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Azzopardi M, Chong YJ, Ng B, Recchioni A, Logeswaran A, Ting DSJ. Diagnosis of Acanthamoeba Keratitis: Past, Present and Future. Diagnostics (Basel) 2023; 13:2655. [PMID: 37627913 PMCID: PMC10453105 DOI: 10.3390/diagnostics13162655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK.
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Affiliation(s)
- Matthew Azzopardi
- Department of Ophthalmology, Royal London Hospital, London E1 1BB, UK;
| | - Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Benjamin Ng
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | | | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Diagnostic armamentarium of infectious keratitis: A comprehensive review. Ocul Surf 2021; 23:27-39. [PMID: 34781020 PMCID: PMC8810150 DOI: 10.1016/j.jtos.2021.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 01/23/2023]
Abstract
Infectious keratitis (IK) represents the leading cause of corneal blindness worldwide, particularly in developing countries. A good outcome of IK is contingent upon timely and accurate diagnosis followed by appropriate interventions. Currently, IK is primarily diagnosed on clinical grounds supplemented by microbiological investigations such as microscopic examination with stains, and culture and sensitivity testing. Although this is the most widely accepted practice adopted in most regions, such an approach is challenged by several factors, including indistinguishable clinical features shared among different causative organisms, polymicrobial infection, long diagnostic turnaround time, and variably low culture positivity rate. In this review, we aim to provide a comprehensive overview of the current diagnostic armamentarium of IK, encompassing conventional microbiological investigations, molecular diagnostics (including polymerase chain reaction and mass spectrometry), and imaging modalities (including anterior segment optical coherence tomography and in vivo confocal microscopy). We also highlight the potential roles of emerging technologies such as next-generation sequencing, artificial intelligence-assisted platforms. and tele-medicine in shaping the future diagnostic landscape of IK.
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The Role of Neurotropic B Vitamins in Nerve Regeneration. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9968228. [PMID: 34337067 PMCID: PMC8294980 DOI: 10.1155/2021/9968228] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022]
Abstract
Damage and regeneration naturally occur in the peripheral nervous system. The neurotropic B vitamins thiamine (B1), pyridoxine (B6), and cobalamin (B12) are key players, which maintain the neuronal viability in different ways. Firstly, they constantly protect nerves against damaging environmental influences. While vitamin B1 acts as a site-directed antioxidant, vitamin B6 balances nerve metabolism, and vitamin B12 maintains myelin sheaths. However, nerve injury occurs at times, because of an imbalance between protective factors and accumulating stress and noxae. This will result in the so-called Wallerian degeneration process. The presence of vitamins B1, B6, and B12 paves the way out to the following important regeneration by supporting the development of new cell structures. Furthermore, vitamin B1 facilitates the usage of carbohydrates for energy production, whereas vitamin B12 promotes nerve cell survival and remyelination. Absence of these vitamins will favor permanent nerve degeneration and pain, eventually leading to peripheral neuropathy.
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Chu HS, Huang SL, Chen WL. In-Depth Thinking About the Diagnostic Methods and Treatment Strategies for the Corneal Nerves in Ocular Surface Disorders. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-019-00223-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Bocheux R, Pernot P, Borderie V, Plamann K, Irsch K. Quantitative measures of corneal transparency, derived from objective analysis of depth-resolved corneal images, demonstrated with full-field optical coherence tomographic microscopy. PLoS One 2019; 14:e0221707. [PMID: 31461476 PMCID: PMC6713351 DOI: 10.1371/journal.pone.0221707] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/13/2019] [Indexed: 11/18/2022] Open
Abstract
Loss of corneal transparency, as occurs with various pathologies, infections, immune reactions, trauma, aging, and surgery, is a major cause of visual handicap worldwide. However, current means to assess corneal transparency are extremely limited and clinical and eye-bank practice usually involve a subjective and qualitative observation of opacities, sometimes with comparison against an arbitrary grading scale, by means of slit-lamp biomicroscopy. Here, we describe a novel objective optical data analysis-based method that enables quantifiable and standardized characterization of corneal transparency from depth-resolved corneal images, addressing the demand for such a means in both the laboratory and clinical ophthalmology setting. Our approach is based on a mathematical analysis of the acquired optical data with respect to the light attenuation from scattering processes in the corneal stroma. Applicable to any depth-resolved corneal imaging modality, it has been validated by means of full-field optical coherence tomographic microscopy (FF-OCT or FF-OCM). Specifically, our results on ex-vivo corneal specimens illustrate that 1) in homogeneous tissues, characterized by an exponential light attenuation with stromal depth (z), the computation of the scattering mean-free path (ls) from the rate of exponential decay allows quantification of the degree of transparency; 2) in heterogeneous tissues, identified by significant deviations from the normal exponential z -profile, a measure of exponential-decay model inadequacy (e.g., by computation of the Birge ratio) allows the estimation of severity of stromal heterogeneity, and the associated depth-dependent variations around the average ls enables precise localization of the pathology.
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Affiliation(s)
- Romain Bocheux
- Laboratoire d'Optique et Biosciences (LOB)–École polytechnique, CNRS UMR 7645, INSERM U 1182, Institut polytechnique de Paris, and LOA–ENSTA ParisTech, École polytechnique, CNRS UMR 7639, Institut polytechnique de Paris, Palaiseau, France
- Vision Institute / Quinze-Vingts National Eye Hospital / GRC32 / CIC1423 –Sorbonne University, CNRS UMR 7210, INSERM U 968, Paris, France
| | - Pascal Pernot
- Laboratoire de Chimie Physique–Université Paris-Sud, CNRS UMR 8000, Orsay, France
| | - Vincent Borderie
- Vision Institute / Quinze-Vingts National Eye Hospital / GRC32 / CIC1423 –Sorbonne University, CNRS UMR 7210, INSERM U 968, Paris, France
| | - Karsten Plamann
- Laboratoire d'Optique et Biosciences (LOB)–École polytechnique, CNRS UMR 7645, INSERM U 1182, Institut polytechnique de Paris, and LOA–ENSTA ParisTech, École polytechnique, CNRS UMR 7639, Institut polytechnique de Paris, Palaiseau, France
| | - Kristina Irsch
- Vision Institute / Quinze-Vingts National Eye Hospital / GRC32 / CIC1423 –Sorbonne University, CNRS UMR 7210, INSERM U 968, Paris, France
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Bohn S, Sperlich K, Stolz H, Guthoff RF, Stachs O. In vivo corneal confocal microscopy aided by optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2019; 10:2580-2587. [PMID: 31143503 PMCID: PMC6524594 DOI: 10.1364/boe.10.002580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 05/21/2023]
Abstract
In vivo corneal confocal microscopy and its operability in scientific as well as in clinical applications is often impaired by the lack of information on imaging plane position and orientation inside the cornea during patient's examination. To overcome this hurdle, we have developed a novel corneal imaging system based on a commercial scanning device and a modified Rostock Cornea Module. The presented preliminary system produces en face images by confocal laser scanning microscopy and sagittal cross-section images by optical coherence tomography simultaneously. This enables imaging guidance during examinations, improved features for diagnostics along with thickness measurements of the cornea as well as corneal substructures from oblique sections.
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Affiliation(s)
- Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University Rostock, 18051 Rostock, Germany
- Co-first authors with equal contribution
| | - Karsten Sperlich
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University Rostock, 18051 Rostock, Germany
- Co-first authors with equal contribution
| | - Heinrich Stolz
- Institute of Physics, University Rostock, 18059 Rostock, Germany
| | - Rudolf F Guthoff
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University Rostock, 18051 Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University Rostock, 18051 Rostock, Germany
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Lee OL, Tepelus TC, Huang J, Irvine AG, Irvine C, Chiu GB, Sadda SR. Evaluation of the corneal epithelium in non-Sjögren's and Sjögren's dry eyes: an in vivo confocal microscopy study using HRT III RCM. BMC Ophthalmol 2018; 18:309. [PMID: 30514255 PMCID: PMC6278105 DOI: 10.1186/s12886-018-0971-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/13/2018] [Indexed: 01/09/2023] Open
Abstract
Background The corneal epithelium is directly affected in dry eye syndrome. Thus, we attempted to describe the morphological features and evaluate the cellular density within the corneal epithelial layers in patients with non-Sjögren’s (NSDE) and Sjögren’s syndrome dry eyes (SSDE) by in vivo confocal microscopy (IVCM). Methods Central cornea was prospectively imaged by IVCM in 68 clinically diagnosed aqueous tear-deficient dry eyes and 10 healthy age-matched control eyes. Morphological characteristics of corneal epithelial layers and cellular densities were evaluated by four trained graders from the Doheny Eye Institute. Results Corneal epithelium in dry eyes presents morphological changes such as areas of enlarged and irregular shaped cells. In comparison with controls, the density of superficial epithelial cells was decreased in both the NSDE (P < 0.05) and SSDE groups (P < 0.01); the density of the outer layer of wing cells was smaller but not significantly different in NSDE (P > 0.05), but was lower in the SSDE group (P < 0.01); the density of the inner layer of wing cells was decreased in both the NSDE (P < 0.05) and SSDE groups (P < 0.01) and the density of basal epithelial cells was lower in both the NSDE (P < 0.01) and SSDE groups (P = 0.01). For all cell counts, the interclass correlation coefficient showed good agreement between graders (ICC =0.75 to 0.93). Conclusions IVCM represents a reliable technique for examining the corneal epithelial microstructural changes associated with dry eyes, as well as for objectively and reproducibly quantifying cell densities within all corneal epithelial layers.
