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Biomedical subjects

C J Koester

Publications and source records attributed to C J Koester.

At least 19 recordsLinked to original sources

Scanning slit confocal microscopic observation of cell morphology and movement within the normal human anterior cornea.

PURPOSE: Noninvasive in vivo observations of the anterior human cornea were performed to study cell structure and dynamics. Cellular elements were identified by their location, morphology, and pattern of movement. The hypothesis that cells in the epithelial layer of the normal cornea migrate centripetally was tested. METHODS: Using a scanning slit confocal microscope with a new 0.75-numeric aperture contact objective, individual cells of normal human corneas were observed over time, quantifying the velocity and direction of cellular movement within the basal epithelial layer. RESULTS: Basal epithelial cells, wing cells, the basal epithelial nerve plexus, and the subepithelial nerve plexus were identified readily. Centripetal motion was observed for three corneal cell types: basal epithelial cells, basal epithelial nerves, and unidentified cellular elements (possibly Langerhans cells). The unidentified cellular elements moved along the length of the basal epithelial nerves. The basal epithelial nerve plexus maintained a roughly stable topology as it slid centripetally. New nerve material appeared at the site of entry of the nerve into the epithelium. No growth cones were present at the distal termini of the growing epithelial nerves. CONCLUSION: In the midperiphery of the normal human cornea, basal epithelial cells and nerves slide centripetally, probably in concert. Unidentified cellular elements used the basal epithelial nerve plexus as a pathway for intraepithelial movement. Observations in this study suggest that neurite growth occurred by the addition of new membrane material along the length of the axon rather than at a distal growth cone.

Adult

In vivo measurement of posterior chamber intraocular lens decentration and tilt.

We report what to our knowledge is the first extensive in vivo clinical study of intraocular lens decentration and tilt. Measurements of posterior chamber intraocular lenses, all implanted by the same surgeon in 89 eyes, showed that decentration and tilt consistently differed between right and left eyes. Lenses tended to decenter superotemporally and tilt with their superonasal edges tipped forward. Decentration magnitude relative to the cornea light reflex axis and line of sight averaged 0.64 mm, with decentration increasing slightly with increased axial length. Average tilt was 6.75 degrees, and the average tilt-induced astigmatism was 0.27 diopter. Tilt magnitude decreased with increased axial length, as did tilt-induced astigmatism and plus sphere.

Adult

The barrier function in extracapsular cataract surgery.

The distribution of fluorescein between the anterior chamber and the anterior vitreous was measured in two groups of patients after oral administration: group I, extracapsular cataract extraction (ECCE) patients with intact capsule and posterior chamber intraocular lens (PC IOL) (n = 12); group II, intracapsular cataract extraction (ICCE) patients with anterior chamber IOL (AC IOL) (n = 13). The fluorescein concentrations were measured by fluorophotometry and the penetration ratios were calculated. The penetration of fluorescein into the anterior vitreous was significantly less in the ECCE group (group I, penetration ratio = 2.03 +/- 1.00 X 10(-3) min-1; group II, penetration ratio = 5.99 +/- 4.89, X 10(-3) min-1, P less than 0.01). The authors concluded that in ECCE versus ICCE a significantly smaller proportion of fluorescein is found in the anterior vitreous relative to the aqueous after passage through the blood-aqueous barrier. This suggests a barrier to posterior movement of other molecules that may initially gain access to the eye in the anterior segment (e.g., prostaglandins).

Aged

Endothelial cell counts following pars plana vitrectomy in pseudophakic and aphakic eyes.

In 13 pseudophakic eyes, endothelial cell counts remained stable following pars plana vitrectomy. The posterior chamber pseudophakos apparently had a protective effect on the corneal endothelium, even though the posterior lens capsule was removed during surgery. By contrast, in nine aphakic eyes, a statistically significant (p greater than .05) cell loss of 7.6% occurred after pars plana vitrectomy. We conclude that vitrectomy therefore poses an increased risk to the cornea in aphakic, but not in pseudophakic eyes.

Aged

Silicone intraocular lens resolution in air and in water.

The resolution efficiencies of 31 biconvex silicone intraocular lenses, ranging in power from 16.0 to 23.5 diopters, were tested in air and in water to see if a predictable relationship existed as previously reported with polymethylmethacrylate lenses. Resolution efficiency is defined as the percentage ratio of the actual resolving power of a lens to that of a perfect lens of the same focal length which is only limited in resolution by diffraction. The lenses ranged from 29% to 58% resolution efficiency in air. No lenses exhibiting multiple images were included. All 31 lenses achieved at least 73% resolution efficiency in water, and one lens achieved 82%. Based on these findings, a biconvex silicone lens that exceeds 30% resolution efficiency in air and does not produce multiple images can perform near its diffraction limit when implanted in the eye.

