摘要:

Purpose.To report the early clinical results of the first U.S. patients to undergo deep lamellar endothelial keratoplasty (DLEK) surgery for the treatment of endothelial dysfunction.Methods.Two patients with pseudophakia with Fuchs' endothelial dystrophy, under an Institutional Review Board-approved protocol, underwent replacement of the endothelium through a limbal, scleral pocket incision (DLEK). Their vision, pachymetry, and corneal map topography were measured in the early postoperative period and were compared with preoperative measurements.Results.Both patients had improvement in all parameters within 1 month after surgery, and corneal topography showed no significant change from before the surgery. The first patient's vision at 6 months was 20/40 (+2) with a 0.75-diopter (D) decrease in astigmatism and a normal pachymetry of 573 &mgr;m. The second patient's vision at 6 months was 20/40 (−2) with a 0.25-D increase in astigmatism and a pachymetry of 618 &mgr;m. Graft endothelial cell counts at 6 months were 1,692 and 2,631 cells/mm2, respectively.Conclusion.The DLEK procedure, with its absence of corneal surface incisions and sutures, preserves the preoperative topography and demonstrates good donor endothelial cell count and function early in the postoperative period. If interface clarity can be maintained, the potential advantages over penetrating keratoplasty in the treatment of endothelial dysfunction are considerable.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To compare the process of conjunctival epithelial regeneration after three types of pterygium excision procedures.Methods.Thirty-eight patients (45 eyes) with primary pterygium were randomly assigned to a bare-sclera procedure (group 1, 15 eyes of 12 patients), bare-sclera with intraoperative mitomycin C (MMC 0.02% for 30 seconds; group 2, 15 eyes of 14 patients), or pterygium excision with conjunctival autografting (group 3, 15 eyes of 12 patients). Controls were healthy fellow eyes and seven eyes of age-and sex-matched subjects. Impression cytology was performed preoperatively, at 1 and 2 weeks, and at 1, 3, 6, and 12 months after surgery. The nucleus-to-cytoplasm (N/C) ratio of nongoblet epithelial cells and goblet cell density (GCD) in the pterygial area were calculated and compared over time across treatment groups.Results.Pterygium excision wounds healed in a similar four-stage process in all groups, but at different rates and with different final results. The N/C ratio was highest at about 1 month postoperatively in groups 1 and 2 and at 2 weeks in group 3, before gradually returning to control levels. Preoperatively, the GCD in treated eyes was almost twice that in control eyes (p= 0.001) but fell to zero immediately postoperatively. Goblet cells first appeared (with the most rapidly increased density) in group 3, followed by group 1. At 12 months, the mean GCD in groups 1 and 3 were not significantly different from those in controls, whereas the mean GCD in group 2 was still less than that of control (p= 0.02).Conclusions.Healing of conjunctiva is delayed by MMC and is promoted by autografting. Even 1 year after surgery, the ocular surface remains abnormal with respect to epithelial phenotypes in eyes treated by any of the three techniques.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To describe the technique, outcomes, and complication rates for a method of pars plana vitreous aspiration to control excessive vitreous pressure during penetrating keratoplasty.Methods.All cases of penetrating keratoplasty were reviewed retrospectively in a large cornea subspecialty private practice over a 5-year period, and 70 cases of penetrating keratoplasty complicated by excessive posterior pressure were identified. Study eyes were treated with a pars plana vitreous aspiration technique to relieve excessive posterior vitreous pressure. The main study parameters included preoperative best corrected visual acuity (BCVA), postoperative BCVA at the last recorded follow-up visit, refractive cylinder at 1 year, complications related to surgery, and other conditions that may have influenced visual function. The mean follow-up period was 24.5 months with a range of 1 to 61.1 months.Results.Adverse outcomes during the extended period of follow-up included rejection in 11 of 70 eyes, graft failure in 7 of 70 eyes, glaucoma in 4 of 70 eyes, and postoperative cystoid macular edema (CME) in 5 of 70 eyes. Posterior capsulotomies using the neodymium–yttrium aluminum garnet laser were necessary in 10 of 70 patients during the follow-up period. The average magnitude of refractive astigmatism at 1 year after surgery was 3.73 diopters (D) with a range of 0 to 8 D. There were no known retinal complications other than CME and no complications that could be directly attributed to the pars plana vitreous aspiration technique.Conclusions.Pars plana anterior vitreous aspiration is a safe and effective technique for controlling increased vitreous pressure, which can complicate penetrating keratoplasty.