Management of dislocated nucleus with corneal opacity by combined deep anterior lamellar keratoplasty, pars- plana vitrectomy and phaco-fragmentation.

A 32-year-old man presented with bilateral diminution of vision for 10 years. Visual acuity was light perception in both eyes with inaccurate projection in the oculus dextrus(OD) and accurate projection in the in oculus sinister (OS). Intraocular pressure was 6 and 12 mm Hg in the OD and OS, respectively. Slit-lamp examination revealed the presence of leucomatous corneal opacification with microcornea in oculus uterque (OU). Both eyes had a dislocated nucleus in the vitreous cavity on ultrasound B-scan with advanced cupping in the right eye. Ultrasound biomicroscopy revealed ciliary body atrophy in the OD and preserved ciliary processes (two quadrants) in the OS. In view of a partially preserved ciliary body function and a potential for gaining useful vision, we planned surgical intervention in the left eye. Deep anterior lamellar keratoplasty with pars planavitrectomy (PPV) and phacofragmentation of the nucleus was done. Donor lamellar graft was sutured after completion of PPV and nucleus fragmentation. The patient regained useful ambulatory vision postoperatively with clear corneal graft.

Cucurbita argyrosperma Seed Extracts Attenuate Angiogenesis in a Corneal Chemical Burn Model.

Severe corneal inflammation produces opacity or even perforation, scarring, and angiogenesis, resulting in blindness. In this study, we used the cornea to examine the effect of new anti-angiogenic chemopreventive agents. We researched the anti-angiogenic effect of two extracts, methanol (Met) and hexane (Hex), from the seed of Cucurbita argyrosperma, on inflamed corneas. The corneas of Wistar rats were alkali-injured and treated intragastrically for seven successive days. We evaluated: opacity score, corneal neovascularization (CNV) area, re-epithelialization percentage, and histological changes. Also, we assessed the inflammatory (cyclooxigenase-2, nuclear factor-kappaB, and interleukin-1ß) and angiogenic (vascular endothelial growth factor A, VEGF-A; -receptor 1, VEGFR1; and -receptor 2, VEGFR2) markers. Levels of Cox-2, Il-1ß, and Vegf-a mRNA were also determined. After treatment, we observed a reduction in corneal edema, with lower opacity scores and cell infiltration compared to untreated rats. Treatment also accelerated wound healing and decreased the CNV area. The staining of inflammatory and angiogenic factors was significantly decreased and related to a down-expression of Cox-2, Il-1ß, and Vegf. These results suggest that intake of C. argyrosperma seed has the potential to attenuate the angiogenesis secondary to inflammation in corneal chemical damage.

Evaluation of a topical cyclosporine A prodrug on corneal graft rejection in rats.

PURPOSE: To assess the efficacy of a topical cyclosporine A (CsA), water-soluble prodrug, for promoting the survival of allogenic rat corneal grafts after penetrating keratoplasty (PKP). METHODS: Corneas of Brown-Norway rats (donors) were transplanted to Lewis rats (recipients). Transplanted rats were divided in three treatment groups: group I (PBS) and group II (0.26% Debio088) received drops five times per day. Group III received a daily intramuscular CsA injection (10 mg/kg/day). Blood CsA concentrations were measured on days 2 and 14. On day 4, 10, 13 after PKP, grafts were scored for corneal transparency, edema and extent of neovascularization. An opacity score of greater than or equal to 3 was considered as a nonreversible graft rejection process. On day 14, the experimental eyes were processed for histology. RESULTS: On day 13, 12 of the 18 corneal transplants (67%) in group I showed irreversible graft rejection. Three of 18 transplants (19%) in group II and 5 of 16 transplants (28%) in group III showed irreversible graft rejection (p=0.013/p=0.019, OR=0.14/0.06 versus vehicle). Each mean clinical score for edema, opacity, and neovessels in group II were significantly lower than those of the grafts in group I (respectively p=0.010, p=0.013, p=0.024) and III except for neovessels (respectively p=0.002, p=0.001, p=0.057). Histology confirmed the clinical results. The mean CsA blood levels for groups II and III were, respectively 54+/-141 mug/l and 755+/-319 mug/l on day 2 and 14+/-34 mug/l and 1318+/-463 mug/l on day 14. CONCLUSIONS: Debio088 CsA prodrug drops given five times daily are as effective as intramuscular injection of 10 mg/kg/day for the prevention of acute corneal graft rejection in rats.

