PubMed Health⌕ Search

Biomedical subjects

G A Stern

Publications and source records attributed to G A Stern.

At least 55 records · Page 3Linked to original sources
PubMed1992

Bacterial keratitis associated with vernal keratoconjunctivitis.

We cared for two patients with longstanding vernal keratoconjunctivitis who had bacterial corneal ulcers in each eye. Both patients were young, black, and had histories of atopy. The patients came for treatment with acute symptoms of pain, redness, and reduced vision in the affected eye. On examination in each case we found an epithelial defect associated with dense stromal infiltration, a calcific plaque in the bed of the ulcer, and a severe anterior chamber reaction, including a hypopyon in two cases. Cultures of corneal scrapings from all four eyes were positive for Staphylococcus aureus, and three of the four infections were polymicrobial. All four eyes responded rapidly to intensive topical antibiotic therapy, debridement of the calcific plaque, and subsequent treatment with topical corticosteroids and/or cromolyn sodium. Bacterial keratitis can occur in patients with vernal keratoconjunctivitis, especially those with vernal corneal ulcers. The abnormalities of ocular immune mechanisms found in patients with vernal keratoconjunctivitis may predispose them to bacterial keratitis.

Adolescent↗
PubMed1992

Treatment of alkali-injured rabbit corneas with a synthetic inhibitor of matrix metalloproteinases.

Healing of corneal alkali injuries remains a severe clinical challenge. The authors evaluated the effect of a new synthetic inhibitor of matrix metalloproteinases (GM6001 or N-[2(R)-2-(hydroxamido carbonylmethyl)-4-methylpentanoyl]-L-tryptophane methylamide) on preventing ulceration of rabbit corneas after alkali injury. Topical treatment of corneas with severe alkali injuries with 400 micrograms/ml or 40 micrograms/ml GM6001 alone prevented ulceration for 28 days, although 8 of 10 corneas treated with vehicle perforated. Corneas treated with 4 micrograms/ml GM6001 had midstromal depth ulcers. Corneas treated with 400 micrograms/ml of GM6001 contained very few inflammatory cells and had significantly reduced vessel ingrowth compared with vehicle-treated corneas. Epithelial regeneration after moderate alkali injuries also was investigated. Persistent epithelial defects developed 4 days after moderate alkali injury in rabbit corneas treated with vehicle and progressively increased to an average of 20% of the original 6 mm diameter wound by 27 days after moderate alkali injury. By contrast, epithelial regeneration was complete and persisted for 21 days for corneas treated with a formulation containing GM6001 (400 micrograms/ml), epidermal growth factor (10 micrograms/ml), fibronectin (500 micrograms/ml), and aprotinin (400 micrograms/ml). Sporadic punctate staining developed in 20% of the corneas treated with the combination of agents between days 21-28 after moderate alkali injury. These results demonstrate that topical application of GM6001 prevented corneal ulceration after severe alkali injury and that a combination containing GM6001, epidermal growth factor, fibronectin, and aprotinin promoted stable regeneration of corneal epithelium after moderate alkali injury.

Alkalies↗
PubMed1992

Preseptal and orbital cellulitis.

The patient with a tender, erythematous, swollen eyelid represents a complex clinical challenge to the physician, who must arrive at a correct diagnosis from numerous differential possibilities. Knowledge of the anatomy of the orbit and surrounding structures and proper clinical and radiologic examination are necessary to accurately diagnose these conditions. Proper selection of antibiotic therapy and timely surgical intervention, directed at both the orbital infection and the underlying condition, are essential to avoid serious morbidity from these infections. This article reviews in detail preseptal cellulitis, Hemophilus influenzae type B infection in children, orbital infection related to paranasal sinusitis, orbital infection from other causes, and mycotic infections of the orbit.

Cellulitis↗
PubMed1991

Use of corticosteroids in combination with antimicrobial drugs in the treatment of infectious corneal disease.

The use of corticosteroids in the management of infectious eye disease is controversial. In this study, the authors attempt to analyze the goals and risks of the use of corticosteroids in the treatment of various forms of infectious keratitis with reference to generally recognized principles for the treatment of infectious diseases. Existing clinical and research data are reviewed in this context to make appropriate recommendations for the use of corticosteroids in the treatment of bacterial, fungal, and acanthamoeba keratitis. The authors conclude that corticosteroids are definitely contraindicated in the treatment of fungal keratitis, and relatively contraindicated in the treatment of Acanthamoeba keratitis. Topical corticosteroid therapy may have a role in the treatment of bacterial keratitis if appropriate guidelines are followed.

Acanthamoeba Keratitis↗
PubMed1990

Pseudomonas keratitis and contact lens wear: the lens/eye is at fault.

