Progressive hyperopic refractive changes after posterior capsule tear following blunt ocular trauma.

Purpose: To describe the mechanism of progressive hyperopia and its management in the long-term course of traumatic cataract with a posterior capsule tear (PCT) following blunt ocular trauma. Observation: A 37-year-old woman presented with blurry vision and photophobia after being hit in the right eye by a slipper. She was found to have PCT with the formation of a traumatic cataract with emmetropia (0 diopters [D]). Three years after the injury, a broader hyperopic change of +8.0 D was found in the patient at her first visit to our clinic. Optical coherence tomography (OCT) analysis of the anterior segment of the eye revealed damage to the posterior capsule and cataracts due to disorganization of the lens fibers and liquefaction of the lens. Femtosecond laser-associated cataract surgery was performed for anterior capsulotomy and segmentation of the nucleus without further enlargement of the PCT, facilitating the placement of a capsular tension ring segment and a multifocal intra ocular lens (IOL) in the capsular bag. At 1-month post-operation, her uncorrected visual acuity was 20/20 in the right eye, with a well-centered IOL. Conclusions and Importance: Isolated PCT due to blunt trauma is rare, and there have been no reports of progressive hyperopia after three years of follow-up. In such cases, the lens may liquefy, resulting in decreased refraction and significant hyperopia.

Measurement of light transmission of human limbal epithelial cells cultured on human amniotic membranes.

PURPOSE: To measure the light transmission properties of human limbal epithelial cell sheets (LECSs) cultured on human amniotic membranes (AMs) and compare them with those of AMs with and without amniotic epithelium. METHODS: Total light transmission of 3 kinds of tissue (LECSs, intact AMs, denuded AMs) was measured in the 250- to 800-nm range by using a spectrophotometer. RESULTS: The percent transmission of each kind of tissue decreased gradually and continually throughout the spectrum as the wavelength shortened and dropped rapidly at 300 nm to less than 20% at 250 nm. All tissues transmitted more than 70% of light in the wavelength region greater than 400 nm and more than 90% in that greater than 600 nm. The percent transmission spectrum of all tissues showed identical curves in the visible light and UV-A regions. However, the percent transmission of LECSs was lower than that of either intact or denuded AMs in the UV-B and UV-C regions. CONCLUSIONS: In the visible and UV-A light region, the percent transmission profiles of amnion-related tissues (LECSs, intact AMs, denuded AMs) are not altered by the presence of either amniotic epithelium or multilayered limbal corneal epithelium. However, the presence of multilayered limbal corneal epithelium, but not amniotic epithelium, on amniotic stroma reduced UV-B and -C transmission significantly. Further study concerning light transmission and other physical properties of LECSs is necessary to fully understand the ocular physiology of eyes grafted with such newly developed bioengineered tissues.

Bilateral corneal perforation in an infant with congenital alacrima.

A 9-month-old infant had bilateral corneal opacity with erosion in the inferior corneas. Clinical examination suggested the infant had congenital alacrima. After 1 week, both corneas perforated with collapsed anterior chambers. Therapeutic soft contact lenses with ofloxacin ointment 4 times daily were successful, and the perforations sealed within 1 week.

In vivo laser confocal microscopic analysis of human corneal epithelial sheet cultured on amniotic membrane.

BACKGROUND AND OBJECTIVE: Corneal epithelial sheet cultured on amniotic membrane ex vivo has been developed for the treatment of severe ocular surface disorders. In this study, human corneal epithelial sheets cultured on amniotic membranes were analyzed using a laser scanning confocal microscope. MATERIALS AND METHODS: Human corneal epithelial cells were cultured on four sheets of amniotic membrane, and they were examined layer by layer using the laser scanning confocal microscope. RESULTS: The superficial layer cells were mosaic in appearance. In the superficial layer, focal areas of slender and elongated cells were noted. In addition, highly reflective materials were noted. Basal epithelial cells of the corneal epithelium sheet at a slightly deeper plane displayed mosaic pattern with smaller cells. At a slightly deeper plane, the basement membrane of amnion showed relatively bright homogeneity. CONCLUSION: The laser scanning confocal microscope can examine the morphology of human corneal epithelial cells cultured on amniotic membranes.