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Affiliation(s)
- Olivia L Lee
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA. .,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 91105, USA.
| | - Tudor C Tepelus
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 91105, USA
| | - Jianyan Huang
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 91105, USA
| | - Anne G Irvine
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA.,Universidad Autonoma de Guadalajara, Lomas del Valle, 45129, Zapopan, Jalisco, Mexico
| | - Christopher Irvine
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA.,Universidad Autonoma de Guadalajara, Lomas del Valle, 45129, Zapopan, Jalisco, Mexico
| | - Gloria B Chiu
- Keck School of Medicine, Roski Eye Institute, 1450 San Pablo Street, Los Angeles, CA, 90033, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 91105, USA
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Wasielica-Poslednik J, Gericke A, Desuki A, Schlötzer-Schrehardt U, Pfeiffer N, Lisch W. Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy. Am J Ophthalmol Case Rep 2018; 11:87-91. [PMID: 30014052 PMCID: PMC6019764 DOI: 10.1016/j.ajoc.2018.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To report on a case of recurrence of paraproteinemic keratopathy (PPK) associated with monoclonal gammopathy after bilateral penetrating keratoplasty. Observations Penetrating keratoplasty was performed on both eyes of a 45-year-old man due to bilateral progressive corneal stromal clouding. Recurrence of the corneal stromal opacities accompanied by a decrease in visual acuity was observed on slit-lamp examination already two years after penetrating keratoplasty. Confocal laser scanning microscopy (CLSM) of the corneal grafts performed three years after penetrating keratoplasty showed bilateral morphological changes identical to that found in the patient's corneas prior to penetrating keratoplasty. A hematological work-up revealed monoclonal gammopathy of type IgG kappa. The histochemical examination of the explanted corneas confirmed the diagnosis of PPK. Conclusions and importance Paraproteinemic keratopathy is an underdiagnosed ophthalmological condition, which may be associated with potentially life-threatening hematologic disorders. A hematological workup should be performed in patients with corneal opacities of uncertain etiology. Penetrating keratoplasty should be performed with caution in patients with monoclonal gammopathy due to the possibility of a very fast recurrence of PPK in the corneal graft. This is the first presentation of the recurrence of flake-like PPK after penetrating keratoplasty assessed with CLSM.
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Bohn S, Sperlich K, Allgeier S, Bartschat A, Prakasam R, Reichert KM, Stolz H, Guthoff R, Mikut R, Köhler B, Stachs O. Cellular in vivo 3D imaging of the cornea by confocal laser scanning microscopy. BIOMEDICAL OPTICS EXPRESS 2018; 9:2511-2525. [PMID: 30258669 PMCID: PMC6154195 DOI: 10.1364/boe.9.002511] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 05/07/2023]
Abstract
We present an in vivo confocal laser scanning microscopy based method for large 3D reconstruction of the cornea on a cellular level with cropped volume sizes up to 266 x 286 x 396 µm3. The microscope objective used is equipped with a piezo actuator for automated, fast and precise closed-loop focal plane control. Furthermore, we present a novel concave surface contact cap, which significantly reduces eye movements by up to 87%, hence increasing the overlapping image area of the whole stack. This increases the cuboid volume of the generated 3D reconstruction significantly. The possibility to generate oblique sections using isotropic volume stacks opens the window to slit lamp microscopy on a cellular level.
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Affiliation(s)
- Sebastian Bohn
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Karsten Sperlich
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Ruby Prakasam
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Klaus-Martin Reichert
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Heinrich Stolz
- Institute of Physics, University of Rostock, 18059 Rostock, Germany
| | - Rudolf Guthoff
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Ralf Mikut
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
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Wolska E, Sznitowska M, Chorążewicz J, Szerkus O, Radwańska A, Markuszewski MJ, Kaliszan R, Raczyńska K. Ocular irritation and cyclosporine A distribution in the eye tissues after administration of Solid Lipid Microparticles in the rabbit model. Eur J Pharm Sci 2018; 121:95-105. [PMID: 29777856 DOI: 10.1016/j.ejps.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 12/25/2022]
Abstract
The aim of this study was to investigate the in vivo effect of Solid Lipid Microparticles (SLM), proposed for topical ocular administration of cyclosporine, on the rabbit eye. SLM carrier is an aqueous dispersion of lipid microparticles (20% w/w) with a size up to 15 μm. Cyclosporine was dissolved in the formulation in the concentration of 0.5 or 2.0% (w/w). Ocular tolerance of microsphere dispersion was assessed in rabbit model by the Draize eye test (SLM was compared with emulsion and oily solution), and cyclosporine distribution in ocular tissues was evaluated after multiple application of tested formulations (SLM dispersions, emulsions and oily solution) for 7 days. Good tolerance of cyclosporine-SLM formulation was demonstrated in the rabbit model. Concentration of cyclosporine in the precorneal tissues, such as cornea and conjunctiva, was much higher than the therapeutic value (8.4 ng/mg and 3.2 ng/mg, respectively). After SLM administration, the cyclosporine concentrations determined in the anterior ocular tissues, were also significantly higher compared to those obtained after the application of other tested carriers (emulsions and oily solution). The obtained results prove that the recognized SLM dispersions are safe formulations for ophthalmic use. It can be concluded that lipid microparticles are highly promising for an efficient ophthalmic drug delivery, when compared to other conventional dosage forms.
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Affiliation(s)
- Eliza Wolska
- Department of Pharmaceutical Technology, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland.
| | - Małgorzata Sznitowska
- Department of Pharmaceutical Technology, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Juliusz Chorążewicz
- Department of Ophthalmology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Oliwia Szerkus
- Department of Biopharmaceutics and Pharmacodynamics, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Aleksandra Radwańska
- Department of Biopharmaceutics and Pharmacodynamics, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Michał J Markuszewski
- Department of Biopharmaceutics and Pharmacodynamics, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Roman Kaliszan
- Department of Biopharmaceutics and Pharmacodynamics, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Krystyna Raczyńska
- Department of Ophthalmology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
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Mazlin V, Xiao P, Dalimier E, Grieve K, Irsch K, Sahel JA, Fink M, Boccara AC. In vivo high resolution human corneal imaging using full-field optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2018; 9:557-568. [PMID: 29552393 PMCID: PMC5854058 DOI: 10.1364/boe.9.000557] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/29/2017] [Accepted: 01/04/2018] [Indexed: 05/18/2023]
Abstract
We present the first full-field optical coherence tomography (FFOCT) device capable of in vivo imaging of the human cornea. We obtained images of the epithelial structures, Bowman's layer, sub-basal nerve plexus (SNP), anterior and posterior stromal keratocytes, stromal nerves, Descemet's membrane and endothelial cells with visible nuclei. Images were acquired with a high lateral resolution of 1.7 µm and relatively large field-of-view of 1.26 mm x 1.26 mm - a combination, which, to the best of our knowledge, has not been possible with other in vivo human eye imaging methods. The latter together with a contactless operation, make FFOCT a promising candidate for becoming a new tool in ophthalmic diagnostics.
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Affiliation(s)
- Viacheslav Mazlin
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
| | - Peng Xiao
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
| | - Eugénie Dalimier
- LLTech SAS, 29 Rue du Faubourg Saint Jacques, Paris, 75014, France
| | - Kate Grieve
- Vision Institute/CIC 1423, UPMC-Sorbonne Universities, UMR_S 968/INSERM, U968/CNRS, UMR_7210, 17 Rue Moreau, Paris, 75012, France
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
| | - Kristina Irsch
- Vision Institute/CIC 1423, UPMC-Sorbonne Universities, UMR_S 968/INSERM, U968/CNRS, UMR_7210, 17 Rue Moreau, Paris, 75012, France
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
- Laboratory of Ophthalmic Instrument Development, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - José-Alain Sahel
- Vision Institute/CIC 1423, UPMC-Sorbonne Universities, UMR_S 968/INSERM, U968/CNRS, UMR_7210, 17 Rue Moreau, Paris, 75012, France
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213, USA
| | - Mathias Fink
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
| | - A. Claude Boccara
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
- LLTech SAS, 29 Rue du Faubourg Saint Jacques, Paris, 75014, France
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12
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Abstract
Pain associated with mechanical, chemical, and thermal heat stimulation of the ocular surface is mediated by trigeminal ganglion neurons, while cold thermoreceptors detect wetness and reflexly maintain basal tear production and blinking rate. These neurons project into two regions of the trigeminal brain stem nuclear complex: ViVc, activated by changes in the moisture of the ocular surface and VcC1, mediating sensory-discriminative aspects of ocular pain and reflex blinking. ViVc ocular neurons project to brain regions that control lacrimation and spontaneous blinking and to the sensory thalamus. Secretion of the main lacrimal gland is regulated dominantly by autonomic parasympathetic nerves, reflexly activated by eye surface sensory nerves. These also evoke goblet cell secretion through unidentified efferent fibers. Neural pathways involved in the regulation of meibomian gland secretion or mucin release have not been identified. In dry eye disease, reduced tear secretion leads to inflammation and peripheral nerve damage. Inflammation causes sensitization of polymodal and mechano-nociceptor nerve endings and an abnormal increase in cold thermoreceptor activity, altogether evoking dryness sensations and pain. Long-term inflammation and nerve injury alter gene expression of ion channels and receptors at terminals and cell bodies of trigeminal ganglion and brainstem neurons, changing their excitability, connectivity and impulse firing. Perpetuation of molecular, structural and functional disturbances in ocular sensory pathways ultimately leads to dysestesias and neuropathic pain referred to the eye surface. Pain can be assessed with a variety of questionaires while the status of corneal nerves is evaluated with esthesiometry and with in vivo confocal microscopy.
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Saito T, Ito T, Ito Y, Manabe Y, Sano K. Relationship between gustatory function and average number of taste buds per fungiform papilla measured by confocal laser scanning microscopy in humans. Eur J Oral Sci 2017; 125:44-48. [DOI: 10.1111/eos.12329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Takehisa Saito
- Department of Otorhinolaryngology, Head and Neck Surgery; Faculty of Medical Sciences; University of Fukui; Fukui Japan
- Research and Education Program for Life Science; University of Fukui; Fukui Japan
| | - Tetsufumi Ito
- Research and Education Program for Life Science; University of Fukui; Fukui Japan
- Department of Anatomy; Faculty of Medical Sciences; University of Fukui; Fukui Japan
| | - Yumi Ito
- Department of Otorhinolaryngology, Head and Neck Surgery; Faculty of Medical Sciences; University of Fukui; Fukui Japan
| | - Yasuhiro Manabe
- Department of Otorhinolaryngology, Head and Neck Surgery; Faculty of Medical Sciences; University of Fukui; Fukui Japan
| | - Kazuo Sano
- Division of Dentistry and Oral Surgery; Department of Sensory and Locomotor Medicine; Faculty of Medical Sciences; University of Fukui; Fukui Japan
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Saito T, Ito T, Ito Y, Yamada T, Okamoto M, Manabe Y. Gustatory Dysfunction and Decreased Number of Fungiform Taste Buds in Patients With Chronic Otitis Media With Cholesteatoma. Ann Otol Rhinol Laryngol 2016; 125:704-9. [PMID: 27141029 DOI: 10.1177/0003489416646793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the number of fungiform taste buds among patients with chronic otitis media (COM), those with pars flaccida retraction type cholesteatoma, and those with pars tensa retraction type cholesteatoma in combination with gustatory function. METHODS Thirty-seven patients with COM, 22 patients with pars flaccida retraction type cholesteatoma, and 17 patients with pars tensa retraction type cholesteatoma were included. An average of 10 fungiform papillae (FP) per patient in the midlateral region of the tongue were observed by confocal laser scanning microscopy in vivo, and the average number of taste buds were counted. Just before the observation of FP, electrogustometry (EGM) was performed to evaluate gustatory function. RESULTS A significant decrease of the average number of fungiform taste buds and significant elevation of EGM thresholds were clarified in the pars tensa retraction type cholesteatoma group but not in the COM or pars flaccida type cholesteatoma group. CONCLUSION It was suggested that some neurotoxic cytokines produced by cholesteatoma tissue might affect the CTN morphology, resulting in a decreased number of fungiform taste buds and elevation of EGM threshold in patients with pars tensa retraction type cholesteatoma.
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Affiliation(s)
- Takehisa Saito
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Fukui, Fukui, Japan Research and Education Program for Life Science, University of Fukui, Fukui, Japan
| | - Tetsufumi Ito
- Research and Education Program for Life Science, University of Fukui, Fukui, Japan Department of Anatomy, Faculty of Medicine, University of Fukui, Japan
| | - Yumi Ito
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Fukui, Fukui, Japan
| | - Takechiyo Yamada
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Fukui, Fukui, Japan
| | - Masayuki Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Fukui, Fukui, Japan
| | - Yasuhiro Manabe
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Fukui, Fukui, Japan
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Prakasam RK, Kowtharapu BS, Falke K, Winter K, Diedrich D, Glass A, Jünemann A, Guthoff RF, Stachs O. Quantitative assessment of central and limbal epithelium after long-term wear of soft contact lenses and in patients with dry eyes: a pilot study. Eye (Lond) 2016; 30:979-86. [PMID: 27101746 DOI: 10.1038/eye.2016.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/11/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeAnalysis of microstructural alterations of corneal and limbal epithelial cells in healthy human corneas and in other ocular conditions.Patients and methodsUnilateral eyes of three groups of subjects include healthy volunteers (G1, n=5), contact lens wearers (G2, n=5), and patients with dry eyes (G3, n=5) were studied. Imaging of basal (BC) and intermediate (IC) epithelial cells from central cornea (CC), corneal limbus (CL) and scleral limbus (SL) was obtained by in vivo confocal microscopy (IVCM). An appropriate image analysis algorithm was used to quantify morphometric parameters including mean cell area, compactness, solidity, major and minor diameter, and maximum boundary distance.ResultsThe morphometric parameters of BC and IC demonstrated no significant differences (P>0.05) between groups. Comparison between three corneal locations (CC, CL, and SL) within the groups showed significant differences (P<0.05) with mean values of cell area, compactness, solidity, and major and minor diameter of BC that increase from CC to limbus. The BC were round and regular in the central cornea (P<0.05) compared with CL and SL.ConclusionsIVCM enables high-quality confocal images from central corneal and limbal epithelium. This quantitative study demonstrated morphological differences in the basal and intermediate epithelium between limbus and central cornea, and found no differences between contact lens wearers, dry eyes, and normal subjects.
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Affiliation(s)
- R K Prakasam
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - B S Kowtharapu
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - K Falke
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - K Winter
- Faculty of Medicine, Institute of Anatomy, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - D Diedrich
- Institute for Biostatistics, University of Rostock, Rostock, Germany
| | - A Glass
- Institute for Biostatistics, University of Rostock, Rostock, Germany
| | - A Jünemann
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - R F Guthoff
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - O Stachs
- Department of Ophthalmology, University of Rostock, Rostock, Germany
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16
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Saito T, Ito T, Ito Y, Manabe Y, Sano K. Comparison of fungiform taste-bud distribution among age groups using confocal laser scanning microscopy in vivo in combination with gustatory function. Eur J Oral Sci 2016; 124:135-40. [DOI: 10.1111/eos.12259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Takehisa Saito
- Department of Otorhinolaryngology; Head and Neck Surgery; Faculty of Medical Sciences; University of Fukui; Fukui Japan
- Research and Education Program for Life Science; University of Fukui; Fukui Japan
| | - Tetsufumi Ito
- Research and Education Program for Life Science; University of Fukui; Fukui Japan
- Department of Anatomy; Faculty of Medical Sciences; University of Fukui; Fukui Japan
| | - Yumi Ito
- Department of Otorhinolaryngology; Head and Neck Surgery; Faculty of Medical Sciences; University of Fukui; Fukui Japan
| | - Yasuhiro Manabe
- Department of Otorhinolaryngology; Head and Neck Surgery; Faculty of Medical Sciences; University of Fukui; Fukui Japan
| | - Kazuo Sano
- Division of Dentistry and Oral Surgery; Department of Sensory and Locomotor Medicine; Faculty of Medical Sciences; University of Fukui; Fukui Japan
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Mastropasqua L, Agnifili L, Mastropasqua R, Fasanella V, Nubile M, Toto L, Carpineto P, Ciancaglini M. In vivo laser scanning confocal microscopy of the ocular surface in glaucoma. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2014; 20:879-894. [PMID: 24576766 DOI: 10.1017/s1431927614000324] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Over the past decade, knowledge about the ocular surface in glaucoma has significantly increased through the use of in vivo laser scanning confocal microscopy (LSCM). This in vivo imaging method can show modifications at the cellular level induced by anti-glaucoma drugs on ocular surface structures and adnexa in the eye. High-quality images of the conjunctiva, cornea, limbus, meibomian glands, and lymphoid structures during therapy can be obtained. In addition, LSCM opened new fields of research on the patho-physiology of aqueous humor (AH) hydrodynamics in untreated, and in medically or surgically treated glaucomatous patients. In these conditions, an enhancement of the trans-scleral AH outflow contributed to clarification of the mechanism of action of different anti-glaucoma medications and surgical approaches. Finally, the use of LSCM represented a huge advance in evaluation of bleb functionality after filtration surgery, defining the hallmarks of AH filtration through the bleb-wall and distinguishing functional from nonfunctional blebs. Thus, signs seen with LSCM may anticipate clinical failure, guiding the clinician in planning the appropriate timing of the various steps in bleb management. In this review we summarize the current knowledge about in vivo LSCM of the ocular surface in glaucoma.