Microbial keratitis with Pseudomonas aeruginosa is the most common corneal infection associated with contact lenses (CLs). Pseudomonas organisms are ubiquitous in nature, and can colonize CLs without a prior breach in lens care or hygiene. Although poor lens care is often found in affected patients, lens contamination and traumatic epithelial defects are more relevant. Hydrophilic lenses, particularly extended wear lenses, have been associated with a greater frequency of Pseudomonas keratitis. The polymer matrix of these lenses is apparently suited to the avid adherence of Pseudomonas organisms. Adherence is promoted by the presence of lens coatings, which begin to accumulate upon lens insertion and whose level mounts over time. Evidence suggests that infection is more common with mucin-coated contaminated CLs than with noncoated contaminated CLs. In general, lens wear can promote bacterial adherence to the ocular surface by shielding the cornea from the wiping action of the eyelids and immune components in tears. Still, experimental models have shown that keratitis develops regularly (84%) only in corneas that have been traumatized. Trauma may arise through lens insertion or removal, deposits or debris entrapment, hypoxia, or toxic reactions to solution preservatives. Extended wear is believed to facilitate the infectious process because of the chronic accumulation of coatings, the chronic exposure of CLs to potentially adherent bacteria, the continuous presence of irritating lens deposits, the prolonged entrapment of debris beneath the lens, and the relative infrequency of lens cleaning and disinfection.

Bacterial Adhesion↗
PubMed1990

Recurrent postoperative endophthalmitis.

We treated five patients for postoperative endophthalmitis who demonstrated an initially good response to intravitreal management of their infection and then suffered a later recurrence. Four of the five patients received a single intravitreal injection of antibiotics as the only intravitreal therapy, and the fifth patient received a single antibiotic injection in addition to a partial vitrectomy. All recurrent infections occurred between 10 and 21 days after the original intravitreal injection of antibiotics. At the time of the recurrence, all five patients remained culture positive with the same organism that was initially isolated. The bacterial species isolated were S. epidermidis, group D streptococcus, P. acnes, P. mirabilis, and P. aeruginosa. All patients were ultimately sterilized with repeated intravitreal injections of antibiotics, vitrectomy, and/or intraocular lens removal. Factors that were related to recurrent infection were marginal susceptibility of the organism to the originally injected antibiotics, infection with a slowly replicating organism, and infection with a gram-negative bacillus. A single intravitreal injection of antibiotics may only partially treat bacterial endophthalmitis. Patients should be observed for at least 3 weeks following treatment of endophthalmitis for recurrence of their infection, and aggressive management, including vitrectomy and repeated intravitreal injections of antibiotics, should be used to treat recurrent infections.

Aged↗
PubMed1989

Immunophenotypic characterization of an unusual T-cell lymphoma presenting as anterior uveitis. A clinicopathologic case report.

A 54-year-old woman presented with a unilateral, anterior uveitis that progressed to hypopyon over 4 months despite treatment with steroids. One hundred percent of the cells collected from aspirates of the anterior chamber of the affected eye were morphologically large granular lymphocytes. The aspirated cells were demonstrated by flow cytometry to be a uniform population of T lymphocytes with a diploid genome and an S fraction of 2.3%. On further investigation, the patient was found to have an extensive abdominal malignant lymphoma with the same immunophenotype but different morphologic features than the anterior chamber lymphoid infiltrate. In contrast to the cells in the anterior chamber, the abdominal tumor was highly aggressive as indicated by the cellular morphologic features and the S fraction of 43%. DNA hybridization studies of the abdominal lymphoma demonstrated a T beta 2 T-cell receptor gene rearrangement. The use of these modern diagnostic methods should facilitate the diagnosis of intraocular lymphomas and may have important therapeutic and prognostic implications in the future.

Diagnosis, Differential↗
PubMed1989

The treatment of postoperative endophthalmitis. Results of differing approaches to treatment.

The authors treated 26 patients with postoperative endophthalmitis over a 4-year period, between 1983 and 1986. Nineteen patients were culture-positive and seven were culture-negative. All patients received intravitreal antibiotics as part of their treatment regimen. Culture-negative patients generally responded well to a single intravitreal antibiotic injection. Five of seven (71.4%) culture-positive patients who were treated with a single intravitreal antibiotic injection and no vitrectomy suffered either a recurrence of their infection or did not respond to treatment. Four of five patients who received a vitrectomy in addition to a single intravitreal antibiotic injection were cured of their infections; the one patient who received repeated intravitreal antibiotic injections alone and all six patients who received repeated intravitreal antibiotic injections in combination with vitrectomy were cured of their infections. Although the intravitreal injection of antibiotics provides an extremely high initial level of antibiotics inside the eye, a single intravitreal antibiotic injection may only partially treat bacterial endophthalmitis. In culture-negative cases, a single intravitreal injection of antibiotics appears to be sufficient treatment. In culture-positive cases, a higher cure rate is achieved with an aggressive approach which includes the use of repeated intravitreal antibiotic injections and/or vitrectomy.

