RESUMEN
A cellular dermal graft (ADG) functions as a scaffold to harness nature's regenerative healing process. Frequently used in eyelid and orbital surgery, application of ADG to the globe has not been reported, to our knowledge. In a patient with a complicated ocular history, wound dehiscence with Ahmed valve extrusion developed. Several attempts to repair the extrusion were made with commonly used biomaterials, resulting in recurrent wound dehiscence. An ADG was placed with glue and then sutured to the edge of the dehiscence. The conjunctiva grew over the graft, allowing the wound to close. The wound site has been intact for more than 3 years. We report the first successful use to date of ADG on the globe. In difficult cases of wound repair on the globe, ADG may be an alternative to conventional graft materials.
Asunto(s)
Enfermedades de la Conjuntiva/cirugía , Trasplante de Piel , Dehiscencia de la Herida Operatoria/cirugía , Remoción de Dispositivos , Adhesivo de Tejido de Fibrina/uso terapéutico , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Implantes de Drenaje de Glaucoma/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Dehiscencia de la Herida Operatoria/etiología , Adhesivos Tisulares/uso terapéutico , Cicatrización de HeridasRESUMEN
PURPOSE: To determine whether use of Corneal Refractive Therapy (CRT, Paragon Vision Sciences) lenses have an adverse effect on the health of corneal epithelium by monitoring epithelial permeability by fluorophotometry. METHODS: Eight patients with healthy eyes and whose refractive error was between -0.50 and -4.00 diopters (D) sphere and up to -1.75 D of astigmatism were enrolled. On the day of the fitting, two baseline fluorometric scans of the right eye were taken using the Ocumetrics Fluorotron Master. After 15 minutes, another two scans were taken of the right eye. The same fluorophotometry technique was repeated on day 1, 1 week, 1 month, and 3 months after the patient began overnight wear of the lenses. Patients' baseline corneal fluorescein levels and peak corneal fluorescence values after rinsing were compared to initial pre-fitting values to determine changes in corneal epithelial permeability. RESULTS: After patients used orthokeratology, uncorrected visual acuity was 20/20 or better in 9/16 eyes and 100% had achieved 20/40 or better by day 7. No adverse events were seen in patients utilizing orthokeratology, and eye examinations for these patients continued to be within normal limits. After nightly use of orthokeratology for 1 month, baseline fluorescence of the cornea (15.64 +/- 2.29 ng/mL vs 17.31 +/-5.43 ng/mL, P = .80) remained stable, and the post-15 minute scan peak corneal fluorescence values did not show significant changes from the pre-fitting (51.46 +/- 17.28 ng/mL) after use of orthokeratology (63.80 +/- 41.25 ng/mL) (P = .78). CONCLUSIONS: Reshaping of the cornea through the use of orthokeratology does not have adverse effects on corneal epithelium as evaluated by changes in corneal epithelial permeability.
Asunto(s)
Lentes de Contacto , Córnea/fisiopatología , Epitelio Corneal/fisiología , Miopía/terapia , Procedimientos de Ortoqueratología , Adulto , Córnea/metabolismo , Femenino , Fluoresceína/metabolismo , Fluorofotometría/métodos , Humanos , Masculino , Miopía/metabolismo , Miopía/fisiopatología , Permeabilidad , Ajuste de Prótesis , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To report and define the clinical presentation, hygienic practices, treatment regimens, and visual sequelae of contact lens wearers infected with Fusarium keratitis in the New York City metropolitan area and to review the literature on Fusarium keratitis. METHODS: A retrospective chart review was conducted on three patients diagnosed with Fusarium keratitis by corneal fungal culture in the New York City metropolitan area from October 2005 to February 2006. None of the patients had a history of recent ocular trauma before infection. RESULTS: All three patients used disposable soft contact lenses and ReNu with MoistureLoc 1 month before infection. All patients experienced a unilateral stabbing pain of the affected eye after removal of the contact lens. Patients had corneal ulcers ranging from 1 to 5 mm in diameter and were all initially treated with topical antibiotics and steroids for a period between 7 and 52 days. Antifungal treatment was eventually prescribed to all patients, with topical natamycin 5% every hour being the most common. One patient required corneal transplantation, and the other two patients recovered visual acuity comparable to their baseline acuity. CONCLUSIONS: A delay in diagnosis and prolonged treatment delay of Fusarium keratitis is associated with significant comorbidity. Physicians must have a higher index of suspicion for fungal keratitis in contact lens wearers to facilitate in early diagnosis and treatment.