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Affiliation(s)
- Leonardo Mastropasqua
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Luca Agnifili
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Rodolfo Mastropasqua
- 2Ophthalmology Unit,Department of Neurological,Neuropsychological,Morphological and Movement Sciences,University of Verona,Verona,53593,Italy
| | - Vincenzo Fasanella
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Mario Nubile
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Lisa Toto
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Paolo Carpineto
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Marco Ciancaglini
- 3Ophthalmic Clinic,Department of Surgical Science,University of L'Aquila,L'Aquila,67100,Italy
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Observation of Regenerated Fungiform Taste Buds After Severing the Chorda Tympani Nerve Using Confocal Laser Scanning Microscopy In vivo. Otol Neurotol 2014; 35:e110-6. [DOI: 10.1097/mao.0000000000000223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Non-contact laser-scanning confocal microscopy of the human cornea in vivo. Cont Lens Anterior Eye 2014; 37:44-8. [DOI: 10.1016/j.clae.2013.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/22/2013] [Accepted: 07/04/2013] [Indexed: 11/21/2022]
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20
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Corneal sensitivity and morphology of the corneal subbasal nerve plexus in primary congenital glaucoma. Eye (Lond) 2014; 28:466-71. [PMID: 24480838 DOI: 10.1038/eye.2014.4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/10/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To quantify the corneal subbasal nerve density and the total number of nerve fibers in primary congenital glaucoma (PCG) and to evaluate their impact on corneal sensitivity. METHODS Forty eyes of 26 PCG patients were compared with 40 eyes randomly selected from 40 non-glaucoma patients who populated the control group. Central corneal sensitivity (CCS) was assessed by means of Cochet-Bonnet esthesiometry. The mean subbasal nerve density and the total number of nerve fibers were quantified by laser-scanning confocal microscopy. Normality of data was assessed by Kolmogorov-Smirnov testing. Differences in parameters were assessed with Student's t-test, while correlations with CSS were assessed with Pearson's correlation. RESULTS Significant differences were identified in the mean subbasal nerve density (2108 ± 692 μm in PCG, 2642 ± 484 μm in controls, P = 0.003) and in the total number of nerve fibers (12.3 ± 4.2 in PCG, 15.4 ± 3.1 in controls, P = 0.02). Both groups presented comparable mean CCS and tortuosity. Both groups presented strong correlations between CCS and mean nerve density (r = 0.57 in PCG, r = 0.67 in controls, all P < 0.05), and between CCS and total number of nerve fibers (r = 0.55 in PCG, r = 0.56 in controls, all P < 0.05). CONCLUSION PCG exerts significant changes in both the mean subbasal nerve density and the total number of nerve fibers. However, these changes do not appear to affect central corneal sensitivity.
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21
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Messmer EM. Confocal microscopy: when is it helpful to diagnose corneal and conjunctival disease? EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.2.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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De Cillà S, Fogagnolo P, Sacchi M, Orzalesi N, Carini E, Ceresara G, Rossetti L. Corneal involvement in uneventful cataract surgery: an in vivo confocal microscopy study. ACTA ACUST UNITED AC 2013; 231:103-10. [PMID: 24296801 DOI: 10.1159/000355490] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/17/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate corneal subbasal layer changes after uneventful cataract surgery by means of in vivo confocal microscopy. METHODS This prospective study included 30 patients. Before surgery, and 1, 3, 6, 8 and 10 months after cataract surgery, all patients underwent a complete ophthalmological and confocal microscopy examination in the central and temporal corneal areas. Number of fibers, beading, tortuosity and reflectivity were analyzed. RESULTS Important changes were shown in the central cornea up to 3 months after surgery: a reduction in nerve fiber number (baseline: 4.4 ± 1.7; month 1: 1.2 ± 0.5, p < 0.0001; month 3: 2.5 ± 1.2, p < 0.005) and reflectivity (baseline: 3.6 ± 0.5; month 1: 1.4 ± 0.6, p < 0.0001; month 3: 1.9 ± 0.9, p < 0. 0001), and an increase in beading (baseline: 0.3 ± 0.5 beads/100 µm(2); month 1: 2.7 ± 0.6 beads/100 µm(2), p < 0.0001; month 3: 2.6 ± 0.5 beads/100 µm(2), p < 0. 0001). The confocal parameters completely progressively recovered thereafter (60% at 6 months, 87% at 8 and 10 months). The temporal plexus was absent at 1 month and fully recovered in all patients at month 8. CONCLUSION Uneventful cataract surgery induces relevant corneal modifications when inspected by means of confocal microscopy.
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Affiliation(s)
- Stefano De Cillà
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
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23
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Ceresara G, Fogagnolo P, Zuin M, Zatelli S, Bovet J, Rossetti L. Study of corneal copper deposits in Wilson's disease by in vivo confocal microscopy. Ophthalmologica 2013; 231:147-52. [PMID: 24107714 DOI: 10.1159/000355090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/03/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To study corneal copper deposits in Wilson's disease (WD) patients by traditional biomicroscopy and in vivo laser scanning confocal microscopy (LSCM). METHODS Twenty WD patients and 20 matched controls underwent an ophthalmic examination in one eye randomly chosen, including slit lamp biomicroscopy with Goldmann's three-mirror contact lens examination and LSCM, in order to evaluate copper deposits in the peripheral cornea. RESULTS No control subjects had corneal changes at both traditional biomicroscopy and LSCM. Only 25% of WD patients had detectable slit lamp changes, compared with 75% with LSCM examination. All cases detected by slit lamp were detected by LSCM. A significant correlation (p < 0.01) was found between deposit intensity at LSCM and daily urinary copper excretion. CONCLUSION LSCM could detect copper deposition in WD corneas in more patients than traditional examination; it may therefore provide important information in cases of suspected WD diagnosis.
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Affiliation(s)
- Gaia Ceresara
- Università degli Studi di Milano, U.O. Oculistica, Dipartimento di Medicina, Chirurgia e Odontoiatria, Azienda Ospedaliera San Paolo, Milano, Italia
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24
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Abstract
Corneal confocal microscopy (CCM) is a noninvasive method for the study of human cornea in vivo. It has increasingly been used to assess the morphology of the sub-basal corneal nerve plexus. CCM has good reproducibility and may contribute to the early diagnosis of diabetic polyneuropathy. It may also be useful to document favorable changes in nerve fiber structure early after therapeutic intervention. Corneal nerve pathology is more pronounced in patients with diabetic polyneuropathy and is associated with its clinical severity. The sensitivity and specificity of CCM for the diagnosis of polyneuropathy is moderate to high. CCM now merits further use in large longitudinal studies to provide more information on the natural history of diabetic neuropathy and effects of treatment. Moreover, there is a need for a larger normative database. Finally, technical progress is expected to enable visualization of larger corneal areas and improve nerve fiber quantification, increasing diagnostic accuracy.
