ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients.Methods.In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up.Results.Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens–Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 ± 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 ± 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant (p= 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid.Conclusion.Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only minor complications.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.(1) To determine the effect of myopic and hyperopic laser in situ keratomileusis (LASIK) on calculation of intraocular lens (IOL) power. (2) To determine a standard way to approach the IOL power determination after LASIK, and (3) To compare different suggested methods.Methods.Biometric analysis and theoretical calculation of IOL powers for eyes undergoing LASIK for myopia and hyperopia were performed.Results.Manual keratometry after LASIK for myopia resulted in underestimation of IOL power. Manual keratometry after hyperopic LASIK resulted in overestimation of IOL power. The amount of error was directly related to the amount of correction by LASIK.Conclusion.The pre-LASIK refraction can be used theoretically to determine an accurate IOL power.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.This study examines the contribution of ocular and systemic factors to diabetic keratoepitheliopathy.Methods.The presence and severity of keratoepitheliopathy was investigated in 114 eyes of patients with diabetes and 59 eyes of patients without diabetes. The ocular factors examined were the status of the lipid layer of the tear fluid assessed with the specular reflection video-recording system, corneal sensitivity using the Cochet–Bonnet method, tear volume by the cotton thread test, tear film stability by tear breakup time, and grade of diabetic retinopathy. The systemic factors examined included patient age, hemoglobin A1c value, and duration of diabetes mellitus. Multivariate regression analysis was performed to assess the factors related to keratoepitheliopathy.Results.The incidence of keratoepitheliopathy was 22.8% and 8.5% in patients with and without diabetes, respectively. Ocular measures, such as nonuniformity of tear lipid layer, corneal sensitivity, and tear breakup time, were significantly worse in patients with diabetes than in patients without diabetes (p< 0.05). Multivariate regression analysis showed that the status of the tear lipid layer was significantly relevant to diabetic keratoepitheliopathy (p< 0.05).Conclusion.Qualitative abnormalities in tear secretion seem relevant to the development of diabetic keratoepitheliopathy. The tear lipid layer interference pattern may yield useful information for the elucidation of the mechanism and treatment of diabetic keratoepitheliopathy.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To determine the efficacy and safety of topical autologous serum as a treatment of dry eye patients.Methods.A 2-month, prospective, single-masked, placebo-controlled study was conducted in patients with bilateral severe dry eye. One eye was randomized to receive the patient's own serum as a tear substitute, and the fellow eye received unpreserved normal saline solution as a placebo. Subjective symptoms and clinical parameters of dry eye including conjunctival impression cytology were assessed at baseline and 1 week, 1 month, and 2 months after treatment.Results.Twelve dry eye patients were enrolled. Both subjective symptoms (discomfort, foreign-body sensation, dryness, and photophobia), objective signs (fluorescein and rose bengal staining and conjunctival impression cytology) improved significantly in treated eyes compared with baseline. Control eyes also had improvement in symptoms, signs, and rose bengal staining compared with baseline. Neither Schirmer test results nor tear break-up time improved in either group. The means score of all parameters were improved in both groups, and the results of conjunctival impression cytology were better in treated eyes; however, these results are not significantly different. There were no serious adverse effects observed in this study.Conclusions.There was a trend toward improvement in symptoms and signs of dry eye including cytologic changes after application of autologous serum in severe dry eye patients. However, this trend was not statistically significant. A larger scale study is warranted.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To determine the efficacy of autologous serum drops in the treatment of superior limbic keratoconjunctivitis (SLK).Methods.Twenty-two eyes of 11 patients were diagnosed with SLK. All eyes were treated with 20% diluted autologous serum eyedrops 10 times a day in addition to ongoing treatment of dry eye. Fluorescein and rose bengal staining scores, as well as subjective symptom gradings, were performed before and after 4 weeks of therapy.Results.Nine of the 11 patients responded well to treatment (82%). The average rose bengal and fluorescein score improved (p< 0.05), and there was subjective improvement.Conclusion.Autologous serum application can be used as an alternative mode of therapy in SLK.