1
|
Bostan C, Randleman JB. Unilateral Granular Type 2 Corneal Dystrophy With Exacerbation After LASIK. Cornea 2024; 43:648-651. [PMID: 38300218 DOI: 10.1097/ico.0000000000003490] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/03/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE The aim of this study was to report a case of unilateral granular corneal dystrophy type 2 (GCD2) with exacerbation after bilateral laser in situ keratomileusis (LASIK). METHODS Clinical evaluation, Scheimpflug imaging, anterior segment optical coherence tomography (AS-OCT), cytology, and genetic testing were used to confirm the diagnosis of unilateral GCD2 with exacerbation after bilateral LASIK. Detailed literature review for possible unilateral GCD2 presentations was performed. RESULTS A 54-year-old White woman presented with blurred vision in her left eye and a history of bilateral LASIK performed 8 years before. Examination revealed dense opacities in the left cornea only, which were confirmed to be confined to the LASIK interface and adjacent corneal stromal tissue, as determined by AS-OCT. The patient underwent flap lift, interface debris removal, and stromal bed phototherapeutic keratectomy. Cytological analysis showed eosinophilic corneal stromal deposits that stained with trichrome stain and were congophilic on Congo red stain. Genetic testing was positive for heterozygous GCD2 transforming growth factor β-induced gene ( TGFBI ), c.371G>A, p.R124H mutation. There were no opacities identifiable in the right eye on serial slit-lamp examination, Scheimpflug imaging, or OCT imaging at 4 or 8 years after bilateral LASIK. Literature review failed to identify any previous reports of unilateral GCD2. CONCLUSIONS This is the first known reported case of unilateral granular corneal dystrophy type 2. LASIK is contraindicated in eyes with corneal stromal dystrophies related to mutations in TGFBI as both flap creation and laser ablation can exacerbate visually significant opacity formation. Scheimpflug and AS-OCT imaging are useful to identify opacities in GCD2.
Collapse
Affiliation(s)
- Cristina Bostan
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - J Bradley Randleman
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH; and
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| |
Collapse
|
2
|
Yahalomi T, Elbaz U. [PETERS ANOMALY AND PETERS PLUS SYNDROME]. Harefuah 2023; 162:616-618. [PMID: 37965860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Peters anomaly is characterized by a defect in the development of the anterior segment of the eye during fetal development (Anterior segment dysgenesis). This anomaly presents a broad clinical presentation ranging from minimal peripheral corneal opacity to extensive adhesions of the iris and lens with dense central corneal opacity that impairs vision. Peters Plus Syndrome is a recessive autosomal syndrome manifested by Peters anomaly, along with systemic disorders such as brachydactyly (short fingers and toes), short stature, a developmental delay, dysmorphic facial features, and may accompanied with heart and genitourinary malformations. The most common sign of Peters' anomaly is corneal opacity that appears at birth. This opacity can cause blockage of the central visual axis and cause the development of a deprivational amblyopia. In addition, the patient may suffer from glaucoma due to malformations in the angle structures as well as a shallow anterior chamber. Treatments are aimed at clearing the central visual axis as soon as possible in order to allow the visual system to mature and to avoid the development of amblyopia. Full-thickness corneal transplantation combined with Cataract surgery if necessary is the current standard of care. Optical iridoplasty is a milder surgical alternative in cases where the corneal opacity is not significant.
Collapse
Affiliation(s)
- Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Schneider Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Bhate M, Fernandes M, Senthil S, Bathula S, Beilur S. Progeroid syndrome of De Barsy - a case report and review of ophthalmic literature. Ophthalmic Genet 2023; 44:509-511. [PMID: 36524384 DOI: 10.1080/13816810.2022.2154810] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND This report describes a very rare case of progeroid syndrome of De Barsy (Cutis laxa-corneal clouding syndrome). MATERIALS AND METHODS A 2 year-old child presented to the pediatric ophthalmology outpatients with bilateral congenital corneal opacification along with dysmorphic facial features, including loose wrinkled skin, progeroid appearance, delayed milestones, short stature, multiple hyper-extensible joints, muscular hypotonia, pectus excavatum and congenital dislocation of the hip joint. The child underwent a detailed ophthalmic work up and systemic evaluation by a clinical geneticist. RESULTS Ophthalmic management in the form of bilateral sequential penetrating keratoplasties and a left eye trabeculectomy for medically uncontrolled angle-closure glaucoma was performed. Visual rehabilitation with glasses and amblyopia therapy is ongoing. Histopathology of the corneal button revealed loss of the bowman's layer which was replaced by a fibrous pannus while the stroma showed loss of stromal lamellar architecture with anterior and mid stroma showing vascularization. Genetic testing confirmed a mutation in the PYCR1 gene for a homozygous autosomal recessive cutis laxa type IIB. CONCLUSIONS Although rare, De Barsy syndrome is an important cause of corneal opacification at birth with multiple systemic abnormalities that requires intervention.
Collapse
Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children's Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, India
| | - Merle Fernandes
- Jasti V Ramanamma Children's Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, India
- Shantilal Sanghvi Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Sirisha Senthil
- Jasti V Ramanamma Children's Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, India
- VST Center for Glaucoma Care, L.V. Prasad Eye Institute, Hyderabad, India
| | - Shruthi Bathula
- Jasti V Ramanamma Children's Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, India
| | | |
Collapse
|
4
|
Lee BJH, Ong HS, Fenner BJ, Mehta JS. Surgical Technique to Treat Presbyopic Inlay-Associated Corneal Haze With Sequential Excimer Photoablation: A Case Series. J Refract Surg 2023; 39:639-646. [PMID: 37675910 DOI: 10.3928/1081597x-20230814-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE To describe an approach using sequential excimer laser ablation of the stromal surface of the corneal flap with or without subsequent excimer ablation to the stromal bed to reduce presbyopic inlay-associated corneal haze. METHODS Twelve patients who underwent KAMRA inlay (Acufocus) explantation due to corneal haze were included. The mean interval between explantation and the primary surgery (phototherapeutic keratotomy [PTK] to corneal flap) was 16.2 ± 29.7 months (range = 1 to 83 months). The corneal flap was lifted and laid on an evisceration spoon and an excimer laser was used to ablate the flap stroma by 30 to 40 µm depth. Subsequently, an excimer laser was used to ablate and treat the stromal bed following a second flap lift according to the manifest refraction, leaving a minimal residual stromal bed thickness of greater than 300 µm. For both procedures, mitomycin C 0.02% was applied to the stromal bed before the flap was replaced and a bandage contact lens applied. RESULTS Reductions in corneal haze were observed, following PTK to the corneal flap with or without photorefractive keratectomy (PRK) to the stromal bed, both clinically and on imaging. No significant changes in uncorrected distance visual acuity (P = .442) and corrected distance visual acuity (P = .565) were observed. Improvements were observed for both spherical equivalent refractive errors (P = .036) and corneal light backscatter (P = .019). There were significant improvements in spherical aberrations (P = .014) but no changes in total lower and higher order aberrations. CONCLUSIONS PTK to the corneal flap with or without subsequent stromal bed PRK is an effective technique in treating corneal haze following presbyopic inlay explantation. [J Refract Surg. 2023;39(9):639-646.].
Collapse
|
5
|
McGrath O, Sornalingam K, Aslam T, Ashworth J. Changes in Corneal Clouding Over Time in Patients With Mucopolysaccharidosis. Cornea 2023; 42:992-999. [PMID: 36857777 DOI: 10.1097/ico.0000000000003214] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/13/2022] [Accepted: 10/24/2022] [Indexed: 03/03/2023]
Abstract
PURPOSE Mucopolysaccharidoses (MPSs) are a rare group of lysosomal storage disorders characterized by the accumulation of incompletely degraded glycosaminoglycans (GAGs) in multiple organ systems, including the eye. Visual loss occurs in MPS predominantly due to corneal clouding. Despite the success of enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT) in improving many systemic manifestations of MPS, less is known about their effect on corneal clouding. This study prospectively analyses the effect of both ERT and HSCT on corneal clouding using objective measures over time. METHODS This is a prospective longitudinal observational study. Corneal clouding was assessed in each participant using slitlamp, digital slit-lamp photographs, and an iris camera (Corneal Opacification Measure [COM] and the Pentacam system). RESULTS Data were collected for 65 participants: 39 MPS I (Hurler), 5 MPS II (Hunter), 12 MPS IV (Morquio), and 9 MPS VI (Maroteaux-Lamy). Follow-up data are available for 45 participants (29 MPS I, 3 MPS II, 6 MPS IV, and 7 MPS VI). CONCLUSIONS This study found corneal clouding to be stable in most participants with MPS I, II, IV, and VI over a follow-up period of 5 to 75 months (median of 30 months) when measured with clinical corneal grading systems, graded digital slit-lamp images, and iris camera COMs. For those with Pentacam densitometry measures, there was a progression of corneal clouding, on average, in those with MPS I and MPS VI. There was no apparent difference in progression of corneal clouding between patients who were on ERT, HSCT, or no treatment.
Collapse
Affiliation(s)
- Orlaith McGrath
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| | - Krishanthy Sornalingam
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| | - Jane Ashworth
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| |
Collapse
|
6
|
Chang MS, Jun I, Kim EK. Mini-Review: Clinical Features and Management of Granular Corneal Dystrophy Type 2. Korean J Ophthalmol 2023; 37:340-347. [PMID: 37336511 PMCID: PMC10427907 DOI: 10.3341/kjo.2023.0032] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
Granular corneal dystrophy type 2 (GCD2) is an autosomal dominant corneal stromal dystrophy that is caused by p.Arg124His mutation of transforming growth factor β induced (TGFBI) gene. It is characterized by well demarcated granular shaped opacities in central anterior stroma and as the disease progresses, extrusion of the deposits results in ocular pain due to corneal epithelial erosion. Also, diffuse corneal haze which appears late, causes decrease in visual acuity. The prevalence of GCD2 is high in East Asia including Korea. Homozygous patients show a severe phenotype from an early age, and the heterozygote phenotype varies among patients, depending on several types of compound heterozygous TGFBI mutations. In the initial stage, conservative treatments such as artificial tears, antibiotic eye drops, and bandage contact lenses are used to treat corneal erosion. Different surgical methods are used depending on the depth and extent of the stromal deposits. Phototherapeutic keratectomy removes anterior opacities and is advantageous in terms of its applicability and repeatability. For deeper lesions, deep anterior lamellar keratoplasty can be used as the endothelial layer is not always affected. Recurrence following these treatments are reported within a wide range of rates in different studies due to varying definition of recurrence and follow-up period. In patients who have undergone corneal laser vision-correction surgeries such as photorefractive keratectomy, LASEK, or LASIK including SMILE surgery, corneal opacity exacerbates rapidly with severe deterioration of visual acuity. Further investigations on new treatments of GCD2 are necessary.
Collapse
Affiliation(s)
- Myung Soo Chang
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul,
Korea
| | - Eung Kweon Kim
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul,
Korea
- Saevit Eye Hospital, Goyang,
Korea
| |
Collapse
|
7
|
Hieda O, Kobayashi A, Sotozono C, Kinoshita S. Corneal Electrolysis for Granular Corneal Dystrophy Type 2 (Avellino Corneal Dystrophy) Exacerbation After LASIK. J Refract Surg 2023; 39:61-65. [PMID: 36630431 DOI: 10.3928/1081597x-20221129-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To report two cases in which exacerbation of granular corneal dystrophy type 2 (GCD2; Avellino corneal dystrophy) after laser in situ keratomileusis (LASIK) was successfully removed by corneal electrolysis. METHODS This study involved a 66-year-old man and a 43-year-old man with GCD2 who had undergone bilateral LASIK for myopia 10 or more years prior to presentation. In both patients, GCD2 corneal opacity gradually developed postoperatively at the LASIK flap interface, thus resulting in a decrease of visual acuity. For treatment, the LASIK flaps in both patients were surgically lifted to directly remove the opacity. Corneal electrolysis was then applied to the back of each LASIK flap and stromal bed. RESULTS Postoperatively, the ocular symptoms and corneal opacities related to GCD exacerbation disappeared, with improvement of corrected and uncorrected distance visual acuity and almost no change of refractive error. CONCLUSIONS The findings reveal that corneal electrolysis is safe and effective for treating exacerbations of GCD2 following LASIK when applied to a surgically lifted flap, and that it successfully removes GCD2-related LASIK flap interface opacities with almost no change of refractive error postoperatively. [J Refract Surg. 2023;39(1):61-65.].
Collapse
|
8
|
Moshirfar M, Peterson T, Ungricht E, McCabe S, Ronquillo YC, Brooks B, Towne F, Hoopes P. Thygeson Superficial Punctate Keratitis: A Clinical and Immunologic Review. Eye Contact Lens 2022; 48:232-238. [PMID: 35301272 DOI: 10.1097/icl.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Thygeson superficial punctate keratitis (TSPK) is clinically characterized by exacerbations and remissions of gray-white opacities within the corneal epithelium, most often bilateral but may be asymmetric. Symptoms typically include photophobia, tearing, blurring, and eye irritation. Although disease progression and prognosis are well described, the exact cause is unknown. Hypotheses exist implicating virus-mediated immunity as the cause of TSPK following cases of viral keratitis; however, several polymerase chain reaction studies refute the infectious process concurrently with symptomatic TSPK. This is further supported by the consistent lack of response to antiviral and antibacterial treatment. A subset of dendritic cells known as Langerhans cells (LC) found within the corneal epithelium has been positively correlated with exacerbations of TSPK. Langerhans cells proliferate to protect and mitigate the cornea's inflammatory response, but the inflammatory triggers and relapses associated with TSPK are not well understood. Several topical drugs exist to treat inflammation related to TSPK; however, drug delivery is a major barrier to treatment because of the tear film and epithelial barrier. Drug-eluting contact lenses that target intermediates of inflammation could serve as a more effective treatment modality because of the increased bioavailability of the drugs. This review is an in-depth survey of the literature regarding the relationship between the origin and pathophysiology of LC and TSPK at the immunologic level. We also discuss potential pharmacotherapeutic interventions for TSPK prevention and treatment.
Collapse
Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center (M.M., S.M., Y.C.R., P.H.), Hoopes Vision, Draper, UT; Department of Ophthalmology and Visual Sciences (M.M.), John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT; Utah Lions Eye Bank (M.M.), Murray, UT; Rocky Vista University College of Osteopathic Medicine (T.P., D.B.B., F.T.), Ivins, UT; University of Utah School of Medicine (E.U.), Salt Lake City, UT; and Mission Hills Eye Center (S.M.), Pleasant Hill, CA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Käsmann-Kellner B, Moslemani K, Seitz B. [Optical rehabilitation and pediatric ophthalmological care following keratoplasty for childhood corneal opacities]. Ophthalmologe 2022; 119:462-470. [PMID: 35394198 DOI: 10.1007/s00347-022-01585-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 01/21/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The younger the children are at the time of corneal transplantation, the worse the survival prognosis of the graft. PREOPERATIVE CONSIDERATIONS Preoperative considerations are significant in terms of accurate parental education, ensuring adherence to treatment and choosing the appropriate surgical time frame (amblyopia versus graft failure, compliance of the patient). Parental education must include the reduced visual prognosis in young children, exceptions being later acquired corneal pathologies such as inflammatory corneal scars (herpes) and keratoconus. POSTOPERATIVE CARE A distinction must be made between morphological care after transplantation and refractive correction as well as treatment of amblyopia. The younger the children, the less favorable the prognosis for the transplant and the more often multiple examinations with anesthesia are necessary in order to detect complications, such as infiltrates or suture loosening at an early stage. Especially unilateral congenital pathologies often do not lead to a sufficient improvement of amblyopia (refractory amblyopia, poor compliance). CONCLUSION The prognosis after keratoplasty in childhood is already partly decided by the careful evaluation of indications (no surgery of a sclerocornea) and the detailed and realistic clarification for the parents (cooperation with long-term ocular and systemic treatment even if the child has poor compliance, frequent check-ups, reduced chances of amblyopia treatment). The younger the child is at the time of transplantation, the more frequent are graft failure and the development of complications. Later manifesting diseases in older children (herpetic corneal scars, keratoconus) have a better prognosis.
Collapse
Affiliation(s)
- Barbara Käsmann-Kellner
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66421, Homburg/Saar, Deutschland.
| | - Kayed Moslemani
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66421, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
10
|
Wilson SE, Sampaio LP, Shiju TM, Hilgert GSL, de Oliveira RC. Corneal Opacity: Cell Biological Determinants of the Transition From Transparency to Transient Haze to Scarring Fibrosis, and Resolution, After Injury. Invest Ophthalmol Vis Sci 2022; 63:22. [PMID: 35044454 PMCID: PMC8787546 DOI: 10.1167/iovs.63.1.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/08/2021] [Accepted: 12/22/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose To highlight the cellular, matrix, and hydration changes associated with opacity that occurs in the corneal stroma after injury. Methods Review of the literature. Results The regulated transition of keratocytes to corneal fibroblasts and myofibroblasts, and of bone marrow-derived fibrocytes to myofibroblasts, is in large part modulated by transforming growth factor beta (TGFβ) entry into the stroma after injury to the epithelial basement membrane (EBM) and/or Descemet's membrane. The composition, stoichiometry, and organization of the stromal extracellular matrix components and water is altered by corneal fibroblast and myofibroblast production of large amounts of collagen type I and other extracellular matrix components-resulting in varying levels of stromal opacity, depending on the intensity of the healing response. Regeneration of EBM and/or Descemet's membrane, and stromal cell production of non-EBM collagen type IV, reestablishes control of TGFβ entry and activity, and triggers TGFβ-dependent myofibroblast apoptosis. Eventually, corneal fibroblasts also disappear, and repopulating keratocytes reorganize the disordered extracellular matrix to reestablish transparency. Conclusions Injuries to the cornea produce varying amounts of corneal opacity depending on the magnitude of cellular and molecular responses to injury. The EBM and Descemet's membrane are key regulators of stromal cellularity through their modulation of TGFβ. After injury to the cornea, depending on the severity of the insult, and possibly genetic factors, trace opacity to severe scarring fibrosis develops. Stromal cellularity, and the functions of different cell types, are the major determinants of the level of the stromal opacity.
Collapse
Affiliation(s)
- Steven E. Wilson
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Lycia Pedral Sampaio
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
- Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | |
Collapse
|
11
|
Ghosh S, Bajad S, Tanna D, Sharma L, Bajaj R, Gupta R. Not Only Skin Deep-A Rare Case of Porphyria Cutanea Tarda With Corneal Opacity Presenting Along With Scleroderma With Interstitial Lung Disease. J Clin Rheumatol 2021; 27:S804-S805. [PMID: 35073640 DOI: 10.1097/rhu.0000000000001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shounak Ghosh
- From the Department of Rheumatology & Clinical Immunology, Medanta-The Medicity, Gurgaon, Haryana, India
| | | | | | | | | | | |
Collapse
|
12
|
Cox AR, Sia RK, Purt B, Ryan DS, Beydoun H, Colyer MH, Rivers BA, Bower KS. Assessment of Corneal Haze After PRK and the Effect of Sutureless Amniotic Membrane Graft by Corneal Densitometry. J Refract Surg 2021; 36:293-299. [PMID: 32396640 DOI: 10.3928/1081597x-20200406-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/02/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess whether densitometry analysis appropriately monitors the development of haze in myopic patients after photorefractive keratectomy (PRK) when compared to subjective slit-lamp haze grade examinations, and whether sutureless cryo-preserved amniotic membrane reduced postoperative haze development when compared to the standard bandage contact lens. METHODS In this retrospective cohort at the Center for Refractive Surgery, Walter Reed National Military Medical Center, a secondary analysis of prospectively collected data was performed. In the prospective study, participants underwent PRK for myopia. Postoperatively, a standard bandage contact lens was applied to the dominant eye and a sutureless cryo-preserved amniotic membrane graft to the nondominant eye. Participants were evaluated at 1, 3, and 6 months postoperatively for haze formation and corneal densitometry using slit-lamp biomicroscopy and Scheimpflug imaging, respectively. RESULTS Densitometry measurements at 6 months postoperatively were positively and significantly associated with the presence or absence of haze as assessed by slit-lamp examination in 39 patients (78 eyes; age range: 21 to 44 years). Eyes with increased densitometry measurements had 2.3 to 3.4 times the odds (P ⩽ .014) of having clinical haze on slit-lamp examination. Eyes with the amniotic membrane graft showed a positive correlation with increased corneal densitometry throughout most layers of the cornea. CONCLUSIONS Densitometry analysis appears to be a useful tool to supplement slit-lamp examination in monitoring haze development after PRK. The amniotic membrane failed to show a reduction in corneal densitometry in myopic eyes after PRK. [J Refract Surg. 2020;36(5):293-299.].
Collapse
|
13
|
Choi MK, Le MT, Cho HS, Lee J, Jeon H, Cha SY, Na M, Chun T, Kim JH, Song H, Park C. Transgenic Mice Overexpressing PG1 Display Corneal Opacity and Severe Inflammation in the Eye. Int J Mol Sci 2021; 22:1586. [PMID: 33557346 PMCID: PMC7915784 DOI: 10.3390/ijms22041586] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
Antimicrobial peptides (AMPs) are of interest as alternatives to antibiotics or immunomodulators. We generated and characterized the phenotypes of transgenic mice overexpressing protegrin 1 (PG1), a potent porcine cathelicidin. No obvious differences were observed between PG1 transgenic and wild-type mice in terms of growth, development, general behaviour, and the major immune cell population. However, PG1 transgenic mice intranasally infected with Staphylococcus aureus resulted in a reduction in microscopic pulmonary injury, improved clearance of bacteria, and lower proinflammatory cytokine secretion, compared to those of wild-type mice. On the other hand, approximately 25% of PG1 transgenic mice (n = 54/215) showed corneal opacity and developed inflammation in the eye, resulting ultimately in phthisis bulbi. Immunohistochemical analyses revealed that PG1 and its activator, neutrophil elastase, localized to the basal cells of the cornea and glands in eyelids, respectively. In addition, apoptosis indicated by a Terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL)-positive signal was detected from flat cells of the cornea. Our study suggests that the expression regulation or localization of AMPs such as PG1 is important to prevent their adverse effects. However, our results also showed that the cytotoxic effects of PG1 on cells could be tolerated in animals, except for the eyes.
Collapse
Affiliation(s)
- Min-Kyeung Choi
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| | - Minh Thong Le
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| | - Hye-Sun Cho
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| | - Juyoung Lee
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| | - Hyoim Jeon
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| | - Se-Yeoun Cha
- College of Veterinary Medicine, Chonbuk National University, Iksan 54596, Korea;
| | - Manheum Na
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Korea; (M.N.); (T.C.)
| | - Taehoon Chun
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Korea; (M.N.); (T.C.)
| | - Jin-Hoi Kim
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| | - Hyuk Song
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| | - Chankyu Park
- Department of Stem Cell Biology and Regenerative Biology, Konkuk University, Hwayang-dong, Seoul 05029, Korea; (M.-K.C.); (M.T.L.); (H.-S.C.); (J.L.); (H.J.); (J.-H.K.); (H.S.)
| |
Collapse
|
14
|
Díaz Barrón A, Sanz Gallen L, Hervás Hernandis JM, Tarragó Simón E, Duch-Samper AM. Bacterial keratitis due to Moraxella nonliquefaciens. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:357-360. [PMID: 32241585 DOI: 10.1016/j.oftal.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
Moraxella keratitis can lead to important complications. Moraxella nonliquefaciens(M. nonliquefaciens) has the worst prognosis. Only three cases of corneal infections due to M. nonliquefaciens have been published. The case is presented of a 79-year-old man with bullous keratopathy, recently affected with severe infectious keratitis. Dense, deep, and central stromal infiltrates and hyphaema were detected. After the identification of M. nonliquefaciens in the culture, and given the progression of the condition, the initial empirical treatment was modified to topical ciprofloxacin and ceftazidime in accordance with the antibiogram, combining oral ciprofloxacin and amoxicillin-clavulanate. After 27 days, there was total resolution of the lesion, with central residual leucoma. Keratitis caused by M. nonliquefaciens is rare and must be suspected in elderly patients with local predisposing factors, such as corneal damage or previous eye surgery. Early antibiogram-guided treatment and close monitoring are important to avoid complications and poor compliance.
Collapse
Affiliation(s)
- A Díaz Barrón
- Departamento de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - L Sanz Gallen
- Departamento de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - J M Hervás Hernandis
- Departamento de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - E Tarragó Simón
- Departamento de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A M Duch-Samper
- Departamento de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España; Facultad de Medicina, Universidad de Valencia , Valencia, España
| |
Collapse
|
15
|
Eghbali A, Hassan S, Seehra G, FitzGibbon E, Sidransky E. Ophthalmological findings in Gaucher disease. Mol Genet Metab 2019; 127:23-27. [PMID: 31047801 DOI: 10.1016/j.ymgme.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 01/06/2023]
Abstract
Gaucher disease is an autosomal recessive lysosomal storage disorder caused by mutations in the gene GBA1, which encodes the lysosomal protein glucocerebrosidase. Patients with Gaucher disease generally have a variety of clinical manifestations ranging from visceral to neurological involvement and some develop ocular involvement. The most commonly affected organs include the spleen, liver, and bone. Moreover, patients often have hepatosplenomegaly, thrombocytopenia, anemia, and bone involvement related to deficient glucocerebrosidase and the subsequent accumulation of glucosylceramide and glucosylsphingosine in cells. A subset of patients develops neurological manifestations, including seizures, myoclonic epilepsy, and progressive neurodegeneration. Eye involvement tends to be less common and presents with diverse clinical findings. These rare and variable ocular manifestations, involving the vitreous, retina, cornea, uvea, conjunctiva and eye movements, can pose a diagnostic challenge for clinicians, especially those not familiar with the disorder. In this review, we explore the different ophthalmologic findings reported in patients with Gaucher disease, aiming to facilitate diagnosis and expedite treatment for patients presenting with ocular manifestations of this rare disorder.
Collapse
Affiliation(s)
- Areian Eghbali
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shahzeb Hassan
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gurpreet Seehra
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Edmond FitzGibbon
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ellen Sidransky
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
16
|
Pietraszkiewicz A, Hampton C, Caplash S, Lei L, Capetanaki Y, Tadvalkar G, Pal-Ghosh S, Stepp MA, Bargagna-Mohan P, Mohan R. Desmin deficiency is not sufficient to prevent corneal fibrosis. Exp Eye Res 2019; 180:155-163. [PMID: 30590024 PMCID: PMC6389382 DOI: 10.1016/j.exer.2018.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/08/2018] [Accepted: 12/22/2018] [Indexed: 12/16/2022]
Abstract
The type III intermediate filament (IF) proteins vimentin and desmin are sequentially overexpressed in stromal myofibroblasts over the period when fibrosis sets in after corneal injury. Prior findings have revealed vimentin-deficient mice are significantly protected from corneal fibrosis after alkali injury, which has implicated this IF protein as an important regulator of corneal fibrosis. It has remained as yet unproven whether desmin contributes in any significant manner to corneal fibrosis. Here we have employed desmin-deficient (Des KO) mice in the corneal alkali injury model and show that injured Des KO mice develop fibrosis and show similar levels of corneal opacity at 14 days post-injury as wild type (WT) mice and retain this phenotype even at 30d post injury. Des KO corneas from injured mice show upregulation of vimentin and alpha-smooth muscle actin expression to equivalent levels as WT corneas, illuminating that desmin deficiency does not interfere with myofibrobast differentiation. Employing the small molecule withaferin A (WFA), an inhibitor of vimentin, we show that WFA treatment causes the decrease in steady state levels of vimentin and serine 38 phosphorylated vimentin, the latter a biomarker associated with corneal fibrosis, and improved corneal clarity through blockade of myofibroblast differentiation. To investigate further the mechanism of fibrosis in desmin deficiency, we examined keratin 8 expression in the epithelium, and found reduced levels of this cytokeratin in injured Des KO corneas compared to WT corneas. This finding also corroborates the decrease of cell proliferation in injured Des KO corneas compared to that in WT corneas. The fibrotic phenotype of Des KO corneas also features abundant vascularization, further exemplifying the magnitude of corneal pathology. Together, these findings illuminate that desmin does not contribute significantly to corneal fibrosis in this injury model.
Collapse
Affiliation(s)
| | - Christopher Hampton
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Sonny Caplash
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Ling Lei
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Yassemi Capetanaki
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gauri Tadvalkar
- Department of Ophthalmology, George Washington University, Washington, DC, USA
| | - Sonali Pal-Ghosh
- Department of Ophthalmology, George Washington University, Washington, DC, USA
| | - Mary Ann Stepp
- Department of Ophthalmology, George Washington University, Washington, DC, USA
| | - Paola Bargagna-Mohan
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Royce Mohan
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA.
| |
Collapse
|
17
|
Moraes RLB, Ghanem RC, Ghanem VC, Santhiago MR. Haze and Visual Acuity Loss After Sequential Photorefractive Keratectomy and Corneal Cross-linking for Keratoconus. J Refract Surg 2019; 35:109-114. [PMID: 30742225 DOI: 10.3928/1081597x-20190114-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the results after photorefractive keratectomy (PRK) followed immediately by standard 30-minute corneal cross-linking (CXL) for keratoconus. METHODS This retrospective study included 26 eyes of 16 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (SE) and cylinder, apical keratometry, corneal higher order aberrations (HOAs), and corneal haze were evaluated. RESULTS Mean follow-up was 32 ± 8 months (range: 19 to 50 months) and mean patient age was 31 ± 5 years (range: 24 to 40 years). Mean UDVA improved significantly from 0.80 ± 0.39 to 0.32 ± 0.36 logMAR after surgery (P < .001), but the mean CDVA worsened significantly from 0.07 ± 0.09 to 0.15 ± 0.14 logMAR after surgery (P = .006). Thirteen eyes (50%) lost at least one line of CDVA, 3 eyes (12%) lost two lines, and 4 eyes (15%) lost three lines. SE, cylinder, and apical keratometry decreased significantly. Corneal haze grade 1 was found in 15 eyes (57.7%), grade 2 in 6 eyes (23.1%), and grade 3 in 1 eye (3.8%). A significant correlation was seen between postoperative CDVA loss and corneal haze (P = .001) and history of atopy (P < .01), but not with corneal HOA change. CONCLUSIONS Despite an improvement in UDVA and topographic values, the loss of CDVA, explained by postoperative haze, demonstrates that this procedure should be approached with caution, may not be as safe as initially thought, especially in patients with atopy and can cause severe visual acuity loss. [J Refract Surg. 2019;35(2):109-114.].
Collapse
|
18
|
Lohmann CP, Patmore A, O'Brart D, Reischl U, Winkler Mohrenfels C, Marshall J. Regression and wound Healing after Excimer Laser Prk: A Histopathological Study on Human Corneas. Eur J Ophthalmol 2018; 7:130-8. [PMID: 9243215 DOI: 10.1177/112067219700700202] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The results of excimer laser PRK are promising as more than 80% of eyes with up to -6.0 diopters of attempted correction have refractive results within 1.0 diopter of emmetropia. However, throughout the dioptric range some unexpected results have been observed with individual patients showing an aggressive wound healing response with excessive myopic regression and severe corneal haze. Unfortunately, only limited data are available about the cellular and extracellular responses in human corneas after PRK and this information is important to establish adequate postoperative pharmaceutical treatment. METHODS We made a histopathological and immunohistochemical study on 20 human corneal samples from patients with severe corneal haze and myopic regression. The indirect immunofluorescence method was used for demonstration of collagen types I, III, IV laminin, chondroitin sulphate, dermatan sulphate, and keratin. RESULTS All corneal specimens showed a hyperplastic epithelium. Histologically, most samples (16/20) showed mainly a loose lamination of extracellular material which could be identified as collagen type IV. The remaining four samples had newly synthesised collagen type III. CONCLUSIONS Our histopathological results indicate that corneal wound healing after excimer laser PRK varies among individuals. In some people epithelial basement proteins, such as collagen type IV, are the main wound healing products, whereas in others mainly collagen type III is found postoperatively, which does not effect the synthesis of collagen type IV. This suggests the need for individually-tailored postoperative pharmaceutical treatment regimens.
Collapse
Affiliation(s)
- C P Lohmann
- University Eye Clinic, University of Regensburg, Germany
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
Eleven patients with the dystrophic form of epidermolysis bullosa underwent ophthalmic assessment to establish the presence, characteristics, and extent of any ocular involvement. Eight patients were found to have eye changes: these included varying degrees of Symblepharon, broadening of the limbus, and corneal opacities. Taken as a group, these changes formed a characteristic pattern. The majority of patients were asymptomatic and the ocular changes appear to be only slowly progressive. Recurrent corneal abrasion and Symblepharon are the most important complications.
Collapse
Affiliation(s)
- P J McDonnell
- Department of Ophthalmology, St Thomas's Hospital, London
| | | |
Collapse
|
20
|
Anumanthan G, Sharma A, Waggoner M, Hamm CW, Gupta S, Hesemann NP, Mohan RR. Efficacy and Safety Comparison Between Suberoylanilide Hydroxamic Acid and Mitomycin C in Reducing the Risk of Corneal Haze After PRK Treatment In Vivo. J Refract Surg 2018; 33:834-839. [PMID: 29227512 DOI: 10.3928/1081597x-20170921-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 08/30/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE This study compared the efficacy and safety of suberoylanilide hydroxamic acid (SAHA) and mitomycin C (MMC) up to 4 months in the prevention of corneal haze induced by photorefractive keratectomy (PRK) in rabbits in vivo. METHODS Corneal haze in rabbits was produced with -9.00 diopter PRK. A single application of SAHA (25 μM) or MMC (0.02%) was applied topically immediately after PRK. Effects of the two drugs were analyzed by slit-lamp microscope, specular microscope, TUNEL assay, and immunofluorescence. RESULTS Single topical adjunct use of SAHA (25 μM) or MMC (0.02%) after PRK attenuated more than 95% corneal haze and myofibroblast formation (P < .001). SAHA did not reduce keratocyte density, cause keratocyte apoptosis, or increase immune cell infiltration compared to MMC (P < .01 or .001). Furthermore, SAHA dosing did not compromise corneal endothelial phenotype, density, or function in rabbit eyes, whereas MMC application did (P < .01 or .001). CONCLUSIONS SAHA and MMC significantly decreased corneal haze after PRK in rabbits in vivo. SAHA exhibited significantly reduced short- and long-term damage to the corneal endothelium compared to MMC in rabbits. SAHA is an effective and potentially safer alternative to MMC for the prevention of corneal haze after PRK. Clinical trials are warranted. [J Refract Surg. 2017;33(12):834-839.].
Collapse
|
21
|
Chiang HH, Wieland RS, Rogers TS, Gibson PC, Atweh G, McCormick G. Paraproteinemic keratopathy in monoclonal gammopathy of undetermined significance treated with primary keratoprosthesis: Case report, histopathologic findings, and world literature review. Medicine (Baltimore) 2017; 96:e8649. [PMID: 29390260 PMCID: PMC5815672 DOI: 10.1097/md.0000000000008649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE We report a case of paraproteinemic keratopathy associated with monoclonal gammopathy of undetermined significance, treated with keratoprosthesis as a primary penetrating procedure. Histopathological findings and a world literature review are presented. PATIENT CONCERNS A 74 year old female recently diagnosed with monoclonal gammopathy undetermined significance presented with progressive blurry vision bilaterally. DIAGNOSES Examination revealed corneal opacities consistent with paraproteinemic keratopathy. INTERVENTIONS Corneal transplantation with the Boston Type I keratoprosthesis was performed on the right and, a year later, on the left. OUTCOMES Visual outcomes were good. Histopathological staining of host corneal buttons were consistent with monoclonality, and electron microscopy revealed fibrillar extracellular aggregates within intervening normal stroma. LESSONS Corneal deposits may be the only manifestation of monoclonal gammopathy of undetermined significance in patients who are otherwise systemically asymptomatic. Ophthalmologists who encounter corneal opacities may order the appropriate diagnostic studies to determine the presence of occult systemic disease. Risk of graft failure after penetrating keratoplasty from recurring opacities is high, so keratoprosthesis as a primary penetrating procedure may afford superior long-term outcomes. Host corneal buttons retrieved from penetrating keratoplasty or corneal biopsy may be sent for histopathological examination to confirm the diagnosis.
Collapse
Affiliation(s)
| | - Rebekah S. Wieland
- University of Vermont College of Medicine
- Department of Pathology and Laboratory Medicine
| | | | | | - George Atweh
- Department of Hematology and Oncology, University of Vermont Medical Center
| | | |
Collapse
|
22
|
Feng X, Pi L, Sriram S, Schultz GS, Gibson DJ. Connective tissue growth factor is not necessary for haze formation in excimer laser wounded mouse corneas. PLoS One 2017; 12:e0172304. [PMID: 28207886 PMCID: PMC5313228 DOI: 10.1371/journal.pone.0172304] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/02/2017] [Indexed: 11/19/2022] Open
Abstract
We sought to determine if connective tissue growth factor (CTGF) is necessary for the formation of corneal haze after corneal injury. Mice with post-natal, tamoxifen-induced, knockout of CTGF were subjected to excimer laser phototherapeutic keratectomy (PTK) and the corneas were allowed to heal. The extent of scaring was observed in non-induced mice, heterozygotes, and full homozygous knockout mice and quantified by macrophotography. The eyes from these mice were collected after euthanization for re-genotyping to control for possible Cre-mosaicism. Primary corneal fibroblasts from CTGF knockout corneas were established in a gel plug assay. The plug was removed, simulating an injury, and the rate of hole closure and the capacity for these cells to form light reflecting cells in response to CTGF and platelet-derived growth factor B (PDGF-B) were tested and compared to wild-type cells. We found that independent of genotype, each group of mice was still capable of forming light reflecting haze in the cornea after laser ablation (p = 0.40). Results from the gel plug closure rate in primary cell cultures of knockout cells were not statistically different from serum starved wild-type cells, independent of treatment. Compared to the serum starved wild-type cells, stimulation with PDGF-BB significantly increased the KO cell culture’s light reflection (p = 0.03). Most interestingly, both reflective cultures were positive for α-SMA, but the cellular morphology and levels of α-SMA were distinct and not in proportion to the light reflection seen. This new work demonstrates that corneas without CTGF can still form sub-epithelial haze, and that the light reflecting phenotype can be reproduced in culture. These data support the possibilities of growth factor redundancy and that multiple pro-haze pathways exist.
Collapse
Affiliation(s)
- Xiaodi Feng
- Institute of Wound Research, University of Florida, Gainesville, Florida, United States of America
| | - Liya Pi
- Department of Pediatrics, University of Florida, Gainesville, Florida, United States of America
| | - Sriniwas Sriram
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Gregory S. Schultz
- Institute of Wound Research, University of Florida, Gainesville, Florida, United States of America
| | - Daniel J. Gibson
- Institute of Wound Research, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| |
Collapse
|
23
|
Wasielica-Poslednik J, Politino G, Schmidtmann I, Lorenz K, Bell K, Pfeiffer N, Pitz S. Influence of Corneal Opacity on Intraocular Pressure Assessment in Patients with Lysosomal Storage Diseases. PLoS One 2017; 12:e0168698. [PMID: 28081172 PMCID: PMC5230782 DOI: 10.1371/journal.pone.0168698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/03/2016] [Indexed: 11/18/2022] Open
Abstract
AIMS To investigate an influence of mucopolysaccharidosis (MPS)- and Morbus Fabry-associated corneal opacities on intraocular pressure (IOP) measurements and to evaluate the concordance of the different tonometry methods. METHODS 25 MPS patients with or without corneal clouding, 25 Fabry patients with cornea verticillata ≥ grade 2 and 25 healthy age matched controls were prospectively included into this study. Outcome measures: Goldmann applanation tonometry (GAT); palpatory assessment of IOP; Goldmann-correlated intraocular pressure (IOPg), corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF) and corneal hysteresis (CH) assessed by Ocular Response Analyzer (ORA); central corneal thickness (CCT) and density assessed with Pentacam. Statistical analysis was performed using linear mixed effect models and Spearman correlation coefficients. The concordance between tonometry methods was assessed using Bland-Altman analysis. RESULTS There was no relevant difference between study groups regarding median GAT, IOPg, IOPcc and CCT measurements. The limits of agreement between GAT and IOPcc/IOPg/palpatory IOP in MPS were: [-11.7 to 12.1mmHg], [-8.6 to 15.5 mmHg] and [- 5.4 to 10.1 mmHg] respectively. Limits of agreement were less wide in healthy subjects and Fabry patients. Palpatory IOP was higher in MPS than in healthy controls and Fabry patients. Corneal opacity correlated more strongly with GAT, IOPg, CH, CRF, CCT and corneal density in MPS (r = 0.4, 0.5, 0.5, 0.7, 0.6, 0.6 respectively) than in Fabry patients (r = 0.3, 0.2, -0.03, 0.1, 0.3, -0.2 respectively). In contrast, IOPcc revealed less correlation with corneal opacity than GAT in MPS (r = 0.2 vs. 0.4). CONCLUSIONS ORA and GAT render less comparable IOP-values in patients suffering from MPS-associated corneal opacity in comparison to Fabry and healthy controls. The IOP seems to be overestimated in opaque MPS-affected corneas. GAT, IOPg and biomechanical parameters of the cornea correlate more strongly with the corneal clouding than IOPcc in MPS patients. TRIAL REGISTRATION ClinicalTrials.gov NCT01695161.
Collapse
Affiliation(s)
- Joanna Wasielica-Poslednik
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Germany
- * E-mail: ,
| | - Giuseppe Politino
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Germany
| | - Katrin Lorenz
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Germany
| | - Katharina Bell
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Germany
| | - Susanne Pitz
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Germany
| |
Collapse
|
24
|
Young S, Murphy R, Iyer S. A rare case of a direct ocular contact burn to the right eye. Ann R Coll Surg Engl 2017; 99:e31-e33. [PMID: 27659381 PMCID: PMC5392806 DOI: 10.1308/rcsann.2016.0285] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/22/2022] Open
Abstract
Ocular thermal burns represent an oculoplastic emergency, with the potential for blindness owing to limbal ischaemia. We present a rare case of a 66-year-old man who sustained a direct thermal contact burn to the right eye.
Collapse
Affiliation(s)
- S Young
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - R Murphy
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - S Iyer
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| |
Collapse
|
25
|
Abstract
PURPOSE To characterize the location and regularity of the opaque bubble layer (OBL) in the corneal stroma after femtosecond laser-assisted LASIK (FS-LASIK) flap generation. METHODS In this prospective study, 30 eyes of 15 patients who had FS-LASIK surgery for myopia, astigmatism, and/or hyperopia were included. Screen captures were obtained at the end of the flap creation and the eyes with hard type OBL were immediately imaged with anterior segment optical coherence tomography. RESULTS The mean age of the 9 men and 6 women was 40 ± 11.3 years (range: 22 to 60 years). Seven eyes (23.3%) developed hard type OBL that was typically localized in the central cornea beneath the LASIK flap and, in the majority of cases, located close to the hinge of the flap. Three of the seven eyes had OBL only within the laser cut, whereas the four other eyes had OBL in a spotty distribution within the stromal bed beneath the flap. None of the eyes had an accumulation of OBL within the flap itself. CONCLUSIONS The excimer laser ablation of a stroma with OBL may be different from that of a stroma without OBL. Management of OBL when it occurs due to flap production, including allowing the bubble to dissipate when they overlie the pupil, is important to obtain the best outcomes with femtosecond laser-assisted LASIK. [J Refract Surg. 2017;33(1):18-22.].
Collapse
|
26
|
Liu X, Zhou Q, Huang X, Liu Z, Bi Y. Clinical evaluation of deep anterior lamellar keratoplasty using glycerol-cryopreserved corneal tissues for refractory herpetic stromal keratitis: An observational study. Medicine (Baltimore) 2016; 95:e4892. [PMID: 27684823 PMCID: PMC5265916 DOI: 10.1097/md.0000000000004892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The study aimed to evaluate the therapeutic effects of deep anterior lamellar keratoplasty (DALK) using glycerol-cryopreserved corneal tissues (GCCTs) in patients with refractive herpes simplex keratitis (HSK). This article was a retrospective, noncomparative, and interventional case series. Patients with HSK underwent DALK using GCCTs at Shanghai Tongji Hospital from 2012 to 2015. The best spectacle corrected visual acuity, recurrent inflammation, graft status, postoperative central graft thickness, and pre/postoperative complications were detected. The follow-up ranged from 24.4 ± 5.6 months (range: 16-38 months). Overall, the best spectacle corrected visual acuity was increased from HM/10 cm to 0.15 before surgery to 0.41 ± 0.14 (range: 0.1-0.8; P < 0.05) at 12 months postoperatively. Intraoperative microperforation occurred in 4 eyes (14.81%), and rejection episodes were encountered in 3 of 27 eyes (11.1%), and all of the eyes reversed. HSK recurred in 2 eyes (7.41%), 1 eye with repeated recurring HSK, and eventually led to perpetual corneal opacity and the patient refused a retransplantation. The mean entire corneal thickness was 0.519 ± 0.018 mm (range: 0.5-0.56 mm) and the mean graft thickness was 0.405 ± 0.033 mm (range: 0.35-0.47 mm) in the final follow-up. The DALK using GCCTs was proven to be an effective and safe therapy in treating refractory HSK.
Collapse
Affiliation(s)
- Xin Liu
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai
- Department of Ophthalmology, Guizhou provincial people's hospital, Guiyang, Guizhou, People's Republic of China
| | - Qi Zhou
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai
| | - Xinyu Huang
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai
| | - Zhenxing Liu
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai
- Correspondence: Yanlong Bi, No.389, Xincun Road, Putuo District, Shanghai 200065, People's Republic of China (e-mail: )
| |
Collapse
|
27
|
Fernández-Vega González Á, Barraquer Compte RI, Cárcamo Martínez AL, Torrico Delgadillo M, de la Paz MF. Neurotrophic keratitis after transscleral diode laser cyclophotocoagulation. Arch Soc Esp Oftalmol 2016; 91:320-326. [PMID: 26810961 DOI: 10.1016/j.oftal.2015.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/29/2015] [Accepted: 12/01/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation. METHODS A study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery. RESULTS It was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880 mW for 3s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery. CONCLUSION Neurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder.
Collapse
Affiliation(s)
- Á Fernández-Vega González
- Centro de Oftalmología Barraquer, Barcelona, España; Institut Universitari Barraquer, Universidad Autónoma de Barcelona, Barcelona, España.
| | - R I Barraquer Compte
- Centro de Oftalmología Barraquer, Barcelona, España; Institut Universitari Barraquer, Universidad Autónoma de Barcelona, Barcelona, España
| | - A L Cárcamo Martínez
- Institut Universitari Barraquer, Universidad Autónoma de Barcelona, Barcelona, España
| | - M Torrico Delgadillo
- Institut Universitari Barraquer, Universidad Autónoma de Barcelona, Barcelona, España
| | - M F de la Paz
- Centro de Oftalmología Barraquer, Barcelona, España; Institut Universitari Barraquer, Universidad Autónoma de Barcelona, Barcelona, España
| |
Collapse
|
28
|
Abstract
PURPOSE To determine the characteristics and risk factors for occurrence of opaque bubble layer (OBL) during femtosecond laser-assisted flap creation for LASIK. METHODS One hundred ninety-eight eyes of 102 consecutive patients who underwent LASIK flap creation performed with the Alcon WaveLight FS200 laser (Alcon Laboratories, Inc., Fort Worth, TX) were retrospectively analyzed in a cohort study. Preoperative manifest refraction, corneal keratometry, central corneal thickness, white-to-white corneal diameter, corneal hysteresis, corneal resistance factor, and programmed flaps parameters were collected. Digital images automatically recorded after flap creation were analyzed to measure OBL areas. Correlation tests were performed between preoperative corneal parameters and OBL areas. RESULTS The incidence rate of OBL was 48% (103 eyes). The mean OBL area as a percentage of the corneal flap area in the OBL group was 4.25% ± 7.16% (range: 0% to 32.9%). The central corneal thickness, corneal resistance factor, and corneal hysteresis were significantly positively correlated with the OBL area (r = 0.242, P = .001; r = 0.254, P = .028; and r = 0.351, P < .0001, respectively). Corneal hysteresis and OBL area were positively correlated, independently of the central corneal thickness and other confounder factors with standardized coefficient (r = 0.353 ± 0.227, P = .002). CONCLUSIONS This study confirms the already known OBL risk factors with a larger cohort and suggests for the first time that an elevated corneal hysteresis is an independent predictive risk for OBL occurrence.
Collapse
|
29
|
Kymionis GD, Liakopoulos DA, Grentzelos MA, Skatharoudi CA, Panagopoulou SI. Uneventful Femtosecond Laser-assisted Flap Creation in a Patient With Postoperative PRK Corneal Haze. J Refract Surg 2016; 31:638-9. [PMID: 26352571 DOI: 10.3928/1081597x-20150821-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
Abstract
IkB kinase β (IKKβ) is a key signaling kinase for inflammatory responses, but it also plays diverse cell type-specific roles that are not yet fully understood. Here we investigated the role of IKKβ in the cornea using IkkβΔCS mice in which the Ikkβ gene was specifically deleted in the corneal stromal keratocytes. The IkkβΔCS corneas had normal morphology, transparency and thickness; however, they did not heal well from mild alkali burn injury. In contrast to the IkkβF/F corneas that restored transparency in 2 weeks after injury, over 50% of the IkkβΔCS corneas failed to fully recover. They instead developed recurrent haze with increased stromal thickness, severe inflammation and apoptosis. This pathogenesis correlated with sustained myofibroblast transformation with increased α smooth muscle actin (α-SMA) expression, higher levels of senescence β-Gal activity and scar tissue formation at the late stage of wound healing. In addition, the IkkβΔCS corneas displayed elevated expression of hemo-oxygenase-1 (HO-1), a marker of oxidative stress, and activation of stress signaling pathways with increased JNK, c-Jun and SMAD2/3 phosphorylation. These data suggest that IKKβ in keratocytes is required to repress oxidative stress and attenuate fibrogenesis and senescence in corneal wound healing.
Collapse
Affiliation(s)
- Liang Chen
- Department of Environmental Health and Center of Environmental Genetics, University of Cincinnati Medical Center, Cincinnati, Ohio, 45267–0056, United States of America
| | - Maureen Mongan
- Department of Environmental Health and Center of Environmental Genetics, University of Cincinnati Medical Center, Cincinnati, Ohio, 45267–0056, United States of America
| | - Qinghang Meng
- Department of Environmental Health and Center of Environmental Genetics, University of Cincinnati Medical Center, Cincinnati, Ohio, 45267–0056, United States of America
| | - Qin Wang
- Department of Environmental Health and Center of Environmental Genetics, University of Cincinnati Medical Center, Cincinnati, Ohio, 45267–0056, United States of America
| | - Winston Kao
- Department of Ophthalmology, University of Cincinnati Medical Center, Cincinnati, Ohio, 45267–0056, United States of America
| | - Ying Xia
- Department of Environmental Health and Center of Environmental Genetics, University of Cincinnati Medical Center, Cincinnati, Ohio, 45267–0056, United States of America
- * E-mail:
| |
Collapse
|
31
|
Yolcu Ü, Ilhan A. Emergency Physicians May See Corneal Clouding Complicating a Corneal Transplant. J Emerg Med 2015; 49:709-10. [PMID: 26279510 DOI: 10.1016/j.jemermed.2014.12.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Ümit Yolcu
- Ophthalmology Department, Sarikamış Military Hospital, Kars, Turkey
| | - Abdullah Ilhan
- Ophthalmology Department, Erzurum Military Hospital, Erzurum, Turkey
| |
Collapse
|
32
|
Tomás-Juan J, Murueta-Goyena Larrañaga A, Hanneken L. Corneal Regeneration After Photorefractive Keratectomy: A Review. J Optom 2015; 8:149-69. [PMID: 25444646 PMCID: PMC4502084 DOI: 10.1016/j.optom.2014.09.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/01/2014] [Indexed: 05/20/2023]
Abstract
Photorefractive keratectomy (PRK) remodels corneal stroma to compensate refractive errors. The removal of epithelium and the ablation of stroma provoke the disruption of corneal nerves and a release of several peptides from tears, epithelium, stroma and nerves. A myriad of cytokines, growth factors, and matrix metalloproteases participate in the process of corneal wound healing. Their balance will determine if reepithelization and stromal remodeling are appropriate. The final aim is to achieve corneal transparency for restoring corneal function, and a proper visual quality. Therefore, wound-healing response is critical for a successful refractive surgery. Our goal is to provide an overview into how corneal wounding develops following PRK. We will also review the influence of intraoperative application of mitomycin C, bandage contact lenses, anti-inflammatory and other drugs in preventing corneal haze and post-PRK pain.
Collapse
Affiliation(s)
- Javier Tomás-Juan
- Department of Visual Science, VallmedicVision International Eye Clinic, Andorra.
| | | | - Ludger Hanneken
- Department of Visual Science, VallmedicVision International Eye Clinic, Andorra
| |
Collapse
|
33
|
Li S, Ning J, Liu C, Guo Z, Lyn F, Chen T. [Clinical results of femtosecond laser assisted lamellar keratoplasty]. Zhonghua Yan Ke Za Zhi 2015; 51:445-449. [PMID: 26310119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To report the clinical results of femtosecond laser assisted lamellar keratoplasty (FS-LK). METHODS Retrospective study. Twenty eyes of 17 patients who were treated with FS-LK were enrolled in this study. The preoperative visions were from 0.02 to 0.4. During the operation, the grafts were prepared with a depth of 400-600 µm according to the character of the affections. RESULTS During the follow-up period, the visions of 18 eyes (90%) were better than preoperative ones. One of them was equal to 0.8. The best corrected visual acuities of 18 eyes (90%) were better than or equal to 0.5, one of which was 1.0. The astigmatisms of 15 eyes were under 3.00 diopters at one year after operation. During the operation of two cases, the paracentral cut occurred. Two patients experienced corneal opacity, and two cases had high astigmatisms after operation. Only one eye experienced immune rejection at one year after operation. CONCLUSIONS The FS-LK appears to be a good alternative surgical method for patients with corneal diseases because of the great manipuility and excellent postoperative results, but more research is needed.
Collapse
Affiliation(s)
- Shaowei Li
- Shenyang Aier Eye Hospital, Shenyang 110003, China;
| | - Jianhua Ning
- Shenyang Aier Eye Hospital, Shenyang 110003, China
| | - Chang Liu
- Shenyang Aier Eye Hospital, Shenyang 110003, China
| | - Zuofeng Guo
- Shenyang Aier Eye Hospital, Shenyang 110003, China
| | - Fangqi Lyn
- Shenyang Aier Eye Hospital, Shenyang 110003, China
| | - Tiehong Chen
- Shenyang Aier Eye Hospital, Shenyang 110003, China
| |
Collapse
|
34
|
Fiorentzis M, Viestenz A, El-Husseiny M, Szentmáry N, Seitz B. [Subjective asymptomatic corneal opacity after Descemet membrane endothelial keratoplasty]. Ophthalmologe 2015; 112:276-8. [PMID: 25566733 DOI: 10.1007/s00347-014-3174-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Fiorentzis
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66424, Homburg/Saar, Deutschland,
| | | | | | | | | |
Collapse
|
35
|
Martín-Escuer B, Cordero-Coma M, Pérez-Díez E, Garzo-García I, Valverde-Romero E. [Bilateral herpetic keratouveitis in an immunocompetent patient]. Arch Soc Esp Oftalmol 2015; 90:30-32. [PMID: 25443215 DOI: 10.1016/j.oftal.2014.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/04/2014] [Accepted: 01/27/2014] [Indexed: 06/04/2023]
Abstract
CASE REPORT We report the case of an immunocompetent male who presented with a limbal-adjacent scleritis and interstitial keratitis in the left eye. A few days later a new dendritiform ulcer in his right eye and bilateral progressive worsening with granulomatous uveitis in both eyes were observed. A thorough review of systems revealed positive serum IgM titles for herpes simplex virus. DISCUSSION In the context of a bilateral keratouveitis refractory to conventional treatment it is mandatory to rule out the herpetic origin based on the different forms of clinical presentation of this virus.
Collapse
Affiliation(s)
- B Martín-Escuer
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España.
| | - M Cordero-Coma
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España
| | - E Pérez-Díez
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España
| | - I Garzo-García
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España
| | - E Valverde-Romero
- Servicio de Microbiología, Complejo Asistencial Universitario de León, León, España
| |
Collapse
|
36
|
Weissman HM, Randleman JB. Therapeutic flap amputation for atypical LASIK flap and interface abnormalities. J Refract Surg 2014; 31:61-7. [PMID: 25420001 DOI: 10.3928/1081597x-20141120-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/07/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe LASIK flap amputation as a therapeutic option for patients with atypical refractory flap complications. METHODS Case series and literature review. RESULTS Seven eyes of 6 patients underwent flap amputation for various atypical indications, including non-infectious flap/interface opacity (3 patients), irregular astigmatism on the flap surface (3 patients), and chronic pain (concurrent in 2 patients with irregular astigmatism). In each case, conservative measures were ineffective. All patients had symptomatic improvement and improved corrected visual function after amputation; however, uncorrected distance visual acuity worsened in 2 patients, manifest refraction worsened in 3 patients, and irregular astigmatism increased in 2 patients. CONCLUSIONS Flap amputation is a reasonable alternative to improve corrected acuity in select cases with significant flap opacities or irregular astigmatism unresponsive to conservative measures, but uncorrected acuity and irregular astigmatism may worsen and should be discussed during the informed consent process.
Collapse
|
37
|
Abstract
The objective of this study was to determine the effect of vitamin C supplementation on reducing the size of corneal opacity resulting from infectious keratitis.The study included 82 patients (82 affected eyes), admitted for infectious keratitis from January 2009 to August 2013, who were followed for more than 3 months. Patients were divided into control, oral vitamin C (3 g/d), and intravenous vitamin C (20 g/d) groups during hospitalization. Corneal opacity sizes were measured using anterior segment photographs and Image J program (version 1.27; National Institutes of Health, Jinju, South Korea) at admission, discharge, and final follow-up. The corneal opacity size used for analysis was the measured opacity size divided by the size of the whole cornea.The corneal opacity size decreased by 0.03 ± 0.10 in the oral vitamin C group, 0.07 ± 0.22 in the intravenous vitamin C group, and 0.02 ± 0.15 in the control group. Intravenous vitamin C reduced the corneal opacity size more than oral vitamin C (P = 0.043). Intravenous vitamin C produced greater reduction in corneal opacity size in younger patients (P = 0.015) and those with a hypopyon (P = 0.036).Systemic vitamin C supplementation reduced the size of corneal opacity resulting from infectious keratitis. Intravenous vitamin C was more beneficial than oral supplementation, especially in younger patients and those with hypopyon.
Collapse
Affiliation(s)
- Yong-Wun Cho
- Department of Ophthalmology (Y-WC, W-SY, S-JK, I-YC, S-WS, J-MY), College of Medicine; and Gyeongsang Institute of Health Science (S-JK, I-YC, S-WS, J-MY), Gyeongsang National University, Jinju, South Korea
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE To describe the outcome of deep anterior lamellar keratoplasty (DALK) for visually significant corneal clouding in patients with mucopolysaccharidoses (MPS). METHODS A retrospective consecutive case series of patients with MPS and corneal clouding were analyzed at a tertiary eye hospital. A review of the English literature regarding MPS and DALK was performed. The main outcomes measures of the study were intraoperative surgical complications, change in visual acuity, and postoperative DALK-related complications. RESULTS Four eyes from 2 patients with MPS I (Hurler's syndrome and Hurler-Scheie syndrome) and a history of DALK met inclusion criteria for the case series. Using the "big-bubble" technique, DALK was performed successfully in all eyes. Completed Descemet's membrane baring was achieved in 3 or 4 eyes and a pre-Descemet's membrane dissection in 1 eye. The mean age at the time of DALK was 17.3 years (range: 15.4 to 19.5 years). Mean follow-up time after DALK was 16.7 months (range: 6 to 31 months). Mean visual acuity before DALK was 20/80 (0.59 ± 0.12 logMAR). Mean visual acuity at the last visit for all 4 eyes was 20/50 (0.41 ± 0.17 logMAR). Visual acuity improved in all eyes. Recurrence of MPS corneal clouding was not noted in any of the corneal grafts. CONCLUSIONS DALK is a beneficial and preferable intervention in appropriate patients with significant corneal clouding due to MPS I. Improvement in vision can be obtained with stable, clear corneal grafts, although other ophthalmic manifestations may limit vision.
Collapse
|
39
|
Majo F, Nicolas M. [Darwin or Lamarck? Understanding the ocular surface and its normal or abnormal differentiation in order to cure ocular surface destruction with corneal opacification]. Biol Aujourdhui 2013; 207:97-108. [PMID: 24103340 DOI: 10.1051/jbio/2013012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Indexed: 06/02/2023]
Abstract
According to the World Health Organization, 5.1% of blindnesses or visual impairments are related to corneal opacification. Cornea is a transparent tissue placed in front of the color of the eye. Its transparency is mandatory for vision. The ocular surface is a functional unit including the cornea and all the elements involved in maintaining its transparency i.e., the eyelids, the conjunctiva, the lymphoid tissue of the conjunctiva, the limbus, the lacrymal glands and the tear film. The destruction of the ocular surface is a disease caused by : traumatisms, infections, chronic inflammations, cancers, toxics, unknown causes or congenital abnormalities. The treatment of the ocular surface destruction requires a global strategy including all the elements that are involved in its physiology. The microenvironnement of the ocular surface must first be restored, i.e., the lids, the conjunctiva, the limbus and the structures that secrete the different layers of the tear film. In a second step, the transparency of the cornea can be reconstructed. A corneal graft performed in a healthy ocular surface microenvironnement will have a better survival rate. To achieve these goals, a thorough understanding of the renewal of the epitheliums and the role of the epithelial stem cells are mandatory.
Collapse
|
40
|
Li XN, Zheng JL, Hu ZG, Wang BJ. [Relationship between corneal thickness and postmortem interval in rabbit]. Fa Yi Xue Za Zhi 2013; 29:241-243. [PMID: 24350535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the relationship between corneal thickness and postmortem interval (PMI) in rabbit. METHODS The rabbit model was established by air embolism. The rabbit cornea was sampled at 6-hour-interval from 0 to 72 h postmortem. After routine HE staining, the whole cornea image was collected by the optical microscope. Three markers were observed including corneal epithelial thickness (x1), corneal stromal thickness (x2) and whole corneal thickness (x3) using Motic Images Plus 2.0 image analysis software and the data were statistically analyzed to establish the regression function with PMI (y). RESULTS Within 72 h postmortem, rabbit corneal stromal thickness and whole corneal thickness increased at 12h postmortem and reached the peak at 54h postmortem. The two markers showed positive correlation with PMI. The regression functions of the two markers were y = -0.070 2 x2(2) +11.398 x2 + 1634 (R2 = 0.712 2, P < 0.05) and y = -0.074 9 x3(2) +12.036 x3 + 1819.4 (R = 0.675 0, P < 0.05), respectively. CONCLUSION The two markers of corneal stromal thickness and the whole corneal thickness showed the strong linear correlation with PMI. The correlation of the corneal stromal thickness is better than the whole corneal thickness. The two markers can be used to estimate PMI.
Collapse
Affiliation(s)
- Xiao-Na Li
- College of Basic Medical Science, China Medical University, Shenyang 110001, China.
| | - Ji-Long Zheng
- Department of Forensic Medicine, China Criminal Police College, Shenyang 110854, China
| | - Zhong-Guo Hu
- Superior People's Count of Jilin Province, Changchun 130033, China
| | - Bao-Jie Wang
- College of Forensic Medicine, China Medical University, Shenyang 110001, China
| |
Collapse
|
41
|
Chatterjee S, Wang Y, Duncan MK, Naik UP. Junctional adhesion molecule-A regulates vascular endothelial growth factor receptor-2 signaling-dependent mouse corneal wound healing. PLoS One 2013; 8:e63674. [PMID: 23667656 PMCID: PMC3648504 DOI: 10.1371/journal.pone.0063674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/07/2013] [Indexed: 12/04/2022] Open
Abstract
Inflammation and angiogenesis are integral parts of wound healing. However, excessive and persistent wound-induced inflammation and angiogenesis in an avascular tissue such as the cornea may be associated with scarring and visual impairment. Junctional adhesion molecule A (Jam-A) is a tight junction protein that regulates leukocyte transmigration as well as fibroblast growth factor-2 (FGF-2)-induced angiogenesis. However its function in wound-induced inflammation and angiogenesis is still unknown. In this study, we report spontaneous corneal opacity in Jam-A deficient mice associated with inflammation, angiogenesis and the presence of myofibroblasts. Since wounds and/or corneal infections cause corneal opacities, we tested the role of Jam-A in wound-induced inflammation, angiogenesis and scarring by subjecting Jam-A deficient mice to full thickness corneal wounding. Analysis of these wounds demonstrated increased inflammation, angiogenesis, and increased number of myofibroblasts thereby indicating that Jam-A regulates the wound-healing response by controlling wound-induced inflammation, angiogenesis and scarring in the cornea. These effects were not due to inflammation alone since the inflammation-induced wound-healing response in Jam-A deficient mice was similar to wild type mice. In order to determine the molecular mechanism associated with the observed aberrant corneal wound healing in Jam-A deficient mice, we assessed the expression of the components of vascular endothelial growth factor A (VEGF-A)/vascular endothelial growth factor receptor- 2(VEGFR-2) signaling pathway. Interestingly, we observed increased levels of VEGF-A mRNA in Jam-A deficient eyes. We also observed nuclear localization of phosphorylated SMAD3 (pSMAD3) indicative of TGFβ pathway activation in the Jam-A deficient eyes. Furthermore the increased wound-induced corneal inflammation, angiogenesis, and scarring in Jam-A deficient mice was attenuated by treatment with DC101, an anti-vascular endothelial growth factor receptor-2 (VEGFR-2) antibody. Our results suggest that in the absence of Jam-A, the VEGF-A/VEGFR-2 pathway is upregulated, thereby augmenting wound induced corneal inflammation, angiogenesis, and myofibroblast accumulation leading to scarring.
Collapse
Affiliation(s)
- Sharmila Chatterjee
- Department of Biological Sciences, University of Delaware, Newark, Delaware, United States of America
| | | | | | | |
Collapse
|
42
|
Ukponmwan CU. Ocular features and management challenges of Marfan's Syndrome in Benin City, Nigeria. Niger Postgrad Med J 2013; 20:24-28. [PMID: 23661206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS AND OBJECTIVES The objective of this study is to describe the ocular features of Marfan's Syndrome in Benin City, Nigeria and highlight problems associated with their management MATERIALS AND METHODS A study of all consecutive patients with a diagnosis of Marfan's syndrome at the eye clinic of the University of Benin Teaching Hospital, Benin City, Nigeria was done between June 1st 2009 and December 31st 2010. RESULTS There were 13 patients (8 males and 5 females). The age range was 10 to 50 years with a mean age of 23+10.1 years. The duration of symptoms was 1 year to 22 years with a mean of 7.9 years. The ocular features were ectopia lentis in 92.3% of the patients, cataract in 69.2%, glaucoma and myopia in 30.8% each. Others were strabismus (7.7%), unilateral corneal opacities from the use of traditional eye medication (15.4%), phthisis bulbi and retinal detachment in 7.7% each. Three (23%) patients were bilaterally blind while 7(53.8%) had unilateral blindness. The best corrected visual acuity in 4 out of 5 patients who had cataract extraction at 8 weeks post op. was 6/60 to 6/12. There was no improvement in 1 patient. CONCLUSION Patients with Marfan's syndrome in Benin City, Nigeria have visual impairment and blindness due to delay in presentation and the use of traditional eye medications. Health education and early presentation to hospital is recommended. This will help in reducing avoidable visual impairment and blindness and thus improve survival and quality of life in these patients.
Collapse
Affiliation(s)
- Catherine U Ukponmwan
- Dept of Ophthalmology, University of Benin Teaching Hospital, School of Medicine, University of Benin
| |
Collapse
|
43
|
Abstract
PURPOSE To investigate the efficacy of umbilical cord serum eyedrops after laser epithelial keratomileusis (LASEK). METHODS Sixty patients (120 eyes) with myopia who underwent LASEK were studied. Thirty-two patients (64 eyes) were treated with 20% umbilical cord serum eyedrops in combination with conventional treatment (group A), and 28 patients (56 eyes) received conventional treatment only (group B). Epithelial healing time was analysed. Visual acuity, refraction, haze score (0-4) and tear film and ocular surface parameters were evaluated at 1, 2, 4 and 12 weeks after LASEK. The concentration of transforming growth factor (TGF)-β1 in tears was measured with ELISA at 1 week after LASEK. RESULTS No significant differences in visual acuity and refraction were found between groups. The mean time to epithelial healing was 3.53 ± 1.19 days in group A and 3.91 ± 1.41 days in group B (p = 0.18). The mean haze scores at 2 and 4 weeks were 0.59 ± 0.80 and 0.31 ± 0.54 in group A and 1.06 ± 0.91 (p = 0.02) and 0.69 ± 0.78 (p = 0.03) in group B. Four and 12 weeks after LASEK, tear film break-up time was longer and keratoepitheliopathy score was lower in group A compared with group B. The mean concentration of TGF-β1 was lower in group A compared with group B (p = 0.01). CONCLUSION Application of 20% umbilical cord serum eyedrops in addition to conventional treatment after LASEK can reduce early postoperative corneal haze and improve tear film and ocular surface parameters.
Collapse
Affiliation(s)
- Kyung-Chul Yoon
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Korea.
| | | | | | | |
Collapse
|
44
|
Beltrán-Becerra KJ, Ríos-González BE, Gutiérrez-Amavizca BE, Silva-Noriega DA, Figuera LE. [Ophthalmic manifestations in Mexican patients with Fabry disease]. Arch Soc Esp Oftalmol 2012; 87:373-375. [PMID: 23058197 DOI: 10.1016/j.oftal.2011.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/14/2011] [Indexed: 06/01/2023]
Abstract
UNLABELLED Fabry disease (FD) is a rare X-linked genetic lysosomal storage disease caused by a deficiency of the enzyme α-galactosidase A, that produces accumulation of globotriaosylceramide. There is a multisystemic involvement, including renal, cardiac, eye, and nervous system manifestations. AIM To perform a descriptive analysis of the ophthalmological manifestations in Mexican patients with FD. MATERIAL AND METHODS We studied 13 patients with clinical and biochemical diagnostic of FD. RESULTS Cornea verticillata was found in 57% of men and 33% carriers. CONCLUSION Cornea verticillata was the most common ocular manifestation in males and carriers of FD in Mexico.
Collapse
Affiliation(s)
- K J Beltrán-Becerra
- Servicio de Oftalmología, Unidad Médica de Alta Especialidad, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | | | | | | | | |
Collapse
|
45
|
Stevenson W, Cheng SF, Emami-Naeini P, Hua J, Paschalis EI, Dana R, Saban DR. Gamma-irradiation reduces the allogenicity of donor corneas. Invest Ophthalmol Vis Sci 2012; 53:7151-8. [PMID: 22991417 PMCID: PMC3474589 DOI: 10.1167/iovs.12-9609] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/26/2012] [Accepted: 08/30/2012] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate the utility and allogenicity of gamma-irradiated corneal allografts. METHODS Corneal buttons were harvested from C57BL/6 mice and decellularized with gamma irradiation. Cell viability was assessed using TUNEL and viability/cytotoxicity assays. Orthotopic penetrating keratoplasty was performed using irradiated or nonirradiated (freshly excised) C57BL/6 donor grafts and BALB/c or C57BL/6 recipients. Graft opacity was assessed over an 8-week period and graft survival was evaluated using Kaplan-Meier survival curves. Mixed-lymphocyte reactions and delayed-type hypersensitivity assays were performed to evaluate T-cell alloreactivity. Real-time PCR was used to investigate the corneal expression of potentially pathogenic T-helper 1, 2, and 17 cell-associated cytokines. RESULTS Corneal cells were devitalized by gamma irradiation as evidenced by widespread cellular apoptosis and plasma membrane disruption. Nonirradiated allograft and isograft rates of survival were superior to irradiated allograft and isograft rates of survival (P < 0.001). Mixed lymphocyte reactions demonstrated that T-cells from irradiated allograft recipients did not exhibit a secondary alloimmune response (P < 0.001). Delayed-type hypersensitivity assays demonstrated that irradiated allografts did not elicit an alloreactive delayed-type hypersensitivity response in graft recipients (P ≤ 0.01). The corneal expression of T-helper 1, 2, and 17 cell-associated cytokines was significantly lower in failed irradiated allografts than rejected nonirradiated allografts (P ≤ 0.001). CONCLUSIONS Gamma-irradiated corneas failed to remain optically clear following murine penetrating keratoplasty; however, gamma irradiation reduced the allogenicity of these corneas, potentially supporting their use in procedures such as anterior lamellar keratoplasty or keratoprosthesis implantation.
Collapse
|
46
|
Affiliation(s)
- Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | | |
Collapse
|
47
|
Pescosolido N, Komaiha C, Dapoto L, Lenarduzzi F, Nebbioso M. Corneal haze in course of Fuchs' endothelial dystrophy. Clin Ter 2012; 163:e169-e171. [PMID: 23007820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article describes the observations obtained with confocal microscopy (CM) on the corneal structure in course of corneal edema in a patient with Fuchs endothelial corneal dystrophy (FD). The patient was a 40 year old male, suffering from second stage FD, in course of corneal edema and bullous keratopathy. The tissue structure was analyzed with CM confoscan CS4 (Nidek Technologies(®), Birmingham, UK) using the 40x mode. The CM has shown the presence of gaps due to corneal edema and a diffuse stromal hyper reflectivity related to the alteration of the extracellular matrix. It has also showed the presence of binucleate cells, assimilable to keratocytes, in cytokinesis which presented a typical fusiform aspect with two highly reflective nuclei awaiting cell division. The total number of cells was much lower than that of healthy control subjects of similar age, sex and race. The CM in this case suggests a significantly lower number of cells, presumably keratocytes, compared to normal range, but mostly it shows the presence of cells undergoing cytokinesis, which witnesses the active processes of collagenogenesis and possible vasculogenesis that represent early stages of loss of the normal corneal transparency.
Collapse
Affiliation(s)
- N Pescosolido
- Department of Geriatric Sciences, Sapienza University of Rome, Italy
| | | | | | | | | |
Collapse
|
48
|
Lisch W, Bron AJ, Munier FL, Schorderet DF, Tiab L, Lange C, Saikia P, Reinhard T, Weiss JS, Gundlach E, Pleyer U, Lisch C, Auw-Haedrich C. Franceschetti hereditary recurrent corneal erosion. Am J Ophthalmol 2012; 153:1073-81.e4. [PMID: 22402249 DOI: 10.1016/j.ajo.2011.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 09/26/2011] [Revised: 12/17/2011] [Accepted: 12/19/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe new affected individuals of Franceschetti's original pedigree of hereditary recurrent erosion and to classify a unique entity called Franceschetti corneal dystrophy. DESIGN Observational case series. METHODS Slit-lamp examination of 10 affected individuals was conducted. Biomicroscopic examinations were supplemented by peripheral corneal biopsy in 1 affected patient with corneal haze. Tissue was processed for light and electron microscopy and immunohistochemistry was performed. DNA analysis was carried out in 12 affected and 3 nonaffected family members. RESULTS All affected individuals suffered from severe ocular pain in the first decade of life, attributable to recurrent corneal erosions. Six adult patients developed bilateral diffuse subepithelial opacifications in the central and paracentral cornea. The remaining 4 affected individuals had clear corneas in the pain-free stage of the disorder. Histologic and immunohistochemical examination of the peripheral cornea in a single patient showed a subepithelial, avascular pannus. There was negative staining with Congo red. DNA analysis excluded mutations in the transforming growth factor beta-induced (TGFBI) gene and in the tumor-associated calcium signal transducer 2 (TACSTD2) gene. CONCLUSION We have extended the pedigree of Franceschetti corneal dystrophy and elaborated its natural history on the basis of clinical examinations. A distinctive feature is the appearance of subepithelial opacities in adult life, accompanied by a decreased frequency of recurrent erosion attacks. Its clinical features appear to distinguish it from most other forms of dominantly inherited recurrent corneal erosion reported in the literature.
Collapse
Affiliation(s)
- Walter Lisch
- Department of Ophthalmology, Johannes Gutenberg University Mainz, Mainz, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Morgan LA. Central toxic keratopathy: a case study and literature review. Optometry 2012; 83:74-79. [PMID: 23231367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Central toxic keratopathy (CTK) is a rare, non-inflammatory corneal opacity that can occur after corneal laser refractive surgery. It is characterized by the absence of inflammatory cells within the cornea or anterior chamber, central stromal necrosis, and corneal opacification, with an onset of 3 to 9 days after refractive surgery; CASE STUDY This case report reviews the clinical findings, differential diagnosis, possible etiologies, and management of CTK; CONCLUSION Though listed in the literature under numerous names, including diffuse lamellar keratitis (DLK) Stage IV, central lamellar keratitis (CLK), central flap necrosis (CFN), flap necrosis syndrome (FNS), and keratocyte-induced corneal microedema (KME), the conditions share characteristics with CTK, including clinical findings and treatment modalities. Treatment for CTK is controversial, though studies show best practices include close monitoring for possible corneal melt, avoiding topical corticosteroids, and possible enhancements for resultant hyperopia.
Collapse
Affiliation(s)
- Linda A Morgan
- Omaha Eye and Laser Institute, 606 N. 164th Street, Omaha, NE 68118, USA.
| |
Collapse
|
50
|
Abstract
A 53-year-old contact lens wearer on renal dialysis developed visual impairment due to corneal opacity. The opacity was of a crystalline type and diffusely scattered in the anterior cornea. As oxalosis was suspected ascorbic acid was immediately omitted from the dialysis treatment schedule. Within a few weeks the visual acuity recovered and the corneas became nearly clear. The cornea is an uncommon manifestation site for oxalosis. Nevertheless, one should be aware of this possible sign for oxalosis, which can be a life-threatening complication of treatment with high dose ascorbic acid.
Collapse
Affiliation(s)
- S Peter
- Abteilung für Augenheilkunde, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800, Feldkirch, Österreich.
| | | | | | | | | |
Collapse
|