1: Cornea. 2012 Jan 27; [Epub ahead of print] 

Effects of Topical Human Amniotic Fluid and Human Serum in a Mouse Model of
Keratoconjunctivitis Sicca.

Quinto GG, Camacho W, Castro-Combs J, Li L, Martins SA, Wittmann P, Campos M,
Behrens A.

*Wilmer Ophthalmological Institute, Department of Ophthalmology, Johns Hopkins
University, Baltimore, MD daggerVision Institute, Department of Ophthalmology,
Federal University of Sao Paulo, Sao Paulo, Brazil.

PURPOSE: To compare the effects of topical human amniotic fluid (HAF), topical
human serum (HS), and topical artificial tears in a mouse model of dry eye.
METHODS: Thirty C57BL/6 mice were divided into 3 treatment groups: HAF, HS, and
preservative-free artificial tears. Dry eye was induced by an injection of
botulinum toxin B (BTX-B) into the lacrimal gland. Tear production and ocular
surface fluorescein staining were evaluated in each mouse at 6 time points
during a 4-week period. Goblet cell density was assessed in stained histological
sections. Apoptotic keratocytes were evaluated by terminal deoxynucleotidyl
transferase-mediated dUTP nick-end labeling test assay. RESULTS: A significant
decrease in tear production was observed 3 days after BTX-B injection in all
groups. At week 1, the HAF and HS groups had improved tear production compared
with the control group (P < 0.001 and P = 0.003, respectively). HAF had a
significantly improved fluorescein staining score compared with the HS (P =
0.043) and control (P = 0.007) groups at week 2. Goblet cell density was
significantly decreased in the control group compared with the HAF and HS groups
(P < 0.001). No difference in the amount of terminal deoxynucleotidyl
transferase-mediated dUTP nick-end labeling-positive keratocytes was observed
among the groups. CONCLUSION: HAF was superior to HS and artificial tears for
improving corneal staining within 2 weeks of therapy in this induced mouse model
of keratoconjunctivitis sicca. Clinical studies are needed to ascertain the
benefits of these therapies in patients with ocular surface disorders associated
with dry eye.

PMID: 22290385  [PubMed - as supplied by publisher]

2: Cornea. 2012 Jan 27; [Epub ahead of print] 

Changing of the Guard.

Sugar A.

Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center,
University of Michigan, Ann Arbor, MI.

PMID: 22290384  [PubMed - as supplied by publisher]

3: Cornea. 2012 Jan 20; [Epub ahead of print] 

Complications of Cosmetic Wide Conjunctivectomy Combined With Postsurgical
Mitomycin C Application.

Rhiu S, Shim J, Kim EK, Chung SK, Lee JS, Lee JB, Seo KY.

*Institute of Vision Research, Department of Ophthalmology, Yonsei University
College of Medicine, Seoul, Republic of Korea daggerDepartment of Ophthalmology,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
double daggerDepartment of Ophthalmology, School of Medicine, Pusan National
University, Pusan, Republic of Korea.

PURPOSE: To raise awareness among clinicians about the risk of severe
complications after cosmetic conjunctivectomy plus postsurgical topical
mitomycin C (MMC) treatment. METHODS: We retrospectively reviewed the medical
records of 48 consecutive patients who received cosmetic wide conjunctivectomy
plus postsurgical topical MMC treatment to eliminate conjunctival injection and
visited our outpatient clinic between January 2009 and January 2011. RESULTS:
Forty-four patients (91.67%) developed complications after cosmetic wide
conjunctivectomy plus postsurgical topical MMC treatment. Complications included
chronic conjunctival epithelial defects (22 patients), scleral thinning with (19
patients) or without (2 patients) calcified plaques, fibrovascular conjunctival
adhesion at the muscle insertion site (15 patients), chronic dysfunctional tear
syndrome (11 patients), avascular zones (10 patients), abnormal vessel growth (5
patients), lymphangiectasis (3 patients), adhesions of Tenon capsule and the
conjunctiva at the extraocular muscle insertion site (1 patient), extraocular
muscle fiber exposure (1 patient), and diplopia (9 patients). The mean time
between surgery and the onset of diplopia was 1.67 months (range, 1-3 months),
and the mean deviation was 11.0 prism diopters (range, 0-25 prism diopters) in
the primary position. Three patients underwent strabismus surgery due to
incomitant esotropia. Eight patients underwent calcified plaque removal because
of severe progression of the calcification. Five patients underwent conjunctival
flap operation because of severe progressive scleral thinning. CONCLUSIONS:
Cosmetic wide conjunctivectomy, which has been advertised as a simple and
effective surgical option for the treatment of conjunctival injection, has
caused disruption in the normal physiology of the ocular surface, which leads to
various devastating complications.

PMID: 22269679  [PubMed - as supplied by publisher]

4: Cornea. 2012 Jan 20; [Epub ahead of print] 

Boston Keratoprosthesis Type 1 Surgery:  Use of Frozen Versus Fresh Corneal
Donor Carriers.

Robert MC, Biernacki K, Harissi-Dagher M.

Department of Ophthalmology, Centre Hospitalier de l'Universite de Montreal,
Hopital Notre-Dame, Montreal, Quebec, Canada.

PURPOSE: This study aims to determine whether frozen corneas can be successfully
used as carriers of the Boston keratoprosthesis (KPro). METHODS: Prospective
study of 37 patients undergoing KPro surgery with fresh or frozen corneas as
carriers. Patients were randomized to receive either a fresh corneal graft or a
frozen corneal graft during implantation of the Boston KPro. The randomization
depended on availability of fresh versus frozen corneas offered by the local eye
bank. All surgeries were performed by the same experienced surgeon. Outcome
measures included retention of the device, level of preoperative and
postoperative visual acuities (VAs), and complications. RESULTS: The indication
for Boston KPro was corneal graft failure in 24 eyes; 13 patients had KPro as a
primary procedure. The assembly of the Boston KPro and surgery were uneventful
in all cases. Mean follow-up was 9.65 months. Median preoperative VA was
counting fingers (range, 20/100 to light perception) in the fresh cornea group
(19 eyes) and hand motions (range, 20/150 to light perception) in the frozen
cornea group (18 eyes). Median postoperative VA were 20/150 (range, 20/30 to
hand motions) and 20/150 (range, 20/40 to counting fingers) in the fresh and
frozen cornea groups, respectively. Inflammation and retroprosthetic membrane
formation were the most common complications with similar rates between the 2
groups. The device retention rate was 100% at the end of the follow-up period.
CONCLUSIONS: Frozen and fresh corneal donors seem equally efficient and safe as
carriers of the Boston KPro with similar recuperation of VA and no untoward
complications, such as melt, leaks, or endophthalmitis.

PMID: 22269678  [PubMed - as supplied by publisher]

5: Cornea. 2012 Jan 20; [Epub ahead of print] 

Practice Patterns and Opinions in the Management of Recurrent or Chronic Herpes
Zoster Ophthalmicus.

Sy A, McLeod SD, Cohen EJ, Margolis TP, Mannis MJ, Lietman TM, Acharya NR.

*Department of Ophthalmology, F.I. Proctor Foundation, and daggerDepartment of
Ophthalmology, University of California, San Francisco, San Francisco, CA double
daggerDepartment of Ophthalmology, New York University, New York, NY  section
signDepartment of Ophthalmology, University of California, Davis, Sacramento,
CA.

PURPOSE: The objective of this study was to determine current practices and
opinions among cornea specialists for treating and preventing recurrences of
herpes zoster ophthalmicus (HZO). METHODS: In November 2010, a survey of 15
questions was distributed to The Cornea Society listserv. Questions identified
respondents' treatment practices for recurrent HZO and opinions regarding
prolonged antiviral prophylaxis and zoster vaccine. RESULTS: Of 100 respondents,
the majority were cornea specialists (83 of 98, 85%). Eighty-seven percent (84
of 97) reported treating recurrent or chronic cases of HZO in the last year. The
most common choice of treatment in the posed recurrent HZO clinical scenario was
a combination of oral antiviral and topical corticosteroid (63 of 100, 63%),
although significant variability existed in the duration of oral antiviral
administration. Fifty-four respondents (56%) believed that prolonged acyclovir
prophylaxis could reduce recurrent signs of HZO; 28% (27 of 98) believed that
recurrences of HZO could be reduced after the period of acyclovir
administration. For patients with a history of HZO, most respondents reported
not recommending the adult zoster vaccine (63 of 98, 64%), but 46% (43 of 94)
believed that the vaccine could reduce recurrent signs or did not know.
CONCLUSIONS: Many cornea specialists are managing recurrent or chronic cases of
HZO, but there is variability in the use of topical corticosteroids and
antivirals. Additionally, no consensus exists on the efficacy of prolonged
antiviral therapy or the adult zoster vaccine to reduce chronic or recurrent
disease. These results demonstrate the need for further systematic study of
treatment and prophylaxis for recurrent and chronic HZO.

PMID: 22269677  [PubMed - as supplied by publisher]

6: Cornea. 2012 Jan 18; [Epub ahead of print] 

Correlation of Straylight and Visual Acuity in Long-Term Follow-up of Manual
Descemet Stripping Endothelial Keratoplasty.

van der Meulen IJ, van Riet TC, Lapid-Gortzak R, Nieuwendaal CP, van den Berg
TJ.

*Department of Ophthalmology, Academic Medical Center, Amsterdam, the
Netherlands daggerNetherlands Institute for Neuroscience, Netherlands Royal
Academy, Amsterdam, the Netherlands.

PURPOSE: Long-term quality of vision after Descemet stripping endothelial
keratoplasty (DSEK) was evaluated and correlated with corneal characteristics
and subjective complaints. METHODS: Thirty-four eyes were examined; patients had
a single visit 6 to 64 months after DSEK for Fuchs dystrophy. Best-corrected
distance acuity (BCDA) and straylight were analyzed. To better evaluate
long-term postoperative BCDA changes, longitudinal data were used from earlier
visits. Corneal thickness was measured with the Visante anterior segment optical
coherence tomography. Interface, stromal, and endothelial haze were
semiquantitatively graded using the slit lamp. Vision-related quality of life
was evaluated with the 39-item National Eye Institute Visual Function
Questionnaire and a straylight questionnaire. Correlation analysis comparing
corneal characteristics with visual quality was performed. RESULTS: Mean
postoperative time was 1027 +/- 453 days. Mean BCDA at this time was 0.33 +/-
0.19 logarithm of the minimal angle of resolution. BCDA remained stable with
long-term postoperative follow-up. Straylight averaged 1.47 +/- 0.19, on average
0.12 log units higher than normal for age-related pseudophakic eyes (P < 0.001).
BCDA correlated with corneal haze (r = 0.50), whereas straylight showed a
nonsignificant association (P = 0.12). Neither BCDA nor straylight correlated
with corneal thickness. Mean Visual Function Questionnaire 39 score was 77/100,
and mean score of the straylight questionnaire was 46/100. CONCLUSION: Quality
of vision after DSEK does not return to normal levels of age-matched
pseudophakic eyes, with decreased BCDA and increased straylight. Questionnaire
scores indicate mild (Visual Function Questionnaire 39) to moderate (straylight)
subjective visual impairment. Corneal thickness and haze do not offer an
adequate explanation for the decreased visual quality.

PMID: 22262226  [PubMed - as supplied by publisher]

7: Cornea. 2012 Jan 18; [Epub ahead of print] 

Candida Keratitis:  Emerging Problem in India.

Sengupta J, Khetan A, Saha S, Banerjee D, Gangopadhyay N, Pal D.

*Cornea and Ocular Surface Disease Clinic daggerOcular Microbiology Services,
Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India double
daggerDepartment of Microbiology, Vidyasagar University, West Bengal, India 
section signSanjibon Eye Care, Howrah, West Bengal, India  paragraph
signPriyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India.

PURPOSE: To determine the epidemiological characteristics and outcome of Candida
keratitis in a Cornea Care Unit of Kolkata-based tertiary eye hospital. METHODS:
A retrospective, noncomparative, observational case series involving patients of
culture-proven fungal keratitis from January 2008 to December 2008. A total of
85 cases of culture-proven fungal keratitis were identified. Of these, 16 cases
were caused by Candida sp and selected for the study. The records were analyzed
for demographics, risk factors, mode of management (medical or surgical),
indication of surgical therapy, and the response to treatment with final
outcome. Medical therapy consisted of topical amphotericin B with or without
intracameral application after obtaining culture reports. Surgical therapy
included application of tissue adhesive with bandage contact lens and
therapeutic keratoplasty. RESULTS: All cases of Candida keratitis were caused by
Candida albicans accounting for 16 cases [18.81%; 95% confidence interval (CI),
11.8-28.5] of total culture-positive fungal keratitis. We found postsurgical
steroid therapy in 8 cases as most important association, followed by diabetes
and trauma (4 cases each) as next common comorbidities. All patients required
therapeutic keratoplasty. Surgical indications were corneal melt in 10 cases
(62.5%; 95% CI, 38.5-81.6), extension up to limbus in 2 cases (12.5%; 95% CI,
12.2-37.2) and nonresponse with worsening in 4 cases (25%; 95% CI, 19.7-49.9).
Final outcome consists of phthisis bulbi in 3 cases (18.8%; 95% CI, 5.8-43.8),
failed graft in 7 cases (43.7%; 95% CI, 23-66.8), and clear graft in 6 cases
(37.5%; 95% CI, 18.4-61.5). CONCLUSIONS: Candida is a new concern in developing
countries like India. We are concerned about the poorer outcome, probably
resulting from our unpreparedness and failure of medical therapy leading to more
complication and requiring surgical intervention in higher numbers.

PMID: 22262225  [PubMed - as supplied by publisher]

8: Cornea. 2012 Jan 18; [Epub ahead of print] 

Surface Quality of Femtosecond Dissected Posterior Human Corneal Stroma
Investigated With Atomic Force Microscopy.

Lombardo M, De Santo MP, Lombardo G, Lomoriello DS, Desiderio G, Ducoli P,
Barberi R, Serrao S.

*IRCCS Fondazione G.B. Bietti, Rome, Italy daggerCNR - IPCF Unit of Cosenza, c/o
LiCryL Laboratory double daggerDepartment of Physics, University of Calabria,
Rende Cosenza, Italy  section signVision Engineering, Reggio Calabria, Italy 
paragraph signDeltae Srl, Rende Cosenza, Italy.

PURPOSE: To investigate and compare the surface roughness and morphology of
posterior stromal lenticules created with a femtosecond laser using various
pulse energies to that obtained with a mechanical microkeratome. METHODS: A 150
kHz femtosecond laser platform (IntraLase iFS; Abbott Medical Optics) was
programmed to create an 8.5-mm-diameter posterior stromal lenticule in 12 human
corneal tissues. Specimens were dissected using different pulse energies (1.00,
0.75, 0.65, and 0.50) and fixed 2 mum spot separations. Three additional
posterior corneal lenticules were prepared using a mechanical microkeratome
(Moria Evolution 3; Moria). After the procedure, each corneal tissue was
examined by atomic force microscopy (Autoprobe CP; Veeco). RESULTS: Femtosecond
laser-treated tissues revealed similar morphological features, however, with
significant differences in surface roughness in relation to the energy pulse
used for lamellar dissection (P < 0.001). The most regular stromal surface was
achieved when using 0.50 muJ pulse energy; on the contrary, the roughest
specimens were those dissected using 1.00 muJ pulse energy. No differences in
surface roughness were measured between mechanically resected tissues and those
treated using 0.50 muJ pulse energy (P > 0.05). CONCLUSIONS: Atomic force
microscopy submicron analysis of femtosecond-dissected donor tissues provided
quantitative demonstration of the relation between pulse energy and stromal
surface roughness. Surface quality of posterior corneal lenticules, comparable
with that provided by mechanical microkeratome, is significantly improved when
setting pulse energy for lamellar dissection of 0.50-muJ and 2-mum spot
separations.

PMID: 22262224  [PubMed - as supplied by publisher]

9: Cornea. 2012 Jan 18; [Epub ahead of print] 

Association of Anti-Herpes Simplex Virus IgG in Tears and Serum With Clinical
Presentation in Patients With Presumed Herpetic Simplex Keratitis.

Borderie VM, Gineys R, Goldschmidt P, Batellier L, Laroche L, Chaumeil C.

*Federation of Ocular Infectious Diseases daggerLaboratory of Microbiology,
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris cedex 12,
France.

PURPOSE: To assess the clinical relevance of tear anti-herpes simplex virus
(HSV) antibody measurement for the diagnosis of herpes simplex keratitis.
METHODS: Records of 364 patients clinically suspect of HSV-related keratitis who
had tear anti-HSV IgG assessment (tear-quantified anti-HSV IgG/filtrated IgG
ratio) in our institution between January 2000 and August 2008 were
retrospectively analyzed. Patients were classified into 4 groups as follows:
group 1, anti-HSV IgG negative in serum and tears; group 2, anti-HSV IgG
negative in tears and positive in serum; group 3, anti-HSV IgG nonsignificantly
positive in tears and positive in serum; and group 4, anti-HSV IgG significantly
positive in serum and tears. Randomly selected patient charts from each group
were reviewed for clinical data. RESULTS: The prevalence of anti-HSV IgG in
blood increased with age from >70% before 20 years to 95% after 70 years. The
prevalence of anti-HSV IgG in tears increased with age from 20% before 20 years
to >50% after 70 years. The presence (either significant or not) of anti-HSV IgG
in tears was significantly associated with decreased corneal sensation, presence
of stromal opacities, and with neurotrophic keratitis. Logistic regression
showed no significant association between age and clinical signs except for
herpetic ulcers and herpetic necrotizing keratitis. CONCLUSIONS: Tear production
of anti-HSV IgG increases with age, and it is associated with sequelae of herpes
simplex keratitis. Conversely, it is poorly associated with clinical signs of
acute herpes simplex keratitis.

PMID: 22262223  [PubMed - as supplied by publisher]

10: Cornea. 2012 Jan 18; [Epub ahead of print] 

Comparison of Central Corneal Thickness Measurements With Optical Low-Coherence
Reflectometry and Ultrasound Pachymetry and Reproducibility of Both Devices.

Koktekir BE, Gedik S, Bakbak B.

Department of Ophthalmology, Selcuklu Faculty of Medicine, Selcuk University,
Konya, Turkey.

PURPOSE: To compare the accuracy of optical low-coherence reflectometry (Lenstar
LS 900; Haag Streit, Koniz, Switzerland) and conventional ultrasound pachymetry
(UP) (US 4000; Nidek, Japan) for measuring central corneal thickness and to
assess the interexaminer reproducibilities of both devices. METHODS: Department
of Ophthalmology, Selcuklu Faculty of Medicine, Selcuk University was the study
setting. Central corneal thickness (CCT) was measured in both eyes of 65
emmetropic patients by the same examiner using Lenstar LS 900 noncontact
biometry and UP. To assess the interexaminer reproducibility, 2 different
examiners consecutively obtained CCT measurements in 16 eyes with Lenstar LS 900
noncontact biometry and UP. RESULTS: Mean CCT measurements with Lenstar LS 900
noncontact biometry and ultrasound biometry were 541.09 +/- 33.8 and 545.69 +/-
34.0, respectively. Significant correlation was present between these 2
measurements; intraclass correlation coefficient was found to be 95.8% (95%
confidence interval: 93.2%-97.4%)(P < 0.001). Interexaminer reproducibility with
Lenstar was high, and the intraclass correlation was found to be 99.3% (95%
confidence interval: 98.0%-99.7%). We have also investigated the interexaminer
reproducibility with UP in these 16 patients, and the results showed a 99.2%
(95% confidence interval: 97.7%-99.7%) intraclass correlation. CONCLUSIONS: The
results of Lenstar LS 900 noncontact biometry correlated with the results of UP.
It may be used as an alternative method to UP for measuring CCT. Because of the
mild underestimation of CCT by Lenstar, the measurements should be carefully
evaluated in patients whose intraocular pressure must strictly be monitored.

PMID: 22262222  [PubMed - as supplied by publisher]

11: Cornea. 2012 Jan 18; [Epub ahead of print] 

Donor Preparation Using Pneumatic Dissection in Endothelial Keratoplasty:  DMEK
or DSEK?

McKee HD, Irion LC, Carley FM, Jhanji V, Brahma AK.

*Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, United
Kingdom daggerHistopathology Department, National Specialist Ophthalmic
Pathology Service, Manchester, United Kingdom double daggerDepartment of
Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon,
Hong Kong.

PURPOSE: To determine if residual stroma remains on the Descemet membrane when
pneumatic dissection is used to prepare donor tissue for endothelial
keratoplasty. METHODS: Pneumatic dissection using a posterior peripheral needle
insertion was carried out on 5 eye bank corneas. Samples were then sent for
histological analysis. RESULTS: A thin layer of stroma remained on the Descemet
membrane in all the samples. The average central stromal thickness was 12.4 mum
(range 6.5-20.0 mum). CONCLUSIONS: Endothelial keratoplasty using pneumatic
dissection to prepare donor tissue should be considered a form of Descemet
stripping endothelial keratoplasty and not Descemet membrane endothelial
keratoplasty. If future studies show excellent visual results using pneumatic
dissection for endothelial keratoplasty, then removal of all donor stroma may be
unnecessary.

PMID: 22262221  [PubMed - as supplied by publisher]

12: Cornea. 2012 Jan 18; [Epub ahead of print] 

Expression of Phosphorylated Heat Shock Protein 27 During Corneal Epithelial
Wound Healing.

Jain S, De la Cruz J, Kang E, Kojima T, Chang JH, Kim JY.

*Department of Ophthalmology and Visual Sciences, Illinois Eye Ear Infirmary,
University of Illinois at Chicago, Chicago, IL daggerDepartment of Ophthalmology
double daggerResearch Institute for Biomacromolecules, University of Ulsan
College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

PURPOSE: The 27-kDa heat shock protein (HSP27) has been implicated in wound
healing in multiple tissues. We investigated the expression and localization of
phosphorylated HSP27 during epithelial wound healing in the murine cornea.
METHODS: Corneas of 8- to 10-week-old C57BL6 mice were wounded by epithelial
debridement (n = 40). Unwounded corneas served as controls (n = 3). After 3, 7,
and 14 days, phosphorylated HSP27 localization in wounded corneas was observed
by confocal immunohistochemistry and double immunogold labeling transmission
immunoelectron microscopy. Western blot analysis was performed to determine
expression levels of phosphorylated HSP27 in scraped epithelia. Phosphorylated
HSP27 localization was also separately performed with confocal
immunohistochemistry 8 hours after epithelial debridement to investigate the
early epithelial wound-healing process. RESULTS: In unwounded corneas,
phosphorylated HSP27 was localized only to the superficial epithelium. In
contrast, phosphorylated HSP27 was localized in the basal and superficial
epithelia 3 days after corneal epithelial wounding. After 7 and 14 days, HSP27
localization was similar to that in unwounded controls. Expression levels of
phosphorylated HSP27 were greater in wounded corneal epithelia on day 3 than in
unwounded controls and on day 14. After 8 hours, phosphorylated HSP27 expression
was prominent in the leading edge of migrating corneal epithelium. CONCLUSIONS:
Constitutive expression of phosphorylated HSP27 is limited to the superficial
corneal epithelium in unwounded murine corneas. Changes in HSP27 epithelial
distribution and expression levels after corneal epithelial wounding suggest
that phosphorylated HSP27 plays a role in early phase of corneal epithelial
wound healing.

PMID: 22262220  [PubMed - as supplied by publisher]

13: Cornea. 2012 Jan 18; [Epub ahead of print] 

The Endothelial Safety of Using a Gentian Violet Dry-Ink "S" Stamp for Precut
Corneal Tissue.

Stoeger C, Holiman J, Davis-Boozer D, Terry MA.

*Lions VisionGift, Portland, OR daggerDevers Eye Institute, Portland, OR.

PURPOSE: To determine the endothelium damage resulting from the application of
"dry" gentian violet (GV) stromal markings on corneas precut for Descemet
stripping automated endothelial keratoplasty (DSAEK) using a Moria "S" Stamp.
METHODS: Five precut corneas had the stromal graft bed marked with GV using the
Moria "S" stamp and 6 precut corneas were left unmarked as controls. After
applying the ink to the stamp, care was taken to allow the alcohol carrier to
dry for 10 seconds before applying the dry dye to the stromal surface. Tissue
was then trephinated and stained with calcein AM to assess endothelial
viability. Grafts were photographed and digital pixel planometry, using an
established analysis technique, was used to compare the damage between the
control and experimental groups. RESULTS: The mean percent cell damage of
corneas treated with GV "S" stamp (n = 5) was 8.6% (range 4.4-12.9), and it was
8.1% (range 3.9-15.1) in the DSAEK control set (n = 6). Median percent cell
damage was 6.7% among GV-treated corneas and 7.4% among control corneas. The
distributions were not significantly different between groups (Mann-Whitney U
test = 15.0, two-tailed P = 1.0). Moreover, no "S" pattern of damage was seen in
any study eye. CONCLUSIONS: There were no significant differences in endothelial
damage between the 2 groups. GV stromal markings may be applied without undue
damage to the endothelium using the dry-ink technique described.

PMID: 22262219  [PubMed - as supplied by publisher]

14: Cornea. 2012 Jan 18; [Epub ahead of print] 

Impact of the Cornea Donor Study on Acceptance of Corneas from Older Donors.

Sugar A, Montoya MM, Beck R, Cowden JW, Dontchev M, Gal RL, Kollman C, Malling
J, Mannis MJ, Tennant B; For the Cornea Donor Study Investigator Group.

*W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences,
University of Michigan, Ann Arbor, MI daggerSightLife, Seattle, WA double
daggerJaeb Center for Health Research, Tampa, FL  section signDepartment of
Ophthalmology, Mason Eye Institute, Columbia, MO  paragraph signMinnesota Lions
Eye Bank, Minneapolis, MN  ||Department of Ophthalmology and Vision Science,
University of California Davis, Sacramento, CA **Midwest Eye-Banks, Ann Arbor,
MI.

PURPOSE: To evaluate retrospectively whether the findings from the Cornea Donor
Study (CDS) led to changes in the transplantation of corneas from older donors.
METHODS: Eye banks in United States provided complete data on donor age and
placement (domestic or international) for 86,273 corneas from 1998 to 2009. The
data were analyzed by 3 periods, preceding CDS (1998-1999), during CDS
(2000-2007), and after publication of CDS 5-year results (2008-2009), and
separately for corneas placed within versus outside the United States. RESULTS:
For corneal tissues transplanted in the United States, the percentage of donors
who were 66 years or older increased from 19% before CDS to 21% during CDS and
25% after CDS (P < 0.001). Corresponding median (25th-75th percentile) donor
ages were 53 (39-63), 54 (41-64), and 57 (46-66), respectively (P < 0.001). The
opposite trend was observed for corneas distributed outside the United States,
with the percentage of donors 66 years and older decreasing from 56% to 42% to
34%, respectively. Donor age trends over time varied by eye bank. CONCLUSIONS:
There was a modest overall increase in the donor age of corneas transplanted in
the United States from 1998 to 2009, but the retrospective nature of the study
limits our ability to attribute this change to the CDS. The modest increases in
the donor age of corneas transplanted is a positive finding, but wider
acceptance of older corneal donor tissue should be encouraged based on the
5-year evidence generated by the CDS.

PMID: 22262218  [PubMed - as supplied by publisher]

15: Cornea. 2012 Jan 18; [Epub ahead of print] 

Bacillus cereus Infection After Descemet Stripping Endothelial Keratoplasty.

Basak SK, Deolekar SS, Mohanta A, Banerjee S, Saha S.

*Cornea Department, Disha Eye Hospitals and Research Centre, Barrackpore,
Kolkata, India daggerMicrobiology Department, Priyamvada Birla Aravind Eye
Hospital, Kolkata, India.

PURPOSE: To report the first case of Bacillus cereus keratitis leading to
panophthalmitis in a patient operated for combined Descemet stripping
endothelial keratoplasty (DSEK) and phacoemulsification with intraocular lens
implantation. METHODS: A 40-year-old woman with corneal decompensation underwent
DSEK with phacoemulsification and posterior chamber intraocular lens
implantation and developed corneal infiltrate in the host cornea progressing to
ring corneal abscess and panophthalmitis within 72 hours of surgery. RESULTS:
The microbiological examination of the patient's corneal scraping revealed
Gram-positive rods on the smear and the culture grew B. cereus. The source of
the organism was found to be in the conjunctival sac of the patient because the
conjunctival swab culture from the other eye revealed B. cereus. Despite
vigorous topical and systemic antibacterial therapy, and immediate therapeutic
penetrating keratoplasty, the infection progressed to panophthalmitis and
required evisceration on the fifth day. CONCLUSIONS: Bacillus cereus is a rare
potential cause of postoperative infective keratitis after DSEK. The fulminant
nature of the infection and its spread resulting in the loss of vision poses
diagnostic and therapeutic challenges to corneal surgeons.

PMID: 22262217  [PubMed - as supplied by publisher]

16: Cornea. 2012 Jan 17; [Epub ahead of print] 

Resolvin E1 (RX-10001) Reduces Corneal Epithelial Barrier Disruption and
Protects Against Goblet Cell Loss in a Murine Model of Dry Eye.

de Paiva CS, Schwartz CE, Gjorstrup P, Pflugfelder SC.

