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Biomedical subjects

H Dwight Cavanagh

Publications and source records attributed to H Dwight Cavanagh.

At least 55 records · Page 3Linked to original sources
PubMed2003

Effect of laser in situ keratomileusis on optic nerve head topography and retinal nerve fiber layer thickness.

PURPOSE: To determine whether laser in situ keratomileusis (LASIK) produces significant changes in optic nerve head (ONH) topography and retinal nerve fiber layer (RNFL) thickness as measured by the Heidelberg Retina Tomograph (HRT) and to evaluate the potential neuroprotective effect of topical betaxolol on these changes. SETTING: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. METHODS: In this prospective randomized double-masked comparative case series, 34 patients having LASIK for myopia were randomly assigned to receive topical betaxolol 0.5% solution or placebo twice a day for 2 days before the procedure and 7 days after the procedure. Preoperative and postoperative (1 week and 1 and 3 months) images were made with the HRT. Four HRT parameters (rim area, rim volume, mean RNFL thickness, and cup shape measure) were analyzed in a masked fashion. The Student paired t test was used for statistical analysis. RESULTS: No significant changes from baseline occurred in any HRT parameter in either patient group or when the patients were evaluated as a single group. CONCLUSIONS: Laser in situ keratomileusis did not adversely affect ONH morphology or RNFL thickness as measured by HRT. Since no neural damage was detected, the potential neuroprotective effect of betaxolol could not be evaluated.

Adrenergic beta-Antagonists↗
PubMed2003

The effects of low- and hyper-Dk contact lenses on corneal epithelial homeostasis.

Contact lens were and eyelid suturing diminish overall Bcl-2 expression in the corneal epithelium, yet nuclear Bcl-2 in the exposed surface epithelial cells seems to be retained for longer periods when compared with the retention in control eyes. This observation may explain why there is a decrease in surface cell exfoliation during CTL wear, because nuclear Bcl-2 loss needs to precede apoptotic surface cell exfoliation. In addition, if the hypothesis is true that Bcl-2 also has a regulatory function in the proliferation and differentiation of tissues, the overall reduced expression of Bcl-2 (nuclear plus cytoplasmic) may clarify the decrease in proliferation of the corneal epithelium seen during CTL wear. Future studies should clarify the role of Bcl-2 in the homeostatic dynamics of the corneal epithelium. CTL wear and eyelid suturing provide excellent noninflammatory models to advance knowledge of Bcl-2 and its regulatory roles. Additionally, these models should help researchers gain a better understanding of the CTL-associated effects on corneal epithelium.

Animals↗
PubMed2003

A 1-year prospective clinical trial of menicon Z (tisilfocon A) rigid gas-permeable contact lenses worn on a 30-day continuous wear schedule.

PURPOSE: To establish the safety and efficacy of clinical performance of a novel hyper-O2-transmitting rigid gas-permeable (RGP) lens (tisilfocon A) worn continuously for 30 days (29 nights) equivalent to a conventional control hydrogel lens (etafilcon A) worn for 7 days (6 nights). METHODS: The study was a prospective, open-label, 24-center, concurrent cohort-controlled clinical trial. OUTCOME MEASURES: Outcome measures included rates of adverse events, slitlamp findings, length of wear achieved, lens-corrected visual acuity, corneal refractive changes, dryness, and lens deposits. RESULTS: The RGP lens wear test was equivalent or superior to the hydrogel control performance in all categories. Two-thirds (66.5%) of patients wearing the RGP lens achieved continuous wear periods greater than 22 nights; and 60.4% achieved more than 28 nights of continuous use. There was a statistically significant lower rate of adverse events, considered definitely related to lens wear, for the RGP test lens versus the hydrogel control (none vs. 2.2%; P = 0.007, Fisher's exact two-sided test). CONCLUSIONS: Continuous wear of the tisilfocon A (Menicon Z, Menicon Co., Ltd., Nagoya, Japan) RGP lens for up to 30 nights is a safe and equivalent alternative to 7-day (6-night) hydrogel wear.

Adult↗
PubMed2003

Effects of contact lens care solutions on surface exfoliation and bacterial binding to corneal epithelial cells.

PURPOSE: The purpose of this study is to assess the effects of commercially available contact lens wetting solutions on bacterial binding and cell exfoliation rates in human corneal epithelium. METHODS: The effects of four contact lens care solutions were tested: ReNu Multi Plus (Bausch & Lomb, Rochester, NY) multipurpose solution; OPTI-FREE Express (Alcon, Ft. Worth, TX) multipurpose solution; Complete Blink-N-Clean (Allergan, Irvine, CA) lens drops; and Lens Plus (Allergan) rewetting drops. STUDY DESIGN: Prospective, double-masked, randomized crossover clinical trial (N = 20 subjects). OUTCOME MEASURES: Measures of outcome included binding of Pseudomonas aeruginosa (PA) to exfoliated corneal epithelial cells, and the rate of surface cell exfoliation. Cells were collected at the baseline (pretreatment) examination and 4 days later, after subjects used the assigned solution six times daily and once again immediately before cell collection (posttreatment). Following cell collection, patients underwent 1 week of recovery, during which no drops were used, and random cross-over assignment to the next test solution. RESULTS: Use of test solutions increased PA binding, with a range of + 11.9% to + 58.2%. Analyzed together, PA binding increased significantly (+ 29%; P = 0.02, paired t-test); Lens Plus solution alone raised PA binding levels significantly (P = 0.022, 2-way ANOVA, Student-Newman-Keuls [SNK] test). Exfoliation rates were decreased from -7% to -52.7%. Analyzed together, cell exfoliation decreased significantly (P = 0.004; Wilcoxon signed rank test). Individual use of OPTI-FREE decreased exfoliation significantly (P = 0.019: 2-way ANOVA, SNK test). CONCLUSIONS: Topical application of common commercial contact lens care solutions increases PA binding and reduces corneal surface cell exfoliation. Similar effects have also been reported with contact lens wear. Taken together, the data suggest that the use of lens solution itself may play a role in increasing PA binding to corneal epithelial cells and, hence, might potentially contribute inadvertently to increased risk for lens-related microbial keratitis.

Adult↗
PubMed2003

Photorefractive keratectomy versus laser in situ keratomileusis for the treatment of spherical hyperopia.

OBJECTIVE: To compare photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in treating spherical hyperopia using the VISX STAR S2 excimer laser. INTERVENTION: Fifteen consecutive eyes of 15 patients underwent PRK, and 16 consecutive eyes of 16 patients underwent LASIK (follow-up: 12 months). MAIN OUTCOME MEASURES: Postoperative pain, uncorrected visual acuity (UCVA), deviation from intended correction, and loss of best spectacle-corrected visual acuity (BSCVA). RESULTS: Mean preoperative spherical equivalent was + 2.18 diopter [D] for PRK and + 2.03D for LASIK. All PRK patients experienced significant postoperative pain that required systemic medication, whereas LASIK patients had minor and transient discomfort. Mean deviation from intended correction was -0.83D, + 0.01D, and + 0.18D at 1, 6, and 12 months after PRK, and + 0.22D, +0.30D, and + 0.40D at 1, 6, and 12 months after LASIK (P = 0.002 at 1 month). A higher proportion of LASIK eyes had a UCVA of 20/20 or better at all time points (P = 0.013 and 0.025 at 1 and 3 months, respectively). There was no statistically significant difference between both groups in BSCVA loss. CONCLUSIONS: LASIK and PRK are comparable in efficacy and safety. However, PRK was more painful, with an initial and temporary myopic over-correction that did not occur after LASIK. Stability was achieved between 3 and 6 months following PRK, and one month following LASIK.

Cornea↗
PubMed2003

Effects of daily and overnight wear of hyper-oxygen transmissible rigid and silicone hydrogel lenses on bacterial binding to the corneal epithelium: 13-month clinical trials.

PURPOSE: For 14 years, the U. S. Food and Drug Administration (FDA) and eye care practitioners have strongly discouraged patients from sleeping in contact lenses. In the past 9 months however, the FDA has approved three new hyper-oxygen transmissible lenses for up to 30-night extended wear. Is this a great advance or another clinical triumph of hope over experience? What should the public know? What should patients do? METHODS: Our research group has studied all three new lenses in prospective, randomized, masked, parallel clinical trials in a single center. As an outcome measure, we looked at whether lens wear caused more bacterial binding to surface corneal cells. RESULTS: Compared with conventional lens use, the new lenses caused no or only small increases in bacterial binding in either daily or extended wear. Furthermore, the increases seen stratified with known infection risks by both lens type (hard or soft) and wearing schedule. Indeed, early epidemiologic reports indicate that this new generation of lenses may reduce lens-related microbial infection risks by 10- to 40-fold. CONCLUSION: This represents a true clinical paradigm shift of the first magnitude in safety of contact lens wear. Taken together, this data suggest that patients will soon replace their current, conventional lenses with this new generation of materials for any schedule of wear.

Bacterial Adhesion↗
PubMed2003

Can postlens tear thickness be measured using three-dimensional in vivo confocal microscopy?

PURPOSE: Confocal microscopy through focusing (CMTF) of the cornea produces a three-dimensional display of corneal structure and intensity profiles that allow objective measurements of corneal sublayer thickness. This study investigated the feasibility of using in vivo CMTF to measure postlens tear thickness (PLTT). METHODS: Two rabbits and one human were evaluated in this study. Both rigid gas-permeable (RGP) and silicone hydrogel contact lenses were used. After contact lens insertion, CMTF scans were performed by rapidly focusing from the tip of the objective, through the contact lens, PLTT, and full thickness of the cornea, and into the anterior chamber of the eye. PLTT was calculated by measuring the distance between the posterior surface of the lens and the anterior surface of the epithelium. RESULTS: With a steep RGP lenses, the position of the posterior lens surface and the superficial epithelial surface was easily visualized using three-dimensional CMTF, and the PLTT could be measured. However, when a properly fit RGP or silicone hydrogel contact lens was used, the strong signal from the posterior surface of the lens washed out the signal from the front surface of the cornea in most cases, and the PLTT could not be directly assessed. We also found that the PLTT was sensitive to applanation of the confocal objective lens. CONCLUSION: The data suggest that the tear film under a properly fit contact lens is less than the 9-microm axial resolution of our confocal microscope. Furthermore, the potential for undetected eye movement and accidental touching of the contact lens raises questions regarding the overall reliability of the measurements.

Animals↗
PubMed2003

Effects of an educational seminar on rejection demographics in patients presenting for laser in situ keratomileusis.

PURPOSE: To evaluate the effectiveness of an educational seminar as an initial screening tool for patients interested in laser in situ keratomileusis (LASIK) and to determine the incidence of and reasons for patients not being candidates for the procedure. METHODS: A retrospective review of the medical charts of 438 consecutive patients, half of whom attended an educational seminar, and half of whom did not. All patients underwent ophthalmic evaluations as candidates for LASIK. The reasons for patients not proving to be good candidates were determined. RESULTS: Thirteen percent of all patients examined were found not to be suitable candidates for LASIK. There was no difference in rejection rates between patients who had attended a seminar and those who had been screened and educated over the telephone by a skilled technician. The principal reasons for rejection were, in decreasing order of frequency: cataract, presbyopia, abnormal corneal curvature, insufficient corneal thickness, unstable refraction, large pupil, irregular astigmatism, anterior basement membrane dystrophy, previous corneal surgery, uncontrollable dry eye, and previously undiagnosed ocular malignancy. CONCLUSIONS: Patients educated through group seminars or individually by trained technicians over the telephone still present for consideration for LASIK with unidentified ocular problems that make them poor surgical candidates. This occurs at a rate of 13%. The majority of the patients required a careful evaluation to uncover the abnormalities.

Attitude of Health Personnel↗
PubMed2003

Recovery time of corneal epithelial proliferation in the rabbit following rigid gas-permeable extended contact-lens wear.

PURPOSE: To determine recovery time needed for the corneal epithelium to return to a normal proliferation rate following 24-hour rigid gas-permeable (RGP) lens wear. METHODS: An RGP lens (Dk/t = 10) was fitted at 9:00 am on one randomly chosen eye of each rabbit (N = 16) and removed 24 hours later while the other eye served as a control. Following contact lens removal, the rabbits were injected at four different time intervals (1,2, 4, and 7 days) with 5-bromo-deoxyuridine (BrdU) at 9:00 am to label dividing corneal epithelial cells. All animals were sacrificed 24 hours after BrdU injection, and corneas were stained for BrdU. A series of continuously adjacent digital images of the whole-mount epithelium was collected from superior limbus to central cornea, and all BrdU-labeled epithelial cell pairs on each digitized image were counted. RESULTS: On day 1 following lens removal, the number of BrdU-labeled corneal epithelium cells was reduced by 50% centrally (C) and 36% peripherally (P) (P < 0.001) compared with control eyes. At day 2, there was no statistically significant difference between control and experimental corneas (P = 0.675). At day 4, a marked significant increase in BrdU-labeled cells was noted, averaging 83% (C) and 96% (P) (P < 0.001). At day 7, BrdU-labeling returned to control values, although it was still slightly elevated (14% [C] and 5% [P], P = 0.045). CONCLUSIONS: The corneal epithelium in the rabbit required at least 1 full week to recover to its stable baseline proliferation rate following only 24 hours of RGP lens wear. Interestingly, hyperproliferation was noted within the limbal, peripheral, and mid-peripheral corneal epithelium 4 days after lens removal.

Animals↗
PubMed2003

Neonatal corneal stromal development in the normal and lumican-deficient mouse.

PURPOSE: The purpose of this study was to characterize temporally stromal growth and transparency in lumican-deficient and normal neonatal mice. METHODS: Lumican-deficient mice and CD1 wild-type mice were evaluated by in vivo confocal microscopy through-focusing (CMTF) to quantify stromal and epithelial thickness and corneal light-scattering and by laser scanning CM to determine density of keratocytes from 1 day to 12 weeks after birth. RESULTS: CD1 corneas showed a rapid loss of light-scattering, decreasing by 50% from day 1 to day 12, that paralleled a 60% decrease in density of keratocytes. By contrast, the stroma demonstrated a marked swelling from day 8 to day 12, followed by thinning at day 14. Compared to corneas from CD1 mice, lumican-deficient corneas showed significantly increased (P < 0.05) light-scattering beginning at week 3 that remained elevated above wild-type levels for the duration of the study. Stromal development was also markedly altered, with thinning detected at week 3, followed by no detectable stromal growth for the duration of the study. Density of keratocytes was significantly increased, but the total cell number was similar compared with that in the wild-type cornea, suggesting no effect on keratocyte differentiation. CONCLUSIONS: Development of normal neonatal corneal transparency appears related to changes in density of keratocytes. The stroma, however, undergoes a marked swelling and thinning at the time of eyelid opening (days 8-14). In the lumican-deficient mouse, stromal swelling is abolished, indicating that this critical phase in stromal development is lumican dependent and essential for normal stromal growth and maintenance of stromal transparency.

Animals↗
PubMed2003

Vertical movement of epithelial basal cells toward the corneal surface during use of extended-wear contact lenses.

PURPOSE: To study the effects of extended contact lens wear (EW) on the movement of basal epithelial cells toward the corneal surface. METHODS: Rabbits (n = 32) were injected with 5-bromo-2-deoxyuridine (BrdU) to label a group of proliferating basal epithelial cells, and, 24 hours later, one randomly chosen eye was fitted with a low- or medium-oxygen-transmissible (Dk/t) rigid gas permeable (RGP) contact lens, while the other eye served as the control (n = 28). Four rabbits were not fitted with any contact lens. Rabbits were euthanatized at different time points and the corneal epithelium was immunocytochemically stained for BrdU and/or Ki-67 and counterstained with propidium iodide or Syto 59. Corneal flatmount tissues were examined three dimensionally under a laser confocal microscope and the location of each BrdU-labeled cell in the corneal epithelium (basal or suprabasal) was determined. RESULTS: Four days after injection of BrdU, both low- (P < 0.001) and medium-Dk/t RGP (P < 0.001) lens groups showed significantly more BrdU-labeled cells in the basal cell layer than in the control eyes. Six days after injection of BrdU, a small percentage of BrdU-labeled cells (<0.5%) were Ki-67 positive. CONCLUSIONS: Within 6 days, the majority (80%) of BrdU-labeled basal cells became terminally differentiated and rarely divided secondarily in the central epithelium. Short-term use of low- and medium-Dk/t RGP EW contact lenses slows the normal movement of basal epithelial cells toward the surface in the central cornea. This is consistent with known EW-lens-induced decreases in corneal epithelial basal cell proliferation and surface cell exfoliation. Overall, the data suggest that EW lenses significantly inhibit the normal homeostatic turnover rate of the corneal epithelium.

Animals↗
PubMed2003

Effects of eyelid closure and disposable and silicone hydrogel extended contact lens wear on rabbit corneal epithelial proliferation.