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Affiliation(s)
- N Papanas
- Institute for Clinical Diabetology, German Diabetes Center at the Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
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25
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Timucin OB, Karadag MF, Cinal A, Asker M, Asker S, Timucin D. Assessment of corneal endothelial cell density in patients with keratoconus not using contact lenses. Cont Lens Anterior Eye 2013; 36:80-5. [DOI: 10.1016/j.clae.2012.10.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 09/08/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
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In vivo laser confocal microscopy after Descemet's membrane endothelial keratoplasty. Ophthalmology 2013; 120:923-30. [PMID: 23380472 DOI: 10.1016/j.ophtha.2012.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/30/2012] [Accepted: 11/02/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the in vivo corneal changes in patients with bullous keratopathy who underwent Descemet's membrane endothelial keratoplasty (DMEK) with the use of in vivo laser confocal microscopy. DESIGN Single-center, retrospective clinical study. PARTICIPANTS Five eyes of 4 patients (3 men, 1 women; mean age, 61.3 ± 9.6 years) with bullous keratopathy who had undergone successful DMEK were enrolled in this study. TESTING In vivo laser confocal microscopy was performed before and 1, 3, and 6 months after DMEK. MAIN OUTCOME MEASURES Selected confocal images of corneal layers were evaluated qualitatively and quantitatively for the degree of haze and the density of deposits. Subepithelial haze, donor-recipient interface haze, donor-recipient interface particles, and host stromal needle-shaped materials were graded on a scale of 4 categories (grade 0 = none, grade 1 = mild, grade 2 = moderate, grade 3 = severe) at each time point. Time trends of the outcomes were graphically displayed and evaluated with Mantel-Haenszel trend test. RESULTS The following were observed preoperatively in all patients: slight corneal epithelial edema, moderate subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle-shaped materials in the stroma. After DMEK, moderate subepithelial haze persisted during the follow-up period. Needle-shaped materials had a tendency to decrease after DMEK. Most notably, donor-recipient interface haze and donor-recipient interface particles were barely noticeable after DMEK as early as 1 month postoperatively. CONCLUSIONS In vivo laser confocal microscopy can identify subclinical corneal abnormalities after DMEK, such as subepithelial haze, host stromal needle-shaped materials, and minimum donor-recipient interface haze/particles. These abnormalities seemed subtle compared with Descemet stripping automated endothelial keratoplasty; this may explain the superior postoperative visual acuity after DMEK. Further studies with this technology in a large number of patients and long-term follow-up are needed to fully understand the long-term corneal changes after DMEK. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Gatzioufas Z, Labiris G, Stachs O, Hovakimyan M, Schnaidt A, Viestenz A, Käsmann-Kellner B, Seitz B. Biomechanical profile of the cornea in primary congenital glaucoma. Acta Ophthalmol 2013; 91:e29-34. [PMID: 22937759 DOI: 10.1111/j.1755-3768.2012.02519.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of our study was to investigate the biomechanical properties of the cornea in primary congenital glaucoma (PCG) and to identify the potential ocular determinants, which affect the corneal biomechanical metrics. METHODS Corneal hysteresis (CH), corneal resistance factor (CRF) and central corneal thickness (CCT) were measured in 26 patients with PCG (40 eyes) with the aid of ocular response analyser. In vivo laser-scanning confocal microscopy was used for the estimation of stromal keratocyte density (KD) and the evaluation of corneal endothelium. Twenty normal subjects (40 eyes) served as controls. Student's t-test and Pearson's correlation coefficients were used for statistical analysis. p Values <0.05 were considered statistically significant. RESULTS Corneal hysteresis, CRF and CCT were significantly reduced in patients with PCG (all p < 0.05). Corneal hysteresis and CRF negatively correlated with the corneal diameter in both groups (r(1) = -0.53, r(2) = -0.66, p < 0.001 for CH and r(1) = -0.61, r(2) = -0.69, p < 0.001 for CRF). Moreover, we identified a significant correlation between CH and CRF with CCT in both groups (r(1) = 0.51, r(2) = 0.48, p < 0.001 for CH and r(1) = 0.45, r(2) = 0.44, p < 0.001 for CRF). Mean KD was significantly reduced both in the anterior and posterior corneal stroma in patients with PCG (764 ± 162 and 362 ± 112 cells/mm(2) , respectively) compared with controls (979 ± 208 and 581 ± 131 cells/mm(2) , respectively) (p < 0.001). There was no significant correlation between the keratocyte density in anterior and/or posterior stroma and CH or CRF in any group (r(1) = 0.29, r(2) = 0.31, p < 0.06). Mean endothelial cell density was also significantly reduced in PCG group (2920 ± 443 cells/mm(2) ) compared with control group (3421 ± 360 cells/mm(2) ) (p < 0.001). Pleomorphism and polymegalism were significantly increased in corneal endothelium of patients with PCG. CONCLUSIONS Our results showed a significant reduction in CH and CRF in PCG. Both CH and CRF were negatively correlated with corneal diameter. A significant correlation of CH and CRF with CCT was identified in both groups. Keratocyte density was decreased in PCG, but did not have a significant impact on CH and CRF. Mean endothelial density was also decreased in PCG. Our results suggest that reduced CCT and increased corneal diameter are major ocular determinants for the modified corneal biomechanical profile in PCG, while cellular alterations in corneal stroma and endothelium have no significant biomechanical impact.
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Affiliation(s)
- Zisis Gatzioufas
- Department of Ophthamology, University Medical Center of Saarland UKS, Homburg/Saar, Germany.
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Marcos S, Requejo-Isidro J, Merayo-Lloves J, Acuña AU, Hornillos V, Carrillo E, Pérez-Merino P, del Olmo-Aguado S, del Aguila C, Amat-Guerri F, Rivas L. Fluorescent labeling of Acanthamoeba assessed in situ from corneal sectioned microscopy. BIOMEDICAL OPTICS EXPRESS 2012; 3:2489-2499. [PMID: 23082290 PMCID: PMC3470004 DOI: 10.1364/boe.3.002489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/31/2012] [Accepted: 07/31/2012] [Indexed: 06/01/2023]
Abstract
Acanthamoeba keratitis is a serious pathogenic corneal disease, with challenging diagnosis. Standard diagnostic methods include corneal biopsy (involving cell culture) and in vivo reflection corneal microscopy (in which the visualization of the pathogen is challenged by the presence of multiple reflectance corneal structures). We present a new imaging method based on fluorescence sectioned microscopy for visualization of Acanthamoeba. A fluorescent marker (MT-11-BDP), composed by a fluorescent group (BODIPY) inserted in miltefosine (a therapeutic agent against Acanthamoeba), was developed. A custom-developed fluorescent structured illumination sectioned corneal microscope (excitation wavelength: 488 nm; axial/lateral resolution: 2.6 μm/0.4-0.6 μm) was used to image intact enucleated rabbit eyes, injected with a solution of stained Acanthamoeba in the stroma. Fluorescent sectioned microscopic images of intact enucleated rabbit eyes revealed stained Acanthamoeba trophozoites within the stroma, easily identified by the contrasted fluorescent emission, size and shape. Control experiments show that the fluorescent maker is not internalized by corneal cells, making the developed marker specific to the pathogen. Fluorescent sectioned microscopy shows potential for specific diagnosis of Acanthamoeba keratitis. Corneal confocal microscopy, provided with a fluorescent channel, could be largely improved in specificity and sensitivity in combination with specific fluorescent marking.
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Affiliation(s)
- Susana Marcos
- Instituto de Óptica “Daza de
Valdés”, Consejo Superior de Investigaciones Científicas,
C/Serrano 121, 28006 Madrid, Spain
| | - Jose Requejo-Isidro
- Instituto de Óptica “Daza de
Valdés”, Consejo Superior de Investigaciones Científicas,
C/Serrano 121, 28006 Madrid, Spain
- Unidad de Biofísica, Consejo Superior de
Investigaciones Científicas-UPV-EHU, Barrio Sarriena s/n. 48940 Leioa
(Bizkaia), Spain
| | - Jesus Merayo-Lloves
- Instituto de Oftalmobiología
Aplicada,Universidad de Valladolid,, Campus Miguel Delibes. Paseo de Belen 17,
47011 28006 Valladolid, Spain
- Fundación de Investigación
Oftalmológica, Instituto Oftalmológico Fundación
Fernández-Vega, Avda. Doctores Fernández-Vega 34, 33012 Oviedo,
Spain
| | - A. Ulises Acuña
- Instituto de Química-Física Rocasolano,
Consejo Superior de Investigaciones Científicas, C/Serrano 119, 28006
Madrid, Spain
| | - Valentin Hornillos
- Instituto de Química-Física Rocasolano,
Consejo Superior de Investigaciones Científicas, C/Serrano 119, 28006
Madrid, Spain
| | - Eugenia Carrillo
- Centro de Investigaciones Biológicas, Consejo
Superior de Investigaciones Científicas, C/Ramiro de Maeztu 9, 28040
Madrid, Spain
| | - Pablo Pérez-Merino
- Instituto de Óptica “Daza de
Valdés”, Consejo Superior de Investigaciones Científicas,
C/Serrano 121, 28006 Madrid, Spain
- Instituto de Oftalmobiología
Aplicada,Universidad de Valladolid,, Campus Miguel Delibes. Paseo de Belen 17,
47011 28006 Valladolid, Spain
| | - Susana del Olmo-Aguado
- Instituto de Oftalmobiología
Aplicada,Universidad de Valladolid,, Campus Miguel Delibes. Paseo de Belen 17,
47011 28006 Valladolid, Spain
- Fundación de Investigación
Oftalmológica, Instituto Oftalmológico Fundación
Fernández-Vega, Avda. Doctores Fernández-Vega 34, 33012 Oviedo,
Spain
| | - Carmen del Aguila
- Facultad de Farmacia, Universidad San Pablo-CEU Urb.
