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Biomedical subjects

C H Dohlman

Publications and source records attributed to C H Dohlman.

17 recordsLinked to original sources
PubMed1979

Effect of bilateral and unilateral grafts on the incidence of rejections in keratoconus.

We studied results of 124 keratoplasties in 100 keratoconus patients; 61 men and 39 women varying in ages from 11 to 69 years with an average age of 30 years. Twenty-four patients had bilateral grafts with a 27% incidence of rejection, and 76 patients had unilateral grafts with a 13% incidence of rejection (P less than .01). Data analysis of the first year after the graft of first eyes and subsequent years after the graft of first and second eyes, however, revealed a nearly fourfold increase of rejections following second grafts, with a 17% increased chance of rejection for the first graft after the second was implanted. Only two of the bilateral and two of the unilateral grafts were irreversibly lost because of graft reaction. The major complication was the formation of posterior subcapsular cataract, which occurred in approximately 32% of the patients. The final postkeratoplasty visual acuities were significantly improved. In the patients who did not develop a cataract, 86% achieved visual acuity of 6/12 (20/40) or better. In the patients who did develop cataracts, 68% achieved visual acuity of 6/12 (20/40) or better.

Adolescent↗
PubMed1978

Effect of topical corticosteroids on ulceration in alkali-burned corneas.

Dexamethasone sodium phosphate was administered topically to one eye of rabbits with bilateral alkali corneal burns, and saline solution was administered to the contralateral eye. Topical steroids were also administered in animals with moderate corneal ulcers and were found to enhance the severity of ulceration when given during the second and third weeks following the burn. If the corticosteroids were given daily in the first six days or in the fourth and fifth weeks following the burn, they did not have an adverse effect on the cornea. Corticosteroids can be used intensively during the first week following an alkali burn, without increasing the risk of corneal melting. The mechanism for the enhancement of corneal ulceration is not a direct augmentation of collagenase activity, but probably involves the inhibition of repair processes.

Alkalies↗
PubMed1978

Corneal donor material selection.

Histologic study of eyes used as donor material for corneal transplant revealed one instance of massive leukemic infiltration with leukemic keratic precipitates on the fellow eye. In another eye, microabscesses composed of acute and chronic inflammatory cells containing Crytococcus neoformans were present. In a third patient metastatic anaplastic cells were present in the choroid. We think donor eyes are absolutely unacceptable if death was caused by any chronic neurologic disorder, unless clearly secondary to trauma. Eyes from patients with septecimia, hepatitis, jaundice and any evidence of any active viral infection, syphilis, and positive serology are also unacceptable. Extreme caution should be used in selecting eyes of patients with ocular or systemic malignancy, long-term diseases, particularly if immunosuppressive agents were used, where a history of eye disease exists, including corneal disease or dystrophy, iritis, absolute glaucoma or acute glaucoma, and eyes with a history of previous intraocular surgery.

Bacterial Infections↗
PubMed1978

Penetration routes of topically applied eye medications.

Tritium-labeled hydrocortisone acetate and pilcarpine hydrochloride solutions were topically applied to the eyes of rabbits. In one group of animals, the drugs were excluded from contact with the cornea by a cylindrical well glued to the eye surface. In another group, the drug solutions were allowed contact with the entire anterior surface of the eye. Total application time in all cases was five minutes, then the eyes were flushed with saline. Samples of aqueous humor, stroma, and iris-ciliary body were taken after five, 20, 35, 65, and 125 minutes and counted in a liquid scintillation counter. With hydrocortisone, up to 70 times more drug reached the stroma when the cornea was exposed; 40 times more reached the iris. Peak stromal levels occurred by 20 minutes, dropping to one third of peak value by two hours. With pilocarpine, about five times more drug reached the iris-ciliary body when corneal access was allowed; the level peaked in about five minutes. These results illustrate the important role of tear film distribution and blinking in delivering remotely applied drugs over the cornea with subsequent entry to interior sites.

Administration, Topical↗
PubMed1978

Punctal occlusion in keratoconjunctivitis sicca.

Occlusion of the lacrimal puncta is a useful and underutilized procedure in the treatment of keratoconjunctivitis sicca. When artificial tears no longer ameliorate symptoms and the Schirmer tests are 2 mm/5 min or less (repeatedly), combined with positive rose bengal staining, punctal occlusion is indicated. Diathermy is the most practical technique for permanent closure, whereas various punctum plugs can be applied for a temporary effect.

Electrocoagulation↗
PubMed1977

Intraocular lens implantation in combination with keratoplasty.

Intraocular lenses were implanted in combination with penetrating keratoplasty in a series of patients followed for up to 2 years. During this period of observation there was little or no evidence that the simultaneous implantation of an intraocular implant adversely affected the corneal graft. Technique and results are described.

Cataract Extraction↗
PubMed1976

Surface ultrastructure in alkali-burned rabbit corneas.

The scanning electron microscope was used to follow morphologic events after alkali burn of rabbit corneas. Immediately after a burn there was extensive destruction and shrinkage of the epithelial cells. In subsequent healing, the regenerated superficial cells were morphologically abnormal and possed multiloculated cysts; three months later the normal polygonal packing of cells was not observed. Although the shape of these cells was irregular, microprojections were present on the cell surface. Basal cells were usually observed at the edge of an epithelial defect, an area where the epithelium was easily detached from the basement membrane. In long-standing epithelial defects, the basement membrane became eroded in a spot-like manner after about two weeks. Eventually, when a frank stromal ulcer had formed, bundles of collagen fibrils were visible in a meshwork-like fashion. These changes did not seem to be caused by the direct action of alkali but rather by latent secondary factors that took days or weeks to activate.

Alkalies↗
PubMed1976

Corneal thickness in glaucoma.

The central corneal stromal thickness of patients with open angle glaucoma, secondary glaucoma (the majority aphakic), or a history of unilateral acute angle closure glaucoma were measured and compared with the stromal thickness of a group of normal patients. In open angle glaucoma, there was a small but significant increase in the average stromal thickness. This thickness increase was, in all likelihood, due to an abnormal function of the endothelium in this disease since the level of the intraocular pressure did not seem to be a factor. There was no correlation between stromal thickness and duration of the glaucoma or type of anti-glaucomatous medication. Most cases of secondary glaucome, controlled medically or not, had markedly increased corneal thickness, again, most likely, due to endothelial damage rather than to level of intraocular pressure. After an angle closure attack, permanent damage to the cornea was found to be rare.

Aged↗
PubMed1975

Is the lacrimal gland dispensable? Keratoconjunctivitis sicca after lacrimal gland removal.

A persistent, unilateral keratoconjunctivitis sicca developed immediately after palpebral dacryoadenectomy in a healthy 43-year-old woman with normal eyes and tear function before the operation. The unoperated on fellow eye remained normal during a ten-year period. Eight similar cases are collected from the literature. On the basis of the presented cases, we believe that the main lacrimal gland is an indispensable element of the tear system, and the accessory lacrimal glands are unable normally to prevent tear insufficiency.

Adult↗
PubMed1975

Corneal epithelial preservation.

While clinical experience has demonstrated that current storage techniques are adequate for the preservation of human endothelial cells, increased use of donor epithelium in cases of severe disturbance to epithelial and stromal integrity requires a reexamination of storage effects on the epithelial layer. Measurement of human and rabbit metabolite levels in stored corneas indicates that the epithelium is maintained in a normal state only if the eye is cooled promptly. If cold storage is delayed for as little as one hour after death, glucose levels in the stroma and aqueous fall below levels known to be required for preservation of epithelial integrity. The fundamental time of interest in preservation of donor corneal tissue is in the interval between death and cooling of the eye. If prompt enucleation is not possible, ice should be applied to maintain viability of the epithelium.

Animals↗
PubMed1975

Clinical experience with a mobile ocular perfusion pump.

The continuous delivery in fluids to the ocular surfaces of 12 patients, for a collective total of 1,500 days, was achieved by means of a mobile perfusion pump. One patient used this device intermittently for a total of 21/2 years. Severe dry-eye symptoms were ameliorated in each patient by the constant perfusion. In various situations, the following perfusion fluids have been tried: commercial balanced salt solution, commercial artificial tear solutions, acetylcysteine, and autologous and homologous serum and plasma. In spite of disadvantages related to its size and weight, the pump seems to be of considerable value, especially following severe chemical burns and after keratoplasty or reconstruction of the lids and fornices in the severely dry eye.

Adult↗
PubMed1975

Comparison of suturing techniques in keratoplasty for keratoconus.

The results of 48 consecutive penetrating keratoplasties for keratoconus were analyzed. The overall success rate was 93% clear grafts and there was no significant difference in the percentage of success, the amount of the spherical equivalent of the myopia, or the types of complications between the technique using 9-0 interrupted virgin silk sutures and 10-0 monofilament nylon running suture. The average astigmatic error was 25% less in the series employing the running suture.

Adolescent↗
PubMedDate not supplied

Epithelial downgrowth--fistula repair and keratoplasty.

Eight patients with leaking fistulas from epithelial downgrowth were repaired by various techniques. Wide excision of the fistula and replacement with a graft, followed by a conjunctival flap, proved to be the most satisfactory technique for dealing with the fistula. However, this subset of patients responded to fistula closure with a much worse secondary glaucoma than downgrowth patients in general. Fifteen patients with proven epithelial down-growth received penetrating keratoplasty. Eleven of these grafts failed within a year, but there was no regrowth of epithelium on the back of the graft in at least two patients. In spite of generally discouraging results, we recommend immediate closure of epithelialized fistula to avoid even more severe complications in the future. We also recommend keratoplasty, repeated if necessary, in severe corneal edema. Both situations may eventually require radical glaucoma surgery and/or keratoprosthesis.

Adult↗