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To quantitatively evaluate the condition of the eyelid skin of patients with atopic blepharitis, their symptoms were scored and the water content of the skin and evaporation from the skin were measured.Methods.Forty patients with atopic blepharitis were examined. The condition of eyelid skin (erythema, edema/papulation/oozing/crust, excoriation/lichenification) was scored from 0 to 3 points. Water content and water evaporation were measured with a Moisture Checker and an evaporimeter, respectively. Eleven age-matched volunteers without atopic disorders were recruited as normal controls.Results.The Moisture Checker values and water evaporation from lid skin were significantly correlated (r= −0.44,p= 0.006). The Moisture Checker values of the patients with atopic blepharitis was 35.5 ± 8.2% (44.7 ± 10.6% in the normal controls,p= 0.009), and water evaporation from their lid skin was 3.6 ± 0.9 g/cm2per second (2.0 ± 0.3 g/cm2per second,p< 0.001); then, the patients were divided into four groups, from “asymptomatic” to “severe,” according to the sum of their blepharitis scores. Patients with lower blepharitis scores tended to have higher Moisture Checker values and lower water evaporation values.Conclusion.Scoring of eyelid condition enabled us to objectively estimate the severity of atopic blepharitis. Measurements of the water content of lid skin and water evaporation from lid skin are useful in evaluation of the severity of this disease.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.The aim of this study was to detect and identify bacterial contaminants in human corneoscleral tissue after organ culture storage.Methods.Seventy-two corneoscleral rims and corneal buttons trephined from organ cultured corneoscleral discs using aseptic technique and 45 organ-cultured donor corneoscleral rims postpenetrating keratoplasty) were subjected to a mechanical extraction technique using a Stomacher laboratory blender. As a control, 28 of the corneoscleral rims and buttons were halved; one half of each corneoscleral rim and button was decontaminated in formalin for 48 hours before thorough washing in balanced salt solution. Corneal specimens, culture medium, and transport (5% dextran) medium were cultured in brain–heart infusion broth at 37°C for 5 days. Bacterial isolates were identified after culture of turbid enrichment broth.Results.Bacterial contamination was demonstrated in 29% (21 of 72) of the corneoscleral rims and 15% (11 of 72) of the corneal buttons that were trephined aseptically from corneoscleral discs and in 29% (13 of 45) of postkeratoplasty corneoscleral rims. Bacterial contaminants were not isolated from controls. Isolated microorganisms included coagulase-negativeStaphylococcus,Staphylococcus aureus,Streptococcus viridans,Pseudomonassp, andBacillussp. A correlation was not demonstrated between contamination and cause of death, death to enucleation, death to culture time, or time in culture. Postkeratoplasty endophthalmitis was not evident in the patients who had received corneal buttons from those corneoscleral discs that had contaminated corneoscleral rims.Conclusions.Bacterial contamination exists in corneoscleral tissue after organ culture storage. The difference in distribution of bacteria and percentage of contamination between the peripheral and central corneas causes us to question the value of routine postpenetrating keratoplasty corneoscleral rim cultures.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To assess the effect of long-term, daily-wear soft contact lenses and rigid gas permeable (RGP) contact lenses on corneal sensitivity using a noninvasive, air-pulse stimulus.Methods.The central and peripheral (temporal, medial, inferior) corneal sensation thresholds of 40 non-lens wearers, 40 soft lens wearers, and 40 RGP lens wearers were assessed using the Non-Contact Corneal Aesthesiometer (NCCA). The individuals who wore contact lenses were grouped according to the number of years of lens wear (10 years or less, 11–20 years, and 21 years or more).Results.Although a significant reduction in corneal sensitivity was found between the contact lens wearers and non-lens wearers (p= 0.000), no difference was found between the two lens-type subgroups (p= 0.939). This pattern of significance was repeated at each of the peripheral test locations. No relationship between corneal sensitivity and years of lens wear was found centrally (r2= 0.004) or at any of the peripheral test locations. No significant difference was found between the central corneal sensation thresholds for the different subgroups of lens wear duration (p= 0.469) or for any of the peripheral test locations.Conclusions.Both soft and RGP lens wear produce a similar type of corneal sensitivity loss, although the mechanism for this loss is different for the two lens types. The extent of sensitivity loss is not related to the duration of lens wear and appears to plateau after the first few months of wear. No topographical variation in sensitivity loss was found with lens type or with the duration of lens wear.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To investigate gender-and age-related differences in the corneal topography of a normal population.Methods.One hundred thirty-two topographic examinations were collected from 100 patients ranging in age from 23 to 83 years (average, 57.35 ± 17.38 years). Data were segregated by gender and further divided into younger (less than 50 years) and older (50 years or more) age groups. The topographic indices of Surface Regularity Index, Surface Asymmetry Index, Irregular Astigmatism Index, Standard Deviation of Corneal Power, Corneal Eccentricity Index, Coefficient of Variation of Corneal Power, Simulated Keratometry 1 and 2, and Average Corneal Power were examined. The astigmatism pattern and corneal irregularity were determined and compared with respect to gender and age.Results.The corneas of older men were flatter than those of older women (p< 0.001). The vertical corneal meridian, but not the horizontal meridian, showed statistically significant gender-related changes with aging (p< 0.001). Older men had a significantly higher potential for against-the-rule astigmatism than women (p< 0.001). Corneal irregularity (measured in terms of the Surface Regularity Index and Irregular Astigmatism Index) increased with age (p< 0.001 andp< 0.001, respectively), although there was no gender-related difference. In the younger group, no gender-related differences in corneal curvature or astigmatism pattern were found.Conclusion.Aging influences changes in patterns of astigmatism differently in men and women. Decreases in levels of sex hormones may play a role in gender-related changes in corneal structure with age.