摘要:

Our objective was to evaluate the effect of ABO antigen blood-group compatibility on corneal allograft rejection. The 199 penetrating keratoplasties performed between 1985 and 1994 were analyzed retrospectively for ABO compatibility and the occurrence of irreversible allograft rejection. Of these, 72 were considered high-risk transplants, as there was significant vascularization of the recipient cornea or a history of irreversible corneal allograft rejection or both. One hundred twenty-seven were low-risk transplants. The data were analyzed by using the Kaplan-Meier method and compared with the log-rank test. Overall, the estimated 1-year graft survival was 83.9% in the low-risk group and 61.4% in the high-risk group (p= 0.001). The estimated 1-year rejection-free graft survival was 89.8% in the low-risk group and 67.1% in the high-risk group (p= 0.0002). In the high-risk group, graft survival (p= 0.008) and rejection-free graft survival (p= 0.0002) were higher in the ABO-compatible subgroup than in the ABO-incompatible subgroup. In the low-risk group, graft survival and rejection-free graft survival of the ABO-compatible and ABO-incompatible subgroups were similar. ABO compatibility may be effective in preventing irreversible allograft rejection in high-risk recipients.

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We sought to identify the types of, prevalence of, and predisposing factors for the development of surface keratopathy after penetrating keratoplasty. We reviewed the records of 120 corneal grafts performed over a 15-month period. Twenty patients were excluded from the study. Fifty-three men and 47 women composed the group studied. All transplants were performed by the same surgeon. Retrospective data from patients' records were gathered preoperatively and from postoperative visits at 1 week and at 1,2, 3, and 4 months. Data included preoperative medical and demographic data, operative time, postoperative medication regimens, assessment of the presence and degree, if present, of punctate epithelial keratopathy (PEK), hurricane keratopathy, macroepithelial defects, microcystic edema, bullous edema, and filamentary keratitis. In addition, information on the donor material was recorded. Surface disease and normal groups were compared to identify risk factors for the occurrence of surface abnormalities. Thirty-three of the patients demonstrated persistent surface abnormalities. Coarse PEK was the most common surface abnormality in the sample studied and was most prominent in the first week after surgery. Postoperative surface keratopathy was not statistically associated with preoperative diagnosis, donor age, death-to-preservation time, preservation-to-surgery time, or donor epithelial status. However, corneal recipients in the group with surface keratopathy were significantly older (mean, 68.7 years) than patients in the group with no surface abnormalities (mean, 52.6 years; Mann-WhitneyUtest,p< 0.001). Although many factors may contribute to the normal integrity of the corneal surface after keratoplasty, recipient age is of key importance in the development of surface disease

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. Viscoelastic-induced ocular hypertension following penetrating keratoplasty (PK) may result in endothelial cell loss and optic nerve damage. Methods: In a prospective, randomized, masked trial, two doses of oral sustained-release acetazolamide were compared to a single dose of topical 0.5% timolol gel after 40 PKs. Results:: The mean preoperative intraocular pressure (IOP) was 17.4 mm Hg for the oral acetazolamide group and 16.7 mm Hg for the timolol gel group. The mean IOP on the first postoperative day was 17.9 mm Hg with oral acetazolamide and 12.9 mm Hg with timolol gel. One patient developed significant adverse reactions with oral acetazolamide: there were no adverse reactions with timolol gel. Conclusion: Prophylactic use of timolol gel for viscoelastic-induced ocular hypertension after PK appears to offer better IOP control than oral acetazolamide, with potentially fewer adverse systemic effects

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We studied the indications for keratoplasty and their changes during 30 years in Israel by retrospective evaluation of pathologic records of 1,018 corneal buttons (from 1961 to 1990). The population included 634 (62.3%) male patients and 384 (37.7%) female patients. Keratoconus (n = 222, 21.8%) was the most common indication, followed by corneal graft failure (n= 113, 11.1%), herpetic infections (n= 95, 9.3%), ocular trauma (n= 87, 8.5%), scarring (n= 74, 7.3%), pseudophakic bullous keratopathy (n= 72, 7.1%), nonherpetic infections (n= 71, 7.0%), and other indications. Whereas ocular infections were the most common indications for keratoplasty before 1970, keratoconus has been the most common indication since 1970. Pseudophakic bullous keratopathy became the second most common indication (13.8%) between the years 1981 and 1990. The number of keratoplasties increased in Israel during the past three decades, and the low percentage of pseudophakic bullous keratopathy is related to the types of intraocular lenses that we implanted in the late 1970s and the early 1980s

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We sought to determine whether there are unique findings in infectious crystalline keratitis (ICK) examined by con-focal microscopy and if confocal microscopy is predictive for bacteriology in ICK. A retrospective review of consecutive patients with a presumed diagnosis of ICK by slit-lamp examination was performed. These patients were then examined with confocal microscope and cultured. Sixteen patients were identified by biomicroscopy. Average age was 71 years; 12 of 16 patients were women; 10 of 16 had prior penetrating keratoplasty; and 12 of 16 were taking topical steroids. Confocal microscopy revealed a variable appearance to the crystals in the corneal stroma. Eight of 16 patients had distinct needle-like deposits at varying depths in the stroma. and eight had amorphous deposits grouped at different levels of the stroma. The results of confocal microscopic examination resembled the reported histopathology with clusters of deposits, but its current resolution does not allow identification of bacterial morphology. There was no correlation of morphology with culture results. Organisms were recovered in 12 of 16 patients by culture. In 10 of 16 patients, the infection was successfully treated with topical antibiotics, usually cefazolin. Crystal morphology of ICK can be observed by confocal microscopy. No pathognomonic, single pattern for this disease is seen with the confocal microscope. The latter may be an aid in determining the clinical response to treatment

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Confocal microscopy provides a new, noninvasive way of imaging the human cornea in vivo. One of its most important clinical uses is the diagnosis and management of infectious keratitis. The authors used tandem scanning confocal microscopy to image the corneas in two culture-proven cases of Aspergillus keratitis. Fungal hyphae were imaged as high-contrast filaments 6 μm in diameter from 60 to 400 μm in length. Confocal microscopy may be a fast and safe diagnostic tool in determining the presence of fungal hyphae in vivo within the human cornea

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Congenital entropion is a rare eyelid anomaly that can cause chronic corneal erosions or ulceration. The diagnosis may be easily overlooked by both the pediatrician and the ophthalmologist, particularly when the lids are tightly closed in the crying child. We present three cases of congenital entropion associated with corneal ulceration. Each patient underwent a complete ophthalmologic examination. Examination under anesthesia, including corneal scrapings for culture and photography, was performed before surgical repair of the entropion. There were two cases of lower lid entropion and one case of upper lid entropion. In all three cases symptoms were present since birth, and the diagnosis was overlooked by the treating pediatrician. Corneal ulceration ultimately developed in all three cases. Cultures revealedStaphylococcus aureusin one case, and coagulase negativeStaphylococcusin another case. Cultures were negative in one case. In all three patients the ulcers healed rapidly after surgical entropion repair. Congenital upper or lower lid entropion is an uncommon condition that does not spontaneously improve and is an important cause of corneal ulceration in infants. Recognition of this condition is often difficult, and early surgical intervention to repair the lid deformity may help to avoid permanent corneal scarring and visual loss

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The trisomy 8 mosaic syndrome (Tr8MS), karyotype 46,XY/47,XY, + 8, is a rare multisystem disorder that may be associated with corneal opacity. We report the case of a dysmorphic infant with multiple congenital abnormalities referred to our unit with a congenital corneal opacity. Subsequent chromosomal analysis of peripheral leucocytes demonstrated constitutional Tr8MS. At 4 years of age, lamellar keratoplasty was performed. Histological examination confirmed the lesion to be consistent with a corneal choristoma. Cytogenetic studies using in situ hybridisation techniques showed the presence of trisomic cells in cell culture derived from the tissue in higher proportion (92%) than in the blood (44%). Amplification of thec-myconcogene on chromosome-8 could not be detected in cells cultured from the corneal lesion. Although not proof, these findings lend support to the concept of the corneal lesion representing a focus of viable trisomic cells rather than an inflammatory response to a nidus of effete cells

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose. To evaluate the effect of topical indomethacin 0.1% on signs and symptoms in inflamed pterygium and pinguecula. Methods. Fifty-one consecutive patients who had inflamed pterygium (n= 32) or pinguecula (n= 19) were studied in a randomized, double-masked, controlled way. Objective signs (conjunctival congestion, redness, edema, and staining of cornea) and subjective complaints (photophobia, pain, foreign-body sensation, discomfort, and tearing) were evaluated and scored. In addition, we evaluated total signs, total symptoms, and total score. Group I (n= 25) received topical indomethacin 0.1% solution and group 2 (n= 26) received a placebo six times daily for 3 days, then four times daily for 11 days. Patients were examined before and at days 3, 7, and 14 after the treatment began. Results. In group 1 at day 3, the scores of total signs, total symptoms, and total score decreased (p= 0.001), and they further decreased after 14 days (p= 0.02 top= 0.05). In group 2 at day 3 these parameters also significantly decreased (p= 0.01 top= 0.02), but no further improvement occurred after 14 days. Comparing groups I and 2 revealed a decrease in scores in group 1 for total signs, total symptoms, and total score at days 3, 7, and 14 (p= 0.03 top= 0.002) except for total signs after 14 days (p= NS). All the patients reported mild stinging for <1 min after administration of the drops. Conclusions. This study indicates that topical indomethacin solution 0.1% is a useful treatment for inflamed pterygium and pinguecula

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background. The efficacy and safety of excimer laser photoastigmatic refractive keratectomy (PARK) for treatment of astigmatism after penetrating keratoplasty (PKP) was evaluated in this study. Methods. A VisX 20/20 excimer laser was used to correct the regular astigmatic component of the grafts. The epithelium was removed manually in seven cases and in three patients with the PTK mode of the laser. The results were analyzed for uncorrected visual acuity (UCVA), best corrected acuity (BCVA), haze, and changes in the cylinder and axis. The vectorial change in astigmatism was measured using Alpins“ method. Results. Preoperative astigmatism ranged from 3.50 to 11.25 D (mean, 5.98 ± 2.28) and the mean attempted correction of astigmatism was 6.28 ± 1.56 D (range, 3.50–9.00 D). The induced reduction of net corneal astigmatism was 48.1%. The vector-corrected astigmatism, which was 6.40 ± 3.49 D at 1 month postoperatively, was reduced at 12 months to 4.28 ± 2.42 D. The Alpin Success Index varied in the range 0.06 to 1.0. Although the UCVA improved by ≥2 lines in 60% of the eyes, the BCVA decreased in 40% of the eyes and three patients required a reoperation. Conclusion. Although PARK is relatively safe and effective in reducing post-PKP cylinder and improves UCVA, the frequently and surprisingly late-developing corneal haze often impairs the BCVA

ISSN:0277-3740    

出版商:OVID    

年代:1997

数据来源: OVID