To evaluate the clinical efficacy and safety of silicone punctal plugs in various ocular surface disorders. Medical records of patients who underwent silicone punctal plug insertion from January 1996 to November 2000 were retrospectively reviewed. The clinical data collected included sex and age of the patients, indications for plug insertion, symptoms, corneal fluorescein staining and frequency of lubricant use at baseline and at 4 ± 2 weeks after the insertion, location (upper versus lower punctum), initial versus replacement plug, spontaneous extrusion or removal of the plug, and percentage of complications and punctum cauterization. There were 203 eyes of 153 patients (126 women and 27 men) in the study group. The total number of silicone punctal plug procedures was 312. Dry eye syndrome was the most common indication for punctal plug treatment (127 eyes, 62.5%), followed by epitheliopathy after penetrating keratoplasty (32 eyes, 15.8%). The symptoms improved in 150 (73.9%) of 203 eyes at 4 ± 2 weeks' follow-up. The mean score of the fluorescein staining of the cornea was reduced from 2.7 ± 0.1 to 1.3 ± 0.1 with silicone punctal plug treatment at 4 ± 2 weeks' follow-up. This reduction was statistically significant (p < 0.01). The overall success rate at 4 ± 2 weeks follow up was 76.8%. The frequency of the lubricant use was significantly decreased with punctal plug treatment (p < 0.001). Considering all plugs, the estimated probability of plug retention was 49.4% with 85.1 ± 7.3 weeks as the mean survival time. There was no statistical difference in plug retention rates between lower (49.6%) and upper (48.7%) plugs (p = 0.15). Retention rate of first plugs (53.5%) was significantly higher than that of second plugs (32.0%) (p = 0.05). The spontaneous total extrusion of silicone punctal plug was the most common complication in our study (158 plugs, 50.7%). The plug was removed in 14 eyes (14 plugs, 6.9%) because of epiphora in 11 eyes and conjunctival erosion in three eyes. The percentage of punctum cauterization performed in our population was 10.8%. Punctal plug insertion is a simple, effective, safe, and reversible method to treat aqueous tear deficiency and other ocular surface diseases, such as epitheliopathy after penetrating keratoplasty, superior limbic keratoconjunctivitis, neurotrophic keratitis, recurrent corneal erosions, and toxic epitheliopathy not controlled by lubrication with preservative-free tears. However, spontaneous extrusion of silicone plug occurs commonly. Careful choosing of the optimal plug size and close follow-up are recommended to ensure the success of the treatment.

To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients. In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up. Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens–Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 ± 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 ± 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant (p = 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid. Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only minor complications.

To evaluate the efficacy and safety of combined treatment with 2% topical cyclosporine (CsA) and topical corticosteroid compared to treatment with topical corticosteroids only after pediatric keratoplasty. Twenty-two grafts in 16 pediatric patients were evaluated retrospectively. The eyes were divided into a CsA group (9 eyes) and a control group (13 eyes) based on the postoperative treatment regimen. Information reviewed included patient age and sex, clinical diagnosis; preoperative and postoperative intraocular pressure and lens status; previous, concurrent, and subsequent surgical procedures; operative and postoperative complications; number of graft rejections, timing of suture removal, and length of follow-up. The clinical outcome of penetrating keratoplasty (PK) was evaluated by the rate of rejection-free graft survival and graft survival evaluation by the Kaplan-Meier log-rank test. The rejection-free graft survival rate was 88.9% in the CsA group and 38.5% in the control group. This difference in rejection-free graft survival rate between the groups was statistically significant (P = .0465). The graft survival rate was 88.9% in the CsA group and 46.2% in the control group. The difference in the graft survival rate was not statistically significant between the groups (P = .6). No clinical signs of systemic or local toxicity were seen with the topical CsA treatment. Two percent topical CsA is safe and effective in reducing the risk of allograft rejection in pediatric recipients.

WOUND infection after cataract extraction is a rare complication. There is little published data on corneoscleral wound infections after extracapsular cataract extraction and no data are available on clear corneal wound infections after phacoemulsification.^1-6 In this article, we report 7 cases of clear corneal wound infections after phacoemulsification.

To describe a post-LASIK patient with decreased vision and a chalazion of the upper eyelid. A 46-year-old man was referred with decreased vision of 1 month's duration. He underwent bilateral uncomplicated LASIK for myopic astigmatism 1.5 years and bilateral enhancements 1 year previously. He had 20/20 uncorrected vision in both eyes after those procedures. He developed a chalazion of his right central upper eyelid 1 month prior with simultaneous blurring of vision. On our examination, his uncorrected visual acuity was 20/60 in the right eye. Complete eye examination including refraction, computerized corneal topography, and pachymetry were done. With a manifest refraction of +1.25 +0.50×80, the visual acuity in the right eye improved to 20/20. Computerized corneal topography revealed circular central corneal flattening in both eyes, much greater in the right eye than the left eye. The location of the chalazion with the right eye closed corresponded to the area of central corneal flattening. The central power from the corneal topography was 39.4 D OD and 40.8 D OS. He was diagnosed as having acquired hyperopia associated with chalazion-induced central corneal flattening of the right eye. Chalazion-induced hyperopic change on topography disappeared, and his uncorrected vision improved to 20/20 in the left eye as the chalazion resolved completely. In post-LASIK patients with decreased vision and topography changes late after surgery, periocular masses should be considered in the differential diagnosis. Decreased corneal thickness and rigidity after LASIK might be a predisposing factor to external compression-induced curvature changes.