Asunto(s)
Lentes de Contacto Hidrofílicos/efectos adversos , Infecciones Fúngicas del Ojo/etiología , Fusarium , Queratitis/microbiología , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Soluciones para Lentes de Contacto/efectos adversos , Trasplante de Córnea , Úlcera de la Córnea/microbiología , Úlcera de la Córnea/patología , Equipos Desechables , Esquema de Medicación , Infecciones Fúngicas del Ojo/complicaciones , Infecciones Fúngicas del Ojo/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Natamicina/administración & dosificación , Natamicina/uso terapéutico , Soluciones Oftálmicas , Retratamiento , Estudios Retrospectivos , Esteroides/administración & dosificación , Esteroides/uso terapéuticoRESUMEN
PURPOSE OF REVIEW: Conductive keratoplasty is a noninvasive, in-office procedure for the correction of hyperopia, hyperopic astigmatism, and management of presbyopia. It serves as an alternative to laser-based refractive surgery with essentially no intraoperative or postoperative complications. RECENT FINDINGS: In the past decade, photorefractive keratectomy and laser in-situ keratomileusis have been the most popular refractive surgical procedures to correct myopia, hyperopia and astigmatism. Although relatively safe, flap-related complications often result in undesirable visual acuity. Since US Food and Drugs Administration approval in 2002, conductive keratoplasty has become a promising technique to correct low to moderate hyperopia and astigmatism. The procedure was first used by Mendez and colleagues in 1993. It is a nonlaser, no cutting procedure that delivers radio-frequency energy to corneal stroma in a circular fashion to steepen the cornea. Multiple studies have shown that conductive keratoplasty offers equal or superior efficacy, predictability, stability and safety than currently used refractive procedures to correct hyperopia or hyperopic astigmatism. In addition, monovision conductive keratoplasty has been shown to be successful for the management of presbyopia. SUMMARY: Conductive keratoplasty, an alternative to the laser-based procedure, is effective, predictable, and safe to correct low to moderate hyperopia, astigmatism, and manage presbyopia.
Asunto(s)
Astigmatismo/cirugía , Sustancia Propia/cirugía , Hiperopía/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Presbiopía/cirugía , Terapia por Radiofrecuencia , Humanos , Agudeza VisualRESUMEN
PURPOSE: To measure the largest diameter of the anterior chamber (AC) and posterior chamber (PC) dimension and its orientation and determine the relationship with the principal keratometric meridians. METHODS: Twenty-eight eyes of 14 subjects were scanned with high frequency (50 MHz) ultrasound in sequential meridional scan planes at 30 degrees increments. Observer identified angle and ciliary sulcus recess boundaries in each patient scan set were fit with an elliptical model to obtain the ellipse semi-major axis corresponding to the largest diameter and its meridional orientation. Anterior and posterior chamber diameters from raw data and model fit were compared using linear statistics. Circular statistics were used to compare the orientation of the largest diameter for raw ultrasound measurements, model estimations of largest diameter, and autorefractor determined keratometric axes. RESULTS: The mean model diameters were anterior chamber OD 12.07 mm (0.32 SD); anterior chamber OS 12.06 mm (0.36 SD); posterior chamber OD 12.35 mm (0.42 SD); posterior chamber OS 12.33 mm (0.43 SD). The general trend for orientation of the meridian of largest diameter was in the horizontal meridian. In over 35% of eyes the difference between AC or PC meridian and the flat keratometric axis was greater than 20 degrees. CONCLUSIONS: Accurate and reproducible anterior segment biometry depends on visualization of structures and minimization of eye and head movement error. The range and standard deviation of the diameter and orientation measures suggests anatomic variation is sufficient to require biometry for proper sizing and placement of intraocular devices that use angle or sulcus fixation.
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Cámara Anterior/diagnóstico por imagen , Biometría/métodos , Adulto , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Valores de Referencia , Refracción Ocular , Reproducibilidad de los Resultados , UltrasonografíaRESUMEN
OBJECTIVES: To identify patients with retinoblastoma whose conditions were diagnosed at the age of 1 month or younger and to describe their clinical features (including ocular and patient survival) and the development of second nonocular tumors. MATERIALS AND METHODS: A retrospective study of 1831 patients. The cumulative incidence of second cancer development was analyzed using the Kaplan-Meier method. RESULTS: Forty-six patients were identified as having a diagnosis of retinoblastoma at the age of 1 month or younger (mean age, 18.5 days). Family history (31 patients [67%]) exceeded leukocoria (6 patients [13%]) as the most common reason for detection. Twenty-six (56%) of the 46 patients were seen with unilateral retinoblastoma, with 22 ultimately developing cancer in the fellow eye. At the initial diagnosis, 81 (85%) of the 95 tumors were detected in zones 1 and 2. Eighty-two (93%) of the 88 subsequent tumors were located in zones 2 and 3. In the 26 patients who had unilateral retinoblastoma, 16 of the initially affected eyes and 21 of the fellow eyes were salvaged. In the 19 (44%) of 20 patients who were seen initially with bilateral retinoblastomas, 31 (82%) of the 38 eyes were salvaged. The mean follow-up was 10.9 years. The incidence of second nonocular cancers reached 54% by 23.7 years for the patients who received radiation therapy, while the incidence was 0% for the patients who did not. Four (8.7%) of the 46 patients developed metastatic disease and died; 3 of these patients had documented metastases in the first month of life (one at birth). CONCLUSIONS: The most common manifesting sign of children diagnosed as having retinoblastoma in the first month of life is family history. Eyes with Reese-Ellsworth group I retinoblastomas were the most common. In patients with bilateral and unilateral retinoblastoma, new (subsequent) ocular tumors developed in a centrifugal pattern. Despite an early diagnosis, patients' eyes came to enucleation, and metastatic disease and death occurred from ocular metastases. In patients who received radiation therapy, the probability of developing second nonocular cancer is 54% by 23.7 years; no second cancers developed in patients who did not receive radiation therapy.
Asunto(s)
Neoplasias de la Retina/patología , Retinoblastoma/patología , Estudios de Cohortes , Supervivencia sin Enfermedad , Salud de la Familia , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Recién Nacido , Masculino , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/mortalidad , Neoplasias de la Retina/mortalidad , Neoplasias de la Retina/radioterapia , Retinoblastoma/mortalidad , Retinoblastoma/radioterapia , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The present study examined the ability of LY235959, a competitive N-methyl-D-aspartate (NMDA) receptor antagonist, to attenuate behaviors and c-fos mRNA expression associated with acute morphine withdrawal in the infant rat. Rat pups were given a single dose of morphine (10.0 mg/kg, s.c.) or saline. Two hours later, pups were removed from the dam and injected with either LY235959 (10.0 mg/kg, s.c.) or saline. Fifteen minutes later acute morphine withdrawal was precipitated with naltrexone (10.0 mg/kg, s.c.) and behaviors were recorded every 15 s for the next 60 min. Immediately after behavioral testing, brain and spinal cord were assayed for c-fos mRNA analysis by solution hybridization. The intensity of the morphine withdrawal syndrome was reduced in pups pre-treated with LY235959. Withdrawal behaviors such as head moves, moving paws, rolling, and walking were decreased, and vocalizations were completely eliminated in pups pre-treated with LY2359559. Acute morphine withdrawal increased c-fos mRNA expression in the brain and the spinal cord, which was attenuated by pre-treatment of LY235959. Thus, in the 7-day-old rat, as in the adult, NMDA receptors play a role in the behavioral and molecular manifestations of acute morphine withdrawal.