Purpose: To assess the direct and indirect costs of infectious conjunctivitis and quantify medica... more Purpose: To assess the direct and indirect costs of infectious conjunctivitis and quantify medical costs due to conjunctivitis transmission in families. Methods: In this retrospective claims analysis from the OptumHealth Care Solutions, Inc. database (1998-2016), beneficiaries with or without at least one diagnosis of infectious conjunctivitis were identified. Direct and indirect costs (in 2016 US$) during the 60 days post conjunctivitis diagnosis (or imputed date for controls) were compared using cost differences in linear regressions. For transmission cost analysis, the total cost of each conjunctivitis episode was the sum of the primary episode (seed patient) and the secondary episode (infected family members) costs. A generalized estimating equation model adjusted for seed patient characteristics was used to assess the impact of number and rate of transmissions on episode cost. Results: Health care resource utilization and direct costs were significantly higher for patients with conjunctivitis (n=1,002,188) versus controls (n=4,877,210): 1.67 all-cause visits per person per month (PPPM) versus 0.
Journal of Ocular Pharmacology and Therapeutics, 2019
The cornea and its adnexa pose a unique situation of a tightly defined set of requirements for it... more The cornea and its adnexa pose a unique situation of a tightly defined set of requirements for its function. This includes: transparency, perfect built to obtain appropriate refractive power, protective barrier from microbial invaders. Moreso, the cornea also endures extreme external physical conditions (temperature, high and low humidity, winds and alike). All these functions are maintained while preserving a constant state of homogenous wetting. Toward that end the cornea is equipped with an elaborated network of sensory neural network. While enabling the blinking reflex and maintaining the physiological steady state of wetting, this neural network also makes the cornea prone to the discomfort that with or without associated changes seen on medical examination. ISOPT Clinical 2018 discussion touched upon this hypercomplex situation, addressing the role of inflammation and its resulting discomfort in dry eye conditions. The discussion also engulfed the emerging neuropathic pain syndrome that is recently gaining more attention. Another related topic was the utilization of autologous serum tears and its ability to provide amelioration to desperate patients. Finally, the panel discussed the issue of treating corneal infection, including when and how to utilize steroids in the course of therapy. We assume the reader will find interest in this discussion that directly addresses issues seen day in and day out in our busy clinics.
Chlamydia has been found to be the cause of a high percentage of cases of neonatal and chronic co... more Chlamydia has been found to be the cause of a high percentage of cases of neonatal and chronic conjunctivitis in an inner-city population. To assess the etiology and epidemiology of acute conjunctivitis in this population, conjunctival scrapings were sampled from 45 patients presenting to an ocular emergency room; and replicate chlamydia!, viral, and bacterial cultures and cytology tests were done. No cases of chlamydia! conjunctivitis were diagnosed, although a viral etiology was established in 36% of the cases and a bacterial etiology in 40%. Twenty-four percent of the cases were not diagnosed. The authors recommend limiting the initial laboratory workup of patients with acute conjunctivitis to obtaining conjunctival smears for Gram and Giemsa staining. Chlamydia! direct immunofluorescent monoclonal antibody (DFA) should be done if the patient is sexually active. Hyperacute conjunctivitis or acute conjunctivitis refractory to treatment mandates a more complete set of laboratory tests.
Advances in surgical techniques have made vitreoretinal and sclerochorio-retinal biopsies part of... more Advances in surgical techniques have made vitreoretinal and sclerochorio-retinal biopsies part of the available diagnostic armamentarium of the ophthalmologist. Special studies can be performed on tissue obtain~d in this way in order to provide a specific etiologic diagnosis of wus as~oc1ated pathology. The advantages and disadvantages of 1mmu~~pat~olog1c and ultrastructural methods, tissue culture, and nucleic acid hybndizat1on techniques for viral identification are compared and discussed.
Eyes from 47 autopsy cases of multiple sclerosis were studied pathologically. Lymphocytic or gran... more Eyes from 47 autopsy cases of multiple sclerosis were studied pathologically. Lymphocytic or granulomatous retinal periphlebitis was found in four cases (seven eyes); focal lymphocytic or granulomatous retinitis was present in three cases (five eyes). These findings were correlated with optic nerve changes (periphlebitis, neuritis, leptomeningitis, and atrophy), retinal venous sclerosis, uveitis, central nervous system involvement, clinical activity of disease at death, and with ultrastructural and immunopathological retinal findings.
