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Biomedical subjects

Peter R Laibson

Publications and source records attributed to Peter R Laibson.

At least 19 recordsLinked to original sources
PubMed2006

Comparative study of ocular herpes simplex virus in patients with and without self-reported atopy.

PURPOSE: To compare the characteristics of ocular herpes simplex virus (HSV) in patients with and without atopy. DESIGN: Retrospective cohort comparative study. METHODS: Patients who presented at the Cornea Service, Wills Eye Hospital, between March 2003 and March 2004 who had been previously diagnosed in the same institution as having ocular HSV diagnosis or were just diagnosed as having the disease were asked to complete a study questionnaire that enabled categorization into atopic and nonatopic. In April 2005, 223 patients who agreed to be in the study had their charts reviewed, and 125 patients were excluded according to exclusion criteria: immunosuppression, follow-up less than one year, previous history of penetrating keratoplasty (PK) out of the Cornea Service, and no active HSV episode during follow-up. MAIN OUTCOME MEASURES: Incidence of all types of HSV recurrences. SECONDARY OUTCOME MEASURES: Bilaterality, visual loss, need for PK , and secondary bacterial infection in both groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS: Ninety eight patients (110 eyes) were included in the study. Atopic/nonatopic (P value): the mean follow-up was 11.6 (+/- 10.6)/8.8 years (+/- 8.4) (P = .14); the mean incidence of HSV episodes per year of follow-up was: total episodes 0.32 (+/- 0.36)/0.28 (+/- 0.33) (P = .14), infectious 0.16 (+/- 0.22)/0.10 (+/- 0.14) (P < .01), inflammatory 0.11 (+/- 0.19)/0.11 (+/- 0.19) (P < .01), and mixed 0.09 (+/- 0.20)/0.07 (+/- 0.16) (P = .06); bilateral HSV was present in 9/3 patients (P = .22); the mean loss of vision was four lines of Snellen in both groups; PK was performed in 14 of 16 eyes (P = .45); secondary bacterial infection was present in two of four eyes (P = .26). CONCLUSIONS: Atopic patients had considerably more infectious and fewer inflammatory episodes when compared with nonatopics.

Adult↗
PubMed2006

Phototherapeutic keratectomy with intraoperative mitomycin C to prevent recurrent anterior corneal pathology.

PURPOSE: To determine the safety and efficacy of the use of intraoperative mitomycin C (MMC) during phototherapeutic keratectomy (PTK) for anterior corneal disease. DESIGN: Retrospective consecutive case series. METHODS: Retrospective chart review of 13 eyes from 12 patients with various anterior corneal disorders who had phototherapeutic keratectomy with the use of intraoperative MMC from July 2001 to present. Data on healing time of epithelial defects, complications, and recurrence of disease were recorded. RESULTS: Average time to heal of the epithelial defects was three days, no patient had corneal or scleral melting, and, as of the printing of this report, no patient has had recurrence of disease in the MMC-treated area. CONCLUSIONS: MMC is safe for intraoperative use during PTK and does not appear to inhibit epithelial healing and may help prevent recurrent anterior corneal disease.

Adolescent↗
PubMed2006

Efficacy of oral antiviral prophylaxis in preventing ocular herpes simplex virus recurrences in patients with and without self-reported atopy.

PURPOSE: To compare the efficacy of oral antiviral prophylactic treatment for herpes simplex virus (HSV) recurrences in patients with and without self-reported atopy. DESIGN: Retrospective cohort comparative study. METHODS: setting: Cornea Service, Wills Eye Hospital. study population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004. From 244 patients invited, 54 patients (58 eyes) were included. One hundred and ninety patients were excluded according to exclusion criteria: no active episode during follow-up, immunosuppression, less than one year of follow-up, or previous history of penetrating keratoplasty. The Questionnaire regarding history of atopic disease, considers: presence of allergic rhinitis, asthma or atopic dermatitis, and chart review of ocular history. main outcome measures: Incidence of all types of HSV recurrences with and without antiviral prophylaxis within each group and between groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS: Atopic/nonatopic (P value): mean follow-up without prophylaxis 8.1 (+/- 8.2)/7.3 years (+/- 8.6) (P = .71); mean follow-up with prophylaxis 2.9 (+/- 2.3)/2.6 years (+/- 2.2) (P = .51); the effect of prophylaxis significantly reduced the all recurrences in both groups except in the inflammatory recurrences in the atopic group and in the mixed recurrences in both groups. Prophylaxis decreased infectious episodes by 44% in nonatopic and 76% in atopics and decreased inflammatory manifestations by 69% in the nonatopic group and 8% in the atopic group. CONCLUSION: Antiviral prophylaxis for HSV recurrences was more effective in reducing infections in atopics and less effective in reducing inflammatory episodes in atopics versus nonatopics.

2-Aminopurine↗
PubMed2006

Wound dehiscence after penetrating keratoplasty.

PURPOSE: To assess the patient characteristics, risk factors, and outcomes of penetrating keratoplasty wound dehiscence. METHODS: Retrospective chart review of 30 eyes of 29 patients with corneal grafts who underwent repair of penetrating keratoplasty wound dehiscence from January 1, 1998 to December 31, 2003, followed on the Cornea Service at Wills Eye Hospital. RESULTS: The mean time from penetrating keratoplasty to wound dehiscence was 7.5 years (range 1 week to 31 years). The mean age at time of wound dehiscence was 66 years (range 28-98 years). One eye developed wound dehiscence following suture removal, whereas the remaining 29 eyes sustained trauma-induced dehiscences. Falls were the most common mechanism of trauma, especially in the elderly population. There was a wide range of visual outcomes in the 21 patients followed for 1 year, with 4 patients maintaining best corrected visual acuity between 20/20 and 20/40 and 5 patients with light perception vision at 1 year. There were no cases of endophthalmitis. CONCLUSIONS: Patients with corneal transplants have a life-long risk for wound dehiscence. This complication may be reduced by the regular use of eye protection in all corneal transplantation patients.

Adult↗
PubMed2006

Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.

PURPOSE: To develop current treatment recommendations for dry eye disease from consensus of expert advice. METHODS: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. RESULTS: A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. CONCLUSION: Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.

Algorithms↗
PubMed2006

Risk factors for the first episode of corneal graft rejection in keratoconus.

PURPOSE: To evaluate the relationship between topical corticosteroids and other variables and the risk for rejection after penetrating keratoplasty for keratoconus. METHODS: The records of all keratoconus patients who, after their first penetrating keratoplasty in that eye, experienced a first episode of corneal graft rejection during a specific 3-year period were retrospectively reviewed in a case-control fashion. Twenty-three cases were identified, and they were matched with 3 controls each, for a total of 69 controls and 92 total patients. Multiple variables including steroid potency, recent steroid tapering, and length of time on the current level of steroids were analyzed to see whether there were any significant relationships between postoperative changes in steroid management and rejection. In addition, other variables such as graft size, suture technique, recent suture removal, suture status at the time of the rejection episode, and prior grafting in the fellow eye were examined to determine if any of these factors were associated with a higher risk of graft rejection. RESULTS: Most of the proposed risk factors, including steroid dose and tapering, differing suturing techniques, loose and/or broken sutures at the time of rejection, percentage of sutures remaining at the time of rejection, and prior grafting in the fellow eye, did not correlate with the risk of rejection. Only graft size had a correlation, with host trephination size > or = 8.25 mm having a nearly sixfold increased risk of rejection (P = 0.015). Most patients (70%) were diagnosed with rejection at a scheduled office visit rather than at an emergency visit, and correspondingly, nearly one half (43%) had no symptoms when rejection was identified. There was no significant difference in final best-corrected visual acuities between the cases and controls, and 91% of the corneas that underwent rejection did not progress to graft failure, remaining centrally clear at most recent follow-up. CONCLUSION: In this study, the most important risk factor for rejection after corneal transplantation for keratoconus was the size of the graft. Physician detection of rejection is paramount, because a graft rejection episode is more often diagnosed at a scheduled office visit than at an emergency visit. Fortunately, progression to graft failure can usually be prevented if treatment is started promptly and intensively.

Adolescent↗
PubMed2005

Ocular copper deposition associated with monoclonal gammopathy of undetermined significance: case report.

To report a case of ocular copper deposition in both eyes at the level of Descemet's membrane associated with a monoclonal gammopathy of undetermined significance (MGUS). A 49-year-old white woman had golden-brown metallic dust-like deposits on Descemet's membrane of both eyes. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin and a normal level of total protein. Serum protein electrophoresis demonstrated a single peak (M-spike) in the gamma region (M-protein in serum = 11 g/l). Flow cytometric analysis of the marrow aspirate identified a monoclonal plasma cell population that represents approximately 2% of the total marrow cells consistent with the diagnosis of monoclonal gammopathy of undetermined significance. Copper deposits at the level of Descemet's membrane may be a finding in a patient with monoclonal gammopathy of undetermined significance.

Blood Protein Electrophoresis↗
PubMed2005

Blepharokeratoconjunctivitis in children.

OBJECTIVE: To evaluate the incidence, history, symptoms, clinical signs, and treatment outcomes of blepharokeratoconjunctivitis in a pediatric population at a tertiary cornea practice. METHODS: In a retrospective case series, we reviewed the medical records of all new pediatric patients from January 1, 1997, through December 31, 2002, noting the reason for referral and subsequent diagnosis. We further noted the history, clinical characteristics, and treatment outcomes of the patients with blepharokeratoconjunctivitis. RESULTS: Review of 195 medical records revealed that blepharokeratoconjunctivitis was the most common single diagnosis at consultation, accounting for 15% of referrals. Of the 29 cases identified, there were 16 girls (55%) and 13 boys (45%). The mean age at consultation was 6(1/2) years (age range, 2-12 years). On initial ophthalmologic examination, 11 (38%) of 29 patients were taking full-strength steroids and 4 patients (14%) were taking oral erythromycin. Oral therapy, in the form of erythromycin (n = 21) and doxycycline (n = 1), was prescribed to most patients (22/29 [76%]). Therapy with topical steroids was tapered at the initial visit in all patients. Follow-up was available for 15 of 29 patients, with a mean follow-up of 5.4 months (range, 2-25 months). The condition of all patients showed clinical improvement. Recurrences were noted in 6 (40%) or 15 patients; all were successfully managed with low-potency steroid therapy. CONCLUSIONS: Blepharokeratoconjunctivitis is a common reason for cornea referral in children. Oral erythromycin therapy is an effective treatment with a steroid-sparing effect. Recurrences are common and may be successfully managed with low-potency steroid therapy.

Administration, Oral↗
PubMed2005

Diamond burr treatment of poor vision from anterior basement membrane dystrophy.

PURPOSE: To determine the outcome of patients with decreased vision associated with anterior basement membrane dystrophy (ABMD) managed with diamond burr (DB) polishing. DESIGN: Retrospective nonrandomized case series. METHODS: A chart review of all patients with ABMD who underwent epithelial debridement and DB polishing to treat visual disturbances resulting from corneal epithelial irregularity was performed. RESULTS: Ten patients' charts were analyzed. The mean age was 57.4 years. DB treatment was performed in 13 eyes. The average preoperative BCVA was 0.40 (20/50). At the last follow-up (mean 21.8 months) the average visual acuity of these patients was 0.88 (20/23), significantly better than pre-operative readings (P < .001). There was no recurrence of dystrophic changes in the treatment zone seen with the slit lamp during the follow-up period. CONCLUSIONS: In this study, DB polishing was shown to be an effective and safe treatment for decreased vision caused by to ABMD over an average follow-up of 21.8 months.

Basement Membrane↗
PubMed2005

Trends in contact lens-related corneal ulcers.

PURPOSE: To analyze the frequency of contact lens-related corneal ulcers and its relationship to the type of contact lens and care. METHODS: Charts of 376 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from July 1, 1999 to December 31, 2002 were retrospectively reviewed. All patients with contact lens-related corneal ulcers were identified, and information regarding cultures, lens type, usage, and cleaning was obtained. RESULTS: Of the 376 cases, 113 (30%) were related to contact lens use. The contact lens history was recorded in 83 of 113 cases (73%). The soft daily wear frequent replacement lens was the most common lens type associated with corneal ulcers (n = 36/83, 43%). Corneal cultures were performed in 71 of 113 cases (63%) and were positive in 51 of 71 cases (72%). The most common microorganism involved was Pseudomonas aeruginosa (n = 17/51, 33%). The frequency of contact lens-related corneal ulcers from 1999-2002 (n = 113/376, 30%) was significantly greater than that from years 1996-1999 (n = 37/299, 12%) at our institution (P < 0.05). CONCLUSION: There was a significant increase in the number of contact lens-related corneal ulcers between 1999 and 2002 compared with previous years (P < 0.05). The contact lens type most frequently associated with corneal ulcers was the soft daily-wear frequent-replacement contact lens (43%). Contact lens-related corneal ulcers continue to be a serious problem despite a shift in the market to the use of frequent-replacement daily-wear contact lenses and advances in contact lens technology.

Adolescent↗
PubMed2005

Management of pellucid marginal corneal degeneration.

PURPOSE: This study was designed to determine how patients with pellucid marginal corneal degeneration (PMCD) are managed in a tertiary corneal practice. METHODS: A retrospective chart review of 45 patients with PMCD from a corneal referral practice was performed. Information collected from the medical records included demographic data, best-corrected visual acuity, videokeratography, contact lens use, and surgical procedures. RESULTS: Forty-five patients (85 eyes; 30 males, 15 females) with PMCD were included in this study. They were followed-up for an average of 4.7 years (standard deviation (SD), +/-8.7). Seventy-five eyes (88.2%) were managed nonsurgically with spectacles in 31 eyes (36.4%) or contact lenses in 44 eyes (51.8%). Contact lens management was initially attempted in 51 eyes (60%); however, 7 eyes failed contact lenses. Visual acuity of 0.5 (20/40) or better was noted in 34 eyes (75.5%) after contact lens fit. Ten eyes (11.8%) underwent penetrating keratoplasty with an average postoperative follow-up of 9 years (SD, +/-8.2; 1.5-20.5). Clear grafts were present in all 10 eyes at the end of the study (average, 9 years; SD, +/-82). CONCLUSIONS: Nonsurgical management of PMCD continues to play a predominant role in the management of this disorder. Poor best-corrected visual acuity at presentation of 0.2 (20/100) or worse and long follow-up (8 years or more) were significantly associated with surgery.

Adult↗
PubMed2005

Serratia corneal ulcers: a retrospective clinical study.

PURPOSE: To study the clinical and microbiological profile of Serratia corneal ulcers at the Cornea Service of the Wills Eye Hospital. METHODS: This was a retrospective, observational case series. The clinical records of patients with Serratia marcescens corneal ulcers seen at the Cornea Service of the Wills Eye Hospital between January 1, 1998 and December 31, 2002 were reviewed. RESULTS: Twenty-four cases of Serratia keratitis were identified in 21 patients. Two patients (9.5%) had recurrent keratitis, 1 of which recurred twice. Both had corneal graft edema and were on topical steroids and antiglaucoma drops. The Serratia infection in 15 patients (71%) was associated with an abnormal corneal surface. Twelve of these patients (57%) had the ulcer in a corneal graft, 4 (19%) of which were associated with suture infiltrates. Fifteen patients (71%) were on topical medications-15 used corticosteroids and 13 used antiglaucoma drops. Six patients (29%) were contact lens wearers-1 had a concomitant suture infiltrate associated with a corneal graft, and 5 had otherwise healthy corneas. One isolate lacked in vitro susceptibility to ciprofloxacin and ofloxacin but was susceptible to gentamicin and tobramycin. Nineteen patients had a favorable response to medical therapy. Two patients with poor outcome had large corneal ulcers with severe necrosis and thinning associated with delay in treatment. CONCLUSIONS: Serratia marcescens keratitis is associated with the presence of an abnormal corneal surface, use of topical medications, and contact lens wear. Prompt medical therapy results in a good clinical response in the majority of cases.

Adolescent↗
PubMed2004

Novel mutations in the carbohydrate sulfotransferase gene (CHST6) in American patients with macular corneal dystrophy.

PURPOSE: To further characterize the mutations within the CHST6 gene responsible for causing macular corneal dystrophy in a cohort of affected patients from the United States. DESIGN: Experimental study. METHODS: Genomic DNA was extracted from buccal epithelium of 16 affected patients (14 families), 17 unaffected relatives, and 127 controls, followed by polymerase chain reaction amplification and direct sequencing of the CHST6 coding region. Subtyping of affected patients into type I and II macular corneal dystrophy was performed by measuring antigenic keratan sulfate (AgKS) serum levels. Haplotype analysis was performed in families that demonstrated common mutations. RESULTS: CHST6 coding region analysis in 10 patients identified as having type I macular corneal dystrophy revealed 10 sequence changes: eight missense mutations, four of which are novel (Met104Val, Tyr110Cys, Gln122Pro, and Leu276Pro) and four of which have been reported previously (Ser51Leu, Pro72Ser, Cys102Gly, and Leu200Arg); one novel homozygous nonsense mutation in two patients from a single family (c. 1683C>T, Gln331X); and one frameshift mutation in a heterozygous state in a single patient (c.1744_1751dupGTGCGCTG). Mutation analysis in the four patients identified as having type II macular corneal dystrophy (serum samples were not obtained from two affected patients) revealed three patients heterozygous for either the c.923G>C, c.969C>A, or c.1519T>C sequence changes. The fourth patient was compound heterozygous for c.969C>A and c.1291T>G. None of these changes was observed in 127 control individuals. Haplotype analysis using microsatellite markers flanking the CHST6 gene did not reveal a common founder for the Leu200Arg (1291T>G) missense mutation, present in five families, identifying this position as a mutation hot-spot. CONCLUSIONS: A variety of previously unreported mutations in the coding region of the CHST6 gene are associated with type I macular corneal dystrophy in a cohort of patients from the United States.

Adult↗
PubMed2004

New onset of herpes simplex virus epithelial keratitis after penetrating keratoplasty.

PURPOSE: To report a series of patients with no previous history of herpes simplex virus (HSV) infection who had new onset of herpetic keratitis after penetrating keratoplasty (PK). DESIGN: Noncontrolled, retrospective case series. METHODS: We included in the study the patients who had new onset of herpetic keratitis after penetrating keratoplasty for corneal diseases unrelated to HSV infection who were seen at the Cornea Service at Wills Eye Hospital (Philadelphia, Pennsylvania) from January 1996 to December 2002. The diagnosis of HSV epithelial keratitis was based on clinical characteristics of either a classic herpetic dendrite, a geographic ulcer, or a nonhealing epithelial defect that responded only to antiviral therapy. RESULTS: Fourteen patients were included in the study. Eight of these (57%) had presented with a geographic ulcer whereas six patients (43%) had a classic dendrite. The most common primary corneal disease that led to PK was pseudophakic bullous keratopathy (36%), followed by keratoconus (29%), Fuchs dystrophy (21%), and corneal scar unrelated to HSV (14%). CONCLUSIONS: The ophthalmologist should be aware of the possibility of herpetic keratitis in eyes after PK, even in patients with no previous history of HSV infection.

Acyclovir↗
PubMed2004

EDTA chelation for calcific band keratopathy: results and long-term follow-up.

PURPOSE: To determine the etiologies and management of calcific band keratopathy (CBK), and assess the results and long-term follow-up after ethylenediamine-tetraacetic acid (EDTA) chelation. DESIGN: Retrospective interventional case series. METHODS: Two hundred thirty patients with clinically significant CBK were included from January 1996 to July 2002. Among these, 54 patients (65 eyes) underwent EDTA chelation. Outcome measures included symptomatic relief, visual improvement, and recurrences. The improvement or worsening of the number of lines of Snellen best-corrected visual acuity was determined at 1 month and at last follow-up visit. RESULTS: The most common causes of CBK were chronic corneal edema in 80 eyes (28%) and idiopathic in 74 eyes (25.9%). The mean follow-up time after EDTA chelation was 36.6 months (range, 1 month to 29.6 years). Forty-four of 45 patients (98%) reported partial or complete symptomatic relief. Seventeen eyes (33.3%) improved 2 or more lines at 1 month and 18 eyes (35.2%) at last follow-up visit (P =.0001). In patients with an initial visual acuity between 20/50 and 20/400, 15 eyes (47%) improved 2 or more lines at 1 month and 16 eyes (50%) at last follow-up visit. Ten of 56 eyes (17.8%) had a recurrence at a mean time of 17.7 years (range, 1 month to 26 years). The highest number of recurrences was in three of five eyes with uveitis (60%; P =.03). CONCLUSION: Chelation with EDTA is an effective treatment of CBK. Visual acuity improves most in eyes with acuity between 20/50 and 20/400. This treatment can be used as the initial surgical intervention after conservative measures fail.

Adolescent↗
PubMed2004

Complications associated with anterior basement membrane dystrophy after laser in situ keratomileusis.

PURPOSE: To evaluate the complications associated with anterior basement membrane dystrophy (ABMD) after laser in situ keratomileusis (LASIK). SETTING: Cornea Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. METHODS: In this noncontrolled retrospective case series, the medical records of all patients with LASIK complications seen in the Cornea Service at Wills Eye Hospital from January 1, 1998, to December 31, 2002, were reviewed. All patients who presented with ABMD changes after LASIK were included in the study. Patients with a history of trauma before or after surgery were excluded. RESULTS: Thirty-five eyes of 18 patients were included. The mean age was 46.2 years. Thirteen eyes (37.1%) had a flap-lift procedure to remove epithelial ingrowth or for an enhancement. The most common reason for the visit was visual complaints, which were seen in 77.8% of patients. Seven patients (38.9%) had visual complaints alone; 27.8% had visual complaints associated with recurrent erosions and 11.1%, with dry eyes. Four patients (22.2%) had recurrent corneal erosions with no visual complaints. On examination, the most common finding was negative staining with fluorescein dye within the LASIK flap, which was seen in all patients. In addition to the ABMD changes, 25.7% had some degree of epithelial ingrowth and 45.7%, irregular astigmatism. CONCLUSIONS: Anterior basement membrane dystrophy changes post LASIK were associated with visual complaints and/or recurrent erosions. Patients should be carefully screened for ABMD. Those who have ABMD signs or symptoms may not be ideal candidates for LASIK.

Adult↗
PubMed2004

Thygeson's superficial punctate keratitis: ten years' experience.

PURPOSE: To evaluate the presentation, treatment, and disease course of Thygeson's superficial punctate keratitis. DESIGN: Observational case series. PARTICIPANTS: Forty patients, diagnosed and managed with Thygeson's superficial punctate keratitis between January 1, 1992, and December 31, 2001, on the Cornea Service at Wills Eye Hospital. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Patient demographics, symptoms, visual acuity, ophthalmic examination, management, duration of disease, and length of follow-up. RESULTS: At the time of presentation, the mean patient age was 28.7 years. The most common presenting symptoms included photophobia, blurred vision, and irritation. Thirty of 38 patients without a history of decreased vision (78.9%) initially were seen with visual acuities in both eyes of 20/30 or better. The 8 (21.1%) remaining patients all had visual acuities between 20/40 and 20/50; improvement in vision with treatment was noted in all 3 observed at our institution. Six patients (16%) had unilateral disease, whereas another 2 patients had bilateral involvement develop after unilateral presentation. Thirty-nine patients (97.5%) were treated with topical steroids at some point in their disease course. The patient not managed with steroids was only seen once and was managed with artificial tears for mild symptoms. In addition to steroids, a patient was treated for recurrent episodes with extended-wear contact lens, and another patient was started on topical cyclosporine because of an inability to be tapered off topical steroids. The average duration of disease in the 15 patients who were observed for more than a single year was 11.1 years. CONCLUSIONS: Thygeson's superficial punctate keratitis is a potentially chronic condition, which might affect people of all ages for years to decades. Corticosteroids are the mainstay of treatment, with extended-wear contact lens and topical cyclosporine reserved as secondary agents.

Adolescent↗