The epidemiology of cosmetic treatments for corneal opacities in a Korean population.

PURPOSE: To describe etiologies and clinical characteristics of corneal opacities leading patients to seek cosmetic treatments. METHODS: The medical records of 401 patients who presented for cosmetic improvement in corneal opacities between May 2004 and July 2007 were retrospectively reviewed. The following parameters were analyzed: age, gender, cause of corneal opacity, time course of the corneal disease, associated diseases, prior and current cosmetic treatments, visual acuity, location and depth of the corneal opacity, and the presence of either corneal neovascularization or band keratopathy. A single practitioner examined all patients. RESULTS: The most common causes of corneal opacity were ocular trauma (203 eyes, 50.6%), retinal disease (62 eyes, 15.5%), measles (38 eyes, 9.5%), and congenital etiologies (22 eyes, 5.5%). Prior treatments included iris colored contact lenses (125 eyes, 31.1%) and corneal tattooing (34 eyes, 8.46%). A total of 321 of 401 eyes underwent cosmetic treatment for corneal opacities. The most common treatment performed after the primary visit was corneal tattooing (261 eyes, 64.92%). CONCLUSIONS: This is the first study to investigate the causes and clinical characteristics of patients presenting for cosmetic treatment of corneal opacities rather than for functional improvement. Various cosmetic interventions are available for patients with corneal opacities, and these should be individualized for the needs of each patient.

Prevalence of and associated factors for corneal blindness in a rural adult population (the southern Harbin eye study).

PURPOSE: To examine the distribution and causes of corneal blindness in a rural Chinese population. METHODS: Cluster sampling of populations age > 50 was used. The protocol consisted of a detailed interview, visual acuity (VA) testing, and clinical examinations. An eye was considered to have cornea blindness if the visual acuity was < 20/400 due to a corneal disease. RESULTS: A total of 5057 eligible subjects agreed to participate, giving an attendance rate of 91.0%. Corneal blindness in at least one eye was present in 48 participants, prevalence of 0.949% (95% CI: 0.682-1.216%) in at least one eye, which included 0.16% prevalence of corneal blindness in both eyes. The most frequent causes of corneal blindness in at least one eye included keratitis during childhood (39.6%), keratitis during adulthood (27.1%), and trauma (20.8%). We found that aging and male gender were associated with prevalence of corneal blindness. Multivariate analysis shows a higher OR of corneal blindness in subjects age 70 and older (1.746) and male gender (1.177). CONCLUSIONS: Corneal blindness is a public health problem in southern Harbin, the majority of which is either preventable or treatable. Eye care planning must focus on corneal blindness as well as cataract.

Keratoprosthesis surgery for end-stage corneal blindness in asian eyes.

PURPOSE: To establish a multidisciplinary surgical program for osteo-odonto-keratoprosthesis (OOKP) surgery in Asia and to evaluate efficacy and preliminary safety of this keratoprosthesis in end-stage corneal and ocular surface disease. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Sixteen adults of Asian ethnic origin, bilaterally blind with end-stage corneal blindness from Stevens-Johnson syndrome, or severe chemical or thermal burns. METHODS: Osteo-odonto-keratoprosthesis surgery involves 2 procedures-in stage 1, an autologous canine tooth is removed, modified to receive an optical polymethyl methacrylate cylinder, and implanted into the cheek. The ocular surface is denuded and replaced with full-thickness buccal mucosa. Stage 2 surgery, performed 2 to 4 months later, involves retrieval of the tooth-cylinder complex and implanting it into the cornea, after reflection of the buccal mucosal flap, corneal trephination, iris and lens removal, and anterior vitrectomy. Concurrent glaucoma and vitreoretinal procedures are also performed at either stage, as required. MAIN OUTCOME MEASURES: Visual acuity (VA), field of vision, anatomical integrity and stability, and ocular and oral complications related or unrelated to the OOKP device. RESULTS: Osteo-odonto-keratoprosthesis surgery was performed on 15 patients, with a mean follow-up of 19.1 months (range, 5-31). Intraoperative complications included expulsive hemorrhage (keratoprosthesis device not implanted), tooth fracture (n = 1), oronasal fistula (n = 1), and mild inferior optic tilt (n = 1). Anatomical stability and keratoprosthesis retention has been maintained in all eyes, with no dislocation, extrusion, retroprosthetic membrane formation, or keratoprosthesis-related infection. Other complications not directly related to device insertion included retinal detachment (RD) related to silicone oil removal (n = 1) and endophthalmitis related to endoscopic cyclophotocoagulation performed 1 year after OOKP surgery (n = 1). Eleven patients (73.3%) attained a stable best spectacle-corrected VA of at least 20/40 or better, whereas 9 (60%) attained stable 20/20 vision. Four patients achieved their best visual potential, ranging from 20/100 to counting fingers vision, related to preexisting glaucomatous optic neuropathy or previous RD. CONCLUSIONS: Establishment of our OOKP program suggests that OOKP surgery has the potential to restore good vision to the most severe cases of corneal blindness in an Asian setting, with minimal device-related complications. Longer follow-up of these cases is currently underway.

