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Biomedical subjects

Ulf Stenevi

Publications and source records attributed to Ulf Stenevi.

At least 19 recordsLinked to original sources
PubMed2006

Posterior capsule opacification: comparisons between morphology, visual acuity and self-assessed visual function.

PURPOSE: To investigate whether posterior capsule opacification (PCO) morphology, visual acuity (VA) and self-assessed visual function correlate, and to compare perceived visual disabilities with those of cataract patients with corresponding VA. METHODS: Twenty-one patients with PCO were examined before capsulotomy. In adjunct to the ophthalmological examination, the patients completed a Catquest questionnaire and a digitized retroillumation image was acquired. The images were analysed with the Evaluation of Posterior Capsule Opacification (EPCO) program. Data for visual function were compared with data from the National Swedish Cataract Register (NCR). RESULTS: The epco values were correlated with VA in the PCO eyes: the higher the epco score, the lower the VA. There were also correlations between the epco scores, satisfaction with vision, and perceived disabilities in daily life. Symptoms of glare were not significantly correlated with epco scores or with VA. Visual acuity in PCO eyes was better correlated with perceived disabilities and satisfaction with vision than VA in eyes with cataract. CONCLUSIONS: There was a significant correlation between epco scores and VA and between epco scores and Catquest. Consequently, the morphological method was related to the self-assessed visual function. Patients with PCO seemed to have more disturbed visual function, as defined by Catquest, than cataract patients with the same VA.

Adult↗
PubMed2006

Donor-derived myofibroblasts in the ocular surface after allogeneic haematopoietic stem cell transplantation.

PURPOSE: To identify and characterize cells of donor origin in the ocular surface of female recipients who have undergone allogeneic haematopoietic stem cell transplantation (allo-SCT) from a male donor. METHODS: Cytological impressions from the eyes of nine allografted patients (17 eyes) were analysed. Donor cells were identified using sex-chromosome-specific fluorescence in situ hybridization (FISH). Cells were characterized by immunohistochemistry (IHC) using the CK3 and CK19 epithelial markers, the panleucocytic marker CD45 and the myofibroblast marker alpha-SMA. RESULTS: No epithelial cells of donor origin were observed in the corneal or conjunctival samples. Cells of donor origin were found in the corneal samples, although these were often too degraded to allow characterization by IHC. In the conjunctiva, a median of 86% of the total number of cells were of recipient origin, including a subgroup (2%) of giant cells exhibiting polyploidy (range 4-18 n), found in the limbal region. Donor cells were detected in the conjunctiva of all nine patients at a median ratio of 9%, of which two-thirds were CD45+/alpha-SMA+. CONCLUSIONS: We observed superficially located myofibroblasts of donor origin in all allografted patients, but not in samples from healthy controls. Whether myofibroblasts are implicated in ocular graft-versus-host disease requires further studies.

Actins↗
PubMed2005

Longterm survival of transplanted human corneal epithelial cells and corneal stem cells.

PURPOSE: To investigate the survival of donor-derived epithelial cells in conventional penetrating keratoplasty (PKP) and in homologous penetrating central limbal keratoplasty (HPCLK). METHODS AND PATIENTS: Epithelial cells from 26 eyes of 26 patients were analysed. All cases were sex-mismatched (i.e. the transplant and patient were of different genders). At suture removal more than 1 year post surgery, epithelial cells were obtained by gently wiping the removed sutures on glass slides. The cell samples were analysed using fluorescent in situ hybridization (FISH) of the sex chromosomes. This technique makes it possible to allocate the origin of each cell nucleus to either the donor or the recipient. RESULTS: All 19 conventional PKPs were clear and seven had donor-derived epithelial cells at suture removal. Five of the seven HPCLK grafts were clear at the time of investigation (365--1355 days post surgery), and donor-derived epithelial cells were found in two grafts. CONCLUSION: Harvesting cells from removed sutures in combination with FISH enables the clinical study of cell survival in corneal transplants without jeopardizing functioning grafts. From the limited sample investigated, the following tentative conclusions can be made. Donor-derived epithelial cells can remain in conventional PKP for over 1 year. In combined stem cell and corneal grafts (HPCLK), donor-derived epithelial cells may also be retrieved at 1 year or beyond following surgery but the correlation between their presence and a remaining clear graft is uncertain.

Adult↗
PubMed2005

Longterm survival of transplanted human corneal epithelial cells and corneal stem cells.

PURPOSE: To investigate the survival of donor-derived epithelial cells in conventional penetrating keratoplasty (PKP) and in homologous penetrating central limbal keratoplasty (HPCLK). METHODS AND PATIENTS: Epithelial cells from 26 eyes of 26 patients were analysed. All cases were sex-mismatched (i.e. the transplant and patient were of different genders). At suture removal more than 1 year post surgery, epithelial cells were obtained by gently wiping the removed sutures on glass slides. The cell samples were analysed using fluorescent in situ hybridization (FISH) of the sex chromosomes. This technique makes it possible to allocate the origin of each cell nucleus to either the donor or the recipient. RESULTS: All 19 conventional PKPs were clear and seven had donor-derived epithelial cells at suture removal. Five of the seven HPCLK grafts were clear at the time of investigation (365-1355 days post surgery), and donor-derived epithelial cells were found in two grafts. CONCLUSION: Harvesting cells from removed sutures in combination with FISH enables the clinical study of cell survival in corneal transplants without jeopardizing functioning grafts. From the limited sample investigated, the following tentative conclusions can be made. Donor-derived epithelial cells can remain in conventional PKP for over 1 year. In combined stem cell and corneal grafts (HPCLK), donor-derived epithelial cells may also be retrieved at 1 year or beyond following surgery but the correlation between their presence and a remaining clear graft is uncertain.

Adult↗
PubMed2005

Endophthalmitis following cataract surgery in Sweden: national prospective survey 1999-2001.

PURPOSE: To investigate the epidemiology of postoperative endophthalmitis (POE) following cataract surgery in Sweden during a 3-year period, using the framework of the Swedish National Cataract Register. METHODS: Clinically presumed cases of POE were reported in a prospective survey involving all Swedish ophthalmic surgical units except one. Data on results of the intraocular culture and visual outcome after infection, as well as patient age and gender and various elements of the surgical procedure, were collected. RESULTS: The nationwide incidence of POE was 0.0595%, representing 112 cases in 188 151 cataract operations. Gram-positive bacteria were the predominant aetiology, with an 84.6% share of culture-positive cases. A significantly decreased risk for POE was found for patients who had received prophylactic intracameral antibiotics (mainly cefuroxime) in comparison with those who had been treated with topical antibiotics only. CONCLUSIONS: The prevalence of POE after cataract surgery in Sweden is at the lower end of the spectrum of incidence currently reported in the developed world. The administration of intracameral antibiotics may have contributed to these results.

Adolescent↗
PubMed2005

Three-year follow-up of posterior capsule opacification with two different silicone intraocular lenses.

PURPOSE: To compare posterior capsule opacification (PCO) after cataract surgery with implantation of two silicone intraocular lenses (IOLs) with different designs. METHODS: We carried out a prospective, clinical study of 116 patients randomized to standardized phacoemulsification with implantation of CeeOn Edge (n = 57) or SI40NB (n = 59) IOLs. The follow-up period was 3 years. To evaluate PCO morphologically, digital images were obtained and analysed using evaluation of posterior capsule opacification computer software (epco). The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded. RESULTS: At 2 and 3 years, the eyes with SI40NB IOLs had significantly more PCO than those with the CeeOn Edge IOLs (p = 0.00014 and p = 0.002). Nine Nd:YAG capsulotomies were performed in the SI40NB group and none in the CeeOn Edge group. This difference was statistically significant (p = 0.003). In some patients a regression of PCO was noticed and confirmed using epco. Statistically less PCO was noted when the capsulorhexis rim was placed so that it covered all 360 degrees of the optic of the IOL. CONCLUSIONS: A clinically and statistically significant difference in PCO development between CeeOn Edge and SI40NB IOLs at 2 and 3 years postoperatively was found. These findings support earlier studies indicating that a sharp edge of the optic is a more important factor in IOL design than IOL material in the prevention of PCO.

Aged↗
PubMed2005

Self-assessed visual function for patients with posterior capsule opacification before and after capsulotomy.

PURPOSE: To describe the functional outcome, as defined using the Catquest questionnaire, for patients with posterior capsule opacification (PCO) after capsulotomy. METHODS: A total of 47 patients with PCO were examined before and 1 month after capsulotomy. In addition to the ophthalmic examination, Catquest was completed and a digital image of the posterior lens capsule acquired. RESULTS: Capsulotomy resulted in a good level of benefit, as defined using Catquest, for 77% of the patients. No subgroup of patients who derived an exceedingly good or poor level of benefit was identified. Disabilities in daily life, satisfaction with vision and symptoms of glare improved from treatment (p < 0.001, p < 0.001 and p = 0.002, respectively). The results were comparable with the benefits of cataract surgery. CONCLUSIONS: Self-assessed visual function as defined using Catquest improved after capsulotomy for the vast majority of patients with PCO. No group of patients with exceptionally good or poor levels of benefit could be identified with certainty. However, the majority of those with a poor outcome were elderly individuals with ocular comorbidity. The overall functional results from treatment of PCO were very similar to those achieved after cataract surgery.

Adult↗
PubMed2004

Postoperative aphakia in modern cataract surgery: part 1: analysis of incidence and risks based on 5-year data from the Swedish National Cataract Register.

PURPOSE: To study the incidence of aphakia after cataract extraction and evaluate the relative risk for this outcome in subgroups of patients based on preoperative conditions. SETTING: Sixty-two community-run or private clinics participating in the Swedish National Cataract Register. METHODS: Data on cataract extractions were collected prospectively from 1997 through 2001. The set of data also covered type of surgery and type of intraocular lens (IOL), including a "no lens implanted" option. All data were stored in a database. Database calculations were made of frequencies and risk ratios of postoperative aphakia in the subgroups of patients based on preoperative conditions. RESULTS: For the entire study period, postoperative aphakia was reported in 1410 of 287,951 surgeries for which complete IOL data were available, corresponding to an overall frequency of 0.49%. The occurrence of ocular comorbidity and poor preoperative visual acuity (< or = 0.1) in the eye to be operated on was significantly related to postoperative aphakia for each year of the study (P<.001). Glaucoma and poor visual acuity (< or =0.1) in the surgical eye meant a 12.8 higher risk for aphakia after surgery than a better visual acuity (>0.1) and no ocular comorbidity. CONCLUSIONS: This national 5-year survey showed that in routine cataract surgery performed during the study, 1 of every 200 operations ended in postoperative aphakia. Poor visual acuity (< or =0.1) in the eye to be operated on combined with ocular comorbidity was the highest risk factor for postoperative aphakia.

Aged↗
PubMed2004

Postoperative aphakia in modern cataract surgery: part 2: detailed analysis of the cause of aphakia and the visual outcome.

PURPOSE: To study the incidence of aphakia after cataract surgery, the surgical complications that can lead to it, and the visual outcome. SETTING: Six community-run eye clinics participating in the Swedish National Cataract Register. METHODS: Data on cataract extractions were collected prospectively from 1997 through 2001. The data also covered the type of surgery and type of intraocular lens, including a "no lens implanted" option. All data were stored in a database. These data were supplemented with data on the intended type of surgery, type of complications, possible second surgery, and visual outcome. RESULTS: The overall incidence of postoperative aphakia was 0.65%. In 87.1% of cases, the aphakia was not planned, corresponding to an incidence of 0.48%. Unplanned aphakia was significantly related to poor preoperative vision, old age, and the presence of ocular comorbidity. The most frequent reasons for unplanned aphakia were intraoperative capsule problems and vitreous loss. In two thirds of cases, a second operation was performed. In 41% of all cases, the final visual acuity was 0.5 or better and in 27.7%, worse than 0.1. CONCLUSIONS: During the study period, 1 of every 200 routine cataract surgeries ended in unplanned aphakia. The incidence of surgical complications leading to unplanned aphakia and a final visual acuity worse than 0.1 (20/200) was 7.8 per 10,000 operations in cases with no ocular comorbidity and 27.6 per 10,000 operations in cases with ocular comorbidity.

Aged↗
PubMed2004

16S rDNA PCR analysis of infectious keratitis: a case series.

PURPOSE: To discuss the value of polymerase chain reaction (PCR) in the management of bacterial infectious keratitis. METHODS: Corneal scrapings of four patients with severe infectious keratitis were analysed by culture and PCR of 16S ribosomal DNA (rDNA), followed by direct sequencing of the resulting amplicon. The medical history of the patients included laser-assisted in-situ keratomileusis (LASIK), penetrating keratoplasty (PKP) and trauma. RESULTS: Using PCR we were able to identify a possible pathogen in all four cases, while bacterial cultures were either negative or did not correspond to the clinical picture. The identified bacteria were a Pseudomonas species, Abiotrophia defectiva, Stenotrophomonas maltophilia and Porphyromonas gingivalis. CONCLUSIONS: Analysis of corneal scrapings by 16S rDNA PCR should be considered as a supplement to standard microbiological procedures. However, the results of this relatively new method have to be interpreted carefully.

Adult↗
PubMed2004

Time-lapse recordings of human corneal epithelial healing.

PURPOSE: The aim of this study was to design an experimental set-up for the study of human corneal epithelial wound healing in a controlled in vitro situation. METHODS: A time-lapse set-up was used. This allowed for pictures to be captured with a magnification ranging from x 80 to x 1800. Pictures were captured at 1-min intervals during the observation period, which lasted up to 4 days. Human corneal tissue was obtained from the Eye Bank or from surgery. A small, rounded lesion was produced in the corneal epithelium with a miniature drill. The specimens were placed in a mini-incubator; the camera focused on the epithelial lesion and continuously observed using the time-lapse set-up. RESULTS: The healing process of human corneal epithelium could be followed for several days. The initial healing response could be divided into a slow, a rapid and a consolidating phase. The first two phases lasted about 12 hours, and by then, epithelial cells covered the lesion. Depending on the origin of the tissue and the placement of the lesion, variations in the healing response could be seen. CONCLUSION: The time-lapse technique makes it possible to study epithelial wound healing over time at the cellular level. Data collected in this way can fill the gap between in vivo studies, where, by nature, human wound healing studies are restricted, and cell culture techniques, where cellular responses in many cases differ from the in vivo situation.

Epithelium, Corneal↗
PubMed2004

Acupuncture treatment in patients with keratoconjunctivitis sicca: a pilot study.

AIM: To evaluate the effects of acupuncture in patients with keratoconjunctivitis sicca (KCS). MATERIAL AND METHODS: Twenty-five patients (20 women, five men) with KCS were randomly assigned to an acupuncture treatment group or a control group. The effects of acupuncture were evaluated by a questionnaire on symptoms, visual analogue scale recordings, registration of drop frequency, and dry eye tests. Ten acupuncture sessions were given. Follow-up was carried out after 2-3 weeks and again after a mean period of 8 months. RESULTS: Patients receiving acupuncture felt better at the first follow-up compared with the control group (p = 0.036). However, no statistical significance could be found concerning any change, or difference, in the total number of subjective symptoms, dosage frequency or, as indicated by the dry eye tests, tear quality, tear secretion and ocular surface disease. CONCLUSION: The results indicate that acupuncture has subjective beneficial effects in patients with KCS and could therefore be tried as a complement to ordinary treatment.

Acupuncture Points↗
PubMed2003

COX-2 inhibitors prolong trauma-induced elevations of iris hyaluronan.

PURPOSE: To investigate whether and how treatment with COX-2 inhibitors influences hyaluronan responses to a standardized trauma, argon laser induced iritis, in rabbits. METHODS: Two different COX-2 inhibitors were used, SC-236 and rofecoxib. The drugs were administered orally, 6 mg/kg/day and 1.5 mg/kg/day respectively. Iris and aqueous humor hyaluronan concentrations were measured with a radiometric assay at different time points after laser irradiation. RESULTS: The hyaluronan concentration in the iris increased 3-4-fold with a peak concentration of 129.1 microg/g wet weight 2 days after laser irradiation. It then decreased to normal values after 1 week. In eyes treated with either of the COX-2 inhibitors, iris hyaluronan concentrations did not decrease as rapidly and were significantly higher at day 4 and 7 when compared to drug untreated eyes. CONCLUSION: Treatment with COX-2 inhibitors prolongs trauma induced elevation of iris content of endogenous hyaluronan. This may be, at least partly, due to an inhibition of interstitial fluid pressure regulation.

Animals↗
PubMed2002

[Growing waiting list for corneal transplantation].

New corneal storage techniques and legislative changes have transformed conditions for corneal grafting in Sweden. Since 1995, the Swedish Corneal Surgery Society has registered the number of grafts, the size of waiting lists for surgery as well as changes in the capacity of the banks. Since 1995 the number of procedures per year has declined while the waiting list has grown. The required number of procedures is 650 rather than the 448 performed in 1999. The decline is due to a lack of donor corneas, priority accorded to other surgery, efforts to adapt contact lenses to keratoconus, and further indications for excimer laser surgery. The four established corneal banks as well as two opening in 2001 will increase the number of grafts available for surgery.

Corneal Transplantation↗
PubMed2002

Strategy to reduce the number of patients perceiving impaired visual function after cataract surgery.

PURPOSE: To reduce the number of patients who perceive more difficulties performing daily life activities 6 months after cataract extraction than before surgery. SETTING: Surgeons at 4 surgical units participating in the yearly outcome studies organized by the Swedish National Cataract Register. METHODS: This study comprised surgical outcomes data and completed Catquest results before and after surgery collected from consecutive patients during a 1-month period yearly since 1995. The reasons for a no-benefit outcome from 1995 to 1997 were identified. During the 1-month study period in 1999, a strategy was launched to reduce postoperative anisometropia and disturbances from cataract in the fellow eye through better surgical planning. RESULTS: The percentage of patients with a no-benefit outcome who had anisometropia or cataract in the fellow eye as a probable reason for the outcome decreased from 27.3% and 13.0%, respectively, in the 1995 to 1997 study to 10.5% and 10.5%, respectively, in the 1999 study. Other reasons for a no-benefit outcome such as ocular co-morbidity or few preoperative problems increased in frequency, presumably as a result of a change in case mix. CONCLUSIONS: A strategy to reduce the number of patients perceiving more difficulties in performing daily life activities after cataract extraction than before surgery was tested. The number of patients with reasons for a poor outcome that the study focused on was reduced. Patients who gave reasons for a poor outcome other than anisometropia or cataract in the fellow eye increased in frequency, probably as a result of a change in case mix.

Activities of Daily Living↗
PubMed2002

Cost-effectiveness of cataract surgery. Method to assess cost-effectiveness using registry data.

To develop a method to estimate the cost per quality-adjusted life year (QALY) gained with cataract surgery using large patient registries.Four centers in Sweden. Five hundred patients scheduled for cataract extraction in 1 eye at 1 of 4 centers in Sweden during March 1999 were asked to complete the EQ-5D, a preference-based quality-of-life instrument, and the Catquest, a disease-specific disability measure, before surgery. Multiple regression analysis was used to study the correlation between utility and visual acuity and/or disability and utility and QALY gain through the intervention estimated. Visual acuity and Catquest scores were available for 484 patients. The mean age was 76.1 years; the mean logMAR visual acuity was 0.59 in the surgical eye and 0.26 in the other eye. The mean Catquest disability score was 13.79 and the mean utility, 0.74. Utilities correlated significantly with visual acuity and disability scores, and the correlations remained significant when both were included in a regression model, indicating that the 2 measure different concepts. The hypothetical cost per QALY gained (discounted at 3%) was estimated at 45000 SKr (4500 US dollars) using the Swedish Cataract Registry. The results indicate that visual acuity and visual disability significantly affect utilities controlled for age and ophthalmic comorbidity. It is thus possible to use data on visual acuity and disability in large registries to estimate the cost-effectiveness of cataract surgery and to compare the cost per QALY gained with other health care interventions.

Aged↗