Intraocular pressure by noncontact tonometry over an amniotic membrane patch in humans.

PURPOSE: To determine the reliability of noncontact tonometry (NCT) in measuring intraocular pressure (IOP) over a combination of amniotic membrane (AM) patch and therapeutic soft contact lens (TSCL) in normal human eyes. DESIGN: Experimental study. METHODS: Twenty-five healthy volunteers (twenty males, five females) participated in this study. After topical anesthesia, IOP was measured using noncontact tonometry before and after the application of a single layer of AM to the right eye and a double layer of AM to the left eye. To enable the IOP measurement by NCT, a TSCL was placed over the AM patch. The thickness of a single or a double layer of AM was measured by pachymetry and correlated with the IOP reading. RESULTS: We found no statistical difference between IOPs measured with and without a combination of a single-layer AM/TSCL (P = .734). In contrast, the IOPs measured over a combination of a double-layer AM/TSCL decreased significantly when compared with the control (P < .0001). The average thicknesses of the single and the double layer of AM were 72.4 +/- 15.0 mum and 126.9 +/- 14.6 mum (mean +/- SD), respectively. There was a negative correlation between total AM thickness and IOP change (r = -.481, P = .0008). CONCLUSIONS: We found that it is reliable to measure IOP by NCT through a combination of a single-layer AM/TSCL on normal human eyes. However, IOP measured by NCT over a combination of a double-layer AM/TSCL was inaccurate and tended to be an underestimation.

Amniotic membrane transplantation in acute phase of toxic epidermal necrolysis with severe corneal involvement.

OBJECTIVE: To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation. DESIGN: Interventional case report. METHOD/INTERVENTION: A 6-year-old boy who had convulsions and fever due to encephalitis was treated by oral phenobarbital. Two weeks later, he developed a high fever and skin rashes involving >40% of the body, with a positive Nikolsky sign and oral blisters. Examination under general anesthesia performed 5 days after the onset of eye symptoms showed severe inflammation and ulceration on the lid margin and the tarsal conjunctiva in both eyes, a total corneal epithelial defect in the right eye, and a geographical corneal epithelial defect in the left eye. Amniotic membrane was transplanted in both eyes as a patch to cover the entire ocular surface, including upper and lower lid margins. RESULTS: Fourteen days after amniotic membrane transplantation, complete corneal and conjunctival epithelialization was observed in the left eye. However, a second amniotic membrane transplantation was performed in the right eye, which still had a total corneal and conjunctival epithelial defect, and resulted in complete epithelialization 14 days later. Corrected visual acuity improved to 20/16 without any superficial punctate keratitis in both eyes 6 months postoperatively. Minimal symblepharon and peripheral scarring were observed only in the right eye. CONCLUSIONS: Amniotic membrane transplantation performed at the acute phase of TEN is highly effective not only in reducing inflammation and preventing scarring in the conjunctival surface, but also in restoring corneal epithelial integrity in eyes with both corneal and conjunctival ulceration. As a result, in this case it prevented sight-threatening cicatricial complications at the chronic stage.

In vivo findings of the bulbar/palpebral conjunctiva and presumed meibomian glands by laser scanning confocal microscopy.

OBJECTIVE: To report in vivo laser scanning confocal microscopic findings of the normal human conjunctiva and presumed meibomian glands and to investigate the potential application of this confocal microscope (HRT II Rostock Cornea Module) as a diagnostic device for normal and abnormal ocular surface structures. METHOD: Four healthy volunteers (51-, 49-, 31-, and 30-year-old men) participated in this study. The temporal bulbar conjunctiva, approximately 5 mm away from the limbus, and the upper tarsus conjunctiva of each patient were examined in vivo by a laser confocal microscope. Also, presumed meibomian glands beneath the tarsal conjunctiva were examined. RESULTS: In all subjects, the in vivo laser confocal microscope obtained similar images. In the superficial epithelial cell layer of the bulbar conjunctiva, numerous bright nuclei were observed. We also observed many Langerhans cells with characteristic dendritic morphology and goblet cells with relatively homogeneous brightness in the bulbar conjunctiva. Most interestingly, the palpebral conjunctival epithelium with invaginations or crypts was observed. In addition, weblike structures, presumably meibomian glands, were observed beneath the palpebral conjunctival epithelium. CONCLUSIONS: These results indicate that in vivo laser confocal microscopy can be used not only to visualize the bulbar conjunctiva but the upper tarsus conjunctiva and possibly subconjunctival meibomian glands. Further investigations of conjunctival and meibomian gland pathologies may further elucidate the potential of this device in clinical ophthalmology.

