1: Cornea. 2009 Feb;28(2):246-7. 

Bevacizumab (avastin) for corneal neovascularization--corneal light shield
soaked application.

Mackenzie SE, Tucker WR, Poole TR.

Eye Unit, Frimley Park Hospital, Frimley, Camberley, Surrey, UK.

PURPOSE: To describe a case where topical bevacizumab (Avastin) was used in an
attempt to reduce corneal neovascularization before corneal graft. METHODS:
Topical bevacizumab was applied through a corneal light shield for 20 minutes
once a week for 11 weeks to the cornea. RESULTS: Corneal vascularization was not
reduced. CONCLUSIONS: Topical bevacizumab was not effective in this case at
reducing corneal neovascularization.

PMID: 19158579 [PubMed - in process]

2: Cornea. 2009 Feb;28(2):243-5. 

Use of anterior segment optical coherence tomography to assess secondary
glaucoma after penetrating keratoplasty.

Chua J, Mehta JS, Tan DT.

Cornea and External Disease Service, Singapore National Eye Centre, Singapore.
jocelynchua77@yahoo.com

PURPOSE: To describe the use of anterior segment optical coherence tomography
(AS-OCT) in the evaluation of a patient with raised intraocular pressures after
penetrating keratoplasty. METHODS: A 52-year-old Indian male with bilateral
keratoconus underwent multiple penetrating keratoplasties because of repeated
episodes of endothelial rejection and graft failure. He also had secondary
glaucoma bilaterally for which he underwent bilateral posterior implantation of
glaucoma drainage device. During the early postoperative period after a repeat
right penetrating keratoplasty with anterior synechiolysis, his right
intraocular pressure was persistently raised. The AS-OCT was used to aid in the
assessment of the patient. RESULTS: The AS-OCT showed obstruction of the
glaucoma drainage device by iris tissue and enabled precise placement of the
iridectomy immediately overlying the tube orifice. CONCLUSIONS: The AS-OCT is a
useful investigative tool that enables a better evaluation of the structures
within the AS. The noncontact nature of the AS-OCT also makes it suitable in
postpenetrating keratoplasty eyes where undue pressure on the corneal graft
should be avoided.

PMID: 19158578 [PubMed - in process]

3: Cornea. 2009 Feb;28(2):240-2. 

Traumatic graft dehiscence after anterior lamellar keratoplasty.

Prasher P, Muftuoglu O, Mootha VV.

Department of Ophthalmology, University of Texas Southwestern Medical Center,
Dallas, TX 75390-9057, USA. pawanprasher@yahoo.com

A 64-year-old man underwent anterior lamellar keratoplasty using the Melles
technique for corneal scar secondary to healed bacterial keratitis in the left
eye. Two months postoperatively, the patient presented with blurry vision in the
left eye after a fall in the bathroom. The uncorrected visual acuity was 20/400
in the left eye, and the external examination showed periorbital swelling with
ecchymosis. Slit-lamp examination revealed an absent graft, a circular crater in
the center, and a fragment of suture on the temporal edge of the crater. The
Seidel test was negative, and there was no sign of infection. The anterior
segment optical coherence tomography showed intact residual stroma with slight
forward protrusion. The patient underwent repeat anterior lamellar corneal
transplantation with improvement in uncorrected visual acuity of 20/100 and best
spectacle-corrected visual acuity of 20/70 in the left eye 3 months
postoperatively.

PMID: 19158577 [PubMed - in process]

4: Cornea. 2009 Feb;28(2):237-9. 

Corneal ectasia after laser in situ keratomileusis after laser thermal
keratoplasty.

Nguyen MT, Hamilton DR.

Division of Cornea and External Diseases, Jules Stein Eye Institute, University
of California-Los Angeles, Los Angeles, CA, USA.

PURPOSE: To report a case of corneal ectasia following hyperopic laser in situ
keratomileusis in a patient who had previous laser thermal keratoplasty.
METHODS: Case report. RESULTS: We report a case of a 66-year-old emmetropic man
initially presented with complaint of difficulty reading without correction.
Laser thermal keratoplasty (LTK) was performed on the non-dominant right eye,
resulting in successful monovision. Three years later, the patient presented
with decreased unaided near vision caused by hyperopic regression of the LTK.
Conventional hyperopic laser in situ keratomileusis (LASIK) was performed, again
resulting in successful monovision. More than three years later, the patient
returned with worsening near vision. A focal corneal ectasia was noted in the
same location as the 6 o\'clock LTK leukoma. CONCLUSIONS: To our knowledge, this
is the first report of ectasia occuring after LASIK following LTK. Consideration
should be given to performing photorefractive keratectomy (PRK) instead of LASIK
following thermal keratoplasty.

PMID: 19158576 [PubMed - in process]

5: Cornea. 2009 Feb;28(2):233-6. 

Ocular surface reconstruction in graft-versus-host disease with HLA-identical
living-related allogeneic cultivated limbal epithelium after hematopoietic stem
cell transplantation from the same donor.

Meller D, Fuchsluger T, Pauklin M, Steuhl KP.

Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany.
meller@uk-essen.de

PURPOSE: To report a case of HLA-identical allogeneic living-related ex vivo
expanded limbal epithelium in ocular surface reconstruction for chronic
graft-versus-host disease (cGVHD). METHODS: Review the clinical findings in a
58-year-old woman with bilateral limbal stem cell deficiency caused by cGVHD who
underwent ocular surface reconstruction on the left eye with cultivated limbal
epithelial cells (LECs) on intact human amniotic membrane combined with
extracapsular cataract extraction and intraocular lens implantation. LECs were
harvested from a small biopsy of the same HLA-identical living-related donor who
already donated peripheral blood cells for hematopoietic stem cell
transplantation. RESULTS: At the present state, after a follow-up of 31 months,
the patient shows a successful ocular surface reconstruction with a clear,
smooth, and stable corneal ocular surface without recurrence of limbal stem cell
deficiency. Nine months postoperatively, patients\' corneal thinning progressed
to a small perforation, which was successfully treated with a tectonic
perforating keratoplasty combined with the removal of irritating lid lashes.
CONCLUSION: The technique of HLA-typed allogeneic ex vivo expansion of LECs
harvested from the same living-related donors who already donated hematopoietic
stem cells offers a possibility to reconstruct ocular surface in cGVHD.

PMID: 19158575 [PubMed - in process]

6: Cornea. 2009 Feb;28(2):231-2. 

Blueberry eye: acquired total anterior staphyloma after a fungal corneal ulcer.

Grieser EJ, Tuli SS, Chabi A, Schultz S, Downer D.

Department of Ophthalmology, University of Florida, Gainesville, FL 32610-0284,
USA.

PURPOSES: The purposes of this study were to report the presentation and
management of an acquired total anterior staphyloma that resulted from a fungal
corneal ulcer and to discuss its pathogenesis. METHODS: Observational case
report. Clinical observation and surgical intervention of a patient who
developed a total anterior staphyloma after a partially treated fungal corneal
ulcer. RESULTS: The patient presented with a large traumatic fungal ulcer but
was poorly compliant with follow-up and medications. He subsequently presented
with a large total anterior staphyloma that resulted from perforation of the
ulcer with plugging of the defect with iris and formation of a pseudocornea over
the iris. The anterior staphyloma measured 15 x 16 mm and progressed to a stage
where the patient was unable to close his eyelids and required a
sclerokeratoplasty. Currently, vision is poor from amblyopia and a cloudy graft;
however, the eye is intact and comfortable. CONCLUSIONS: Anterior staphylomas
usually result from untreated fungal ulcers in developing nations. Poor
compliance with medications and follow-up was the cause of our patient\'s
anterior staphyloma. Sclerokeratoplasty can restore the globe structurally but
has poor visual prognosis.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19158574 [PubMed - in process]

7: Cornea. 2009 Feb;28(2):228-30. 

Donor-to-host transmission of Candida glabrata to both recipients of corneal
transplants from the same donor.

Tappeiner C, Goldblum D, Zimmerli S, Fux C, Frueh BE.

Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland.
christoph.tappeiner@insel.ch

PURPOSE: To report 2 cases of exogenous Candida glabrata endophthalmitis after
penetrating keratoplasty in recipients of corneas from the same donor
transplanted on the same day. METHODS: Case reports with ophthalmologic,
electron microscopic, and microbiological findings including fungal strain
analysis. RESULTS: Two patients developed fungal keratitis and endophthalmitis
caused by the same C. glabrata strain within 1 day after penetrating
keratoplasty of corneas from the same donor on the same day. Donor-to-host
transmission was postulated when eye bank sterility checks were repeatedly
negative. CONCLUSIONS: A short death-to-harvesting time, routine donor rim
cultures, and respecting of a time interval before transplantation may provide
an additional safety feature in dealing with corneal tissue from high-risk
donors.

PMID: 19158573 [PubMed - in process]

8: Cornea. 2009 Feb;28(2):224-7. 

Fabry disease and chemosis.

Edwards JD, Bower KS, Brooks DB, Walter A.

Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC
20307-5001, USA. jayson.edwards@amedd.army.mil

PURPOSE: To report the case of a patient with Fabry disease (FD) whose ocular
presentation with chronic chemosis we feel is related to FD and to describe the
conjunctival fluorescein angiographic findings. METHODS: A 51-year-old male
patient with FD on enzyme replacement therapy presented with 1-month chemosis
and mild irritation in the left eye. Ocular examination revealed pronounced
noninflammatory chemosis inferotemporally in the left eye with conjunctival
tortuosity and microaneurysms bilaterally. There was mild corneal verticillata,
spoke-like lens opacities, and retinal vascular tortuosity bilaterally, with no
evidence of disc or macular edema. Evaluation revealed no systemic cause for his
chemosis, including an orbital computerized tomography scan, which showed clear
sinuses and no evidence of an intraorbital mass. RESULTS: Conjunctival
fluorescein angiography revealed rapid subconjunctival accumulation of dye in
the involved eye but failed to demonstrate leakage from tortuous conjunctival
vessels or microaneurysms. CONCLUSIONS: Although the pathology of chronic
chemosis in patients with FD is as yet unknown, we believe that FD should be
considered in the differential diagnosis of patients presenting with chronic
chemosis of unknown etiology.

PMID: 19158572 [PubMed - in process]

9: Cornea. 2009 Feb;28(2):221-3. 

Limbal stem cell deficiency arising from systemic chemotherapy with
hydroxycarbamide.

