Laboratory diagnostic methods, applied for the diagnosis of Acanthamoeba Keratitis, were evaluated for their usefulness in 16 patients of suspicious Acanthamoeba keratitis. Wet smear, Acridine orange(AO) stain, Gram stain and culture on nonnuturent agar plate were routinely used in all patients, and among them, and used saline of 7 contact lens not ideal for the corneal scraping specimens. AO and Gram stains were very useful in the identification of acanthamoeba, and culture on nonnutrient agar plates was essential to confirm this infection. Light and electron microscopic examinations were also useful in patients with negative results of ordinary diagnostic techniques. Suspicion of Acanthamoeba infection in patients that are recalcitrant to antibiotic treatment or related to contact lens wear, is the mont important step for the diagnosis of Acanthamoeba Keratitis. And also examination of corneal specimens by experienced observer is prerequisite for the accurate diagnosis of Acanthamoeba keratitis.
Acanthamoeba ; Acanthamoeba Keratitis ; Agar ; Clinical Laboratory Techniques* ; Coloring Agents ; Diagnosis ; Humans ; Keratitis*

Epidemiologic study of contact lens related infectious keratitis was performed in 19 hospitals which were located nation wide, Two hundred eighteen cases of contact lens related infectious keratitis(male 55 patients, female 163 patients) were diagnosed among 649 infectious keratitis patients between April 1995 and September 1997. Patients were mainly in twenties (54.6%) and residents of Seoul and Pusan(65.6%). Their major occupations were student(31.7%) and office worker(25.5%). Soft contact lens was involved in infectious corneal ulcer in 96.8% and disposable lens in 13.3%. Lenses were puchased at optical shop in most cases (72%). Unfortunately, 51.6% of patients was not aware of possible contact lens complication and 66.7% was not able to use contact lens properly due to improper education. Pseudomonas was isolated from corneal ulcer in 65.4% of cases and Serratia in 9%. This study reveals that contact lens related infectious keratitis can be devastation disease especially socially active age group, and proper education of both contact lens usage and proper lens dispense system should be needed.
Contact Lenses, Hydrophilic ; Corneal Ulcer ; Education ; Epidemiologic Studies ; Epidemiology* ; Female ; Humans ; Keratitis ; Occupations ; Pseudomonas ; Seoul ; Serratia

In 44 out of 218 cases of contact lens related infectious keratitis from 19 hospitals throughout the country, contact lenses or contact lens storge cases were cultured. Microorganism was detected in 40 cases[90.9%]. Two or more organisms were isolated in 31 cases[77.5%]. Pseudomonas was the most common organism isolated from contact lens or contact lens storage medium[31 out of 84, 45.2%], followed by Serratia[15 out of 84, 17.9%], fungi [4], and acanthamoeba[4]. Acanthamoeba was found only in one hospital. Antibiotic sensitivity test for isolated pseudomonas showed that 96%of cases was sensitive to ciprofloxacin and 88%to ceftazidime.
Acanthamoeba ; Ceftazidime ; Ciprofloxacin ; Contact Lenses ; Fungi ; Keratitis* ; Pseudomonas

Herpes simplex virus keratits(HSK) is one of the most common external eye diseases that cause corneal blindness, Therefore early diagnosis and proper treatment of HSK are essential. However it is frequently misdiagnosed because it shows non-specific corneal lesion than other infectious corneal disease. And also diagnosis of HSK mostly rely on clinical examination and patient history. We evaluated suspicious HSK patients by indirect immunofluofluorescent(IF) antibody test and analyzed its efficacy in the early diagnosis of HSK. Among 47 patients(47 eyes), 37 patients were suspicious heretic keratitis and others not. Dendritic keratitis patients existed in 17 out of 37 patients and they were evaluated with virus culture and indirect IF test. The result of indirect IF test was confirmed under the immunofluorescent microscope and for virus culture the specimens were inoculated on Vero cells(monkey kidney cells). The positive results of indirect IF test was 28 out of 37 suspicious HSK patients and 1 out of 10 non-suspicious HSK patients. Dendritic HSK patients showed IF positive in 15 out of 17 patients(82.3%). Sensitivity of indirect IF test in suspicious HSK patients was 75.7%(2837) and 88.2%(15/17) in dendritic HSK patients. Indirect IF test was all positive(14/14) in dendritic HSK patients that showed culture positive. From these results, indirect IF test has a high sensitivity in early diagnosis of HSK and might be ussful as a rapid diagnostic tool in HSK patients.
Blindness ; Corneal Diseases ; Diagnosis ; Early Diagnosis ; Eye Diseases ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic* ; Kidney ; Simplexvirus

Chronic endophthalmitis following cataract extraction and intraocluar lens implantation has been reported occasionally and Propionibacterium acnes is Known as the most common organism. This infection is often misdiagnosed as uveitis in early stage, and diagnosis depends on anaerobic culture of intraocular specimens. Intravitreal infection of antibiotics, pars plana vitredtomy, removal of IOL with lens capsule are suggested for successful treatment of chronic endophthalmitis. We report a case of Propionibacterium acnes endophthalmitis after extracapsular cataract extraction and posterior chamber lens(PCL) implantation that was treated successfully by PCL removal and intraviteal antibiotic infection.
Anti-Bacterial Agents ; Cataract Extraction* ; Cataract* ; Diagnosis ; Endophthalmitis* ; Propionibacterium acnes* ; Propionibacterium* ; Uveitis

Herpes simplex virus keratits(HSK) is one of the most common external eye diseases that cause corneal blindness, Therefore early diagnosis and proper treatment of HSK are essential. However it is frequently misdiagnosed because it shows non-specific corneal lesion than other infectious corneal disease. And also diagnosis of HSK mostly rely on clinical examination and patient history. We evaluated suspicious HSK patients by indirect immunofluofluorescent(IF) antibody test and analyzed its efficacy in the early diagnosis of HSK. Among 47 patients(47 eyes), 37 patients were suspicious heretic keratitis and others not. Dendritic keratitis patients existed in 17 out of 37 patients and they were evaluated with virus culture and indirect IF test. The result of indirect IF test was confirmed under the immunofluorescent microscope and for virus culture the specimens were inoculated on Vero cells(monkey kidney cells). The positive results of indirect IF test was 28 out of 37 suspicious HSK patients and 1 out of 10 non-suspicious HSK patients. Dendritic HSK patients showed IF positive in 15 out of 17 patients(82.3%). Sensitivity of indirect IF test in suspicious HSK patients was 75.7%(2837) and 88.2%(15/17) in dendritic HSK patients. Indirect IF test was all positive(14/14) in dendritic HSK patients that showed culture positive. From these results, indirect IF test has a high sensitivity in early diagnosis of HSK and might be ussful as a rapid diagnostic tool in HSK patients.
Blindness ; Corneal Diseases ; Diagnosis ; Early Diagnosis ; Eye Diseases ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic* ; Kidney ; Simplexvirus

The purpose of this study was to investigate the process of Acanthamoeba penetration into the organ-cultured human cornea by scanning and transmission electron microscopy. Human cornea was obtained through the eye bank of Catholic Medical Center and cultured in Optisol solution at at37degrees C. Acanthamoeba lugdunensis was cultured on non-nutrient agar plate and collected to make suspension in concentration of 1 x 106/ml.100 microliterof amoeba suspension was added to the epithelial surface of cultured cornea and each cornea was incubated for 48 and 120 hours. Each cornea was examined by scanning and transmission electron microscopy at each time point. In scanning electron microscopy, Acanthamoeba penetrated into the deep epithelial layer through the intercellular space with progressive epithelial breakdown. In transmission electron microscopically, Acanthamoebapene-trated through the intercellular space of the superficial corneal epithelium and reached to the basement membrane of basal corneal epithelium. Penetrating trophozoites had numerous electronense, mineral-like deposits in their cytoplasm and secreted enzyme-like materials. In conclusion, Acanthamoebae penetrated through the intercellular space of the corneal epithelium by their locomotion and migrated into the deep epithelial layer with secreation of enzyme-like materials and phagocytosis until they reached to the basement membrane of the basal corneal epithelium.
Acanthamoeba* ; Agar ; Amoeba ; Basement Membrane ; Cornea* ; Cytoplasm ; Epithelium, Corneal* ; Extracellular Space ; Eye Banks ; Humans* ; Locomotion ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission* ; Organ Culture Techniques ; Phagocytosis ; Trophozoites

PURPOSE: To evaluate 20% ethanol toxicity on the rabbit corneal epithelium, ethanol-treated rabbit corneas were examined with electron microscopy. METHODS: Rabbit corneas(24 eyes) were treated with 20% ethanol for 30 seconds, 1 minute, and 2 minutes by using LASEK(Laser Assisted Subepithelial Keratomileusis) instruments, and washed with sterile water. Zero time, 1, 3, 5 days after ethanol treatment, corneas were excised and examined with scanning and transmission electron microscopy. RESULTS: Widespread damage or disappearance of microvilli and local breaks of intercellular junction were observed. The changes were more severe in corneas with longer ethanol treament. In corneas with over 1 minute ethanol treatment, slough of superficial corneal epithelium was shown and increased with time. It was difficult to recognize microvilli or distinctive intercellular junction in corneas with 2 minute-treament. These pathologic changes persisted 5 days after ethanol-treatment. CONCLUSIONS: From these results, 30 seconds to 1 minute-ethanol treatment is recommended in corneal surgery to avoid severe, persisting damage of superficial corneal epithelium.
Cornea ; Epithelial Cells* ; Epithelium, Corneal ; Ethanol ; Intercellular Junctions ; Microscopy, Electron ; Microscopy, Electron, Transmission ; Microvilli ; Water

PURPOSE: To investigate the difference in donor corneal cell changes after penetrating keratoplasty in various corneal diseases. METHODS: Subjects included 36 eyes from 35 people with at least 6 months of follow-up who had undergone penetrating keratoplasty between August 2000 and December 2002. The patients were classified into three groups based on the state of the corneal endothelium. Changes in cell density, polymorphisms, and polymegathism of the donor cornea were compared between groups. Results were analyzed by ANOVA. RESULTS: The overall corneal endothelial cell density after grafting was lower, but the differences in endothelial cell states between the recipient cases were not statistically significant. The change in corneal endothelial cell density showed a significantly higher difference (p=0.0013) when patients had either undergone a rejection episode during recovery or recurred herpetic uveitis. CONCLUSIONS: The preoperative state of the corneal endothelium may affect the survival of donor corneal endothelium after grafting. However, rejection of the transplant contributes more significantly to the survival of the donor corneal endothelium than other factors. We suggest close observation and keen therapy with respect to rejection after grafting.
Cell Count ; Cornea ; Corneal Diseases ; Corneal Transplantation* ; Endothelial Cells ; Endothelium, Corneal* ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Tissue Donors* ; Transplants ; Uveitis

PURPOSE: To investigate the difference in donor corneal cell changes after penetrating keratoplasty in various corneal diseases. METHODS: Subjects included 36 eyes from 35 people with at least 6 months of follow-up who had undergone penetrating keratoplasty between August 2000 and December 2002. The patients were classified into three groups based on the state of the corneal endothelium. Changes in cell density, polymorphisms, and polymegathism of the donor cornea were compared between groups. Results were analyzed by ANOVA. RESULTS: The overall corneal endothelial cell density after grafting was lower, but the differences in endothelial cell states between the recipient cases were not statistically significant. The change in corneal endothelial cell density showed a significantly higher difference (p=0.0013) when patients had either undergone a rejection episode during recovery or recurred herpetic uveitis. CONCLUSIONS: The preoperative state of the corneal endothelium may affect the survival of donor corneal endothelium after grafting. However, rejection of the transplant contributes more significantly to the survival of the donor corneal endothelium than other factors. We suggest close observation and keen therapy with respect to rejection after grafting.
Cell Count ; Cornea ; Corneal Diseases ; Corneal Transplantation* ; Endothelial Cells ; Endothelium, Corneal* ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Tissue Donors* ; Transplants ; Uveitis