Osmotically induced central and peripheral corneal swelling in the cat

The central and peripheral corneal response to short-term hypoxia

PURPOSE

To quantify the magnitude and recovery of central and limbal corneal oedema induced by short-term unilateral eyelid closure without contact lens wear.

METHODS

The left eye of 10 adults with healthy corneas was patched using a folded eye pad for 30 min. High-resolution optical coherence tomography images (which captured the limbal and central corneal regions simultaneously) were obtained before patching, immediately after eye opening and again at 1, 2, 5, 6, 9, 10, 14 and 15 mins after eyelid opening. Oedema was measured from the limbus (scleral spur) to the central cornea (thinnest corneal location) along the horizontal meridian.

RESULTS

A greater amount of limbal oedema was noted (mean [SD] 3.84 [1.79] %) compared to the central cornea (2.48 [0.61] %; p = 0.04) after 30 mins of unilateral eyelid closure. Both central and limbal corneal oedema recovered rapidly following eyelid opening, with no significant differences in the rate of corneal recovery between corneal locations (p = 0.90).

CONCLUSIONS

Short-term unilateral eyelid closure resulted in ~55% more relative oedema in the limbal region compared to the central cornea. Rapid recovery of oedema and corneal overshoot (thinning beyond the baseline corneal thickness) was observed within 1-2 min of eyelid opening for both central and peripheral regions.

Dual-Scheimpflug-Placido-disc corneal analysis in cats

OBJECTIVE

To evaluate the corneal topography and tomography of cats using a dual Scheimpflug and Placido disc device.

ANIMAL STUDIED

Sixteen mixed-breed cats (32 eyes).

PROCEDURE(S)

Cats were sedated using meperidine (4.3 mg/kg/IM) and xylazine (0.5 mg/kg/IM), and evaluated using the software Galilei™. Values assessed included anterior and posterior corneal curvature, total corneal power, and corneal thickness.

RESULTS

Ten males and six females aged between 18 and 48 months were evaluated. The simulated keratometry (SimK) was 38.37 ± 0.83D, mean posterior keratometry -4.89 ± 0.34D, and mean total corneal power 38.04 ± 0.94D. The mean central corneal thickness (CCT) was 617.34 ± 53.38 μm with a mean thinnest point of 583.74 ± 60.60 μm.

CONCLUSION

The Galilei™ examination was feasible in cats, enabling a detailed study of the cornea. To the best of our knowledge, this is the first study evaluating the corneal topography and tomography of cats using a device that integrates data from a dual Scheimpflug and Placido disc system.

Espessura corneana mensurada pelo paquímetro ultra-sônico e pelo microscópio especular Topcon SP-2000P em gatos

Avaliou-se a espessura corneana central de 13 gatos normais com microscópio especular de não-contato Topcon SP-2000P e paquímetro ultra-sônico. Foi observado aumento da espessura corneana mensurada pelo paquímetro ultra-sônico comparado ao microscópio especular.

Contact Lens-Induced Corneal Swelling and Surface Changes Measured with the Orbscan II Corneal Topographer

PURPOSE

The purpose of this study was to measure central and topographical corneal swelling in response to contact lens wear and eye closure, to determine whether the swelling induced by soft and polymethyl methacrylate (PMMA) lenses is different, and to determine whether the anterior and/or posterior corneal shape alters with corneal swelling.

METHODS

An Orbscan II corneal topographer was used to measure corneal swelling and the shape of the anterior and posterior corneal surfaces of 16 neophytes before and after wearing soft and PMMA contact lenses with near-zero oxygen transmissibility. The lens-wearing eye was patched for 3 h.

RESULTS

The mean 15.1% +/- 3.8% (+/- SD) central corneal swelling with soft lenses was significantly >12.6% +/- 4.1% with PMMA lenses. Topographical corneal swelling was significantly greater with soft vs. PMMA lenses. However, the difference between central and peripheral corneal swelling was much greater with PMMA lenses. With both lenses, the cornea swelled significantly more in the center than the periphery. The anterior best-fit sphere radius remained unchanged in response to soft lenses (0.00 +/- 0.04 mm) and steepened slightly but significantly with PMMA lenses (-0.04 +/- 0.05 mm). The posterior best-fit sphere radius flattened significantly with both lenses (0.12 +/- 0.07 mm with soft and 0.14 +/- 0.08 mm with PMMA lenses).

CONCLUSIONS

Corneal swelling (greater centrally than peripherally) flattens the posterior surface of the cornea and is independent of lens type. Although the anterior best-fit sphere radius steepened with PMMA, the magnitude is probably clinically unimportant. Both lens types produced greater central vs. peripheral corneal swelling. However, the soft lens induced significantly greater overall swelling than PMMA. Because their oxygen transmission was the same, these results suggest that there is lateral diffusion of oxygen from the peripheral area of the cornea (that is not covered by the lens) toward the center.

LASIK complications: etiology, management, and prevention

Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By examining the etiology, management, and prevention of these complications, the refractive surgeon may be able to improve visual outcomes and prevent vision-threatening problems. Reporting outcomes and mishaps of LASIK surgery will help refine our approach to the management of emerging complications.

Successful treatment of severe wrinkled corneal flap after laser in situ keratomileusis with deionized water

PURPOSE

To investigate a case of severe wrinkled corneal flap after laser in situ keratomileusis (LASIK) successfully treated by hydrating the flap with deionized water and applying a bandage contact lens.

METHODS

A 39-year-old woman presented with corneal flap wrinkles 24 hours after undergoing LASIK in her left eye. Under the operating microscope the flap was refloated and hydrated with sterile deionized water for 2 minutes without stretching or ironing the flap. A bandage contact lens was then applied for 24 hours. Sterile deionized water was used topically every 2 hours for 1 day.

RESULTS

Twenty-four hours after treatment with sterile deionized water and a bandage contact lens, the cornea was smooth and wrinkle free.

CONCLUSIONS

Hydration with deionized water may offer advantages over isotonic solutions in treating a wrinkled corneal flap after LASIK.

Topographical corneal edema. An update

Measurement of the topographical corneal edema response has been previously restricted by the use of optical pachometry and small sample sizes. This study uses ultrasound pachometry to measure changes in the corneal thickness of 23 subjects at 9 locations during 2 hours' wear of a thick soft contact lens. The data are analysed using both averaged and individual location data. The averaged location analysis supports the current paradigm that less edema occurs in the peripheral cornea than in the central cornea during contact lens wear. However, the individual location analysis reveals a more complex corneal edema response in which the greatest amount of edema following 2 hours' contact lens wear occurred in the central and mid-peripheral temporal cornea, in comparison with the peripheral nasal and peripheral inferior cornea which showed the least edema. The edema measured in the peripheral temporal and peripheral superior cornea following 2 hours' contact lens wear was not significantly different from that measured in the central cornea. The edema measured in the central cornea following 2 hours' contact lens wear was not significantly different from that found at any mid-peripheral location. This study demonstrates that the corneal edema response associated with 2 hours' wear of a thick soft contact lens is a complex dynamic topographical process and cannot be simply modelled using averaged data from small samples.

Corneal pathophysiology with contact lens wear

Contact lens wear induces a wide spectrum of changes in the appearance and function of the cornea. The most salient effect of lens wear is the hypoxically induced reduction in the rate of metabolic activity of the corneal epithelium and its sequellae. Other important alterations to corneal health associated with contact lens wear may be caused by antigenic and toxic stimuli, mechanical forces, osmotic effects and carbon dioxide retention. Perhaps the most important task facing the contact lens clinician is to distinguish between an acceptable state of physiological modification and an anomalous or pathological state of hypofunction. In this article, we review the assortment of corneal changes primarily on the basis of the causative agents and time scale with reference to the physical and chemical processes leading to the observed signs or symptoms. This procedure allows a strong foundation for understanding the etiology and management principles for the variety of effects that contact lenses may have on the cornea.

Cornea fluid dynamics. I: measurement of hydrostatic and colloid osmotic pressure in rabbits

Interstitial fluid pressure (Pi) has been measured in vivo in ocular tissues of rats and rabbits, and in vitro in corneas of cows and humans with micropipettes connected to a servocontrolled counterpressure system. The in vivo measurements were performed after anaesthesia and careful immobilization of the head. In all species Pi became gradually more negative from the limbus to the cornea centre; in rabbits the change was from -17.8 mmHg 0.5 mm centrally to the limbus to -42.7 mmHg in central cornea. Cornea and sclera interstitial fluid was isolated by centrifugation, and was used for analysis of colloid osmotic pressure (both tissues) and Na(+)-concentration and electrophoresis (cornea only). During low speed centrifugation (3000 rpm), a wet weight fraction of 2-4% was isolated from cornea, having a colloid osmotic pressure not significantly different from that of plasma (18.9 mmHg). Na+ analysis suggested that the isolated fluid did not derive from corneal cells. Electrophoresis showed a protein pattern in cornea fluid similar to that of plasma except for a band with MW corresponding to 39,000 found in cornea only. The present study demonstrates a pressure gradient from sclera to cornea, and along cornea from periphery to centre, and suggests that proteins in cornea fluid contribute significantly to swelling pressure.

Changes in corneal endothelial morphology in cats as a function of age

A cross-sectional study of changes in cat corneal endothelial cell morphology with age was conducted. The central corneal endothelium of 12 kittens and 70 adult cats was photographed using specular microscopy. Endothelial cell density (ECD), coefficient of variation of cell size (used as an index of polymegethism), and cellular shape factor (perimeter 2/area) were determined for each animal and analysed as a function of age. We found a rapid non-linear decrease in ECD and polymegethism in the first nine months of post-natal life. Subsequently there was a slight central cell loss of 11 cells/mm2 or 0.37% per year during adult life which was not statistically significant. However, polymegethism increased significantly with age during adult life. The shape factor for endothelial cells was 13.61 throughout adult life, indicating that the cat corneal endothelium consists predominantly of six-sided cells. Possible explanations for the finding of no significant decrease in cell density with age could include the higher peripheral ECD in the cat which may compensate for central loss, the short life expectancy of the cat and the large individual variation in corneal diameter.