Ding X, Bishop RJ, Herzlich AA, Patel M, Chan CC.

Section of Immunopathology, Laboratory of Immunology, National Eye Institute,
National Institutes of Health, Bethesda, MD 20892-1857, USA.

PURPOSE: The purpose of this study was to report a case of limbal stem cell
deficiency (LSCD) after systemic chemotherapy with hydroxycarbamide. METHODS:
Clinical manifestations and pathology are detailed. RESULTS: We describe the
case of a woman with sickle cell disease, who developed bilateral LSCD after
treatment with hydroxycarbamide. Histologic examination confirmed the diagnosis
of LSCD, revealing goblet cells, inflammatory cells, deposits of new collagen
components, and neovascularization in the peripheral cornea. Matrix
metalloproteinase-3, fibronectin, and collagen III were also detected in the
lesions. CONCLUSIONS: The systemic use of the antineoplastic drug,
hydroxycarbamide, may cause severe LSCD. We recommend that a medication history,
including that of cytotoxic drugs, be considered in evaluating LSCD.

Publication Types:
    Research Support, N.I.H., Intramural

PMID: 19158571 [PubMed - in process]

10: Cornea. 2009 Feb;28(2):219-20. 

MoisturePlus contact lens solution as a source of acanthamoeba keratitis.

Hasler S, Dedes W, Mathis A, Grimm F, Thiel MA.

Department of Ophthalmology, Kantonsspital Lucerne, Lucerne, Switzerland.
sih@gmx.net

Recently, it was suggested that the use of the Advanced Medical Optics Complete
MoisturePlus multipurpose cleaning solution might be a risk factor for
contracting Acanthamoeba keratitis, and the manufacturer voluntarily recalled it
in May 2007. Polymerase chain reaction amplification and sequencing of a
variable part of the 18S rRNA gene allowed for the first time tracking of
Advanced Medical Optics Complete MoisturePlus-associated Acanthamoeba keratitis
isolate from a patient back to the lens cleaning solution itself.

PMID: 19158570 [PubMed - in process]

11: Cornea. 2009 Feb;28(2):217-8. 

The use of voriconazole in the treatment of cylindrocarpon keratomycosis.

Mitra A, Savant V, Aralikatti A, Dean S, Shah S.

Birmingham and Midland Eye Centre, Birmingham, West Midlands, UK.
drarijitmitra@yahoo.com

PURPOSE: To describe a rare form of fungal keratitis due to Cylindrocarpon
lichenicola. METHOD: A 56-year-old woman presented with an atypical corneal
ulcer that did not respond to broad- spectrum antibiotics. RESULTS: Additional
diagnostic tests such as confocal microscopy and corneal biopsy were useful aids
in establishing the diagnosis of fungal keratitis. The ulcer healed completely
after the initiation of antifungal therapy. CONCLUSIONS: To the best of our
knowledge, this is the first case of C. lichenicola keratomycosis in the United
Kingdom. Our case demonstrates that prompt recognition and effective treatment
of this condition can lead to a good visual outcome.

PMID: 19158569 [PubMed - in process]

12: Cornea. 2009 Feb;28(2):214-6. 

Flipping the inverted donor disk in descemet stripping automated endothelial
keratoplasty.

Hashemi H, Shamshiri M, Mehravaran S.

Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
hhashemi@noorvision.com

We describe a technique we used to flip the donor corneal lenticule during
Descemet stripping automated endothelial keratoplasty. In this case, in which we
performed standard phacoemulsification and intraocular lens implantation as a
combined procedure with Descemet stripping automated endothelial keratoplasty,
the donor lenticule unfolded upside down in the anterior chamber (AC). To flip
the donor to a stromal side up position with minimum manipulation, we first
passed in a needle and fixed it on the edge of the lenticule. This needle was
used to push the edge of the lenticule upward while we filled up the AC with
balanced salt solution, directing the fluid to push the distal edge down and
away. Having flipped the lenticule halfway, the procedure was continued by
placing the needle on the midperipheral stroma of the donor lenticule and
sliding it toward the recipient cornea. Then, the AC was filled with air to
allow adhesion of the donor, and at the end of surgery, the air was replaced
with balanced salt solution. The cornea cleared over a period of 10 days after
surgery. At the end of the fourth postoperative week, the final best-corrected
visual acuity was 20/50.

PMID: 19158568 [PubMed - in process]

13: Cornea. 2009 Feb;28(2):211-3. 

Femtosecond-assisted anterior lamellar corneal staining-tattooing in a blind eye
with leukocoria.

Kymionis GD, Ide T, Galor A, Yoo SH.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami,
Miami, FL 33136, USA. gkymionis@med.miami.edu

PURPOSE: To describe the technique and a case report of femtosecond-assisted
anterior lamellar corneal staining-tattooing in a blind eye with leukocoria.
METHODS: An anterior lamellar corneal free flap (thickness: 120 microm,
diameter: 7.0 mm) was created using femtosecond laser (IntraLase-AMO, Irvine,
CA). The free flap was removed and immersed in a commercially available black
tattoo pigment. After 9 minutes of flap incubation with the tattoo pigment
solution, the flap was continuously irrigated for 3 minutes with balanced salt
solution (Alcon Laboratories, Fort Worth, TX) until all the excessive pigment
was removed. The flap was repositioned on the residual corneal bed, and a
bandage contact lens was placed. RESULTS:: There were no intraoperative or
postoperative adverse events seen by the 6-month follow-up, although an
excellent cosmetic result was achieved. CONCLUSIONS:: The technique of FALT is
simple and efficient for treating cosmetically blind eyes with leukocoria and
may overcome the limitations of previously reported techniques. The long-term
safety of the commercially available corneal tattoo dyes should be studied
further.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19158567 [PubMed - in process]

14: Cornea. 2009 Feb;28(2):206-10. 

