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Biomedical subjects

Edward J Holland

Publications and source records attributed to Edward J Holland.

At least 19 recordsLinked to original sources
PubMed2007

Nepafenac ophthalmic suspension 0.1% for the prevention and treatment of ocular inflammation associated with cataract surgery.

PURPOSE: To determine whether nepafenac ophthalmic suspension 0.1% decreases the incidence and severity of inflammation and pain after cataract surgery with posterior chamber intraocular lens implantation. SETTING: Twenty-one ophthalmology clinics in the United States. METHODS: A randomized double-blind vehicle-controlled trial was conducted in which adult patients were randomly assigned to receive nepafenac 0.1% or vehicle beginning 1 day before surgery and continuing on the day of surgery (day 0) for 14 days. Patients were evaluated on days 1, 3, 7, and 14. The primary efficacy variable was the percentage of patients cured at day 14 (cure defined as aqueous cells score + aqueous flare score = 0). Other efficacy variables included percentage of patients who were pain free at all visits and aqueous cells, flare, and cells plus flare scores. RESULTS: The mean age of the 476 patients (243 nepafenac, 233 vehicle) was 70 years (range 27 to 93 years). At day 14, 152 patients (62.6%) in the nepafenac group and 40 (17.2%) in the vehicle group were cured (P<.0001). A higher percentage of patients in the nepafenac group was pain free at all visits (P<.0001). Throughout the study, most nepafenac-treated patients were pain free (83.1% to 93.0%) compared with less than half the vehicle-treated patients (41.6% to 46.4%). The nepafenac group had lower mean aqueous cells, flare, and cells plus flare scores at all visits (P<.0001). No treatment-related ocular adverse events occurred in either group. CONCLUSION: Nepafenac ophthalmic suspension 0.1% was safe and effective for preventing and treating ocular inflammation and pain associated with cataract surgery.

Adult↗
PubMed2006

Clinical profile and early surgical complications in the Cornea Donor Study.

PURPOSE: The Cornea Donor Study was designed to investigate the safety and efficacy of older donor corneal tissue compared with younger donor tissue in recipient eyes at moderate risk to the graft from progressive endothelial failure. Baseline patient data, including indications for transplant, intraoperative complication rates, and early postoperative complication rates are described herein. METHODS: This study was a multicenter prospective, double-masked, controlled clinical trial. RESULTS: Fuchs dystrophy was the most common indication for corneal transplantation (61%). Intraoperative complications occurred in 33 (3%) patients. A persistent epithelial defect was the most commonly reported postoperative complication, occurring in 92 patients (8%). CONCLUSION: Intraoperative and postoperative complication rates were low. There was no apparent association between donor or recipient age and either intraoperative or early postoperative complication rates.

Adult↗
PubMed2006

Incidence and prevalence of glaucoma in severe ocular surface disease.

PURPOSE: To describe the incidence and prevalence of glaucoma in a patient population with severe ocular surface disease (OSD). METHODS: A retrospective case series was compiled from all charts of patients in the Cincinnati Eye Institute/University of Cincinnati and University of Minnesota population with a diagnosis of severe OSD from 1991 to 2003. The incidence and prevalence of glaucoma in the overall patient population were identified, and stratified into disease subgroups. RESULTS: Of the 108 eyes evaluated in this study, 71 were diagnosed with glaucoma. The overall prevalence of glaucoma in patients with severe OSD is 65.7%, with a range from 42.9% to 88.4%. Analysis by subgroup shows the highest percentage of patients with concurrent glaucoma fall into the categories of aniridia and chemical injury, and the lowest was noted in those patients with autoimmune or iatrogenic OSD. Overall, the incidence of glaucoma was 20.4%, with a range of 13.6% to 60%. CONCLUSIONS: Compared with previous studies, our results show a significantly higher prevalence of glaucoma in patients with severe OSD. This information warrants increased attention to treatment and management of OSD and concurrent glaucoma.

Adolescent↗
PubMed2006

AlphaCor: Clinical outcomes.

