ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To investigate the safety and efficacy of human processed pericardium used as an onlay after pterygium excision.Methods.Twenty-five eyes of 25 patients (11 female, 14 male) with recurrent pterygium were included in this study. The median age was 50 years (range 24–89 years). Twenty-eight percent of the eyes previously had been operated on two or more times. The mean follow-up was 9.4 months (± 2.1 months, range 8–15 months). Following bare-sclera surgical removal of recurrent pterygium, a patch of processed human pericardium was sutured to cover the area of excision. The pericardium was not covered with conjunctiva, nor were adjuvant radiation or antimetabolite administered. All patients were treated with a combination of dexamethasone 0.1% / chloramphenicol drops three times per day for 1 month. Ketorolac tromethamine 0.5% three times per day was added to this regimen after complete corneal reepithelialization.Results.Recurrence (any growth >1 mm onto the cornea) was detected in 12 patients (48%). The mean time of recurrence was 4.1 ± 1.7 months. Three patients (12.0%) presented a regrowth of fibrovascular tissue not reaching 1 mm of the cornea. Pyogenic granulomas occurred in three patients, and all of them required surgical excision. Corneal thinning was present in one patient and was treated with a therapeutic contact lens and artificial tears with complete resolution and vascularization of the thinned area. No decrease in visual acuity was observed in any patient.Conclusions.The use of processed pericardium in pterygium surgery is a safe procedure but is associated with a relatively high rate of recurrence. It should only be considered as an option in managing recurrent pterygium when conjunctival autografting is not an available alternative.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To describe the time course, diagnosis, clinical features, and treatment of seven patients withMycobacterium szulgaikeratitis that developed from 7 to 24 weeks after laser in situ keratomileusis (LASIK).Methods.Seven of 30 eyes of 18 patients were identified with keratitis after LASIK. The first two patients presented 12 to 14 weeks after LASIK; nontuberculous mycobacteria were identified 1 month after the flaps were cultured. Patient recall identified three additional cases by culture and two cases by clinical features alone. Pulsed-field gel electrophoresis (PFGE) was used to type the isolates, and treatment was modified based on susceptibilities.Results.M. szulgaiwas identified in five patients for whom cultures were performed, but response to empiric therapy based on cultures proved unsatisfactory. The keratitis resolved in all patients with treatment including clarithromycin based on susceptibilities. Medical therapy was sufficient, although one patient required flap amputation. Six of seven patients recovered best-corrected visual acuity (BCVA), while one patient lost one line of BCVA. Two patients lost one line of postoperative uncorrected visual acuity (UCVA), two patients gained one line of UCVA, and three patients recovered postoperative UCVA. PFGE analysis revealed that theM. szulgaistrains were identical, and the infection source was contaminated ice used to chill syringes for saline lavage.Conclusions.Nontuberculous mycobacterial keratitis after LASIK is a diagnostic and management challenge, but outcomes can be preserved with treatment based on susceptibilities. This cluster underscores the importance of adherence to sterile protocol during LASIK.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To report the epidemiological features and laboratory results of 1,352 cases of fungal keratitis diagnosed at the L.V. Prasad Eye Institute (LVPEI) in south India.Methods.The medical and microbiology records of 1,352 culture proven cases (1,354 eyes) of fungal keratitis diagnosed at the LVPEI between January 1991 to December 2000 was retrospectively reviewed for demographic features, risk factors, seasonal variation, and laboratory findings.Results.Males (962) were affected significantly more (p< 0.0001) than females (390). Of 1,352 patients, 853 (64.4%) were in the younger age group (16–49 years). Ocular trauma predisposed to infection in 736 (54.4%) of 1,354 eyes. There was a higher incidence of fungal keratitis during the monsoon and winter than summer. A fungal cause was established by smears of corneal scrapings in 1,277 (95.4%) eyes. The potassium hydroxide preparation (KOH), Calcofluor white (CFW), Gram-, and Giemsa-stained smears revealed fungus in 1,219 (91.0%), 1,224 (91.4%), 1,181 (88.2%), and 1,139 (85.1%) eyes, respectively.Fusarium(506, 37.2%) andAspergillusspecies (417, 30.7%) predominated the hyaline fungal spectrum (1,133) andCurvulariaspecies (39, 2.8%) were the highest among the dematiaceous isolates (218).Conclusions.To the best of our knowledge, this review presents the epidemiological features and laboratory results of the largest series of fungal keratitis ever reported in the literature. Keratomycosis is predominant in young adults with trauma as the major predisposing factor. With fungal keratitis being a major ophthalmologic problem in the tropical regions of the world, data available on the epidemiological features of a large series would greatly help medical practitioners at primary and secondary health care centers in the management of the disease. A simple KOH preparation of corneal scraping alone is highly beneficial in confirming the diagnosis.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To examine the incidence of sporadic diffuse lamellar keratitis (DLK) in a large series of LASIK eyes and to suggest the hypothesis that the etiology of sporadic DLK differs from that of epidemic DLK.Methods.The incidence and severity of DLK was noted in 1352 consecutive eyes that had primary LASIK for myopia or hyperopia and 217 consecutive eyes that had LASIK enhancement.Results.Twelve of the eyes having primary LASIK had stage 1 DLK and 5 had stage 2 DLK (.9% total). No eyes had stage 3 or stage 4 DLK. Three of the 217 eyes (1.4%) that had LASIK enhancement had stage 1 DLK. The difference in the rate of DLK for primary LASIK compared with LASIK enhancement was not statistically significant (p= 0.69). All eyes responded to intensive corticosteroid therapy, with the addition of flap lifting and irrigation for the eyes with stage 2 DLK. Two of the eyes (one primary LASIK and one LASIK-enhancement) had implanted epithelial nests associated with the DLK. None of the cases of DLK occurred in eyes of patients who had surgery on the same operating day in this series. Two other eyes that had epithelial abrasions more than 3 months after LASIK or LASIK enhancement developed stage 1 DLK.Conclusions.Many cases of sporadic DLK, including cases associated with epithelial trauma after LASIK, are likely attributable to endogenous factors that trigger inflammation. One trigger is the release of epithelium-derived cytokines such as interleukin-1 that stimulate keratocytes to produce chemokines that are chemotactic to inflammatory cells. Cells likely accumulate at the interface because it is potential space, representing a path of least resistance for cell movement. Some sporadic cases may also be related to exogenous factors such as Betadine. Epidemic DLK is likely associated with exogenous factors that stimulate inflammation, such as endotoxin contaminating sterilizer reservoirs or detergents on instruments.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.We evaluated whether laser in situ keratomileusis (LASIK) was a safe and effective treatment for myopia and astigmatism after penetrating keratoplasty (PK).Methods.We performed a retrospective review of medical records of all the patients who underwent LASIK following PK at the University of Minnesota between January 1999 and March 2000.Results.Seventeen patients (20 eyes) underwent LASIK following PK between January 1999 and March 2000. Mean age of the patients at the time of LASIK was 37 years (range, 20–62). Keratoconus was the indication for PK in the majority of the eyes (73.7%). Anisometropia and/or contact lens intolerance was the indication for LASIK following PK. No intraoperative complications occurred. Following LASIK, the best spectacle-corrected visual acuity remained within 1 line of preoperative visual acuity in 94.7% of the eyes. The mean sphere was reduced by 3.93 diopters (80.0%) and the mean cylinder was reduced by 2.83 diopters (69.9%) from the preoperative values at the last follow-up visit. Uncorrected visual acuity became 20/40 or better in 73.7% of the eyes after LASIK.Conclusions.LASIK is a safe procedure in eyes in which PK has previously been performed. LASIK is effective in the treatment of myopia and astigmatism following PK.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.The purpose of the study was to investigate the recurrence-free interval after phototherapeutic keratectomy (PTK) in patients with corneal dystrophies resulting from an Arg124His (R124H) mutation of the Big-h3 gene.Methods.Patients with corneal dystrophy resulting from a genetically confirmed Big-h3 R124H mutation were examined with a slit lamp. The patients were divided into two groups on the basis of the mutation genotype, and the recurrence-free interval was analyzed.Results.In the 4 eyes of 3 homozygous patients, the mean (± standard deviation [SD]) recurrence-free interval was 9.5 ± 3.1 months, whereas in the 7 eyes of 4 heterozygous patients it was 38.4 ± 6.2 months. The former interval was statistically shorter than the latter (Kaplan–Meier survival analysis with log-rank test,p= 0.004).Conclusions.These results strongly suggest that the mutation genotype of Big-h3 gene determined the recurrence-free interval as well as the clinical picture after PTK. Therefore, PTK should be considered for patients with Big-h3 R124H corneal dystrophy, on the basis of the expected recurrence-free interval deduced from molecular analysis of the zygosity of the Big-h3 R124H mutation.