The authors tested their hypothesis that Epstein-Barr virus (EBV) infection is a risk factor for ... more The authors tested their hypothesis that Epstein-Barr virus (EBV) infection is a risk factor for aqueous tear deficiency (ATD) by evaluating 38 ATD patients and 17 controls for serologic evidence of EBV infection. Aqueous tear deficiency was graded clinically as mild or severe. A linear trend toward elevated EBV capsid (P less than 0.05) and early antigen (P less than 0.001) titers was noted from control to severe ATD patients. Rubella and cytomegalovirus antibody titers were poorly correlated with EBV titers, suggesting that the elevated EBV antibodies in ATD patients were not due to nonspecific polyclonal B-cell activation. Epstein-Barr virus antigens were detected in two of six lacrimal gland biopsies from severe ATD patients with Sjögren's syndrome, but in none of the control glands. Aqueous tear deficiency patients were evaluated for immunologic dysfunction associated with EBV infection. Linear trends of elevated serum IgG (P less than 0.05), autoantibody and immune complex positivity (P less than 0.05), and reduced natural killer cell cytotoxicity (P less than 0.05) were found from controls to severe ATD patients. Furthermore, reduced T-helper lymphocyte counts (P less than 0.06) and an increased percentage of HLA-DR+ CD8 lymphocytes (P less than 0.05) were observed in severe ATD patients compared with the mild and control groups. A multivariate analysis of the data showed a significant correlation between severe ATD and elevated EBV early antigen titers, Sjögren's syndrome, and an increased percentage of HLA-DR+ CD8 lymphocytes. The authors' findings suggest that EBV infection may be a risk factor for development of ATD in a subset of ATD patients with greater disease severity, Sjögren's syndrome, and immunologic dysfunction.
Despite the presence of gentamicin in corneal storage medium, postoperative endophthalmitis may r... more Despite the presence of gentamicin in corneal storage medium, postoperative endophthalmitis may result from the transmission of bacteria via contaminated corneal tissue. The authors evaluated the antimicrobial activity and endothelial toxicity of vancomycin (10 micrograms/ml) in combination with gentamicin (100 micrograms/ml) in DexSol corneal storage medium. When tested against a panel of common ocular pathogens, vancomycin combined with gentamicin proved more effective than gentamicin alone for inhibiting the growth of Streptococcus pneumoniae at 4 degrees C after 1- and 5-day incubation periods. Ultrastructural and morphometric analyses of paired human corneas stored for 5 days in either DexSol supplemented with vancomycin combined with gentamicin or DexSol with gentamicin alone did not show a significant difference in endothelial toxicity between the two groups. These results suggest that vancomycin combined with gentamicin has superior antimicrobial effect and similar corneal toxicity when compared with media supplemented with gentamicin alone.
To compare various methods of estimating corneal power for intraocular lens (IOL) calculation in ... more To compare various methods of estimating corneal power for intraocular lens (IOL) calculation in patients with irregular corneal astigmatism.
To evaluate a commercially available neural network program for calculation of photorefractive ke... more To evaluate a commercially available neural network program for calculation of photorefractive keratectomy treatment nomograms. University referral refractive surgery clinic. PRK/LASIK Brain, a commercial neural network computer program, was trained using the demographics, preoperative clinical data, surgical parameters, and 1 year postoperative clinical data of 44 patients treated with a Summit Technology excimer laser using a 5.0 mm optical zone. The neural-network derived nomogram was compared with the standard treatment nomogram for each patient. The relative contribution of age, sex, keratometry, and intraocular pressure (IOP) to the predicted nomograms was also assessed. Nomograms produced by the neural network were qualitatively similar to the standard nomogram. The sequence of data entry during training affected the network's predictions. Entry ordered by outcome (as opposed to entry by chronological order) yielded a nomogram that was more consistent with the standard nomogram. However, both outcome- and chronologically ordered network-derived nomograms diverged from the standard nomogram in individual patients, including a subset for whom use of the standard nomogram yielded desired refractive results (within 0.25 diopter of emmetropia). Further analysis of the neural-network-derived nomograms revealed marked sensitivity to sex, age, keratometry readings, and IOP. Neural networks offer a potential means of individualizing treatment nomograms, to account for patient demographics, preoperative examination, surgeon style, and equipment bias. However, a data set of 44 patients was not sufficient to train the PRK/LASIK Brain network to accurately predict treatment parameters in individual cases in the training set. A larger training set or a different learning algorithm may be required to improve the neural network's performance.
Purpose of review This study provides an overview of the three types of corneal inlays now in use... more Purpose of review This study provides an overview of the three types of corneal inlays now in use for the correction of presbyopia and reviews recently published evidence of the inlays' safety and efficacy. Recent findings Results for corneal reshaping and refractive inlays are promising, but very limited. Small-aperture inlays are already in widespread use and have been shown to improve uncorrected near and intermediate vision without a significant loss in distance acuity or an unacceptable increase in visual symptoms. Complications have been minimal, but the inlays may be removed if necessary. They do not prevent visualization or imaging of the retina and may be retained during subsequent cataract surgery.
Purpose: To apply an objective method to topographically determine functional optical zone (TFOZ)... more Purpose: To apply an objective method to topographically determine functional optical zone (TFOZ) dimensions in order to compare ablation centration, and refractive outcomes, following myopic laser in situ keratomileusis (LASIK) with and without automated, infrared (IR) pupil tracking. Methods: Thirty-seven eyes that underwent LASIK using the Technolas 217A with active IR pupil tracking (IT) were retrospectively compared to 37 matched eyes treated with manual tracking (MT). Visual acuity, refractive error, and corneal topography were measured pre-and postoperatively. Videokeratography and specialized software were used to assess centration. Results: The IR-tracked eyes had statistically better mean postoperative spherical equivalent (IT +0.02 6 0.38 D; MT 20.21 6 0.48 D; P = 0.03) and uncorrected distance visual acuity (IT +0.07 6 0.08 logMAR; MT +0.02 6 0.09 logMAR; P = 0.02). One versus three eyes lost 1 line of best spectacle-corrected visual acuity in the IT and MT groups, respectively. While similar mean displacement of the TFOZ center from the pupil center was found in the MT (0.54 6 0.27 mm) and IT (0.51 6 0.21 mm) groups (P = 0.77), 4 MT eyes (10.8%) were topographically decentered .1.0 mm, whereas the ablation center was within 1 mm of the pupil center for all IT eyes. Conclusions: Custom software provided a novel, objective method to determine topographic functional optical zone dimensions, then mathematically calculate the center of the optical zone relative to the pupil center and measure the vector of decentration. Use of IR pupil tracking improved uncorrected visual acuity, produced more predictive refractive outcomes, and fewer large centration outliers. This may reflect increased fidelity of spot placement to the attempted ablation profile.
Recent advances in immunologic technology are making the rapid diagnosis of viral infections of t... more Recent advances in immunologic technology are making the rapid diagnosis of viral infections of the ocular surface possible. The prompt use of these diagnostic techniques can directly influence therapeutic decision making, such as the use of antiviral drugs and steroids. In this article, existing methods of sampling the ocular surface are discussed, and the yield of infectious virus and viral antigens from various sites on the ocular surface is reviewed. The immunologic principles underlying radio-immunoassays, enzyme immunoassays, and a variety of immunocytologic methods are outlined, along with the advantages and disadvantages of each immunologic technique. In addition to reviewing the methods for detecting viral antigens on the ocular surface, the value of assessing antiviral antibodies in the tear film, as well as prospects for future diagnostic techniques, are discussed.
Debridement may be a useful adjunct to antiviral therapy for the treatment of herpes simplex dend... more Debridement may be a useful adjunct to antiviral therapy for the treatment of herpes simplex dendritic keratitis. Impression debridement may be superior to presently accepted forms of mechanical debridement including blunt spatula and minimal wiping since it avoids damage to the basement membrane, avoids spread of infectious viral particles, and allows the immediate initiation of antiviral therapy. Impression debridement is performed by application of cellulose acetate filter paper to the dendrite. Infected cells adhere to the filter paper and are lifted off while uninfected epithelial cells remain on the corneal surface. Patient discomfort is minimal avoiding the need for patching. Impression debridement was applied to dendritic lesions produced in six BALB/c mice and to the corneas of four normal BALB/c mice. Immunoperoxidase histochemical staining techniques readily demonstrated herpes simplex virus (HSV) antigen-bearing cells adherent to the filter paper in all six infected mice. The four controls showed no staining. Five patients with herpes simplex dendritic keratitis were treated with impression debridement combined with trifluorothymidine therapy. Complete epithelial healing occurred in all five cases within four days without observed recurrences.
Purpose: To assess the direct and indirect costs of infectious conjunctivitis and quantify medica... more Purpose: To assess the direct and indirect costs of infectious conjunctivitis and quantify medical costs due to conjunctivitis transmission in families. Methods: In this retrospective claims analysis from the OptumHealth Care Solutions, Inc. database (1998-2016), beneficiaries with or without at least one diagnosis of infectious conjunctivitis were identified. Direct and indirect costs (in 2016 US$) during the 60 days post conjunctivitis diagnosis (or imputed date for controls) were compared using cost differences in linear regressions. For transmission cost analysis, the total cost of each conjunctivitis episode was the sum of the primary episode (seed patient) and the secondary episode (infected family members) costs. A generalized estimating equation model adjusted for seed patient characteristics was used to assess the impact of number and rate of transmissions on episode cost. Results: Health care resource utilization and direct costs were significantly higher for patients with conjunctivitis (n=1,002,188) versus controls (n=4,877,210): 1.67 all-cause visits per person per month (PPPM) versus 0.
Journal of Ocular Pharmacology and Therapeutics, 2019
The cornea and its adnexa pose a unique situation of a tightly defined set of requirements for it... more The cornea and its adnexa pose a unique situation of a tightly defined set of requirements for its function. This includes: transparency, perfect built to obtain appropriate refractive power, protective barrier from microbial invaders. Moreso, the cornea also endures extreme external physical conditions (temperature, high and low humidity, winds and alike). All these functions are maintained while preserving a constant state of homogenous wetting. Toward that end the cornea is equipped with an elaborated network of sensory neural network. While enabling the blinking reflex and maintaining the physiological steady state of wetting, this neural network also makes the cornea prone to the discomfort that with or without associated changes seen on medical examination. ISOPT Clinical 2018 discussion touched upon this hypercomplex situation, addressing the role of inflammation and its resulting discomfort in dry eye conditions. The discussion also engulfed the emerging neuropathic pain syndrome that is recently gaining more attention. Another related topic was the utilization of autologous serum tears and its ability to provide amelioration to desperate patients. Finally, the panel discussed the issue of treating corneal infection, including when and how to utilize steroids in the course of therapy. We assume the reader will find interest in this discussion that directly addresses issues seen day in and day out in our busy clinics.
Chlamydia has been found to be the cause of a high percentage of cases of neonatal and chronic co... more Chlamydia has been found to be the cause of a high percentage of cases of neonatal and chronic conjunctivitis in an inner-city population. To assess the etiology and epidemiology of acute conjunctivitis in this population, conjunctival scrapings were sampled from 45 patients presenting to an ocular emergency room; and replicate chlamydia!, viral, and bacterial cultures and cytology tests were done. No cases of chlamydia! conjunctivitis were diagnosed, although a viral etiology was established in 36% of the cases and a bacterial etiology in 40%. Twenty-four percent of the cases were not diagnosed. The authors recommend limiting the initial laboratory workup of patients with acute conjunctivitis to obtaining conjunctival smears for Gram and Giemsa staining. Chlamydia! direct immunofluorescent monoclonal antibody (DFA) should be done if the patient is sexually active. Hyperacute conjunctivitis or acute conjunctivitis refractory to treatment mandates a more complete set of laboratory tests.
Advances in surgical techniques have made vitreoretinal and sclerochorio-retinal biopsies part of... more Advances in surgical techniques have made vitreoretinal and sclerochorio-retinal biopsies part of the available diagnostic armamentarium of the ophthalmologist. Special studies can be performed on tissue obtain~d in this way in order to provide a specific etiologic diagnosis of wus as~oc1ated pathology. The advantages and disadvantages of 1mmu~~pat~olog1c and ultrastructural methods, tissue culture, and nucleic acid hybndizat1on techniques for viral identification are compared and discussed.
Eyes from 47 autopsy cases of multiple sclerosis were studied pathologically. Lymphocytic or gran... more Eyes from 47 autopsy cases of multiple sclerosis were studied pathologically. Lymphocytic or granulomatous retinal periphlebitis was found in four cases (seven eyes); focal lymphocytic or granulomatous retinitis was present in three cases (five eyes). These findings were correlated with optic nerve changes (periphlebitis, neuritis, leptomeningitis, and atrophy), retinal venous sclerosis, uveitis, central nervous system involvement, clinical activity of disease at death, and with ultrastructural and immunopathological retinal findings.
