摘要:

Purpose.To present a small kindred with a unique dominantly inherited corneal stromal dystrophy.Methods.A 31-year-old man was noted to have bilateral, symmetric, central discoid corneal stromal opacification. We performed bilateral penetrating keratoplasties for decreased visual acuity, glare, and photophobia.Results.Light microscopy revealed multiple extracellular vacuoles, concentrated in the anterior one-half of the central corneal stroma. Material within the vacuoles demonstrated intense reactivity with alcian blue and colloidal iron stains, consistent with glycosaminoglycan deposition. Transmission electron microscopy demonstrated nonmembrane-bound vacuoles in the stroma that contained a faintly osmiophilic matrix and black circular profiles. Immunohistochemical analysis of the vacuolar deposits revealed that chondroitin sulfate was the primary glycosaminoglycan present. A clinical and serologic evaluation revealed no evidence of a systemic storage disorder. Genetic analysis did not reveal a mutation in the coding region of the CHST6 gene.Conclusions.Given these unique clinical and histopathologic findings as well as nearly identical clinical findings in the patient's father and one of four brothers, the authors believe that this represents a previously unreported, dominantly inherited corneal stromal dystrophy.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.We investigated whether a portable, hand-held topography unit could be used to measure corneal topography either at the donor site or in the laboratory and whether the technology could be used to screen donor eye tissue for prior refractive surgery.Methods.The corneal topography of 22 eyes of 12 normal donors was measured with the Keratron Scout portable topography machine before and after whole-eye enucleation. Field and laboratory measurements of central curvature, astigmatism, and the difference between the corneal curvature at the 7-mm and the 3-mm zone were compared. The 7-mm and 3-mm zone curvature differences were also used to screen for eyes that had undergone refractive surgery.Results.The mean central curvature of the normal eyes in the field [43.28 ± 1.58 diopter (D)] was not significantly different from the mean curvature in the laboratory (43.52 ± 1.72 D;p= 0.20). Field and laboratory astigmatism was 2.02 ± 1.13 D and 1.64 ± 1.38 D, respectively (p= 0.26, not significant). The eyes had a normal prolate shape, with the corneal power less in the periphery than in the center (mean difference between the 7-mm and 3-mm zone of −1.48 ± 0.83 D in the field and −1.77 ± 0.73 D in the lab;p= 0.069). Field and laboratory measurements of corneal shape correlated well with each other. Eight of eight eyes with refractive surgery for myopia and one of two eyes with hexagonal keratotomy for hyperopia were outside 2 SD of the normal range.Conclusion.The Scout can be used to measure corneal topography at the donor site and in the eye bank laboratory with comparable results. Regional power differences between the corneal periphery and center could be used as a method for screening donor eyes for prior refractive surgery.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To compare the accuracy of several techniques for calculating intraocular lens (IOL) power after laser in situ keratomileusis (LASIK).Methods.Retrospective review of 10 eyes from nine patients undergoing phacoemulsification after LASIK. Corneal power (K) was measured by manual keratometry (MK), refractive history (RH), contact lens overrefraction (CTL), videokeratography (VK), and an average of the refractive history and contact lens methods (AVG 2). Results were compared with the back-calculated K value generated by the Holladay IOL Consultant program. Age-matched patients undergoing phacoemulsification without previous refractive surgery served as controls.Results.Mean spherical equivalent postoperative refraction was +0.21 diopter (D) (SD, 1.54; range, −2.25 to +2.25 D) for patients undergoing cataract extraction after LASIK versus −0.56 D (SD, 0.66; range, −2.375 to +0.5 D;p= 0.16) for controls. Thirty percent of cases versus 90% of controls were within 1 D (p= 0.002) of emmetropia. Forty percent of cases versus no controls were more than 1 D hyperopic (p= 0.08). The mean differences for each method compared with the back-calculated K values were MK, +0.82 D; VK, +1.24 D; RH, −0.76 D; CTL, +0.91 D; AVG 2, +0.08 D. The mean absolute deviations from the back-calculated K values were MK, 1.91 D; VK, 2.01 D; RH, 1.68 D; CTL, 1.62 D; AVG 2, 1.42 D.Conclusion.Significant refractive errors occurred with each of the methods investigated for determining IOL power after LASIK. RH, CL, or AVG 2 provided the most accurate results.