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To determine a possible relationship between donor epithelial status on the first postoperative day after keratoplasty and the eventual health of the corneal surface.Methods.We analyzed 91 patients who underwent penetrating corneal transplantation between January 1998 and January 2000, monitoring the epithelial status of the corneas with fluorescein staining using slit-lamp biomicroscopy. Recipient pre- and postoperative variables and donor characteristics were recorded. Macroepithelial defects were classified into three groups according to the extent of the epithelial defect. The results on the first postoperative day were compared with the first and third operative month. Donor and recipient variables were compared with the epithelial status on the first and third month as well.Results.On the first postoperative day, 64.84% of the patients had epithelial defects, 10.99% had defects at the 1-month postoperative visit, and none had defects at the third month. Graft recipients with macroepithelial defects in the first postoperative month were older, had a higher prevalence of blepharitis, higher prevalence of inadequate eye hydration, and slightly increased corneal sensation compared with the group without epithelial defects; however, none of these trends were statistically significant. Patients with macroepithelial defects in the first postoperative month received older donor tissue, and the average preservation-to-surgery time was longer. These donor variables, however, were not significant statistically (pvalue >0.10) in determining outcome of the epithelial status at the first or third months.Conclusions.Our results suggest that the epithelial status on the first postoperative day is not predictive of surface integrity at 1-month postoperative (pvalue is 0.2676 for the likehood ratio test). The epithelial status on the first postoperative day is not predictive of the status of the third month after keratoplasty, because none of the 91 patients had epithelial defects after 3 months.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.The use of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) has increased as a method of assessing patients' impressions of their vision-specific quality of life. The purpose of this study was to assess the performance and test-retest repeatability of the 25-question format of the NEI-VFQ in patients with dry eye.Methods.The self-administered NEI-VFQ-25 was administered to 75 patients with dry eye on two occasions in a university-based optometry practice. Dry eye severity was assessed with use of the European criteria for dry eye. The weighted kappa statistic (&kgr;w) was used to evaluate test-retest repeatability of the NEI-VFQ-25 individual test questions, and the 95% limits of agreement and the intraclass correlation coefficients were calculated for the overall VFQ and subscale scores.Results.With use of the European dry eye criteria, 21.9% of participants were classified with moderate to severe dry eye. For the sample, the ocular pain subscale score was lower (indicating more ocular pain) than published normative values. Repeatability of individual NEI-VFQ-25 questions ranged from moderate to substantial (&kgr;wvalues: 0.42 [pain and discomfort] to 0.90 [stay home because of vision]). The intervisit mean (± standard deviation) difference in the overall VFQ score was −0.66 ± 4.26 (95% limits of agreement: −9.02, 7.69), and the intraclass correlation coefficient for the ocular pain subscale was 0.57.Conclusion.Patients with dry eye have lower ocular pain subscale scores. The repeatability of the overall NEI-VFQ score and the subscale scores was moderate to high, and it may be influenced by the number of questions in each subscale.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To understand the mechanism of corneal ulceration by characterizing the intracellular signaling pathways that regulate collagen degradation by corneal fibroblasts cultured in three-dimensional type I collagen gels. Specifically, the potential roles of protein kinase C (PKC) and protein kinase A (PKA) in collagen degradation were investigated.Methods.Rabbit corneal fibroblasts were cultured in three-dimensional type I collagen gels for 24 hours in the presence of plasminogen and in the absence or presence of activators or inhibitors of PKC or PKA. Degradation of collagen fibrils was then evaluated by measurement of released hydroxyproline, and the production of matrix metalloproteinases (MMPs) was assessed by gelatin zymography and immunoblot analysis.Results.The PKC activator phorbol 12-myristate 13-acetate (PMA) increased the extent of collagen degradation by corneal fibroblasts in a dose-dependent manner, with the maximal effect apparent at a concentration of 0.1 &mgr;M. The inactive analog 4&agr;-PMA had no effect on collagen degradation. The PKC inhibitor H-7 reduced the extent of collagen degradation by corneal fibroblasts in the absence or presence of PMA. Phorbol 12-myristate 13-acetate also increased the production of proMMP-1, -3, and -9 by corneal fibroblasts, whereas H-7 inhibited this effect. Neither the PKA activators 8-bromo-cAMP, isobutylmethylxanthine, and forskolin nor the PKA inhibitor HA1004 affected collagen degradation by corneal fibroblasts.Conclusion.These results demonstrate that PKC plays an important role in collagen degradation by corneal fibroblasts in three-dimensional type I collagen gels, whereas PKA does not appear to participate in this process.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID