The contact lens/fusarium "outbreak".
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Contact Lenses↗
Biomedical subjects
Joel Sugar
Publications and source records attributed to Joel Sugar.
Epidemiological characteristics of a Chicago-area Acanthamoeba keratitis outbreak.
PURPOSE: To characterize Acanthamoeba keratitis (AK) cases and analyze the geographical distribution within the Chicago-Gary-Kenosha metropolitan area, Chicago, Illinois, USA. DESIGN: Retrospective, population-based cohort study. METHODS: All AK cases diagnosed at the University of Illinois at Chicago Cornea Service from June 1, 2003, to November 30, 2005, were included in analysis. Patients with keratitis were defined as cases through confocal microscopy, histology, and/or positive cultures. Exploratory analyses were performed to evaluate whether AK cases were unequally distributed geographically. County population data were extracted from US Census 2000 data, and rates were age-standardized to Cook County. Poisson regression analysis was used to estimate the age-standardized rate ratio (RR) between AK cases and county of residence. Current cases (June 1, 2003 to November 30, 2005) were compared with historical cases (June 1, 2000 to November 30, 2002) to determine if the current rate of AK diagnosis differed from historical rates. RESULTS: Forty AK cases were diagnosed between June 1, 2003 and November 30, 2005. The average (+/-SD) age of patients with AK was 28.0 +/- 15.0 years (range, 13 to 70 years), 52.5% were men, and 95.0% wore contact lenses. Estimated RR measures demonstrated increased rates for all counties relative to Cook, and were significant for both DuPage County (RR 3.59; 95% confidence interval [95% CI] 1.44, 8.39) and Will County (RR 3.66; 95% CI 1.18 to 9.56). Current AK diagnosis rates were significantly higher than historical rates (RR 6.67; 95% CI 3.05 to 17.52). CONCLUSIONS: AK cases are increasing in frequency. The increased rates are unevenly distributed in the study area. Further research is warranted to better understand the increase and unusual geographical distribution.
Acanthamoeba Keratitis↗
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↗
The effect of temperature on the antimicrobial activity of Optisol-GS.
PURPOSE: To determine the survival of different bacteria inoculated in Optisol-GS at refrigerated storage temperature (6 degrees C) and after subsequent warming to room temperature (19-22 degrees C). METHODS: Staphylococcus aureus, Enterococcus faecium, Streptococcus pneumoniae, and Pseudomonas aeruginosa were chosen from stock clinical isolates for inclusion in the study. The first group consisted of 12 Optisol-GS vials. The second group consisted of 12 Optisol-GS vials containing corneas inappropriate for transplantation according to the Eye Bank Association of America (EBAA) protocols. Each group was inoculated with 3 concentrations of approximately 10, 10, and 10 colony-forming units (CFU)/mL of each bacterial species and then refrigerated per EBAA protocol. After 48 hours of refrigeration, all vials were placed at room temperature (RT) and counts were performed at 48, 50 (2 hour RT), 54 (6 hour RT), 60 (12 hour RT), 72 (24 hour RT), and 96 (48 hour RT) hours. At 96 hours, the corneal tissue from 10 and 10 inocula were cultured. All samples underwent serial dilution, spiral plating on blood agar plates, and incubation at 35 degrees C. Viable colony counts were determined at 24 hours. RESULTS: Except for the 10 CFU/mL inocula of P. aeruginosa, all isolates were viable after 48 hours of refrigeration. Rapid bactericidal activity was observed against P. aeruginosa after 2 hours at RT, with complete sterilization by 6 hours. The rate and extent of killing against S. aureus were influenced by the initial inoculum. Bactericidal activity was achieved after 2 hours at RT with 10 CFU/mL of S. aureus versus 24 hours with the 10 inoculum. Of note, bactericidal activity was not observed against S. pneumoniae and E. faecium following 24 hours of storage at RT. The presence of corneal tissue did not affect viable counts, with counts from corneal tissue cultures reflecting the counts seen from Optisol-GS after 48 hours at RT. CONCLUSIONS: The antimicrobial activity of Optisol-GS was reduced at refrigerated temperature and enhanced at RT. Bactericidal activity was not observed against E. faecium at either refrigerated temperature or RT.
Anti-Bacterial Agents↗
Deep lamellar endothelial keratoplasty: histopathology of complications in initial cases.
PURPOSE: To report complications encountered after 2 initial cases of deep lamellar endothelial keratoplasty. METHODS: Review of clinical findings of 2 initial cases in which intraoperative and postoperative complications were encountered. Corneal buttons from the 2 cases were evaluated by light microscopy and transmission electron microscopy. RESULTS: Complications encountered were related to the graft-recipient interface and the lamellar dissection of the recipient and donor corneas. CONCLUSION: Deep lamellar endothelial keratoplasty is an evolving procedure that shows much promise. These 2 cases show that the procedure entails a separate skill set from penetrating keratoplasty and requires significant surgeon practice before being introduced into the individual's transplant practice.
Aged↗
Conjunctival mucoepidermoid carcinoma: clear cell variant.
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Aged↗
Developmentally regulated expression of Sp1 in the mouse cornea.
PURPOSE: To examine the expression of transcription factor Sp1 in the cornea of the mouse eye throughout developmental stages. The environmental effect of light on Sp1 expression was also assessed. METHODS: C57BL/6 mice were set up for timed mating. Embryos on embryonic day (E)10.5, E12.5, E15.5, and E18.5 and eyes from mice on postnatal day (P)0, P7, P11, P15, P30, and P60 were collected for immunohistochemical staining and in situ hybridization. One group of mice was bred strictly in the dark between E18.5 and P15, and the eyes were collected at P0, P7, P11, and P15 time points. RESULTS: Sp1 expression was observed in the ectoderm and lens vesicle as early as E10.5. Both Sp1 protein and mRNA were abundant in the corneal basal epithelium and keratocytes until P11. Their levels were markedly reduced at P15, right after eyelid opening, and declined further between P15 and P60. In those mice bred in the dark, Sp1 was evident in the cornea at P0. The Sp1 level gradually increased until P11 and was decreased at P15. This expression pattern was nearly identical in mice bred either in a light/dark cycle or in the dark. The Sp1 level in the central lens epithelium was much lower than that in the cornea from E15.5 to late stages. CONCLUSIONS: The present study indicates that Sp1 expression is developmentally regulated, providing a basis for further investigations on the regulation of the Sp1 gene during the course of corneal development and in diseases such as keratoconus.
Animals↗
Neoplastic corneal pannus in sebaceous cell carcinoma.
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Adenocarcinoma, Sebaceous↗
Corneal thickness changes during herpes simplex virus disciform keratitis.
OBJECTIVE: To describe the changes in corneal thickness determined by ultrasonic pachymetry during follow-up of herpes simplex virus disciform corneal edema. METHODS: Thirty-five patients with herpetic keratitis underwent slit-lamp biomicroscopy and ultrasonic pachymetry. Measurements during follow-up and at clinical resolution of corneal inflammation were compared with the initial corneal thickness. RESULTS: Corneal thickness of disciform stromal keratitis decreased 15% (95% confidence interval 10% to 20%) during follow-up, and 65% (95% confidence interval 43% to 88%) of this decrease occurred during the first 2 weeks. Increased central corneal thickness measured by pachymetry was associated with biomicroscopic detection of corneal edema (P = 0.03). CONCLUSIONS: Corneal pachymetry supplements clinical assessment of herpetic disciform edema.
Body Weights and Measures↗
Late-stage progressive corneal astigmatism after penetrating keratoplasty for keratoconus.
PURPOSE: Progressive corneal astigmatism occurring at least 10 years after penetrating keratoplasty for keratoconus is a late-phase complication of surgery. This report characterizes this condition in a series of patients from three corneal referral centers in the United States. METHODS: Charts were retrospectively reviewed which met the following criteria: penetrating keratoplasty performed for keratoconus at least 10 years ago, keratometry or simulated keratometry from topography as well as manifest refraction recorded at least 6 months after the last suture removal ("baseline"), and an increase in corneal astigmatism of at least three D over baseline recorded at least 5 years later. Patients who had any other corneal or intraocular surgery performed were excluded. RESULTS: Data from 15 patients (11 males and 4 females) who had penetrating keratoplasties performed by 8 different surgeons are included in this descriptive series. Postoperative follow-up averaged 17.27 years (range 11-24 years). The average donor button size was 7.83 mm (range 7.25-8.5 mm). Baseline corneal astigmatism was obtained an average of 5.2 years after penetrating keratoplasty (range 1.5-16 years) and was on average 3.57 +/- 1.8 D (10 with-the-rule [WTR], 3 against-the-rule [ATR], 2 oblique). Corneal astigmatism significantly increased to an average of 11.23 +/- 3.56 D (range 8.00-19.37 D, P < 0.0001) and most astigmatism was regular and WTR (9 WTR, 3 ATR, 3 oblique) 15.3 years (range 10-22 years) after surgery. Inferior steepening on topography was often noted, even those with oblique and ATR axes. CONCLUSIONS: High, late-stage, regular astigmatism after penetrating keratoplasty for keratoconus is described in a series of patients occurring at least 10 years after surgery. Possible mechanisms of this progressive astigmatism are recurrence of keratoconus in the graft, progressive corneal thinning of the host cornea, or progressive misalignment of the graft-host interface over time.
Astigmatism↗
Developmentally regulated expression of KLF6 in the mouse cornea and lens.
PURPOSE: To examine the expression of transcription factor Kruppel-like factor-6 (KLF6) in the cornea and lens of mouse eyes throughout developmental stages. METHODS: C57BL/6 mice were set up for timed mating. Embryos on embryonic day (E)10.5, E12.5, E15.5, and E18.5 and eyes from mice on postnatal day (P)0, P7, P11, P15, P30, and P60 were collected for immunofluorescence staining. Transcript of KLF6 was detected by in situ hybridization with digoxigenin-labeled RNA probes. Relative quantitative reverse transcription (RT)-PCR was performed to measure the KLF6 transcript level in eyes enucleated at embryonic stages, and the corneas and lenses isolated at postnatal stages. RESULTS: Staining for the KLF6 protein was observed at E10.5 in the lens pit and at E12.5 in the ectoderm, the mesenchyme, and the lens epithelium. Nuclear staining for KLF6 protein was evident at E15.5 in the corneal epithelium and the stroma. The staining was abundant between E18.5 and P60. In the lens epithelium, nuclear staining was detected at P0, P7, and P11. The staining intensity declined subsequently. The KLF6 transcript was found in the lens pit at E10.5 and in the ectoderm and mesenchyme at E12.5. The KLF6 mRNA level in corneal layers remained relatively constant until P60. In the lens epithelium, it was high during embryonic stages but decreased with development. CONCLUSIONS: KLF6 is expressed in both the cornea and the lens in mouse eyes. Its expression in the lens is temporally regulated, suggesting that it has a central role in lens development.
Animals↗
Assessment of visual function after corneal transplantation: the quality of life and psychometric assessment after corneal transplantation (Q-PACT) study.
PURPOSE: Many patients with successful corneal grafts have poor vision postoperatively. This study evaluates changes in vision-related quality of life after penetrating keratoplasty (PK). DESIGN: Multicenter prospective cohort study. METHOD: Penetrating keratoplasty candidates from the university-affiliated ophthalmology clinics of four participating centers were enrolled and followed up prospectively. We used the PK-VFQ, a modified version of the Visual Function Index-14, combined with clinical examinations before and at 6 and 12 months after PK. We used multivariate linear regression models to examine predictors of change in PK-VFQ scores. RESULTS: We studied 74 grafts in 71 eyes of 67 patients aged 23 to 91 (mean, 61) years who were followed up for at least 6 months. Indications for surgery included bullous keratopathy (27%), scarring (16%), keratoconus (16%), dystrophies (16%), and regrafts (15%). Median preoperative visual acuity was 20/200 in the graft candidate and 20/30 in the best eye. Median best-corrected postoperative visual acuity in the operated eyes was 20/60 at 6 months. PK-VFQ scores improved at 6 months in 79% by an average of 13.0 points (range, -16.7 to 67.5). Improvement in PK-VFQ scores was associated with younger age (P =.04), poorer preoperative visual acuity in the best eye (P =.001), and postoperative contact lens use (P =.04) but not with postoperative acuity in the grafted eye (P =.49). Postoperatively, 80% of patients were moderately to very satisfied with their vision, and 97% of patients stated they would have the surgery again. CONCLUSIONS: Improvement in visual function is inversely associated with visual acuity in the better-seeing eye but does not correlate with the postoperative acuity in the grafted eye. Although most keratoplasties are done unilaterally in the setting of good visual acuity in the contralateral eye, for the majority of patients visual function improves after PK.
Adult↗
Reporter gene construct containing 1.4-kB alpha 1-proteinase inhibitor promoter confers expression in the cornea of transgenic mice.
