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Biomedical subjects

R D Stulting

Publications and source records attributed to R D Stulting.

At least 73 records · Page 4Linked to original sources
PubMed1990

Iris melanoma seeding through a trabeculectomy site.

A 59-year-old man who had previously undergone a trabeculectomy in his right eye was examined because of an enlarging pigmented lesion of the inferior portion of the iris. A fine-needle aspiration biopsy of aqueous fluid revealed spindle cells and epithelioid malignant melanoma cells. The eye was enucleated, and subsequent histopathologic examination demonstrated a mixed spindle cell and epithelioid cell melanoma of the inferior portion of the iris with seeding of melanoma cells into the conjunctival filtering bleb via the trabeculectomy site. This case illustrates the usefulness of fine-needle aspiration biopsy in the evaluation of pigmented iris lesions and illustrates that iris melanoma can seed through a trabeculectomy site.

Aqueous Humor↗
PubMed1990

Corneal and conjunctival crystals in paraproteinemia.

A 64-year-old woman with bilateral corneal and conjunctival crystal deposition was evaluated. A biopsy of her conjunctiva showed intracytoplasmic inclusions of immunoglobulin crystals in fibrocytes, macrophages, and endothelial cells. Serum protein electrophoresis showed elevated kappa and IgA light and heavy chains which corresponded with immunoperoxidase staining results of the conjunctival biopsy. Conjunctival and corneal crystal deposition may be indicative of paraproteinemia, and histopathologic examination of a conjunctival biopsy may be useful in diagnosing this condition.

Conjunctival Diseases↗
PubMed1990

Interleukin-2 induces corneal neovascularization in A/J mice.

Mitogen-stimulated lymphocytes induce a highly reproducible form of corneal neovascularization (CNV) in inbred mice. To determine if supernatants derived from stimulated lymphocytes and their constituent mediators were also angiogenic, we injected conditioned medium (CM) from mitogen-stimulated lymphocytes, control non-conditioned medium, recombinant interleukin-2 (rIL-2), or control bovine serum albumin (BSA), a component of rIL-2, into the corneas of syngeneic A/J mice. Control, nonconditioned medium was not angiogenic. While the other injections all induced some CNV, the CM and rIL-2 both induced a significantly greater area of CNV than BSA (p less than 0.05). The area of CNV induced by the CM was greater than that induced by IL-2 (p = 0.03). These data show that IL-2, which stimulates vascular endothelial cells in vitro and is elaborated during corneal immune reactions in vivo, is one of the potential mediators of immunologically mediated CNV.

Animals↗
PubMed1990

The effect of external ocular compression on intraocular pressure following retrobulbar anesthesia.

Thirty consecutive patients scheduled for cataract surgery were randomized to external compression with the Honan intraocular pressure (IOP) reducer or digital pressure. The average increase in IOP after retrobulbar injection of 4 ml of anesthetic was 6.20 mm Hg. This increase was followed by a rapid decline in IOP within the first 2 1/2 minutes, averaging 1.20 mm Hg +/- 0.70 below baseline level for the Honan group and 1.00 mm Hg +/- 0.96 below baseline level for the digital group. From 5 to 10 minutes after injection there was a more gradual decline in IOP that averaged 0.35 mm Hg/min in the Honan group and 0.36 mm Hg/min in the digital group. After 10 minutes of external compression the IOP was 5.73 mm Hg +/- 0.96 below baseline level in the Honan group and 4.67 mm Hg +/- 0.64 below baseline level in the digital group. No statistical difference between the IOP measurements of the two groups was observed at 2 1/2 minutes at 5 minutes, or at 10 minutes.

Anesthesia, Local↗
PubMed1989

Immunohistochemical evaluation of murine HSV-1 keratouveitis.

The intraocular inflammatory reaction in a murine model of herpes simplex keratouveitis was studied using immunohistochemical techniques. 5 x 10(5) PFU of HSV-1 (Stewart strain) was applied to the abraded cornea of BALB/c mice. The subsequent development of keratouveitis was documented by sequential examination, conventional histology and immunohistochemical staining of frozen sections with the following monoclonal antibodies: Thy-1, Lyt-1, Lyt-2, Ia, Mac-1 and Lyb-8.2. At one week (in the early stage) there was moderate central corneal edema with inflammatory cell infiltration, consisting of a predominance of polymorphonuclear leukocytes, with the appearance of helper/inducer T-cells(Th/i). At two weeks (in the middle stage), a geographic corneal ulcer developed and the majority of inflammatory cells were still polymorphonuclear leukocytes. However, there was a further increase in the Th/i cell population, with the first appearance of B-cells. At three weeks (in the late stage), a dense stromal corneal scar was observed and there was a decrease in the inflammatory cell population, with the predominant cell being the B-cell. Throughout the evolution of HSV-1 keratouveitis, a mild inflammatory reaction was observed in the uvea. However, the number of inflammatory cells present was too small to allow more definitive characterization. Patchy Ia staining which is noted in the normal choroid increased markedly throughout the keratouveitis.

Animals↗
PubMed1989

Penetrating keratoplasty in the management of iridocorneal endothelial syndrome.

The clinical results of penetrating keratoplasty for iridocorneal endothelial (ICE) syndrome are presented. Nine cases of penetrating keratoplasty for ICE syndrome were reviewed retrospectively. All grafts remain clear, with posterior corneal changes occurring in only one case, after a mean follow-up of 43 months. Penetrating keratoplasty produced visual improvement in 7 of the 9 cases, relief of pain in 6 of 6 cases, and prevention of further corneal infection in 1 case. We believe that penetrating keratoplasty has a place in the treatment regimen of this disease, not only to achieve improvement in vision, but also for relief of pain, and avoidance of recurrent corneal infections, and to allow a clear media for careful monitoring of optic disc and field changes in the associated glaucoma.

Adult↗
PubMed1988

Laser trabeculoplasty for glaucoma in aphakic and pseudophakic eyes after penetrating keratoplasty.

We used argon laser trabeculoplasty to treat medically uncontrolled glaucoma after penetrating keratoplasty in ten eyes that were aphakic or pseudophakic. These patients were examined over an average of 22.8 months (range, 12 to 37 months) after treatment. We found an average decrease in intraocular pressure of 9.1 mm Hg (range, +8 to -19), from an average of 30.6 mm Hg before treatment to an average of 21.5 mm Hg after treatment. Eight of ten eyes had a reduction of greater than 5 mm Hg, and six of ten eyes had intraocular pressure of less than 20 mm Hg. Visual function remained stable, and complications were rare. We now prefer argon laser trabeculoplasty to cyclocryotherapy for the initial treatment of patients with medically uncontrolled glaucoma who have predominantly open angles and a clear penetrating keratoplasty.

Aged↗
PubMed1988

Late bacterial and fungal keratitis after corneal transplantation. Spectrum of pathogens, graft survival, and visual prognosis.

The authors reviewed 108 bacterial and fungal corneal ulcers that developed 1 to 72 months after penetrating keratoplasty in 79 eyes of 78 patients. Graft hypesthesia, topical corticosteroid and antibiotic treatment, exposed sutures, epithelial defects, and poor visual acuity commonly predated infectious keratitis. There were 69 bacterial, 34 fungal, and 5 combined infections. Candida albicans and Staphylococcus epidermidis were the most common pathogens. Follow-up after infection averaged 23 months (range, 1-80 months). Despite hospitalization and fortified topical antibiotic treatment, complications such as wound dehiscence and corneal perforation necessitated emergency regraft in 38 (35%) cases. Of 73 previously clear grafts, only 29 (40%) retained clarity. Median visual acuity, 20/200 before infection, fell to counting fingers at last follow-up; 12 eyes lost light perception.

Adolescent↗
PubMed1988

Effect of donor epithelium on corneal transplant survival.

Two hundred thirty-two penetrating keratoplasties in 228 eyes were performed with or without the removal of donor corneal epithelium in a prospective, randomized clinical trial to determine the effect of epithelial removal on graft survival. The removal of epithelium did not reduce the likelihood of graft failure, irreversible allograft reaction, or reversible allograft reaction.

Corneal Transplantation↗
PubMed1988

Variation in the number of sites of latency of herpes simplex virus in trigeminal ganglia of inbred mice.

Following uniocular topical corneal inoculation with herpes simplex virus type 1 (HSV), 176-fold more virus was recovered by 14-day cultivation in vitro from latently infected ipsilateral trigeminal ganglia (TG) of BALB/c mice than from TG of C57BL/6 mice (p = 0.002). Since these quantitative differences may reflect a difference in the number of latently infected cells or a difference in the ability of virus to replicate in secondarily infected cells during cultivation in vitro, experiments were designed to estimate the actual number of sites of latency. Two to four months after topical corneal inoculation, when no active ocular disease was present, minced TG were digested with 2% collagenase. The dissociated cells were placed on monolayers of vero cells, incubated at 31 degrees C, and observed for cytopathic effect (CPE) for 14 days. Ipsilateral TG from BALB/c mice produced five-fold more foci of infection than TG from C57BL/6 mice (p = 0.007). The number of foci of infection was also dependent upon the dose of virus used to infect the eye. Following infection with high doses of HSV, virus was reactivated from contralateral TG, but in lower numbers than from ipsilateral TG. In vitro studies showed that the replication of virus in ganglia from BALB/c mice was 3-8-fold greater than that in ganglia from C57BL/6 mice. These data support the hypothesis that host genetic factors and the number of infectious particles inoculated influence the number of latently infected cells in the trigeminal ganglion after corneal infection with HSV.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Recovery of herpes simplex virus from ocular tissues of latently infected inbred mice.

Evidence for latent infection of ocular tissues following topical corneal inoculation with herpes simplex virus type 1 (HSV) was sought in three strains of inbred mice that differ in susceptibility to HSV stromal keratitis. Corneas of BALB/c, C57BL/6, and DBA/2 mice were inoculated topically with HSV. At 6-8 weeks after inoculation, when no active ocular infection was present, minced whole eyes and trigeminal ganglia were assayed for latent virus. Virus was recovered by explantation from minced eyes of all three strains (DBA/2 = 20%; BALB/c = 17%; C57BL/6 = 7%). In order to determine which ocular structures harbored virus, corneas, retinas and choroid-sclera were cultivated separately. Virus was activated from corneas of DBA/2 and BALB/c mice, but not from corneas of C57BL/6 mice. These findings suggest that HSV is capable of establishing latent infection in ocular tissue of inbred mice and that the rate of establishment of latency is under host genetic control. Since neural cell bodies are not present in the cornea, the data suggest that latency is established in cells other than neurons.

Animals↗
PubMed1988

The effect of selective suture removal on astigmatism following penetrating keratoplasty.

We retrospectively evaluated selective removal of interrupted nylon sutures to reduce astigmatism following penetrating keratoplasty in 68 eyes with eight or 12 interrupted sutures and one running suture. Following removal of one to four interrupted sutures at one visit (N = 234 visits), corneal astigmatism had changed 2 to 3 diopters (range 0 to 12 D) by the next visit. The astigmatism decreased greater than or equal to 1 D in 54%, changed 0 to .87 D in 28%, and increased greater than or equal to 1 D in 18%. When a total of five or six sutures were removed during the 5 months following surgery, less than 3 D of residual astigmatism was present in 50 eyes (74%). The axis of astigmatism changed less than or equal to 40 degrees in 74% (n = 65). In a second group of 20 eyes with double running sutures, removal of the 10-0 running suture in all 20 eyes produced an average change of 1.8 D (range = 0 to 3.75 D), with an equal number of increases and decreases. Vector analysis showed the total induced change in astigmatism was approximately twice the absolute keratometric change.

Astigmatism↗
PubMed1988

Modulation of HLA antigen expression on corneal epithelial and stromal cells.

Human corneal epithelial cells and stromal fibroblasts in culture were incubated with gamma interferon or with medium conditioned by phytohemagglutinin (PHA)-stimulated mononuclear cells. The corneal cells were placed into suspension, assayed for class I (HLA-A,B,C) and class II (HLA-DR) antigens by indirect immunofluorescence, and analyzed with flow cytometry. Epithelial cells treated for 5 days with conditioned medium (CND-M) did not exhibit an increase in class I or an induction of class II antigen expression, although a trend toward increased class I antigen expression was present. Epithelial cells treated for 5 days with 250-500 U/ml of gamma interferon did not demonstrate an increase in class I but did show an induction of class II antigen expression; again, however, a trend toward increased class I antigen expression was present. Stromal fibroblasts treated for 3-5 days with CND-M exhibited an increase in class I antigen expression, but stromal fibroblasts treated for 1-5 days with CND-M did not show an induction of class II antigen expression. Stromal fibroblasts incubated for 1-5 days with 250-750 U/ml of gamma interferon demonstrated both an increase in class I and an induction of class II antigen expression. These data suggest that host lymphokines may intensify the process of corneal graft rejection by augmenting class I antigen expression on allogeneic cells. Moreover, the induction of class II antigen expression by host lymphokines on cells in transplanted corneal tissue may lead to host sensitization and subsequent allograft rejection.

Cornea↗
PubMed1988

Analysis of human corneal IgG by isoelectric focusing.

Parameters which regulate the localization and retention of IgG within the corneal stroma are complex and poorly understood. Although multiple factors are involved, electrostatic interactions between IgG and anionic corneal tissue components, ie, proteoglycans (PG) and glycosaminoglycans (GAG) may regulate the distribution of antibodies within the corneal stroma. Isoelectric focusing (IEF) and blotting analysis of IgG revealed a restricted pI profile for both central and peripheral regions of the normal cornea. Similar analysis of pathological corneas from keratoplasty specimens in Fuchs' dystrophy and keratoconus reveal a variable IEF profile. In the majority of keratoplasty specimens from patients with corneal edema or graft rejection, there was generally little or no IgG detectable. These results suggest that in edematous corneas where there is altered PG/GAG in the stroma and modified fluid dynamics, there is a concomitant loss of IgG. These findings may have implications for immunologic surveillance and protection of the avascular cornea.

Alkalies↗
PubMed1987

Penetrating keratoplasty for pseudophakic corneal edema with exchange of intraocular lenses.

We studied one eye in each of 25 consecutive patients with pseudophakic corneal edema. Each patient underwent a penetrating keratoplasty with exchange of intraocular lenses and was followed up for 12 to 38 months (mean, 18.7 months). The corneal graft remained clear in 22 (88%) eyes, but only eight eyes (32%) had acuity of 20/40 or better; nine eyes (36%) manifested cystoid macular edema, and six eyes (24%) had degenerative maculopathy. Elevated intraocular pressure was present in 12 eyes after surgery, with three eyes manifesting visual field loss; in all eyes the condition was controlled medically. Peripheral anterior synechiae appeared postoperatively in two eyes. We now treat severe cases of pseudophakic corneal edema with a penetrating keratoplasty, meticulous anterior vitrectomy, gonioplasty, iridoplasty, and exchange of intraocular lenses, employing a flexible-loop anterior chamber lens or a posterior chamber lens sutured to the iris.

Adult↗