Montepríncipe, Ctra. Boadilla del Monte, Km. 5.300, 28668 Madrid,
Spain
| | - Francisco Amat-Guerri
- Instituto de Química Orgánica, Consejo
Superior de Investigaciones Científicas, C/Juan de la Cierva 3, 28006
Madrid, Spain
| | - Luis Rivas
- Centro de Investigaciones Biológicas, Consejo
Superior de Investigaciones Científicas, C/Ramiro de Maeztu 9, 28040
Madrid, Spain
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Ferrari G, Reichegger V, Ludergnani L, Delfini E, Macaluso C. In vivo evaluation of DSAEK interface with scanning-laser confocal microscopy. BMC Ophthalmol 2012; 12:32. [PMID: 22853313 PMCID: PMC3441224 DOI: 10.1186/1471-2415-12-32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 06/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) allows selective replacement of the endothelium. Post-operative haze and particles can affect the interface quality and, ultimately, visual outcome. In this study, we evaluated DSAEK interface with in vivo laser confocal microscopy (LCM) in order to: (i) correlate interface status with best corrected visual acuity, and (ii) with time from surgery; (iii) correlate interface particle number with best corrected visual acuity. Host-donor interface was imaged and graded using a published reflectivity scale. Particles at the interface were counted. METHODS 18 eyes of 16 patients (6 males and 10 females); mean age: 74 ± 8.3 years which underwent DSAEK were examined by means of in vivo laser confocal microscopy between 1 and 24 months after surgery. Host-donor interface was imaged and graded using a published reflectivity scale. Particles present at the interface were counted. RESULTS Interface reflectivity was 2.17 ± 1.2 and significantly correlated with visual acuity (Spearman correlation coefficient -0.83; P < 0.001), and with time after surgery (Spearman correlation coefficient -0.87; P < 0.001). Visual acuity was 0.67 ± 0.27. The number of particles was 205 ± 117.8; no correlation was found between this number and visual acuity (Spearman correlation coefficient -0.41; P = 0.15). CONCLUSION DSAEK interface imaged with LCM is helpful in diagnosing poor host-donor interface quality in DSAEK surgery. A good quality interface is related to a better visual acuity. Moreover, the quality of the interface appears to improve as time passes from the surgery. Interface quality is related with visual acuity and improves with time from surgery. LCM should be considered as an added tool in post-DSAEK follow-up of patients. Finally, our study shows that the presence of particles does not influence visual outcome.
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Kobayashi A, Yokogawa H, Sugiyama K. In vivo laser confocal microscopy findings in patients with map-dot-fingerprint (epithelial basement membrane) dystrophy. Clin Ophthalmol 2012; 6:1187-90. [PMID: 22888214 PMCID: PMC3413338 DOI: 10.2147/opth.s34196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this study was to investigate pathological changes of the
corneal cell layer in patients with map-dot-fingerprint (epithelial basement
membrane) dystrophy by in vivo laser corneal confocal microscopy. Methods: Two patients were evaluated using a cornea-specific in vivo laser scanning
confocal microscope (Heidelberg Retina Tomograph 2 Rostock Cornea Module,
HRT 2-RCM). The affected corneal areas of both patients were examined. Image
analysis was performed to identify corneal epithelial and stromal deposits
correlated with this dystrophy. Results: Variously shaped (linear, multilaminar, curvilinear, ring-shape, geographic)
highly reflective materials were observed in the “map” area,
mainly in the basal epithelial cell layer. In “fingerprint”
lesions, multiple linear and curvilinear hyporeflective lines were observed.
Additionally, in the affected corneas, infiltration of possible Langerhans
cells and other inflammatory cells was observed as highly reflective
Langerhans cell-like or dot images. Finally, needle-shaped materials were
observed in one patient. Conclusion: HRT 2-RCM laser confocal microscopy is capable of identifying corneal
microstructural changes related to map-dot-fingerprint corneal dystrophy in
vivo. The technique may be useful in elucidating the pathogenesis and
natural course of map-dot-fingerprint corneal dystrophy and other similar
basement membrane abnormalities.
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Affiliation(s)
- Akira Kobayashi
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Bouzoukis DI, Kymionis GD, Panagopoulou SI, Diakonis VF, Pallikaris AI, Limnopoulou AN, Portaliou DM, Pallikaris IG. Visual Outcomes and Safety of a Small Diameter Intrastromal Refractive Inlay for the Corneal Compensation of Presbyopia. J Refract Surg 2012; 28:168-73. [PMID: 22301097 DOI: 10.3928/1081597x-20120124-02] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 11/23/2011] [Indexed: 11/20/2022]
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Ranno S, Fogagnolo P, Rossetti L, Orzalesi N, Nucci P. Changes in corneal parameters at confocal microscopy in treated glaucoma patients. Clin Ophthalmol 2011; 5:1037-42. [PMID: 21845031 PMCID: PMC3151567 DOI: 10.2147/opth.s22874] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Indexed: 12/26/2022] Open
Abstract
Background: The purpose of this study was to evaluate corneal parameters in treated glaucoma patients, nontreated glaucoma patients, and normal subjects using confocal microscopy. Methods: Forty patients with primary open-angle glaucoma and 22 untreated controls underwent confocal microscopy of the cornea using the Heidelberg retinal tomograph cornea module. The glaucoma group was divided into two subgroups, ie, patients on medical treatment for at least two years before inclusion (with beta-blockers or prostaglandin analogs) and nontreated glaucoma patients. The following corneal parameters were evaluated: endothelial cell density and number, reflectivity, and tortuosity of sub-basal nerves. For reflectivity and tortuosity, a dedicated grading scale ranging from 0 to 4 was used. Differences between treatments were also evaluated in the treated glaucoma group. Results: Number of fibers and reflectivity of the sub-basal plexus were significantly lower in glaucoma patients as compared with controls (2.5 ± 0.7 versus 2.9 ± 0.9, P = 0.006, and 2.3 ± 0.8 versus 2.7 ± 0.9, P = 0.04, respectively), whereas tortuosity was significantly higher (2.6 ± 1 versus 2.0 ± 0.8, P = 0.007). Endothelial cell density (measured as cells per mm2) was lower in the glaucoma group comparing treated patients with nontreated patients (2826 ± 285 versus 3124 ± 272, P = 0.0003). Comparing treated patients with nontreated patients, relevant differences were found in number (2.3 ± 0.7 versus 2.8 ± 0.8, P = 0.004), tortuosity (2.8 ± 1 versus 2.2 ± 0.8, P = 0.004), and reflectivity (2.2 ± 0.8 versus 2.6 ± 0.8, P = 0.04). No differences in corneal parameters were found between beta-blockers and prostaglandin analogs. Conclusion: This study shows that differences in corneal parameters between glaucoma patients and controls may be due to the medical treatments used for glaucoma. These data should be taken into consideration in long-standing medical glaucoma treatment and in potential candidates for surgery.
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Affiliation(s)
- Stefano Ranno
- Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
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Abstract
PURPOSE We looked for microstructural corneal characteristics of Thygeson superficial punctate keratitis (TSPK) in an in vivo investigation using laser scanning confocal microscopy. METHODS Five patients (3 men and 2 women; mean age, 51.8 years) with clinically diagnosed TSPK were enrolled in this study. All patients were examined by slit-lamp biomicroscopy and in vivo laser confocal microscopy. Deposits in selected confocal images of all corneal layers were evaluated qualitatively for shape and degree of light reflection. RESULTS The most characteristic finding was aggregates of highly reflective deposits with a starburst-like appearance that corresponded with epithelial punctate lesions identified by slit-lamp biomicroscopy; the aggregates were sporadically observed in all cases at the superficial and basal epithelial cell layers. Subepithelial haze was observed in all cases. Langerhans cells were also sporadically observed in all cases at the basal epithelial layer. Bowman layer abnormalities were observed in 3 of 5 cases; all these patients had a long history of TSPK (eg, more than 1 year). In addition, the 3 patients had highly reflective, tiny, needle-shaped materials in the corneal stroma. CONCLUSIONS In vivo laser confocal microscopy is capable of identifying characteristic corneal microstructural changes related to TSPK with a higher resolution than is available with slit-lamp biomicroscopy. It may also be a valuable tool for further research to elucidate both pathogenesis and the natural course of TSPK.
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Confocal laser-scanning microscopy allows differentiation between Fabry disease and amiodarone-induced keratopathy. Graefes Arch Clin Exp Ophthalmol 2011; 249:1689-96. [PMID: 21720814 DOI: 10.1007/s00417-011-1726-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 05/05/2011] [Accepted: 05/21/2011] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim of this work is to compare the microstructure of cornea verticillata in Fabry disease with amiodarone-induced keratopathy by means of in vivo confocal laser-scanning microscopy (CLSM). METHODS Ten eyes of ten patients suffering from Fabry disease, six eyes of six patients with amiodarone-induced keratopathy and eight eyes of healthy control subjects were examined by conventional slit-lamp microscopy and CLSM. One Fabry patient received amiodarone therapy. All Fabry patients were under enzyme replacement therapy with agalsidase alfa. RESULTS Seven out of ten Fabry patients and all patients receiving amiodarone showed typical cornea verticillata on slit-lamp examination. CLSM revealed hyper-reflective intracellular inclusions in basal epithelial cells of all Fabry patients with cornea verticillata and in one Fabry patient without slit-lamp-detectable vortex keratopathy, as well as in all eyes featuring amiodarone keratopathy. Amiodarone deposits were more reflective and of grossly different size. Seven Fabry patients and all amiodarone patients had stromal microdots. Two amiodarone patients showed amiodarone inclusions in the endothelium. The number of CLSM changes in Fabry patients did not correlate with that of slit-lamp detectable cornea verticillata. CONCLUSIONS While Fabry-induced cornea verticillata and amiodarone keratopathy cannot be distinguished by conventional slit-lamp microscopy, CLSM allows the differentiation between both etiologies in the majority of patients. CLSM appears to reveal corneal changes prior to the detection of cornea verticillata on slit-lamp microscopy and may thus be helpful in the early diagnosis of Fabry disease. CLSM does not allow quantitative monitoring of corneal changes in Fabry patients under enzyme-replacement therapy.
