摘要:

Purpose.To evaluate the prevalence of HIV seropositivity among patients with malignant conjunctival squamous cell carcinoma (SCC) and carcinoma in situ (CIS) and to reassess the potential linkage, albeit well documented, between ocular surface epithelial dysplasia (OSED) and HIV infection.Patients and Methods.A case-control design study was conducted in an African provincial hospital. Twenty-three African black patients underwent excisional biopsy of conjunctival malignant lesions. In 18 of these patients, ELISA for HIV antibodies was performed prior to the excisional biopsy.Results.Pathological evaluation revealed SCC in 12 (52%) patients, CIS in six (26%) patients, and Kaposi sarcoma (KS) in five (22%) patients. Eighteen patients (78.3%) agreed to take a serological HIV test, and among these, seropositivity for HIV was significantly (p< 0.01) higher (92.3%, 12 of 13) in the SCC/CIS subgroup than in a control group with benign conjunctival lesions (28.5%, two of seven). The most common (91.7%) clinical finding in the SCC/CIS/HIV group (12 patients) was corneal overriding. Conjunctival malignancy was the first presenting sign for AIDS in 50% of our patients.Conclusions.A significantly high rate of HIV seropositivity was found in a group of African black patients with conjunctival SCC/CIS compared with a control group with benign conjunctival lesions. The direct correlation between HIV infection and SCC/CIS was reconfirmed in a case-control study. Therefore, an HIV test should probably be performed in cases of conjunctival SCC/CIS or dysplasia, especially among patients in high-risk populations.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To study the corneal topographic patterns following three different types of single continuous suturing techniques in penetrating keratoplasty.Methods.One hundred forty-eight maps obtained from 40 patients who underwent penetrating keratoplasty with single continuous suturing were retrospectively analyzed at a tertiary eye care center. The videokeratograph maps were obtained on the Eye Sys System 2000 at 1, 3, and 6 months after surgery. Suture adjustment was done for cases with astigmatism greater than 3 diopters, and maps were also obtained after suture adjustment. The maps were classified according to the corneal profile and the astigmatic pattern seen in the topographic maps.Results.Combined prolate patterns were seen most frequently, and their proportion was significantly higher at 1 month (p= 0.009), 3 months (p= 0.0004), and 6 months (p= 0.0008). The simulated keratometric astigmatism was significantly higher in the prolate group compared with the other groups at 1 month (p= 0.0021). However, all the topographic patterns showed comparable magnitude of astigmatism after suture adjustment and at 3 and 6 months. The antitorque suturing technique showed a higher proportion of prolate maps compared with the other suturing techniques.Conclusions.Prolate patterns of the cornea are the most frequently seen patterns after single continuous suturing, which is the normal physiological pattern of the cornea. The initial astigmatism is higher in the prolate pattern, which can be successfully reduced with suture adjustment.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To determine whether canalicular occlusion with collagen and silicone plugs reduces the severity of symptoms in patients with conjunctivitis secondary to dry eye.Methods.This was a prospective, randomized, double-masked study conducted at a single center in Mexico, in which 61 patients with dry eye/conjunctivitis were assigned to progressive lacrimal occlusion with collagen and silicone plugs or a sham procedural group. Outcome variables included total and individual dry eye and conjunctivitis symptom scores, moisturizing agent usage, best-corrected visual acuity, ocular comfort level, visual performance, corneal/conjunctival fluorescein staining, and incidence of adverse events.Results.Total dry eye and conjunctival symptom scores were reduced by 43.7 and 33.7%, respectively 2 weeks after occlusion of all four lacrimal canaliculi with collagen plugs, increasing to 77.4 and 72.1% 2 weeks later following superior canalicular occlusion of both eyes with silicone plugs and inferior placement of collagen plugs. At the 8-week visit (4 weeks after silicone plug implantation of the inferior canaliculi of both eyes), the reduction in total dry eye and conjunctival symptom scores further increased to 94.2 and 93.0%, respectively, accompanied by a marked decline in each of the seven individual symptom scores (dryness, watery eyes, itching, burning, foreign body, fluctuating vision, and light sensitivity). In concert with these changes, moisturizing agent usage and corneal/conjunctival fluorescein staining decreased in a progressive fashion over the 8-week study period, and best-corrected visual acuity, ocular comfort, and visual performance improved in the absence of any treatment-related adverse events except for one case of epiphora. The response of patients to lacrimal occlusion can be sharply contrasted with the sham procedure group, which remained relatively unchanged from baseline at each of the study visits.Conclusions.Progressive lacrimal occlusion with collagen and silicone plugs was of clinical benefit to patients with dry eye and conjunctivitis.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To examine the possible relation between corneal sensation or tear secretion and the stage of diabetic retinopathy in diabetic patients.Methods.Total reflex or basal tear secretion and corneal sensation were determined in 95 patients with type II diabetes mellitus and 58 nondiabetic control subjects. Tear secretion was measured by the Schirmer test and corneal sensation with a Cochet-Bonnet esthesiometer.Results.Corneal sensation and total or reflex tear secretion were significantly reduced in diabetic patients compared with nondiabetic controls. The loss of corneal sensation, but not that of tear secretion, was significantly correlated with stage of diabetic retinopathy in diabetic patients who were diagnosed with no diabetic retinopathy, simple diabetic retinopathy, preproliferative retinopathy, or proliferative retinopathy.Conclusion.Both corneal sensation and total or reflex tear secretion are reduced in individuals with diabetes. The decrease in corneal sensation, but not that in each tear secretion, was correlated with the stage of diabetic retinopathy. Given that loss of corneal sensation is a manifestation of diabetic polyneuropathy, these results are consistent with the notion that both diabetic retinopathy and polyneuropathy result from a basement membrane abnormality.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To assess the rates of simple and clinically significant recurrences of stromal dystrophies in corneal grafts.Methods.We conducted a retrospective review of Wills Eye Hospital records from 1984 to 2001, identifying all patients with stromal corneal dystrophies who had penetrating keratoplasties. Kaplan-Meier curves and &khgr;2analysis were performed.Results.The study population consisted of 35 eyes (21 patients) with lattice dystrophy, 17 eyes (10 patients) with corneal dystrophy of Bowman's membrane (CDB), 14 eyes (eight patients) with macular dystrophy, seven eyes (five patients) with granular dystrophy, and four eyes (four patients) diagnosed with Schnyder's crystalline dystrophy. There was a simple recurrence in 21 (60%) eyes (14 patients) with lattice and in 15 (88%) eyes (eight patients) with CDB. The median time to simple recurrence for the first eye transplanted of each patient was 8.4 years for lattice and 2.0 years for CDB. After 5 years of follow-up, there was a clinically significant recurrence, manifested by recurrent erosions or associated with decreased visual acuity, in the first eye transplanted of each patient, respectively, in six (17.1%) and seven (20%) eyes with lattice and in two (11.8%) and three (17.6%) eyes with CDB.Conclusion.Corneal dystrophy of Bowman's membrane has the highest rate of simple recurrence followed by granular and lattice dystrophies, respectively. However, the rate of clinically significant recurrence, both recurrent erosions and decreased visual acuity, in the first 5 years is similar in CDB and lattice dystrophies. Recurrence is infrequent in macular and Schnyder's crystalline dystrophy. As expected, in genetic diseases, the potential for recurrence exists and increases with follow-up time.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To describe a case of inferior corneal steepening with a keratoconus-like pattern in a patient with nocturnal lagophthalmos and aqueous tear deficiency (ATD).Methods.Axial curvature mapping was performed with the Tomey TMS-2N videokeratoscopy instrument. Keratoconus-like topography patterns were identified with the Klyce Software package of this instrument.Results.Axial videokeratoscopy showed asymmetric inferior corneal steepening in the right eye. The surface regularity index (SRI), surface asymmetry index (SAI), and the simulated keratometric cylinder change (CYL) were 1.05, 5.05, and 0.75, respectively. The keratoconus screening indices were as follows for the right eye: Klyce/Maeda index of 95% similarity (clinical keratoconus interpreted) and Smolek/Klyce index of 23.09% severity (keratoconus suspect interpreted). Ultrasound pachymetric mapping showed a normal central corneal thickness. We found a similar topographic pattern of keratoconus in seven eyes of 74 dry eye patients who were previously evaluated with the Tomey TMS-2N.Conclusion.Chronic ocular desiccation and aqueous tear deficiency can produce inferior corneal steepening and high astigmatism resembling keratoconus.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To study the effects of induced autoimmune dacryoadenitis on lacrimal gland function, histopathology, and ocular surface disease in a rabbit model.Methods.One lacrimal gland was surgically excised from each experimental rabbit, and epithelial cells were purified, cultured, irradiated, and then cocultured with autologous peripheral blood lymphocytes (PBLs) for 5 days. Autoimmune dacryoadenitis was induced by injecting the autologous mixed cell reactions (AMCRs) into the rabbit's remaining lacrimal gland. Normal rabbits and rabbits with both lacrimal glands injected with nonstimulated PBLs were examined as controls. Eyes were evaluated biweekly for 8 weeks by slit-lamp biomicroscopy, Schirmer testing, tear break-up time measurement, and rose bengal examination. Sections of lacrimal glands removed at 8 weeks post-operation were immunostained using antibodies against rabbit class II major histocompatibility complex molecule (MHC-II), CD4, CD8, CD18, and rabbit thymic lymphocyte antigen (RTLA). Relative numbers of positively stained cells were quantified with a ChromaVision image analysis system.Results.During an 8-week period, a continuous decrease in tear production and stability, accompanied by a continuous increase in rose bengal staining, occurred in eyes in which AMCR-PBL had been injected into the ipsilateral lacrimal glands. Similar, though generally less severe, changes occurred in eyes contralateral to the AMCR-PBL-injected eyes. No obvious changes by 8 weeks in these parameters were found in eyes in which the lacrimal glands had been injected with nonstimulated PBLs or in the lacrimal gland-excised eyes contralateral to normal eyes. Interstitial cells in normal lacrimal glands expressed CD18 and RTLA antigens, but few expressed CD4, CD8, or MHC-II. Focal mononuclear cell infiltrates were only found in lacrimal glands from animals with induced autoimmune dacryoadenitis. These cells were predominantly positive for CD4 (7.3-fold increase), RTLA (7.8-fold increase), or CD18 (42-fold increase). MHC-II expression in interstitial and ductal epithelial cells was also significantly greater in these animals than in control animals. The mononuclear cell infiltrates were frequently found enveloping venules, some of which appeared to be high endothelial cell venules. The ductal epithelium also contained CD4 and CD8 immunopositivity, within the epithelium, at the lumenal surface, or surrounding the ducts. Occasionally CD4 and CD8 immunopositive cells could be identified within the acinar lumens.Conclusions.Injection of activated PBLs (i.e., AMCR-PBLs) in the lacrimal gland induces autoimmune dacryoadenitis with immunopathologic features similar to those of Sjögren's syndrome. The lacrimal immunopathology is accompanied by typical clinical manifestations of dry eye syndrome. The persistent significant dry eye does not appear to result just from failure of the diseased gland but from a more general dysfunction of the surface secretory tissues.