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Messina M, Tucci D, Mocini S, Marruso V, Crotti S, Said D, Dua HS, Cagini C. Increasing incidence of contact-lens-related Acanthamoeba keratitis in a tertiary ophthalmology department in an Italian population. Eur J Ophthalmol 2024:11206721241242165. [PMID: 38509758 DOI: 10.1177/11206721241242165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this paper is to report the increasing incidence of contact-lens related Acanthamoeba keratitis (AK) in a tertiary ophthalmology department in Umbria, central Italy. METHODS Observational and retrospective case series were carried out. A total of nine eyes with a diagnosis of AK were examined. All patients underwent a full slit lamp examination, in vivo confocal microscopy (IVCM) and corneal scraping. The IVCM was repeated at one and two-week and at one, three and six-month intervals. Samples of domestic tap water were also examined for PCR analysis. Patients were treated with levofloxacin0,5%, Polyhexamethylene biguanide 0.02%, and Propamidine Isetionate0,1%. RESULTS All patients were contact lens wearers. The average patient age was 27.75 (range 18-45), with three men and five women. The main clinical features were ciliary congestion, diffuse epitheliopathy with punctuated keratitis, multiple, small sub-epithelial, greyish, corneal infiltrates with epithelial defect, pseudodendritic corneal lesions, perineural infiltrates, corneal stromal cellularity, and stromal infiltrates. IVCM was indicative of Acanthamoeba in seven out of the nine eyes. All the positive IVCM images were section images showing double walled, bright-spot cysts with a clear chain-like arrangement of five or more cysts identified in three of the patients. PCR analysis of the water was negative in all cases. CONCLUSION Although PCR is the most common method used, the increased incidence of AK could mainly be related to a proper IVCM interpretation. A broad-spectrum antibiotic, such as levofloxacin might play a role in the early treatment of AK reducing the virulence of the amoeba.
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Affiliation(s)
- Marco Messina
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Davide Tucci
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Stefano Mocini
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Virginia Marruso
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Silvia Crotti
- Diagnostic Laboratory, Sperimental Zooprophylactic Institute of Umbria and Marche "Togo Rosati", Perugia, Italy
| | - Dalia Said
- Department of Ophthalmology, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Harminder Singh Dua
- Department of Ophthalmology, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
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Kepez Yildiz B, Freitas R, Filippini P, Habroosh F, Said DG, Dua HS, Sahay P. Relationship of posterior peripheral corneal layers and the trabecular meshwork: an immunohistological and anatomical study. Br J Ophthalmol 2024:bjo-2023-324844. [PMID: 38418206 DOI: 10.1136/bjo-2023-324844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/23/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM With the popularity of endothelial keratoplasty (EK) procedures, Descemet membrane (DM) EK and pre-Descemet EK, considerable work has been done on understanding the posterior corneal anatomy. Most of the information available relates to the central cornea. We evaluated the peripheral cornea to explore the immunohistological and anatomical relationship between the pre-Descemet layer (PDL), DM and trabecular meshwork (TM). METHODS Six donor human sclerocorneal discs were studied. PDL, DM and TM were examined by light microscopy, transmission electron microscopy (TEM) and immunohistology. The DM was peeled from the centre to the limit of its peripheral attachment, to reach the transition zone (TZ) between TM and peripheral cornea. Ten-micron sections were stained with antibodies against collagens 1, 2, 3, 4, 5, 6, 12, elastin, myocilin, wnt-1, aquaporin, tenascin C, laminin and integrin alpha 3. RESULTS Collagens 2, 3, 4, laminin and myocilin were predominantly seen in the TZ between TM and peripheral cornea. Wnt-1, integrin alpha 3 and tenascin C were highly concentrated in TM. Collagen 1 was present predominantly in the corneal stroma. On TEM; DM was thinner with a denser banded structure spread throughout its thickness in the periphery compared with the central cornea where it presents as the distinct anterior banded layer. CONCLUSION The TZ between DM, PDL and TM shows a unique histological structure at the periphery. The collagen and elastin fibres of the TM are continuous with the PDL. The structures are firmly attached to each other. These findings provide structural information that is relevant to the preparation of DMEK donor tissue.
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Affiliation(s)
- Burçin Kepez Yildiz
- Ophthalmology, Ministry of Health Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rui Freitas
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Perla Filippini
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Fatima Habroosh
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dalia G Said
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Harminder Singh Dua
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Prity Sahay
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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El Zawahry FO, Beer F, Yildiz BK, Said DG, Dua HS. The 'barcode sign' seen on optical coherence tomography of extensive corneal vascularization. Eye (Lond) 2023; 37:3863-3864. [PMID: 37524827 PMCID: PMC10698166 DOI: 10.1038/s41433-023-02602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
| | - Frederick Beer
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Burcin Kepez Yildiz
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dalia Galal Said
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Harminder Singh Dua
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Ong ZZ, Sadek Y, Liu X, Qureshi R, Liu SH, Li T, Sounderajah V, Ashrafian H, Ting DSW, Said DG, Mehta JS, Burton MJ, Dua HS, Ting DSJ. Diagnostic performance of deep learning in infectious keratitis: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e065537. [PMID: 37164459 PMCID: PMC10173987 DOI: 10.1136/bmjopen-2022-065537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Infectious keratitis (IK) represents the fifth-leading cause of blindness worldwide. A delay in diagnosis is often a major factor in progression to irreversible visual impairment and/or blindness from IK. The diagnostic challenge is further compounded by low microbiological culture yield, long turnaround time, poorly differentiated clinical features and polymicrobial infections. In recent years, deep learning (DL), a subfield of artificial intelligence, has rapidly emerged as a promising tool in assisting automated medical diagnosis, clinical triage and decision-making, and improving workflow efficiency in healthcare services. Recent studies have demonstrated the potential of using DL in assisting the diagnosis of IK, though the accuracy remains to be elucidated. This systematic review and meta-analysis aims to critically examine and compare the performance of various DL models with clinical experts and/or microbiological results (the current 'gold standard') in diagnosing IK, with an aim to inform practice on the clinical applicability and deployment of DL-assisted diagnostic models. METHODS AND ANALYSIS This review will consider studies that included application of any DL models to diagnose patients with suspected IK, encompassing bacterial, fungal, protozoal and/or viral origins. We will search various electronic databases, including EMBASE and MEDLINE, and trial registries. There will be no restriction to the language and publication date. Two independent reviewers will assess the titles, abstracts and full-text articles. Extracted data will include details of each primary studies, including title, year of publication, authors, types of DL models used, populations, sample size, decision threshold and diagnostic performance. We will perform meta-analyses for the included primary studies when there are sufficient similarities in outcome reporting. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review. We plan to disseminate our findings via presentation/publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022348596.
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Affiliation(s)
- Zun Zheng Ong
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Youssef Sadek
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Su-Hsun Liu
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Daniel Shu Wei Ting
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Dalia G Said
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
- Research Institute of Ophthalmology, Cairo, Egypt
| | - Jodhbir S Mehta
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Harminder Singh Dua
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren Shu Jeng Ting
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
- Birmingham and Midland Eye Centre, Birmingham, UK
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Dua HS, Ting DSJ, AlSaadi A, Said DG. Management of limbal stem cell deficiency by amnion-assisted conjunctival epithelial redirection using vacuum-dried amniotic membrane and fibrin glue. Br J Ophthalmol 2023; 107:342-348. [PMID: 34610946 DOI: 10.1136/bjophthalmol-2020-318496] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 09/03/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To study the outcome of a modified amnion-assisted conjunctival epithelial redirection (ACER) technique using vacuum-dried amnion (Omnigen) and fibrin glue for managing total limbal stem cell deficiency (LSCD). METHOD A retrospective, interventional case series of all patients with total LSCD who underwent limbal stem cell transplant (LSCT) using the modified ACER procedure between 2016 and 2019. The outcome was defined as: (1) success: complete corneal re-epithelialisation without conjunctivalisation; (2) partial success: sub-total corneal re-epithelialisation with partial non-progressive conjunctivalisation sparing the visual axis and (3) failure: conjunctivalisation affecting the visual axis. RESULTS Ten patients (six men), with a mean age of 46.2±18.4 years, were included. The mean follow-up was 23.0±13.9 months. Causes of LSCD were chemical eye injury (30%), congenital aniridia-related keratopathy (30%), ocular surface malignancy (20%), Steven-Johnson syndrome (10%) and contact lens overuse (10%). 50% were bilateral. The time from diagnosis to ACER (for acquired causes) was 45.6±44.4 months. 80% of patients achieved a complete/partial success following ACER and 20% of patients required repeat LSCT. Auto-LSCT was associated with a significantly higher chance of success than allo-LSCT (p=0.048). The mean best-corrected-visual-acuity (logMAR) improved significantly from 1.76±0.64 preoperatively to 0.94±0.94 at final follow-up (p=0.009). Omnigen was available off-the-shelf stored at room temperature and its transparency enabled visualisation of the healing epithelium beneath. CONCLUSION LSCT using the modified ACER serves as an effective ocular surface reconstruction technique in managing total LSCD and improving vision. Vacuum-dried amnion provides advantages of easy handling, transparency and storage at room temperature.
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Affiliation(s)
- Harminder Singh Dua
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK .,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Ahmed AlSaadi
- Department of Ophthalmology, Zayed Military Hospital, Abu Dhabi, UAE
| | - Dalia G Said
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
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Gopal BP, Titi-Lartey OA, Fernandes P, Noubani NE, Blatherwick E, Said D, Dua HS, Ting DSJ. Evaluation of junior doctors' knowledge of corneal donation and the new opt-out system in England. Postgrad Med J 2021; 98:e174-e176. [PMID: 34039706 DOI: 10.1136/postgradmedj-2021-140108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | - Elizabeth Blatherwick
- Nottingham Tissue and Eye Donation Partners, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Dalia Said
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.,Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Harminder Singh Dua
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.,Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren S J Ting
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK .,Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
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Deshmukh R, Ting DSJ, Elsahn A, Mohammed I, Said DG, Dua HS. Real-world experience of using ciclosporin-A 0.1% (Ikervis) in the management of ocular surface inflammatory diseases. Br J Ophthalmol 2021; 106:1087-1092. [PMID: 33687999 PMCID: PMC9340021 DOI: 10.1136/bjophthalmol-2020-317907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the real-world experience of using topical ciclosporin, Ikervis, in the management of ocular surface inflammatory diseases (OSIDs). METHODS This was a retrospective study of patients treated with Ikervis for OSIDs at the Queen's Medical Centre, Nottingham, between 2016 and 2019. Relevant data, including demographics, indications, clinical parameters, outcomes and adverse events, were collected and analysed for patients who had completed at least 6 months follow-up. For analytic purpose, clinical outcome was categorised as 'successful' (resolved or stable disease), 'active disease' and 'drug intolerance'. RESULTS 463 patients were included; mean age was 51.1±21.6 years, with a 59.0% female predominance. Mean follow-up was 14.6±9.2 months. The most common diagnosis was dry eye disease (DED; 322, 69.5%), followed by allergic eye disease (AED; 53, 11.4%) and ocular mucous membrane pemphigoid/Steven-Johnson syndrome (OMMP/SJS; 38, 8.2%). Successful treatment was achieved in 343 (74.1%) patients, with 44 (9.5%) requiring additional treatment and 76 (16.4%) reporting drug intolerance. The efficacy of Ikervis was highest in DED (264, 82.0%), followed by OMMP/SJS (25, 65.8%) and post-keratoplasty (7, 50.0%; p<0.001). Logistic regression analysis demonstrated age <70 years (p=0.007), AED (p=0.002) and OMMP/SJS (p=0.001) as significant predictive factors for Ikervis intolerance. AED and post-keratoplasty were 8.16 times (95% CI, 2.78 to 23.99) and 13.98 times (95% CI, 4.22 to 46.28), respectively, more likely to require additional treatment compared with DED. CONCLUSIONS Ikervis is a useful steroid-sparing topical treatment for managing OSIDs in the real-world setting. Preparations with improved tolerability are needed to benefit a larger number of patients.
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Affiliation(s)
- Rashmi Deshmukh
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
| | - Darren Shu Jeng Ting
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Ahmad Elsahn
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Imran Mohammed
- Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Dalia G Said
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Harminder Singh Dua
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK .,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
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Ting DSJ, Ho CS, Cairns J, Elsahn A, Al-Aqaba M, Boswell T, Said DG, Dua HS. 12-year analysis of incidence, microbiological profiles and in vitro antimicrobial susceptibility of infectious keratitis: the Nottingham Infectious Keratitis Study. Br J Ophthalmol 2021; 105:328-333. [PMID: 32580955 PMCID: PMC7907586 DOI: 10.1136/bjophthalmol-2020-316128] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS To examine the incidence, causative microorganisms and in vitro antimicrobial susceptibility and resistance profiles of infectious keratitis (IK) in Nottingham, UK. METHODS A retrospective study of all patients who were diagnosed with IK and underwent corneal scraping between July 2007 and October 2019 (a 12-year period) at a UK tertiary referral centre. Relevant data, including demographic factors, microbiological profiles and in vitro antibiotic susceptibility of IK, were analysed. RESULTS The estimated incidence of IK was 34.7 per 100 000 people/year. Of the 1333 corneal scrapes, 502 (37.7%) were culture-positive and 572 causative microorganisms were identified. Sixty (4.5%) cases were of polymicrobial origin (caused by ≥2 different microorganisms). Gram-positive bacteria (308, 53.8%) were most commonly isolated, followed by Gram-negative bacteria (223, 39.0%), acanthamoeba (24, 4.2%) and fungi (17, 3.0%). Pseudomonas aeruginosa (135, 23.6%) was the single most common organism isolated. There was a significant increase in Moraxella spp (p<0.001) and significant decrease in Klebsiella spp (p=0.004) over time. The in vitro susceptibilities of Gram-positive and Gram-negative bacteria to cephalosporin, fluoroquinolone and aminoglycoside were 100.0% and 81.3%, 91.9% and 98.1%, and 95.2% and 98.3%, respectively. An increase in resistance against penicillin was observed in Gram-positive (from 3.5% to 12.7%; p=0.005) and Gram-negative bacteria (from 52.6% to 65.4%; p=0.22). CONCLUSION IK represents a relatively common and persistent burden in the UK and the reported incidence is likely underestimated. Current broad-spectrum antimicrobial treatment provides a good coverage for IK, although challenged by some level of antimicrobial resistance and polymicrobial infection.
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Affiliation(s)
| | | | - Jessica Cairns
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ahmad Elsahn
- Academic Ophthalmology, University of Nottingham, Nottingham, UK
| | | | - Tim Boswell
- Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, University of Nottingham, Nottingham, UK
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Harminder Singh Dua
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK
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Pereira NC, Forseto ADS, Maluf RCP, Dua HS. Pre-Descemet's endothelial keratoplasty: a simple, Descemet's membrane scoring technique for successful graft preparation. Br J Ophthalmol 2021; 106:786-789. [PMID: 33597193 DOI: 10.1136/bjophthalmol-2020-317613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/04/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Pre-Descemet's endothelial keratoplasty (PDEK) donor tissue preparation involves the intrastromal injection of air to create a type 1 big bubble (BB) and avoidance of the creation of a type 2 BB. The purpose of this study was to design and test a technique to consistently creates a type 1 BB without risk of creating a type 2 BB. METHODS A prospective matched study with 64 human donor sclerocorneal discs, which were not suitable for corneal transplantation, was conducted. The corneas were divided into two groups, of which 32 were subjected to the standard technique of preparing the PDEK donor tissue (group 1, control) and 32 new technique, where in the donor Descemet's membrane was scored with a Sinskey hook. Frequency of occurrence of different types of BB was compared and statistically analysed. RESULTS With the standard technique (group 1), type 1 BB occurred in 53.1%, type 2 BB in 34.4% and mixed BB in 12.5% of samples. With the scoring technique (group 2), a type 1 BB occurred in 100% of the samples. No type 2 or mixed BB occurred in any case in group 2. The difference in creation of a type 1BB between the two groups was statistically significant (p=0.00). CONCLUSION The scoring technique is a simple, inexpensive and reproducible option to consistently achieve a type 1 BB to prepare PDEK graft tissue. The next step would be to study the clinical outcomes of PDEK performed with tissue obtained by the scoring technique.
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Affiliation(s)
- Nicolas Cesario Pereira
- Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, São Paulo, Brazil .,Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Adriana Dos Santos Forseto
- Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, São Paulo, Brazil.,Eye Clinic, São Paulo, São Paulo, Brazil
| | | | - Harminder Singh Dua
- Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
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Mohammed I, Mohanty D, Said DG, Barik MR, Reddy MM, Alsaadi A, Das S, Dua HS, Mittal R. Antimicrobial peptides in human corneal tissue of patients with fungal keratitis. Br J Ophthalmol 2020; 105:1172-1177. [PMID: 32855162 DOI: 10.1136/bjophthalmol-2020-316329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 07/03/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fungal keratitis (FK) is the leading cause of unilateral blindness in the developing world. Antimicrobial peptides (AMPs) have been shown to play an important role on human ocular surface (OS) during bacterial, viral and protozoan infections. In this study, our aim was to profile a spectrum of AMPs in corneal tissue from patients with FK during the active pase of infection and after healing. METHODS OS samples were collected from patients at presentation by impression cytology and scraping. Corneal button specimens were collected from patients undergoing therapeutic penetrating keratoplasty for management of severe FK or healed keratitis. Gene expression of human beta-defensin (HBD)-1, -2, -3 and -9, S100A7, and LL-37 was determined by quantitative real-time PCR. RESULTS Messenger RNA expression (mRNA) for all AMPs was shown to be significantly upregulated in FK samples. The levels of HBD-1 and -2 mRNA were found to be elevated in 18/20 FK samples. Whereas mRNA for HBD-3 and S100A7 was upregulated in 11/20 and HBD9 was increased in 15/20 FK samples. LL-37 mRNA showed moderate upregulation in 7/20 FK samples compared with controls. In healed scar samples, mRNA of all AMPs was found to be low and matching the levels in controls. CONCLUSION AMP expression is a consistent feature of FK, but not all AMPs are equally expressed. HBD-1 and -2 are most consistently expressed and LL-37 the least, suggesting some specificity of AMP expression related to FK. These results will help to identify HBD sequence templates for designing FK-specific peptides to test for therapeutic potential.
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Affiliation(s)
- Imran Mohammed
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham United Kingdom
| | - Debasmita Mohanty
- Kanupriya Dalmia Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham United Kingdom.,Ophthalmology Department, Nottingham University Hospitals, Queens Medical Centre, Nottingham United Kingdom
| | - Manas Ranjan Barik
- Ocular Microbiology Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Mamatha M Reddy
- Ocular Microbiology Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Ahmed Alsaadi
- Ophthalmology Department, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Sujata Das
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Harminder Singh Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham United Kingdom .,Ophthalmology Department, Nottingham University Hospitals, Queens Medical Centre, Nottingham United Kingdom
| | - Ruchi Mittal
- Kanupriya Dalmia Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
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Cagini C, Riccitelli F, Messina M, Piccinelli F, Torroni G, Said D, Al Maazmi A, Dua HS. Epi-off-lenticule-on corneal collagen cross-linking in thin keratoconic corneas. Int Ophthalmol 2020; 40:3403-3412. [PMID: 32794082 PMCID: PMC7669785 DOI: 10.1007/s10792-020-01526-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) performed on overlaying a corneal lenticule to thin recipient corneas of progressive keratoconus (KC) patients. Methods In this study were enrolled eyes of patients affected by progressive KC with a minimum corneal thickness less than 400 µm, after overlaying a lenticule of human corneal stroma prepared with the femtosecond laser. The lenticules used were 100 µm thick and of 8.5 mm diameter in all the cases. Both the host cornea and the lenticules were subjected to epithelial debridement. CXL was carried out according to the standard protocol. Visual acuity, refraction, slit-lamp examination, endothelial cell density, pachymetry and keratometry, anterior segment tomography (AS-OCT) and confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Results CXL was performed in 10 eyes of 8 patients (main age 23), corneal thickness range 379–414 µm, mean 387.6 µm. One patient was lost at follow-up. In all other cases, visual acuity and the endothelial cell density remained stable over a 12-month follow-up. Preoperative mean K1 and mean K2 were 46.91 ± 1.9 and 50.75 ± 2.93, respectively, and at 12 months mean K1 was 47.36 ± 2.66 and mean K2 50.53 ± 3.35. The AS-OCT clearly showed a demarcation line in all patients at 1, 3 (mean depth 283 µm and 267 µm, respectively) and in some cases at 6 months. Reduced keratocyte density and stromal oedema were observed immediately up to 1 month after treatment, while a slight subepithelial haze was present at 1-month and completely disappeared by 6 months. Conclusion This new technique seems to offer a therapeutic opportunity for young patients suffering from progressive KC with very thin corneas, in which the standard treatment is not indicate, and delay or avoid the need for a corneal transplant.
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Affiliation(s)
- Carlo Cagini
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy.
| | - F Riccitelli
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - M Messina
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - F Piccinelli
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - G Torroni
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - D Said
- Larry A Donoso Laboratory for Eye Research, Division of Clinical Neuroscience, Academic Section of Ophthalmology, University of Nottingham, Nottingham, UK
| | - A Al Maazmi
- Larry A Donoso Laboratory for Eye Research, Division of Clinical Neuroscience, Academic Section of Ophthalmology, University of Nottingham, Nottingham, UK
| | - H S Dua
- Larry A Donoso Laboratory for Eye Research, Division of Clinical Neuroscience, Academic Section of Ophthalmology, University of Nottingham, Nottingham, UK
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AlMaazmi A, Said DG, Messina M, AlSaadi A, Dua HS. Mechanism of fluid leak in non-traumatic corneal perforations: an anterior segment optical coherence tomography study. Br J Ophthalmol 2019; 104:1304-1309. [PMID: 31822464 DOI: 10.1136/bjophthalmol-2019-315098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/02/2019] [Accepted: 11/07/2019] [Indexed: 11/03/2022]
Abstract
AIM Non-traumatic corneal perforations (CPerfs) may present with shallow/flat or formed anterior chamber (AC). This study uses anterior segment optical coherence tomography (ASOCT) to ascertain these differences. METHOD The study included 14 eyes of 13 patients. They underwent high-resolution ASOCT scans at multiple time points, prior to and after cyanoacrylate glueing, between January 2016 and July 2018. A retrospective analysis of over 2500 ASOCT sections and AS photographs was conducted by two independent observers. The findings were correlated with clinical features and diagnoses. RESULT All patients had documented Seidel's positive sign at the outset. Two groups with distinctive features were identified. In group 1, 'formed' AC, there was hydration of the cornea with lamellar separation of the stroma, intrastromal pockets of fluid, epithelial bullae and an indirect communication between AC and the exterior. In group 2, 'flat' AC, the corneal hydration was less obvious, there were no pockets of intrastromal fluid, no epithelial bullae and a direct communication of the AC with the exterior. After glueing, the stromal hydration resolved, and healing occurred beneath the glue. The glue and corneal blood vessels consistently cast a dense shadow posteriorly on ASOCT. CONCLUSION ASOCT demonstrates that leaking CPerfs can be indirect or direct. The former is associated with a 'formed' AC and the latter with a very shallow/flat AC. The valvular nature of the communication in indirect perforations allows the AC to maintain its volume despite a continuous leak.
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Affiliation(s)
- Amna AlMaazmi
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Ophthalmology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt
| | - Marco Messina
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ahmed AlSaadi
- Ophthalmology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Harminder Singh Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
Neurotrophic keratopathy (NK) is a degenerative corneal disease that is based on an impairment of the corneal innervation. The damage to the sensory innervation, which is delivered through the 1st branch of the trigeminal nerve (ophthalmic nerve), can occur throughout the entire length of the nerve from the nucleus in the brainstem, e.g. caused by brain tumors, to the terminal nerve fibers in the cornea, caused for example by refractive corneal surgery (e. g. LASIK). Due to the loss of the sensory innervation, a reduced lacrimation and a reduction in the secretion of trophic factors occur. This in turn inhibits the regeneration potential of the corneal epithelium. In the most severe cases of the disease, the reduction or loss of lacrimation, together with the impaired regeneration potential of the epithelial cells, can lead to persistent epithelial defects, ulcers and corneal perforation. The NK has a prevalence of 5 or fewer individuals per 10,000 and is classified as a rare, i. e. orphan disease (ORPHA137596). A fundamental understanding of the pathogenesis and epidemiology of NK supports the early diagnosis and therefore the initiation of a specific treatment.
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Affiliation(s)
- S Mertsch
- Univ.-Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland. .,Univ.-Klinik für Augenheilkunde, Pius-Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg, Deutschland.
| | - J Alder
- Univ.-Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - H S Dua
- Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Großbritannien
| | - G Geerling
- Univ.-Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Cagini C, Di Lascio G, Messina M, Riccitelli F, Dua HS. Correlation of central and peripheral keratometric parameters after corneal collagen cross-linking in keratoconus patients. Int Ophthalmol 2018; 39:2041-2048. [PMID: 30421316 DOI: 10.1007/s10792-018-1041-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the difference in the central and peripheral keratometric parameters in patients with keratoconus after corneal collagen cross-linking (CXL). METHODS Forty-eight eyes of 32 patients (18 males, 16-28 years) affected by progressive keratoconus in different stages of evolution underwent CXL using the standard epithelium-off protocol. Corneal thickness and corneal curvature before CXL and after 6 and 12 months using the Sirius tomographer were analyzed. The values of the mean corneal thickness at the corneal apex (CAT), center of the pupil (PCT), thinnest point (CTTL) and along concentric circles of 2, 4, 6, 8, 8.5, 9, 9.5 and 10 mm diameter were evaluated; the values of the mean curvature at the corneal apex and at the points in which the inferior, superior, nasal and temporal meridians crossed the above-mentioned concentric circles were also evaluated. RESULTS The mean preoperative values for CAT, PCT and CTTL were 461.4 ± 30.3, 475.3 ± 30.5 and 441 ± 32.0, respectively. The values after 12 months of CXL were 444.6 ± 36.2, 451.6 ± 36.7 and 418.2 ± 41.4. The peripheral corneal thickness at the eight points ranged from 479 to 733 preoperatively. At 12-month post-CXL, the values ranged from 444.6 to 734.1. The mean posterior curvature from apex to periphery ranged from - 4.5 to - 9.1 days preoperatively and from - 4.5 to - 9.2 days at 12 months. These were not statistically significant (ANOVA and unpaired T test). CONCLUSIONS Our data suggest that CXL over an 8-mm zone can stabilize the peripheral cornea. Longer-term follow-up studies on the peripheral cornea after CXL will provide useful information.
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Affiliation(s)
- C Cagini
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - G Di Lascio
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - M Messina
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - F Riccitelli
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - H S Dua
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Abstract
Lamellar keratoplasty (LK) has revolutionized corneal graft surgery in several ways. Deep anterior LK (DALK) has eliminated risk of failure due to endothelial rejection. Endothelial keratoplasty (EK) has almost eliminated induced astigmatism and the “weak” graft–host junction as seen with penetrating keratoplasty (PK) and also reduced the risk of endothelial rejection. LK provided new insights into posterior corneal anatomy that led to better understanding and performance of DALK and to the development of another EK procedure, namely pre-Descemet's EK (PDEK). Surgical procedures for LK were further refined based on the improved understanding and are able to deliver better surgical outcomes in terms of structural integrity and long-term patient satisfaction, reducing the need of further surgeries and minimizing patient discomfort. In most specialist centers, anterior lamellar techniques like DALK and EK techniques like Descemet's stripping EK (DSEK) and Descemet's membrane EK (DMEK) have replaced the full-thickness PK where possible. The introduction of microkeratome, femtosecond laser, and PDEK clamp have made LK techniques easier and more predictable and have led to the innovation of another LK procedure, namely Bowman membrane transplant (BMT). In this article, we discuss the evolution of different surgical techniques, their principles, main outcomes, and limitations. To date, experience with BMT is limited, but DALK has become the gold standard for anterior LK. The EK procedures too have undergone a rapid transition from DSEK to DMEK and PDEK emerging as a viable option. Ultrathin-DSEK may still have a role in modern EK.
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Affiliation(s)
- Nadisha P Singh
- Division of Clinical Neuroscience, University of Nottingham, UK
| | - Dalia G Said
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Division of Clinical Neuroscience, University of Nottingham, UK
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Ross AR, Said DG, El-Amin A, Altaan S, Cabrerizo J, Nubile M, Hogan E, Mastropasqua L, Dua HS. Deep anterior lamellar keratoplasty: dissection plane with viscoelastic and air can be different. Br J Ophthalmol 2018; 102:1646-1652. [PMID: 29615397 DOI: 10.1136/bjophthalmol-2017-311349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/11/2018] [Accepted: 01/27/2018] [Indexed: 12/19/2022]
Abstract
AIMS To investigate and define the nature of big bubbles (BB) formed by injection of viscoelastic in deep anterior lamellar keratoplasty. METHODS Intrastromal injections of 0.1 and 0.3 mL of sodium hyaluronate 1.2% and 0.6% were made into sclera-corneal discs (n = 32) at superficial (anterior-third), midstromal (middle-third) and deep (posterior-third) levels to simulate deep anterior lamellar keratoplasty. Postinjection optical coherence tomograms (OCT) were obtained with the needle in situ. The samples were sectioned and examined histologically. Twelve control samples were injected with air. RESULTS With superficial injections (n=8) only intrastromal accumulation of viscoelastic was noted. With midstromal injections (n=10) intrastromal accumulation of viscoelastic (n=6) and intrastromal big bubbles (IBB) (n=4) with substantial and variable stromal tissue in the walls were noted. No type 1, type 2 or mixed BB were noted. With deep injections (n=14), type 1 BB (n=4), IBB (n=4) and mixed BB (n=6) were obtained.There was no difference in the results with the two different concentrations of viscoelastic used. With air injection (n=12), 10 type 1 and 1 type 2 BB and 1 mixed BB were obtained. No IBB was noted. CONCLUSIONS BB obtained by injection of viscoelastic and air can be different. The former tends to occur at the site of injection, especially with midstromal injections, takes the form of tissue separation by stretch and tearing and does not cleave in a consistent plane like air. Surgeons should be aware of IBB created by viscodissection and not confuse it for a type1 BB. Intraoperative OCT should help identify IBB.
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Affiliation(s)
- Andrew R Ross
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, UK.,Ophthalmology, Aswan University, Aswan, Egypt
| | - Dalia G Said
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, UK.,Research Institute of Ophthalmology, Cairo, Egypt
| | | | - Saif Altaan
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, UK
| | | | - Mario Nubile
- Ophthalmology, University of Chieti Pescara, Chieti, Italy
| | - Emily Hogan
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, UK
| | | | - Harminder Singh Dua
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Department of Ophthalmology, University of Nottingham, Nottingham, UK
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Cagini C, Iaccheri B, Torroni G, Fiore T, Cerquaglia A, Lupidi M, Cillino S, Dua HS. Reply to Comment on: 'Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine'. Eye (Lond) 2018; 32:836-837. [PMID: 29171507 PMCID: PMC5898852 DOI: 10.1038/eye.2017.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- C Cagini
- Department of Surgery and Biomedical Science University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy
| | - B Iaccheri
- Department of Surgery and Biomedical Science University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy
| | - G Torroni
- Department of Surgery and Biomedical Science University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy
| | - T Fiore
- Department of Surgery and Biomedical Science University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy
| | - A Cerquaglia
- Department of Surgery and Biomedical Science University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy
| | - M Lupidi
- Department of Surgery and Biomedical Science University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy
| | - S Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - H S Dua
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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AlTaan SL, Mohammed I, Said DG, Dua HS. Air pressure changes in the creation and bursting of the type-1 big bubble in deep anterior lamellar keratoplasty: an ex vivo study. Eye (Lond) 2018; 32:146-151. [PMID: 28664905 PMCID: PMC5770697 DOI: 10.1038/eye.2017.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/04/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo measure the pressure and volume of air required to create a big bubble (BB) in simulated deep anterior lamellar keratoplasty (DALK) in donor eyes and ascertain the bursting pressure of the BB.Patients and methodsTwenty-two human sclera-corneal discs were used. Air was injected into the corneal stroma to create a BB and the pressure measured by means of a pressure converter attached to the system via a side port. A special clamp was designed to prevent air leak from the periphery of the discs. The pressure at which air emerged in the corneal tissue; the bursting pressure measured after advancing the needle into the bubble cavity and injecting more air; the volume of air required to create a BB and the volume of the BB were ascertained.ResultsType-1 BB were achieved in 19 and type-2 BB in 3 eyes. The maximum pressure reached to create a BB was 96.25+/- 21.61 kpa; the mean type-1 intrabubble pressure was 10.16 +/- 3.65 kpa. The mean bursting pressure of a type-1 BB was 66.65 +/- 18.65 kpa, while that of a type-2 BB was 14.77 +/- 2.44 kpa. The volume of air required to create a type-1 BB was 0.54 ml and the volume of a type-1 BB was consistently 0.1 ml.ConclusionsDua's layer baring DALK can withstand high intraoperative pressures compared to Descemet's membrane baring DALK. The study suggests that it could be safe to undertake procedures such as DALK-triple with a type-1 BB but not with a type-2 BB.
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Affiliation(s)
- S L AlTaan
- Larry A Donoso Laboratory for Eye Research, Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - I Mohammed
- Larry A Donoso Laboratory for Eye Research, Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - D G Said
- Larry A Donoso Laboratory for Eye Research, Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - H S Dua
- Larry A Donoso Laboratory for Eye Research, Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Abstract
PurposeTo design and produce a clamp that enables good handling of donor sclera-corneal disks, allows air to be injected in the corneal stroma and consistently provides pre-Descemets endothelial keratoplasty (PDEK) tissue by creation of a type-1 big bubble (BB) avoiding a type-2BB by shutting the fenestrations in the periphery of the pre-Descemets layer and preventing escape of air.Patients and methodsA clamp with spring loaded handles attached to two rings of 9 mm diameter and 1 mm width with a side port for insertion of a needle for air injection was designed and produced. The clamp was tested in 20 human donor sclera-corneal disks and refined over three prototypes. The final design was used for PDEK in 8 patients.ResultsThe clamp was able to prevent any escape of air or the formation of a type-2BB. By preventing air leak, it provided better control over the volume of air injected allowing for consistent formation of a type-1BB, which could be expanded to its full diameter by advancing the tip of the needle into the bubble cavity. Centration of tissue in the clamp was important. The clamp was used successfully to obtain PDEK tissue from 8 donor sclara-corneal disks for transplant in three eyes with pseudophakic bullous keratopathy and five eyes with pseudophakia and Fuchs' endothelial dystrophy.ConclusionThe PDEK clamp is a simple and useful instrument that will give surgeons the confidence of consistently obtaining PDEK tissue with ease and without the risk of separating the Descemets membrane in a type-2BB.
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Affiliation(s)
- H S Dua
- Academic Section of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queens Medical Centre, University Hospitals NHS Trust, Nottingham, UK
| | - D G Said
- Academic Section of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queens Medical Centre, University Hospitals NHS Trust, Nottingham, UK
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Yeung AM, Faraj LA, McIntosh OD, Dhillon VK, Dua HS. Fibrin glue inhibits migration of ocular surface epithelial cells. Eye (Lond) 2016; 30:1389-1394. [PMID: 27367746 DOI: 10.1038/eye.2016.127] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/01/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeFibrin glue has been used successfully in numerous ophthalmic surgical procedures. Recently, fibrin glue has been used in limbal stem cell transplantation to reduce both operative time and to negate the need for sutures. The aim of this study was to determine the effects of fibrin glue on epithelial cell migration in vitro.MethodsCorneoscleral rims were split to retain the epithelial layer, Bowman's layer, and anterior stroma. Rims were cut into eight equal-sized pieces and were placed directly on culture plates or affixed with fibrin glue. Rims were maintained in culture for 25 days and epithelial cell growth was monitored. Cells were photographed to measure area or growth and immunofluorescence staining of explants for fibrin was performed.ResultsExplants that were glued demonstrated significantly delayed epithelial cell growth and migration as compared with explants without glue. By day 16, all fibrin glue had dissolved and coincided with onset of cell growth from glued explants. Cell growth commenced between days 3 and 4 for control explants without glue and around days 14-16 for explants with fibrin glue.ConclusionsFibrin glue delays epithelial cell migration by acting as a physical barrier and can potentially interfere with explant-derived limbal epithelial cell migration on to the corneal surface. We propose that glue should be used to attach the conjunctival frill of the limbal explant but care should be taken to ensure that the glue does not wrap around the explant if used to secure the explant as well. Strategic use of glue, to attach the recessed conjunctiva, can be advantageous in delaying conjunctival cell migration and reducing the need for sequential sector conjunctival epitheliectomy.
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Affiliation(s)
- A M Yeung
- Larry A Donoso Laboratory for Eye Research, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - L A Faraj
- Larry A Donoso Laboratory for Eye Research, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - O D McIntosh
- Larry A Donoso Laboratory for Eye Research, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - V K Dhillon
- Larry A Donoso Laboratory for Eye Research, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - H S Dua
- Larry A Donoso Laboratory for Eye Research, Section of Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Affiliation(s)
- H S Dua
- Larry A Donoso Laboratory, Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham and Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D G Said
- Larry A Donoso Laboratory, Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham and Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Zaki AA, Elalfy MS, Said DG, Dua HS. Deep anterior lamellar keratoplasty--triple procedure: a useful clinical application of the pre-Descemet's layer (Dua's layer). Eye (Lond) 2014; 29:323-6. [PMID: 25359285 DOI: 10.1038/eye.2014.273] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To describe a technique which exploits the transparency and toughness of the pre-Descemets layer (Dua's layer) to safely perform deep anterior lamellar keratoplasty (DALK) and phacoemulsification at the same time. METHODS Three DALK procedures combined with phacoemulsification were performed by the same surgeon using the big-bubble (BB) technique at the Research Institute of Ophthalmology, Cairo, Egypt. In two cases a type-1 BB, baring Dua's layer, was achieved and in one case a type-2 BB, baring the Descemet's membrane (DM), was achieved. The surgeries were video recorded and photo slit-lamp images were taken in the follow-up visits. RESULTS DALK with phacoemulsification and lens implant was carried out in both patients where a type-1 BB was achieved. At a follow up of 18 months (first case) and 6 months (second case), the best corrected vision was 6/12 for each. In the case where a type-2 BB was achieved, the DM ruptured during injection of viscoelastic prior to capsulorhexis. The procedure was converted to a penetrating keratoplasty without phacoemulsification. CONCLUSION When a type-1 BB is achieved simultaneous DALK and phacoemulsification can be safely accomplished. Dua's layer allows a clear view for performing phacoemulsification with the added benefit of its toughness, which can maintain a stable anterior chamber for cataract surgery. This should not be attempted when a type-2 BB is achieved.
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Affiliation(s)
- A A Zaki
- Research Institute of Ophthalmology, Cairo, Egypt
| | - M S Elalfy
- 1] Research Institute of Ophthalmology, Cairo, Egypt [2] Academic Ophthalmology, Division of Clinical Neuroscience, B Floor, Eye ENT Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - D G Said
- 1] Research Institute of Ophthalmology, Cairo, Egypt [2] Academic Ophthalmology, Division of Clinical Neuroscience, B Floor, Eye ENT Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - H S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, B Floor, Eye ENT Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK
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Dua HS, Singh AD. Beginnings and endings. Br J Ophthalmol 2014; 98:716. [DOI: 10.1136/bjophthalmol-2014-305469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Singh A, Dua HS. Highlights from this issue. Br J Ophthalmol 2013. [DOI: 10.1136/bjophthalmol-2013-304441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hashmani K, Branch MJ, Sidney LE, Dhillon PS, Verma M, McIntosh OD, Hopkinson A, Dua HS. Characterization of corneal stromal stem cells with the potential for epithelial transdifferentiation. Stem Cell Res Ther 2013; 4:75. [PMID: 23800436 PMCID: PMC4058700 DOI: 10.1186/scrt226] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/04/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The corneal stroma is being increasingly recognized as a repository for stem cells. Like the limbal and endothelial niches, stromal stem cells often reside in the peripheral cornea and limbus. These peripheral and limbal corneal stromal cells (PLCSCs) are known to produce mesenchymal stem cells in vitro. Recently, a common corneal stromal and epithelial progenitor was hinted at. This study aims to examine the stem cell potential of corneal stromal cells and to investigate their epithelial transdifferentiation ability. METHODS PLCSCs were grown in traditional Dulbecco modified Eagle medium (DMEM)-based keratocyte culture medium and an M199-based medium and analyzed for a profile of cell-surface markers by using flow cytometry and differentiated into mesenchymal phenotypes analyzed with quantitative polymerase chain reaction (qPCR) and histologic staining. PLCSCs in M199 were subsequently divided into subpopulations based on CD34 and CD105 expression by using fluorescence- activated cell sorting (FACS). Subpopulations were characterized by marker profile and mesenchymal differentiation ability. Both whole PLCSCs and subpopulations were also cultured for epithelial transdifferentiation. RESULTS Cells cultured in M199 demonstrated a more stem-like cell-surface marker profile, and the keratocyte marker CD34 was retained for several passages but absent in cells cultured in DMEM. Cells cultured in M199 also exhibited a greater mesenchymal differentiation potential, compared with DMEM. PLCSCs could be divided into CD34(+)CD105(+), CD34-CD105(+), and CD34-CD105- subpopulations, of which CD34(+)CD105(+) cells were the most stemlike with regard to marker expression and mesenchymal differentiation potential. Subpopulations of PLCSCs exhibited differing abilities to transdifferentiate into epithelial phenotypes. Cells that were initially CD34(+)CD105(+) showed the greatest differentiation potential, producing CK3(+) and CK19(+) cells, and expressed a range of both epithelial progenitor (HES1, FRZB1, DCT, SOD2, ABCG2, CDH1, KRT19) and terminally differentiated (DSG3, KRT3, KRT12, KRT24) genes. CONCLUSIONS Culture medium has a significant effect on the phenotype and differentiation capacity of PLCSCs. The stroma contains a heterogeneous cell population in which we have identified CD34(+) cells as a stem cell population with a capacity for mesenchymal and epithelial differentiation.
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Fares U, Mokashi AA, Elalfy MS, Dua HS. Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism. Eye (Lond) 2013; 27:1032-7. [PMID: 23743526 DOI: 10.1038/eye.2013.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/13/2013] [Indexed: 11/09/2022] Open
Abstract
AIMS In a previous study, we proposed that corneal topography performed 30-40 min after the initial suture removal can identify the next set of sutures requiring removal, for the treatment of post-keratoplasty astigmatism. The aim of this study was to evaluate the effect of removing subsequent sets of sutures at the same sitting. METHODS 10/0 nylon interrupted sutures were placed, to secure the graft-host junction, at the time of keratoplasty. Topography was performed using Pentacam (Oculus) before suture removal. The sutures to be removed in the steep semi-meridians were identified and removed at the slit-lamp biomicroscope. Topography was repeated 30-40 min post suture removal, the new steep semi-meridians determined, and the next set of sutures to be removed were identified and removed accordingly. Topography was repeated 4-6 weeks later and the magnitude of topographic astigmatism was recorded. A paired-samples t-test was used to evaluate the impact of selective suture removal on reducing the magnitude of topographic and refractive astigmatism. RESULTS Twenty eyes of 20 patients underwent sequential selective same-day suture removal (SSSS) after corneal transplantation. This study showed that the topographic astigmatism decreased by about 46.7% (3.68 D) and the refractive astigmatism decreased by about 37.7% (2.61 D) following SSSS. Vector calculations also show a significant reduction of both topographic and refractive astigmatism (P<0.001). CONCLUSION SSSS may help patients to achieve satisfactory vision more quickly and reduce the number of follow-up visits required post keratoplasty.
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Affiliation(s)
- U Fares
- 1] Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK [2] Division of Ophthalmology and Visual Sciences, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
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Keeler R, Singh AD, Dua HS. A master mastering the ophthalmoscope: Eduard von Jaeger. Br J Ophthalmol 2013. [DOI: 10.1136/bjophthalmol-2013-303294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fares U, Mokashi AA, Al-Aqaba MA, Otri AM, Miri A, Dua HS. Management of postkeratoplasty astigmatism by paired arcuate incisions with compression sutures. Br J Ophthalmol 2013; 97:438-43. [PMID: 23390168 DOI: 10.1136/bjophthalmol-2012-302128] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To analyse the efficacy of paired arcuate incisions and compression sutures technique in the management of post penetrating keratoplasty (PK) astigmatism. METHODS A paired arcuate incision with compression sutures procedure was used to treat 26 eyes with post-PK astigmatism ranging from 6.00 to 16.50 dioptres (D). The incisions were placed at the 7.0 mm optical zone inside the graft-host junction at a depth of 80% of corneal thickness. A 45° paired arc length was planned for eyes with preoperative astigmatism between 6D and 9D, and a 60° paired arc length was planned for eyes with preoperative astigmatism of >9D. At 3 months, corneal topography and refraction was performed and suture(s) removed if indicated. Net and vector astigmatism changes were calculated to determine the efficacy of the procedure. The indications for PK included keratoconus, Fuch's endothelial dystrophy, pseudophakic bullous keratopathy and corneal scar. RESULTS There was a statistically significant reduction in the mean magnitude of astigmatism from 9.66 ± 2.90D preoperatively to 4.37 ± 2.53D postoperatively in the whole group. The mean decrease in the astigmatism was 4.37 ± 2.05D (58.4%) and 6.23 ± 3.63D (52.6%) in patients with 6-9D and >9D, respectively. Vector power calculations also showed a significant astigmatism reduction in all groups. The safety and efficacy indices were 1.40 and 0.28, respectively. CONCLUSIONS Manual astigmatic keratotomy is a viable technique with relatively good safety and efficacy outcomes. Based on the results we propose that increasing the arc length to a minimum of 60° for astigmatism of 6-9D, and to 75° for astigmatism >9D, is likely to have a greater beneficial effect.
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Affiliation(s)
- Usama Fares
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK
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Keeler R, Singh AD, Dua HS. Richard Banister 1570–1625. Father of British Ophthalmology. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Keeler R, Singh AD, Dua HS. Cataract surgery springing into action: the French connection. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dua HS, Singh AD. Highlights from this issue. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dua HS, Singh AD. Highlights from this issue. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Keeler R, Singh AD, Dua HS. Eyes through Bader's Eyes (Charles Bader 1825–1899). Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Singh Dua H, Singh AD. Highlights from this issue. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Branch MJ, Hashmani K, Dhillon P, Jones DRE, Dua HS, Hopkinson A. Mesenchymal stem cells in the human corneal limbal stroma. Invest Ophthalmol Vis Sci 2012; 53:5109-16. [PMID: 22736610 DOI: 10.1167/iovs.11-8673] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Peripheral and limbal corneal stromal cells (PLCSCs), which contain keratocytes, have a complex phenotype. Knowledge of keratocyte cell properties, function, and origin is limited. Evidence available thus far has suggested both mesenchymal stromal and hematopoietic characteristics. Multipotent mesenchymal stromal cells (MSCs) are found in an increasing number of tissues and are the subject of considerable interest and investigation in the disciplines of tissue engineering, immunology, gene therapy, and oncology. METHODS Isolated PLCSCs were characterized by markers aldehyde dehydrogenase and keratocan, cultured, and analyzed against a set of criteria for the identification of MSCs developed by the International Society of Cellular Therapy (ISCT). PLCSCs were directly compared to fetal liver MSCs (flMSCs). Additional cell surface markers were also used to quantify differentiation, which was also performed on both cell types. RESULTS PLCSCs were found to be plastic adherent, displayed the correct profile and proportions of CSMs, and demonstrated trilineage potential in accordance with the ISCT guidelines. Furthermore, PLCSCs displayed a high degree of similarity to flMSCs and this likeness extended into the non-ISCT MSC cell surface markers and trilineage differentiation, which were often but not always comparable. CONCLUSIONS Herein we report a novel observation that PLCSCs conform to all the ISCT criteria and are therefore MSCs. Furthermore, this study has identified the limbal stroma as yet another MSC niche and presents a new perspective on the role of the PLCSC.
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Affiliation(s)
- Matthew James Branch
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
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Keeler R, Singh AD, Dua HS. Scoping strabismus: stand-mounted synoptiscope. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dua HS, Singh AD. Highlights from this issue. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-302142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dua HS, Singh AD. Highlights from this issue. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-301961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Miri A, Hashmani K, Al-aqaba M, Faraj LA, Fares U, Otri AM, Said DG, Dua HS. The effect of gravitational force on limbal stem cell growth. Br J Ophthalmol 2012; 96:1034-7. [DOI: 10.1136/bjophthalmol-2012-301624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Khatib T, Singh AD, Dua HS. Looking back at Orpheus. Br J Ophthalmol 2012. [DOI: 10.1136/bjophthalmol-2012-301693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Miri A, Alomar T, Nubile M, Al-aqaba M, Lanzini M, Fares U, Said DG, Lowe J, Dua HS. In vivo confocal microscopic findings in patients with limbal stem cell deficiency. Br J Ophthalmol 2012; 96:523-9. [DOI: 10.1136/bjophthalmol-2011-300551] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Perrella G, Scott CA, Spelat R, Brusini P, Dua HS. Cultured Human Keratocytes from the Limbus and Cornea Both Express Epithelial Cytokeratin 3: Possible Mesenchymal-Epithelial Transition. ACTA ACUST UNITED AC 2012. [DOI: 10.4172/2324-8599.1000101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Kulkarni B, Mohammed I, Hopkinson A, Dua HS. Validation of endogenous control genes for gene expression studies on human ocular surface epithelium. PLoS One 2011; 6:e22301. [PMID: 21857920 PMCID: PMC3152287 DOI: 10.1371/journal.pone.0022301] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/21/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate a panel of ten known endogenous control genes (ECG) with quantitative reverse transcription PCR (qPCR), for identification of stably expressed endogenous control genes in the ocular surface (OS) epithelial regions including cornea, limbus, limbal epithelial crypt and conjunctiva to normalise the quantitative reverse transcription PCR data of genes of interest expressed in above-mentioned regions. Method The lasermicrodissected (LMD) OS epithelial regions of cryosectioned corneoscleral buttons from the cadaver eyes were processed for RNA extraction and cDNA synthesis to detect genes of interest with qPCR. Gene expression of 10 known ECG—glyceraldehyde-3-phosphate dehydrogenase (GAPDH), beta actin (ACTB), peptidylprolyl isomerase (PPIA), TATA-box binding protein (TBP1), hypoxanthine guanine phosphoribosyl transferase (HPRT1), beta glucuronidase (GUSB), Eucaryotic 18S ribosomal RNA (18S), phosphoglycerate kinase (PGK1), beta-2-microglobulin (B2M), ribosomal protein, large, P0 (RPLP0)—was measured in the OS epithelial regions by qPCR method and the data collected was further analysed using geNorm software. Results The expression stability of ECGs in the OS epithelial regions in increasing order as determined with geNorm software is as follows: ACTB<18S<TBP<B2M<PGK1<HPRT1<GUSB<GAPDH<PPIA-RPLP0. In this study, geNorm analysis has shown the following ECGs pairs to be most stably expressed in individual OS epithelial regions: HPRT1-TBP in cornea, GUSB-PPIA in limbus, B2M-PPIA and RPLP0-TBP in LEC and conjunctiva respectively. However, across the entire ocular surface including all the regions mentioned above, PPIA-RPLP0 pair was shown to be most stable. Conclusion This study has identified stably expressed ECGs on the OS epithelial regions for effective qPCR results in genes of interest. The results from this study are broadly applicable to quantitative reverse transcription PCR studies on human OS epithelium and provide evidence for the use of PPIA-RPLP0 ECGs pair in quantitative reverse transcription PCR across the OS epithelium.
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Affiliation(s)
- Bina Kulkarni
- Division of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Imran Mohammed
- Division of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham, United Kingdom
- Institute for Translational Medicine and Therapeutics, Department of Pharmacology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Andrew Hopkinson
- Division of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Harminder Singh Dua
- Division of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham, United Kingdom
- * E-mail:
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