Prevalence of cicatricial trachoma in an indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS).

BACKGROUND: Trachoma is one of the leading causes of blindness worldwide, resulting from conjunctival scarring, upper lid entropion and trichiasis, leading to corneal scarring and opacification. This study was designed to investigate the current prevalence of cicatricial trachoma in an indigenous population within Central Australia and help determine whether trachoma remains a public health issue. METHODS: Participants aged 40 and over were recruited from patients attending one of 16 remote ophthalmology clinics held at indigenous communities in Central Australia within the Northern Territory. Once informed consent had been obtained, each patient underwent examination for evidence of trachomatous scarring, trachomatous trichiasis and corneal opacities. Results were collated and compared with previous prevalence surveys. RESULTS: Among the sample (n = 181), there were 97 patients (54%; 95% CI 46.7-61.3) with trachomatous scarring, 15 patients (8%; 95% CI 2.8-13.2) with trichiasis and 5 patients (3%; 95% CI 0.5-5.5) with corneal opacities. CONCLUSION: This study suggests that, although the prevalence of the cicatricial and blinding consequences of trachoma may be decreasing in patients aged 40 years or greater, when compared with the current prevalence in other areas of Australia, trachoma still remains a public health issue in Central Australia.

Corneal haze among blue eyes and brown eyes after photorefractive keratectomy.

BACKGROUND: To compare the incidence and severity of corneal haze after photorefractive keratectomy (PRK) among white patients with blue eyes and Saudi patients with brown eyes. DESIGN: Retrospective, nonrandomized, comparative trial. PARTICIPANTS: A total of 150 patients (71 females and 79 males) were included in this study. Two hundred sixty-six eyes of 150 patients were subjected to PRK. One hundred blue eyes of 50 white patients and 166 brown eyes of 100 Saudi patients were included in this study. METHODS: Two hundred sixty-six eyes of 150 patients were subjected to PRK with the Chiron Technolas Keracor 117C for the correction of myopia and astigmatism. MAIN OUTCOME MEASURES: All patients had complete ophthalmologic examinations, visual acuity testing, intraocular pressure, pachymetry, corneal haze assessment (0-4+), and computerized corneal topography. RESULTS: There were 266 eyes of 150 patients with 100 blue irides and 166 brown irides. The spherical equivalent was -0.50 diopter (D) to -8.75 D. The mean postoperative spherical equivalent at 6 months was -0.063 D (standard deviation [SD], +/-0.595) in blue eyes compared to -0.28 D (SD, +/-0.683) in brown eyes (P = 0.006). Ninety-five (95%) of 100 of the blue eyes achieved +/- 1 D of attempted correction compared to 148 (89.2%) of the 166 brown eyes. All patients with blue eyes had a visual acuity of 20/30 or better compared to 153 (92.2%) of the 166 brown eyes (P = 0.009). Forty-eight (18.04%) eyes had minimal to mild haze, 3 (1.12%) eyes had moderate haze, and 2 (0.75%) eyes had severe haze. The incidence of corneal haze among brown eyes was 48 (28.9%) of 166 eyes compared to 5 (5%) of 100 in blue eyes (P < 0.001). The difference remained significant after adjustment for age and gender with a P value of 0.0283. The relative risk for developing haze in brown eyes was found to be 7.72. CONCLUSION: The incidence of corneal haze after PRK was significantly higher among Saudi patients with brown irides than among white patients with blue irides. This suggests that racial factors may play a role in the development of corneal haze.

Autosomal dominant cataracts and Peters anomaly in a large Australian family.

Peters anomaly is a congenital corneal opacity with underlying defects in the posterior stroma, Descemets membrane and corneal endothelium. It is a disorder resulting from abnormal migration or function of neural crest cells and may include abnormalities of other anterior segment structures, such as the lens and iris. We report a family in which anterior segment abnormalities, including Peters anomaly and cataracts, were inherited in an autosomal dominant fashion. Although the PAX6 gene on chromosome 11 has been shown to be involved in some cases of anterior segment developmental defects, we found no evidence that the condition in this family is linked to the PAX6 gene. Identification of this gene will indicate another gene with major involvement in the development of the anterior segment of the eye.

Anthropometric status and cataract: the Salisbury Eye Evaluation project.

BACKGROUND: Weight or body mass index (BMI; in kg/m2) is frequently identified as a risk factor for cataract, but the nature of the association is unclear. OBJECTIVE: We aimed to characterize the relation between BMI and stature and risk of different types of cataract. DESIGN: We analyzed data from participants in the Salisbury Eye Evaluation (SEE), a cross-sectional survey of visual status and demographic, nutritional, and environmental factors conducted between 1993 and 1995 in a representative sample of community-dwelling older persons in Salisbury, MD. Multiple logistic regression techniques were used to compare risk factors between individuals with nuclear, cortical, or posterior subcapsular (PSC) opacities and individuals with no cataract. RESULTS: Risk of nuclear opacification was greater in participants with lower BMIs [adjusted odds ratio of 1.13 (95% CI: 1.02, 1.27) with a BMI of 22.5 compared with 28.0] and of taller stature [1.12 (95% CI: 1.01, 1.25) with a stature of 170.5 cm compared with 164]. In contrast, risk of cortical opacification was greater in participants with higher BMIs and of taller stature, but the relation for stature diminished in magnitude and was not significant after adjustment for other risk factors. BMI was not related to risk of PSC opacities, but there was some evidence that taller stature is a risk factor for PSC opacification (P = 0.06) after adjustment for other risk factors. CONCLUSIONS: Both BMI and stature are independent risk factors for cataracts in the SEE population, with the nature of the risk dependent on cataract type.

West Indian punctate keratopathy.

We found corneal lesions of West Indian punctate keratopathy in 128 of 2,048 patients examined in a general eye clinic in Grenada, West Indies. Of these, 125 were Black, two were Indians (Hindu), and one a White female. The lesions occurred in asymptomatic persons with no history of trauma or recurrent erosions. Males were affected more than females, and older adults more than children. The condition was usually unilateral but occasionally bilateral, with one to four lesions in the intrapalpebral fissure in a paracentral location. The lesions were round, discrete, white to yellowish-gray dots 0.2-0.6 mm in size located at the level of the epithelial basement membrane and Bowman's layer. No vascularization nor other anterior membrane disorders were observed. Corneal biopsies of 11 patients were studied by histopathologic and immunoperoxidase techniques. Histopathology revealed areas of lipid positive material in Bowman's layer and adjacent corneal stroma. The epithelium showed basal cell edema, degeneration, and irregular thickening of the basement membrane. Immunoperoxidase studies did not contribute any new information about these lesions.