Short-term effect of topical dorzolamide hydrochloride on intrastromal corneal
pressure in rabbit corneas in vivo.

Teus MA, Bolivar G, Alio JL, Lipshitz I.

Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain.

PURPOSE: To evaluate the effect of topical dorzolamide on the intrastromal
corneal pressure (ICP) in rabbit corneas in vivo. METHODS: This is an
interventional prospective study. Topical dorzolamide was applied to 7 eyes of 7
male New Zealand rabbits 3 times daily for 3 consecutive days. The ICP changes
were recorded with a pressure transducer connected to the midperipheral cornea.
The ICP was measured in the same manner in 7 eyes of 7 male New Zealand rabbits
that were treated with artificial tears (control group). RESULTS: The ICP values
averaged -6.2 +/- 3.2, -10 +/- 5.8, and -12.5 +/- 8.7 mm Hg at 15, 30, and 45
minutes in the control group, respectively. In the dorzolamide-treated eyes, the
ICP readings were 1.8 +/- 3.4, -0.28 +/- 4.3, and -1.8 +/- 5.3 mm Hg at the same
time points, respectively. The differences in the ICP between both groups were
significantly different at all time points (P = 0.004, P = 0.005, and P = 0.02).
CONCLUSIONS: Measuring ICP is a valid and sensitive method to evaluate in vivo
the endothelial function. This method seems to be more sensitive than measuring
the central corneal thickness or the corneal deswelling rate in detecting
changes in the corneal physiology with the use of topical dorzolamide.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19158566 [PubMed - in process]

15: Cornea. 2009 Feb;28(2):200-5. 

Time- and temperature-dependent stability of growth factor peptides in human
autologous serum eye drops.

Bradley JC, Simoni J, Bradley RH, McCartney DL, Brown SM.

Department of Ophthalmology and Visual Sciences, University of California at
Davis, Sacramento, CA, USA.

PURPOSES: To develop a step-by-step production method for human autologous serum
(AS) eye drops that was broadly compliant with US Food and Drug Administration
requirements for reinjection of processed biological substances. To determine
optimum storage conditions for AS eye drops by measuring the concentration of
growth factor peptides (GFP) as a function of storage temperature and storage
duration. METHODS: AS derived from the blood of 3 healthy male volunteers was
produced using a closed, vacuum-driven, cascade-filtration system under sterile,
low-pyrogen conditions. In-process controls included methods for monitoring
protein electrophoretic mobility and degradation rate and the content of free
hemoglobin and endotoxin. Stability of transforming growth factor beta1,
substance P, nerve growth factor, calcitonin gene-related peptide, insulin-like
growth factor 1, and epidermal growth factor was evaluated at -15 degrees C, +4
degrees C, +25 degrees C, +37 degrees C, and +42 degrees C at different time
intervals (hours to weeks). The main outcome measures were the concentrations of
GFP, endotoxin, and lipid peroxidation by-products (a proxy measure for protein
degradation) in dilute AS. RESULTS: The stability of GFP varies: transforming
growth factor beta1, nerve growth factor, epidermal growth factor, and
insulin-like growth factor 1 were more temperature and time resistant, but
substance P and calcitonin gene-related peptide significantly degraded at +4
degrees C in 24 hours. Endotoxin and lipid peroxidation by-products were not
significantly increased by processing. CONCLUSIONS: This pilot study developed a
closed, cascade-filtration system that was an effective method for the
production of high-quality, low-pyrogen AS. The processing method broadly
complied with Food and Drug Administration requirements for reinjection of
biological substances. Variable GFP stability was observed at +4 degrees C and
above. For clinical use, AS should be packaged in daily-use containers, which
should be stored frozen; the container in active use should be refrigerated
between doses.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19158565 [PubMed - in process]

16: Cornea. 2009 Feb;28(2):194-9. 

Expression pattern of connexins in the corneal and limbal epithelium of a
primate.

Yuan X, Chen Z, Yang Z, Gao J, Zhang A, Wu SM, Jacoby R.

Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine,
Houston, TX 77030, USA.

PURPOSE: To detect the expression pattern of connexins in epithelial cells of
the central cornea and limbus of the macaque. METHODS: Total RNA was extracted
from the central corneal and limbal epithelia of Macaca fascicularis and
processed by reverse transcriptase-polymerase chain reaction with isoform
primers to detect the expression of 16 connexin (Cx). Immunofluorescent staining
of frozen sections of corneal tissue confirmed and localized connexin proteins
expression. RESULTS: Transcripts encoding 10 Cx isoforms (Cx26, Cx30, Cx30.3,
Cx31, Cx31.1, Cx32, Cx43, Cx45, Cx50, and Cx58) were detected by reverse
transcriptase-polymerase chain reaction in both central and peripheral corneal
epithelium. Six (Cx26, Cx31, Cx32, Cx43, Cx45, and Cx58) were confirmed by laser
scanning confocal microscopy. Cx26 was detected throughout the central corneal
epithelium and in the mid and superficial layers of the limbal epithelium. Cx43
and Cx45 were localized to the basal and suprabasal epithelial cells. Cx58 was
expressed in the superficial epithelium throughout the cornea, whereas Cx31 and
Cx32 were mainly expressed in the central corneal epithelium and weakly in the
limbal area. CONCLUSIONS: The complex distribution pattern of the connexins
suggests that selected isoforms play important roles in maintaining corneal
homeostasis.

