Clearing of corneal argyrosis by YAG laser.

A 75-year-old woman with corneal argyrosis was treated by a Q-switched Nd-YAG laser iridotomy after acute angle closure glaucoma. Each laser shot caused clearance of the argyrotic deposits anterior to the iridotomy site. The same effect was seen when a preventive iridotomy was performed in the other eye. The areas of clear cornea remained unchanged for a follow-up period of eight months.     

Occupational corneal argyrosis in art silver solderers

PURPOSE: To determine the value of confocal and specular microscopy in the examination of corneal argyrosis in art silver solderers. METHODS: Six patients with corneal argyrosis underwent a complete physical and ophthalmologic examination. Specular microscopy was performed in three cases, and in vivo confocal microscopy in four cases. Ultrasound biomicroscopy and corneal topography were performed in three cases. A conjunctival specimen of one patient was examined histologically in paraffin sections. RESULTS: Slit-lamp examination showed gray, diffuse opacities in the deep corneal stroma. Confocal microscopy showed highly reflective deposits with a granular pattern anterior to the corneal endothelium and hypereflective keratocyte nuclei with visible cytoplasm in the anterior stroma. Specular microscopy demonstrated round white bodies anterior to the corneal endothelium. Silver deposits were not found histologically. CONCLUSIONS: Silver solderers with long-term exposure to silver compounds are at high risk of developing corneal argyrosis. We conclude that specular microscopy and in vivo confocal microscopy provided important information for the diagnosis of corneal argyrosis.     

Limbal lymphangiogenesis after corneal injury: an autoradiographic study

Blood and lymphatic vessel proliferation into the cornea occurs after severe trauma. Whilst the events early in blood vessel growth are reasonably understood, little is known of the early events in lymphangiogenesis. In this study, a model for proliferating lymphatic vessels using tritiated-thymidine autoradiography and light microscopy is described. A two-hour labeling index of 0.59% occurred in the lymphatic endothelium of the normal unstimulated limbus. After thermal cautery of the peripheral cornea, labeling of the limbal lymphatic vessels increased significantly at 36 hours, rose to a maximum of 6.8% four days after injury and thereafter returned to normal levels. Blood capillaries with a background level of 0.83% showed an increase in labeling at 17 hours, with high levels occurring at 36 hours (13.6%) and again from 61 to 84 hours (12.6%). Venular cells increased labeling at 25 hours from a control level of 0.58%, with a sharp peak of activity around 36 hours (13.2%). Synthesis of DNA similarly returned to normal levels in the blood vessels after four days. The staggered onset and differing durations of significantly increased labeling suggest either that various stimuli or arrays of stimuli are involved, or each cell type responds differently to the same stimulus for proliferation.     

Astigmatism after corneal thermal injury

A 42-year-old woman developed significant astigmatism after localized thermal injury to the cornea during a cosmetic eyelid procedure. The induced astigmatism regressed substantially over the ensuing months. One year after the injury, astigmatic keratotomy (AK) was performed, further reducing the astigmatism and improving the patient's subjective vision. Patients with induced astigmatism from thermal corneal injury should be monitored for regression. When refractive stability is achieved, AK can reduce the remaining astigmatism. This case reviews concepts that apply to refractive thermal keratoplasty.     

准分子激光原位角膜磨镶术术后角膜外伤3例

男，21岁，学生。左眼被手指戳伤后疼痛、严重畏光伴视力骤降2h，门诊以“角膜外伤”包扎3d，症状加重转准分子激光中心治疗。1年前因近视在外院接受双眼准分子激光原位角膜磨镶术(LASIK)手术。急诊检查：视力，右眼1．2，左眼0．01。右眼正常。左眼结膜充血，角膜上皮水肿混浊，片状缺损。角膜瓣显著混浊、水肿及皱褶，整个角膜瓣与基质床分离、向颞侧移位。前房(-)。     

Amelanotic corneal melanoma after a blast injury

PURPOSE: To report a case of a corneal melanoma after trauma. METHODS: Case report. RESULTS: A 68-year-old man sustained an ocular injury from a blast furnace explosion in 1958. In 1998, he underwent a penetrating keratoplasty for a corneal scar. Histologic examination and cell markers of the host button revealed intrastromal and subepithelial melanoma. No clinical or microscopic evidence of adjacent conjunctival or uveal melanoma was found. CONCLUSION: Melanoma of the cornea can present as a stromal opacity after trauma.     

Ocular argyrosis after long-term self-application of eyelash tint

PURPOSE: To report cases of ocular argyrosis that developed after long-term self-application of commercially available eyelash tint. DESIGN: Observational case series. METHODS: Case review, clinicopathologic analysis, and literature review. RESULTS: Three patients developed ocular argyrosis after the long-term self-application of Revlon Professional Roux Lash and Brow Tint (Colomer USA Corp, New York, New York, USA). Clinical evaluation revealed various degrees of silver deposition on the upper eyelid, lid margin, caruncle and conjunctiva, and diffuse Descemet's membrane deposits. In one case, histologic examination demonstrated silver deposition in the basement membrane and superficial substantia propria of the conjunctiva. CONCLUSIONS: Argyrosis can occur after long-term application of readily available eyelash tints, and the deposition of silver may be permanent. In certain circumstances, conjunctival argyrosis may simulate benign and malignant lesions, including conjunctival melanoma. These products should only be applied by trained cosmetologists.     

碱烧伤后角膜新生淋巴管与炎症反应指数间的关联

目的 探讨角膜碱烧伤后的角膜新生淋巴管与炎症反应指数间的关联.方法 实验研究.制备大鼠角膜碱烧伤模型.采用5'核苷酸酶-碱性磷酸酶(5'-NA-ALP)双重酶组织化学染色及全角膜免疫荧光法分别检测碱烧伤后1、3 d,1、2、3、4、5、6、7及8周的角膜新生淋巴管和血管的动态变化,并进行淋巴管计数(LVC)和血管计数(BVC).同时,于裂隙灯显微镜下观察角膜炎症反应的变化,记录炎症反应指数(IF),并比较LVC和IF之间的关联.11例人角膜取自碱烧伤后行角膜移植的11例患者.淋巴管内皮细胞受体(LYVE-1)免疫组织化学染色法标记人角膜中的新生淋巴管,LVC和IF之间的关联运用Pearson's相关分析,采用配对t检验比较角膜中存在淋巴管和不存在淋巴管的患者之间IF、炎性细胞计数、碱烧伤病史、年龄的差异.结果 碱烧伤后,角膜基质层存在着新生淋巴管.碱烧伤后3 d时出现角膜新生淋巴管,2周末达到高峰,5周末消退.新生淋巴管的出现滞后于炎症反应,但先于炎症反应和新生血管而消退.LVC与IF之间呈正相关(r=0.572,P＜0.01).11例患者中3例存在着角膜新生淋巴管.与另8例角膜中无新生淋巴管的患者相比,前者IF显著性升高(t=3.28,P＜0.05)、炎性细胞计数显著性增加(t=2.42,P＜0.05),年龄显著性下降(t=2.62,P＜0.05),而碱烧伤病史无显著性差异(t=1.28,P＞0.05).结论 角膜碱烧伤后有淋巴管生成,角膜新生淋巴管和炎症反应指数之间存在着密切的关联.     

Effect of metalloproteinase inhibitor on corneal cytokine expression after alkali injury.

PURPOSE: Interleukin (IL)-1alpha and IL-6 levels in the cornea are greatly elevated during the early stages after an alkali burn in mice. The authors investigated the effect of synthetic inhibitor of matrix metalloproteinase (SIMP) on the expression of inflammatory cytokines in alkali-burned murine corneas and evaluated the clinical appearance of the eyes. METHODS: After 0.5N NaOH-alkali burns to 400 corneas of ICR mice, 200 received 400 microg/ml of SIMP topically 4 times a day while 200 corneas were similarly treated with vehicle only. At days 4, 7 and 14 after injury, each cornea was assigned a clinical score for corneal opacity, corneal epithelial defect, hyphema and cataract. Extracts of injured corneas in each group were then assayed for cytokine production using ELISA systems for IL-1alpha, IL-1beta, IL-6 and tumor necrosis factor-alpha (TNF-alpha). RESULTS: The levels of IL-1alpha, IL-1beta and IL-6 were significantly lower in the SIMP-treated group than in the vehicle-treated group 7 days after the burn. However, levels of these cytokines were similar in the SIMP and non-SIMP groups at days 4 and 14. Levels of TNF-alpha did not differ between both groups at any postinjury time. In the SIMP-treated corneas, there was less opacification and hyphema formation and epithelial regeneration was faster. CONCLUSIONS: Topical application of SIMP in alkali-burned murine corneas reduced the expression of IL-1alpha, IL-1beta, and IL-6 and lessened the severity of the injury.     

Pentacam前房分析仪评估白内障超声乳化术后相关的角膜损伤

目的 评价Pentacam前房分析仪对白内障超声乳化手术后角膜内皮细胞损伤评估的有效性.方法 由同一名术者对68例患者施行白内障超声乳化术,术前及术后3月分别使用角膜内皮镜和Pentacam前房分析仪测量角膜内皮细胞及功能改变.结果 使用角膜内皮镜检测角膜内皮计数,术前(2667.63±272.85)个/mm2,术后3月为(2545.56±298.64)个/mm2,两者相比差异存在统计学意义(P<0.05).使用Pentacam在术后3月测量角膜体积较术前略有增大,术前为(59.48±3.87)mm3,术后3月为(61.68±4.25)mm3,差异也具有统计学意义(P<0.05).二者相比,Pentaeam所测量的角膜体积手术前后差异据有更大的统计学意义.角膜容积按3、5、7mm不同直径分区,术后3月较术前数值有所增大.7mm区域角膜容积明显改变.但差异均无统计学意义(P>0.05).使用Pentacam测量角膜中心厚度,术后为(560.26±31.49)mm,术前为(556.59±34.99)mm,术后较术前中心角膜厚度略有增厚,但无统计学差异.结论 Pentaeam前房分析仪可以更有效的评估白内障超声乳化手术对整体角膜的损伤情况.     

Prognosis of corneal transplantation after penetrating eye injury

BACKGROUND: The success of penetrating keratoplasty (PKP) after penetrating eye injuries is often worse than in keratoplasty with Fuchs' endothelial dystrophy. However, comparable investigations are rare. Therefore, we have retrospectively analyzed the results and complication rates of PKPs in patients who experienced penetrating eye injuries. PATIENTS AND METHODS: Between 1990 and 1997 forty-four patients who received a corneal transplant at Kiel University Eye Hospital after penetrating eye injury (study group S) were analyzed. 29 patients were re-examined (visual acuity testing, slit lamp microscopy, applanation tonometry, stereo testing, corneal TMS topography, keratometry, endothelial microscopy, perimetry, indirect retinoscopy, testing of the retinal visual acuity and probatory contact lens fitting). Postoperative follow-up ranged between 1 and 6 years (median 3 years). The results were compared to a group of corneal grafts performed in patients with Fuchs' endothelial dystrophy (K, n = 18 patients, 25 eyes, median follow-up 2.8 years). RESULTS: 38males and 6 women had had a bilateral visual acuity of 0.8 or better before the accident, except for three cases. At the time of eye injury the patients' age ranged from 4 to 76 years. The eye trauma was caused by splinters of metal (45 %), glass (20 %), wood (16 %) or stone (11 %). In 73 % of the cases the injury was confined to the anterior segment of the eye (S1). The posterior part of the eye was involved in 27 % (S2). BCVA of S before keratoplasty (KP) was 1/15 on average (K 0.2), at least one year after KP 0.25 (K 0.4); post KP S1 was better than S2 (p = 0.0234), and K better than S (p = 0.0009). In group S 29 patients received a graft at random because of a central corneal scar, 14 patients received an HLA-typed graft with 2.3 mismatches on average. 93 % of the grafts (41 patients) were clear at the last examination, 8 patients showed rejection episodes, half of them were reversible. 5 patients received a second graft because of an irreversible rejection or endothelial decompensation. BCVA improved by at least one line in 84 % in S (K 92 %). BCVA was unchanged after KP in 6.8 % (K 8 %). In 9.1 % of S BCVA after KP was worse (K 0 %). 32 out of 44 patients had a BCVA of 0.1 or better after the last check-up, 13 out of 44 patients presented with a BCVA of 0.5 or better (K40 %). 15 out of 29 patients separately tested showed stereopsis compared to 8 preoperatively in S. In 48 % of the patients studied stereovision could not be restored. 82 % of the patients suffered from topographical irregular astigmatism in S, the superficial geometry of recipient's cornea seems relevant for astigmatism of the graft. Frequent postsurgical complications consisted of secondary glaucoma (S 27 %, K 4 %), immunological rejections (S 18 %, K 0 %), and amblyopia (S 14 %, K 0 %). CONCLUSION: Compared to patients with Fuchs' dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary glaucoma and graft rejection.     

Localized argyrosis 58 years after strabismus operation--an ophthalmological rarity

BACKGROUND: A pigmented episcleral lesion may have several etiologies. We describe the rare occurrence of a localized argyrosis secondary to former strabismus treatment. HISTORY: A 70-year old female patient was referred to our clinic for diagnosis and treatment of a pigmented episcleral process near the insertion of the left lateral rectus muscle which was noticed on a routine control by her ophthalmologist. The patient was free from ocular symptoms. There was a history of strabismus surgery on the left eye at the age of twelve. Due to the suspicious appearance of the lesion the possibility of a conjunctival malignant melanoma was considered. A ultrasound exam could not exclude this suspicion and therefore a biopsy was performed. Silver deposits and rests of a suture could be found. CONCLUSION: Silver deposits are a rare cause of a pigmented localized episcleral lesion. Several possibilities of silver contamination in our patient are discussed. The most likely explanation is the use of silver containing suture material in strabismus surgery performed 58 years ago. A localized argyrosis secondary to past strabismus surgery should therefore be included in the differential diagnosis of a pigmented episcleral lesion.     

Morphological changes in rabbit corneal endothelium after surgical injury

PURPOSE: To understand the responses of the corneal endothelium to different types of surgical insults, we chronologically investigated morphologic changes in rabbit endothelial cells after injury. METHODS: We performed a mechanical incision, epithelial ablation, or excimer laser irradiation on rabbit corneas and observed the changes in the endothelial cells for up to 2 weeks after surgery under a light microscope and an electron microscope. RESULTS: Although we observed enlargements of intercellular spaces between neighboring endothelial cells, intercellular adhesion complexes were maintained and the cells joined tightly near their apexes immediately after each procedure. We observed no signs of endothelial cell degeneration after the procedures, but we did observe many Golgi apparati, rough-surfaced endoplasmic reticula, and secreted granules, indicating that the cells had been activated. After each procedure, varying periods of time were required before the intercellular junctions and spaces returned to normal. CONCLUSION: These results suggest that the different kinds of surgical injuries affected the corneal endothelium in different ways, but that the early changes were reversible.     

Decreased fibronectin levels in aqueous humor after corneal injury

Fibronectin plays an important role in wound healing and cell differentiation. The present study measures fibronectin levels in aqueous humor from injured corneas. In response to transcorneal freezing treatments, a thickened scar-like matrix is deposited on the posterior surface of rabbit corneas. This posterior collagenous layer (PCL) is visible grossly and has a uniform diameter. Aqueous humor from eyes with established posterior corneal scarring has significantly less fibronectin compared with control eye aqueous humor. Tissue culture experiments show that corneal endothelial cells from control eyes and PCL-associated cells from injured eyes produce similar amounts of fibronectin. The marked decline in fibronectin levels in aqueous humor in scarred corneas supports the hypothesis that fibronectin plays a role in the pathological events which result from corneal injury.     

Corneal argyrosis associated with silver soldering.

We report a patient who developed corneal argyrosis secondary to occupational silver soldering. Clinically, the cornea was notable for a green-brown discoloration localized to Descemet's membrane by slit-lamp biomicroscopy. Silver particles were identified within the anterior three eighths of Descemet's membrane by light and electron microscopy and energy-dispersive x-ray microanalysis. To our knowledge, the association between corneal argyrosis and silver soldering has not been previously reported.     

角膜穿通伤的临床分析

本文分析７９例（８０眼）角膜穿通伤的发生率、致伤原因、受伤部位、伤口大小，并发症及治疗情况，并对伤口、眼内容物脱出及外伤性白内障的处理提出讨论。指出角膜穿通伤后及时控制眼内感染，积极预防并发症，争取恢复视功能的重要性。     

海水浸泡对角膜爆炸穿孔伤后角膜上皮细胞超微结构的影响

目的 观察海水浸泡对兔角膜爆炸穿孔伤后角膜上皮细胞超微结构的影响.方法 健康灰兔12只,爆竹致兔角膜爆炸伤并于角膜中周部全层切开,切口长约3mm.右眼为实验眼,对侧眼为对照眼.实验眼将海水通过角膜切口注入前房,海水持续灌注角结膜面30 min.对照眼使用生理盐水注入前房和灌注眼表.使用光镜及电镜分别观察造模后1d、3d、5d、7d、10 d、14 d两组角膜上皮细胞和基质层超微结构的变化.结果 实验组造模后1d至14 d,角膜上皮细胞胞浆出现不同程度的空泡样变性,微绒毛状突起消失或部分消失,染色质增多,线粒体肿胀,细胞核固缩、碎裂、崩解,基质层胶原纤维排列紊乱,胞核空泡样变性,其中3d改变最明显,10 d、14 d可见部分上皮细胞增生;相同时间段对照组改变明显轻于实验组,对照组7d、10 d大部分上皮细胞增生,14 d无明显异常改变.结论 角膜爆炸穿孔伤合并海水浸泡后角膜上皮细胞的超微结构改变明显重于对照组,提示海水浸泡加重角膜上皮细胞的损伤.     

Multifocal vision after cataract surgery

Recent improvements in cataract surgery and intraocular lens (IOL) technology have allowed rapid improvement in quality visual acuity. Cataract surgeons can also reliably reduce a patient's dependency on spectacles. Through careful monitoring of implant power calculations to improve their accuracy and reduce unwanted astigmatism, our patients are now able to enjoy clear, uncorrected vision. Newer technology, such as multifocal IOLs and accommodating IOLs, can provide a return to prepresbyopic visual acuity for the cataract patient.