PURPOSE: To study the outcomes of AlphaCor implantation. METHODS: : The AlphaCor artificial cornea is indicated for corneal blindness not treatable by donor grafting. Prospective preoperative and follow-up data were collected. Data were evaluated using SPSS for statistical analysis of outcomes, trends, and associations. RESULTS: This report includes data returned through February 28, 2006, for all 322 devices implanted, with mean follow-up in situ of 15.5 months and a maximum of 7.4 years. The probability of AlphaCor retention at 6 months and 1 and 2 years for protocol cases was 92%, 80%, and 62%, respectively, and off-label cases were at higher risk (P = 0.010), as were cases not prescribed medroxyprogesterone (MPG; P = 0.001). Currently, the most common complications were stromal melting, fibrous reclosure of the posterior lamellar opening, and white intraoptic deposits, with incidences in 2005 of 11.4%, 5.1%, and 2.6%, respectively. MPG seems to protect against melts, and eyes with a history of herpetic keratitis were not at increased risk. A history of glaucoma or the presence of tubes did not affect device retention. Complications culminated in loss of an eye in 1.3%. Mean preoperative visual acuity (VA) was hand movements. The VA achieved postoperatively (light perception to 20/20) was affected by previous pathology and postoperative course, with a mean improvement of 2 lines. CONCLUSION: AlphaCor provides a treatment option where a donor tissue graft would not succeed in severe corneal conditions, while being reversible to a donor graft in the event of complications for anatomic integrity. Surgical technique and adjunctive therapies are evolving with experience. Continued data collection is important for a fuller understanding of AlphaCor's role.

Adult↗
PubMed2005

A progressive anterior fibrosis syndrome in patients with postsurgical congenital aniridia.

PURPOSE: To report the characteristics of a newly recognized clinical entity in congenital aniridia that we have termed aniridic fibrosis syndrome. DESIGN: Interventional case series. METHODS: Retrospective chart review of 155 eyes in 80 patients with congenital aniridia was carried out to identify and characterize eyes that had anterior chamber fibrosis. Histopathologic evaluation was performed in three eyes. RESULTS: Seven eyes in six patients were identified to have aniridic fibrosis syndrome. All eyes had undergone previous intraocular anterior segment surgery, some eyes with multiple procedures. Seven eyes had undergone cataract surgery with posterior chamber intraocular lens; six eyes had undergone previous implantation of tube shunt devices, and four eyes had undergone previous penetrating keratoplasty. Clinically, the syndrome was characterized by a progressive retrolenticular and retrocorneal membrane that caused forward displacement of intraocular lenses. Surgical findings indicated that the fibrotic membrane also can involve the ciliary body and anterior retina. Histopathologic evidence from three eyes indicated that the extensive fibrotic tissue originated from the root of the rudimentary iris and entrapped the intraocular lens haptics. Endothelial decompensation that was subsequent to the formation of the aniridic fibrosis syndrome was seen in all eyes. CONCLUSION: Aniridic fibrosis syndrome is characterized by the development of a progressive anterior chamber fibrosis. A possible mechanism that promotes the formation of this fibrotic material may be the proximity or touching of intraocular devices on immature vessels in the rudimentary iris found in aniridia. Patients with aniridia with a history of penetrating keratoplasty, intraocular lenses, and tube shunts should be monitored for aniridic fibrosis syndrome; early surgical intervention is recommended.

Adolescent↗
PubMed2005

An evaluation of image quality and accuracy of eye bank measurement of donor cornea endothelial cell density in the Specular Microscopy Ancillary Study.

