摘要:

Purpose.In 2001, more than one million laser in situ keratomileusis (LASIK) procedures were performed worldwide. Considering the increasing number of refractive procedures, eye banks will be increasingly confronted with the problem of how to identify those donors with prior refractive surgery. To date, efficient screening methods to identify LASIK surgery in donor eyes have not been established. Therefore, the purpose of the current study was to determine whether optical coherence tomography (OCT) can be used to detect the presence of LASIK-induced changes in human corneas.Methods.Laser in situ keratomileusis was performed on 20 organ-cultured human cornea disks. The excimer laser ablation performed ranged from 0 to 12 diopters. The corneas were maintained in culture, and the visibility of flap-stromal interface by OCT was assessed up to 6 months after the LASIK procedure. Additionally, two donor corneas with the history of LASIK treatment before death were screened for structural changes.Results.Optical coherence tomography scans were able to detect the interface between the corneal flap and the residual stromal tissue in all corneas and at all examined time intervals. There were no differences in signal intensity among the different depths of ablation. The relative signal intensity of the interface compared with the averaged stromal intensity ranged from 2.1 to 6.0. In both donor corneas with suspected prior LASIK surgery, OCT scanning showed the characteristic stromal interface as found in the in vitro model.Conclusions.Corneal examination by OCT could be an appropriate technique for eye banks to screen donor corneas for prior LASIK surgery.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To present clinical, microbiologic, and histopathologic features of keratitis due toCandida parapsilosis.Methods.Clinicomicrobiologic evaluation of four patients (four eyes) with culture-provenC. parapsilosiskeratitis. The patients were evaluated for symptoms, visual acuity, clinical observations, microbiologic examination of corneal scrapings, and pathologic examination of corneal buttons.Results.Three cases were observed after penetrating keratoplasty, and one case occurred after inhalation of corticosteroids. Clinical presentation ofC. parapsilosiskeratitis showed a great diversity. There was one case of crystalline keratopathy and three cases of suppurative corneal infiltrate. Histopathology of corneal buttons showed interlamellar accumulations of yeast. Medical treatment included topical amphotericin B and systemic triazoles. Penetrating keratoplasty was required in three patients.Conclusion.Risk factors forC. parapsilosiskeratitis may include corticosteroid use and prior corneal transplantation. The prognosis ofC. parapsilosiskeratitis with antifungal and surgical therapy may vary from good visual outcome to intraocular extension with phthisis bulbi.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To report a case of insect corneal foreign body with in vivo confocal microscopy performed.Methods.Clinical presentation, clinical pictures, and treatment are discussed. Confocal microscopy of the injured cornea was performed in areas showing foreign bodies with and without infiltrations seen under the slit-lamp.Conclusion.Confocal microscopy is useful in detection of subtle inflammatory reaction, monitoring the progress of the injury and decision of treatment plans.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To report a case of a primary corneal diffuse neurofibroma in a patient with von Recklinghausen disease (NF-1).Methods.Case report. A physical examination and histopathology were performed. The immunohistochemical studies were performed using an avidin-biotin-peroxidase complex technique on formalin-fixed and paraffin-embedded tissue. Histologic sections from corneal tissue were incubated with primary antibodies against vimentin and S-100 protein. A complementary ultrastructural study of the same formalin-fixed and paraffin-embedded tissue was made.Results.The ophthalmologic examination revealed a yellowish-white elevated mass that involved the supratemporal cornea but not the limbus. Histologic study showed a tumor of the peripheral nerve sheath, a diffuse neurofibroma in the corneal stroma, and proliferation of spindle cells with markedly elongated nuclei. Cells comprising the tumor reacted with vimentin and S-100 protein, and the ultrastructural studies revealed myelinated nerve fibers confirming the diagnosis.Conclusion.The development of a primary diffuse neurofibroma in the cornea of patients with von Recklinghausen disease is possible. The present case supports the statement that neurofibromas arising from the peripheral nerve sheath may involve any part of the body.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To report the result of a combined surgical procedure of pterygium excision with simultaneous amniotic membrane transplant, conjunctival limbal autograft, and mitomycin C application in the management of two cases of chronically recurring pterygium.Methods.Report of two cases.Results.The two male patients, ages 24 and 42 years, had undergone six previous surgeries for pterygium, with and without adjunct procedures. In the follow-up period of 26 months for the first case and 25 months for the second case, no recurrence or complications were encountered.Conclusion.A combined procedure seems to be beneficial in cases of chronically recurring pterygia in younger patients. This approach may be considered when all other types of surgery have failed.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To report the occurrence, management, and outcome of late-onset traumatic dehiscence and dislocation of laser in situ keratomileusis (LASIK) flaps.Methods.Two interventional case reports of patients with late-onset LASIK corneal flap dislocation after ocular trauma occurring at 7 and 26 months after surgery, respectively.Results.The flaps were lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flaps were successfully repositioned in both cases. The patient whose dislocated flap was repositioned 4 hours after the trauma recovered his uncorrected visual acuity (UCVA) of 20/20 1 week after the procedure and had a well-positioned flap with a clear interface. The patient who was managed 48 hours after the injury required repeat flap repositioning at 10 and 24 days after the initial procedure for treatment of persistent folds and striae in the visual axis. His uncorrected visual acuity 2 weeks after the third flap repositioning was 20/40 + 2. Diffuse lamellar keratitis developed in both patients that resolved with the use of topical corticosteroids.Conclusion.Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which can occur more than 2 years after the procedure.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.Our group performed cultivated allogeneic corneal epithelial transplantation in 13 eyes from 11 patients with severe ocular surface disorders. After the clinical application of this new surgical treatment, some patients experienced epithelial and subepithelial opacities. We applied our procedure again in these patients to achieve successful ocular surface reconstruction.Methods.The corneal limbal epithelial cells from donor corneas were cultivated for 4 weeks on denuded amniotic membrane (AM) carrier, with 3T3 fibroblast coculture and airlifting. The study subjects consisted of 3 patients. At 3 and 12 months after the first operation, the failed epithelial graft with AM was replaced with new allogeneic corneal epithelium cultivated on AM.Results.At 48 hours after transplantation, the corneal surfaces of the 3 eyes were clear and smooth; the entire corneal surfaces were evenly covered with the transplanted cultivated corneal epithelium, which did not stain with fluorescein. The ocular surface epithelia of these patients are all stable without epithelial defects.Conclusions.We have shown that, in cases where the initially transplanted cultivated epithelium becomes opaque, it is possible to repeat the transplantation process with new cultivated epithelium on AM.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To report a case of unilateral fungal and mycobacterial keratitis after simultaneous laser in situ keratomileusis (LASIK).Methods.Case report of a 37-year-old woman who developed corneal infiltrates located at the flap-stroma interface in her left eye 3 weeks after LASIK for myopia. The infiltration progressed despite topical antibiotic therapy; therefore, the flap was lifted and irrigated with antibiotic solution. Parallel corneal scrapings were taken. The patient's condition deteriorated, prompting a lamellar keratoplasty.Results.Corneal scrapings demonstrated no growth. Microbiologic cultures of the corneal specimen were reported as negative, whereas histopathologic examination disclosed fungal filaments. Two months later, the patient presented corneal infiltrates of the left eye again. Because the situation worsened despite therapy, a penetrating keratoplasty was performed. Histopathologic examination of the host cornea revealed no pathogenic species; microbiologic cultures, however, demonstratedMycobacterium chelonae.Conclusion.Fungi andM. chelonaeare rare and insidious causes of infectious keratitis after LASIK. Our case emphasizes the possible difficulties in diagnosing and treating a combined or subsequent infection with both species.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To analyze clinical and in vivo microstructural characteristics of both corneas of a 13-year-old male subject with Scheie's syndrome and compare the observations with the pathologic reports in the literature.Methods.Standard clinical examination and real-time, slit-scanning in vivo confocal microscopy were performed and repeated after 1 year.Results.In vivo confocal microscopy images at all cellular layers demonstrated brighter intercellular spaces than those of normal corneas. Cicatrization of the anterior stroma was identified, and the keratocytes of the middle and posterior stroma exhibited markedly altered morphology, often round or elliptical in shape, and with clearly demarcated, hyporeflective centers. The nerve fibers of the subbasal plexus were somewhat more irregular and difficult to distinguish, possibly due to underlying fibrosis.Conclusions.The potential of in vivo confocal microscopy to highlight microstructural alterations of the intact human cornea and evaluate such changes over time might reduce reliance on histopathologic investigations in such conditions and contribute to the ophthalmic management of the mucopolysaccharidoses in the future.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To report a case of fungal keratitis associated with vernal keratoconjunctivitis.Case Report.A 22-year-old man with a history of vernal keratoconjunctivitis since October 1999 developed a shield ulcer in the left eye in June 2000, which resolved with intensive topical steroid therapy. He presented in August 2001 with onset of acute pain, redness, and decreased vision. The tarsal conjunctiva in the left eye showed large papillae. The cornea showed a white plaque-like lesion with an underlying stromal infiltrate involving the upper half of the cornea. The overlying epithelial defect measured 4.5 × 2.5 mm. The anterior chamber showed 1+ flare and cells and hypopyon measuring about 1 mm.Results.Corneal scrapings were performed for microbiologic investigations. Smears of corneal scrapings revealed septate fungal filaments, and the culture showed a significant growth ofAspergillus flavus.Conclusions.Fungal keratitis may be associated with vernal keratoconjunctivitis. Though rare, fungal keratitis should be considered in the differential diagnosis of infections associated with vernal keratoconjunctivitis.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID