Biomedical subjects
Publications and source records attributed to R A Eiferman.
We report herein a patient with iridoschisis and keratoconus. Since the posterior layers of the cornea and the iris stroma have a common embryological deviation, the combination of these two conditions suggests an inter-related pathogenesis. This case is similar to those of patients with progressive essential iris atrophy and keratoconus described by Cavanagh.
Corneal transparency is maintained by an active transport system, located at the endothelial cell membranes. This bicarbonate-dependent pump counteracts the tendency of the corneal stroma to absorb water, swell and become opaque. Carbonic anhydrase inhibitors (CAI) are capable of attenuating the bicarbonate efflux, therefore causing thickening of the cornea. Eight novel sulfonamides were evaluated as potential probes for assessing the corneal endothelial functional reserves. Five of the six thiadiazoles and both benzothiazoles have demonstrated carbonic anhydrase inhibitory properties in vitro. Of the eight compounds tested, 2-ethyladipoyl-1,3,4-thiadiazole-5-sulfonamide (compounds III), 2-epoxy-1,3,4-thiadiazole-5-sulfonamide (compound V), and 2-acetamido-1,3,4-thiadiazole-5-N-methylsulfonamide (compound VI) have induced reversible corneal thickening. Although statistically significant (p < 0.05), the magnitude of the pachymetric effect did not exceed 6-10% of the total corneal thickness, probably because carbonic anhydrase (CA) is only one component of the active pump complex. The fact that a non-CAI (compound VI) was capable of inducing a reversible corneal thickening may suggest that other mechanisms are involved. Further studies will be conducted to identify a pharmacological agent capable of reversibly inhibiting the endothelial function in normal and diseased corneas, with a higher magnitude of effect.
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Excimer photorefractive keratectomy was performed at three centers on 16 highly myopic eyes (8 diopters [D] or more) and followed up for 6 months. Ablation depths ranged from 137 to 230 microns. The preoperative spherical equivalent of myopia ranged from -8.62 D to -14.50 D (mean +/- SD, -11.57 +/- 1.62 D). Six months after surgery, the mean refraction (spherical equivalent) was -0.90 +/- 2.13 D. Eleven of 16 eyes achieved refractions within 2 D of that attempted. All eight patients at one site were treated with a maximum-beam diameter of 6.0 mm and were corrected to within 2 D of that attempted, and all were 20/40 or better uncorrected. Three of eight eyes at the other two sites were treated with a 5.5- or 5.6-mm maximum-beam diameter, which achieved corrections within 2 D of that attempted. The epithelium healed within 3 to 4 days, and there were no erosions. Mild subepithelial reticular haze, similar to that seen with excimer photorefractive keratectomy for lower myopia, was seen in all patients, with two patients experiencing more significant corneal haze. This peaked at 3 to 6 weeks and then gradually diminished. All but two patients had a return of their best corrected preoperative visual acuity to within one Snellen line at 6 months. This preliminary study shows excimer photorefractive keratectomy to be a promising surgical treatment for patients with higher myopia.
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Peptide growth factors and other physiological growth modifiers were evaluated for their ability to stimulate DNA synthesis in early passage cultures of bovine corneal endothelial cells (BCEC). Increasing concentrations of newborn bovine serum (0.5-10%) causes a progressive increase in DNA synthesis, which approached a plateau at 10% serum. Supplementing medium with 10% serum from different lots of newborn bovine serum or fetal bovine serum stimulated significantly different levels of DNA synthesis by BCEC. Addition of epidermal growth factor (EGF) (2 nM) to medium containing 10% newborn or fetal bovine serum further increased DNA synthesis. Dose-response curves for EGF, transforming growth factor-alpha, basic fibroblast growth factor (bFGF), and insulin-like growth factor I showed that each significantly stimulated high levels of DNA synthesis (200-700% increase) compared with BCEC cultured in serum-free medium. Vaccinia growth factor, insulin, and transforming growth factor-beta each significantly stimulated lower levels of DNA synthesis (30-200% increase), whereas nerve growth factor, multiplication stimulating activity, and platelet-derived growth factor all failed to significantly stimulate DNA synthesis above the level of serum-free medium. Other physiological growth modifiers were tested for their effects on DNA synthesis of BCEC. Transferrin and low levels of 3',5'-cyclic monophosphate (cAMP) stimulated very low levels of DNA synthesis (50% increase) whereas linoleic acid, high levels of selenium, or cAMP each inhibited DNA synthesis 25-75% below the level of BCEC cultured in serum-free medium. A series of eight formulations containing various combinations of EGF, FGF, insulin, transferrin, selenium, linoleic acid, retinoic acid, cAMP, heparin, and endothelial cell growth factor were tested for their mitogenic action on BCEC cultures. A formulation containing EGF, insulin, transferrin, selenium, and linoleic acid (EGF + ITSL) stimulated the highest level of DNA synthesis of BCEC, which was approximately 25% higher than the increase stimulated by addition of 10% newborn bovine serum. The formulation consisting of EGF + ITSL was also evaluated as a supplement to corneal storage media. Addition of EGF + ITSL to three corneal storage media (McCarey-Kaufman, K-Sol, CSM) significantly stimulated increases in cell numbers of approximately 50% above the unsupplemented corneal storage media. These results demonstrate that BCEC respond selectively to different defined peptide growth factors and physiological growth modifiers, and suggest that supplementation of corneal storage media with a defined formulation (EGF + ITSL) may enhance corneal endothelial cell density.
Epidermal growth factor (EGF) is a potent mitogen for corneal endothelial cells and may play a role in endothelial wound healing. To further characterize the interaction of EGF with endothelial cells, we measured biochemical parameters of 125I-EGF binding to cultured bovine corneal endothelial cells (BCEC), determined the pattern of EGF-induced protein phosphorylation, and investigated the influence of retinoic acid (RA) and transforming growth factor beta (TGF-beta) on EGF-induced DNA synthesis and receptor levels. Binding of 125I-EGF to BCEC was dependent on time, reaching a plateau after approximately 2 h at 37 degrees C, was specific for EGF, and had high affinity (Kd = 100 pM) with approximately 21,000 receptors per cell. Cellular substrates for the EGF receptor kinase, which may function as initial second messengers for EGF, were detected by autoradiography of sodium dodecyl sulfate polyacrylamide gels of 32P-labeled BCEC proteins. EGF stimulated phosphorylation of 170, 37, 21 and 20-kDa proteins. Addition of 1 nM, 100 nM, and 10 microM RA to BCEC cultured in serum-free medium for 24 h progressively inhibited DNA synthesis by up to 80% compared with control cultures. However, when added in combination with 5 nM EGF, 1 nM and 100 nM RA synergistically stimulated DNA synthesis by up to 80% above the level of EGF stimulation without altering EGF receptor levels or binding affinity. Thus, short-term exposure of BCEC to RA potentiated EGF-stimulated DNA synthesis, most likely by acting at a postreceptor step.(ABSTRACT TRUNCATED AT 250 WORDS)
Endothelin, a potent vasoconstrictor, was found to be ineffective in the treatment of experimentally induced corneal neovascularization. Endothelin was administered topically, subconjunctivally, and intraluminally in serial concentrations ranging from 0.0005 to 5.0 micrograms/mL in New Zealand white rabbits without effect. Electron microscopy of the neovascular cornea revealed the vessels consisted only of endothelin and pericytes. Hence, the vessels were not responsive to endothelin because they lacked contractile smooth muscle.
Spontaneous iris stromal cysts are rare and usually are identified early in life. They resemble implantation iris cysts after nonsurgical and surgical trauma; both have an epithelium which usually is conjunctival in nature. However, in spontaneous iris stromal cysts, no ocular trauma history is found. We present a case report and review of literature.
We studied the potency of fortified ophthalmic antibiotic preparations of cefazolin sodium (50 mg/ml) and tobramycin sulfate (15 mg/ml), as measured by the minimum inhibitory concentration, against Streptococcus pneumoniae and Pseudomonas aeruginosa, respectively. We also examined absorbance spectra, pH, and the effect of storage temperature on these fortified solutions to determine their stability over a four-week period. Cefazolin and tobramycin maintained a constant potency throughout the experiment. There was no difference in potency if the fortified solutions were stored at 4 C or 24 C. Cefazolin stored at 24 C exhibited changes in both its absorbance spectra and pH after seven days. Cefazolin stored at 4 C and tobramycin stored at 24 C and 4 C remained stable throughout the four-week period.
Phototherapeutic keratectomy using a 193-nm excimer laser was performed at four centers on 33 sighted patients with corneal opacity and/or irregular astigmatism. Pathologic conditions included anterior stromal and superficial scarring from postinfectious and posttraumatic causes, including inactive herpes simplex virus, anterior corneal dystrophies, recurrent erosions, granular dystrophy, and band keratopathy. Most patients received peribulbar anesthesia and underwent removal of the epithelium prior to laser ablation. A majority of patients had a reduction in the amount of corneal scarring and approximately half had improved visual acuity. No intraocular reaction or changes in endothelial counts were seen, and some patients avoided the need for penetrating keratoplasty. Reepithelialization usually occurred within 4 or 5 days and we noted no significant scarring secondary to use of the laser. It was difficult to eliminate preexisting irregular astigmatism despite the use of surface modulators, such as methylcellulose. A hyperopic shift secondary to corneal flattening was encountered in approximately 50% of the patients. A combination of myopic ablation, followed immediately by a secondary hyperopic steepening, may minimize this refractive change. The 193-nm excimer laser is an effective new tool in the treatment of selected patients with superficial corneal opacity from a variety of conditions.
Three patients with corneal ulcers had gram-positive cocci isolated on initial scrapings. There was no response to topical fortified aminoglycosides or cephalosporins. Cultures revealed methicillin-resistant Staphylococcus aureus that was sensitive only to topical vancomycin eye drops. Because the microbiologic spectrum is similar, vancomycin should be considered instead of a cephalosporin in the treatment of corneal ulcers to cover methicillin-resistant S. aureus and S. epidermidis.
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Explore the source record for details and available documents.