Transplantation of congenitally opaque corneas from eyes with exaggerated buphthalmos

We treated three eyes with marked buphthalmos and congenitally opaque corneas with cyclocryotherapy, one application in one eye and two applications in two eyes. The size of the eyes became rapidly smaller during the first two weeks postoperatively. Thereafter, corneal transplantation improved vision in each eye.     

Band-like opacity in the corneas of abattoir-acquired pig eyes

In the course of an investigation into the distribution of immune cells in the porcine cornea, a band-like lesion on the cornea of two-thirds of the eyes acquired from the local abattoir was noted. Histological investigations revealed an area of corneal epithelium debridement with no obvious other pathological changes. Discussions with abattoir staff soon revealed the cause of the lesions to be the scalding process that all pig carcasses undergo immediately post-mortem that serves to remove unwanted hair and reduce skin-dwelling bacterial contamination. We concluded that the band-like opacity was the result of thermal injury to the anterior surface of the cornea between the open eyelids. It is hoped that this short communication will act as a cautionary note to other investigators who currently use or are considering using porcine eyes in research or as a model in surgical training and who may be unaware of the conventional handling procedures in pig abattoirs.     

Evaluation and transplantation of corneas from pseudophakic donor eyes

PURPOSE: To evaluate the quality of corneal donor tissue from pseudophakic eyes for transplantation. METHODS: Only capsular-supported posterior chamber pseudophakia was studied. Forty-five pairs of donor eyes were assessed and evaluated by standard Minnesota Lions Eye Bank (MLEB) protocol. Thirty-three pairs were unilaterally pseudophakic with the unoperated phakic eye used as a control eye. Twelve donors were bilaterally pseudophakic. All corneas were rated for corneal clarity, epithelial defects, stromal edema, Descemet's membrane folding, endothelial cell density (ECD), and cell damage by slit-lamp examination and specular microscopy. If the corneas were not transplanted, the endothelium was vital stained with trypan blue and counterstained with alizarin red S for quantitation, localization, and visualization of cell morphology and damage. RESULTS: Sixty-eight of the 90 corneas in this study did not meet transplantation criteria. A significant difference in ECD (>22%) and in overall corneal rating was found in seven (21%) of 33 pairs of unilateral pseudophakic donors. Fourteen corneal transplants were performed using corneas from the donors in this study. Nine corneas from pseudophakic donor eyes were transplanted, resulting in one primary graft failure reported. CONCLUSION: Corneas from pseudophakic donor eyes may need more extensive evaluation for endothelial viability than is currently required by eye bank standards.     

Vitreous hemorrhage in diabetic eyes previously treated with panretinal photocoagulation

Background Vitreous hemorrhage (VH) is a major cause of severe vision loss in diabetic patients. The aim of this study was to assess the incidence and risk factors for new VH in diabetics previously treated with panretinal photocoagulation (PRP) for proliferative retinopathy (PDR) in community base center. Methods Records of 192 diabetics (35 type 1, 157 type 2), undergoing PRP for diabetic retinopathy were retrospectively reviewed. Eyes presenting initially with high-risk PDR received PRP without delay, and eyes presenting initially with severe non proliferative retinopathy (NPDR) or early PDR had undergone central retinal photocoagulation (CRP), and then, when high risk PDR developed, received PRP treatment. Results VH had developed in 39% of the eyes despite PRP. Risk factors for VH in type 1 diabetes were: early onset and long duration of disease (23.8 versus 39.0 years of age, P = 0.007, and 25.8 versus 16.0 years, P = 0.002, respectively). In type 2, VH occurred with less follow-up and angiographic examinations (7.4% versus 3.8%, P = 0.027, and 33% versus 47%, P = 0.07, respectively). CRP decreased the risk for VH from 43 to 15%, P = 0.013. Conclusions In type 2 diabetes, regular ophthalmic follow-up and intensive PRP may reduce the risk for VH in eyes previously treated by PRP. In type 1, early onset disease and long duration are associated with higher incidence of VH.     

CD-34 stromal expression pattern in normal and altered human corneas

OBJECTIVE: To test CD-34 immunoreactivity in stromal cornea cells in normal and pathologic samples obtained from penetrating keratoplasty. DESIGN: Prospective, consecutive histopathologic human tissue study. PARTICIPANTS AND CONTROLS: One hundred two cornea buttons from patients with different diseases, submitted for cornea transplant, were examined. Controls were expired corneas from healthy donor patients who died (n = 4), and globes enucleated for primitive intraocular neoplasias, that is, retinoblastomas (n = 8), and malignant choroidal melanomas (n = 2). METHODS: The expression of CD-34 in stromal cornea cells was examined by immunohistochemistry analysis. Other immunohistochemical stains included an endothelial cell marker (CD-31), common leukocyte antigen, and alpha-smooth muscle actin. MAIN OUTCOME MEASURES: Different diseases that may cause blindness and require penetrating keratoplasty have been tested for CD-34 immunoreactivity. RESULTS: In control corneas, keratocytes present strong and consistent CD-34 immunoreactivity. Diseases leading to the loss of transparency and penetrating keratoplasty, such as keratoconus, herpes keratitis, trauma, and heredofamilial dystrophies, are associated with focal or diffuse loss of CD-34 expression, whereas pseudophakic bullous keratopathy and Fuchs' endothelial dystrophy show normal CD-34 immunoreactivity in most cases and patchy unstained stromal areas in a few cases. CONCLUSIONS: Scar tissue formation in the cornea, as in herpes keratitis and trauma, is always associated with loss of CD-34 immunoreactivity, which may otherwise be a primary event in keratoconus and heredofamilial dystrophies. Both in the pseudophakic bullous keratopathy and Fuchs' endothelial dystrophy, CD-34 immunoreactivity may be normal or lost, hence these two diseases may be considered as one and part of the same group with regard to CD-34 expression, as revealed by immunohistochemistry analysis.     

In-vivo slit scanning confocal microscopy of normal corneas in Indian eyes

OBJECTIVE: To study the cellular populations of healthy corneas of Indian eyes using confocal microscopy and to evaluate the correlation with age, gender and laterality. METHODS: The central corneas of 100 eyes of 50 healthy subjects were examined using an in-vivo slit scanning confocal microscope (Confoscan 2). Images were analysed for cell densities of the epithelium, stroma and endothelium. RESULTS: Good quality images enabling analysis of all cell layer populations were obtained in 74 eyes of 43 healthy subjects (22 males and 21 females) with a mean age of 31.89 +/- 13.47 (range 19-71 years). The basal epithelial cell density was 3601.38 +/- 408.19 cells/mm2 (range 3017.3-4231.1 cells/mm2). The mean keratocyte nuclei density in the anterior stroma was 1005.02 +/- 396.86 cells/mm2 (range 571.6-1249.6 cells/mm2) and in the posterior stroma was 654.32 +/- 147.09 cells/mm2 (range 402.6-1049.1 cells/mm2). Posterior keratocyte nuclei density was 30.76% less than the anterior stromal keratocyte nuclei density. The difference in keratocyte nuclei density was statistically significant (P=0.001). The mean endothelial cell density was 2818.1 +/- 361.03 cells/mm2 (range 2118.9-4434 cells/mm2) and the mean endothelial cell area was found to be 385.44 +/- 42.66 mm2 (range 268.9-489.2 mm2). Hexagonal cells formed 22.5-69.4% of the endothelial cell populations (mean 42.04 +/- 11.81%). Mean coefficient of cell size variation was 32.29 +/- 3.06 (range 27.2-39.2). No statistically significant differences were found in cell densities of any corneal layer either between female and male patients or between right and left eyes. Basal epithelial cell density, anterior stromal keratocyte nuclei and posterior stromal keratocyte nuclei density were unaffected by age (r=0.12, 0.07, -0.12 respectively) (P=0.001). There was a statistically significant negative correlation between mean endothelial cell density and increase in age (r=-0.42, P=0.001). Coefficient of cell size variation and age were positively correlated (r=0.73, P=0.001). CONCLUSION: In-vivo slit scanning confocal microscopy is useful for the study of corneal cell populations. Our study provides normative data of these cell populations.     

Results of cataract surgery in previously vitrectomized eyes

PURPOSE: To evaluate the difficulties and results of manual extracapsular cataract extraction (ECCE) and phacoemulsification cataract surgery performed in previously vitrectomized eyes. SETTING: Pécs University of Sciences, Faculty of Medicine, Department of Ophthalmology, Pécs, Hungary. METHODS: This retrospective case-control study comprised a series of 84 cataract extractions with or without intraocular lens implantation. Forty-three patients had manual ECCE and 41, phacoemulsification. The intraoperative and postoperative complications and visual outcomes in the 2 groups were analyzed and compared. RESULTS: Cataract extractions were performed a mean of 15.8 months (range 1 to 86 months) after the pars plana vitrectomy. The indications for vitrectomy were diabetic retinopathy, retinal detachment, proliferative vitreoretinopathy, giant retinal tear, macular hole, eye trauma, vitreous hemorrhage after central retinal vein occlusion, and uveitis. Primary posterior capsule fibrosis was the most common intraoperative complication, occurring in 24% of eyes. Posterior capsule rupture occurred in 5 eyes in the ECCE group and 3 in the phacoemulsification group. Zonulysis occurred in 2 and 1 eyes, respectively. A dropped nucleus occurred in 3 cases in the phacoemulsification group. Posterior capsule opacification and secondary glaucoma were the most common postoperative complications, occurring in 5 and 3 cases in the ECCE group, respectively, and in 3 and 4 cases in the phacoemulsification group. Visual acuity 6 weeks postoperatively improved or remained within 2 Snellen lines in 95% of eyes, which is comparable to data in the recent literature. CONCLUSIONS: Phacoemulsification gave better results than manual ECCE in previously vitrectomized eyes. Underlying retinal disease limited the final visual acuity.     

Histopathology of anterior lens capsules in vitrectomized eyes with tamponade by silicone oil

Histopathologic examination and immunohistochemistry for collagen type V were performed on residual anterior lens capsules of vitrectomized eyes (2 patients) that had been tamponaded with silicone oil. Many spaces, presumably occupied by oil droplets, were observed in connective tissue accumulations beneath the capsules. Immunoreactivity in the extracellular matrix for collagen type V was most marked adjacent to these spaces. These silicone droplets may delay capsule healing as collagen type V indicates immature connective tissue.     

Histopathology of eyes enucleated after endoresection of choroidal melanoma

PURPOSE: To demonstrate the histopathologic features of eyes enucleated after endoresection for choroidal melanoma to assess the complications of this treatment and to determine indications for further treatment after endoresection in the setting of possible tumor recurrence. DESIGN: Retrospective, observational case series. PARTICIPANTS: Sixty-one consecutive patients who had undergone endoresection for uveal melanoma. METHODS: Eyes that had undergone enucleation after endoresection were identified, and their charts and histologic characteristics were reviewed. Pertinent features were described. One patient was excluded because enucleation was performed as a primary treatment when endoresection was abandoned at the time of his initial treatment. MAIN OUTCOME MEASURES: The outcome measures included: reasons for enucleation; tumor recurrence; and location, clinical, and histologic characteristics of each recurrence. RESULTS: Twelve eyes were identified that had undergone enucleation after endoresection. The reasons for enucleation were: (1) local tumor recurrence detected by ophthalmoscopy (2 patients) or echography (1 patient); (2) opaque media preventing adequate ophthalmoscopy (4 patients); (3) blind and painful eye of uncertain cause (1 patient); and (4) a combination of blind eye and limited fundus view (4 patients), which was the result of untreatable retinal detachment (3 patients) and endophthalmitis (1 patient). Eight of 12 patients had recurrent choroidal melanoma. Recurrences were all located adjacent to the resection site, although in 1 patient there was extensive diffuse recurrence throughout the eye. The recurrence was visible clinically in 3 patients and obscured because of opaque media (2 patients), a combination of inadequate echography and retinal detachment (1 patient), retinal detachment (1 patient), and endophthalmitis (1 patient). CONCLUSIONS: Recurrent disease occurred at the site of the primary tumor with no seeding except in 1 patient, whose marginal recurrence was not immediately detected and treated because of opaque media. As with other treatments conserving the eye, enucleation should be performed if adequate ocular examination is not possible, and follow-up should be lifelong.     

Long-term safety of laser in situ keratomileusis in eyes with thin corneas: 5-year follow-up

AIM: To investigate the long term (≥5y) efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) in eyes with thin corneas [central corneal thickness (CCT) <500 μm]. METHODS: A total of 339 patients met the criteria of this study. Finally, 175 eyes of 89 patients who had thin corneas and underwent LASIK≥5y ago returned to our clinic and included in this study. Preoperative parameters recorded included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), manifest refraction, CCT and corneal topography. At returning visits, in addition to visual acuity and manifest refraction, ultrasound CCT and corneal topography were performed. Optical coherence tomography was used to measure the CCT, LASIK flap thickness, and residual stromal bed thickness (RSBT). Safety index, efficacy index, percentage of eyes within ±0.5 D and ±1.0 D of refraction, percent tissue altered (PTA), and percentage stromal bed thickness (PSBT) were calculated. RESULTS: The safety index was 1.09 and efficacy index was 0.99. The percentages of eyes within ±0.5 D and ±1.0 D were 71.2% and 87.7%, respectively. The mean PTA was 40%±6% (range 20% to 55%); 76 eyes (43.4%) had PTA <40% and 99 eyes (56.6%) had PTA≥40%. The mean RSBT was 303±27 μm (range 240 to 390 μm), and 2 eyes had RSBT<250 μm. The mean PSBT was 61%±9% (range 51% to 85%). No eyes developed ectasia. CONCLUSION: In this cohort with the PSBT of 50% or more, LASIK is safe with follow-up for at least 5y.     

Refractive and visual outcomes of small incision lenticule extraction (SMILE) in eyes with thin corneas

ObjectivesTo report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy.SettingRefractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.DesignRetrospective case series.MethodsThe pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated.ResultsThe study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time.ConclusionSMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.Subject terms: Outcomes research, Refractive errors     

Genodermatosis with changes in eyes not previously described (author's transl)

Report on a patient with several symptoms which had not previously occurred together. The main symptom is palmoplantar keratosis; further alterations were kypho-skoliosis, brachytelephalangia of the thumbs, and in the eyes, keratoconus, a cataract and electroretinographic alterations.     

Clinical outcome of wavefront-guided laser in situ keratomileusis in eyes with moderate to high myopia with thin corneas

