Biomedical subjects

Henry D Perry

Publications and source records attributed to Henry D Perry.

43 records · Page 3Linked to original sources

PubMed2003

Bilateral methicillin-resistant staphylococcus aureus keratitis in a medical resident following an uneventful bilateral photorefractive keratectomy.

PURPOSE: To present a case of bilateral methicillin-resistant Staphylococcus aureus (MRSA) keratitis after photorefractive keratectomy (PRK). METHODS: Retrospective chart review. RESULTS A 26-year-old female internal medicine resident underwent an uneventful bilateral PRK. After the procedure, the patient was fit with a bandage contact lens and was prescribed tobramycin 0.3%, fluorometholone 0.1%, and diclofenac sodium 0.1% four times per day. Postoperatively, corneal ulcers were noted in each eye, and the patient was referred for a consultation. Gram stain showed gram-positive cocci. The patient immediately started using vancomycin, 35 mg/mL every half hour, and ofloxacin 0.3% every hour around the clock. Forty-eight hours later, corneal and lid cultures were positive for MRSA. Three months after the infection, there was approximately 40% corneal thinning in the right eye and 10% thinning in the area of the corneal ulceration of the left eye. The patient is awaiting corneal transplantation of the right eye. CONCLUSIONS: To our knowledge, this represents the first reported case of bilateral MRSA keratitis after PRK. Methicillin-resistant S. aureus is a potentially serious infectious agent after PRK and may be associated with exposure to a hospital setting. For patients who have had extensive exposure to a hospital environment and are undergoing ocular surgery, we recommend prophylaxis against MRSA. To treat a possible MRSA keratitis, we suggest starting a fourth-generation topical fluoroquinolone every 30 minutes, alternating it with vancomycin 50 mg/mL every 30 minutes, and discontinuing steroid use. A high degree of suspicion coupled with rapid and appropriate treatment may result in improved visual recovery.

Adult↗

PubMed2003

Flap folds after femtosecond LASIK.

PURPOSE: To report a case of bilateral flap folds after a laser-assisted in situ keratomileusis (LASIK) procedure in which the flap was created by the femtosecond laser. METHODS: Retrospective chart review. RESULTS: A 43-year-old white woman underwent bilateral simultaneous LASIK. The corneal flap was created with the femtosecond laser. Postoperatively, the patient noted significantly decreased visual acuity, glare, and haloes. She was diagnosed with corneal flap striae, which were treated unsuccessfully with a lifting and stretching procedure, but responded to subsequent bilateral flap suturing. CONCLUSIONS: Despite the increased accuracy in flap creation with the femtosecond laser, large flap folds may develop.

Adult↗

PubMed2003

Medications for dry eye syndrome: a drug-therapy review.

Early interventions were palliative, attempting to replace water lost from the tear film. Today, therapy is directed at the underlying inflammation, a recognized component of dry eye syndrome, and at the resulting progressive changes to the ocular surface. This approach offers promise of lasting relief to patients with moderate to severe symptoms.

Adrenal Cortex Hormones↗

PubMed2003

Issues in the use of preservative-free topicals.

In a perfect world, patients would use medications as prescribed. In reality, patients may cut corners, especially if they may save money by doing so. Clinicians and pharmacists must acknowledge this tendency, yet at the same time protect patients from using contaminated ophthalmologic agents and strive to achieve optimal clinical outcomes.

Cyclosporine↗

PubMed2002

Antiinflammatory effect of preoperative ketorolac in phacoemulsification.

We report the antiinflammatory effect and efficacy of preoperative treatment with ketorolac in a patient with rheumatoid arthritis having phacoemulsification. This 70-year-old woman was on a maintenance dose of systemic methylprednisolone at the time of uneventful phacoemulsification in the left eye. She developed a sterile hypopyon on the first postoperative day and was treated aggressively with topical and systemic therapy, resulting in a gradual resolution of the inflammatory response. The patient subsequently had phacoemulsification in the right eye. The only significant difference in the preoperative management this time was that the patient received topical ofloxacin and ketorolac 4 days before surgery. The postoperative inflammatory response was much more controlled. The patient was continued on ketorolac and prednisolone acetate, resulting in the usual postoperative inflammatory response.

Aged↗

PubMed2002

Topical cyclosporin A in the management of therapeutic keratoplasty for mycotic keratitis.

PURPOSE: To investigate the efficacy of topical cyclosporine A 0.5% as a substitute for corticosteroids in the management of therapeutic keratoplasties for mycotic keratitis. METHODS: Prospective, nonrandomized interventional case series. Three patients with culture-proven mycotic keratitis underwent therapeutic keratoplasties. All were treated with topical cyclosporine A 0.5% postoperatively as a primary or an adjunctive therapy for prevention of allograft rejection. The patients were followed up from 15 to 42 months for maintenance of graft clarity and best-corrected visual acuity. RESULTS: Two of three patients maintained clear grafts while using topical cyclosporine A 0.5% twice daily with best-corrected visual acuity of 20/40 and 20/50. One patient developed an opacified graft secondary to preexisting ocular surface disease. CONCLUSIONS: Topical cyclosporine A 0.5% may be a useful adjunct in the management of therapeutic keratoplasties for mycotic keratitis.

Administration, Topical↗

PubMed2002

Herpes simplex reactivation following laser in situ keratomileusis and subsequent corneal perforation.

PURPOSE: To present a case of corneal perforation secondary to herpes simplex reactivation after laser in situ keratomileusis (LASIK) and its subsequent management. METHODSL A case report of a 69-year-old man who underwent LASIK after penetrating keratoplasty for herpes simplex keratitis (HSK) is presented. RESULTS: The patient is a 69-year-old man who had a penetrating keratoplasty of the right eye 6 years prior for corneal scarring secondary to HSK. A spectacle refraction of -13.25 + 6.00 x 45 yielded 20/60 visual acuity in his grafted eye. LASIK was performed, and the patient's visual acuity without correction on postoperative day 1 was 20/60. Ten days after LASIK, the patient developed thinning of the cornea at the temporal edge of the flap, which perforated the following day. The perforation site was glued with cyanoacrylate adhesive and covered with a soft contact lens. After 7 months, a 4-mm lamellar keratoplasty and conjunctivoplasty was performed. Nine months after surgery, the patient's visual acuity without correction is 20/50 and the graft remains intact. CONCLUSION: Herpes simplex keratitis may be a contraindication for LASIK in postkeratoplasty patients. Bandage contact lenses and cyanoacrylate adhesive can be used successfully to manage the rare complication of corneal perforation after LASIK.

Aged↗