The Cornea Service at the Wills Eye Institute evaluated the changes and trends in the number of characteristics of contact lens-related ulcers (CLRUs), discovering a significant increase in the number of cases of presumed bacterial keratitis associated with soft contact lens wear over the study period.

Medical records of all patients diagnosed with presumed bacterial corneal ulcers seen at the Institute between January 1, 2004 and December 31, 2007 were retrospectively reviewed. Five hundred seven corneal ulcers were identified. Of these, 223 (43.9 percent) were contact lens-related and 284 (56.1 percent) were not. The proportion of CLRU showed a significant increase over time (p=0.003), with a significantly greater percentage of CLRU in 2006 and 2007 compared to 2004 (p=0.004 and p=0.005). One hundred thirty-one (58.7 percent) of the 223 CLRU patients were men. Many CLRUs were vision-threatening, with 45.7 percent (92 of 201) more than 4 mm2 in size, 36.3 percent (81 of 223) associated with hypopyon, and 46.4 percent (103 of 222) central or paracentral in location. Pseudomonas aeruginosa was the most frequent agent isolated in CLRUs, found in 75 (63 percent) of the 119 positive cultures. 

Soft daily-wear frequent replacement lenses were the most common lenses associated with corneal ulcers, used in 68 (33.5 percent) of the 203 cases. There was a history of overnight wear of contact lenses in more than half of the cases (121 of 223, 54.3 percent). Of these, 21 (9.4 percent) were not approved for overnight wear.
Cornea 2012;21:1097-1102
Yildiz E, Airiani S, Hammersmith K, Rapuano C, et al.

Retinal Function Improves in Early AMD with Carotenoids
Research out of China suggests that early functional abnormalities of the central retina in early age-related macular degeneration patients may be improved by supplementation with lutein and zeaxanthin. These improvements may be attributed to the elevations in macular pigment optical densities (MPOD).

In a randomized, double-masked, placebo-controlled trial, 108 subjects with early AMD were assigned to receive 10 mg/d lutein (n=27), 20 mg/d lutein (n=27), 10 mg/d lutein plus 10 mg/d zeaxanthin (n=27) or placebo (n=27) for 48 weeks. Thirty-six age-matched controls without AMD were also enrolled to compare baseline data with early AMD patients. Multifocal electroretinogram (mfERG) responses and MPODs were recorded and analyzed at baseline, 24 and 48 weeks.

Results showed that there were significant reductions in N1P1 response densities in ring one to ring three in early AMD patients compared with the controls (p<0.05), whereas neither N1P1 response densities in ring four to ring six, nor P1 peak latencies, significantly changed. After 48 weeks of supplementation, the N1P1 response densities showed significant increases in ring one for the 20 mg/d lutein group and for the lutein and zeaxanthin group, and in ring two for the 20 mg/d lutein group. The increases in MPOD related positively to the increases in N1P1 response density in ring one and ring two for nearly all active treatment groups. N1P1 response densities in ring three to ring six, or P1 peak latencies in all rings, did not change significantly in any group.
Am J Ophthalmol 2012;154:625-634
Ma L, Dou H, Huang Y, Lu X, et al.

Retinal Artery Occlusion Caused By Cosmetic Facial Fillers
In a retrospective, non-comparative case series, Korean researchers have determined that cosmetic filler injections into the glabellar region of the nasolabial fold can cause retinal artery occlusion. Iatrogenic ophthalmic artery occlusion is associated with painful blindness, a thin choroid, brain infarction and poor visual outcomes, particularly when autologous fat is used.

Twelve consecutive patients with retinal artery occlusion were seen. Patients had ophthalmic artery occlusions (n=7), central retinal occlusions (n=2) and branch retinal occlusions (n=3). Injected materials included autologous fat (n=7), hyaluronic acid (n=4) and collagen (n=1), and injection sites were the glabellar region (n=7), nasolabial fold (n=4) or both (n=1). Injected autologous fat was associated with worse final best-corrected visual acuity than the other materials. All patients with ophthalmic artery occlusion had ocular pain and no improvement in BCVA. 

Optical coherence tomography revealed thinner and less vascular choroids in eyes with ophthalmic artery occlusion than in adjacent normal eyes. Concomitant brain infarction developed in two cases each of central retinal artery occlusion and ophthalmic artery occlusion. Phthisis developed in one case of ophthalmic artery occlusion. As such, ophthalmic examination and systemic brain magnetic resonance imaging should be performed in patients with ocular pain after cosmetic injections.
Am J Ophthalmol 2012;154:625-634
Ma L, Dou H, Huang Y, Lu X, et al.

Lower Tear Film Osmolarity in Patients with Epiphora
Patients attending an oculoplastic clinic with a primary complaint of epiphora had their tear osmolarity recorded. In the absence of other ocular surface pathology, these patients had a significantly lower tear osmolarity. 

Patient Group One (n=32) included those whose primary complaint was of epiphora due to either punctal stenosis, nasolacrimal duct obstruction (partial or complete) or eyelid laxity (without evidence of frank ectropion or entropion). Patient Group Two (n=31) formed the controls, and consisted of the second eye of some of the above patients or those attending the clinic for other oculoplastic procedures not related to epiphora. Subjects were excluded if they had current or recent topical eye therapy, active ocular infection or allergy, ocular surface scarring, evidence of dry eye, previous laser eye surgery or worn a contact lens within the previous 12 hours. Testing of tear osmolarity was performed in the clinic using the TearLab osmometer.

Sixty-three readings were obtained. Patients with epiphora had a mean tear osmolarity of 291.8 mOsms/l (r: 269 to 324) compared with the control group mean of 303.7 mOsms/l (r: 269 to 354). The difference was found to be statistically significant (p=0.025).
Ophthal Plast Reconstr Surg 2012;28:338-340
Saleh G, Hussain B, Woodruff S, Sharma A, Litwin A.