The authors tested their hypothesis that Epstein-Barr virus (EBV) infection is a risk factor for ... more The authors tested their hypothesis that Epstein-Barr virus (EBV) infection is a risk factor for aqueous tear deficiency (ATD) by evaluating 38 ATD patients and 17 controls for serologic evidence of EBV infection. Aqueous tear deficiency was graded clinically as mild or severe. A linear trend toward elevated EBV capsid (P less than 0.05) and early antigen (P less than 0.001) titers was noted from control to severe ATD patients. Rubella and cytomegalovirus antibody titers were poorly correlated with EBV titers, suggesting that the elevated EBV antibodies in ATD patients were not due to nonspecific polyclonal B-cell activation. Epstein-Barr virus antigens were detected in two of six lacrimal gland biopsies from severe ATD patients with Sjögren's syndrome, but in none of the control glands. Aqueous tear deficiency patients were evaluated for immunologic dysfunction associated with EBV infection. Linear trends of elevated serum IgG (P less than 0.05), autoantibody and immune complex positivity (P less than 0.05), and reduced natural killer cell cytotoxicity (P less than 0.05) were found from controls to severe ATD patients. Furthermore, reduced T-helper lymphocyte counts (P less than 0.06) and an increased percentage of HLA-DR+ CD8 lymphocytes (P less than 0.05) were observed in severe ATD patients compared with the mild and control groups. A multivariate analysis of the data showed a significant correlation between severe ATD and elevated EBV early antigen titers, Sjögren's syndrome, and an increased percentage of HLA-DR+ CD8 lymphocytes. The authors' findings suggest that EBV infection may be a risk factor for development of ATD in a subset of ATD patients with greater disease severity, Sjögren's syndrome, and immunologic dysfunction.
Despite the presence of gentamicin in corneal storage medium, postoperative endophthalmitis may r... more Despite the presence of gentamicin in corneal storage medium, postoperative endophthalmitis may result from the transmission of bacteria via contaminated corneal tissue. The authors evaluated the antimicrobial activity and endothelial toxicity of vancomycin (10 micrograms/ml) in combination with gentamicin (100 micrograms/ml) in DexSol corneal storage medium. When tested against a panel of common ocular pathogens, vancomycin combined with gentamicin proved more effective than gentamicin alone for inhibiting the growth of Streptococcus pneumoniae at 4 degrees C after 1- and 5-day incubation periods. Ultrastructural and morphometric analyses of paired human corneas stored for 5 days in either DexSol supplemented with vancomycin combined with gentamicin or DexSol with gentamicin alone did not show a significant difference in endothelial toxicity between the two groups. These results suggest that vancomycin combined with gentamicin has superior antimicrobial effect and similar corneal toxicity when compared with media supplemented with gentamicin alone.
To compare various methods of estimating corneal power for intraocular lens (IOL) calculation in ... more To compare various methods of estimating corneal power for intraocular lens (IOL) calculation in patients with irregular corneal astigmatism.
To evaluate a commercially available neural network program for calculation of photorefractive ke... more To evaluate a commercially available neural network program for calculation of photorefractive keratectomy treatment nomograms. University referral refractive surgery clinic. PRK/LASIK Brain, a commercial neural network computer program, was trained using the demographics, preoperative clinical data, surgical parameters, and 1 year postoperative clinical data of 44 patients treated with a Summit Technology excimer laser using a 5.0 mm optical zone. The neural-network derived nomogram was compared with the standard treatment nomogram for each patient. The relative contribution of age, sex, keratometry, and intraocular pressure (IOP) to the predicted nomograms was also assessed. Nomograms produced by the neural network were qualitatively similar to the standard nomogram. The sequence of data entry during training affected the network's predictions. Entry ordered by outcome (as opposed to entry by chronological order) yielded a nomogram that was more consistent with the standard nomogram. However, both outcome- and chronologically ordered network-derived nomograms diverged from the standard nomogram in individual patients, including a subset for whom use of the standard nomogram yielded desired refractive results (within 0.25 diopter of emmetropia). Further analysis of the neural-network-derived nomograms revealed marked sensitivity to sex, age, keratometry readings, and IOP. Neural networks offer a potential means of individualizing treatment nomograms, to account for patient demographics, preoperative examination, surgeon style, and equipment bias. However, a data set of 44 patients was not sufficient to train the PRK/LASIK Brain network to accurately predict treatment parameters in individual cases in the training set. A larger training set or a different learning algorithm may be required to improve the neural network's performance.
