[HLA system and corneal grafts. Undoubtedly a factor of success, if only little known].
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Biomedical subjects
Publications and source records attributed to B Delbosc.
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The authors compared the growth of limbal and central explants removed from human cornea. Epithelial growth began on the third day, was greater during the first week and was subsequently slightly invaded by fibroblasts. This study demonstrated that peripheral corneal epithelial cells growth better than central cells. In this study, the cytologic and histologic features of the cells were examined. However, epithelial immunofluorescence staining by anti-cytokeratin antibodies was rather poor. This in vitro system may provide a suitable model for epithelial human corneal cell culture, allowing further biocompatibility studies.
Fresh human corneas and corneal buttons were studied for expression of HLA antigens. Using monoclonal antibodies in an indirect immunofluorescence assay, corneal layers were examined for class I (HLA-A, B, C) and class II (HLA-DR) histocompatibility antigens. Twenty-one human corneas were studied, 6 normal and 15 pathological: 4 buttons of allograft rejection, 9 buttons of pseudophakic bullous keratopathy. In fresh control corneas, HLA-A, B, C antigens were localized on corneal epithelium and on stromal keratocytes but were never found on endothelial cells. HLA-DR antigens were not detected on corneal epithelium, stroma or endothelium but were detected on Langerhans cells within epithelium and anterior stroma. At the corneal limbus, HLA class I-II antigens were expressed on vascular endothelium. HLA antigen distribution was modified in pathological corneas. Antigens HLA-A, B, C were induced on endothelial cells of rejected corneal allografts. Antigens HLA-DR were detected on epithelial cells, cells in the stroma of pseudophakic bullous keratopathy and also on endothelial cells of rejected corneal allografts. These results suggest that induction of class I and II antigen expression by inflammatory factors may occur in vivo. In rejected corneal allografts induction of HLA-DR antigen on corneal layers would intensify the process of rejection. This study and others have demonstrated the ability of modulation of HLA antigen expression on human corneal cells in vivo.
To increase the number of HLA typed corneas a microlymphocytotoxicity assay on lymphocytes and PHA lymphoblasts was investigated. A double immunofluorescence technique using magnetic beads coated with anti-T8 (for class I) and anti-DR (for class II) monomorphic antibodies was applied. Blood samples from 50 non selected donors were obtained. HLA class I and class II typing was possible in 74% of the cases. Using PBL's (Peripheral Blood Lymphocytes) HLA class I could be defined in 29 out of 50 Cases and class II in 15 out of 50 cases. On PHA blasts HLA class I and class II antigens could be defined in 32 and 33 out of 50 cases respectively. Mean time of culture was 10 days (6-20). No influence of donor age and post partum time could be observed. By combination of both methods a significant proportion of eye donors could be reliably typed within a short time.
Using organ-culture preservation human corneas were preserved up to 5 weeks in a modified tissue culture medium at 37 degrees C. The endothelial viability was examined after staining with trypan-blue 0.3%, after determination of endothelial cell density and cell loss and by light microscopy after staining with trypan-blue 0.3% and alizarin red 1%. The biochemical analysis of the medium (pH, glucose, lactate) has allowed the evaluation of three kinds of storage. The influence of time preservation on the endothelial viability and the metabolic conditions are determined. At the end of this study a clinical trial is proposed.
This study reports donor corneas stored at +37 degrees C in organ culture incubation. The follow up is 12 months. The graft survival is 92%. Two grafts are failed before 6 months. The mean control thickness is 0.54 mm and the mean endothelial cell density 1625 cells per mm2. A mean decrease in cell density of 40.6% is recorded. This study demonstrates that banked donor material can be successfully employed for corneal transplantation.
SSPE is a panencephalitis who involves children and who leads to death. It is due to a defective measles virus. Ophthalmologic features are frequent and may be the first manifestation of the disease. The most typical ocular involvement is retinitis which can be misdiagnosed as a toxoplasmosis.
27 consecutive cases of non freeze myopic keratomileusis (using Barraquer Krumeich Swinger Set) were performed by one surgeon on 22 patients in a retrospective study. 4 per operative complications were noticed. Visual acuity with and without correction, astigmatism before and after surgery were reviewed preoperatively, at 1 week, 1 month, 3 months, 6 months and 1 year postoperative. The preoperative myopia (mean +/- standard deviation) was -15.55 +/- 5.46 D, the average postoperative residual myopia was: at 1 week -0.43 +/- 3.58 D, at 1 month -1.18 +/- 4.15 D, at 3 month -4.44 +/- 4.80 D, at 6 month -5.43 +/- 5.51, at 1 year -6.95 +/- 4.81 D. Visual acuity without correction was always better postoperatively. The best visual acuity (with correction) was preoperatively 0.38 +/- -0.22 at 1 week postoperative 0.21 +/- 0.09, at 1 month 0.35 +/- 0.16, at 3 month 0.31 +/- 0.15, at 6 month 0.32 +/- 0.15, at 1 year 0.34 +/- 0.17. Further investigation is monitoring to assess the predictability and stability of non freeze keratomileusis.
This study used peripheral human corneal epithelium in tissue culture. Cells were observed in cytology, histology and by immunofluorescence staining. This in vitro-system may provide a suitable model to study biocompatibility but also to collect free human corneal cells.
27 consecutive cases of non freeze myopic keratomileusis were performed on 22 patients in a retrospective study. 4 per operative complications were noted. Visual acuity with and without correction, keratometry, astigmatism, pachymetry, esthesiometry before and after surgery were reviewed at 1 week, 1 month, 3 months, 6 months and 1 year post operatively.
This study reports the clinical use of donor corneas stored at +37 degrees C in organ culture medium. Twenty-five penetrating keratoplasties were performed. The mean storage time of organ-cultured donor corneas was 12.3 days (3-21). The follow up of the patients was 12 months. The criteria for the survival of corneal grafts was mean central corneal thickness, clarity of the cornea and mean endothelial cell density. The graft survival was 92% at 12 months. The mean central corneal thicken was 0.54 mm. The mean endothelial cell density was 1625 cells/mm2. The mean decrease in endothelial cell density at 12 months was 40.6%.
A study of 36 penetrating keratoplasties using donor corneas stored at +37 degrees C in organ culture incubation for an average of 12 days prior to transplantation is reported. The criteria for the survival of corneal grafts were mean central corneal thickness, clarity of the cornea and mean endothelial cell density. A total of 86% of the grafts remained clear after 12 months follow-up time. The mean central corneal thickness was 0.47 mm. The mean endothelial cell density was 1452 cells/mm2. Based on the results of this study, organ culture reported here appears to be a safe and efficient method of medium to long-term corneal storage.
Authors have studied the penetration of ciprofloxacin in the aqueous humor of 30 patients (30 eyes). The concentration in the anterior chamber was on average 0.73 mg/l (33% of serum level), from 1.30 hours after a single oral dose (1000 mg) till the 5th hour after this dose. The samples were assessed by a microbiological method. These results are over the minimal inhibitory concentration for many bacterial agents found in endophthalmitis. So this antibiotic may be proposed in the treatment of endophthalmitis, with further investigations assessing the safety of this procedure.
A corneal endothelium staining technique is described which can be performed in a few minutes. The first step of this in vitro staining is atraumatic for the endothelium. The cell density and the number of dead cells are thus determined. The second step is a staining of nuclear and intercellular spaces with a fixation by ethanol. Which then permits an histological analysis. This method of the endothelium, as described, thus allows for the control of corneal button either before grafts or after preservation, as well as the analysis of corneal pathologies.
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