Quantitative evaluation of corneal epithelial oedema by confocal microscopy.

BACKGROUND: To develop a novel quantitative index for evaluation of corneal epithelial oedema, the pixel intensity of confocal microscopic images was measured derived from the basal cell layer (BCL) of the corneal epithelium in normal eyes, eyes before and after cataract surgery, and eyes affected by bullous keratopathy. METHODS: Five eyes of five normal volunteers, 14 eyes of 11 cataract patients and 12 eyes of 12 bullous keratopathy patients were examined by confocal microscopy. The cataract patients underwent cataract surgery, and they were examined by confocal microscopy, corneal pachymetry, and anterior fluorometry both before and at various times after surgery. The pixel intensity of BCL images obtained by confocal microscopy was measured and expressed as the BCL index. RESULTS: The coefficient of variation for repeated (five times) measurement of the BCL index in each of the five normal eyes was 3.4%. The BCL index was 54.8 5.3 (mean SD) before surgery, increased significantly to 65.2 10.0 on the day after surgery, and gradually decreased thereafter in the cataract patients. The time-course of the BCL index coincided well with that of corneal thickness and anterior fluorometry value. The BCL index in eyes affected by bullous keratopathy was significantly increased at 95.0 6.4. CONCLUSION: The BCL index was increased after cataract surgery and in eyes affected by bullous keratopathy, conditions associated with corneal epithelial oedema. This quantitative measure obtained by confocal microscopy may prove useful in the clinical evaluation of corneal epithelial oedema.

Reversibility of effects of orthokeratology on visual acuity, refractive error, corneal topography, and contrast sensitivity.

OBJECTIVES: To investigate the changes in corneal shape and optical performance during and after discontinuation of overnight orthokeratology for correction of myopia. METHODS: Both eyes of 15 subjects were fitted with overnight reverse-geometry orthokeratology lenses, which were then worn for >4 hr overnight for 52 weeks. Subjects were free of ocular disease and had a corrected visual acuity of > or =1.0. Refractive correction, uncorrected visual acuity, corneal topography, and contrast sensitivity (at 4 spatial frequencies) were measured under photopic conditions. RESULTS: Refractive error (spherical equivalent) and contrast sensitivity were decreased, whereas uncorrected visual acuity, the surface asymmetry index, and the surface regularity index were increased, 1 week after the onset of overnight orthokeratology and remained so during the 52 weeks of treatment. These parameters had largely returned to baseline values by 8 weeks after treatment discontinuation. CONCLUSIONS: Overnight orthokeratology improved uncorrected visual acuity and reduced refractive error but increased corneal irregularity and impaired contrast sensitivity. However, these changes in visual function and corneal shape were reversed after discontinuation of orthokeratology lens wear.

Abnormal retinal blood vessels in Ehlers-Danlos syndrome type VI.

BACKGROUND: Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder caused by defective collagen synthesis and categorized into 11 types based on genetic mutations and clinical features.(1) Its principal clinical characteristics include hyperelasticity and vulnerability of the skin and joints to laxity, and fragility of blood vessels. CASE: We recently performed vitreous surgery with introduction of an artificial cornea and corneal allograft transplantation in a boy with EDS type VI, whose visual acuity had decreased rapidly because of vitreous hemorrhage. OBSERVATIONS: An ultrasound examination revealed posterior vitreous detachment with fresh vitreous hemorrhage. After vitrectomy with introduction of an artificial cornea and cornea allograft transplant were carried out, visual acuity improved to 0.05 and was maintained for at least 22 months. CONCLUSIONS: Abnormal collagen synthesis is thought to lead to systemic disorders such as hyperelasticity, vulnerability to skin and joint laxity, and fragile blood vessels in patients with Ehlers-Danlos syndrome.

Lipopolysaccharide-induced expression of intercellular adhesion molecule-1 and chemokines in cultured human corneal fibroblasts.

PURPOSE: Invasion of bacteria into the corneal stroma induces the infiltration of leukocytes and subsequent corneal ulceration. The role of corneal fibroblasts in the detection of bacterial invasion into the stroma was investigated by examining the in vitro expression of the receptor complex for lipopolysaccharide (LPS), a common component of Gram-negative bacteria, as well as the possible effects of LPS on both the expression of adhesion molecules and the release of chemokines in cultured human corneal fibroblasts. METHODS: Expression of the LPS receptor complex, intercellular adhesion molecule (ICAM)-1, and the chemokines interleukin (IL)-8 and monocyte chemotactic protein (MCP)-1 was examined by reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, or immunofluorescence analysis. RESULTS: Corneal fibroblasts were found to contain transcripts encoding toll-like receptor-4, CD14, and MD-2, all of which are components of the LPS receptor complex. The expression of ICAM-1 at the surface of corneal fibroblasts and the amount of ICAM-1 mRNA in the cells were both increased by LPS. Similarly, LPS increased both the release of IL-8 and MCP-1 by corneal fibroblasts as well as the amounts of the corresponding mRNAs in these cells. These various effects of LPS were potentiated by the presence of a low concentration of human serum. CONCLUSIONS: Corneal fibroblasts may play an important role in the defense system of the cornea by recognizing the presence of LPS and subsequently expressing adhesion molecules and chemokines that promote leukocyte infiltration.

Potentiation of lipopolysaccharide-induced chemokine and adhesion molecule expression in corneal fibroblasts by soluble CD14 or LPS-binding protein.

PURPOSE: The detection of bacterial lipopolysaccharide (LPS) by human cells is facilitated by LPS-binding protein (LBP) and soluble (s)CD14. The effects of these proteins on chemokine release and adhesion molecule expression in cultured human corneal fibroblasts were examined. METHODS: The release of chemokines into culture supernatants and the expression of the intercellular adhesion molecule (ICAM)-1 on the cell surface were determined by enzyme-linked immunosorbent assays. The intracellular abundance of chemokine and ICAM-1 mRNAs was quantitated by reverse transcription and real-time polymerase chain reaction analyses. The phosphorylation and degradation of IkappaB-alpha and the subcellular localization of NF-kappaB were examined by immunoblot and immunofluorescence analyses, respectively. RESULTS: Neither sCD14 nor LBP alone affected the expression of chemokines or ICAM-1 in cultured human corneal fibroblasts. However, sCD14 or LBP enhanced the LPS-induced upregulation of ICAM-1 and the chemokines interleukin-8 and monocyte chemoattractant protein (MCP)-1 in these cells at the protein and mRNA levels. Combined stimulation with LPS and either sCD14 or LBP also induced the phosphorylation and degradation of IkappaB-alpha and the translocation of NF-kappaB from the cytoplasm to the nucleus of corneal fibroblasts. CONCLUSIONS: LBP and sCD14 may play important roles in the defense of the cornea against bacterial infection, by facilitating the detection of LPS by corneal fibroblasts.

Device for cataract analysis: development and relevance to cataract surgery.

PURPOSE: To evaluate the relationship between World Health Organization (WHO) cataract grade determined with a new device and (1) preoperative visual acuity and (2) the difficulty of specific steps in cataract surgery. SETTING: Yamaguchi University Hospital, Yamaguchi, Japan. METHODS: Patients who had cataract surgery between January 2006 and September 2008 were enrolled in this prospective study. Preoperatively, the Konan Anterior Segment Tri Camera System 1000 cataract analysis device was used to evaluate the WHO cataract grade in each eye. The main outcome measures were preoperative visual acuity, the time required for continuous curvilinear capsulorhexis (CCC) and for irrigation/aspiration (I/A), and the total effective phaco time (EPT). RESULTS: Sixty-four eyes (53 patients) were evaluated. Preoperative visual acuity decreased significantly as the posterior subcapsular cataract (PSC) grade increased (P<.01). Preoperative logMAR values also differed significantly between cataracts classified as mild (score 1 to 3), moderate (score 4 to 6), and severe (score 7 to 9) on the basis of the total nuclear (NUC) + cortical (COR) + PSC score. The CCC and I/A times increased with increasing COR grade, whereas the total EPT increased with increasing NUC grade. CONCLUSIONS: Evaluation of lens opacity based on the WHO grading system using the new cataract analysis device indicated which surgical procedures are likely to be problematic. The device may also be useful in training residents in cataract surgery. FINANCIAL DISCLOSURE: Mr. Araki is an employee of Konan Medical, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Efficacy of substance P and insulin-like growth factor-1 peptides for preventing postsurgical superficial punctate keratopathy in diabetic patients.

PURPOSE: The efficacy of eyedrops containing peptides based on substance P (FGLM-amide) and insulinlike growth factor-1 (SSSR) for prevention of superficial punctate keratopathy (SPK) after cataract surgery in individuals with type 2 diabetes was examined. METHODS: Twenty-nine patients (29 eyes) with diabetes were enrolled in a double-masked, prospective, randomized, placebo-controlled clinical study. They were randomly assigned to one of two groups that received eyedrops containing either FGLM-amide and SSSR (n = 14) or phosphate-buffered saline (n = 15) four times a day for 14 days starting 1 day after phacoemulsification. SPK scores (area, density, and combined area and density) were determined before as well as 1, 3, 7, and 14 days after surgery as main outcome measures. RESULTS: SPK scores did not differ between the two groups before surgery or before initiation of treatment. At day 2 after treatment initiation, all SPK scores were significantly lower in the FGLM-amide/SSSR group than in the control group. The density score was also significantly lower in the former group at day 7 after surgery. All scores returned to preoperative levels by day 14 after surgery in both groups. CONCLUSIONS: Eyedrops containing FGLM-amide and SSSR were effective for the prevention of SPK after cataract surgery in diabetic patients.