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To examine the immediate effect of ocular rubbing on corneal topography.Methods.Corneal topography and analysis were performed before, immediately after, and 5 minutes after eyelid rubbing in 29 volunteers without ocular disease.Results.The surface regularity index increased from a baseline of 0.24 to 0.91 (p< 0.0001) immediately after rubbing and returned to baseline after 5 minutes. The surface asymmetry index increased from 0.27 to 0.89 (p= 0.0018) immediately after rubbing. There was a small amount of astigmatism induced immediately by rubbing (0.5 diopter) (p= 0.01).Conclusions.Ocular rubbing should be avoided prior to standard corneal topography. The increased surface regularity index may reflect the alterations of the tear film and/or the molding of the corneal surface.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To evaluate the incidence, risk factors, management, and visual outcome of postoperative glaucoma in comparison with preexisting glaucoma in repeated corneal transplantation.Methods.The charts of all the patients who underwent repeated corneal transplantation between 1985 and 1998 were reviewed for the occurrence of preexisting and postoperative glaucoma. Eighty patients underwent 122 repeated corneal transplantations, of which six underwent surgery in both eyes. The mean follow-up period from the primary keratoplasty was 89.5 months and the minimal follow-up period was at least 6 months after the last transplantation.Results.Postoperative glaucoma affected 29 eyes (34%) in 28 patients (35%) with repeated corneal transplantation. Herpetic scar as an indication for transplantation and a history of previous immune graft rejection were more common in patients who developed postoperative glaucoma compared with the entire regrafted group (p= 0.016 andp< 0.001, respectively). The incidence of glaucoma usually increased with the increased number of keratoplasties. The following types of glaucoma were disclosed: closed angle (59%), corticosteroid induced (21%), open angle (11%), angle recession (3%), aqueous misdirection (3%), and unknown cause (3%). Surgical intervention was required in 62%. Glaucoma was controlled in nine eyes (31%) and resolved following regrafting or discontinuation of corticosteroids in four eyes (14%), of which five (17%) had clear regrafts. Better intraocular pressure control was achieved in those cases that did not require surgical intervention (p= 0.019). In 15 eyes (52%), regrafts failed due to uncontrolled glaucoma and/or other causes. At the end of the follow-up period, visual acuity was 20/30 to 20/200 in 17%, counting fingers from less than 20 ft in 31%, hand movement/light perception in 35%, and no light perception in 17%. Six of the 86 eyes (7%) in six patients (7.5%) had preexisting glaucoma. Graft clarity and glaucoma control in patients with preexisting glaucoma were similar to those of postkeratoplasty glaucoma (50% had controlled glaucoma and 33% had clear regraft).Conclusions.Glaucoma, either preexisting or postoperative, is one of the most devastating complications of repeated corneal transplantation and the cause for regraft failure and visual loss even when intensively treated. Close monitoring and early targeted therapy are warranted to increase the survival of repeated corneal transplants in eyes affected by glaucoma.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To evaluate the safety and efficacy of intraoperative daunorubicin during a bare sclera procedure in primary pterygium surgery and to compare with conjunctival autograft.Methods.The data for 84 patients who underwent pterygium surgery at Safdarjung Hospital and Guru Nanak Eye Center were analyzed retrospectively. The patients were divided into two groups: group A, those who underwent bare sclera excision along with conjunctival autograft, and group B, those who underwent bare sclera excision with intraoperative daunorubicin (0.02%) for 3 minutes. We evaluated pterygium recurrence and postoperative complications for both groups. Recurrence of pterygium was defined as growth of 2 mm of fibrovascular tissue over the corneoscleral limbus into the clear cornea in the area of previous pterygium excision.Results.Follow-up ranged from 18 to 37 months (mean, 27). Recurrence rates of 8.33% (three of 36) and 7.14% (three of 42) were found in groups A and B, respectively. When compared statistically, the difference was not significant. All the recurrences occurred in patients younger than 30 years of age. Pyogenic granuloma, graft edema, loose graft, and dellen formation were seen, respectively, in 5.5% (two of 36), 2.77% (one of 36), 2.77% (one of 36), and 2.77% (one of 36) patients in group A. Nine of 42 (21.42%) patients in group B had chemosis of the conjunctiva and two of 42 (4.76%) had delayed epithelization.Conclusion.We conclude that intraoperative daunorubicin (0.02%) and conjunctival autograft are both equally effective adjuncts to pterygium surgery.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To evaluate patients' self-assessment of their symptoms and cosmetic appearance after fluorescein-potentiated argon laser treatment (FPAL) for corneal inflammation associated with neovascularization. To describe the objective effects of FPAL therapy on established corneal neovascularization with secondary corneal edema and lipid keratopathy.Methods.Fifteen patients with corneal neovascularization resulting from various infectious and traumatic etiologies were enrolled in an open, nonrandomized pilot study. Treatment consisted of repeated sessions of intravenous fluorescein, a photosensitizer, combined with blue-green argon laser applications to abnormal corneal vessels. Patients completed a written survey to grade their symptoms and cosmetic appearance prior to treatment and at the end of the follow-up period. Objective changes in signs after FPAL treatment were described by two nonmasked ophthalmologists after slit-lamp examinations and review of serial corneal photographs.Results.Clinical symptoms of blurred vision (p≤ 0.003), photophobia (p≤ 0.03), and cosmetic appearance (p≤ 0.02) were found to be significantly improved by the patient's subjective assessment survey. There was a trend toward pain reduction (p≤ 0.06) but no apparent reduction in tearing or foreign body sensation (p≤ ns). Objective signs of corneal edema, neovascularization, and lipid keratopathy appeared to be reduced after FPAL therapy.Conclusion.FPAL therapy for corneal neovascularization, edema, and lipid keratopathy resulted in a significant reduction in symptoms and improved quality of life for 14 of 15 (93%) patients. A controlled clinical trial to confirm the reported improvement in signs observed in this pilot study should be considered.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To describe the histopathology of familial, band-shaped, spheroidal keratopathy in ethnic Chinese siblings. New histopathologic findings are presented that may shed light on the etiology of this rare and unique condition.Methods.Three ethnic Chinese siblings in Urumqi, People's Republic of China, were examined. One brother and sister had spheroidal, amber-colored droplets in the superficial, central corneal stroma. Each had a diffuse gray haze and thickening of the peripheral corneal stroma. A histopathologic study of penetrating keratoplasty specimens was performed. Another sister had only thickening and haze of the corneal stroma.Results.Typical spheroidal deposits in the superficial stroma were demonstrated. One cornea had vascularization and amyloid deposition. One cornea had loss of endothelial cells and a thickened Descemet's membrane.Conclusion.Neovascularization and amyloid deposition are likely secondary phenomena in this familial disease. A new clinical finding is the hazy, thickened stroma. New pathologic findings are the loss of endothelial cells and the marked thickening of Descemet's membrane. An endothelial cell dystrophy may accompany familial, band-shaped, spheroidal keratopathy.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To report the effect of topically applied ketotifen fumarate in the treatment of superior limbic keratoconjunctivitis (SLK).Methods.Five patients with clinical findings of bilateral SLK with no relief of symptoms with standard reported modalities of treatment were treated with topical ketotifen fumarate twice daily in both eyes. All patients were evaluated 2 to 4 weeks after initiation of treatment of symptomatic and clinical improvement and at regular intervals thereafter.Results.Topical ketotifen provided immediate relief of ocular symptoms in all patients. In one patient, the response was long lasting, whereas in the other four, it was temporary, lasting 1 to 3 months. The objective signs, however, did not necessarily correlate with the subjective improvement.Conclusions.Ketotifen fumarate can be effective at least in the short to medium term in the management of SLK. Although the mechanism of action of ketotifen remains unclear, this preliminary experience further supports the use of agents with mast cell-stabilizing activity in the treatment of SLK.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To study the effect of autologous serum in the treatment of recurrent corneal erosions.Methods.Eleven eyes of 11 consecutive patients with acute macroform corneal erosions who had suffered several relapses despite receiving different types of treatment were analyzed from November 2000 to February 2002. All patients were treated with autologous serum for 3 months.Results.Mean follow-up time was 9.4 ± 3.7 months (range, 4–16). No side effects were noted in any of the treated patients. Treatments prior to the use of autologous serum had failed to avoid recurrences in all the patients, with the mean recurrence rate being 2.2 recurrences per month of follow-up. After the onset of serum treatment, only a single recurrence was recorded in three of the patients (0.028 recurrences per month of follow-up).Conclusion.The use of autologous serum for the treatment of patients with recurrent corneal erosion is effective and safe in reducing the number of recurrences experienced by patients.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID