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Biomedical subjects

Terry Kim

Publications and source records attributed to Terry Kim.

17 recordsLinked to original sources
PubMed2007

Tissue adhesives in corneal cataract incisions.

PURPOSE OF REVIEW: The purpose of this review is to provide an updated overview of the peer-reviewed literature on the use of a variety of tissue adhesives used to seal corneal incisions in cataract surgery. We will review recent publications on the complications, safety profile, and efficacy of currently available and investigational tissue adhesives used for corneal incisions. We will also briefly review the relationship between clear corneal incisions and postoperative endophthalmitis. RECENT FINDINGS: Tissue adhesives have recently been investigated as alternate methods for corneal wound closure. Cyanoacrylate and fibrin glues are used widely because of their safety and effectiveness in sealing corneal incisions. However, both of these adhesives have certain limitations. For instance, cyanoacrylate adhesives have been shown to cause foreign-body sensation, local inflammatory reaction, and conjunctival hyperemia. Fibrin-based adhesives carry the disadvantages of prolonged preparation time, increased cost, and the theoretical risk of viral transmission. SUMMARY: Whereas currently available adhesives offer an alternative to sutures, other novel biomaterials are being evaluated for the sealing of corneal and cataract incisions. Hopefully, these studies will result in an optimal material tailored for ophthalmic use to facilitate wound closure and healing with an improved side-effect and biocompatibility profile.

Cataract Extraction↗
PubMed2006

Treatment of traumatic LASIK flap dislocation and epithelial ingrowth with fibrin glue.

PURPOSE: To describe a case of a traumatic late dislocation of a laser-assisted in situ keratomileusis (LASIK) flap complicated by epithelial ingrowth. DESIGN: Interventional case report. METHODS: A 50-year-old woman presented 21 months after uncomplicated LASIK with painful vision loss in the right eye after minor trauma. RESULTS: A dislocation of the LASIK flap was noted at examination and was repositioned. One week later, epithelial ingrowth was detected in the flap interface. The ingrowth was treated with flap lifting, debridement, and sealing of the flap with fibrin glue. Visual acuity returned to baseline, and there was no recurrence after 20 months of follow-up. CONCLUSIONS: Traumatic dislocations of LASIK flaps may occur many months after uncomplicated surgery and may be associated with epithelial ingrowth after successful repositioning. The additional use of fibrin glue in conjunction with thorough debridement may be helpful in preventing the recurrence of epithelial ingrowth.

Corneal Stroma↗
PubMed2006

Ocular permeation and inhibition of retinal inflammation: an examination of data and expert opinion on the clinical utility of nepafenac.

BACKGROUND: The efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation in the anterior segment, and pain control after cataract surgery, is well established. However, their effectiveness in the posterior segment has not been as well studied. Nepafenac ophthalmic suspension, 0.1% is a new topical NSAID pro-drug that has been approved by the US Food and Drug Administration (FDA) for the treatment of pain and inflammation after cataract surgery. Preclinical data suggest nepafenac may also provide unique efficacy in the posterior segment. SCOPE: We searched the PubMed database from 1966 to 2005 for various combinations of the search terms 'nepafenac', 'ophthalmic', 'inflammation', 'anterior segment', and 'posterior segment'. We review here the three articles identified in the search, and also include findings from three recent clinical trials. RESULTS: Nepafenac's corneal permeability characteristics are superior to those of ketorolac tromethamine, diclofenac sodium, and bromfenac sodium. Nepafenac is hydrolyzed by intraocular tissues to amfenac, a potent cyclooxygenase inhibitor. In addition to a limited hydrolysis in the cornea, significant bioactivation occurs in the iris/ciliary body and retina/choroid. Nepafenac administration significantly suppresses PGE2 synthesis in the retina/choroid. Topical nepafenac administration also significantly inhibits prostaglandin (PG)-mediated blood-retinal barrier breakdown and concurrent protein extravasation into the vitreous. In these studies, topical ketorolac and diclofenac failed to inhibit these key markers of inflammation. Nepafenac's clinical effectiveness in the posterior segment may be explained by its superior corneal permeation, biodistribution, and bioactivation to amfenac by the target tissues (i.e., iris, ciliary body, retina, and choroid) known to generate PGs. CONCLUSIONS: Nepafenac's ability to inhibit PG synthesis in the retina/choroid following topical administration indicates the drug also targets suppression of PG synthesis in the posterior segment. Nepafenac may therefore have a clinical role in conditions that are caused by PG-mediated vascular leakage, such as anterior chamber inflammation and cystoid macular edema following cataract surgery.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Novel tissue adhesives to secure laser in situ keratomileusis flaps.

PURPOSE: To evaluate 2 novel biodendrimer tissue adhesives in sealing and securing laser in situ keratomileusis (LASIK) flaps. SETTING: Duke University Eye Center, Durham, North Carolina, USA. METHODS: Laser in situ keratomileusis flaps were created in 10 human eye-bank eyes using the Hansatome microkeratome system (Bausch & Lomb). These eyes were divided into 2 groups. Flaps in the first group (n=4) were secured with a laser-activated biodendrimer adhesive along the flap edge. In the second group (n=6), the flaps were secured with a self-gelling dendritic adhesive. Dry Merocel sponges (Medtronic Solan) were used to test the strength of flap adherence in both groups. Further testing was performed in the second group. The hinges of these flaps were cut with a scalpel blade and fluorescein dye was injected under the flap to observe potential dye leakage along the flap edge. RESULTS: Laser in situ keratomileusis flaps sealed with both adhesives were secure with no flap dislocation. There was no leakage of fluorescein dye observed in the second group. Both adhesives were easy to apply, clear when dry, and had a soft rubbery consistency. CONCLUSIONS: Two novel biodendrimer adhesives successfully sealed and secured LASIK flaps. These adhesives may prove to be an effective alternative for treating LASIK flap complications such as epithelial ingrowth or flap dislocation.

Corneal Stroma↗
PubMed2005

Eyelid disease.

Explore the source record for details and available documents.

Corneal Diseases↗
PubMed2005

Trends in the indications for penetrating keratoplasty, 1980-2001.

PURPOSE: To study the leading indications and changing trends for penetrating keratoplasty (PK) over the past 3 decades. METHODS: This is a retrospective review of 696 cases of PK. The indications for PKs performed at the Duke University Eye Center during the years 1980-1981, 1990- 1991, and 2000-2001 were tabulated to determine trends over the past 3 decades. The main outcome measures were indications for PK. RESULTS: During this study, 696 PKs were performed. The leading indications for PK and their respective frequencies during 1980-1981, 1990-1991, and 2000-2001 were failed grafts (10.8%, 19.0%, 27.0%, respectively), pseudophakic bullous keratopathy (PBK)/aphakic bullous keratopathy (ABK) (19.4%, 20.6%, 16.7%, respectively), Fuchs dystrophy (15.6%, 13.0%, 23.8%, respectively), keratoconus (13.4%, 8.2%, 11.8%, respectively), and corneal scar (7.0%, 8.9%, 10.7%, respectively). The number of PKs for failed grafts and Fuchs dystrophy increased over time. CONCLUSIONS: In this study, failed graft has gradually become the leading indication for PK, whereas most other studies have reported PBK as the leading indication. Unlike many other studies, Fuchs dystrophy was a common indication for PK.

Corneal Diseases↗
PubMed2004

Dendritic macromers as in situ polymerizing biomaterials for securing cataract incisions.

Dendritic macromers are attractive macromolecules for hydrogel formation since high cross-linking densities at low polymer concentration can be obtained, varied physical properties can be observed based on the macromer structure, and low viscous aqueous solutions can be injected in an in vivo site of irregular shaped to form a well-integrated polymer network. A peptide dendron possessing terminal cysteine residues was synthesized and characterized. When this peptide dendron was mixed with poly(ethylene glycol dialdehyde) in aqueous solution at pH = 7.4, a hydrogel spontaneously formed as a consequence of thiazolidine linkages between the macromers. Such in situ polymerized hydrogels are of interest for tissue engineering and wound-repair applications. To evaluate the potential use of this hydrogel sealant in ophthalmic surgeries, a 3-mm clear corneal incision (i.e., the wounds created during a typical cataract surgery) was successfully sealed.

Biocompatible Materials↗
PubMed2004

New dendritic adhesives for sutureless ophthalmic surgical procedures: in vitro studies of corneal laceration repair.

OBJECTIVE: To compare a biodendrimer adhesive with a conventional suture for repairing linear and stellate corneal lacerations. METHODS: A keratome knife was used to create 4.1-mm full-thickness linear incisions (n = 36) and 3 x 4-mm full-thickness stellate incisions (n = 25) in the central cornea of enucleated human eyes. The incisions were sealed with either a suture or the biodendrimer adhesive. The globes were inflated with balanced salt solution, and the increase in intraocular pressure was monitored via a cardiac transducer until fluid leaked from each eye. This intraocular pressure reading from the transducer was recorded at the sight of any leakage through the wound (leakage pressure). By using the Wilcoxon rank sum test, the median leakage pressure was compared for each closure method, separately for each wound group. By using the 1-sided 1-sample t test, each mean leakage pressure value was compared with 34 mm Hg, which is the intraocular pressure under certain stressful physiologic conditions (eg, coughing and the Valsalva maneuver). RESULTS: For globes that underwent a linear incision, the mean leakage pressure was 78.7 mm Hg for the sutured group and 109.6 mm Hg for the adhesive group. Globes that underwent a stellate incision had a mean leakage pressure of 57.8 mm Hg for the sutured group and 78.7 mm Hg for the adhesive group. All of these pressures showed a statistical significance from 34 mm Hg via a 1-sided 1-sample t test. CONCLUSIONS: The difference in leakage pressures for all 4 groups was statistically significant relative to 34 mm Hg. This suggests that either method of closure, adhesive or suture, can withstand physiologic increases in intraocular pressure postoperatively and that biodendrimer adhesives are able to seal large corneal lacerations.Clinical Relevance The use of biodendrimer adhesives to repair a corneal wound constitutes a viable alternative clinical procedure to conventional sutures.

Biocompatible Materials↗
PubMed2002

Hybrid dendritic-linear polyester-ethers for in situ photopolymerization.

Novel first through fourth generation hybrid dendritic-linear copolymers, composed entirely of building blocks known to be biocompatible or degradable to natural metabolites in vivo, are described. Specifically, these copolymers are composed of poly(ethylene glycol), glycerol, and succinic acid and are synthesized using a divergent approach in high yield. A photo-cross-linkable derivative of this copolymer successfully seals 4.1 mm corneal lacerations. The mechanism of tissue repair is likely one of physical entrapment where an interpenetrating network (IPN) is formed between the cross-linked copolymer and the tissue.

Eye Injuries↗
PubMed2002

A new technique for repairing descemet membrane detachments using intracameral gas injection.

Descemet membrane detachments are not uncommon following cataract surgery, and large and extensive detachments can have an impressive presentation, with severe corneal edema and marked reduction in visual acuity. Traditional treatment regimens have included observation (with the hopes of spontaneous resolution), anterior chamber injections of air or viscoelastic, transcorneal suturing, and even corneal transplantation for persistent cases. During the past few years, intracameral injection with either sulfur hexafluoride (SF6) or perfluoropropane (C3F8) gas has gained increasing acceptance as an efficient and effective treatment option for Descemet membrane detachments. Previously described techniques of gas injection have required corneal and paracentesis incisions; sterile blades, cannulas, and other instruments; and occasionally, an operating room setting. We describe a simple, safe, and effective technique for intracameral gas injection that can be performed by one person at the slitlamp microscope or in a minor operating room with minimal equipment.

Cataract Extraction↗
PubMed2002

Intraoperative choroidal hemorrhage in the Osler-Rendu-Weber syndrome.

PURPOSE: To describe a patient with Osler-Rendu-Weber syndrome who developed a nonsimultaneous intraoperative choroidal hemorrhage in each eye. METHOD: Interventional case report. A 65-year-old Caucasian woman with Osler-Rendu-Weber syndrome developed a choroidal hemorrhage in the left eye during vitrectomy for a complicated retinal detachment with a poor visual outcome. Fifteen years later, she developed a macula on retinal detachment in the right eye, which also had a dense cataract. Immediately after uncomplicated phacoemulsification and intraocular lens implantation, under monitored anesthesia care and retrobulbar block, and without valsalva stress, ophthalmoscopy demonstrated a choroidal hemorrhage. A planned scleral buckle was replaced by pneumatic retinopexy. RESULTS: Seven months postoperatively, the retina remained attached with resolution of the choroidal hemorrhage. Visual acuity was 20/30. CONCLUSION: Choroidal hemorrhage may occur more commonly in individuals with Osler-Rendu-Weber syndrome. Recognition of this possible association and institution of appropriate intraoperative precautions may facilitate a good visual outcome.

Aged↗
PubMed2002

Exacerbation of Avellino corneal dystrophy after laser in situ keratomileusis.

PURPOSE: To report a case of Avellino corneal dystrophy that increased in severity 1 year after uncomplicated laser in situ keratomileusis (LASIK) for myopia. METHODS: Avellino dystrophy was confirmed by polymerase chain reaction sequencing of DNA from the patient and her parents. RESULTS: Best spectacle-corrected visual acuity decreased from 20/20 to 20/30 12 to 20 months after LASIK owing to opacities that appeared centrally in the corneal stroma and the LASIK flap and remaining posterior stroma interface. CONCLUSIONS: LASIK is contraindicated in patients with Avellino corneal dystrophy because vision may be reduced by corneal opacities that appear in the interface of the flap and remaining posterior stroma postoperatively.

Adult↗
PubMed2002

A photopolymerized sealant for corneal lacerations.

PURPOSE: To determine whether a novel photocrosslinkable polymer synthesized from hyaluronic acid would seal experimental full-thickness corneal lacerations in a rabbit model. METHODS: A solution of hyaluronic acid was modified with methacrylate groups (HA-MA), precipitated, dried, reconstituted in an aqueous solution, and sterilized before use. The viscous polymer solution was applied to 38 of 43 experimental corneal lacerations in rabbits and subsequently irradiated with a low-intensity argon laser beam to produce a clear flexible polysaccharide hydrogel patch. The ability of this sealant to repair corneal lacerations was evaluated in four types of full-thickness, 3-mm corneal wounds (linear, linear + epithelium removed, stellate, and stellate + epithelium removed). Slit-lamp examinations, measurements of intraocular pressure, Seidel tests, and histologic studies were performed at selected intervals to evaluate the wound and determine the rate of healing. RESULTS: Corneal perforations were completely sealed and the anterior chambers had reformed by 6 hours in HA-MA-treated eyes. There was no evidence of leakage at this or later times in 37 of the 38 eyes. Intraocular pressure had risen to near-normal levels by day 7 in all four groups, and the sealant was still present in most eyes at day 7. In contrast, the anterior chambers did not re-form in control eyes (five) with untreated perforations because of aqueous leakage through the wounds. Minimal inflammation was observed clinically or in histologic sections of treated corneas. There was extensive proliferation of stromal cells and formation of new extracellular matrix at the wound edges, which became tightly adherent between days 4 and 7. CONCLUSION: Our novel photocrosslinkable methacrylated hyaluronan polymer sealed 97% (37/38) of the experimental corneal lacerations. HA-MA may prove useful for sealing corneal lacerations in patients and for other sutureless ophthalmic surgical procedures.

Animals↗
PubMedDate not supplied

Hydrogels formed by multiple peptide ligation reactions to fasten corneal transplants.

A stable cross-linked hydrogel was formed under mild aqueous conditions using pseudoproline peptide ligation chemistry. A cysteine-terminated lysine dendron containing four cysteines and a PEG macromolecule modified with terminal ester aldehydes were prepared. Upon mixing, the two macromers gave a stable hydrogel. This hydrogel along with sutures was used to successfully secure a corneal transplant in vitro.

Corneal Transplantation↗