PURPOSE: The Specular Microscopy Ancillary Study was designed to examine donor corneal endothelial specular image quality, compare the central endothelial cell density determined by eye banks with the endothelial cell density determined by a central specular microscopy reading center, and evaluate donor factors that may have an impact on specular image quality and endothelial cell density accuracy. DESIGN: Nonrandomized comparative trial. PARTICIPANTS: Endothelial specular images of donor corneas assigned in the Cornea Donor Study. METHODS: Certified readers assessed donor image quality (analyzable from fair to excellent vs. unanalyzable) and determined the central endothelial cell density. Independent adjudication was performed if there was a difference in the quality of grading or if the endothelial cell density varied by > or =5.0% between readers. Average reading center-determined endothelial cell density was compared with the endothelial cell density determined by each eye bank. MAIN OUTCOME MEASURES: Evaluation of image quality and accuracy of endothelial cell density. RESULTS: Of 688 donor endothelial images submitted by 23 eye banks, 663 (96%) were analyzable (excellent, 40 [6%]; good, 302 [44%]; fair, 321 [47%]), and 25 (4%) were unanalyzable by reading center standards. In situ retrieval and greater epithelial exposure correlated with a higher image quality grading. The eye bank-determined endothelial cell density of 434 of the 663 (65%) analyzable images were within 10% of the endothelial cell density determined by the reading center, whereas 185 (28%) were more than 10% higher and 44 (7%) were more than 10% lower. Greater variation in endothelial cell density between the eye banks and the reading center was observed with shorter time of death to preservation, presence of an epithelial defect, folds in Descemet's membrane, lower image quality, and the use of fixed-frame or center method endothelial cell density analysis. CONCLUSIONS: Overall, donor endothelial specular image quality and accuracy of endothelial cell density determination were good. However, the data suggest that factors that may affect image quality and contribute to variation in interpretation of the endothelial cell density should be addressed, because the donor endothelial cell density is an important parameter for assessing long-term corneal graft survival.

Cell Count↗
PubMed2005

Baseline donor characteristics in the Cornea Donor Study.

PURPOSE: The Cornea Donor Study (CDS) is an ongoing study that is being conducted to determine whether donor age is related to long-term corneal graft survival. Characteristics of the donor population have been evaluated with respect to donor age, endothelial cell density, and death to preservation interval. METHODS: Within the context of a prospective, double-masked, controlled trial, 1101 donor corneas were assigned without regard to donor age. RESULTS: Slit-lamp characteristics of the donor corneas showed little variation with donor age, except for the presence of corneal arcus. As death to preservation time decreased, fewer epithelial abnormalities and a lower frequency of stromal edema and Descemet folds were observed. There was little change in the mean of the endothelial cell density with donor age beyond age 60, despite variation. CONCLUSION: With respect to donor age, there was little difference in either the slit-lamp characteristics or endothelial cell density of the donor corneas. Fewer epithelial abnormalities were observed with shorter death to preservation time.

Adolescent↗
PubMed2005

Survival of donor epithelial cells after limbal stem cell transplantation.

PURPOSE: To determine the long-term fate of donor epithelial cells after limbal allograft transplantation. METHODS: Corneal buttons and peripheral blood leukocytes were obtained at the time of penetrating keratoplasty from three patients who had undergone a successful limbal allograft transplantation. Microdissection was used to remove the corneal epithelial cells from the button. The presence of donor and recipient epithelial cells in each sample was determined by using PCR for DNA microsatellites. Phenotypic analysis of the epithelium was performed by immunohistochemistry. RESULTS: Various patterns of DNA microsatellites were observed. Nonrecipient cells (presumed to be donor) were consistently detected in all three corneal buttons. In two of the three cases, recipient cells were also detected, whereas in the third case, exclusively donor epithelial cells were found at 3.5 years after limbal allograft transplantation. Mild T-lymphocytes and macrophages were observed in one of the corneal buttons. CONCLUSIONS: This study provides evidence for the persistence of donor epithelial cells up to 3.5 years after limbal allograft transplantation and supports the use of systemic immunosuppressive therapy.

Aged↗
PubMed2004

Efficacy and safety of international donor sharing: a single-center, case-controlled study on corneal transplantation.

BACKGROUND: To overcome the shortage of donor corneas, we are currently using donor corneas supplied by foreign eye banks. This single-center, case-controlled study was conducted to show the efficacy and safety of corneal transplantation using corneas from foreign donors. METHODS: A retrospective, case-controlled comparison of 118 corneal transplants using foreign donor corneas (foreign group) and domestic donor corneas (domestic group) was performed. The two groups were matched according to original disease, age, severity of preoperative neovascularization, and history of previous grafting. Clinical outcome and incidence of postoperative complications were compared between the two groups. RESULTS: The foreign group had a longer preservation-to-operation time than the domestic group, reflecting the longer transportation time. However, the incidence of clear grafts and postoperative complications such as immunologic rejection, infection, and glaucoma was not significantly different between the two groups. CONCLUSIONS: Corneal transplantations using foreign donor corneas are as effective and safe as those using domestic donor corneas, despite the longer preservation time.

Case-Control Studies↗
PubMed2004

Diode-laser-induced cataract and iris atrophy as a complication of eyelid hair removal.

PURPOSE: To caution about ocular risks of dermatologic diode laser, including cataract formation and iris atrophy. DESIGN: Observational case report. METHODS: A 63-year-old woman underwent diode epilation in the upper eyelid area without protective eye shields and experienced a sharp ocular pain during treatment of her left eye. She later presented with decreased vision in that eye and sensitivity to light. RESULTS: Iris atrophy and a nuclear cataract were seen on examination. In the absence of any such observations at previous eye examinations and of any contributory ocular history, these findings were attributed to the diode laser treatment. CONCLUSION: Diode laser epilation in the upper eyelid region could entail risks for intraocular structures, including cataractogenesis and iris atrophy.

Atrophy↗
PubMed2004

A randomized, double-masked, placebo-controlled, multicenter comparison of loteprednol etabonate ophthalmic suspension, 0.5%, and placebo for treatment of keratoconjunctivitis sicca in patients with delayed tear clearance.

PURPOSE: To evaluate loteprednol etabonate ophthalmic 0.5% suspension, versus placebo for treatment of the inflammatory component of keratoconjunctivitis sicca in patients with delayed tear clearance. DESIGN: Randomized, double-masked, placebo-controlled clinical trial. METHODS: Sixty-four patients with keratoconjunctivitis sicca and delayed tear clearance were randomly assigned to receive either loteprednol or vehicle 4 times a day for 4 weeks. Patients were evaluated at weeks 2 and 4 of treatment and 2 weeks after treatment was discontinued. Symptoms were scored using a visual analog scale (VAS) of 1 to 100. Corneal fluorescein staining was scored 0 to 4 in five areas. Conjunctival injection was graded 0 to 3 in the inferior bulbar, nasal bulbar, and inferior tarsal areas. Lid margin injection was graded 0 to 3. Safety was assessed by funduscopy, lens examination, biomicroscopy, visual acuity, and Goldmann tonometry, and by monitoring adverse events and changes in symptoms. RESULTS: In subsets of patients with at least moderate clinical inflammation, there was a significant difference between the loteprednol-treated group and vehicle-treated group after 2 weeks of therapy. The differences did not reach statistical significance at 4 weeks, although the loteprednol-treated patients retained their improvement compared with the vehicle-treated group. Safety evaluations showed both treatments to be well tolerated and similar in the frequency and type of adverse event reported. CONCLUSION: The use of topical loteprednol etabonate 0.5% 4 times a day may be beneficial in patients who have keratoconjunctivitis sicca with at least a moderate inflammatory component.

Androstadienes↗
PubMed2004

Pressure-induced interface keratitis: a late complication following LASIK.

PURPOSE: Interface inflammation is a common complication of laser in situ keratomileusis (LASIK). The most well-described presentation is diffuse lamellar keratitis (DLK), which typically develops early after LASIK and responds quickly to topical steroids. In this report, we describe a novel presentation of interface inflammation that resembles DLK in appearance but presents late in the postoperative period, is associated with increased intraocular pressure, and is exacerbated by steroid treatment. METHODS: A retrospective case series and chart review of all patients treated in our tertiary care private practice for late-onset interface inflammation associated with elevated intraocular pressure. RESULTS: Ten eyes in 6 patients with late-onset interface inflammation and increased intraocular pressure were identified. At presentation, all patients were presumed to have classic DLK and were treated initially with aggressive topical steroids. Eight of the 10 eyes were receiving topical steroids at the time of presentation. The average time of presentation was 17 days after LASIK (range, 7-34). Elevated intraocular pressure was noted on average 28 days after presentation (range, 8-69). Lamellar inflammation was exacerbated by topical steroids. Resolution of the interface inflammation did not occur until intraocular pressure was controlled. CONCLUSIONS: This case series describes a clinically distinct form of interface inflammation that presents late and is associated with elevated intraocular pressure. The lamellar inflammation was refractory to topical steroids and only resolved when pressure was controlled. These findings suggest that elevated intraocular pressure can contribute to interface inflammation. Postoperative assessment of intraocular pressure is essential in patients presenting with flap inflammation.

