Cornea
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Shortages in transplantable corneas are common, yet little appears in the medical literature about patterns of tissue donation and factors affecting procurement. We have analyzed data on eye donations and taken measures to improve procurement rates based on our findings. Fifty consecutive Cardiovascular Intensive Care Unit (CVICU) deaths were reviewed to compare the number of transplant-eligible donors to the amount of tissue received. ⋯ During the 12 months after this initiative, the number of transplantable corneas donated from our facility doubled, as compared with the same period in 1992. Despite required request laws and regulations, failure to request tissue donation is common in our facility and may be common elsewhere. Systematic analysis of obstacles to donor eye procurement and their solutions may help to improve our country's performance in this area.
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The treatment of herpes simplex keratitis has ranged from simple debridement to the use of prototypic antiviral agents specific to the herpes family, such as acyclovir. The various treatment modalities for dendritic keratitis, for the most part, have been effective. However, in recent years numerous reports of antiviral-resistant strains of herpes simplex have appeared, particularly in immunocompromised patients receiving chronic acyclovir. ⋯ After 7 weeks without improvement on multiple treatment regimens, including trifluridine, vidarabine, debridement, and topical and systemic acyclovir, interferon alpha-2a was added to topical acyclovir therapy, and the keratitis quickly resolved. Topical interferon alpha-2a appears to be an effective treatment adjunct for refractory herpes simplex keratitis in patients with cell-mediated immune dysfunction and subsequent lack of endogenous interferon. Its value in nonimmunocompromised patients remains to be determined.