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Comparison Between Laser Scanning In Vivo Confocal Microscopy and Noncontact Specular Microscopy in Assessing Corneal Endothelial Cell Density and Central Corneal Thickness. Cornea 2011; 30:754-9. [PMID: 21150426 DOI: 10.1097/ico.0b013e3182000c5d] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Timucin OB, Karadag MF, Cinal A. Assessment of keratocyte density in patients with keratoconus not using contact lenses. Cornea 2011; 30:576-9. [PMID: 21490530 DOI: 10.1097/ico.0b013e3182000fd4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the keratocyte density (KD) in the cornea of patients with keratoconus not using contact lenses. METHOD In this pilot study, the eyes (n = 68) of 35 patients with the diagnosis of keratoconus, who did not use contact lenses and the eyes(n = 70) of 35 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock cornea module (HRT3/RCM). The cases with keratoconus and controls were compared with regard to KD in the anteroposterior stromal layers. RESULTS Of the cases with keratoconus, 15 (42.9%) were men and 20 (57.1%) were women. The mean age was 21.1 ± 11.1 (range =14-41) years. Of the controls, 26 (73.9%) were men and 9 (26.1%)were women. The mean age was 23.9 ± 12.9 (range = 14-35) years.Of the 68 eyes with keratoconus, 22 (28.2%) had mild keratoconus, 23 (35.9%) had moderate keratoconus, and 23 (35.9%) had severe keratoconus. The mean anterior stromal KD was 651.4 ± 89 cells per square millimeter in cases with keratoconus and 879.4 ± 75 cells per square millimeter in controls (P < 0.05). The mean anterior stromal KD decreased by 25.9% in corneas with keratoconus. The mean posterior stromal KD was found to be 363.6 ± 74 cells per square millimeter in cases with keratoconus and 469.7 ± 56 cells per square millimeter in controls (P< 0.01). The mean posterior stromal KD decreased by 22.6% in corneas with keratoconus. The anterior stromal KD was higher than the posterior stromal KD (P < 0.001). No significant relationships were found between the stromal KD data and central corneal thickness or steepest keratometric. CONCLUSIONS The KD in the anterior and posterior corneal stroma was decreased in patients with keratoconus, but without the use of contact lens, compared with healthy controls. This density difference was independent from the central corneal thickness and the stage of keratoconus.
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Knop E, Knop N, Zhivov A, Kraak R, Korb DR, Blackie C, Greiner JV, Guthoff R. The lid wiper and muco-cutaneous junction anatomy of the human eyelid margins: an in vivo confocal and histological study. J Anat 2011; 218:449-61. [PMID: 21413985 DOI: 10.1111/j.1469-7580.2011.01355.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The inner border of the eyelid margin is critically important for ocular surface integrity because it guarantees the thin spread of the tear film. Its exact morphology in the human is still insufficiently known. The histology in serial sections of upper and lower lid margins in whole-mount specimens from 10 human body donors was compared to in vivo confocal microscopy of eight eyes with a Heidelberg retina-tomograph (HRT II) and attached Rostock cornea module. Behind the posterior margin of the Meibomian orifices, the cornified epidermis stopped abruptly and was replaced by a continuous layer of para-keratinized (pk) cells followed by discontinuous pk cells. The pk cells covered the muco-cutaneous junction (MCJ), the surface of which corresponded to the line of Marx (0.2-0.3 mm wide). Then a stratified epithelium with a conjunctival structure of cuboidal cells, some pk cells, and goblet cells formed an epithelial elevation of typically about 100 μm initial thickness (lid wiper). This continued for 0.3-1.5 mm and formed a slope. The MCJ and lid wiper extended all along the lid margin from nasal to temporal positions in the upper and lower lids. Details of the epithelium and connective tissue were also detectable using the Rostock cornea module. The human inner lid border has distinct zones. Due to its location and morphology, the epithelial lip of the lid wiper appears a suitable structure to spread the tear film and is distinct from the MCJ/line of Marx. Better knowledge of the lid margin appears important for understanding dry eye disease and its morphology can be analysed clinically by in vivo confocal microscopy.
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Affiliation(s)
- Erich Knop
- Ocular Surface Center Berlin, Department for Cell and Neurobiology, Center for Anatomy, Charité- Universitätsmedizin Berlin, Berlin, Germany.
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Confocal laser scanning microscopy for detection of Schistosoma mansoni eggs in the gut of mice. PLoS One 2011; 6:e18799. [PMID: 21533168 PMCID: PMC3078923 DOI: 10.1371/journal.pone.0018799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 03/20/2011] [Indexed: 11/24/2022] Open
Abstract
Background The gold standard for diagnosing Schistosoma mansoni infections is the detection of eggs from stool or biopsy specimens. The viability of collected eggs can be tested by the miracidium hatching procedure. Direct detection methods are often limited in patients with light or early infections, whereas serological tests and PCR methods fail to differentiate between an inactive and persistent infection and between schistosomal species. Recently, confocal laser scanning microscopy (CLSM) has been introduced as a diagnostic tool in several fields of medicine. In this study we evaluated CLSM for the detection of viable eggs of S. mansoni directly within the gut of infected mice. Methodology/Principal Findings The confocal laser scanning microscope used in this study is based on the Heidelberg Retina Tomograph II scanning laser system in combination with the Rostock Cornea Module (image modality 1) or a rigid endoscope (image modality 2). Colon sections of five infected mice were examined with image modalities 1 and 2 for schistosomal eggs. Afterwards a biopsy specimen was taken from each colon section and examined by bright-field microscopy. Visualised eggs were counted and classified in terms of viability status. Conclusions/Significance We were able to show that CLSM visualises eggs directly within the gut and permits discrimination of schistosomal species and determination of egg viability. Thus, CLSM may be a suitable non-invasive tool for the diagnosis of schistosomiasis in humans.
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Arba Mosquera S, de Ortueta D. Optimized Zernike Term Selection in Customized Treatments for Laser Corneal Refractive Surgery: Case Report. J Refract Surg 2011; 27:148-152. [DOI: 10.3928/1081597x-20100224-01] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 02/10/2009] [Indexed: 11/20/2022]
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Reichard M, Hovakimyan M, Wree A, Meyer-Lindenberg A, Nolte I, Junghans C, Guthoff R, Stachs O. Comparative in vivo confocal microscopical study of the cornea anatomy of different laboratory animals. Curr Eye Res 2010; 35:1072-80. [PMID: 20961216 DOI: 10.3109/02713683.2010.513796] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of the present study was to analyze and compare in vivo morphology of healthy cornea of six different laboratory animals. MATERIALS AND METHODS One Pomeranian Coarsewool sheep, 5 Beagle dogs, 1 Norwegian and 2 Domestic Short-haired cats, 20 New Zealand White rabbits, 6 Wistar rats, and 10 Balb/c mice were included. The examination was performed bilaterally, using Heidelberg Retina Tomograph equipped with Rostock Cornea Module. The morphology of living corneal layers was visualized and compared between species. The central corneal thickness, density of keratocytes, and endothelial cells were quantified. RESULTS The epithelial multilayer showed a similarity in morphology between animal types, displaying three clearly distinguishable layers: superficial, intermediate, and basal. Subbasal nerve fibers were displayed as hyperreflective structures underneath basal cells. The subbasal fibers were confirmed in all species, however, the density varied between species. A pronounced Bowman's membrane was visualized in sheep. In all other species, however, a thin acellular layer with overlying nerve fibers could be seen between basal epithelial cells and anterior stroma. The keratocytes nuclei could be demonstrated in all species except for mice, where no nuclei but only reflective structures resembling keratocytes cell bodies were detected. Overall, the density of keratocytes nuclei was significantly higher in the anterior than in the posterior stroma. Besides endothelial cells density, the endothelial cells morphology was very similar among all species, except for sheep. The endothelial cells were displayed as polygonal structures with bright cytoplasm and dark borders. In sheep, the appearance of the endothelium was very poor because of a thick hyperreflective Descemet's membrane. CONCLUSIONS The present study will help researchers consider appropriate models for animal experiments, depending on focus of investigation. In vivo CLSM can be used for the characterization of the living cornea over time, thus, reducing the number of animal experiments.
