Craig and Blades
are unsuitable. The limitations of contact lens correction
after keratoplasty are discussed.
Clinical Assessment of Ocular Response to a
Multipurpose Contact Lens Care Solution.
Bergmanson JPB, Barbeito R: Ophthalmic Physiol Opt
1995;15:535-544.
The authors investigated the possible adverse ocular effects
of complex-formulation multipurpose contact lens solu-
tions. In addition to an investigation of the extent of tear
film destabilizing surfactant effects, other ocular variables
were examined as indicators of toxicity resulting from ab-
sorption across the ocular surface. Seventy-three normal
subjects (around 50% contact lens wearers) were examined
on two occasions, 15 minutes postdelivery of 100 ~1 of B&L
m ings, great care should be taken on the presentation of
Renu or 0.9% saline to the ocular surface. Measurements
were conducted to ascertain invasive and noninvasive tear
film breakup time; intraocular pressure, pupil size, accom-
modation, vertical palpebral aperture size, pupil reactivity,
and conjunctival vascular response. The data were analyzed
by the use of both traditional parametric techniques and
equivalence analysis. Fluorescein breakup time data were
found to be more variable than the data associated with the
corresponding noninvasive technique, allowing less reliable
conclusions to be drawn. No significant differences in the
ocular variables examined, were found between the two
treatments. This would suggest that this multipurpose con-
tact lens solution does not mediate any detectable delete-
rious tear film stability effects or toxicity-mediated auto-
nomic effects within 15 to 45 minutes postocular exposure.
Although this investigation detected no short-term effect
of a contact lens care solution, further investigation may be
warranted to fully discount the possibility of accumulative
toxic effects associated with the ocular application of such
agents.
Acanthumoeba Keratitis: Risk Factors and
Outcome.
Illingworth CD, Cook SD, Karabatsas CH, Easty DL: Br J
Ophthalnol 1995;79:1078-1082.
The authors present a review of the etiology, diagnosis,
treatment, and outcome of 23 cases of Acunthamoeba kera-
titis presenting between 1985 and 1995 to a United King-
dom eye hospital Twenty-three patients (mean age, 31
years) presented over this period. Of the suffers 88%, had
no previous history of ocular problems, and all were contact
lens wearers. Sixty-seven percent were disposable soft lens
wearers, and 91% of the patients presented in the 1990s.
Forty-eight percent of the patients presented between Janu-
ary 1994 and February 1995 alone. Of the sufferers, 50%
used a chlorine-based disinfectant system (18% used no
disinfectant, and others reported poor lens hygiene). Diag-
nosis was based on clinical appearance and laboratory find-
ings. In 77% of cases, an incorrect initial diagnosis of a viral
keratitis was made. Over the lo-year period, a decrease in
diagnostic delay has been achieved. A total of 39% of the
patient’s required penetrating keratoplasty to be performed.
These were all cases with a lengthy period between presen-
tation and treatment initiation. Seventy-eight percent of
the sufferers had a final corrected acuity of 6/6 after medi-
cal/surgical intervention. Although Acanthamoeba keratitis,
possibly associated with contact lens wear, would appear to
be on the increase, advances in medical and surgical inter-
vention and decreased diagnostic delay may provide suc-
cessful treatment in the majority of cases. Both contact lens
wear (especially disposable lens wear) and chlorine-based
disinfectant systems are proposed as possible predisposing
factors in Acunthumoeba keratitis. In the light of these find-
atypical keratitis in association with contact lens wear.
Successful Immunization Against Acunthamoeba
Keratitis in a Pig Model.
Alizadeh H, He Y, McCulley JP, et al.: Cornell
1995;14:180-186.
Although free-living Acantharnoeba protozoa are common
in the environment, and contact lens wear is a major risk
factor of infection, the incidence of Acanthamoeba keraticis
is relatively rare. This would suggest some form of wide-
spread immune response-mediated protection in the gen-
eral population. This may still leave a small group of non-
immune individuals at risk of infection. An animal model
(pig) has been developed for the investigation of this in-
fection. The pig is susceptible to Acunthamoeba keratitis in
a way similar to that of the human. It is understood that
100% of normal pigs develop severe keratitis when infected
via a parasite-laden contact lens. Using this model, the
authors investigated the effects of prior ocular infection
with Acanthamoeba trophozites or injections of parasite an-
tigens either (a) intramuscularly; (b) subconjunctivally; or
(c) intramuscularly and subconjunctivally, in an attempt to
induce sustained immunity. Intramuscular inoculation
alone and prior ocular infection alone gave no protection
against pathologic response to future exposure. Subcon-
junctival exposure alone afforded protection in 5C% of
cases. Combined subconjunctival and intramuscular inocu-
lation afforded protection in 100% of cases tested. The
results would suggest that it is possible to induce total pro-
tection against Acanthamoeba keratitis in an animal model
that is similar to the human condition. Further work elu-
cidating the immune response to Acanthamoeba antigens
may extend our ability to prevent, detect, and treat this
sight-threatening infection with greater accuracy and
efficiency.
ICLC, Vol. 23, March/April 1996 79
4bstlu ‘ts

Jennifer P. Craig, PhL>, MCOptom, is currently a postdoctoral research

fellow in the Department of Vision Sciences at Glasgow Caledonian
University in Scotland. Her main research interest is the physiology of
the tear film in normal and dry eyes. Jennifer ohtained a first-class
h~~nors degree in optometry in 1991 from the same institution, then
known as Glasgow Polytechnic. After a years’s experience within the
Hospital Eye Service, she attained professional membership in the Brit-
ish College of Optometrists in 1992. Returning to Glasgow Caledonian
University the same year, Jennifer undertook a 3-year studentship, un-
der the supervision of Professor Alan Tomlinson, and was awarded a
PhD, for research into tear physiology, in 1995. She has won numenjus
prizes to date, including the national Naylor Prize and several prizes
from the Scottish Committee of Optometrists.

Kenny Blades, BSc( Hons), is a postgraduate student in the Department

of Vision Sciences at Glasgow Caledonian University in Scotland.
Under the supervision of Sudi Patel, he is currently researching the
potential role of antioxidant therapy in the management of marginal
dry eye and is hoping to complete his PhD program, within the next
year. Studying physiology at St. Andrew’s University in Scotland,
Kenny was awarded an upper second-class honors degree in 1993. Dur-
ing the q-year course, he also studied psychology, logic, and philosophy
of science as minor subjects and his senior honors project involved the
investigation of a 5-HT (serotonin)-dependent sensory pathway in the
skin of Xenopus embryos.

80 ICLC, Vol. 23, March/April 1996