Biomedical subjects
J Nobe
Publications and source records attributed to J Nobe.
Community care of corneal ulcers.
Because of increasing concern about the appropriate and cost-effective use of eye care services and procedures, several organizations have sought to arrive at practice guidelines or practice patterns from which physicians can draw guidance. To assess the potential effectiveness of such guidelines, we reviewed the care of patients with corneal ulcers. Corneal specialists recommend that cultures be obtained before initiation of treatment. We determined whether ophthalmologists implemented these guidelines by the following: (1) a review of records of 79 patients referred to a tertiary care corneal and external disease service for evaluation of keratitis, and (2) a survey by mail of practicing ophthalmologists. Antibiotic therapy without any cultures was observed in 38 of 79 referred patients with corneal ulcers (48.1%). Our survey of general ophthalmologists disclosed that 274 of 560 patients with corneal ulcers (48.7%) were treated with antibiotics without any cultures being obtained. Compliance with recommended practice in the care of corneal ulcers is poor, as measured with either method. This procedure provides insights into more effective implementation of future practice guidelines.
Propionibacterium acnes isolated from explanted intraocular lens in pseudophakic bullous keratopathy.
Propionibacterium acnes is an anaerobic bacterium that has been reported to produce ocular infection or inflammation following surgery or penetrating trauma. It has been well documented as an etiologic agent associated with infections of prosthetic implants, including intraocular lenses (IOLs). P. acnes is part of the natural flora of the external eye and has biological properties that may promote, heighten, or prolong an inflammatory response. It not only resists in vitro degradation by reticuloendothelial cells, but also demonstrates adjuvant properties in vivo. In this study, we cultured the IOLs removed from patients undergoing routine penetrating keratoplasty for pseudophakic bullous keratopathy (PBK). Four of the 12 IOLs were culture positive for P. acnes as late as 36 months postimplantation. Although this does not describe a role for P. acnes in PBK, it does suggest that the organism can remain in the pseudophakic eye for an extended time.
In vivo transillumination biomicroscopy and photography of meibomian gland dysfunction. A clinical study.
Meibomian gland transillumination biomicroscopy and infrared photography were performed on 18 patients with clinically evident meibomian gland dysfunction (MGD) and dermatologic rosacea, 22 patients having MGD without evidence of dermatologic rosacea, and 15 unaffected individuals who served as controls. All patients having clinical signs of MGD demonstrated morphologic abnormalities of their meibomian glands by transilluminated biomicroscopy. Patients without dermatologic rosacea were noted to have varying degrees of gland distortion. Moreover, infrared photography documented a loss of the normal grape-like clusters of dark spots that represent the gland, suggesting a loss of glandular acini. Patients with dermatologic rosacea had more severe alterations, including marked distortion and loss of normal gland anatomy. There were no such abnormalities in clinically unaffected individuals. These data demonstrate that transilluminated biomicroscopy and infrared photography have the ability to identify a spectrum of morphologic alterations of the meibomian glands in MGD patients. The authors suggest that these techniques could be used to classify clinical MGD based upon the presence or absence of identifiable meibomian gland abnormalities.