PURPOSE: To evaluate the clinical outcome of wavefront-guided laser in situ keratomileusis (LASIK) for the treatment of moderate to high myopia associated with a thin cornea. SETTING: Enaim Laser Medical Center, Tel Aviv, Israel. METHODS: This retrospective study included 98 eyes of 49 patients with moderate to high myopia (-5.20 to -10.35 diopters [D]) and thin corneas (456 to 498 mum) treated with wavefront-guided LASIK (Zyoptix, Bausch & Lomb) and followed for 36 months. Preoperative wavefront analysis was performed with a Hartmann-Shack aberrometer, and treatment was performed with the Technolas 217 z excimer laser system (Bausch & Lomb). Final refraction data, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), optic zone size, ablation depth, optical aberrations, and night glare complaints were evaluated. RESULTS: Mean patient age was 28 years +/- 7 (SD), and mean preoperative spherical equivalent refraction was -7.06 D (range -5.20 to -10.35 D). Final UCVA ranged between 6/6 and 6/30. The safety index of the technique was 1.03, and the efficacy index was 0.67. Undercorrection of more than 0.50 D was observed in 41.3% of the high-myopic eyes (-7.00 to -10.35 D, n = 58) compared with 10% in the moderately myopic eyes (-5.00 to -6.75 D, n = 40). A significant reduction in spherical aberration (Z(4)0) was found 12 months postoperatively in all eyes. Night glare was documented in 4 eyes (4%) in the high myopia group. There were no cases of corneal ectasia. CONCLUSION: Zyoptix was safe in eyes with moderate to high myopia with relatively thin corneas (<498 microm). For myopia between -7.00 D and -10.35 D, a small optical zone (4.3 to 5.6 mm) may be applied as night glare was relatively rare, but significant undercorrection should be expected.     

兔眼非穿透性小梁切除术后早期葡萄膜巩膜途径的组织病理学改变

目的:观察兔眼非穿透性小梁切除术(nonpenetratingtabecularsurgery,NPTS)后房水葡萄膜巩膜引流途径的组织病理学改变,进一步阐明其降压机制。方法:8只家兔,随机选1眼作NPTS即A组(n=8),另1眼为正常对照即B组(n=8)。术后观察眼压,1wk后处死家兔摘除眼球分别行HE染色、SMA免疫组化染色,光镜下观察葡萄膜巩膜途径的各组织结构改变。结果:A组术前、术后1wk时眼压差别有显著性(P<0.01);光镜观察见A组房水池底部巩膜纤维间隙疏松、睫状体微小脱离,SMA免疫组化显示睫状肌细胞间隙无明显改变。结论:NPTS后房水池底部巩膜纤维间隙增大和/或睫状体微小脱离是葡萄膜巩膜途径引流量增强的组织解剖基础。     

Comparison of iCare tonometer and Goldmann applanation tonometry in normal corneas and in eyes with automated lamellar and penetrating keratoplasty

Purpose

To compare intraocular pressure (IOP) measurements with Goldmann applanation tonometry (GAT) and iCare tonometry in normal and post-keratoplasty corneas and to assess the influence of central corneal thickness (CCT), corneal curvature (CC), and corneal astigmatism (CA) on IOP.

Methods

This prospective cross-sectional study included one eye of 101 subjects with normal corneas (58 healthy subjects, 43 glaucoma); and 90 post-keratoplasty patients: 34 penetrating keratoplasties (PK); 20 automated-lamellar-therapeutic keratoplasties (ALTK); 19 Descemet-stripping-automated-endothelial keratoplasties (DSAEK); 17 edematous grafts. All subjects underwent GAT and iCare IOP measurements in random order, and CCT, CC, and CA evaluation. The Bland–Altman method and multivariate regression analysis were used to assess inter-tonometer agreement and the influence of CCT, CC, and CA on IOP.

Results

iCare significantly underestimated IOP in all groups compared with GAT (GAT minus iCare of 3.5±3.5 mm Hg, P<0.001), but overestimated IOP in the edematous grafts (GAT minus iCare of −6.5±1.9 mm Hg, P<0.001). In normal corneas, both tonometer measurements were directly related to CCT values; iCare readings appeared inversely related to CC. There was no significant relationship between IOP and CCT, CC and CA in post-keratoplasty eyes, except between CC and iCare measurements for PK eyes.

Conclusions

The agreement between GAT and iCare was clinically acceptable in control, ALTK and DSAEK groups, and poor in PK and edematous grafts eyes. In normal corneas, GAT was significantly affected by CCT; iCare was influenced by CCT and CC. The iCare appeared less influenced by corneal edema when compared with GAT. High IOP readings taken with both tonometers in grafts should raise suspicion of true elevated IOP.