Inter- and intraobserver repeatability and reproducibility of choroidal thickness measurements using two different methods.

PURPOSE: To measure the inter- and intraobserver repeatability and reproducibility of choroidal thickness measurements taken by the enhanced depth imaging of spectral-domain optical coherence tomography (EDI-OCT) in randomly selected subjects using two different protocols. METHODS: Twenty subjects of the Thessaloniki Eye Study database were randomly selected. The participants underwent EDI-OCT, and the choroidal thickness was measured on EDI images using two different protocols. All images were assessed by two examiners independently in two sessions in different days. RESULTS: The interobserver intraclass correlation coefficient (ICC) for average choroidal thickness was 0.944. The average ICC for central, Cmin, and Cmax choroidal thickness was 0.899, 0.863, and 0.955, respectively. The interobserver ICC for average choroidal volume was 0.932. Intraobserver repeatability ICC for grader 1 ranged between 0.925 and 0.9720 and for grader 2 between 0.913 and 0.994. CONCLUSION: Choroidal thickness measurements by EDI-OCT showed a high inter- and intraobserver reproducibility.

Descemet's Stripping Automated Endothelial Keratoplasty Using Donor Tissue from an 83-Day-Old Infant.

Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification in an adult recipient using endothelial graft from an 83-day-old infant donor. Methods: A corneoscleral button was obtained from an infant donor and a DSAEK graft was prepared using a microkeratome. In comparison to the standard technique of DSAEK graft preparation some modifications were made in order to avoid inadvertent perforation, as the donor cornea had a very spherical shape, probably due to the very young age of the donor. The DSAEK graft was transplanted to the left eye of a 68-year-old woman suffering from Fuchs' endothelial dystrophy. Her preoperative best-corrected visual acuity (BCVA) in that eye was 20/100 and central corneal thickness 831 µm. Results: An uneventful DSAEK combined with phacoemulsification was performed. The main complication noted was detachment of the peripheral part and contraction of the corneal graft, observed two months after the procedure. The implanted tissue remained centrally attached with a BCVA of 20/40, 3 years postoperatively. Conclusion: This case report highlights the difficulties emerging from preparation and implantation using an endothelial graft tissue from the youngest ever reported donor.

Primary melanoma of the cornea.

Purpose: To present an extremely rare case of corneal melanoma. Method: An 84-year-old female patient presented to our department with a pigmented corneal lesion in her right eye (OD), 6x4 mm, complaining of mild pain and inability of complete eyelid closure. Tumor growth had been noted the previous year. She had undergone cataract surgery in her right eye three years before, followed by an unspecified postoperative complication. Her visual acuity was 3/10 OD and 9/10 OS. Ophthalmic evaluation and ultrasonography (A- and B-scan) did not reveal any other pathology. The pigmented lesion was surgically removed and the patient underwent a protocol therapy of topical chemotherapy (mitomycin 0.03%, 2x4 for 2 weeks and dexamethasone 0.1%, 2x4 for the following 2 weeks, followed by another cycle of mitomycin 0.03%, 2x4 for another 2 weeks). Results: The surgical removal of the lesion was uncomplicated, as was the postoperative period. The patient's visual acuity improved to 6/10 three months postoperatively. The histologic examination revealed malignant melanoma. Conclusions: Despite its rarity, primary melanoma of the cornea is an existing entity. Treatment of corneal melanoma consists of surgical removal and postoperative topical chemotherapy. Postoperative follow-up is mandatory.

The Antiangiogenic Properties of Adipose-Derived Mesenchymal Stem/Stromal Cells in Corneal Neovascularization in a Rabbit Model.

The purpose was to study the anti-angiogenic effect of adipose-derived mesenchymal stem/stromal cells (ADMSCs) on experimentally induced corneal injuries. Corneal neovascularization (NV) was induced by incising and subsequently suturing the corneal surface in 32 New Zealand rabbits. Following suturing, the rabbits were randomly allocated into 2 groups, and received either phosphate-buffered saline (PBS) (control) or ADMSCs, both administered via three different routes. Digital images of the cornea were obtained two weeks post-incision to measure the area of neovascularized cornea. Tumor necrosis factor (TNF) was immunohistochemically assessed in the both groups. The corneal tissue was evaluated for vascular endothelial growth factor (VEGF). The extent of corneal NV in all eyes was assessed photographically by an independent observer. Fourteen days after the incisions, the degree of corneal NV was substantially decreased in the ADMSC-treated group (1.87 ± 0.9 mm2, 1.4 % ± 0.67 % of corneal surface) compared to the control and PBS-treated group (4.66 ± 1.74 mm2, 3.51 % ± 1.31 %, p < 0.001). ADMSCs significantly decreased injury-induced corneal NV in New Zealand rabbits two weeks post-treatment. This strategy has potential for use in the control of corneal NV in vivo.

Bilateral Herpes Simplex Virus-related Peripheral Ulcerative Keratitis Leading to Corneal Perforation in a Patient with Primary Herpes Simplex Virus Infection.

PURPOSE: To present a case of bilateral peripheral ulcerative keratitis (PUK) caused by primary herpes simplex virus-1 (HSV-1) infection resulting in corneal perforation. CASE REPORT: A 24-year-old man presented at the eye casualty of our clinic, with a 20-day history of severe pain, redness, photophobia, and tearing in both of his eyes. Slit-lamp examination revealed bilateral superior corneal perforation. A laboratory work-up that included immunological testing for infectious and autoimmune factors showed primary HSV infection. Positive PCR analysis of corneal scrapings for HSV confirmed initial end-organ ocular infection. Because the patient showed progressive HSV-1-related PUK resulting in bilateral superior corneal perforation with iris prolapse, he was prescribed both systemic and topical acyclovir and prednisone. He then underwent bilateral surgical intervention, namely eccentric penetrating keratoplasty in one eye and a two step procedure in the other, whereby two corneal patch grafts and an amniotic membrane transplant were initially used, followed 1 month later by a large diameter penetrating keratoplasty. CONCLUSION: In cases of PUK, differential diagnosis should include infectious and autoimmune diseases. Primary HSV should also be considered as a potential cause of this form of keratitis, which, if left untreated, can lead to devastating outcomes. To our knowledge, this is the first published case of bilateral PUK caused by primary HSV-1 infection.

The omega-3 and retinopathy of prematurity relationship.

The aim of this article is to examine the effect of omega-3 (ω-3) long-chain polyunsaturated fatty acids (LCPUFAs) intake on retinopathy of prematurity (ROP) by reviewing the experimental and clinical trials conducted on animal models and infants. LCPUFAs demonstrate cytoprotective and cytotherapeutic actions contributing to a number of anti-angiogenic and neuroprotective mechanisms within the retina. Their intake appears to have a beneficial effect on ischemia, oxidative stress, inflammation and cellular signaling mechanisms, influencing retinal cell gene expression and cellular differentiation. ω-3 LCPUFAs may modulate metabolic processes that activate molecules implicated in the pathogenesis of vasoproliferative and neurodegenerative retinal diseases such as ROP.