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.To determine the in vitro antifungal activity of voriconazole, a new triazole, compared with other polyene and imidazole antifungal agents against corneal isolates ofScedosporium apiospermum.Methods.Macro-broth dilution susceptibility testing was performed on five isolates ofS. apiospermumobtained from patients with keratomycosis to determine the minimal inhibitory concentrations (MICs) for amphotericin B, natamycin, ketoconazole, itraconazole, and voriconazole. The use of oral voriconazole in the management of a patient with posttraumaticS. apiospermumkeratitis is described.Results.S. apiospermumis generally resistant to commonly used topical ophthalmic antifungal agents. The MIC of voriconazole was 0.5 &mgr;g/mL, a concentration lower than that of other imidazoles.Conclusion.Voriconazole has promising activity againstS. apiospermumand may prove useful in the management of fungal keratitis.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.Amniotic membrane is an ultra-thin cellophane-like membrane that is used in ocular surface reconstruction. We evaluated the staining characteristics of commonly available dyes on preserved human amniotic membrane to aid in handling of amniotic membrane during transplantation.Methods.Five dyes, indocyanine green (2.5%, 1.0%, and 0.5%), fluorescein (0.25%), rose bengal (1%), lissamine green B (1%), and trypan blue (0.5%), were used to stain amniotic membrane. After staining, the specimens were observed under a dissecting microscope to evaluate for the uptake of the stains. Positively stained membranes were evaluated for the persistence of staining by placing them in 2 to 3 mL of balanced saline solution that was changed every 30 minutes over 6 hours.Results.Preserved human amniotic membrane is stained by indocyanine green, rose bengal, lissamine green B, and trypan blue. Of these four dyes, only the membrane stained with 1% lissamine green B was free of stain after 120 minutes. Indocyanine green, rose bengal, and trypan blue continued to strongly stain the membrane after 24 hours.Conclusions.Indocyanine green, rose bengal, trypan blue, and lissamine green B all stain amniotic membrane. Lissamine green B appears to have advantages over the other dyes in that it will stain the membrane well, and in our model, dissipate in 120 minutes. Intraoperative staining with lissamine green B may be a simple and effective way to assist surgeons in the proper handling of amniotic membrane.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose.Several mucins including MUC1, MUC2, MUC4, and MUC5AC have been identified at the ocular surface and in tears. The lacrimal gland, however, is not generally considered a source of ocular mucin. Because the lacrimal glands are similar to the salivary glands, we hypothesized that the lacrimal gland would express MUC7, a distinctive salivary mucin. We report the presence of MUC7 RNA and protein in normal human lacrimal glands as determined by reverse transcription–polymerase chain reaction (RT-PCR), in situ hybridization, and Western blot analysis.Methods.RNA from lacrimal glands and conjunctivae was isolated and subjected to RT-PCR with primers specific for MUC7. The identity of the PCR products was confirmed by sequencing. In situ hybridization with PCR product–based riboprobes was used to locate MUC7 transcripts in the lacrimal gland. MUC7 protein was detected by Western blot analysis.Results.Of six normal human lacrimal glands from which relatively intact mRNA could be extracted, four expressed MUC7. Hybridization with an antisense riboprobe for MUC7 indicates the presence of MUC7 transcripts in the cytoplasm of acinar cells. Western blot analysis confirms expression of the protein in the lacrimal gland. The presence of MUC1, MUC4, and MUC5B was also demonstrated by RT-PCR in lacrimal gland tissue. MUC7 transcripts and protein were also detected in normal human conjunctivae.Conclusions.The mucin profile of the lacrimal gland resembles that of the salivary gland. Both RNA and protein corresponding to MUC7 are present in the normal human lacrimal gland. Reverse transcription–polymerase chain reaction indicates that other transcripts of MUC1, MUC4, and MUC5B are present as well. Ocular MUC7 is also produced by the conjunctival mucosa. The lacrimal gland, therefore, contributes not only to the aqueous component of tears but also, in concert with the conjunctiva, may contribute to the total pool of ocular surface mucins.

ISSN:0277-3740    

出版商:OVID    

年代:2003

数据来源: OVID