Aged↗
PubMed1988

Acanthamoeba keratitis. Potential role for topical clotrimazole in combination chemotherapy.

Clotrimazole is an antifungal agent that has been shown to have excellent in vitro activity against most strains of Acanthamoeba. We encountered four patients who developed Acanthamoeba keratitis while wearing contact lenses that had been stored in homemade saline. Their medical treatment regimens included the use of topical 1% clotrimazole. In two patients in whom conventional therapy failed, clotrimazole was successful in controlling recurrent infection following penetrating keratoplasty. Two other patients were treated with clotrimazole as well as propamidine isethionate and neomycin sulfate-polymyxin B sulfate-gramicidin from the outset, and had an excellent response to medical therapy. In those patients who found the commercially available cream uncomfortable, a 1% clotrimazole suspension formulated in artificial tears was used and found to be well tolerated.

Acanthamoeba↗
PubMed1988

Corneal amyloidosis associated with keratoconus.

Nodular, gray-white, central corneal opacities which extended from the subepithelial zone through the anterior four fifths of the stroma developed in a 50-year-old man with a longstanding history of hard contact lens wear for keratoconus. Results of histopathologic analysis of the corneal button obtained at the time of penetrating keratoplasty disclosed that the opacities were composed of amyloid. Corneal amyloidosis is rarely found in association with keratoconus. Although there were some similarities in the pattern of amyloid deposition to that seen in primary familial amyloidosis of the cornea, the authors believe that their patient is more likely to have had a secondary amyloidosis. Corneal amyloidosis should be considered in keratoconus patients with development of unusual forms of central corneal opacification.

Amyloidosis↗
PubMed1987

Serious corneal complications of glaucoma filtering surgery with postoperative 5-fluorouracil.

We studied four patients who, having received postoperative 5-fluorouracil after glaucoma filtering operations, developed serious corneal complications. All four patients had preexisting corneal abnormalities including keratoconjunctivitis sicca, exposure keratopathy, and bullous keratopathy. All of the patients developed epithelial defects in the postoperative period. The complications included bacterial corneal ulceration (two patients), sterile corneal ulceration and corneal perforation (one patient), and a keratinized corneal plaque with underlying sterile stromal infiltrate (one patient). The use of 5-fluorouracil, which is an antimetabolite with considerable corneal epithelial toxicity, after glaucoma filtering surgery frequently causes corneal epithelial defects that may lead to secondary complications. Patients receiving this drug should have their corneal status closely monitored. In patients with corneal epithelial disease, 5-fluorouracil should be used with caution.

Aged↗
PubMed1987

The effect of enzymatic contact lens cleaning on adherence of Pseudomonas aeruginosa to soft contact lenses.

Previous studies have demonstrated that Pseudomonas aeruginosa adheres more readily to soft contact lenses with a mucin coating than to unworn contact lenses. The mucin coatings that develop on soft contact lenses may, therefore, play a significant role in the pathogenesis of contact lens-associated Pseudomonas corneal ulceration. We tested the ability of a variety of enzymatic contact lens cleaners and other enzyme solutions to decrease the adherence of Pseudomonas to mucin-coated soft contact lenses. Of the commercially available solutions that were tested, cleaning with Optizyme and Extenzyme significantly reduced the adherence of Pseudomonas to the lenses, whereas cleaning with the Softmate Weekly Cleaning System had no effect. Optizyme and Extenzyme were as effective as a 10% solution of acetylcysteine and more effective than a 0.25% trypsin solution. Neuraminidase at pH 5 was the most effective solution at reducing the adherence of Pseudomonas to the lenses, supporting the finding that sialic acid is a specific receptor for Pseudomonas aeruginosa. Soft contact lenses should be cleaned frequently with an effective enzymatic cleaner to reduce the likelihood of Pseudomonas adhering to the lens and thereby reduce the incidence of Pseudomonas corneal ulceration in soft contact lens wearers.

Acetylcysteine↗
PubMed1987

Mycobacterium avium-intracellulare corneal ulcer.

A healthy 28-year-old man developed a slowly progressive corneal ulcer 21 months after an episode of corneal trauma. Acid-fast bacilli were identified in corneal scrapings, and the causative organism was identified as Mycobacterium avium-intracellulare. Medical treatment with topical amikacin and oral rifampin was ineffective, and a therapeutic penetrating keratoplasty was necessary to cure the infection. To the best of our knowledge, this is only the second reported case of a corneal infection caused by a slow-growing nontuberculous mycobacterium (Runyon groups I, II, and III) and the first caused by M. avium-intracellulare. Slowly growing nontuberculous mycobacteria should be considered among those organisms that cause corneal infection, especially in cases characterized by a protracted course and lack of response to conventional antimicrobial therapy.

Adult↗