*Ocular Surface Center, Department of Ophthalmology, Baylor College of Medicine,
Houston, TX daggerResolvyx Pharmaceuticals, Inc, Cambridge, MA.

PURPOSE: Resolvin E1 (RvE1; RX-10001) belongs to a new class of endogenous
immunoregulating mediators, originally identified as a metabolite of the omega-3
polyunsaturated fatty acid, eicosapentaenoic acid. Based on its proven efficacy
in models of chronic inflammation, this study investigated the efficacy of
resolvin E1 in a murine model of dry eye. METHODS: C57/B6 mice, aged 6 to 8
weeks, were treated with systemic scopolamine and exposed to air draft and low
humidity for 16 hours/day for 5 days and allocated to the following groups:
unexposed controls, disease controls, treatment with vehicle or RvE1 delivered
topically as its methyl ester prodrug, RX-10005, to enhance corneal surface
penetration. Treatment was initiated at the time of desiccating stress
induction. Treatment efficacy was assessed by corneal permeability using Oregon
Green Dextran and by conjunctival goblet cell density using periodic acid-Schiff
reagent. RESULTS: RvE1 reduced the increase in corneal staining by 80% compared
with untreated disease controls. Goblet cell density was reduced by 20% in
disease controls but fully maintained in the group receiving RvE1. CONCLUSIONS:
RvE1, delivered as its methyl ester prodrug, improved the outcome measures of
corneal staining and goblet cell density in this murine model of dry eye,
indicating the potential utility of endogenous resolvins and resolvin analogues
in the treatment of dry eye.

PMID: 22257864  [PubMed - as supplied by publisher]

17: Cornea. 2012 Jan 17; [Epub ahead of print] 

Posterior Dislocation and Immediate Retrieval of a Descemet Stripping Automated
Endothelial Keratoplasty Graft.

Sng CC, Mehta J, Tan DT.

*Corneal Service, Singapore Eye Research Institute and Singapore National Eye
Centre, Singapore daggerDepartment of Ophthalmology, National University Health
System, Singapore.

PURPOSE: To report a case of intraoperative graft dislocation into the vitreous
cavity during Descemet stripping automated endothelial keratoplasty (DSAEK) in
an aniridic eye despite the presence of an iris prosthetic lens, and the
surgical technique for immediate rescue of the donor lenticule. METHODS: A
30-year-old man, who had undergone previous pars plana vitrectomy, penetrating
keratoplasty, and iris prosthetic lens implantation (Morcher Aniridia Implants
67G) for traumatic aniridia, underwent DSAEK for failed penetrating
keratoplasty. Intraoperatively, the graft dislocated into the posterior segment
through the gap between the lens implant and the scleral wall. The dislocated
graft was grasped with a 23-gauge vitrectomy forceps inserted through the
temporal scleral incision and the implant-scleral wall gap. The straight
endoglide insertion forceps was then introduced through a nasal paracentesis and
used to pull the donor from the posterior segment into the anterior chamber
through the implant-scleral wall gap. RESULTS: Postoperatively, the patient did
well with no evidence of graft dislocation or retinal detachment, and rapid
clearing of the donor and recipient cornea. Donor endothelial cell loss was only
11% at 6 months after DSAEK. CONCLUSIONS: Graft dislocation into the vitreous
cavity can occur during DSAEK, even in the presence of a large iris prosthetic
lens implant. In a previously vitrectomized eye, immediate retrieval of the
donor from the retina can be performed using a vitrectomy forceps inserted
through the existing temporal scleral DSAEK incision into the posterior segment,
thus obviating the need for further pars plana incisions.

PMID: 22257863  [PubMed - as supplied by publisher]

18: Cornea. 2012 Jan 17; [Epub ahead of print] 

Interocular Comparison by In Vivo Confocal Microscopy of the 2-Dimensional
Architecture of the Normal Human Corneal Subbasal Nerve Plexus.

Misra S, Craig JP, McGhee CN, Patel DV.

Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical
and Health Sciences, University of Auckland, Auckland, New Zealand.

PURPOSE: To investigate the configuration of the living human corneal subbasal
nerve plexus in paired eyes of normal subjects using in vivo confocal
microscopy. METHODS: Laser scanning in vivo confocal microscopy was performed on
both corneas of healthy human subjects, and a grid fixation pattern facilitated
examination of consistent areas of central to midperipheral cornea.
Macromedia/Adobe Freehand 10 was used to manually arrange images into contiguous
montages. The subbasal nerve density and overall patterns were analyzed.
RESULTS: Both eyes of 6 subjects (3 women and 3 men, aged between 25 and 36
years) were examined. In all subjects, the subbasal nerve plexus exhibited a
clockwise whorl configuration inferior to the central cornea. The mean subbasal
nerve density at the whorl was 39.17 +/- 4.95 mm/mm and 41.36 +/- 4.19 mm/mm in
the right and left eyes, respectively. There was no significant difference in
the nerve density between the eyes (P = 0.61). Bland and Altman analysis
confirmed high intraobserver repeatability and moderate interobserver
repeatability. CONCLUSIONS: This study reveals the marked similarities between
the corneal subbasal nerve plexus configuration in the right and left eyes of
the living human cornea, highlighting that the typical mirror-image symmetry in
corneal topographic patterns is not obeyed in respect to corneal innervation and
that a clockwise orientation of the subbasal plexus is typically encountered.
There was no statistical difference in the subbasal nerve density between the
eyes.

PMID: 22257862  [PubMed - as supplied by publisher]

19: Cornea. 2012 Jan 12; [Epub ahead of print] 

Thermocautery for Inferior Conjunctivochalasis.

Nakasato S, Uemoto R, Mizuki N.

From the *Department of Ophthalmology, Miura Municipal Hospital, Miura, Japan;
and daggerDepartment of Ophthalmology, Yokohama City University School of
Medicine, Yokohama, Japan.

PURPOSE:: To describe a thermocautery technique to treat symptomatic inferior
conjunctivochalasis. METHODS:: Thirty-nine eyes of 23 patients with symptomatic
inferior conjunctivochalasis were treated with thermocautery. The mean age of
the patients was 78.6 +/- 5.4 years (+/-SD) with a range of 69-89 years.
Patients with symptomatic inferior conjunctivochalasis were initially treated
with topical medication, and the eyes that were unresponsive underwent the
ligation test. We treated those eyes in which symptoms improved or disappeared
during the ligation test. The redundant bulbar conjunctival tissue was grasped
with smooth forceps and cauterized with the OPTEMP variable low temperature
cauterizer until the redundant conjunctival tissue was gone. The mean follow-up
period was 469.5 +/- 234.6 days (range, 101-823 days). RESULTS:: After the
thermocautery, the symptoms disappeared in 36 of 39 eyes (92.3%) and improved in
the remaining 3 eyes (7.7%). The conjunctival laxity disappeared in 36 of 39
eyes (92.3%) and improved in 3 eyes (7.7%). There were no recurrences of the
conjunctival laxity during the follow-up period. CONCLUSIONS:: Thermocautery is
a simple and effective treatment for symptomatic inferior conjunctivochalasis.

PMID: 22245977  [PubMed - as supplied by publisher]

20: Cornea. 2012 Jan 11; [Epub ahead of print] 

"In Situ" Corneal and Contact Lens Thickness Changes With High-Resolution
Optical Coherence Tomography.