In vivo laser and white-light confocal microscopic findings of human conjunctiva.

BACKGROUND AND OBJECTIVE: To report in vivo laser and white-light confocal microscopic findings of human conjunctiva to investigate the potential application of these confocal microscopes as diagnostic devices for normal and pathologic conjunctiva. PATIENTS AND METHODS: Two healthy volunteers, 28- and 35-year-old men, participated in this study. The temporal bulbar conjunctiva, which was approximately 5 mm away from the limbus, was examined by in vivo laser and white-light confocal microscopic analysis. RESULTS: Using laser confocal microscopy, at least two different cell types could be distinguished in both subjects: conjunctival superficial epithelial cells and conjunctival basal epithelial cells. In contrast, conjunctival epithelial cells could not be visualized using white-light confocal microscopy. CONCLUSIONS: These results indicate that laser confocal microscopy, but not white-light confocal microscopy, can be used to visualize in vivo human conjunctiva. Further investigations in a large number of normal subjects and in patients with conjunctival pathologies are required to fully evaluate the usefulness of this device in daily clinical ophthalmology.

Oxygen permeability of amniotic membrane and actual tear oxygen tension beneath amniotic membrane patch.

PURPOSE: To investigate the oxygen permeability (Dk) and oxygen transmissibility (Dk/t) of amniotic membrane (AM), and tear oxygen tension beneath AM in rabbits. DESIGN: Experimental study. METHOD: The water content of AM was measured to calculate Dk and Dk/t, and compared with those of a therapeutic soft contact lens (TSCL). The tear oxygen tension beneath AM and TSCL was also measured in four male albino rabbits. RESULTS: The average water content of AM was significantly higher than that of TSCL (96.8 +/- 0.8% (mean +/- SD) vs 78%, P =.0006), giving rise to a significantly higher Dk and Dk/t in AM as compared with TSCL (142.8 +/- 4.7 vs 65.3, respectively, P =.0012, and 92.9 +/- 3.0 vs 29.7, respectively, P =.0008). The average tear oxygen tension under AM was also higher than TSCL (94.9 +/- 2.9 vs 59.1 +/- 4.9 mm Hg, P =.0006). CONCLUSIONS: These findings support the rationale of using AM as a superior bandage in treating persistent corneal epithelial defects or ulcers.

Reliability of intraocular pressure by Tono-Pen XL over amniotic membrane patch in human.

PURPOSE: To determine the reliability of Tono-Pen XL in measuring intraocular pressure (IOP) over the amniotic membrane patch in human eyes. METHOD: Ten healthy volunteers (nine males and one female) participated in this study. After topical anesthesia, IOP was measured using the Tono-Pen XL before and after the application of a single-layer amniotic membrane patch in the right eye and double-layer amniotic membrane patch in the left eye. RESULTS: We found no statistical difference between the IOP measured with and without a single layer amniotic membrane (P = 0.808). Nor did we find any statistical difference between the IOP measured with and without double-layer amniotic membrane patch (P = 0.813). The average thickness of the single- and the double-layer amniotic membrane patch measured by pachymetry was 131.9 +/- 31.4 microm (mean +/- SD) and was 246.1 +/- 69.3 microm (mean +/- SD), respectively. CONCLUSIONS: This study showed that it is reliable to measure IOP by Tono-Pen XL over single or a double layer of amniotic membrane patch on healthy human eyes. Further studies are required to determine the accuracy of IOP measurement over amniotic membrane patch on diseased corneas.

White-light and laser confocal microscopic findings of rabbit conjunctiva.

BACKGROUND AND OBJECTIVE: To report laser and white-light confocal microscopic findings of ex vivo rabbit conjunctiva to investigate the potential application of these confocal microscopes as diagnostic devices for normal and pathologic conjunctiva. MATERIALS AND METHODS: Three male albino rabbits were killed and six eyeballs were removed with as much bulbar conjunctiva as possible. The bulbar conjunctiva approximately 5 mm away from the limbus was then subjected to an ex vivo laser and white-light confocal microscopic analysis. RESULTS: Using laser confocal microscopy, conjunctival epithelial cells, subepithelial conjunctival vessels, and sclera were clearly observed. By contrast, white-light confocal microscopy yielded images of conjunctival epithelium, subepithelial layers, and sclera that were not clearly defined. CONCLUSIONS: This study indicates that laser confocal microscopy has a superior ability to visualize ex vivo, non-fixed conjunctiva when compared with white-light confocal microscopy. It also suggests that the laser confocal microscope might be a useful, non-invasive, in vivo, "quasi-cytological" device for observing and diagnosing the conjunctival condition in humans.

Detection of rabbit corneal epithelium over amniotic membrane patch by white-light and laser confocal microscopy.

PURPOSE: To report confocal microscopic observation of rabbit corneal epithelium through amniotic membrane patch (AMP). DESIGN: Experimental study. METHOD: Six rabbit eyes were patched by amniotic membrane. Then, white-light and laser confocal microscopic observation was performed. RESULTS: Images of human amniotic epithelium, amniotic basement membrane, and amniotic stroma were obtained using both devices, followed by detection of rabbit corneal epithelium. CONCLUSION: This study indicates that observation of corneal epithelium through AMP is possible in rabbit eyes using both these methods. This implies that both devices might be used clinically to observe the epithelial healing process under an AMP to better determine when it should be removed.

Accuracy of intraocular pressure by Tono-Pen XL over amniotic membrane patching in rabbits.

PURPOSE: To report an accuracy of intraocular pressure (IOP) by Tono-Pen XL over amniotic membrane patching in rabbits. DESIGN: Experimental study. METHODS: Seven male albino rabbits were used in this study. After general anesthesia, IOP was measured in both eyes using the Tono-Pen without amniotic membrane. A single layer amniotic membrane was then immediately placed over the rabbit eye, and the IOP measurement was repeated. RESULTS: The average IOP without amniotic membrane was 5.8 +/- 0.6 mm Hg (mean +/- SD). The average IOP through amniotic membrane was 6.0 +/- 0.4 mm Hg (mean +/- SD). There was no statistical difference in IOP measured on corneas with or without the amniotic membrane (P =.34). CONCLUSIONS: The accuracy of IOP measurement by Tono-Pen XL over a single layer of amniotic membrane patching was demonstrated using rabbit eyes. Further studies in human eyes may verify our findings in actual clinical settings.

Successful management of conjunctival intraepithelial neoplasia by interferon alpha-2b.

BACKGROUND: Interferon alpha-2b (IFN alpha 2b) was recently shown to be effective as an alternative therapy for conjunctival intraepithelial neoplasia (CIN). Herein, we report our successful management of CIN by the use of IFN alpha 2b. CASE: A 73-year-old woman presented with a complaint of irritation due to a tumorous lesion in her left eye. Slit-lamp microscope examination revealed a tumorous lesion involving the bulbar and palpebral conjunctiva as well as the limbus, from the 3-o'clock position to the 8-o'clock position. She had already undergone cryotherapy in the same eye in another hospital, twice for a lesion on the lower tarsal conjunctiva and once for a lesion on the upper tarsal conjunctiva. The histological diagnosis had been CIN. OBSERVATIONS: In treating this patient, IFN alpha 2b was injected subconjunctivally twice and also applied as eye drops for 12 weeks. Two weeks after the initial treatment, the tumorous lesion disappeared. During a 1-year follow-up period, no recurrence was noted. CONCLUSION: Topical and subconjunctival IFN alpha 2b is a valuable treatment option for CIN.