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Biomedical subjects

M S Insler

Publications and source records attributed to M S Insler.

At least 19 recordsLinked to original sources
PubMed1997

Mucocutaneous features of autoimmune blistering diseases.

This review will describe adult onset mucocutaneous/autoimmune diseases that involve defects in cell-to-cell, cell-to-matrix, or cell-to-basement membrane adhesion. Included in this group are pemphigus, cicatricial pemphigoid, linear IgA bullous dermatosis, epidermolysis bullosa acquisita, and bullous systemic lupus erythematous. Detection and treatment of blistering disorders that manifest early in the oral cavity may prevent widespread involvement of skin. During the past few years, targets of autoantibodies have been clarified and new targets have been identified, allowing better understanding of the pathophysiology involved in these diseases. New information about more effective regimens with fewer side effects has also been obtained, presenting new treatment options. Clinical manifestations and management of these disorders will be described as well as histopathologic, ultrastructural, and immunopathologic studies that distinguish each disorder and facilitate diagnosis and treatment.

Adult↗
PubMed1996

Keratoconus in two pairs of identical twins.

We studied two sets of identical twins with keratoconus. The first 21-year-old pair had bilateral fully developed keratoconus and the second 35-year-old pair presented with early bilateral keratoconus detected by videokeratography. To our knowledge, these are the seventh and eighth sets of identical twins with keratoconus reported in the literature. They support the evidence of heredity as a factor in the etiology of keratoconus. Videokeratography proved to be a valuable adjunct for the detection of early keratoconus in a cornea with normal slit-lamp microscopy and photokeratoscopy results. Radial keratotomy in one eye produced an unstable refraction.

Adult↗
PubMed1996

Surgical repair of a traumatic iridodialysis.

A novel method for the surgical repair of traumatic iridodialysis is described. This method involves the use of a double-armed suture with straight needles to re-appose the iris by means of mattress sutures. In the case report presented, good cosmetic and optical results were obtained.

Ciliary Body↗
PubMed1995

Early clinical experience with the Baerveldt implant in complicated glaucomas.

PURPOSE: To evaluate our early experience with the Baerveldt implant in patients with complicated glaucoma. METHODS: We reviewed the charts of all patients with more than six months of follow-up after placement of a Baerveldt implant at LSU Eye Center. Surgery was considered a success if intraocular pressure was 21 mm Hg or less (with or without antiglaucoma medications) at the last postoperative visit, except when further glaucoma surgery had been performed or when loss of light perception occurred. RESULTS: Fifty eyes (50 patients) were divided into six diagnostic groups, with mean follow-up times of 16.1 to 19.2 months. Success was achieved in 36 of 50 patients (72%): 26 of 35 (74%) patients with aphakia or pseudophakia, nine of 12 (75%) patients with previously failed filtering surgery, three of seven patients with neovascular glaucoma, all three patients under the age of 13 years, nine of 13 (69%) patients who underwent penetrating keratoplasty, and four of five phakic patients. Overall, visual acuity improved or remained within one line of the preoperative acuity in 32 (64%) patients. The most frequently observed short- and long-term complications were serous choroidal effusion associated with hypotony in 13 (26%) patients and corneal graft failure in six of 13 (46%) corneal transplant patients, respectively. CONCLUSION: Within the study follow-up time, the Baerveldt implant appeared to be safe and effective, with success rates for intraocular pressure control similar to those reported in a recent retrospective study of the Molteno implant.

Adult↗
PubMed1993

Ciprofloxacin ointment versus ciprofloxacin drops for therapy of experimental Pseudomonas keratitis.

To compare the efficacy of ciprofloxacin hydrochloride ointment with that of ciprofloxacin drops for treatment of experimental Pseudomonas keratitis, rabbit eyes were infected by intrastromal injection of 10(3) colony-forming units (CFU) log-phase P. aeruginosa. Infected and uninfected eyes were treated with either 0.3% ciprofloxacin ointment applied hourly for 6 h or 0.3% ciprofloxacin drops applied every 15 min for 6 h. Infected eyes treated with the ointment or drop vehicle alone served as placebo controls. Ciprofloxacin ointment significantly reduced the number of viable bacteria (CFU) per cornea more than four logs compared to the placebo control (p < 0.0001). Ciprofloxacin drops significantly reduced the number of bacteria (CFU) per cornea > 7 logs as compared with placebo-treated controls (p < 0.0001). Ciprofloxacin ointment may be a useful adjunct to conventional topical drops for therapy of bacterial keratitis.

Animals↗
PubMed1992

Fungal keratitis from nylon line lawn trimmers.

Ocular trauma from nylon line lawn trimmers is becoming more prevalent. Previous case reports have described penetrating trauma caused by these tools. We managed three cases of fungal keratitis caused by injuries from nylon line trimmers. Fungal keratitis should be strongly considered as the cause of any corneal ulcer related to trauma from a nylon line lawn trimmer.

Accidents, Home↗
PubMed1992

Ciprofloxacin and prednisolone therapy for experimental Pseudomonas keratitis.

Rabbit corneas were injected intrastromally with Pseudomonas aeruginosa. Sixteen hours after injection, the rabbits were divided randomly into four treatment groups (3 rabbits/6 eyes per group: 1, ciprofloxacin and prednisolone; 2, ciprofloxacin only; 3, prednisolone only; 4, untreated. Ocular signs of inflammation were graded in a masked fashion by slit lamp examination before injection and 16 and 27 hours after injection. Slit lamp examination scores were significantly lower in eyes receiving ciprofloxacin and prednisolone or prednisolone alone, compared with scores in untreated eyes. Slit lamp examination scores were not significantly lower in eyes receiving ciprofloxacin alone, compared with untreated controls. The numbers of viable bacteria in the corneas treated with ciprofloxacin and in the corneas treated with ciprofloxacin and prednisolone were similar and were significantly less (P less than 0.0001) than those in untreated corneas, indicating that the presence of the steroid did not interfere with the bactericidal action of ciprofloxacin.

Administration, Topical↗
PubMed1992

Methicillin-resistant Staphylococcus aureus keratitis in the rabbit: therapy with ciprofloxacin, vancomycin and cefazolin.

To determine the efficacy of a fluoroquinolone antibiotic in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) keratitis, topical administration of 0.3% ciprofloxacin was compared with topical 5.0% vancomycin or 5.0% cefazolin in experimental infections in the rabbit eye. The infections were established by intrastromal injection of 100 colony forming units (CFU) of MRSA, which resulted in greater than 10(6) CFU per cornea by 12 hr postinfection. Chemotherapy (one drop every 15 min) was given from 4-9, 10-15, or 10-20 hr postinfection. Early therapy (4-9 hr postinfection) with ciprofloxacin rendered all eyes free of bacteria; ciprofloxacin was significantly more effective than vancomycin or cefazolin. When treatment was initiated 6 hr later (10-15 hr postinfection), no corneas became free of bacteria, but ciprofloxacin was again more effective than vancomycin or cefazolin. Bacterial killing by ciprofloxacin after treatment from 10-20 hr postinfection was also significantly greater than that of vancomycin. Overall, the results show that ciprofloxacin is effective in killing methicillin-resistant staphylococcus aureus, and is most effective when applied during the very early stages of infection.

Animals↗
PubMed1992

Topical antibiotic therapy for the treatment of experimental Staphylococcus aureus keratitis.

A rabbit model of Staphylococcus aureus keratitis was developed to study the chemotherapeutic efficacy of ciprofloxacin, vancomycin, and cefazolin. Intrastromal injection of 100 colony forming units of log phase S. aureus ATCC strain 25923 resulted in rapid growth in the cornea, peaking at 10(7) cfu/cornea by 12 hr post-infection. Slit-lamp examination revealed that infected eyes reached 30% of maximum inflammation by 10 hr and 60% by 22 hr post-infection. Antibiotic therapy (one drop every 15 min for 5 hr) was initiated at 4 hr post-infection (experiment 1) or 10 hr post-infection (experiment 2). Another group was initiated at 10 hr post-infection and treated for 10 hr (experiment 3). In experiment 1, treatment from 4-9 hr post-infection with 0.3% ciprofloxacin drops decreased the cfu per cornea 6.1 logs, compared to placebo-treated controls (P = 0.0001), and rendered 50% of inoculated eyes sterile. Vancomycin (5.0%) and cefazolin (5.0%) each lowered the cfu per cornea 4.6 logs (P = 0.0187) but did not sterilize any eyes. In experiment 2, therapy from 10-15 hr post-infection with 0.3% ciprofloxacin reduced the cfu per cornea 0.9 logs (P = 0.0001). Vancomycin (5.0%) and cefazolin (5.0%) decreased the cfu per cornea 0.2 logs (P = 0.3973) and 0.3 logs (P = 0.1307), respectively. In experiment 3, therapy from 10-20 hr post-infection with 0.3% ciprofloxacin reduced the cfu per cornea 3.9 logs (P < 0.0001). In this keratitis model, ciprofloxacin was more effective than vancomycin or cefazolin in killing S. aureus.

Animals↗
PubMed1992

EGF cell surface receptor quantitation on ocular cells by an immunocytochemical flow cytometry technique.

A method is presented for the rapid flow cytometric determination of epidermal growth factor (EGF) receptor densities on the surface of cultured ocular cells. The technique uses a biotinylated monoclonal antibody directed against the EGF receptor in conjunction with a streptavidin-bound fluorochrome and requires the specific fluorescence per cell to be measured as a function of ligand and receptor concentration. Because the measurement is noninvasive and restricted to cell surface-bound material, the cells can be kept in a physiologic environment, even at the moment of assay. Calculated receptor densities ranged from 5142/cell (infant human corneal endothelium) to 35,678/cell (infant human keratocytes) to greater than 5 x 10(5)/cell for an A431 control cell line. Species and donor age differences were noted, as was transient receptor downregulation after EGF administration. Flow cytometry represents a valuable time saving procedure for large scale applications while providing the same level of sensitivity as standard radioimmunoassays. This technique is applicable to quantitation of other growth factor cell surface receptors and could greatly expand the use of flow cytometry in the research laboratory.

Animals↗
PubMed1991

Successful treatment of methicillin-resistant Staphylococcus aureus Keratitis with topical ciprofloxacin.

Ciprofloxacin is a new quinolone antibiotic with a broad spectrum of activity against most aerobic gram-positive and gram-negative bacteria. Topical ciprofloxacin (3 mg/ml) was used to treat bacterial keratitis caused by methicillin-resistant strains of Staphylococcus aureus in two patients. Both corneal ulcers had been previously treated with other antibiotics without success. Topical ciprofloxacin was curative in both cases. The authors recommend the use of topical ciprofloxacin for methicillin-resistant S. aureus keratitis.

Administration, Topical↗
PubMed1991

Heterologous transplantation versus enhancement of human corneal endothelium.

The ability to successfully transplant human corneal endothelium would offer a significant advance in the treatment of many corneal diseases. To investigate the feasibility of this, we established cultures of endothelial cells derived from neonatal human corneas. Eye bank donor corneas were either enhanced with a suspension of cultured endothelial cells or underwent endothelial cell removal and subsequent replacement with cultured endothelium. Following a 48-h incubation, the corneas were transplanted into the eyes of nonhuman primates. Over a 12-month period, 67% of the corneas with complete endothelial cell replacement thinned and remained clear, with a mean corneal thickness of 0.57 mm. Enhanced corneal buttons demonstrated a significantly lower success rate (35%), with opacified and thickened corneas. Control eyes in which the native endothelium was removed demonstrated advanced corneal edema and vascularization, with a mean corneal thickness in excess of 1 mm. By utilizing established tissue-culture techniques, we have demonstrated that human corneal endothelium, when cultured and subsequently transplanted, retains its in vivo pump function. Although further studies are warranted, these results indicate that transplanted human corneal endothelial cells can function normally and suggest the possibility of endothelial cell replacement for therapeutic purposes.

Animals↗
PubMed1991

Infection of rhesus monkeys with topical instillation of simian immunodeficiency virus (SIV)B670 into the conjunctival sac.

We tested the ability of SIV to cause local and systemic infection in three rhesus monkeys after topical instillation of cell-free virus into the conjunctival cul-de-sac. Conjunctivitis or other signs of infection were monitored after inoculation. Conjunctiva were swabbed for virus culture and biopsied for PCR. Changes in lymphocyte subsets, seroconversion, antigenemia, and virus isolation from PBL were assessed systemically postinoculation. Viral DNA was detected in conjunctival biopsy by PCR in one of three animals that later developed systemic infection. The other two animals remained uninfected. These data demonstrate that the conjunctiva is a route by which SIV (and perhaps HIV) may cause systemic infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Extended incubation times improve corneal endothelial cell transplantation success.

To investigate the ability of extended incubation times to improve the success of endothelial cell transplantation, eight human donor corneas were denuded of their native endothelium, seeded twice during a 1-hr interval with a suspension of cultured infant human corneal endothelial cells, and then incubated for 144 hr under standard conditions. Subsequently the corneas were transplanted into African green monkeys using routine penetrating keratoplasty techniques. Rotational autografts and corneas devoid of endothelial cells served as controls. The seeded corneas appeared hazy at the time of surgery (mean pachymetry 48 hr postoperatively, 0.794 mm). Six corneas (75%) subsequently cleared, yielding a mean corneal thickness of 0.541 +/- 0.040 and 0.554 +/- 0.040 at 6 and 12 postoperative months, respectively. All control eyes showed advanced edema (thickness, greater than 1.0 mm) and developed extensive neovascularization. Clinically, the extended postseeding incubation corneas were observed to clear more rapidly and stabilize their thickness earlier than corneas incubated for only 24-48 hr. Scanning electron microscopy of extended postseeding incubation corneas revealed an intact monolayer of contact-inhibited cells with the hexagonal mosaic typical of corneal endothelium in vivo and improved intercellular contact compared with corneas incubated for only 24-48 hr.

Animals↗
PubMed1990

Penetrating keratoplasty for keratoconus in Down's syndrome.

Five patients with Down's syndrome underwent penetrating keratoplasty for keratoconus. In three patients, the indication for surgery was acute corneal hydrops, which had not resolved in the three months before surgery. The other two patients had corneal scars. Two patients had combined penetrating keratoplasty, cataract extraction, and intraocular lens insertion. Four of the five patients maintained clear grafts at their most recent follow-up examination. Two of the five patients had one or more graft reaction episodes; one graft was lost. Good results can be obtained in penetrating keratoplasty for keratoconus in patients with Down's syndrome who do not demonstrate a tendency toward excessive eye rubbing and for whom a single observant caretaker can be relied on to provide consistent postoperative care.

Adult↗
PubMed1990

Topographic changes in contact lens-induced corneal warpage.

Twenty-one eyes of 12 patients with contact lens-induced corneal warpage were followed prospectively using computer-assisted topographic analysis. Sixteen eyes had worn rigid contact lenses (13 eyes, polymethylmethacrylate; three eyes, gas-permeable), and five eyes had worn soft contact lenses. Initial corneal topographic patterns were characterized by the presence of central irregular astigmatism, loss of radial symmetry, and frequent reversal of the normal topographic pattern of progressive flattening of corneal contour from the center to the periphery. A correlation was noted between the initial corneal topography and the resting position of the contact lens on the cornea for nine of the 16 eyes with rigid contact lenses. Initial topography for each of these corneas showed relative flattening of the corneal contour underlying the resting position of a decentered contact lens. Superior-riding lenses produced a topography that simulated early keratoconus. After cessation of contact lens wear, 16 of 21 eyes had a change in corneal shape to a topography that was consistent with a normal pattern. Five corneas stabilized with an abnormal topographic pattern. A much longer time without contact lenses than had been previously reported, up to 5 months, was required for a return of a stable corneal topography in eyes with contact lens-induced corneal warpage caused by rigid lenses.

Astigmatism↗