PMID: 19158564 [PubMed - in process]

17: Cornea. 2009 Feb;28(2):189-93. 

Elevated tear interleukin-6 and interleukin-8 levels in patients with
conjunctivochalasis.

Erdogan-Poyraz C, Mocan MC, Bozkurt B, Gariboglu S, Irkec M, Orhan M.

Department of Ophthalmology, Hacettepe University School of Medicine, Ankara,
Turkey.

PURPOSE: To determine the interleukin (IL)-6 and IL-8 levels in the tear samples
of patients with conjunctivochalasis (CCh) and to correlate the severity of
symptoms with tear IL levels. METHODS: Fifty-one eyes at different stages of CCh
and 10 eyes of healthy controls were recruited for this prospective study
undertaken at a single university-based hospital. CCh was graded based on the
extent of inferior lid margin involvement as follows: 1 = single (temporal)
location, 2 = 2 locations, and 3 = whole lid. The presence of punctal occlusion
and fluorescein clearance patterns were recorded. Enzyme-linked immunosorbent
assay was used to determine IL levels. Severity of symptoms was assessed with
the ocular surface disease index. RESULTS: Of the 51 study patients (mean age =
63.4 +/- 6.9 years), 16 had grade 1, 21 had grade 2, and 14 had grade 3 CCh.
Tear IL-6 and IL-8 levels were significantly higher in patients with CCh than in
controls (P  0.001). No influence
of sex, refraction, and intraocular pressure on the thickness of the thinnest
point of the cornea could be observed. The difference between central corneal
thickness and thickness at the thinnest point was not subject to a statistically
significant influence of age. CONCLUSIONS: In the calculation of the residual
corneal layer thickness in laser refractive surgery, the thinnest point of the
cornea should form the basis.

PMID: 19158561 [PubMed - in process]

20: Cornea. 2009 Feb;28(2):170-6. 

Fibrin glue-assisted augmented amniotic membrane transplantation for the
treatment of large noninfectious corneal perforations.

Kim HK, Park HS.

Department of Ophthalmology, Kyungpook National University School of Medicine,
Daegu, South Korea. okeye@knu.ac.kr

PURPOSE: To evaluate and report the efficacy of fibrin glue (FG)-assisted
augmented amniotic membrane transplantation (AMT) in patients with large corneal
perforations. METHODS: In a retrospective case series, 10 patients with corneal
perforations more than 2 mm in diameter were treated with "FG-assisted augmented
AMT." A 5- or 7-ply "augmented amniotic membrane" (AM) was constructed by
applying FG to each sheet of AM to repair the corneal perforation. The augmented
AM was designed 0.5 mm larger than the diameter of the perforation. The
augmented AM was transplanted onto the perforation site with 10-0 nylon suture.
If needed, additional overlay AM was sutured on top. RESULTS: The mean
ulceration diameter was 2.7 +/- 0.95 mm (range, 2-5 mm). All patients retained
their own globes after the procedure and had well-formed deep anterior chambers,
and 90% of patients showed complete epithelialization over the AM. The mean
reepithelialization time was 14.9 +/- 4.9 days (range, 10-24 days). No eyes
showed evidence of infection or recurrent corneal melting during the follow-up
period. CONCLUSIONS: FG-assisted augmented AMT was easily performed for
repairing large corneal perforations. This surgical method was very helpful in
stabilizing the wound in the early postoperative period.

PMID: 19158560 [PubMed - in process]

21: Cornea. 2009 Feb;28(2):166-9. 

Prospective study on the safety and efficacy of combined conjunctival rotational
autograft with intraoperative 0.02% mitomycin C in primary pterygium excision.

Young AL, Tam PM, Leung GY, Cheng LL, Lam PT, Lam DS.

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong
Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
youngla@ha.org.hk

PURPOSE: To describe the novel use of combined conjunctival rotational autograft
(CRA) and intraoperative 0.02% mitomycin C (MMC) in the treatment of primary
pterygium and to evaluate its safety and efficacy. METHODS: Prospective
interventional case series comparing with historical controls was conducted.
Patients with primary pterygium underwent pterygium excision, MMC was applied to
the scleral bed after the surface conjunctiva was harvested, and the CRA was
sutured back with a 180-degree rotation. Patients were followed for a minimum of
1 year. RESULTS: Sixty-seven eyes from 67 patients participated in the study, of
which 31 (46.3%) were men and 36 (53.7%) were women. The mean age was 58 +/-
10.6 years, (range 36-79 years). There were 2 recurrences (3%), one occurring at
month 3 and the other at month 9. Compared with historical controls, CRA-MMC
resulted in significantly fewer recurrences than MMC alone (P = 0.005) when
adjusted for age and was equally effective when compared with
limbal-conjunctival autografts. The main postoperative problem was graft
injection, which was noted in 41 eyes (61%) at 1 year. CONCLUSIONS: To the best
of our knowledge, this was the first study on the combined use of CRA and MMC in
the treatment of primary pterygium. CRA with MMC was found to be effective in
the prevention of recurrence. Although injection remained as a cosmetic concern,
it was a safe alternative to limbal-conjunctival autograft in cases where
mobilizing autologous conjunctival tissue would not be feasible.

PMID: 19158559 [PubMed - in process]

22: Cornea. 2009 Feb;28(2):163-5. 

Microbial keratitis in patients with down syndrome: a retrospective study.

Jhanji V, Moorthy S, Vajpayee RB.

Royal Victorian Eye and Ear Hospital; and Centre for Eye Research Australia,
University of Melbourne, Melbourne, Victoria, Australia.

PURPOSE: To study the microbiological and clinical profile of cases of microbial
keratitis in patients with Down syndrome. METHODS: A retrospective chart review
of all patients with Down syndrome and microbial keratitis admitted to the Royal
Victorian Eye and Ear Hospital, Melbourne, Australia, between January 1997 and
January 2007 was undertaken. Main parameters evaluated were clinical and
microbiological profile and final outcome. RESULTS: Of 18 patients included in
this study, 11 were men and 7 were women, with mean age of 50 +/- 29 years
(range 20-61 years). The most common associated ocular abnormality was eyelid
diseases (94%) followed by atopic keratoconjunctivitis (44%). Positive
microbiological cultures were obtained in 5 (28%) cases with Streptococcus
pneumoniae being the most prevalent isolate. Ocular herpes was detected in 2
patients with polymerase chain reaction. Surgical intervention was required in
13 (72%) patients in the form of keratoplasty (n = 3) corneal gluing (n = 2),
tarsorrhaphy (n = 5), botox injection (n = 1), and enucleation (n = 2).
CONCLUSIONS: Microbial keratitis in Down syndrome is associated with eyelid
problems and ocular atopy, and due to failure of medical therapy alone, surgical
intervention is required in majority of cases.

PMID: 19158558 [PubMed - in process]

23: Cornea. 2009 Feb;28(2):157-62. 

Complex deep lamellar endothelial keratoplasty for complex bullous keratopathy
with severe vision loss.

Huang T, Wang Y, Gao N, Wang T, Ji J, Chen J.

From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun
Yat-sen University, Guangzhou, China.

PURPOSE: To determine the efficacy and postoperative complications of complex
deep lamellar endothelial keratoplasty (DLEK) when used for the management of
complex bullous keratopathy with severe vision loss. METHODS: Twelve consecutive
eyes with severe bullous keratopathy and other associated intraocular
abnormalities underwent complex DLEK which was combined with other intraocular
surgeries such as vitrectomy, intraocular lens removal, and secondary
intraocular lens implantation. An air bubble was used in 9 eyes and an air and
C3F8 gas bubble in 3 eyes for tissue support. Prospective data of best
spectacle-corrected visual acuity, corneal astigmatism, and curvature were
collected on all 12 eyes preoperatively and at 6, 9, and 12 months
postoperatively. Average donor endothelial cell density was recorded
preoperatively and at 9 months postoperatively. RESULTS: Preoperatively, severe
visual loss was recorded at hand motions (n = 3), count fingers (n = 7), and
20/400 (n = 2). Best spectacle-corrected visual acuity improved in 83% of eyes
with vision of 20/67 or better in 42% (5/12) and 20/100 or better in 66% (8/12)
of eyes at 12 months postoperatively. Vision was not improved in three eyes due
to coexistent retinal disease. Four aphakic eyes underwent secondary intraocular
lens implantation later at 4-6 months after DLEK, and best spectacle-corrected
visual acuity was increased from count fingers to 20/200 or better. At 12 months
postoperatively, average corneal astigmatism and curvature were 2.3 +/- 0.5
diopters and 44.0 +/- 0.9 diopters, respectively. Average central corneal
thickness at 12 months postoperatively (541.3 +/- 26.7 microm) was significantly
thinner than that before surgery (673.8 +/- 77.5 microm, P < 0.01). Preoperative
average donor endothelial cell density was 2685.1 +/- 193.9 cells/mm. At 9
months postoperatively, average endothelial cell density was 1920.1 +/- 94.0
cells/mm (27.3% of endothelial cell loss) in eyes with primary surgery and
1866.3 +/- 92.8 cells/mm (33.9% of endothelial cell loss) in eyes with secondary
surgery. Postoperative complications usually occurred within 3 months of
surgery. After surgery, 3 eyes showed narrow gaps between the border of the
graft and the host. Epithelial bullae in these areas recurred in 2 eyes but
disappeared within 3 months. There was one graft dislocation in this series, no
pupillary block cases, and no primary graft failures. CONCLUSIONS: In cases of
complex bullous keratopathy with severe vision loss, DLEK combined with other
intraocular surgeries is a feasible and effective procedure to significantly
improve visual acuity to a functional level in most patients. DLEK can be used
successfully in eyes with aphakia and other anterior segment abnormalities
without a high risk of graft dislocation or failure. Mild postoperative
complications usually occurred early after DLEK and did not affect visual
outcomes and graft survival if managed appropriately.