A 1.4-kb human alpha1-proteinase inhibitor (alpha1-PI) 5'-flanking sequence fused to the E. coli LacZ gene was used to generate transgenic mice. The 1.4-kb alpha 1-PI fragment was found to target LacZ expression preferentially in the epithelium and stroma of the mouse cornea, and moderately or weakly in white blood cells and a few other tissues, such as the skin and brain. This finding implies that the alpha 1-PI promoter may offer an option for targeting foreign genes in both the epithelial and stromal layers of the cornea in future transgenic experiments.
Animals↗
Mapping of Sp1 regulation sites in the promoter of the human alpha1-proteinase inhibitor gene.
Keratoconus is a potentially blinding disease that thins the central cornea. In afflicted corneas, the level of an inhibitor, alpha1-proteinase inhibitor (alpha1-PI), is found reduced. An increased expression of transcription factor Sp1 is also demonstrated. To examine the role of Sp1 in regulation of the human alpha1-PI gene, a 1.4-kb (-1397/+9) 5'-flanking promoter sequence that contains 10 Sp1 sites was cloned. Previous transient transfection experiments showed that Sp1 expression indeed repressed the alpha1-PI promoter activity. In this study, 12 DNA segments, a series of 5', 3', and internal deletions of the 1.4-kb alpha1-PI promoter sequence, were ligated into the SEAP (secreted alkaline phosphatase) reporter gene vector and transfected into human corneal stromal cells. Co-transfection with a Sp1 expression vector pPacSp1 was also performed in parallel. The SEAP enzyme activity was assayed. A fragment with 489 bp (-480/+9) of the 3' sequence, and three fragments with internal deletions, were found to confer a majority of the full promoter activity. Other deletions significantly abolished the promoter activity. Site-directed mutagenesis experiments further revealed that the most proximal Sp1 site (-100/-87) may be an essential element involved in the negative regulation of alpha1-PI promoter activity by Sp1. Interaction between the proximal and distal Sp1 sites also seemed to be important. These results provide the first in-depth characterization of the transcription mechanisms regulating the expression of alpha1-PI. Mapping of the Sp1 sites may help elucidate the molecular pathway leading to the alterations observed in keratoconus.
Adult↗
Lysosomal hydrolase staining of conjunctival impression cytology specimens in keratoconus.
PURPOSE: This study sought to assess the feasibility of impression cytology for the determination of conjunctival intracellular lysosomal hydrolase (acid esterase) levels in patients with keratoconus. METHODS: Twenty-two patients with keratoconus currently enrolled in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study and 22 age-and sex-similar controls underwent impression cytology. Samples were collected from each subject and control pair on the same day. The cells of the respective specimens were fixed immediately and were stained for acid esterase with use of identical batches of fixatives and stains. After staining, the specimens were cleared in xylene for mounting in synthetic resin on glass slides. The acid esterase staining intensity of each specimen was quantified as the percentage of light transmitted with use of an image analysis system (Zeiss). Multiple cells from each specimen were analyzed for each sample collected. RESULTS: Mixed model analysis was used to account for the subject-control pairings and for the multiple cells from each sample. With this method, the mean light transmission for normal controls (mean = 63.0; standard error [SE] = 3.0) was highly statistically significantly different from that for the keratoconus subjects (mean = 52.4; SE = 3.0) (two-tailed p= 0.0032). CONCLUSIONS: This study establishes the feasibility of adapting an acid esterase staining technique to conjunctival cells collected via impression cytology. Higher levels of lysosomal enzyme staining in patients with keratoconus have been previously reported by other investigators using full-thickness conjunctival specimens. We also demonstrate the value of using objective microspectrophotometry in measuring lysosomal enzyme staining with impression cytology specimens.
Acetylesterase↗
Cicatricial entropion caused by asymptomatic allergic conjunctivitis.
Cicatricial entropion is an acquired process caused by scarring of the inner eyelid with mechanical shortening of the posterior lamella. We present two consecutive patients with cicatricial entropion as the heralding sign of allergic blepharoconjunctivitis. A 12-year-old girl and a 41-year-old man presented to a referral oculoplastics practice with ocular irritation and conjunctival symblepharon. Neither patient had a history of allergic ocular symptoms. Slit lamp examination revealed marked conjunctival scarring of all four eyelids in each patient. Conjunctival scraping and cell staining revealed eosinophils and polymorphonuclear leukocytes. No evidence of infection, including Chlamydia and Herpes zoster, was detected. Asymptomatic allergic blepharoconjunctivitis should be included in the differential diagnosis of cicatricial entropion. Conjunctival scraping may be helpful in the diagnosis.
Journal Article↗