Air

Measurement of intraocular lens decentration and tilt in vivo.

A method for measuring the tilt and decentration of intraocular lenses (IOLs) in the static eye using the Purkinje image locations is presented. The patient fixates on a target that is coaxial with the camera or is at a predetermined angle with the camera axis. A telecentric stop is introduced in the camera so the positions of the Purkinje images on the film are independent of their distance from the camera. Measurements of the image locations on the film are used with anterior chamber depth and corneal curvature measurement to calculate the tilt and decentration of the IOL. In a group of 14 randomly selected patients with posterior chamber IOLs, 13 gave Purkinje images that could be measured. The average tilt was 7.8 degrees and the average decentration was 0.7 mm.

Humans

Intraocular lens resolution in air and water.

The resolution of 96 polymethylmethacrylate intraocular lenses with convexo-plano optics, ranging in power from 13 to 27 diopters, was measured in air and water. The resolution of each lens was expressed in linear units of resolving power, which is the maximum number of line-pairs that can be resolved per millimeter, as described in the current ANSI Standard Z80.7-1984. There was no clearly defined relationship between linear resolving power measured in air and that measured in water. Measurements on high power lenses (greater than 20 diopters) indicate that it is possible for an intraocular lens to meet the current 100 line-pair per millimeter standard for resolution and still be a limiting factor in a patient's best attainable visual acuity. An alternative method for evaluating lens resolution is to determine the resolution efficiency (the relative percentage performance of a lens compared to a diffraction-limited lens of the same dioptric power). Using these units, a consistent and predictable relationship from air to water was demonstrated. Our findings confirm that if a minimum standard of 30% resolution efficiency in air is established, in contrast to linear resolving power, the lens will perform near its diffraction limit when implanted in the eye. For intraocular lenses of materials other than polymethylmethacrylate, a minimum resolution efficiency in air other than 30% may be required.

Air

Vitreous fluorophotometer data analysis by deconvolution.

The measurement process in fluorophotometry inherently involves a loss of information due to the finite sampling volume of the instrument. Mathematically, the effect is expressed as a convolution of the actual fluorescein distribution with the spread function of the instrument. Scattering by the ocular media can increase the spread function over that due to the instrument alone. A method is proposed for deconvolution of vitreous fluorophotometry data. Simulation studies and analyses of patient data demonstrate recovery of information with this method, including enhancement of retinal peaks and resolution of detail in the posterior vitreous which was not apparent from the original scans.

Data Display

Determining intraocular lens power within the eye.

A method is described for determining the power of an intraocular lens (IOL) within the eye by measuring the horizontal dimension of the corneal reflected image (Purkinje-Sanson I) and the anterior IOL reflected image (Purkinje-Sanson III) as seen through a standard slitlamp with a target positioned 68 mm anterior to the focal plane of the biomicroscope. The horizontal K-reading (at 180 degrees) and the anterior chamber depth are the two other parameters necessary to calculate the exact power of the IOL. Seven tables that use these four measurements have been provided, eliminating the need for complex calculations. To determine the accuracy of this technique, ten implanted IOLs ranging from 9 diopters (D) to 27 D were chosen and their powers calculated; these calculated values were then compared to the actual IOL powers. The largest error was 0.5 D and the average error was 0.17 D.

Anterior Chamber

Colour wide field specular microscopic investigation of corneal surface disorders.

Colour wide field specular microscopy (WFSM) may be used to examine different phases of corneal surface pathology in vivo. A soft contact lens facilitates colour differentiation of cell surface variations by interference. Pathologic states may be characterised by modifications in apparent cell colour, brightness, morphology and configuration. Cell brightness is altered by interference phenomena, cell surface irregularities (microprojections), homogeneity of substances covering cells, intracellular components and changes in indices of refraction at the interfaces between the cell surface and the tear layers. Colour photography has been helpful in deciding which intensity variations may be due to interference effects.

Adult

The corneal endothelium following photocoagulation: induced decompensation.

The wide-field specular microscope was used to study retrospectively the corneal endothelia of six patients. Each patient had recovered from an episode of corneal decompensation in one eye, which consisted of subepithelial edema, punctate staining, iritis, and a fixed dilated pupil, following retinal photocoagulation with the xenon arc. In each case, the normal and the previously decompensated eyes were found to have equal endothelial cell counts and indistinguishable cell morphology. Nothing was seen to suggest why these corneas should have decompensated. It is concluded that photocoagulation-induced corneal decompensation did not produce permanent morphological changes in corneal endothelial cells. Possible mechanisms of corneal decompensation are discussed.

Adult