Gonzalez-Meijome JM, Cervino A, Peixoto-de-Matos SC, Madrid-Costa D, Jorge J,
Ferrer-Blasco T.

*Clinical and Experimental Optometry Research Lab, Center of Physics
(Optometry), University of Minho, Braga, Portugal daggerIberian Contact Lens
Research Group double daggerOptometry Research Group, University of Valencia,
Valencia, Spain  section signOptica Queiros Lda, Povoa de Lanhoso, Portugal.

PURPOSE: To show the use of high-resolution spectral-domain optical coherence
tomography (HR-SOCT) for the in situ evaluation of epithelial, stromal, and
contact lens (CL) thickness changes under closed-eye conditions without lens
removal. METHODS: Eight young healthy patients wore a thick soft CL for 90
minutes under closed-eye conditions, and measures of epithelial and stromal
corneal thickness were obtained at regular intervals using a HR-SOCT (Copernicus
HR; Optopol Tech. SA, Zawiercie, Poland). RESULTS: Minimal changes in epithelial
thickness were detected with a transient statistically significant increase in
epithelial thickness in the fellow control eye 30 minutes after insertion (P =
0.028). A significant and progressive increase in stromal thickness up to 8%
after 90 minutes of lens wear was observed at a constant rate of 2.5% every 30
minutes, being statistically significant in all observations (P < 0.001). Fellow
control eyes also showed a significant increase in stromal thickness at a much
lower rate of 0.5% every 30 minutes. Lens thickness decreased significantly by
2% after 90 minutes of lens wear under closed-eye conditions (P < 0.001).
Individual analysis showed that all eyes displayed stromal swelling, whereas
only half of them showed epithelial swelling. CONCLUSIONS: Increase in stromal
thickness and a slight decrease in lens thickness were observed in response to a
hypoxic stimulus under closed-eye conditions. HR-SOCT is a powerful tool to
investigate in vivo the physiological interactions between cornea and CLs.

PMID: 22240923  [PubMed - as supplied by publisher]

21: Cornea. 2012 Jan 11; [Epub ahead of print] 

Penetrating Keratoplasty in Congenital Hereditary Endothelial Dystrophy.

Ozdemir B, Kubaloglu A, Koytak A, Coskun E, Cnar Y, Sar ES, Ozerturk Y.

*Kartal Training and Education Hospital, Second Eye Clinic, Istanbul, Turkey
daggerBezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey double
daggerDepartment of Ophthalmology, Faculty of Medicine, Gaziantep University,
Gaziantep, Turkey  section signDepartment of Ophthalmology, Faculty of Medicine,
Dicle University, Diyarbakir, Turkey  ||Nusaybin State Hospital, Mardin, Turkey.

PURPOSE: To compare the results of penetrating keratoplasty (PK) in a series of
congenital hereditary endothelial dystrophy (CHED) patients operated at
amblyogenic years and at later ages. METHODS: Records of 65 eyes of 35 CHED
patients who underwent PK were reviewed retrospectively. Visual results and
graft clarity rates were compared between patients operated after (group 1) and
before (group 2) 12 years of age. Results were also compared between eyes with
and without nystagmus. RESULTS: Group 1 consisted of 47 eyes (24 patients),
whereas group 2 consisted of 18 eyes (11 patients). Thirteen patients (54%) in
group 1 and 10 patients (91%) in group 2 had nystagmus. Mean ages at surgery
were 26.4 and 7.6 years in group 1 and group 2, respectively. Mean follow-up
period was 101.0 months in group 1 and 59.7 months in group 2. Group 1 cases had
better graft clarity rates than group 2 cases (P = 0.023). Postoperative
best-corrected visual acuities (BCVAs) were 20/80 or better in 39 eyes of group
1 (83%) and in 5 eyes of group 2 (28%). Visual outcomes were found significantly
better in group 1 cases (P < 0.001). In group 1, 76% of eyes with nystagmus and
91% of eyes without nystagmus had BCVAs of 20/80 or better. In group 1, both
preoperative and postoperative BCVAs were found significantly better in eyes
without nystagmus (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Delayed
keratoplasty seems to offer better graft outcomes and visual prognosis to CHED
patients, even in the presence of nystagmus.

PMID: 22240922  [PubMed - as supplied by publisher]

22: Cornea. 2012 Jan 10; [Epub ahead of print] 

Meta-analysis of Randomized Controlled Trials Comparing Excimer Laser and Phakic
Intraocular Lenses for Myopia Between 6.0 and 20.0 Diopters.

Barsam A, Allan BD.

Department of External Disease, Moorfields Eye Hospital, London, United Kingdom.

PURPOSE: Meta-analysis of randomized controlled trials (RCTs) comparing excimer
laser refractive surgery and phakic intraocular lenses (pIOLs) for the
correction of myopia between 6.0 and 20.0 diopters (D). pIOLs are an alternative
surgical option to excimer laser for these patients. The evidence base comparing
these 2 methods has never been assessed systematically. METHODS: Cochrane Eyes
and Vision Group, International. We performed a comprehensive literature search
using the Cochrane Collaboration methodology to identify RCTs. A meta-analysis
on the results of RCTs was performed. We analyzed data for efficacy outcomes,
accuracy outcomes, safety outcomes, adverse effects, and quality-of-life
measures. RESULTS: This review included 3 RCTs with a total of 228 eyes. The
range of myopia was 6.0 to 20.0 D with up to 4.0 D of astigmatism. The pIOL
group was less likely to lose 2 or more lines of best spectacle-corrected visual
acuity at 12 months (odds ratio, 0.35; 95% confidence interval, 0.19-0.66, P =
0.001). PIOL surgery scored more highly on patient satisfaction/preference
questionnaires. CONCLUSIONS: The results of this systematic review show that
pIOLs are safer within 1 year of follow-up compared with excimer laser surgical
correction for myopia between 6 and 20 D. There is weaker evidence for superior
visual quality in pIOL recipients. Further RCTs adequately powered for subgroup
analysis with long-term follow-up are necessary to establish the ideal myopic
range for excimer laser and pIOL treatments.

PMID: 22236791  [PubMed - as supplied by publisher]

23: Cornea. 2012 Jan 10; [Epub ahead of print] 

Diphosphonium Ionic Liquids as Broad-Spectrum Antimicrobial Agents.

O'toole GA, Wathier M, Zegans ME, Shanks RM, Kowalski R, Grinstaff MW.

*Department of Microbiology and Immunology, Dartmouth Medical School, Hanover,
NH daggerDepartments of Biomedical Engineering and Chemistry, Boston University,
Boston, MA double daggerDepartment of Surgery, Dartmouth Medical School,
Lebanon, NH  section signUPMC Eye Center, Charles T. Campbell Laboratory of
Ophthalmic Microbiology, Department of Ophthalmology, University of Pittsburgh
School of Medicine, Pittsburgh, PA.

PURPOSE: One of the most disturbing trends in recent years is the growth of
resistant strains of bacteria with the simultaneous dearth of new antimicrobial
agents. Thus, new antimicrobial agents for the use on the ocular surface are
needed. METHODS: We synthesized a variety of ionic liquid compounds, which
possess 2 positively charged phosphonium groups separated by 10 methylene units
in a "bola"-type configuration. We tested these compounds for antimicrobial
activity versus a variety of ocular pathogens, as well as their cytoxicity, in
vitro in a corneal cell line and in vivo in mice. RESULTS: The ionic liquid
Di-Hex C10 demonstrated broad in vitro antimicrobial activity at low micromolar
concentrations versus gram-negative and gram-positive organisms, including
methicillin-resistant Staphylococcus aureus strains and ocular fungal pathogens.
Treatment with Di-Hex C10 resulted in bacterial killing in as little as 15
minutes in vitro. Di-Hex C10 showed little cytotoxicity at 1 muM versus a
corneal epithelial cell line or at 10 muM in a mouse corneal wound model. We
also show that this bis-phosphonium ionic liquid structure is a key because a
comparable monophosphonium ionic liquid is cytotoxic to both bacteria and
corneal epithelial cells. CONCLUSIONS: Here, we report the first use of
dicationic bis-phosphonium ionic liquids as antimicrobial agents. Our data
suggest that diphosphonium ionic liquids may represent a new class of
broad-spectrum antimicrobial agents for the use on the ocular surface.

PMID: 22236790  [PubMed - as supplied by publisher]

24: Cornea. 2012 Jan 10; [Epub ahead of print] 

Repeatability of Pachymetric Mapping Using Fourier Domain Optical Coherence
Tomography in Corneas With Opacities.

Samy El Gendy NM, Li Y, Zhang X, Huang D.

*Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine of
the University of Southern California, Los Angeles, CA daggerOphthalmology
Department, Kaser Al Aini Medical School, Cairo University, Cairo, Egypt.

PURPOSE: To evaluate the repeatability of Fourier domain optical coherence
tomography (OCT) pachymetric mapping in patients with corneal opacities and to
assess the reliability of Fourier domain OCT with 830 nm wavelength as a
pachymetric measurement tool in opaque corneas. METHODS: A Fourier domain OCT
system was used to map the corneal thickness of patients with corneal scars or
dystrophy. A retrospective study of a consecutive series was conducted. The
repeatability was measured using pooled standard deviation of repeated
measurements. A slit-scanning tomography device provided pachymetric mapping for
comparison. RESULTS: Seventeen eyes of 12 patients with corneal scars (7 trauma
and 3 post infection) or dystrophy (2 Reis-Bucklers and 5 granular dystrophy)
were included. The posterior corneal boundary was detectable in all cases. The
average corneal thickness measured by OCT was 536 +/- 89 mum in central 2 mm
area, 553 +/- 76 mum in pericentral 2- to 5-mm area, and 508 +/- 93 mum for the
minimum corneal thickness. The slit-scanning tomography central corneal
thickness, 433 +/- 111 mum, was significantly lower than OCT readings (mean
difference -91.1 +/- 33.3 mum, P = 0.002). Repeatability of the OCT measurements
was 2.1 mum centrally and 1.2 mum pericentrally. CONCLUSION: Pachymetric mapping
with Fourier domain OCT was highly repeatable. Fourier domain OCT is a reliable
pachymetric tool in opaque corneas. In comparison, corneal thickness measured by
the slit-scanning tomography is significantly thinner than those measured by the
Fourier domain OCT in the presence of corneal opacities.

PMID: 22236789  [PubMed - as supplied by publisher]

25: Cornea. 2012 Jan 10; [Epub ahead of print] 

Prevalence and Risk Factors of Meibomian Gland Dysfunction:  The Singapore Malay
Eye Study.

Siak JJ, Tong L, Wong WL, Cajucom-Uy H, Rosman M, Saw SM, Wong TY.

*Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
daggerGraduate Medical School, Duke-National University of Singapore, Singapore
double daggerDepartment of Epidemiology and Public Health, Yong Loo Lin School
of Medicine, National University of Singapore, Singapore  section signCenter for
Eye Research Australia, University of Melbourne, Melbourne, Australia  paragraph
signDepartment of Ophthalmology, Yong Loo Lin School of Medicine, National
University Hospital, National University Health System, Singapore.

PURPOSE: To describe the prevalence and associations of meibomian gland
dysfunction (MGD) in an urban Malay population in Singapore. METHODS:
Population-based cross-sectional study of 3280 (78.7% response rate) Malay
persons aged 40 to 80 years, living in Singapore. MGD was defined by a slit-lamp
clinical examination as either lid margin telangiectasia or meibomian gland
orifice plugging in at least one eye. Participants underwent a standardized
questionnaire and clinical examination, including laboratory investigations.
Data were analyzed for 3271 persons. RESULTS: The age-standardized prevalence of
MGD was 56.3% [95% confidence interval (CI), 53.3-59.4]. A higher MGD prevalence
was found in male participants across all age groups [odds ratio (OR), 1.30; 95%
CI, 1.35-1.79], postmenopausal women (OR, 1.64; 95% CI, 1.19-2.33), and all
participants with pinguecula (OR, 2.43; 95% CI, 2.08-2.85), high diastolic blood
pressure (OR, 1.32; 95% CI, 1.08-1.62), and use of angiotensin II receptor
blockers (OR, 4.02; 95% CI, 1.74-9.27). CONCLUSIONS: MGD was highly prevalent in
this Asian population and associated with various systemic and ocular
conditions.

PMID: 22236788  [PubMed - as supplied by publisher]

26: Cornea. 2012 Jan 10; [Epub ahead of print] 

Postoperative Complications of Conjunctival Limbal Autograft Surgery.

Baradaran-Rafii A, Eslani M, Jamali H, Karimian F, Tailor UA, Djalilian AR.

*Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical
Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
daggerSchool of Medicine, Tehran University of Medical Sciences, Tehran, Iran
double daggerDepartment of Ophthalmology, Shiraz University of Medical Sciences,
Shiraz, Iran  section signDepartment of Ophthalmology and Visual Sciences,
University of Illinois at Chicago, Chicago, IL.

PURPOSE: To report postoperative complications of conjunctival limbal autograft
in patients with unilateral total limbal stem cell deficiency (LSCD). METHODS:
In this retrospective observational case series, medical charts of 34 patients
with unilateral total LSCD with at least 6 months of follow-up were reviewed.
Main outcome measure was postoperative complications. RESULTS: The mean
follow-up period was 17.2 +/- 6.3 (range, 6-33) months. The postoperative
complications observed included conjunctival encroachment over the graft, small
graft, graft dislodging, thick graft, improper position, graft edema, ocular
surface exposure, progressive horizontal conjunctivalization, and pyogenic
granuloma. Persistent epithelial defect occurred in 5 eyes because of ocular
surface exposure (n = 2), conjunctival encroachment (n = 1), and small graft
size (n = 2). Epithelial defects healed in 4 of them with sectoral
vascularization of the cornea. Optical penetrating keratoplasty was performed on
18 eyes with dense corneal opacification. Persistent epithelial defect occurred
in 6 eyes with inadvertent cut limbal graft (n = 2), small limbal graft (n = 2),
and ocular surface exposure (n = 2). CONCLUSIONS: Conjunctival limbal autograft
is an effective procedure for anatomical and visual rehabilitation of eyes with
unilateral total LSCD. However, it may be complicated by several adverse events.
The most common complications are related to the transplanted grafts (size,
thickness, position, and alignment) and chronic ocular surface exposure, which
may later lead to epithelial breakdown and corneal conjunctivalization.

PMID: 22236787  [PubMed - as supplied by publisher]

27: Cornea. 2012 Jan 10; [Epub ahead of print] 

Treatment of Early Acanthamoeba Keratitis With Alcohol-Assisted Epithelial
Debridement.

Li ML, Shih MH, Huang FC, Tseng SH, Chen CC.

Departments of *Ophthalmology daggerPathology, National Cheng-Kung University
College of Medicine and Hospital, Tainan, Taiwan.

PURPOSE: To study the safety and efficacy of treating early-stage Acanthamoeba
keratitis (AK) with 20% alcohol-assisted epithelial debridement. METHODS: Four
consecutive patients (2 wearing orthokeratology lenses and 2 wearing soft
contact lenses) presented with pseudodendrites, radial keratoneuritis, and
epithelial irregularities. Using a technique similar to laser-assisted
subepithelial keratomileusis, we performed alcohol-assisted full-thickness
debridement of the corneal epithelium and sent portions for smears,
histopathologic and ultrastructural examinations, and culture for evidence of
Acanthamoeba. Patients were then started on topical propamidine isethionate and
0.02% polyhexamethylene biguanide. RESULTS: Immediately after debridement,
minimal underlying anterior stromal infiltrate or haze was seen. Dosages of
antiamoebic agents were tapered as corneal defects reepithelialized (in 1-3
weeks) with no evidence of post-debridement corneal infection. At the final
follow-up, 1 cornea was transparent and the other 3 corneas had very faint
subepithelial haze. Cultures of all epithelial debridement specimens yielded
Acanthamoeba trophozoites and cysts, and histopathologic and electron
microscopic examinations revealed Acanthamoeba organisms within corneal
epithelial layers. CONCLUSIONS: Alcohol-assisted epithelial debridement
facilitates detachment of the full-thickness corneal epithelial layer in a
controlled manner and seems to be effective in the treatment of early-stage AK.
Unlike the fragile fragmented specimens obtained by mechanical scraping without
alcohol soaking, epithelial sheets detached easily and the architectures were
well preserved, permitting histopathologic and ultrastructural examinations.
Most importantly, 20% alcohol-assisted epithelial debridement did not prevent
culturing of Acanthamoeba from the removed epithelial specimens.

PMID: 22236786  [PubMed - as supplied by publisher]

28: Cornea. 2012 Jan 10; [Epub ahead of print] 

Outcomes of Boston Keratoprosthesis Implantation for Failed Keratoplasty After
Keratolimbal Allograft.

Hou JH, Cruz JD, Djalilian AR.

Department of Ophthalmology and Visual Sciences, University of Illinois at
Chicago, Chicago, IL.

PURPOSE: To evaluate factors that contribute to keratoplasty failure after
keratolimbal allograft (KLAL) and report the outcomes of Boston keratoprosthesis
type I (KPro) as salvage therapy. METHODS: Retrospective noncomparative case
series of 7 eyes in 7 consecutive patients with ocular surface disease and
limbal stem cell deficiency treated with KPro after failed KLAL. Mechanisms of
graft failure, KPro device retention rate, and preoperative and postoperative
best-corrected visual acuities were studied. RESULTS: In the studied cohort,
keratoplasty graft failure occurred at an average of 9.9 months (range, 1-17
months) after KLAL. Among the 7 eyes reviewed, 4 had tube shunts, 3 of which
contributed directly to endothelial graft failure. One eye failed due to fungal
keratitis, 1 eye failed due to immune-mediated endothelial rejection, and 2 eyes
failed due to recurrent surface disease. During an average follow-up of 585 days
(19.5 months) after KPro, best-corrected visual acuity improved from a median of
counting fingers CF@2ft (range, hand motions to 20/400) to a median of 20/400
(range, CF@3ft to 20/25). There was 85.7% (6 of 7) retention of implanted
devices at the last follow-up, with 1 eye requiring repeat KPro for corneal melt
and implant extrusion after abrupt cessation of immunosuppression. CONCLUSIONS:
Despite successful KLAL outcomes and systemic immunosuppression, patients who
undergo ocular surface reconstruction with KLAL are still at risk for subsequent
keratoplasty failure. Keratoprosthesis is a viable salvage therapy for visual
rehabilitation in these patients. Adequate immunosuppression is important in
postoperative management of these patients.

PMID: 22236785  [PubMed - as supplied by publisher]

29: Cornea. 2012 Jan 10; [Epub ahead of print] 

Intraocular Lens Opacifications in Descemet Stripping Endothelial Keratoplasty
Patients.

Patryn E, van der Meulen IJ, Lapid-Gortzak R, Mourits M, Nieuwendaal CP.

*Department of Ophthalmology, Academic Medical Centre, Amsterdam, The
Netherlands daggerRetina Total Eye Care, Driebergen, The Netherlands.

PURPOSE: To report 3 cases of unexplained intraocular lens (IOL) opacification
in patients who previously underwent Descemet stripping endothelial keratoplasty
(DSEK). METHODS: Case series. Three pseudophakic eyes of 3 patients, who
developed a membraneous opacification of the IOL after uneventful DSEK are
presented. RESULTS: In 2 eyes, the opacification interfered with visual acuity.
In 1 case, an attempt was made to remove the opacification with the aid of YAG
laser and surgically, to no avail, necessitating an IOL explantation.
CONCLUSIONS: IOL opacification can occur in eyes previously subjected to DSEK.
The majority of patients subjected to DSEK are pseudophakic; surgeons should be
aware of this possible complication. To the best of our knowledge, this has not
been described in the literature to date. Further research is required to
elucidate the nature of such IOL opacifications and possible ways to prevent
them.

PMID: 22236784  [PubMed - as supplied by publisher]

30: Cornea. 2012 Jan 10; [Epub ahead of print] 

Long-term Outcomes of Penetrating Keratoplasty for Keratoconus With Resolved
Corneal Hydrops.

Basu S, Reddy JC, Vaddavalli PK, Vemuganti GK, Sangwan VS.

*Cornea and Anterior Segment Service daggerOcular Pathology Laboratory, L V
Prasad Eye Institute, Hyderabad, India.

PURPOSE: To address the controversial issue of whether the occurrence of corneal
hydrops adversely affects the fate of subsequent penetrating keratoplasty (PK),
this study compared the long-term outcomes of PK in keratoconic eyes with
resolved corneal hydrops with those without prior corneal hydrops. METHODS: This
was a retrospective chart review of 102 eyes of 102 patients with keratoconus
who underwent PK. The primary outcome measure was endothelial rejection-free
allograft survival and the secondary outcomes were vision, postoperative
complications, and histopathologic findings of corneal buttons obtained during
PK. RESULTS: The mean follow-up after PK was 5.5 +/- 3.3 years. The Kaplan-Meier
endothelial rejection-free allograft survival at 1 and 5 years post-PK were
93.7% +/- 4% and 82.6% +/- 7%, respectively, in 32 eyes with hydrops and 100%
and 98% +/- 2%, respectively, in 70 eyes without hydrops (P = 0.04).
Multivariate analysis showed that the risk of endothelial rejection episodes was
greater in eyes with longer duration of corneal hydrops (P = 0.019) and
coexistent ocular allergy (P = 0.012). All rejection episodes were reversed
medically and only 1 allograft failed because of postoperative endophthalmitis.
More than 90% of eyes achieved a visual acuity of better than 20/40. Common
postoperative complications were cataract and graft infiltrate. Histopathology
in cases of resolved hydrops after intracameral gas showed unique compression
artifacts like folding and burial of the broken ends of Descemet membrane in the
stroma. CONCLUSIONS: Although endothelial rejection episodes are more common in
eyes with resolved corneal hydrops, long-term allograft survival and visual
results after PK in eyes with keratoconus are excellent, irrespective of prior
corneal hydrops.

PMID: 22236783  [PubMed - as supplied by publisher]