The protective role of topical propolis on experimental keratitis via nitric oxide levels in rabbits.

The aim of this study was to investigate antioxidant, anti-inflammatory, and antibacterial properties of propolis in the treatment of experimental Staphylococcus aureus keratitis. Twenty young New Zealand white rabbits were used in this experiment. Staphylococcus aureus were given by intrastromal injection to 16 rabbits and 4 rabbits were used as control group (Group 1). Group 2 was treated with phosphate-buffered solution drops; Group 3 was administered ethanolic extract of propolis drops; Group 4 received topical ciprofloxacin drops; Group 5 was treated with topical ciprofloxacin drops along with ethanolic extract of propolis drops. The eyes were examined by slit lamp to assess corneal opacity. And then, corneas were removed to determine nitric oxide (NO) levels and count bacteria. Corneas were also evaluated histologically. Corneal NO concentration in group 5, treated with a combination of propolis and ciprofloxacin was determined significantly lower (10.0+/- 1.8 micromol/g wet tissue) than in Group 4, treated with ciprofloxacin (24.0+/- 3.1 micromol/g wet tissue), from Group 3, treated with propolis (15.6+/- 1.8 micromol/g wet tissue), and treated with PBS (44.7+/- 7.8 micromol/g wet tissue). There were significantly fewer bacteria in eyes that received propolis plus ciprofloxacin than in eyes treated with ciprofloxacin (p = 0.0001) or propolis (p = 0.0001) or eyes treated with PBS (p = 0.0001). The light microscopic examination revealed that the control group showed normal corneal morphology. In the nontreated group, sections of the stromal infiltration revealed the presence of inflammatory cells, which were diffusely distributed (p < 0.05). Administrations of ciprofloxacin plus propolis resulted in a significantly reduced histological damage with fewer bacterial inoculation of the corneal stroma in comparison with the other groups (p < 0.05). Based on these findings, we suggest that ethanolic extract of propolis has antioxidant, anti-inflammatory, and antibacterial properties for S. aureus keratitis in rabbits.

[Tear examinations in primary peripheral lipid keratopathy]. / Untersuchungen der Tränenflüssigkeit im Falle einer primären peripheren Lipidkeratopathie.

The authors report a case of a bilateral peripheral lipid keratopathy, rising differential diagnostic points as well. After several year-long follow-up period the peripheral corneal opacity left the center unaffected. The diagnosis was confirmed by tear examinations which disclosed elevated level of fatty and phosphorous content compared to healthy control eyes.

[Chemical constituents of grub and grub eye drops].

The chemical constituents of grub (Holotrichia diomphalia Bates.) were systematically analyzed. The results showed that grab contained amino acids, polypeptide or protein, carbohydrate, alkaloid, organic acid, steroid et al. The analysis of amino acids in the hydrolysate in grub eye drops showed the content of Glu and Gly was high, which occupied 40.33% of total amino acids in the hydrolysate. We inferred that Glu and Gly might be the active principle on catatract and nebula.

Effects of tranilast on cultured rabbit corneal keratocytes and corneal haze after photorefractive keratectomy.

PURPOSE: In vitro and in vivo studies were performed to elucidate the effects of tranilast on cellular proliferation and collagen synthesis. METHODS: Subculturing was carried out using keratocytes from rabbits that underwent photorefractive keratectomy (PRK) and developed corneal haze, and keratocytes from normal rabbit cornea. RESULTS: Tranilast suppressed proliferation in cultured keratocytes from the corneal haze region at doses of 30 and 300 micromol/L and collagen synthesis at doses of 3, 30, and 300 micromol/L. Normal corneal cultures showed suppression of keratocyte proliferation and collagen synthesis only at a high dose of tranilast (300 micromol/L). Betamethasone suppressed proliferation of keratocytes in both haze and normal cornea at a dose of 10 micromol/L, as well as collagen synthesis at respective doses of 1 and 10 micromol/L. Diclofenac sodium suppressed collagen synthesis of keratocytes in haze cornea at a high dose of 100 micromol/L, and in keratocytes in normal cornea, at doses of 10 and 100 micromol/L. In an in vivo study, either 0.5% tranilast, 0.1% betamethasone phosphate eye drops, or a tranilast base solution (control) was instilled four times daily to rabbits that had undergone PRK. Weekly evaluation of the inhibitory effect of these drugs on the development of haze was performed 2 weeks after surgery. Tranilast suppressed haze 6-13 weeks after PRK, but betamethasone phosphate showed no effect. CONCLUSION: These results indicate that tranilast is potentially effective for inhibiting the corneal haze that occurs after PRK.

Corneal endothelial toxicity of topical anesthesia.

PURPOSE: To determine the relative corneal endothelial toxicities of the following topical anesthetic agents: bupivacaine HCl 0.75%, unpreserved lidocaine HCl 4%, proparacaine HCl 0.5%, and tetracaine HCl 0.5%. METHODS: The experiment was conducted using pigmented rabbits. Approximately nine animals each were randomly assigned to eight groups. Right eyes received injections of 0.2 ml of one of the four anesthetic agents at one of two concentrations and left eyes received injections of 0.2 ml of balanced salt solution. Corneal thickness and clarity were measured before surgery and on postoperative days 1, 3, and 7. RESULTS: A statistically significant increase (P < 0.05) in corneal thickness and opacification over preoperative measurements was noted with injections of bupivacaine, lidocaine, and proparacaine, controlling for changes occurring in control eyes from surgery alone. Proparacaine was statistically more toxic than were the others. The toxicity of tetracaine was statistically indistinguishable from balanced salt solution, although mild toxicity was evident clinically. Injection of 1:10 dilutions of the same anesthetic agents failed to produce a statistically significant increase in corneal thickness or opacification on any postoperative examination. CONCLUSIONS: Anterior chamber injection of bupivacaine HCl 0.75%, unpreserved lidocaine HCl 4%, and proparacaine HCl 0.5% produces corneal thickening and opacification that is clinically and statistically significant. Tetracaine HCl 0.5% injection produces corneal thickening and opacification that is clinically apparent in some eyes but statistically insignificant. Ophthalmic surgeons should be aware of the potential for endothelial cell injury if anesthetic agents enter or are injected into the eye during cataract surgery in the concentrations supplied commercially.

[Band-like keratopathy after treatment of postoperative fibrin reaction with tissue plasminogen activator]. / Bandförmige Keratopathie nach Behandlung der postoperativen Fibrinreaktion mit Gewebeplasminogenaktivator.

BACKGROUND: In recent years TPA (tissue-plasminogen activator) has been increasingly and successfully used for the treatment of severe, postoperative fibrin reaction in the anterior chamber. So far no serious side effects of this treatment have been reported. PATIENTS AND METHODS: Altogether, 32 patients received 0.2 ml solution with 20 micrograms TPA intracamerally. In 2 cases a dense corneal opacity was observed 12-24 hours after the injection of TPA which was resistant to treatment with local dexamethasone and lubricants. Therefore it was removed by superficial keratectomy. In one case the keratectomy specimen could be examined by light- and electronmicroscopy. RESULTS: In the keratectomy specimen a selective, fine-granular calcification of Bowman's membrane could be demonstrated. CONCLUSIONS: The intracameral TPA treatment for postoperative fibrin reaction can cause a rapid band keratopathy. Therefore the application of TPA should be restricted to severe therapy-resistant cases of intracameral fibrin reaction. In cases with the development of a band keratopathy EDTA-treatment is recommended.

[Phototherapeutic keratectomy in recurrences of granular corneal dystrophy after keratoplasty]. / Phototherapeutische Keratektomie bei Rezidiven einer granulären Hornhautdystrophie nach Keratoplastik.

BACKGROUND: Recurrences of granular corneal dystrophy (Groenouw type I dystrophy) after penetrating keratoplasty have been often reported in the literature. Up to now the therapy of these recurrences consists in performing a lamellar or penetrating re-keratoplasty. As those recurrent opacities at first are located in the area of Bowman's membrane and the superficial corneal stroma, a phototherapeutic keratectomy (PTK) with an excimer laser offers a therapeutic alternative to re-keratoplasty. PATIENTS AND METHODS: We describe three eyes of two patients with recurrent opacities on the transplant after successful keratoplasty because of granular corneal dystrophy. In all eyes we performed an excimer-laser PTK (Keratom of Schwind Company, Kleinostheim/Germany, wave length 193 nm) after abrasion of the epithelium with a hockey-knife. The depth of ablation depended on the location of the opacities and was between 7 microns and 35 microns. During the excimer-laser treatment several biomicroscopical slit-lamp controls were performed to make sure whether a sufficient depth of ablation was obtained. RESULTS: The opacities could be totally removed in all eyes by excimer-laser PTK. Postoperatively the visual acuity increased and the patient's photophobia decreased. At the same time a slight progression of hyperopia developed depending on the depth of ablation. During the follow-up period of 5 to 12 months no recurrent opacities could be found until now. CONCLUSIONS: Phototherapeutic keratectomy with the excimer laser seems to be a good alternative to re-keratoplasty in superficially located recurrences of granular corneal dystrophy in a graft after keratoplasty. A slight progression of hyperopia depending on the depth of ablation has to be accepted. The future will show whether there will develops recurrent opacities of the dystrophy after an excimer laser treatment.

Spontaneous development of corneal crystalline deposits in MRL/Mp mice.

PURPOSE: The presence of corneal opacities associated with dacryoadenitis and lacrimal gland destruction has led investigators to consider MRL/Mp mice as models for band keratopathy and Sjögren syndrome. In this study, the authors examined the time course of the corneal opacification and investigated whether the opacities were associated with altered serum levels of parathyroid hormone, calcium, and phosphorus, as well as quantitative and qualitative differences in tear production. METHODS: Corneas were analyzed microscopically and tear fluid production was measured by a modified Schirmer test. RESULTS: Corneal lesions were observed as early as the fifth week after birth. The lesions consisted of calcium phosphate and appeared as punctate, crystalline opacities located subeithelially. Lesions were present in 72% (56 of 78) of the MRL/Mp mice, with no significant difference in incidence between MRL/Mp +/+ and MRL/Mp lpr/lpr mice. Corneal calcification was occasionally associated with a self-limiting keratitis and neovascularization. In control mice, corneal opacities were not observed before the animals were 6 months of age. Levels of circulating parathyroid hormone decreased significantly during the first 16 weeks of age in MRL/Mp mice. In addition, MRL/Mp mice of both sexes had a significantly lower tear fluid production as compared to BALB/c mice of the same age. CONCLUSION: Because corneal lesions start to develop in 5-week-old MRL/Mp mice, thereby preceding the clinical signs of systemic autoimmune disease, and may develop in 6-month-old nonautoimmune-prone mice, it is suggested that calcification develops independent of the systemic autoimmune disease and might be restricted to the cornea.

Phototherapeutic keratectomy in herpes simplex keratitis. Clinical results in 20 patients.

Twenty eyes in 20 patients with herpetic keratitis were treated with excimer laser photoablation. Sixteen eyes underwent phototherapeutic keratectomy because of scars and surface irregularities, with the goal to improve vision and 1 eye for cosmetic reasons. Two eyes had slight scars but were treated because of a refractive error (PRK). One eye had a metaherpetic ulcer where the wound surface was ablated with the intention to improve healing. Twelve of the 16 eyes showed improved visual acuity of 2 lines or more on the Snellen chart. The refractive outcome was acceptable in the 2 PRK eyes. The cosmetic result was good and the metaherpetic wound epithelialized within 3 weeks. Of the 20 patients 5 had 1 or more recurrences during the 16.8 months of follow-up. In the 17 months preceding the laser surgery 9 eyes had 1 or more recurrences. Three of these eyes still showed improved vision. Phototherapeutic excimer laser surgery is advantageous in selected cases and should be considered before corneal grafting. The procedure does not seem to increase the incidence of recurrences.

Corneal opacity in LCAT disease.

Deficiency of lecithin:cholesterol acyltransferase, LCAT disease, is one of the dyslipoproteinemias with characteristic lipid deposits in the cornea. The present report documents the clinicopathologic abnormalities of one case in which a full-thickness corneal specimen was obtained at the time of corneal transplantation. The characteristic clinical abnormality was a progressive corneal opacification with a peripheral arcus that extended into the sclera. The pathologic abnormality consisted of vacuoles prevalent in the anterior corneal stroma by light microscopy and containing extracellular, membranous deposits by electron microscopy. These observations confirm and supplement the previous six pathologic reports of corneal changes in LCAT disease and demonstrate, for the first time, histopathologic evidence of unesterified cholesterol in the corneal stroma of LCAT disease.

Role of eicosanoids in the ocular response to intracameral hydrogen peroxide.

The intracameral injection of hydrogen peroxide induces a sequence of responses in the tissues bounding the anterior chamber. These changes include intraocular pressure, corneal thickness, iris hyperemia, increased leakiness of the iris vasculature, and edema of the ciliary processes as judged from microscopic examination. Some of these responses appear to include inflammatory effects that may be the result of the local release of eicosanoids. Several antagonists of the arachidonic acid cascade, indomethacin, aspirin, dexamethasone, and nordihydroguaiaretic acid (NDGA) were used to examine their influence on the sequelae of hydrogen peroxide injection. Indomethacin, and high dose (7.5 mg/kg) NDGA were most effective in reducing the number of parameters that were altered after intracameral hydrogen peroxide. Microscopic observations supported the physiological changes and the responses to antagonists. The data indicate that a portion of the ocular tissue responses to intracameral hydrogen peroxide in the rabbit eye may be the result of eicosanoid production in these tissues.

Effect of ketorolac on herpes simplex virus type one ocular infection in rabbits.

Corticosteroids can exacerbate viral ocular infections. Ketorolac tromethamine is an effective nonsteroidal anti-inflammatory agent that may be a useful substitute for corticosteroids following ocular surgery. In this study, rabbits ocularly infected with herpes simplex virus type 1 (HSV-1) were treated topically four times daily with 0.5 percent ketorolac or 0.1 percent dexamethasone for 7 days after infection. Severity of the infection was determined by scoring corneal opacity and HSV-1 corneal ulcerations with the Draize scale as well as iritis and conjunctivitis. Ten days after treatment ended both the corneal opacity scores (1.5 out of 4) and HSV-1 corneal ulcerations (0.3 to 0.7 out of 4) were similar for ketorolac and the vehicle, indicating no exacerbation of the infection, whereas with dexamethasone these scores were increased (3.6/4 and 3.4/4, respectively). Furthermore, both iritis scores (0.5/2) and conjunctivitis scores (1.3 to 1.4/10) were also similar for ketorolac and the vehicle, while dexamethasone increased both iritis (1.8/2) and conjunctivitis (4.3/10) compared to vehicle. Thus, ketorolac appears to be an anti-inflammatory agent that does not worsen viral ocular infection.