Biomedical subjects
Publications and source records attributed to M S Jenkins.
Fifty-seven percent of patients scheduled for excision of chalazia over 19 years of age and 64% of patients over the age of 29 were found to have rosacea. This compares to an incidence in our control group of 12% and 13%, respectively. Rosacea was almost twice as common in patients with recurrent chalazia as in those with only one occurrence.
Ocular rosacea was diagnosed in 49 patients. The most common signs and symptoms were foreign body sensation, burning, superficial punctate erosions, chalazia, and belpharitis. Less common but dangerous to the vision was corneal thinning, vascularization, and infiltrates. Three new associated symptoms were found. These were mapdot subepithelial opacities, recurrent erosions, and moderately severe foreign body sensation, pain or burning with minimal associated signs. Of the 49 patients, 37 were treated with 250 mg of oral tetracycline four times a day, which resulted in improvement in almost all patients from four to 17 days after initiation of therapy. Most of the patients have been able to taper, or taper and stop therapy without recurrence of their symptoms. Those patients with foreign body sensation, burning, and pain required the most prolonged therapy in order to taper or stop treatment with tetracycline.
Seven patients with ocular cicatricial pemphigoid displayed acute inflammatory activity that could not be attributed to secondary bacterial infections, trichiasis, or lagophthalmos secondary to symblepharon. This acute inflammatory activity was manifested either as a localized conjunctival mound that was ulcerated and intensely hyperemic or as diffuse and intense conjunctival hyperemia and chemosis. Acute disease activity developed shortly after conjunctival biopsy in three patients and appeared spontaneously in the other four patients. Conjunctival biopsy specmens disclosed a heavy infiltrate of polymorphonuclear leucocytes within and beneath the conjunctival epithelium in addition to the chronic inflammatory cells typically found in this condition. The acute manifestations of ocular cicatricial pemphigoid cause rapid shrinkage and scarring of the conjunctiva. Systemic corticosteroids suppressed the acute disease activity and prevented additional scarring in all five patients treated.
Because the significance of donor age in penetrating keratoplasty remains controversial, a study was undertaken to analyze the results of keratoplastics performed with older (greater than 70) and younger (less than 55) donor corneas. Thirty-seven eyes which received older donor corneas were divided into 4 diagnostic categories and were compared with 37 eyes having the same diagnosis which received younger donor corneas. The average follow-up for both groups was 24 months. There was no significant difference between the number of clear grafts in each group. It would appear that older donor corneas can withstand the surgical trauma of transplantation and remain clear for a relatively significant period.
Controlled aspiration of aqueous before excising the recipient cornea resulted in maintenance of an intact vitreous face during aphakic penetrating corneal transplants in eight of 11 eyes. Vitreous corneal contact or subsequent graft opacification has not occurred in the study group during the observation period.
A 63-year-old man and his 24-year-old son developed recurrences of granular dystrophy in their three corneal grafts within three years after surgery. We regrafted one of the son's corneas. Histologic examination of the corneal button removed during surgery showed an avascular connective tissue layer with the histochemical characteristics of granular dystrophy interposed between the epithelium and Bowman's layer. In the remaining two corneal grafts, we fixed the globe with corneal forceps and removed the opaque dystrophic layer by separating it from the cornea with a spatula. Postoperatively, all three corneal grafts were once more transparent.
A blink beeper was devised to remind patients with incomplete or infrequent blinking to blink completely and at normal intervals; the beeper worked by transmitting an audible tone every ten seconds through an earphone. In three postkeratoplasty patients, this simplistic approach not only resulted in a complete blink at regular intervals, but seemed to condition this response to continue when the blink beeper was taken away; this resulted in healing of large chronic epithelial defects. The blink beeper has also proved valuable in patients with either punctate epithelial erosions or those who wore hard contact lenses unsuccessfully because of infrequent or incomplete blinking.