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To compare the repeatability of fluorescein break-up time (FBUT) measurements determined with either a standard fluorescein strip or the Dry Eye Test (DET) modified fluorescein strip methods.Methods.This was a prospective, randomized contralateral study of 100 patients, in which FBUT measurements were determined with a standard FUL-GLO fluorescein strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) in one eye and a DET strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) for the contralateral eye. Three consecutive measurements were made immediately after fluorescein instillation. The second eye was evaluated 1 minute after completion of the first eye. Data from patients with FBUT values less than 20 seconds were included in the data analysis, because measurements greater than 20 seconds are not diagnostically significant.Results.Seventy-five patients met enrollment and FBUT measurement criteria. For three consecutive FBUT measurements, the DET values were within 3 seconds for 72 of the 75 patients (96%). Eighty percent of patients reported no sensation with the DET strip, 20% reported mild sensation, and no patient reported moderate sensation. With FUL-GLO strips, measurements were within 3 seconds for 53 of the 75 patients (71%) (p <0.005). The standard fluorescein strip method elicited reports of no sensation from 31% of patients, mild sensation from 60%, and moderate sensation from 9% (p <0.001).Conclusions.The DET strip provides a significant reduction in sensation upon application, improved single measurement reliability, and enhanced measurement precision, compared with a conventional fluorescein strip.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To study the incidence of suture-related complications following penetrating keratoplasty (PK) and their effect on the success of corneal grafting.Methods.The records of 332 patients receiving 361 grafts in 1993 and 1994 were reviewed, and suture-related complications were recorded. These complications were divided into five groups: suture erosions, infiltrates at the suture sites, infectious keratitis, loose sutures with imminent wound dehiscence, and wound dehiscence after suture removal.Results.Occurrence rates were suture erosions, 10.8%; infiltrates, 9.4%; infectious keratitis related to sutures, 3.3%; loose sutures with imminent wound separation in need of surgical repair, 8.3%; and wound dehiscence following suture removal, 2.4%.Conclusions.Suture-related complications frequently occur after PK. Infectious keratitis and wound separations needing surgical repair may lead to loss of best-corrected visual acuity due to scarring, induced allograft reactions, and/or increased astigmatism. Recommendations for post-PK suture management are proposed.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To evaluate subclinical inflammation and mucus production of the conjunctiva in asymptomatic contact lens (CL) wearers, and to obtain an estimation of the chronologic variations in each group.Methods.Eighteen eyes fitted with rigid CL (RCL) and 28 eyes with soft CL (SCL) worn daily were compared with 10 eyes from five healthy non-CL wearers. Impression cytology (IC) specimens were collected after clinical examination and were analyzed by flow cytometry using antibodies directed to HLA DR and intercellular adhesion molecule type 1 (ICAM-1) (CD 54), as inflammatory markers, and to the peptidic core of the conjunctival mucin (M1/MUC5AC) for mucus and goblet cell detection. The percentage of positive cells was calculated, and levels of fluorescence expression were quantified and compared between each group.Results.A significant increase of HLA DR and ICAM-1 was observed in the SCL group in comparison with the control group. The two inflammatory markers were highly positively correlated with each other. Mucin detection with M1/MUC5AC did not find a significant difference between each group in terms of percentage of positive cells, but analyses of mean levels of fluorescence showed a significant decrease in the two CL groups. Evolution in time was different for each group, with a regular low level of inflammation in the RCL group in the first 10 years in comparison with the SCL group. In the SCL group, inflammation seemed to be higher before 2 years and after 10 years of wear. Mucin expression was variable in time, but without significant difference at any time.Conclusion.This study confirms difference in expression of subclinical conjunctival inflammation in asymptomatic CL wearers, with lower levels for RCL than SCL wearers with daily or extended wear. The mucin system is also modified by this low but chronic aggression of the ocular surface, with a tendency to decrease with time in the RCL and SCL groups.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.Videokeratoscopes provide a wealth of information about the topography of the ocular surface. Although there have been numerous studies of the accuracy and precision of videokeratoscopes with inanimate test objects, little information exists on their precision (repeatability) for real eyes.Methods.To investigate the stability of the ocular surface in the inter-blink period, 10 patients were recruited for videokeratoscopy. Tear break-up time was measured and videokeratographs were acquired immediately post-blink and again at 4, 8, and 12 seconds post-blink. To permit statistical inferences to be drawn from the data, we acquired 24 videokeratographs for each of the four post-blink intervals. The videokeratograph data were interpolated (bilinear) to a common grid, and average and standard deviation (SD) maps were derived for each post-blink condition.tTests were used to test the significance of changes observed in the topography.Results.The instantaneous power SD maps showed increasing variation toward the periphery, with most maps showing less than ±0.5 diopters (D) of SD in the central 4 to 5 mm and variation in the periphery often reaching more than ±1 D SD at the edge of an 8-mm diameter. When the 4-, 8-, and 12-second average maps were subtracted from the average map acquired immediately after blinking, regions of statistically significant (p< 0.001) change were apparent in the upper and lower regions of the maps. The upper and lower bands of change were found to correlate with the natural position of the patients' lid margins.Conclusions.For normal eyes, the central regions of videokeratographs show high stability in the inter-blink period. However, the upper and lower edges of 8-mm diameter maps show statistically significant variability, which appears to be related to the effects of eyelid pressure.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID