A novel approach to processing descemet stripping automated endothelial keratoplasty specimens for histopathologic analysis.

PURPOSE: To describe a new technique for handling Descemet stripping automated endothelial keratoplasty (DSAEK) specimens intraoperatively and during processing. METHODS: The processing method begins by adding a drop of eosin to the specimen intraoperatively, followed by submersion in 10% formalin solution. The specimen appears reddish, allowing for easy identification and is floated onto an immersed slide to maintain an unfolded flattened specimen. After bisection, one half is stained with hematoxylin and eosin and covered with a cover slip, whereas the other half is transferred to filter paper and a cassette and is submitted for paraffin embedding on the cut edge. RESULTS: The technique reduces the chances of a specimen not surviving processing. The new method also allows for 2 views of DSAEK specimens, both topographical and cross-sectional, thus permitting analysis of endothelial cell density, spatial distribution of cells and guttae, endothelial cell count, and thickness measurements. CONCLUSIONS: A novel technique for handling DSAEK specimens to prevent loss and folding, while also allowing for cross-sectional and topographical viewing is reported.

Long-term intraocular pressure control and corneal graft survival in eyes with a pars plana Baerveldt implant and corneal transplant.

PURPOSE: To investigate long-term intraocular pressure (IOP) control and corneal graft survival in eyes with a valveless Baerveldt glaucoma drainage implant (GDI) through the pars plana (PP) and a penetrating keratoplasty (PK). METHODS: We reviewed the medical records of 48 patients (51 eyes) who underwent PP placement of a GDI and a PK between July 1996 and June 2006 at the University of Virginia. The GDI was inserted during the same operation as the PK in 26 eyes (51.0%). Glaucoma control was assessed by IOP and the need for further glaucoma medication or surgery. Corneal grafts were assessed for clarity. RESULTS: Mean follow-up was 38.4 months. IOP was successfully controlled in 88%, 85%, and 82% of eyes at 12, 24, and 48 months, respectively. Corneal grafts were clear in 89%, 67%, and 41% of eyes at 12, 24, and 48 months, respectively. Corneal graft failure was significantly higher in eyes with an anterior chamber intraocular lens (P

A conjunctival lesion with histological features similar to large-cell acanthoma of the skin.

Large-cell acanthoma (LCA) is a sharply demarcated epidermal lesion composed of large keratinocytes and characterized by hyperkeratosis, hypergranulosis and orthokeratosis. It usually affects actinically damaged skin. LCA is currently believed to be a distinct entity with an unclear pathogenesis and a benign biologic behavior. Here, we describe the first occurrence of LCA in the conjunctiva. The lesion recurred following initial excision, and later recurred as a carcinoma in situ following a second excision. This case suggests that LCA may have a malignant and transformation potential.

Dry eye and designer ophthalmics.

Expressed sequence tag (EST), proteomic, and antibody capture assays are revealing a level of tear film protein complexity far greater than previously appreciated. A systems biology approach will be needed to fully appreciate function as tear protein doses fluctuate in time through different conditions. Although consensus is growing on what fully constitutes the human tear proteome, questions remain about the source and significance of the approximately 256 tear proteins designated as "intracellular." Many of these may derive from normal cellular turnover and could therefore be informative. A further >183 are designated as "extracellular." Surprisingly, only 4 to 5% of these appear to be dysregulated in the three forms of dry eye preliminarily examined to date. Some differ and a couple overlap, suggesting that disease-specific signatures could be identified. Future dry eye treatment might include recombinant tear protein rescue as a personalized ophthalmic approach to ocular surface disease.