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.Testing for the p24 antigen of the human immunodeficiency virus (HIV) may detect early HIV infection in the seronegative window; however, falsely reactive results may occur in cadaver specimens. Although neither the Food and Drug Administration (FDA) nor the Eye Bank Association of America requires p24 testing of cornea donors, many tissue banks using other organs from cornea donors do perform this assay, and the FDA requires that eye banks reject corneal tissue if a reactive p24 assay is reported. We investigated the impact of p24 testing on eye banking and corneal transplantation.Methods.Two clinical cases and records from the Lions Eye Bank of Delaware Valley (LEBDV) were reviewed retrospectively.Results.Two corneas from the LEBDV were transplanted before the reporting of p24 reactivity by other tissue banks. In one case, because of the young age of the recipient, the surgeon elected to replace the cornea with new tissue hours after the original transplant, and later polymerase chain reaction (PCR) testing was negative. In the other case, there was not enough specimen to perform Western blot or PCR confirmatory testing. The patient was followed with periodic serologic testing for HIV and has remained seronegative. To avoid such problems in the future, the LEBDV initiated testing of all donors with p24 and other nonrequired screening tests. Over a 2-month period, 22 corneas (from 11 donors) were discarded because of these tests: 4 donors had reactive p24 tests, 6 were reactive for antibody to hepatitis B core antigen, and 1 had a reactive syphilis test.Conclusions.Results from p24 assays by other tissue banks may cause difficult clinical situations when the results are received after transplantation of the tissue, but the use of the p24 assay in the screening of cornea donors may result in excessive waste of donor tissue. Further guidance is needed regarding the management of positive results from this and other nonrequired screening tests.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To determine the optical coherence tomographic (OCT) characteristics of normal corneas and to characterize the OCT images of abnormal corneal lesions.Methods.Eleven eyes from 10 patients were examined at the Cornea Service of the Nagoya University Hospital: 4 had corneal pathologies, 4 underwent keratoplasty, and 2 were normal controls; 1 enucleated eye was also examined. OCT (OCT 2000 Zeiss-Humphrey) was used to study the normal cornea and various corneal abnormalities. We compared the OCT images to the observations made by slit-lamp biomicroscopy.Results.Fluid spaces were detected as black images. A highly reflective reflex was observed at the interface of different tissues, and intensive backscattering (reflex) was seen when the incident ray hit the laminated layers vertically. Corneal opacities were not clearly imaged when they were diffuse and mild, or when they were arranged axially in a small area, as was the scar of the graft–host junction. It was possible to obtain images from the region of the cornea that was not clearly visible by slit-lamp examination because of a corneal opacity.Conclusion.OCT is a noncontact and noninvasive technique that can be performed safely on diseased corneas. OCT can provide objective documentation of corneal disorders that cannot be obtained by slit-lamp examination. The use of OCT in conjunction with other conventional instruments should provide a more complete image of the cornea.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Purpose.To identify changes in number of contact lens–related corneal ulcers per year and the type of contact lenses involved.Methods.Charts of 299 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from January 1, 1996, to June 30, 1999, were retrospectively reviewed. A corneal ulcer was defined as an infiltrate that was treated at least hourly with topical fortified antibiotics or fluoroquinolones.Results.Of these 299 cases, 37 (12.4%) were related to contact lens use. Contact lens–related ulcers accounted for 10.7% of all corneal ulcers in 1996, 15.3% in 1997, 8.6% in 1998, and 18.2% in the first 6 months of 1999. The contact lenses most commonly associated with ulcers were conventional soft daily-wear contact lenses (33%). There were similar numbers of ulcers associated with extended wear (n= 16) and daily wear (n= 17) of soft contact lenses. In addition, the number of cases associated with conventional (n= 17) and disposable/frequent replacement (n= 16) lenses were similar. Corneal cultures were performed in 15 (40.5%) cases and were positive in 8. There has been a significant decrease in the number of contact lens–related ulcers treated at our institution compared with previous years (1988–1999,p< 0.01).Conclusions.The number of contact lens–related corneal ulcers in the past 4 years was significantly fewer than previous years at our institution. A similar number of ulcers were associated with conventional and disposable/frequent replacement lenses despite the commercial preponderance of the latter type of lenses.

ISSN:0277-3740    

出版商:OVID    

年代:2001

数据来源: OVID