术后者6眼,玻璃体切除术后2眼,全身状况良好者5眼,停药后,眼部症状缓解、消失。结论:临床医生应关注妥布霉素地塞米松滴眼液对角膜的毒性作用,并积极预防和治疗,规范用药。     

小切口白内障术后角膜水肿相关因素临床分析

目的:分析小切口白内障手术后角膜水肿的相关因素及预防治疗。方法:对397例白内障手术后56例56眼角膜发生水肿的原因进行临床分析。结果:患者56例发生角膜水肿,年龄偏大(70～80岁以上)13例,核硬度Ⅲ～Ⅳ级核29眼,有眼部并发症且全身并发症发生率高11例,糖尿病发生3例。结论:白内障手术后发生角膜水肿与年龄、核硬度、眼部并发症及患者全身状况密切相关。     

A viral model for corneal scarring and neovascularization following ocular infection of rabbits with a herpes simplex virus type 1 (HSV-1) mutant

PURPOSE: Herpes simplex virus type 1 (HSV-1) remains a major cause of corneal scarring and visual loss. Although efforts have been made, no reproducible animal model is available to examine recurrent corneal disease. Here we propose a rabbit ocular model to study recurrent corneal disease using an HSV-1 mutant that reactivates with high efficiency. METHODS: Rabbits were ocularly infected with 2 x 10 PFU/eye of the parental McKrae, dLAT2903 (a LAT-null virus with a low-reactivation phenotype), or CJLAT (a high-reactivation virus). Acute ocular disease [days 2, 4, 7, and 10 postinfection (pi)], recurrent ocular disease, and neovascularization (days 30 to 58 pi) were monitored. RESULTS: All acute ocular disease symptoms, including conjunctivitis and corneal disease, were similar with all 3 viruses. No corneal scarring was detected in any eyes up to day 30 pi. Between days 35 and 58 pi, corneal scarring was observed in 11/14 (experiment 1) and 18/22 (experiment 2) eyes of CJLAT-infected rabbits. Significantly less corneal scarring was seen in eyes of rabbits infected with McKrae (0/18 and 0/16) or dLAT2903 (0/16 and 3/24) (P < 0.0001). Many of the eyes with corneal scarring developed obvious, measurable neovascularization. CONCLUSIONS: Rabbits infected with CJLAT developed corneal scarring and neovascularization similar to that of clinical ocular HSV-1 recurrent disease. Because this occurred well after the acute infection had resolved, the corneal scarring and neovascularization appeared to be recurrent disease. Thus, CJLAT ocular infection of rabbits may provide a good and reproducible animal model to study factors involved in corneal scarring and neovascularization from recurrent ocular HSV-1.     

The relation of conjunctival and corneal findings in severe ocular allergies

OBJECTIVE: Corneal lesions such as ulcers and erosions are major complications observed in patients with severe ocular allergic diseases. We aimed to look into the relationship between specific clinical conjunctival findings and the severity of corneal complications. METHODS: Thirty eyes of 6 patients with vernal keratoconjunctivitis (VKC) and 13 patients with atopic keratoconjunctivitis (AKC) were evaluated in this study. Slit-lamp photographs of upper tarsal conjunctiva and cornea were used to evaluate the clinical findings objectively. The corneal findings and clinical findings of upper tarsal conjunctiva such as conjunctival injection, edema, the height of papillae, and mucous discharge were evaluated and graded. Statistical correlations between conjunctival findings and the severity of corneal damage were analyzed. RESULTS: Conjunctival injection and edema significantly correlated with the severity of corneal complications. The height of the papillae and the amount of mucous discharge did not correlate with the severity of corneal complications. CONCLUSION: Direct signs of inflammation such as injection and edema correlated with corneal damage. The height of papillae did not show a significant correlation with the corneal findings. Our results suggest that inflammation of the conjunctiva rather than mechanical factors may play a greater role in the formation of corneal damage in severe ocular allergies.     

准分子激光治疗性角膜切削术治疗兔细菌性角膜病变

目的：研究准分子激光治疗性角膜切削术(phototherapeutic keratectomy,PTK)对兔眼细菌性角膜溃疡愈合的影响,并探讨该方法用于临床上治疗细菌性角膜病变的可能性。

方法：24只新西兰大耳兔48眼接种金黄色葡萄球菌,成功制作细菌性角膜溃疡模型。接种细菌后1～2d溃疡明显形成,予以左氧氟沙星滴眼液滴眼。术前行双眼前节裂隙灯检查,双眼光学相干断层扫描(optical coherence tomography,OCT)检查并测量角膜溃疡中央深度。接种3d后所有实验兔右眼行PTK手术,左眼不予以处理作为对照眼。术后3、7d再行裂隙灯检查,并行OCT检查测量角膜溃疡中央厚度。术后7d处死实验兔,摘除双眼眼球取角膜组织行病理切片观察。

结果：经裂隙灯观察,随时间推移两组兔眼角膜溃疡均有愈合倾向,表现为溃疡面积缩小和表面变平坦光滑。观察组术前测量角膜溃疡深度与对照组比较,差异无统计学意义(t=0.706,P=0.484)。观察组术后3、7d角膜溃疡厚度与对照眼比较,差异有统计学意义(P<0.05)。

结论：PTK能有效治疗兔眼金黄色葡萄球菌性角膜溃疡,促进溃疡创面愈合,这可能为PTK应用于临床治疗患者细菌性角膜病变提供实验依据。     

Corneal nerve disruption reactivates virus in rabbits latently infected with HSV-1

Trauma, inflammation, and neuronal stimulation or damage can reactive latent herpes simplex virus type 1 (HSV-1). The innervation density of the corneal epithelium is 300-600 times that of skin and, therefore, corneal nerve disruption could provide a strong stimulus for HSV-1 reactivation. This study has documented HSV-1 ocular reactivation following three methods of corneal nerve disruption in rabbits. Twenty HSV-1 latently infected rabbits (26 eyes) were divided into three groups: 7 rabbits received uniocular cryogenic injury, 7 rabbits underwent uniocular anterior superficial keratectomy, and 6 rabbits had binocular transection of the corneal nerves at the corneoscleral limbus which, in contrast to the other treatments, produced minimal epithelial change. Opposite eyes in the first two groups of rabbits were left undisturbed to serve as HSV-1 infected controls. Three additional rabbits, not infected with HSV-1, underwent gold chloride impregnation of the corneal nerves for light microscopic documentation of corneal nerve damage induced by each procedure. On all HSV-1 infected eyes, daily HSV-1 ocular cultures were obtained for 7 consecutive days. All three procedures resulted in marked corneal nerve destruction and degeneration. HSV-1 shedding occurred in 5/7 (71%) of the eyes that underwent cryogenic lesioning; in 5/7 (71%) of the eyes that underwent anterior keratectomy; and in 8/12 (67%) of the eyes that had the corneal nerves transected at the corneoscleral limbus. Only 4 (29%) of the 14 control eyes had positive HSV-1 ocular cultures. This investigation provides strong evidence that corneal nerve disruption is correlated with ocular HSV-1 reactivation.     

兔眼局部应用小檗碱溶液安全性的初步研究

目的研究兔眼部局部应用小檗碱溶液的安全性及其对兔眼角膜上皮修复的影响。方法实验研究。日本大耳白兔92只,随机数字表法分为一般情况组(32只兔,64只眼)和角膜损伤组(60只兔,60只眼)。一般情况组再用随机数字表法分为4个组,每组8只兔(16只眼),根据给予去离子水或0.5、1.0、1.5 mg/ml小檗碱溶液,分为一般情况对照组及一般情况A、B、C组;双眼给药,每只眼先单次给药,观察72 h后再连续4周多次给药。角膜损伤组兔右眼制作角膜上皮损伤模型后,根据给予去离子水或0.5、1.0、1.5 mg/ml小檗碱溶液,分为角膜损伤对照组及角膜损伤A、B、C组,每组15只兔(15只眼),连续给药1周。一般情况组兔进行行为学观察,并应用Draize眼刺激性评分系统,对兔角膜、结膜、虹膜受累的面积、程度和反应进行评分,测量不同时间眼压,视网膜电图(ERG)检测b波振幅。角膜损伤组兔于角膜缺损后1、2、3、4、5、6、7 d观察角膜上皮缺损修复情况。所有兔停药后进行角膜组织病理学观察。兔泪液pH值比较采用配对t检验,Draize眼刺激性评分采用秩和检验,眼压、视网膜电图b波振幅及角膜上皮损伤面积和修复时间的多组比较采用方差分析及SNK-q检验。结果单次给药和多次给药后一般情况组兔均无明显异常行为。一般情况对照及A、B、C组在多次给药1、2、4周时Draize眼刺激评分差异均无统计学意义,其中一般情况C组的Draize眼刺激评分分别为7(0,12)、6(0,10)、6(0,16)分(χ^2=1.640,0.265,1.963,1.381;P>0.05)。一般情况对照及A、B、C组在多次给药前后不同时间的眼压差异均无统计学意义(F=0.065,0.292,0.015,0.041;P>0.05)。在多次给药前及给药后2、4周一般情况对照组的b波振幅分别为(127.75±17.12)、(129.18±15.83)、(128.81±13.58)μV,一般情况A组为(130.68±18.75)、(131.38±16.96)、(130.62±12.18)μV,一般情况B组为(128.00±16.74)、(128.44±16.64)、(129.06±16.16)μV,一般情况C组为(131.81±19.37)、(132.13±18.36)、(129.94±12.60)μV,各组在给药前后不同时间b波振幅差异均无统计学意义(F=0.037,0.011,0.017,0.702;P>0.05)。一般情况对照组与一般情况A、B、C组角膜组织病理学检查结果无明显差异。角膜损伤各组在不同时间的角膜上皮缺损面积有统计学意义(F=5.316,25.864,127.613;P<0.05),角膜损伤对照组与角膜损伤A、B、C组之间两两比较,角膜损伤C组的角膜上皮缺损面积明显大于其他3个组,差异具有统计学意义(q=5.153,10.313,6.976;P<0.05)。角膜损伤对照及A、B、C组的修复愈合时间为(83.0±1.85)、(82.9±2.07)、(83.7±2.09)和(101.6±2.20)h,角膜损伤C组角膜上皮缺损修复时间长,差异有统计学意义(F=301.437,P=0.000),角膜损伤对照组及角膜损伤A、B组之间比较,角膜上皮缺损修复时间差异无统计学意义(F=0.813,P=0.450);修复结束后,角膜损伤组之间角膜组织的病理学检查结果无明显差异。结论兔眼局部应用小檗碱溶液较安全,兔眼眼表未见明显的毒性反应,对视网膜未见明显影响。1.5 mg/ml浓度小檗碱溶液可延迟兔眼角膜上皮缺损修复,但对修复后的角膜组织结构的完整性无影响。     

Interface corneal edema secondary to steroid-induced elevation of intraocular pressure simulating diffuse lamellar keratitis

PURPOSE: To describe interface corneal edema secondary to steroid-induced elevation of intraocular pressure (IOP) following LASIK. METHODS: Retrospective observational case series. Diffuse interface edema secondary to steroid-induced elevation of IOP was observed after LASIK simulating diffuse lamellar keratitis (DLK) in 13 eyes. Mean patient age was 31.4 +/- 5.3 years. Patients were divided into two groups according to provisional misdiagnosis: DLK group (group 1) comprised 11 eyes and infection group (group 2) comprised 2 eyes (microbial keratitis). Mean follow-up was 8.1 +/- 0.5 weeks. RESULTS: In the DLK group, typical diffuse haze was confined to the interface and extended to the visual axis, impairing vision in all eyes. Provisional diagnosis was late-onset DLK and topical steroids were started. Repeat examination showed elevated IOP as measured at the corneal center and periphery using applanation tonometry (mean 19.1 mmHg and 39.5 mmHg, respectively), causing interface edema with evident interface fluid pockets. Steroids were stopped and topical anti-glaucoma therapy was started. The interface edema decreased and at the end of follow-up the corneal transparency was restored and IOP dropped to normal values. The infection group demonstrated a microbial keratitis-like reaction and underwent flap lifting and interface wound debridement and biopsy with administration of fortified antibiotics and steroids. After elevated IOP was detected, steroids and antibiotics were stopped and topical anti-glaucoma therapy was started, resulting in the resolution of the interface edema. CONCLUSIONS: Interface fluid syndrome secondary to steroid-induced elevation of IOP might develop in steroid responders after LASIK with a misleading clinical picture simulating DLK or infectious keratitis. Management includes stopping topical steroids and starting topical antiglaucoma therapy.     

周边性角膜水肿的临床观察

目的探讨白内障摘除术后周边性角膜水肿—Ｂｒｏｗｎ－ＭｃＬｅａｎ综合征的发病机理。方法对５例（８只眼）患者进行超声角膜厚度测量及角膜内皮显微镜检查,并对其临床表现和发病机理进行分析。结果术后角膜水肿平均发生时间为１０．５年,水肿发生于角膜下方,向上方周边部进展,中央保持透明;水肿区角膜厚度增加,其内皮上可见点状棕色色素性后沉着物,中央区内皮细胞密度减低。结论周边性角膜水肿是一种国内尚未见文献报告的新的角膜水肿类型。其临床表现与白内障摘除术后发生的持续性角膜水肿不同。病因不明,可能与无晶体眼、慢性葡萄膜炎或某些遗传特性有关。     

白内障超声乳化术后角膜水肿的临床分析

目的：探讨白内障超声乳化术后角膜水肿的相关因素。 方法：通过观察532例564眼白内障超声乳化术后第1d角膜水肿的情况,分析角膜水肿与年龄、核硬度、合并青光眼、糖尿病的关系。 结果：患者564眼中角膜水肿共计118眼,发生率为209%。其中70岁以上角膜水肿占24.0%,Ⅳ级核占36.9%,Ⅴ级核为100%。其中抗青光眼术后白内障角膜水肿比例为68.1%,合并有糖尿病白内障角膜水肿比例为48.6%。 结论：白内障超声乳化术后角膜水肿程度与年龄、核硬度程度呈平行关系;糖尿病和抗青光眼术后的患者角膜容易发生水肿反应,反之无眼部手术病史、糖尿病史患者术后角膜水肿发生率低,水肿反应轻。     

准分子激光原位角膜磨镶术后角膜细菌性感染的实验研究

目的:建立日本大耳白兔LASIK术后感染模型,了解LASIK术后细菌性角膜炎的病理过程,为LASIK术后细菌性角膜炎诊断、治疗提供依据。方法:选取健康成年日本大耳白兔20只,右眼行LASIK术后接种金黄色葡萄球菌,在术后12h;1,3,5,10d各时期行肉眼、数字化裂隙灯和共焦显微镜观察,10d后处死实验动物取角膜行病理切片。结果:18眼成功建立了LASIK术后细菌性角膜炎模型。其早期表现为角膜瓣浅基质层点状或小斑片状炎性浸润,随着时间的推移慢慢融合,并以层间为起点同时向前（角膜瓣）和向后（深基质层）发展,晚期造成角膜瓣移位、角膜瓣溃疡、穿孔伴前房积脓。结论:建立LASIK术后细菌性角膜炎模型可行。LASIK术后细菌性角膜炎会导致严重的病理损害。     

兔眼准分子激光近视角膜切削术后角膜膨出的研究

目的：探讨兔眼在准分子激光近视角膜切削术（Excimer laser in-situ keratomileusis,LASIK)手术后在不同的眼压下角膜膨出的程度。方法：26兔52眼随机分为对照组，LASIK手术组，单盲法，术前，术后测量角膜厚度和角膜地形图后，再将两组随机交叉分为正常眼压组，低度高眼压组，高度高眼压组，并观察1个月，用角膜地形图对实验前后的角膜形态进行分析。并应用统计学方法将手术切削量和眼压两个因素对角膜扩张的影响做双因素方差分析。结果：LASIK手术的角膜切削量，术后高眼压以及两者的交互效应对角膜抵抗力都有显著影响。较大的切削量和术后持续高眼压后的兔眼角膜地形图经分析符合圆锥角膜模式，并出现前，后弹力膜断裂的形态学改变。结论：角膜较大的切削量和术后持续的高眼压是导致兔眼LASIK术后发生圆锥角膜的重要原因。     

深低温保存角膜缘干细胞自体移植实验研究

目的:评价深低温冷冻保存兔眼角膜缘干细胞活性及自体移植治疗角膜干细胞缺乏眼表疾病的疗效。方法:12只新西兰白兔用刀片制备带2mm周边角膜和2mm球结膜的环行浅层角膜缘植片,去除余下的角膜上皮,制成角膜干细胞缺乏眼表疾病模型。角膜缘植片通过程序降温仪程序降温后-196℃深低温保存。30天和60天后作自体移植行兔眼眼表重建术。结果:角膜干细胞缺乏导致角膜上皮愈合延迟,7眼在术后22～26天愈合,平均24±1天,4眼复发性上皮糜烂;基质混浊水肿;角膜血管化,平均5±1天出现新生血管。深低温保存角膜缘干细胞自体移植能促进角膜上皮愈合,平均10±2天愈合,基质混浊逐渐吸收,新生血管消退、变细,2眼消失。结论:深低温保存法能保存角膜缘干细胞活性;能随时按需为临床提供活性角膜缘材料;为临床深低温保存角膜缘干细胞移植治疗眼表疾病提供了实验依据。眼科学报1998;14:224～226。     

Ocular lesions arising after stings by hymenopteran insects

PURPOSE: To describe the ocular lesions that occur after stings from hymenopteran insects. METHODS: We examined the ocular alterations in five patients who suffered ocular trauma from hymenopteran insect stings. RESULTS: In 4 cases where the insect was identified as a wasp, all the patients presented with persistent corneal decompensation and two presented with total cataract, requiring surgical treatment. In the case of trauma by a bee sting, the patient presented with corneal edema and an inflammatory reaction of the anterior chamber with total regression of these alterations after clinical treatment. CONCLUSION: Although a rare occurrence, ocular trauma caused by hymenopteran insects can result in severe ocular alterations in humans.     

角膜上皮损伤后海水浸泡影响的动物实验研究

目的:通过对角膜上皮损伤后病理改变的动物实验观察,了解海水浸泡对伤后上皮组织愈合的影响。方法:对10只灰兔表麻下刮除双侧全角膜上皮,右眼为实验眼,左眼为对照眼。实验眼海水浸泡半小时,对照眼生理盐水浸泡半小时。分别于伤前和伤后1、3、5、7、10d进行角膜厚度测定、角膜上皮荧光染色、裂隙灯下检查。按期依序处死2只实验兔,取全眼球甲醛固定后,石蜡包埋切片,常规染色,光镜下观察。角膜厚度值分别进行伤前与伤后自身对照t检验,实验眼和对照眼t检验。结果:角膜去上皮损伤后,裂隙灯下见伤后角膜明显水肿混浊并逐日加重,且实验眼较对照眼严重,实验眼伤后10d可见角膜缘有大量新生血管长入。角膜上皮荧光染色检查见,伤后角膜上皮均呈片状着色,但实验眼明显大于对照眼。光学显微镜下见实验眼角膜组织炎性反应明显加重,上皮细胞愈合明显延迟,基质血管化加重。伤后角膜厚度均较伤前明显增加,实验眼角膜厚度增加更为明显,伤后角膜与伤前角膜自身对照t检验和实验眼与对照眼伤后角膜厚度经分组t检验,均有显著差异。结论:海水浸泡对伤后上皮组织的愈合有不良影响。     

Ocular surface changes with applanation contact lens and coupling fluid use after argon laser photocoagulation in noninsulin-dependent diabetes mellitus

PURPOSE: To describe the effect of coupling solutions used during laser photocoagulation on the ocular surface of patients with noninsulin-dependent diabetes mellitus (NIDDM). DESIGN: A prospective case-controlled study. METHODS: Ninety-two eyes of 46 NIDDM patients with clinically significant macular edema, poor metabolic control of diabetes, and peripheral neuropathy and 100 eyes of 50 normal control subjects were studied. The patients' eyes were assigned to argon green focal/grid laser photocoagulation using an applanation contact lens and one of the coupling fluids; 2% methocel, Thilo-Tears Gel, 1.4% sodium hyaluronate, or 0.9% simple saline. The control subjects received time-matched three-mirror contact lens fundus examinations. All subjects underwent corneal sensitivity measurements, Schirmer test, tear film breakup time, and corneal fluorescein staining before as well as 3 and 8 days after the laser procedures and contact lens examinations. Patients with corneal problems persisting after 8 days were followed longer. RESULTS: Diabetic eyes assigned to 2% methocel and 1.4% sodium hyaluronate had significantly lower mean corneal sensitivities and break-up time values as well as significantly higher mean fluorescein staining scores at all examination points after laser photocoagulation. All diabetic eyes with aqueous deficiency assigned to 2% methocel and 1.4% sodium hyaluronate developed delayed corneal epithelial healing. CONCLUSION: The use of viscous coupling solutions during applanation contact lens-aided laser procedures may be detrimental for the corneal epithelium in poorly controlled NIDDM patients with peripheral neuropathy and coexisting aqueous deficiency.     

Corneal edema related to accidental Hibiclens exposure

Five patients developed corneal edema presumably caused by accidental preoperative ocular exposure to Hibiclens. In all cases, the patients complained of ocular pain after surgery. Conjunctival inflammation and corneal epithelial defects were found in all patients. Between two and ten weeks after exposure, stromal and epithelial edema, with a predilection for the inferior cornea initially, developed in all patients. The corneal edema resolved in three patients in approximately six months, leaving mild stromal scarring and reduced endothelial cell counts. The corneal edema in the other two patients progressed to diffuse bullous keratopathy, which eventually required penetrating keratoplasty. We recommend that Hibiclens be avoided in preoperative preparation of the facial skin to prevent accidental ocular exposure.