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At least 289 records · Page 16Linked to original sources

PubMed2004

Corneal swelling with overnight wear of scleral contact lenses.

PURPOSE: The management of some ocular surface diseases may be enhanced by the overnight wear of a rigid gas-permeable (RGP) scleral contact lens (ScCL). There is little information of the hypoxic effect of extended RGP ScCL wear. The authors measured the corneal swelling after overnight wear of a rigid gas permeable scleral contact lens in normal subjects. METHODS: Four subjects wore an RGP ScCL overnight in 1 eye only on 4 occasions. The following morning the lens was removed immediately before optical pachymetry, and the corneal thicknesses of both eyes were measured by a masked observer. On another four occasions optical pachymetry was performed, but the lens was not worn the previous night. For each subject the lens was of the same thickness. Specular microscopy was used to estimate endothelial cell density. RESULTS: There were no adverse effects, and subjects reported no difficulties in handling the lenses. Overnight wear of ScCL induced a variable amount of corneal swelling among subjects from 4.9% to 17.5%. The overnight swelling correlated strongly with endothelial cell density. CONCLUSIONS: Overnight wear of ScCL caused an increased degree of corneal swelling compared with daytime wear. This degree of swelling should not rule out overnight therapeutic ScCL wear if the disease process is deemed to be more damaging than the hypoxic effect of an RGP ScCL worn overnight. However, when used for refractive correction, they should not be left in overnight.

Adult↗

PubMed2004

Combination of adult inclusion conjunctivitis and mucosa-associated lymphoid tissue (MALT) lymphoma in a young adult.

PURPOSE: To report a patient who was diagnosed with combined adult inclusion conjunctivitis (AIC) and mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: This is a case report. RESULTS: An 18-year-old male patient presented with chronic conjunctivitis and giant follicles. Evaluation by chlamydial antigen assay was positive. Conjunctival biopsy for the immunohistochemical stain and polymerase chain reaction of the left eye showed MALT lymphoma. CONCLUSIONS: MALT lymphoma can masquerade as other ocular surface diseases. Chlamydial infection causes chronic inflammation of the conjunctiva. Both of these diseases should be considered as a differential diagnosis of refractory follicular conjunctivitis. It is worthy of further study to determine whether chronic inflammation resulting from chlamydial infection increases the risk of MALT lymphoma or it is coincidental.

Adolescent↗

PubMed2000

Decay-accelerating factor in tears of contact lens wearers and patients with contact lens-associated complications.

PURPOSE: Complement activation fragments have been detected in the anterior segment during 1) eye closure, 2) contact lens wear, and 3) in some contact lens-associated pathologies. The decay-accelerating factor (DAF), a membrane-associated complement regulatory protein that inhibits the central C3 amplification convertases of the cascade, is present on both the ocular surface and in tears. In this study, we measured levels of tear DAF in asymptomatic contact lens patients and in patients who presented with contact lens-associated complications. METHODS: Tears were collected from 55 patients using capillary pipettes. Subjects included normal non-contact lens wearing controls (N = 14), asymptomatic soft (N = 13) and rigid gas permeable (N = 5) wearers, and individuals with contact lens-induced acute red eye (CLARE) (N = 4), ulcerative keratitis (N = 3), giant papillary conjunctivitis (GPC) (N = 8), contact lens peripheral ulcers (N = 3), and infiltrative keratitis (N = 5). Levels of DAF were assessed using a two-site immunoradiometric assay using anti-DAF monoclonal antibodies. RESULTS: The mean concentration of DAF in normal controls was found to be 149+/-78 ng/ml, 117+/-59 ng/ml, and 111+/-86 ng/ml for noncontact lens patients, and asymptomatic soft and rigid gas permeable lens wearers, respectively. In the conditions of CLARE, infiltrative keratitis, and GPC, DAF concentrations were significantly reduced compared with normal noncontact lens controls. Compared with asymptomatic soft lens patients, the condition of infiltrative keratitis showed a significant reduction in tear DAF. CONCLUSIONS: This study documents a trend toward decreased levels of tear DAF in patients with the contact lens associated inflammatory conditions CLARE, GPC, and infiltrative keratitis. Tears of patients with infiltrates show the most significant reduction of tear DAF. The reductions may be associated with enhanced complement activation contributing to the pathogeneses of infiltrative keratitis and associated ocular surface diseases.

CD55 Antigens↗

PubMed2001

The dry eye: an introduction.