Purpose of review This study provides an overview of the three types of corneal inlays now in use... more Purpose of review This study provides an overview of the three types of corneal inlays now in use for the correction of presbyopia and reviews recently published evidence of the inlays' safety and efficacy. Recent findings Results for corneal reshaping and refractive inlays are promising, but very limited. Small-aperture inlays are already in widespread use and have been shown to improve uncorrected near and intermediate vision without a significant loss in distance acuity or an unacceptable increase in visual symptoms. Complications have been minimal, but the inlays may be removed if necessary. They do not prevent visualization or imaging of the retina and may be retained during subsequent cataract surgery.
Purpose: To apply an objective method to topographically determine functional optical zone (TFOZ)... more Purpose: To apply an objective method to topographically determine functional optical zone (TFOZ) dimensions in order to compare ablation centration, and refractive outcomes, following myopic laser in situ keratomileusis (LASIK) with and without automated, infrared (IR) pupil tracking. Methods: Thirty-seven eyes that underwent LASIK using the Technolas 217A with active IR pupil tracking (IT) were retrospectively compared to 37 matched eyes treated with manual tracking (MT). Visual acuity, refractive error, and corneal topography were measured pre-and postoperatively. Videokeratography and specialized software were used to assess centration. Results: The IR-tracked eyes had statistically better mean postoperative spherical equivalent (IT +0.02 6 0.38 D; MT 20.21 6 0.48 D; P = 0.03) and uncorrected distance visual acuity (IT +0.07 6 0.08 logMAR; MT +0.02 6 0.09 logMAR; P = 0.02). One versus three eyes lost 1 line of best spectacle-corrected visual acuity in the IT and MT groups, respectively. While similar mean displacement of the TFOZ center from the pupil center was found in the MT (0.54 6 0.27 mm) and IT (0.51 6 0.21 mm) groups (P = 0.77), 4 MT eyes (10.8%) were topographically decentered .1.0 mm, whereas the ablation center was within 1 mm of the pupil center for all IT eyes. Conclusions: Custom software provided a novel, objective method to determine topographic functional optical zone dimensions, then mathematically calculate the center of the optical zone relative to the pupil center and measure the vector of decentration. Use of IR pupil tracking improved uncorrected visual acuity, produced more predictive refractive outcomes, and fewer large centration outliers. This may reflect increased fidelity of spot placement to the attempted ablation profile.
Recent advances in immunologic technology are making the rapid diagnosis of viral infections of t... more Recent advances in immunologic technology are making the rapid diagnosis of viral infections of the ocular surface possible. The prompt use of these diagnostic techniques can directly influence therapeutic decision making, such as the use of antiviral drugs and steroids. In this article, existing methods of sampling the ocular surface are discussed, and the yield of infectious virus and viral antigens from various sites on the ocular surface is reviewed. The immunologic principles underlying radio-immunoassays, enzyme immunoassays, and a variety of immunocytologic methods are outlined, along with the advantages and disadvantages of each immunologic technique. In addition to reviewing the methods for detecting viral antigens on the ocular surface, the value of assessing antiviral antibodies in the tear film, as well as prospects for future diagnostic techniques, are discussed.
Debridement may be a useful adjunct to antiviral therapy for the treatment of herpes simplex dend... more Debridement may be a useful adjunct to antiviral therapy for the treatment of herpes simplex dendritic keratitis. Impression debridement may be superior to presently accepted forms of mechanical debridement including blunt spatula and minimal wiping since it avoids damage to the basement membrane, avoids spread of infectious viral particles, and allows the immediate initiation of antiviral therapy. Impression debridement is performed by application of cellulose acetate filter paper to the dendrite. Infected cells adhere to the filter paper and are lifted off while uninfected epithelial cells remain on the corneal surface. Patient discomfort is minimal avoiding the need for patching. Impression debridement was applied to dendritic lesions produced in six BALB/c mice and to the corneas of four normal BALB/c mice. Immunoperoxidase histochemical staining techniques readily demonstrated herpes simplex virus (HSV) antigen-bearing cells adherent to the filter paper in all six infected mice. The four controls showed no staining. Five patients with herpes simplex dendritic keratitis were treated with impression debridement combined with trifluorothymidine therapy. Complete epithelial healing occurred in all five cases within four days without observed recurrences.
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