Adult↗
PubMed2004

Concentrations of levofloxacin, ofloxacin, and ciprofloxacin in human corneal stromal tissue and aqueous humor after topical administration.

OBJECTIVE: To evaluate the penetration of commercially available levofloxacin 0.5%, ofloxacin 0.3%, and ciprofloxacin 0.3% topical ophthalmic solutions in human corneal stromal and aqueous humor tissues. METHODS: A total of 67 patients scheduled to undergo penetrating keratoplasty for treatment of stromal scar or dystrophy, keratoconus, pellucid marginal degeneration, or endothelial disease were enrolled in this prospective, double-blind, 3-center study. To be considered for inclusion, patients had to have an intact corneal epithelium and minimal or no corneal edema (pachymetry < 650 microm). After informed consent was obtained, patients were randomized to receive 1 drop of levofloxacin 0.5%, ofloxacin 0.3%, or ciprofloxacin 0.3% topical ophthalmic solution at approximately 15 and 10 minutes before surgery. Approximately 0.1 mL of aqueous fluid was aspirated by paracentesis through the trephination wound at the onset of surgery, followed by excision of the affected cornea and removal of its epithelium. Specimens were stored frozen at -70 degrees C until assayed by high-performance liquid chromatography. RESULTS: All 3 fluoroquinolones were well tolerated. A total of 65 corneas and 59 aqueous fluid samples were obtained and assayed. The mean +/- standard deviation corneal concentrations of ciprofloxacin, ofloxacin, and levofloxacin following a 2-drop administration were 9.92 +/- 10.99 microg/g (n = 18), 10.77 +/- 5.90 microg/g (n = 23), and 18.23 +/- 20.51 microg/g (n = 24), respectively. Although corneal stromal levels were highest in the levofloxacin group, the high degree of interpatient variability prevented demonstration of statistically significant differences when compared with ofloxacin (P = 0.377). In contrast, levofloxacin concentrations were approximately twice as high as ciprofloxacin, and this difference reached statistical significance (P = 0.014). The corresponding aqueous humor concentrations of ciprofloxacin, ofloxacin, and levofloxacin were 0.135 +/- 0.231 microg/mL (n = 15), 0.135 +/- 0.111 microg/mL (n = 20), and 0.372 +/- 0.546 microg/mL (n = 24, P < 0.001 versus ciprofloxacin and ofloxacin). CONCLUSION: The topical administration of all 3 agents was well tolerated in patients undergoing penetrating keratoplasty. Two drops of levofloxacin 0.5% solution results in a 1.7- to 2.7-fold greater penetration into human corneal stromal and aqueous humor tissues than ofloxacin 0.3% or ciprofloxacin 0.3%. The mean intracorneal concentrations of all three agents following 2 drops exceeds the MIC90 for the majority of pathogens causing bacterial keratitis. Topical levofloxacin appears to offer pharmacokinetic and pharmacodynamic advantages over ofloxacin and ciprofloxacin in terms of enhanced transcorneal penetration; however, clinical comparative trials are needed to confirm these relative advantages.

Administration, Topical↗
PubMed2004

Recurrence of Fuchs marginal keratitis within a lamellar graft.

We report a case of Fuchs marginal keratitis with a recurrence and spontaneous perforation on the lamellar graft. A constellation of marginal corneal infiltrates and stromal thinning under a pseudopterygium characterize this condition. Two years after an initial lamellar keratoplasty, the pathology recurred within the graft. A repeat lamellar keratoplasty was performed, this time combined with a conjunctival autograft.

Adult↗