Understanding the dry eye would be a great deal easier if we thoroughly understood normal tear function. To date, many aspects of tear function remain poorly understood. Only when normal tear characteristics and function are fully illuminated will the treatment of tear abnormalities and ocular surface disease be remedied. This instructional article aims to provide the reader with basic information regarding tear production, abnormalities, and current therapies in order to permit ophthalmic health care providers to intervene and teach patients who suffer from the frustrating and often chronic maladies associated with a dry eye.

Blepharoplasty↗

PubMed1993

Storage, surgery, outcome, and complications of corneal and conjunctival grafts.

Corneal transplantation is still limited by a shortage of donor material, but the type of storage medium used once a cornea has been acquired is probably irrelevant to graft outcome. Vancomycin HCl shows promise as a supplement to gentamicin sulfate in storage media. New methods of HLA typing using donor ocular tissue have largely helped to overcome the problems associated with typing of cadaveric blood, but the value of HLA typing in improving corneal graft survival is now in doubt. Alternative regimens of immunosuppression are being tested in animal models, but there is still no consensus on the best ways to use existing agents such as corticosteroids. Rejection remains the most common cause of unsuccessful corneal grafting in large cohorts, but glaucoma and astigmatism also limit postoperative graft function. Limbal stem cell grafts are promising for the management of many ocular surface diseases and conjunctival limbal autografts for pterygia may be the most successful surgical method for preventing recurrence.

Anti-Bacterial Agents↗

PubMed2006

Use of cyclosporine 0.05% ophthalmic emulsion for contact lens-intolerant patients.

PURPOSE: To evaluate the effect of cyclosporine 0.05% ophthalmic emulsion (Restasis, Allergan, Inc., Irvine, CA) on contact lens comfort and reducing dry eye symptoms in patients with contact lens intolerance. METHODS: A 5-week, randomized, investigator-masked study of 17 patients with self-reported contact lens-related dryness. Patients were randomized to cyclosporine twice per day or rewetting drops (carboxymethylcellulose 0.5%, Refresh Contacts) twice per day, to be used before and after lens wear. Changes from baseline in fluorescein staining of the cornea and conjunctiva and in tear breakup time were used to determine improvement of dry eye signs. Symptoms were assessed by lens wear time, use of rewetting drops during lens wear, subjective evaluation of dryness, and the completion of the Ocular Surface Disease Index questionnaire. RESULTS: Five weeks of cyclosporine treatment significantly improved dry eye symptoms (mean improvement of 0.88 +/- 0.64 with cyclosporine; no change of 0 +/- 0.58 [P = 0.01] with rewetting drops). Patients using cyclosporine decreased the use of rewetting drops by a mean 1.0 +/- 1.1 drops per day, and patients using rewetting drops increased their use (mean increase of 0.86 +/- 1.1 drops per day [P = 0.032]). Wearing time increased 1.9 +/- 2.1 hours per day with cyclosporine and 0.93 +/- 1.0 hours per day with rewetting drops (P = 0.258). There were no significant differences in mean corneal staining between groups. After 5 weeks, patients using cyclosporine showed statistically better improvements in temporal bulbar conjunctival fluorescein staining (decrease of 0.63 +/- 0.52 vs. increase of 0.57 +/- 0.67 [P = 0.002]) than patients using rewetting drops. Both treatments were tolerated well. CONCLUSIONS: The results of this pilot study indicate that cyclosporine 0.05% is beneficial for contact lens wearers with dry eye and reduces contact lens intolerance.

Adult↗

PubMed2005

Hyaluronic acid-CD44 interaction mediates the adhesion of lymphocytes by amniotic membrane stroma.

PURPOSE: To demonstrate the role of intrinsic hyaluronic acid (HA) in the entrapment of inflammatory cells by amniotic membrane (AM) in vitro. METHODS: HA concentration in AM was analyzed by the sandwich protein binding assay, and the approximate molecular weight was measured by gel filtration chromatography. To localize HA in AM tissue, toluidine blue staining with and without hyaluronidase treatment was performed. Adhesion of the lymphocyte cell lines, Jurkat and Molt 4, and peripheral blood mononuclear cells (PBMC) to AM and HA-coated glass slides was analyzed in an in vitro binding assay. Flow cytometry was performed to quantify the expression of the HA receptor, CD44, in Jurkat, Molt 4, and PBMC. RESULTS: HA was present in high levels in the stroma of AM, also demonstrated by intense staining with toluidine blue. Staining was inhibited by both hyaluronidase treatment and acidic pH. Molt 4, which constitutively expressed CD44, bound to AM and HA-coated slides significantly more than Jurkat cells (CD44-). Adhesion of Molt 4 was inhibited by pretreatment with both soluble HA and anti-CD44 antibody. LPS- or TNF-alpha-treated PBMC also bound to AM and HA-coated slides and was inhibited by pretreatment with an anti-CD44 antibody. CONCLUSION: HA in AM stroma may play an important role in the entrapment of inflammatory cells including lymphocytes when used as a patch in ocular surface disease.

Cell Adhesion↗

PubMed2005

Scleral contact lenses: the expanding role.

PURPOSE: The purpose of this study was to describe the current indications for scleral contact lens (ScCL) management at Moorfields Eye Hospital, London. METHODS: A database of 1003 patients (1560 eyes) seen between September 1999 and May 2003, either assessed for an ScCL trial or to follow up previously issued lenses, was analyzed. RESULTS: The major contact lens indication groups were keratoconus or other primary corneal ectasia (PCE), corneal transplant, and ocular surface disease (OSD). The 3 main small groups were aphakia, myopia, and ptosis. A total of 538 patients continued lens wear in 1 or both eyes, for a total of 808 eyes. The total numbers of eyes for each contact lens indication were PCE, 496 (61.4%); corneal transplant, 150 (18.6%); OSD, 91 (11.4%); aphakia, 17 (2.1%); myopia 21 (2.6%); ptosis 14 (1.7%); and a miscellaneous indication, 19 (2.2%). The percentages were similar to those of the total group of 1560 eyes. Seven hundred twenty lenses (89.1%) were rigid gas permeable (RGP), 708 were nonventilated, and 12 were fenestrated; 88 (10.9%) were ventilated polymethylmethacrylate or ptosis props. CONCLUSIONS: ScCLs continue to play a significant role in the management of corneal abnormalities, especially PCE, corneal transplant, and OSD. The great majority of lenses in use were nonventilated RGP designs.

Adolescent↗

PubMed2005

Standards for modified osteoodontokeratoprosthesis (OOKP) surgery according to Strampelli and Falcinelli: the Rome-Vienna Protocol.

PURPOSE: To establish a time-proven "gold standard" in modified osteoodontokeratoprosthesis (OOKP) surgery. METHODS: The OOKP is the procedure of choice for restoring sight in patients with corneal blindness caused by end-stage ocular surface disease not amenable to penetrating keratoplasty. Members of the OOKP Study Group met in Rome, Italy in 2001 and Vienna, Austria in 2002 to discuss indications and contraindications, patient selection, surgical technique, postoperative care, and recognition and management of complications of OOKP surgery according to Strampelli and modified by Falcinelli. RESULTS: Falcinelli's modification of Strampelli's technique of OOKP surgery remains the gold standard as far as visual and keratoprosthesis-retention results are concerned. The agreement on indications and contraindications, patient selection, surgical technique, postoperative care, and recognition and management of complications of this technique of OOKP surgery is summarized in the text of this manuscript. CONCLUSION: This standard technique of modified OOKP surgery, where adequately performed, is capable of providing excellent anatomic and functional results even in the long term. In patients with corneal blindness untreatable by other approaches, we strongly recommend this technique for visual rehabilitation. Students of OOKP surgery should become familiar with the protocol described in this paper before subjecting the technique to further modifications.

Alveolar Process↗

PubMed2006

Bilateral infectious ulcers associated with atopic keratoconjunctivitis.

PURPOSE: A case of atopic keratoconjunctivitis complicated by bilateral infectious ulcers is described. METHODS: Both eyes underwent complete ophthalmologic examination and in vivo confocal microscopy imaging by using the Heidelberg Retina Tomograph II Rostock-cornea-module (HRT II-RCM) and were photographed. RESULTS: Topical antibiotics and corticosteroids associated with oral antibiotics and corticosteroids were given. After 4 weeks of treatment, the corneal lesions healed completely. CONCLUSION: Bilateral infectious ulcers with perforation are a rare and severe complication of atopic keratoconjunctivitis. HRT II-RCM in vivo confocal microscopy imaging is useful in monitoring the progression of ocular surface diseases.

Anti-Bacterial Agents↗

PubMed2006

Tear film normalization test: a new diagnostic test for dry eyes.

PURPOSE: To evaluate the normalization of the tear film (tear film normalization test [TNT]) as a diagnostic test for dry eye syndrome. METHODS: The uncorrected distance vision of 20 patients with dry eyes (40 eyes) and 20 normals (40 eyes) before and after instillation of carboxymethyl cellulose 0.5% (CMC; Refresh Plus; Allergan, Irvine, CA) was recorded. We used study early treatment diabetic retinopathy (ETDRS) vision charts to test vision in each eye. Tear film breakup time (TBUT), presence or absence of superficial punctate erosions (SPE), tear film meniscus height, meibomian gland function, and ocular surface disease index (OSDI) questionnaire scores were evaluated. RESULTS: CMC improved visual acuity in the dry eye group (P < 0.0001). Response operator's curve (ROC) analysis showed that vision improvement of 2 lines or more after tear normalization was associated with an 82.5% (95% CI: 66.6%-92.1%) sensitivity and 100% (95% CI: 89.1%-100%) specificity for dry eye. There was a significant correlation between vision improvement and OSDI score in the dry eye group (P = 0.003). CONCLUSION: The TNT is a highly sensitive and specific test for dry eyes and is available in every eye care professional's office. The more symptomatic the dry eye, the greater the improvement.

Adolescent↗

PubMed2006

Superficial hypertrophic dendritic epitheliopathy occurring before and after penetrating keratoplasty in a patient with psoriasis.

PURPOSE: To report a patient with superficial hypertrophic dendritic epitheliopathy that occurred in 1 eye after keratoplasty and in the other eye that had not undergone previous corneal transplantation. In both eyes, the epitheliopathy recurred even after subsequent penetrating keratoplasties. METHODS: Case report. RESULTS: A patient with chronic eyelid and ocular surface disease secondary to psoriasis was monitored over a 17-year period. During this time, the patient developed a superficial hypertrophic dendritic epitheliopathy of the left eye 3 years after corneal transplantation. In the right eye, which had not undergone a penetrating keratoplasty, the patient was also noted to have a superficial hypertrophic dendritic epitheliopathy that changed morphologies over the ensuing 5.5 years. Both eyes subsequently required penetrating keratoplasties for decreased vision secondary to subepithelial scarring. After surgery, both corneas suffered recurrences of the superficial hypertrophic epitheliopathy. CONCLUSION: In addition to the original findings that superficial hypertrophic dendritic epitheliopathy occurs in postkeratoplasty eyes, this condition can also occur in corneas that have not been transplanted previously. The morphology of these lesions can vary.

Adult↗

PubMedDate not supplied

Eyelid retraction and incomplete eyelid closure secondary to human immunodeficiency virus-associated muscle wasting.

Human immunodeficiency virus (HIV)-associated weight loss remains a significant problem, even in the era of highly active antiretroviral therapy. This interventional case report describes eyelid retraction and poor eyelid closure caused by orbicularis atrophy in the setting of HIV-associated muscle wasting. A 65-year-old HIV-infected man sought treatment for chronic ocular irritation. On examination, he was thin with marked temporal wasting. Corneal epithelial defects were present bilaterally. There was 2 mm of superior scleral show in the right eye and trace inferior scleral show bilaterally. With attempted closure, lagophthalmos approached 1 cm in the right eye and was 3 mm in the left eye. The remainder of the examination was unremarkable. Gold weight placement achieved symptomatic improvement with adequate eyelid closure. Biopsy demonstrated fibrous tissue with an absence of identifiable muscle fibers. In the setting of HIV-associated muscle wasting, orbicularis oculi muscle atrophy may result in eyelid retraction, lagophthalmos, and ocular surface disease.

Aged↗

PubMed2003

Blind canalicular marsupialization in complete punctal absence as part of a systematic approach for classification and treatment of lacrimal system obstructions.

The procedure of choice for epiphora caused by bipunctal and canalicular obstruction is conjunctivodacryocystorhinostomy. Despite its high success rate, it may result in multiple complications, such as extrusion, migration, and secondary obstruction. The author describes a simple alternative procedure to conjunctivodacryocystorhinostomy for patients with epiphora caused by bipunctal and proximal canaliculus complete occlusion and a systematic approach to treat lacrimal system obstructions. Ten instances of bipunctal and proximal canaliculus absence in five consecutive patients, caused in four patients by ocular surface disorders (topical drug toxicity, herpetic keratoconjunctivitis, and trachoma), were treated by blunt dissection of the presumed lower punctal site under a surgical microscope. The punctal site was determined by several landmarks, the peaked medial lid margin, a dimple at that site, or an area of relative avascularity. The canaliculus was exposed and expanded to create a pocket. After the procedure, the lacrimal drainage system was found patent in nine of the 10 procedures. After one additional procedure, irrigation of the lacrimal drainage system revealed a nasolacrimal duct obstruction that was treated with dacryocystorhinostomy and silicone tube insertion. After these procedures, an objective resolution of the epiphora was noted in all patients. Epiphora resulting from lack of punctal and proximal canaliculus caused by ocular surface diseases may be treated with blind exposure and marsupialization of the proximal canaliculus instead of conjunctivodacryocystorhinostomy. If, in addition, the nasolacrimal duct is obstructed, a dacryocystorhinostomy may be performed. If this proposed procedure fails, the patient can still undergo conjunctivodacryocystorhinostomy or other procedures. The procedure may be part of a systematic approach to treat lacrimal drainage obstructions that is based on an association between the location and the cause of the obstruction.

Adult↗

PubMed1996

Topical urea as a treatment for non-infectious keratopathy.

The purpose of this study was to evaluate topical urea ophthalmic ointment as an agent to promote epithelial healing. Corneal epitheliopathy and epithelial defects were chemically induced in rabbits. Urea ophthalmic ointment was administered to one eye and control ointment to the fellow eye. The rabbits were examined by a masked observer for eleven days and points were awarded for steps of improvement in their ocular surface disease. The eyes receiving the urea ointment improved an average of 5.73 points while the control eyes improved 4.2 points (p < 0.0001). In conclusion, topical urea dissolved in a bland ointment encourages corneal reepithelialization and limits epithelial damage after toxic injury to corneal epithelium.

Administration, Topical↗

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↗

PubMed2004

Autologous serum eye drops for ocular surface disorders.

Tears have antimicrobial, nourishing, mechanical, and optical properties. They contain components such as growth factors, fibronectin, and vitamins to support proliferation, migration, and differentiation of the corneal and conjunctival epithelium. A lack of these epitheliotrophic factors--for example, in dry eye, can result in severe ocular surface disorders such as persistent epithelial defects. Recently, the use of autologous serum in the form of eye drops has been reported as a new treatment for severe ocular surface disorders. Serum eye drops may be produced as an unpreserved blood preparation. They are by nature non-allergenic and their biomechanical and biochemical properties are similar to normal tears. In vitro cell culture experiments showed that corneal epithelial cell morphology and function are better maintained by serum than by pharmaceutical tear substitutes. Clinical cohort studies have reported its successful use for severe dry eyes and persistent epithelial defects. However, the protocols to prepare and use autologous serum eye drops varied considerably between the studies. As this can result in different biochemical properties protocol variations may also influence the epitheliotrophic effect of the product. Before the definitive role of serum eye drops in the management of severe ocular surface disease can be established in a large randomised controlled trial this has to be evaluated in more detail. In view of legislative restrictions and based upon the literature reviewed here a preliminary standard operating procedure for the manufacture of serum eye drops is proposed.

Cornea↗

PubMed2004

Five year follow up of biocolonisable microporous fluorocarbon haptic (BIOKOP) keratoprosthesis implantation in patients with high risk of corneal graft failure.

AIM: To study the anatomical and visual performance following implantation of a model of artificial cornea and to evaluate the postoperative long term complications. METHODS: 11 eyes of 11 patients with bilateral corneal blindness considered as potentially having high risk of failure of penetrating corneal keratoplasty were implanted with biocolonisable Kpro keratoprosthesis (BIOKOP I, FCI, Rantigny, France) in the period between January 1996 and May 1998. Only one eye was implanted in all patients and followed up for a period of 60 months. The visual outcome, anatomical and functional stability, complications, and the general performance of the keratoprosthesis were evaluated. RESULTS: The keratoprosthesis (BIOKOP I) only 36.3% remained in position to date. In the patients' last visit five eyes (45.4%) were blind and one (9.0%) showed a slight improvement in the best corrected visual acuity (BCVA) in comparison to preoperative tests. Six eyes (54.5%) showed improved BCVA before having postoperative complications. Four eyes underwent replacement of a BIOKOP I Kpro with a BIOKOP II as a result of extrusion. The keratoprostheses remained anatomically in situ for a mean of 25.5 months and their functional performance period was limited to a mean of 22 months. CONCLUSION: Corneal keratoprosthesis (BIOKOP I, II) does not provide a stable anatomical relation with the surrounding ocular structures. Its ability to restore vision is limited to a short postoperative period in eyes implanted with severe ocular surface disease.

Adolescent↗