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Affiliation(s)
- Maria Reichard
- Department of Ophthalmology, University of Rostock, Rostock, Germany
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Yokogawa H, Kobayashi A, Tagawa K, Sugiyama K. In Vivo Laser Confocal Microscopic Analysis of Corneal K-Structures After Keratorefractive Surgery (LASIK and Epi-LASIK). Ophthalmic Surg Lasers Imaging Retina 2010; 41:494-8. [DOI: 10.3928/15428877-20100625-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 03/26/2010] [Indexed: 11/20/2022]
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[Schnyder's crystalline-like corneal dystrophy: a case report]. J Fr Ophtalmol 2010; 33:264.e1-5. [PMID: 20334950 DOI: 10.1016/j.jfo.2010.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 12/22/2009] [Indexed: 11/21/2022]
Abstract
Schnyder's crystalline corneal dystrophy is a rare bilateral hereditary disease with various clinical features. It typically presents as a central disc-like opacification with or without crystalline deposits. We report the case of a particular crystalline-free and ring-like pattern dystrophy resembling Schnyder's corneal dystrophy in an 82-year-old woman. In addition, we describe the aspects of this dystrophy with in vivo confocal microscopy using the Heidelberg Retina Tomograph II-Rostock Cornea Module and with anterior segment optical coherence tomography (OCT-Visante((R))). These techniques can be useful in the diagnosis or the therapeutic process, showing crystalline structures that are not clinically distinguishable or validating the histological localization of the corneal disease.
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Comparison of Data From the Rostock Cornea Module of the Heidelberg Retina Tomograph, the Oculus Pentacam, and the Endothelial Cell Microscope. Cornea 2010; 29:314-20. [DOI: 10.1097/ico.0b013e3181ac9e0d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Farahati B, Stachs O, Prall F, Stave J, Guthoff R, Pau HW, Just T. Rigid confocal endoscopy for in vivo imaging of experimental oral squamous intra-epithelial lesions. J Oral Pathol Med 2009; 39:318-27. [PMID: 20050982 DOI: 10.1111/j.1600-0714.2009.00841.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A rigid confocal endoscope has been developed to assess the oral squamous epithelium of mice and to determine sensitivity, specificity, and accuracy of this new technology. METHODS This endoscope is connected to the commercially available Heidelberg Retina Tomograph (HRT). HRT is a device with a 670-nm diode laser designed to acquire topographical measurements of the optic nerve head. Real-time rigid confocal endoscopy is demonstrated by imaging the epithelial lesions of a mice model. Six-week-old male C57Bl/6 mice were randomly divided into a non-treated group (n = 10) and into a 4-nitroquinoline 1-oxide (4-NQO)-treated group (n = 50). In the 4-NQO-treated group, the mice obtained 4-nitroquinoline 1-oxide in the drinking water (100 microg/ml) to induce tumourigenesis in the mouse tongue. The 4-NQO-solution was diluted in the drinking water for mice. After an 8-16-week carcinogen treatment with 4-NQO (ad libitum), mouse tongues were dissected within 3 h after CO(2) overdose. After confocal microscopy of all lesions of the tongue, conventional histopathological investigation was performed. RESULTS The inter-rater reliability for the two observers of the confocal microscopic findings was found to be Kappa = 0.59 (P < 0.001). The penetration depth varied in the healthy tissue of the underside of the tongue throughout this study and was measured between 104 and 240 microm. In keratotic lesions, the penetration depths were diminished and varied between 80 and 140 microm. Strong keratinization inhibits the evaluation of the epithelium. For differentiation between low-grade and high-grade squamous intra-epithelial lesions, a sensitivity and specificity of 73% and 88% was reached. CONCLUSIONS The animal experiment with this non-invasive new technology indicates that this imaging technology facilitates the detection of pre-cancerous lesions of the underside of the oropharynx. Human studies on oropharyngeal and laryngeal lesions are needed to prove the applicability of this method in the field of otorhinolaryngology.
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Affiliation(s)
- Behnaz Farahati
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Rostock, Germany
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Srur E, Stachs O, Guthoff R, Witt M, Pau HW, Just T. Change of the human taste bud volume over time. Auris Nasus Larynx 2009; 37:449-55. [PMID: 20031354 DOI: 10.1016/j.anl.2009.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 11/24/2009] [Accepted: 11/26/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The specific aim of this study is to measure the taste volume in healthy human subjects over a 2.5-month period and to demonstrate morphological changes of the peripheral taste organs. MATERIAL AND METHODS Eighteen human taste buds in four fungiform papillae (fPap) were examined over a 10-week period. The fungiform papillae investigated were selected based on the form of the papillae or the arrangement of surface taste pores. Measurements were performed over 10 consecutive weeks, with five scans in a day once a week. The following parameters were measured: height and diameter of the taste bud, diameter of the fungiform papilla and diameter of the taste pore. RESULTS The findings of this exploratory study indicated that (1) taste bud volumes changed over a 10-week period, (2) the interval between two volume maxima within the 10-week period was 3-5 weeks, and (3) the diameter of the fPap did not correlate with the volume of a single taste bud or with the volume of all taste buds in the fPap within the 10-week period. CONCLUSIONS This exploratory in vivo study revealed changes in taste bud volumes in healthy humans with age-related gustatory sensitivity. These findings need to be considered when studying the effect of denervation of fungiform papillae in vivo using confocal microscopy.
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Affiliation(s)
- Ehab Srur
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Strasse 137-139, 18057 Rostock, Germany
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Kymionis GD, Grentzelos MA, Diakonis VF, Pallikaris AI, Pallikaris IG. Nine-year follow-up of intacs implantation for keratoconus. Open Ophthalmol J 2009; 3:77-81. [PMID: 20087439 PMCID: PMC2808049 DOI: 10.2174/1874364100903010077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 07/06/2009] [Accepted: 08/13/2009] [Indexed: 11/22/2022] Open
Abstract
Purpose: To present a case of nine- year bilateral Intacs (Addition Technology, Inc, Fremont, California, USA) implantation for early stage keratoconus. Methods: A 25-year-old male underwent bilateral Intacs implantation for the management of keratoconus and hardcontact-lens intolerance (stage 1) in 1999. Results: Nine years postoperatively, spherical equivalent refraction changed from preoperative -0.75 and -2.25 to +0.75 and –1.25 for the right and the left eye, respectively. UCVA was improved from 20/50 to 20/25 in the right and from 20/200 to 20/32 in the left eye. BSCVA of 20/20 in the right eye maintained stable in comparison with the Pre-Intacs BSCVA, while BSCVA was improved from 20/25 to 20/20 in the fellow eye. No early or late complications were observed. Conclusions: Nine years after bilateral Intacs implantation for the management of early stage keratoconus, there was a significant improvement and postoperative stability in patient’s visual acuity. No long-term, sight-threatening complications were identified during follow-up.
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Affiliation(s)
- George D Kymionis
- Institute of Vision and Optics, Department of Ophthalmology, Medical School, University of Crete, Greece
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Dalton K, Schneider S, Sorbara L, Jones L. Confocal microscopy and optical coherence tomography imaging of hereditary granular dystrophy. Cont Lens Anterior Eye 2009; 33:33-40. [PMID: 19945908 DOI: 10.1016/j.clae.2009.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 09/26/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This case report examines the clinical characteristics of hereditary granular dystrophy through the use of slit lamp digital photography, confocal microscopy (CM) and optical coherence tomography (OCT). A review of the literature describing the histopathological and genetic associations of stromal dystrophies, suggest it may be possible to differentiate dystrophies based on their clinical manifestations, and appearances of CM and OCT images, with or without the use of genetic testing. CASE REPORT Two sisters, previously diagnosed with Granular (Groenouw I) Dystrophy, were examined. Examination included the use of digital slit lamp photography, CM and OCT imaging. RESULTS "Breadcrumb" opacities were visualized in the anterior two-thirds of the stroma with all three imaging techniques. Opacities were demonstrated in the posterior third of the stroma with the digital photography and OCT techniques. CONCLUSIONS The digital photography, CM and OCT images support the sister's diagnosis of Granular (Groenouw I) Dystrophy. Currently, genetic and histopathological testing are the only techniques available to determine exactly which corneal dystrophy and gene mutation are present. The results of this case report demonstrate that slit lamp digital photography, combined with CM and OCT may be capable of providing sufficient diagnostic information to diagnose corneal granular dystrophies in a clinical setting.
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Affiliation(s)
- Kristine Dalton
- School of Optometry, University of Waterloo, Ontario, Canada.
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Stachs O, Schumacher S, Hovakimyan M, Fromm M, Heisterkamp A, Lubatschowski H, Guthoff R. Visualization of femtosecond laser pulse–induced microincisions inside crystalline lens tissue. J Cataract Refract Surg 2009; 35:1979-83. [DOI: 10.1016/j.jcrs.2009.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 06/18/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
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Nohr-Westphal C, Stachs O, Kröger M, Kram W, Guthoff R, Hakenberg O. Konfokale Laserscanningmikroskopie von Urothel. Urologe A 2009; 48:1025-6, 1028, 1030-1. [DOI: 10.1007/s00120-009-2078-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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