PURPOSE: To examine the rabbit corneal epithelial cell proliferation rate after extended wear of disposable or silicone hydrogel contact lenses or prolonged eyelid closure. METHODS: One randomly chosen eye of 40 New Zealand White rabbits was assigned to silicone hydrogel contact lens wear (n = 15, SH), disposable hydrogel contact lens wear (n = 6, DH), eyelid suturing (n = 15, SUT), or no intervention (n = 4). Contralateral eyes served as the control. After 24 hours or 1 week of lens wear, 5-bromo-2-deoxyuridine (BrdU) was injected intravenously to label dividing corneal epithelial cells, and animals were killed 24 hours after injection. Corneas were stained with monoclonal anti-BrdU antibody and FITC-conjugated secondary antibody. A series of continuous digital images of the wholemounted epithelium were collected from the superior to inferior limbus, and the number of BrdU-labeled cell pairs was counted. RESULTS: SH, DH, and SUT caused a significant decrease in BrdU-labeled pairs of cells over the entire corneal epithelium at day 2 compared with the number in contralateral control eyes (P < 0.001). One week of SUT or SH caused a significant increase centrally in BrdU-labeled cells (P < 0.01). BrdU labeling at the limbus in all groups was not significantly different from the control. Unexpectedly, the proliferation rate of the control corneas was also significantly affected by contralateral lens wear and suturing. CONCLUSIONS: Short-term overnight SH, DH, and SUT all significantly suppressed the cell proliferation rate in the rabbit corneal epithelium. However, adaptation, with central hyperproliferation of cells, appeared to occur at 8 days. The effects of lens wear and eyelid suturing on the cell proliferation rate in contralateral control eyes suggests a central mechanism that regulates corneal epithelial proliferation.

Animals↗
PubMed2002

TGFbeta induced myofibroblast differentiation of rabbit keratocytes requires synergistic TGFbeta, PDGF and integrin signaling.

There is a growing consensus that corneal myofibroblasts are derived from adjacent stromal keratocytes which undergo an orderly phenotypic transition from quiescent keratocyte to activated fibroblast to myofibroblast. Both in vivo and in vitro studies have shown this transition to be dependent, in part, on transforming growth factor beta (TGFbeta). In many fibroblastic cells autocrine production of platelet derived growth factor (PDGF) is known to mediate the growth up-regulation by TGFbeta. In this study, blocking antibodies to PDGF significantly reduced by 80% (P<0.025) the TGFbeta1 stimulated cell cycle entry of serum-free cultured rabbit corneal keratocytes. AntiPDGF treatment also markedly reduced the TGFbeta1-induced intracellular actin filament re-organization, fibronectin fibril assembly, and focal contact formation as well as reducing by 80% the expression of alpha-smooth muscle (alpha-SM) specific isoform of actin characteristic of myofibroblast differentiation. Although PDGF treatment of quiescent keratocytes produced an activated, fibroblastic cell type, PDGF stimulated keratocytes exhibited the same temporal, myofibroblastic differentiation response to TGFbeta1 as did quiescent keratocytes. Furthermore, blocking TGFbeta1 induction of myofibroblast differentiation with the Arg-Gly-Asp containing peptide, GRGDdSP, for 3 days followed by allowing progression of myofibroblast differentiation by removing GRGDdSP did not change the temporal response or tyrosine phosphorylation cascade (2-72 hr) leading to myofibroblast differentiation. Nor did PDGF treatment of keratocytes reverse the RGD blockade of TGFbeta1 induced myofibroblast differentiation. Overall these cumulative findings indicate that myofibroblast differentiation in the rabbit corneal keratocyte requires synergistic growth factor/integrin signaling involving TGFbeta, PDGF, and the fibronectin receptor. Additionally, the similar TGFbeta1 temporal response of PDGF-stimulated compared to nai;ve keratocytes suggests that myofibroblast differentiation does not require transition through a fibroblast phenotype.

Actins↗
PubMed2002

Adaptive effects of 30-night wear of hyper-O(2) transmissible contact lenses on bacterial binding and corneal epithelium: a 1-year clinical trial.

OBJECTIVE: To determine effects of lens type and oxygen transmissibility on human corneal epithelium during extended wear (EW). DESIGN: Prospective, randomized, double-masked, single-center, parallel treatment groups, 1-year clinical trial. PARTICIPANTS: One hundred seventy-eight patients completed the study: (1) high-O(2) soft lens (6-night [N] EW) (n = 27); (2) hyper-O(2) soft lens (6N-EW, n = 33) or (30N-EW, n = 66); and (3) hyper-O(2) rigid gas-permeable lens (RGP) (30N-EW, n = 52). INTERVENTION: Irrigation chamber to collect exfoliated corneal surface cells, confocal microscopy, and tear collection at baseline, 1, 3, 6, 9, 12 months of EW. MAIN OUTCOME MEASURES: (1) Pseudomonas aeruginosa (PA) binding to exfoliated corneal surface cells; (2) central epithelial thickness; (3) superficial epithelial cell area; (4) epithelial surface cell exfoliation; and (5) tear lactate dehydrogenase. RESULTS: Quantitative evidence demonstrated increased binding of PA to human exfoliated corneal epithelial cells during the first 3 months of soft lens EW; the control high-O(2) test lens showed significantly higher bacterial binding (P < 0.05). Binding activity gradually decreased thereafter and returned to baseline after 9 and 12 months. The corneal epithelium demonstrated enlargement of surface cell size, thinning of central epithelium, and a significant decrease in surface cell shedding (P < 0.05). Remarkably, there was subsequent partial adaptive recovery in cell shedding and epithelial thickness but not surface cell size. There was no significant difference between 6N and 30N continuous wear of the hyper-O(2) soft lens for all outcome measures. Importantly, hyper-O(2) RGP lens wear did not show significantly increased PA binding during 1 year. CONCLUSIONS: This study establishes three important new findings: (1) hyper-O(2) soft lens EW produces significantly less PA binding than the lower O(2) soft lens with no significant difference in PA binding with 6N versus 30N EW of the hyper-O(2) soft lens; (2) there is a remarkable adaptive recovery after 6 months with all soft lens wear with gradual return to prelens PA binding levels and partial recovery of other outcome measures for all test lenses EW except surface cell size; (3) 30N EW of the hyper-O(2) RGP lens produced no significant increases in PA binding over 1 year. Taken together, these results suggest that introduction of new hyper-O(2) transmissible lens materials into clinical use may offer safer EW, and future epidemiologic studies of ulcerative infectious keratitis should consider both lens type and time in lens EW in any incidence/risk analysis.

Adult↗
PubMed2002

Possible role of the vitamin E solubilizer in topical diclofenac on matrix metalloproteinase expression in corneal melting: an analysis of postoperative keratolysis.

OBJECTIVE: To analyze tissue matrix metalloproteinase (MMP) expression in three patients who developed postoperative corneal melts after treatment with topical diclofenac sodium 0.1% (Falcon; Fort Worth, TX) ophthalmic solution. DESIGN: Retrospective noncomparative interventional case series with tissue analysis. MAIN OUTCOME MEASURES: Three patients were examined in this study. We report two patients from the same center with acute corneal melts after uncomplicated photorefractive keratectomy (PRK). Prior to these cases, 1500 patients were treated at the Zale Lipshy University Laser Center for Vision with no adverse effects. All 1500 patients were treated with the same postoperative regimen of ciprofloxacin, rimexolone, and suprofen ([Profenal, (CIBA, Duluth, GA]). The next 27 cases were treated postoperatively with ciprofloxacin and rimexolone. However, diclofenac sodium 0.1% was used instead of Profenal. A third case was also discussed. This melt occurred at another center in a postoperative cataract patient who developed cystoid macular edema after cataract extraction with intraocular lens placement. He was initially treated with diclofenac sodium 0.1% (Ciba Vision, Duluth, GA) then with diclofenac sodium 0.1%. He subsequently developed a corneal perforation requiring penetrating keratoplasty. All tissue specimens were examined by light microscopy. Microbiologic cultures and stains were also performed. Immunolocalization and in situ hybridization were performed on all keratoplasty specimens to detect expression and localization of MMPs. All patients had a complete diagnostic evaluation for systemic autoimmune diseases. RESULTS: Postoperatively, all patients developed corneal perforations requiring surgical intervention while being treated with diclofenac sodium 0.1%. Microbiologic cultures and special stains were negative for microorganisms. Induced expression of specific tissue degrading enzymes of the matrix metalloproteinase family was demonstrated within corneal epithelial cells, stromal keratocytes, and at the level of Descemet's membrane. The uniform distribution pattern of expression was not consistent with the localization expected of a repair response, suggesting the involvement of some outside agent. CONCLUSIONS: Whereas MMP expression is a normal component of repair, excessive or inappropriate MMP activity is associated with corneal keratolysis. Our study provides preliminary evidence that topical application of diclofenac sodium 0.1% may be associated with aberrant MMP expression in the cornea.

Administration, Topical↗