PMID: 19158557 [PubMed - in process]

24: Cornea. 2009 Feb;28(2):152-6. 

Diamond burr polishing for recurrent corneal erosions: results from a
prospective randomized controlled trial.

Wong VW, Chi SC, Lam DS.

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong
Kong, Hong Kong, People\'s Republic of China. drvwong@hotmail.com

PURPOSE: To evaluate the use of diamond burr polishing as an in-office treatment
for recurrent corneal erosion (RCE). METHODS: A double-masked randomized
controlled trial was conducted. Patients with RCE secondary to trauma or
anterior basement membrane dystrophy underwent epithelial debridement (ED) or
diamond burr superficial keratectomy (DBSK) at the slit lamp. Patients were
followed up for 6 months, and the recurrence rates of RCE and visual outcomes
were compared. RESULTS: Forty-eight eyes of 48 patients were recruited. The mean
+/- SD age was 38.3 +/- 12.9 years. Twenty-five patients underwent DBSK, and 23
patients received ED alone. There was no significant difference in the baseline
demographics between the 2 groups. Kaplan-Meier survival analysis showed
significantly less major and minor recurrences and less need for repeated
surgical interventions in the DBSK group compared with the ED group (P < 0.001).
Eyes in the DBSK group also had significantly lower mean magnitude of
astigmatism after treatment compared to the ED group (P = 0.021). CONCLUSION:
Diamond burr polishing is a safe, convenient, and inexpensive treatment option
for the management of RCE and resulted in better outcomes compared to simple
epithelial debridement.

PMID: 19158556 [PubMed - in process]

25: Cornea. 2009 Feb;28(2):148-51. 

Agreement between stratus and visante optical coherence tomography systems in
tear meniscus measurements.

Savini G, Goto E, Carbonelli M, Barboni P, Huang D.

Studio Oculistico D\'Azeglio, Bologna, Italy. giacomo.savini@alice.it

AIM: To compare the tear meniscus height (TMH) measurements provided by the
Stratus and Visante optical coherence tomography systems. METHODS: A
cross-section image of the lower tear meniscus was captured with both
instruments in 26 volunteers. An external application was used to manually
measure the TMH as imaged by the Stratus; measurements by the Visante were
analyzed by the internal software. Only 1 eye for each subject was considered
for statistical analysis. RESULTS: The mean (+/-SD) TMH was higher when measured
by the Visante (0.28 +/- 0.12 mm) compared with the Stratus (0.23 +/- 0.07 mm, P
= 0.029). Measurements were correlated (R = 0.38, P = 0.0008), but Bland-Altman
analysis showed low agreement (95% limits of agreement: -0.15 to +0.26 mm).
CONCLUSIONS: Visante and Stratus cannot be used interchangeably to measure the
TMH. The differences between the 2 instruments are likely to be related both to
the dynamic nature of the tear meniscus and to the distortion of Stratus images,
which are not dewarped and calibrated for anterior segment imaging.

PMID: 19158555 [PubMed - in process]

26: Cornea. 2009 Feb;28(2):144-7. 

Excimer laser phototherapeutic keratectomy for keratoconus nodules.

Elsahn AF, Rapuano CJ, Antunes VA, Abdalla YF, Cohen EJ.

Department of Ophthalmology, Wills Eye Institute, Jefferson Medical College,
Thomas Jefferson University, Philadelphia, PA, USA.

PURPOSE: To report the outcomes of contact lens-intolerant patients with
keratoconus (KCN) with subepithelial nodules treated with excimer laser
phototherapeutic keratectomy (PTK). METHODS: The charts of all contact
lens-intolerant patients with KCN who underwent excimer laser PTK for
subepithelial nodules were identified using a computer database and were
retrospectively reviewed. Preoperative and postoperative visual acuity and
method of correction, surgical treatment, epithelial healing, complications, and
KCN nodule recurrence were all analyzed. RESULTS: Fifteen eyes of 15 patients
with a minimum follow-up of 3 months were reviewed. Mean follow-up time was 23.1
months (SD +/- 42.5 months, range 3-143 months). In 9 eyes, the epithelial
defect healed by postoperative day 3 and all eyes healed by postoperative day 6.
There was no infection or corneal melting in any of the eyes. After PTK, 11
patients were refit successfully with rigid gas-permeable contact lenses and 4
wore glasses. Three patients had a recurrence of the KCN nodule at 3, 8, and 23
months postoperatively. One of them had a repeat PTK 23 months after the initial
surgery, improving to 20/40 with contact lenses at 55 months postoperatively.
Another patient decided to have a penetrating keratoplasty, and the third
patient is considering repeat PTK or penetrating keratoplasty. CONCLUSION: PTK
effectively removed KCN nodules without recurrences in most patients and can be
a successful modality to improve contact lens tolerance and delay or avoid more
invasive surgery.

PMID: 19158554 [PubMed - in process]

27: Cornea. 2009 Feb;28(2):140-3. 

Deep anterior lamellar keratoplasty with melles technique for granular corneal
dystrophy.

Salouti R, Hosseini H, Eghtedari M, Khalili MR.

Department of Ophthalmology, Poostchi Ophthalmic Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran.

PURPOSE: The purpose of this study was to evaluate the clinical results of deep
anterior lamellar keratoplasty (DALK) using the Melles technique in granular
corneal dystrophy. METHODS: Seven eyes from 5 patients who underwent DALK using
Melles technique for granular corneal dystrophy were included in this study. The
parameters evaluated included patients\' demographics, preoperative and
postoperative best spectacle-corrected visual acuities (BSCVAs), and timing and
pattern of recurrence. RESULTS: The mean age of the patients was 37 +/- 9.4
years (range 29-46 years) at the time of surgery. The mean length of follow-up
(DALK to last visit) was 38.4 +/- 18.6 months (range 10-63 months). The
procedure was performed without any major complication in all eyes. Mean
preoperative BSCVA was 20/220 (range 20/400 to 20/100), which improved to 20/27
(range 20/30 to 20/25) at 6 months after DALK. Mean BSCVA was 20/50 (range
20/400-20/20) at last follow-up. Simple recurrence occurred in 5 (71%) of 7
eyes. The mean time from surgery to recurrence was 15.6 +/- 1.8 months (range
13-16 months). Clinically significant recurrences occurred 34 +/- 2 months after
the procedures in 3 (43%) of 7 eyes. Two (30%) of 7 eyes had no recurrence at
all. CONCLUSIONS: Although granular corneal dystrophy is likely to recur after
DALK, this technique can restore and preserve useful visual function for a
significant period in these patients.

PMID: 19158553 [PubMed - in process]

28: Cornea. 2009 Feb;28(2):136-9. 

Age-related differences in central corneal thickness alterations caused by
short-term hypobaric hypoxia.

Karadag R, Sen A, Golemez H, Basmak H, Yildirim N, Akin A.

Department of Ophthalmology, Eskisehir Military Hospital, Eskisehir, Turkey.
drrkaradag@yahoo.com

PURPOSE: To assess the effect of short-term hypobaric hypoxic exposure on
central corneal thickness (CCT) in healthy participants in 2 different age
groups. METHODS: Seventy eyes in 35 healthy men were investigated. Twenty
participants (mean age 22.8 +/- 0.6 years) comprised 1 group, and 15 (mean age
32.1 +/- 2.8 years) comprised another group. CCT was measured via ultrasound
pachymetry initially at local ground level (792 m above sea level), then during
short-term hypobaric hypoxic exposure (equivalent to 9144 m altitude), and then
again under ground level conditions. The mean of 10 consecutive CCT measurements
in each eye under each set of conditions was used in statistical analysis.
RESULTS: In the younger group, initial CCT was 561.5 +/- 36.1 microm. This
increased to 562.3 +/- 36.7 microm under hypobaric hypoxic conditions, and after
the return to local ground level conditions, CCT decreased to 560.1 +/- 34.5
microm. CCT values under hypobaric hypoxic conditions were not significantly
different from those measured before or afterward (P > 0.05). In the older
group, initial CCT was 566.0 +/- 33.7 microm. This increased to 576.9 +/- 28.5
microm under hypobaric hypoxic conditions, and after the return to local ground
level conditions, CCT decreased to 567.9 +/- 33.3 microm. In the older group,
CCT values under hypobaric hypoxic conditions were significantly greater than
those measured initially (P < 0.001) or afterward (P < 0.01). In both age
groups, initial CCT did not differ significantly from final CCT (P > 0.05).
CONCLUSION: Short-term hypobaric hypoxic exposure increased CCT significantly in
the older age group, whereas it yielded a nonsignificant minor increase in the
younger age group.

PMID: 19158552 [PubMed - in process]

29: Cornea. 2009 Feb;28(2):127-35. 

Keratoconus associated with other corneal dystrophies.

Cremona FA, Ghosheh FR, Rapuano CJ, Eagle RC Jr, Hammersmith KM, Laibson PR,
Ayres BD, Cohen EJ.

Cornea Service, Wills Eye Institute, Philadelphia, PA 19107, USA.

OBJECTIVE: To report the concomitant presentation of keratoconus and corneal
dystrophies at Wills Eye Hospital for the 10-year period from January 1, 1997,
to December 31, 2006. METHODS: Patients with concomitant keratoconus and corneal
dystrophies were identified using a computer database. Complete ophthalmologic
examination, keratometry, pachymetry, and computerized videokeratography were
performed in all patients. When present, cornea guttata were confirmed by
clinical examination and specular microscopy. Histopathologic examination with
special stains of excised corneal buttons was performed. RESULTS: Fifty-one
patients manifested typical signs and topographic evidence of keratoconus
associated with another corneal dystrophy. Fuchs dystrophy was the most common
association accounting for 27 cases (52.9%), followed by anterior basement
membrane dystrophy with 13 cases (25.5%) and posterior polymorphous dystrophy
with 7 cases (13.8%). A bilateral combination of Fuchs dystrophy and anterior
basement membrane dystrophy with keratoconus was seen in 3 cases (5.8%).
Finally, there was 1 bilateral case (2%) of granular dystrophy. Histopathologic
studies in cases that underwent penetrating keratoplasty confirmed the clinical
diagnoses. CONCLUSION: To our knowledge, this is the largest report of such a
concurrence in the English literature and could lead to further studies on the
possible pathophysiologic or genetic links between these entities, although a
chance association cannot be excluded.

PMID: 19158551 [PubMed - in process]