摘要:

Purpose.Evaluation of donated corneal tissue for transplantation relies on visual inspection by slit lamp biomicroscopy and specular micrography at the eye bank and then slit lamp biomicroscopy by the transplanting surgeon. An overall grade of tissue quality is assigned, but endpoints for biomicroscopic assessment are not universally accepted. We investigated the application of darkfield illumination to evaluate corneal transparency and provide a more standardized and reproducible method of tissue examination.Methods.We built a fixture to securely hold a standard cornea storage container, and used two versions of photographic slit lamp biomicroscopes to examine donated corneal tissue with darkfield illumination.Results.In every cornea we examined, darkfield illumination portrayed increased subject detail as compared with conventional methods of biomicroscopy. The epithelium appeared as a richly textured “ground-glass” field. We noted variations in transparency that could not be detected with conventional slit lamp biomicroscopy. The actual surface area of lesions such as cornea verticillata and herpetic dendrites appeared larger in darkfield illumination because of its high sensitivity to subtle alterations of transparency.Conclusion.Darkfield biomicrography of donated corneal tissue permits evaluation of the entire surface area, measurement of localized lesions of varying brightness, and assessment of epithelial cell coverage. As such, it extends our understanding of tissue clarity. Coupled with digital imaging technology, darkfield biomicrographs could be shared on the Internet and would allow transplanting surgeons to review tissue before selecting it for surgery. This technique could also be used in pharmaceutical research to measure changes in lesion size after therapy and could be incorporated into an eye bank quality assurance program. A new challenge for eye banking is to identify corneas in vitro that have undergone refractive surgeries such as laser in situ keratomileusis and photorefractive keratectomy—surgical alterations not easily seen at the slit lamp. Darkfield biomicrography may also be useful in detecting these lesions.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To describe a patient with bilateral, recurrent marginal corneal infiltrates consistent with Fuchs' superficial marginal keratitis who developed bilateral nasal pseudopterygia encroaching on the visual axis, reducing visual acuity in both eyes.Methods.Bilateral superficial keratectomy combined with conjunctival autografting was performed in each eye.Results.Best corrected visual acuity improved from 20/60 in the left eye and 20/40 in the right eye to 20/25 in both eyes. Our patient has had no disease relapses in her right eye, as of 29 months after the surgery, but experienced a mild flare-up of marginal keratitis in her left eye 8 months after the surgery. Despite this flare-up, disease symptoms in the left eye have markedly diminished.Conclusion.Superficial keratectomy combined with conjunctival autograft is a therapeutic alternative in the management of severe, recurrent Fuchs' superficial marginal keratitis. In the present case, it has resulted in an improvement in visual acuity as well as a decrease in the frequency of disease flare-ups. The clinical course of this patient suggests that the conjunctiva may play a role in the etiology of Fuchs' superficial marginal keratitis.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To report a case of dermal and ocular changes after prolonged use of high-dose chlorpromazine hydrochloride therapy.Method.This case report includes clinical history, clinical findings, and photographic images of ocular and dermal changes.Results.Chlorpromazine therapy in a cumulative dosage exceeding 1,100 g resulted in dramatic skin discoloration and multiple crystalline deposits in both corneas. Anterior capsular opacities were binocularly present. These changes were sufficient to cause reduction in visual acuity.Conclusions.Chlorpromazine deposition at high levels can cause reduction in visual acuity and significant skin discoloration.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To describe a case of successful treatment of a corneal perforation with 2-octyl cyanoacrylate.Methods.2-Octyl cyanoacrylate was applied at the slit lamp with topical proparacaine anesthesia to a cornea with an inferior perforation with iris plugging the defect.Results.After application of 2-octyl cyanoacrylate, the anterior chamber was noted to deepen, and visual acuity improved to 20/200. The glue remained intact for more than 6 weeks and eventually fell out. The underlying cornea healed without scarring, vascularization, or thinning.Conclusion.We have described a case in which 2-octyl cyanoacrylate was used to treat a corneal perforation with excellent results. Further study of this adhesive will be useful in comparing the effectiveness and safety of 2-octyl cyanoacrylate with that of previously studied adhesives.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To describe corneal intrastromal epithelial cysts and present a minimally invasive surgical technique successfully used to treat such a lesion.Methods.A 5-year-old girl with a progressive, vision-threatening, intrastromal corneal opacity in the left eye is described. The patient had a history of accommodative esotropia and bilateral medial rectus recession two years before presentation. A presumptive diagnosis of an epithelial cyst secondary to iatrogenic seeding of the limbal corneal stroma was made. Because of documented growth toward the visual axis and a decrease in best-corrected visual acuity, surgical treatment was initiated. The cyst was incised and debrided through a 2.0-mm, partial-thickness, limbus-parallel, clear corneal incision.Results.Cytologic analysis of the cyst contents showed intact and degenerated epithelial cells, thereby confirming the diagnosis. The cyst walls were scraped through the nonenlarged incision, and irrigation resulted in nearly complete clearing of the opacity. Stable vision and no recurrences were documented with 21 months of follow-up.Conclusion.This minimally invasive surgical approach may be a good alternative to previously described treatments for intrastromal corneal cysts.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To report a case of explosive fungal endophthalmitis after penetrating keratoplasty and to review additional published and unpublished cases to consider possible strategies for prevention.Methods.Records of this patient with postkeratoplasty candidal endophthalmitis and previously reported cases of postkeratoplasty candidal endophthalmitis were reviewed. Additional information of 26 unpublished cases was obtained from the Eye Bank Association of America.Results.After standard keratoplasty, the patient developed precipitous endophthalmitis on the second postoperative day. Abundant contamination withCandidawas found in the residual donor corneoscleral rim, andCandida albicanswas isolated from the aqueous humor of the recipient. Despite therapy with local antimicrobial agents, intraocular amphotericin B, and systemic fluconazole, the patient had a poor outcome with hand-motion visual acuity. Of the 44 collected cases of postkeratoplasty candidal endophthalmitis, 40 (91%) had the same organism cultured from the donor rim or medium. Forty-three donor corneas had been preserved in cold storage medium at 4°C. Of 15 cases in which the outcome was available, 9 (60%) resulted in visual acuity of 20/200 or worse.Conclusion.Case reports confirm the occurrence of donor-to-host transmission of postkeratoplasty candidal endophthalmitis. Despite the low reported incidence, the poor prognosis of the affected eye in the majority of these cases suggests the need for antifungal supplementation of cold preservation media and other preventative strategies.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT).Methods.Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were successfully cured using HFG and AMT. The technique consists first of using a high-viscosity sodium hyaluronate viscoelastic material to restore anterior chamber depth followed by a debridement of the ulcer. The perforation site is filled with the HFG to corneal surface level. The so-formed plug is then secured with an AMT to avoid its extrusion. An extended-wear bandage contact lens and topical antibiotics were used in these patients for 3 weeks.Results.Total reepithelialization was observed after an average of 15 postoperative days. The AMT dissolved within 8 weeks to uncover a whitish scar formed within the perforation sites. No complications were observed in any patients. After a follow-up period of 195–325 days, all corneas remained stable; there was no infection or ulcer recurrence, but some corneal scar thinning was observed in all three cases.Conclusion.The described surgical approach using HFG and AMT allowed a successful repair of corneal perforations with a diameter of 2 mm associated with significant loss of stroma. This method may be a good alternative to delay penetrating keratoplasty for treating corneal perforations, especially in acute cases in which graft rejection risk is high.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To report the histopathologic findings of the cornea verticillata observed in a woman who was heterozygous for Fabry's disease.Method.A 67-year-old woman was found to have a whorl-like corneal opacity on her visit to the Department of Ophthalmology, Aichi Saiseikai Hospital. Her visit was because of a sudden loss of vision in her right eye owing to a central retinal artery occlusion in association with an ophthalmic artery occlusion. The patient died suddenly of an acute heart failure; with family consent, an autopsy was performed and the right eye was removed for histopathologic examination by light and electron microscopy.Results.Low levels of &agr;-galactosidase in the leukocytes together with the corneal finding led to the diagnosis of heterozygous Fabry's disease. Light microscopy revealed a 0.3-to 0.5-&mgr;m thick layer between the epithelial and Bowman's layers. Oil red O positive deposits were accumulated in the subepithelial layer, and the density varied in different regions. Electron microscopy showed that subepithelial layer differed in thickness, and the basal lamina reduplicated regionally. We were not able to determine the structure that correlated with the “ridge” in the central part of the cornea.Conclusion.The oil red O positive deposits and their variation in density in the subepithelial area of the cornea may have caused the characteristic whorl-like corneal opacity in this woman who was heterozygous for Fabry's disease.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID