RESUMEN
PURPOSE: To evaluate agreement between eye banks (EBs) and a reading center on endothelial cell density (ECD) determinations in the Cornea Preservation Time Study. METHODS: The Cornea Image Analysis Reading Center (CIARC) performed variable frame image analysis on EB-obtained-preoperative central endothelial images (after lamellar dissection for Descemet stripping automated endothelial keratoplasty by the EBs or before shipping, if surgeon prepared) to determine ECD. The EBs performed their usual method of ECD determination. The CIARC and EBs also provided ECD determinations from screening central endothelial images taken by the EBs during donor evaluation. Two independent masked CIARC readers determined ECD with measurements averaged. RESULTS: The mean preoperative ECD was 15 cells/mm greater by the EBs than by CIARC (N = 1286, P < 0.001) with 95% limits of agreement of (-644, 675 cells/mm). The limits of agreement in preoperative ECD were wider in the After-Lamellar-Dissection Group (-687, 683 cells/mm) than in the Before Shipping Group [(-505, 633 cells/mm); P = 0.03]. The EBs-determined preoperative ECD was within 10% of the CIARC-determined ECD for 886 (69%) image sets, with 236 (18%) higher by >10% and 164 (13%) lower by >10%. Excellent agreement appeared between the EBs and CIARC when 100-300 cells could be analyzed in contrast to <100 cells (SD = 308 cells/mm vs. SD = 603 cells/mm; P < 0.001). CONCLUSIONS: The mean ECD by the EBs and CIARC were similar, but there was considerable variability between determinations for individual corneas. Agreement improved between the 2 measurements when more than 100 cells were able to be analyzed.
Asunto(s)
Recuento de Células/métodos , Pérdida de Celulas Endoteliales de la Córnea/diagnóstico por imagen , Endotelio Corneal/citología , Bancos de Ojos/estadística & datos numéricos , Procesamiento de Imagen Asistido por Computador , Adolescente , Adulto , Anciano , Niño , Queratoplastia Endotelial de la Lámina Limitante Posterior , Endotelio Corneal/diagnóstico por imagen , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
PURPOSE: To identify factors related to graft rejection following Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS). DESIGN: Cohort study within a multicenter randomized clinical trial. METHODS: A total of 1330 eyes of 1090 subjects undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0-7 days (n = 675) or 8-14 days (n = 655) and followed for 3 years. Central endothelial cell density (ECD) was determined by a central image analysis reading center. Multivariable Cox models adjusted for PT, recipient diagnosis, and surgeon effect were used to identify factors associated with rejection. RESULTS: Cumulative probability of definite graft rejection was 3.6% (99% confidence interval 2.5%-5.3%). Younger recipient age was associated with graft rejection (P < .001; hazard ratio: 0.53 [0.33, 0.83] per decade). PT, donor-recipient sex mismatch, recipient diagnosis, recipient race, graft size, discontinuation of topical corticosteroids and immune-modulators, prior immunizations within 3 months, and prior glaucoma surgery were not associated with rejection (P > .01). Among clear grafts with an ECD measurement at baseline and 3 years (n = 913), endothelial cell loss (ECL) was greater in eyes that experienced a rejection episode (n = 27) than in those that did not (n = 886) (48% vs 38%, P = .03). Twelve of 44 eyes (27%) with definite graft rejection subsequently failed, comprising 15% of the 79 failures in the CPTS. CONCLUSIONS: Graft rejection is uncommon after DSAEK and more likely with younger age, in a study cohort mostly > 50 years old. Rejection increases ECL, but it is not a leading cause of DSAEK failure.
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Enfermedades de la Córnea/cirugía , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Rechazo de Injerto , Preservación de Órganos/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de TiempoRESUMEN
PURPOSE OF REVIEW: To evaluate and summarize literature from the past 18 months reporting advancements and issues in astigmatism assessment prior to cataract surgery. RECENT FINDINGS: New and updated toric calculators and regression formulas offer the opportunity for more accurate lens selection for our patients. Concurrently, improvements in topographic evaluation of corneal keratometry have allowed for a decrease in unplanned residual corneal astigmatism. Measuring posterior corneal astigmatism is especially valuable in eyes with keratoconus when planning to implant toric intraocular lens (IOL) and now allows access to this patient population. SUMMARY: Improved accuracy of astigmatism evaluation now occurs with point reflections on the corneal surface along with the latest generation toric lens formulas which integrated posterior corneal astigmatism, predicted lens position, and intended spherical power of the IOL. These improvements can allow for incorporation of toric lenses in keratoconus patients.
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Astigmatismo/diagnóstico , Extracción de Catarata , Catarata/complicaciones , Córnea/diagnóstico por imagen , Agudeza Visual , Astigmatismo/complicaciones , Astigmatismo/fisiopatología , Humanos , Periodo PreoperatorioAsunto(s)
Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Refractivos , Enfermedades de la Retina/etiología , Manejo de la Enfermedad , Humanos , Complicaciones Posoperatorias/fisiopatología , Enfermedades de la Retina/fisiopatología , Enfermedades de la Retina/terapia , Factores de Riesgo , Estrés Fisiológico/fisiologíaAsunto(s)
Infecciones Virales del Ojo , Herpes Simple , Complicaciones Infecciosas del Embarazo , Antivirales/uso terapéutico , Preescolar , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/transmisión , Femenino , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Herpes Simple/transmisión , Humanos , Lactante , Recién Nacido , Embarazo , RecurrenciaRESUMEN
PURPOSE: Persistent hyperplastic primary vitreous (PHPV) is a developmental ocular malformation often associated with additional ocular abnormalities. This study involved a novel mouse model of PHPV, generated by a null mutation of the Ski proto-oncogene, that displays other anterior segment and retinal malformations often found in human cases of PHPV. METHODS: Morphologic and histologic analyses of Ski-/- mice were used to document ocular abnormalities in comparison to those of normal littermates. Immunohistochemical studies were used to examine the expression of relevant markers of ocular and vascular development including Pax6, beta-III tubulin, and Flk1. RESULTS: PHPV and microphthalmia were found in 100% of Ski-/- fetuses. Other abnormalities included anterior segment and lens dysgenesis, retinal folds, chorioretinal coloboma, and Peters anomaly. The severity was variable, even in a highly homogeneous genetic background. PHPV was characterized by the presence of retrolental fibrous and vascular tissue that did not express the neuronal marker beta-III tubulin, but was positive for Flk1 expression and contained no obviously pigmented cells. CONCLUSIONS: The results show that normal ocular development requires the function of the Ski proto-oncogene, and mice lacking Ski have many features associated with PHPV, and some similarities with Peters anomaly in humans. Defects in Ski-/- mice closely resemble those described in animals lacking several of the retinoic acid receptor genes, or in animals exposed to excess retinoic acid during gestation. Ski has been shown to repress transcription induced by retinoic acid signaling, and may thus affect ocular development by regulating RA signaling.
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Anomalías Múltiples/genética , Proteínas de Unión al ADN/fisiología , Anomalías del Ojo/genética , Regulación del Desarrollo de la Expresión Génica/fisiología , Proteínas Proto-Oncogénicas/fisiología , Cuerpo Vítreo/anomalías , Anomalías Múltiples/metabolismo , Anomalías Múltiples/patología , Animales , Modelos Animales de Enfermedad , Anomalías del Ojo/metabolismo , Anomalías del Ojo/patología , Proteínas del Ojo/metabolismo , Femenino , Genotipo , Proteínas de Homeodominio/metabolismo , Hiperplasia , Inmunohistoquímica , Hibridación in Situ , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Microftalmía/genética , Microftalmía/metabolismo , Microftalmía/patología , Factor de Transcripción PAX6 , Factores de Transcripción Paired Box/metabolismo , Proto-Oncogenes Mas , Proteínas Represoras/metabolismo , Tubulina (Proteína)/metabolismo , Receptor 2 de Factores de Crecimiento Endotelial Vascular/metabolismo , Cuerpo Vítreo/metabolismo , Cuerpo Vítreo/patologíaRESUMEN
PURPOSE: To determine the mechanism through which topical mitomycin C prevents and treats corneal haze after photorefractive keratectomy (PRK) and to examine the effects of dosage and duration of exposure. METHODS: In 224 New Zealand rabbits, -9.0 diopter PRK with mitomycin C or balanced salt solution was performed. Haze level was graded at the slit-lamp. Rabbits were sacrificed at 4 hours, 24 hours, 4 weeks, or 6 months after surgery and immunohistochemistry was performed with TUNEL assay, Ki67, and alpha-SMA. RESULTS: TUNEL-positive apoptotic cells marginally increased in all mitomycin C groups whereas Ki67-positive mitotic cells decreased significantly following mitomycin C application. A greater decrease in myofibroblasts was noted with prophylactic mitomycin C treatment than therapeutic mitomycin C treatment. There was, however, an anterior stromal acellular zone (approximately 20% of the total stroma) in eyes treated with mitomycin C, which persisted to the maximum follow-up of 6 months. CONCLUSIONS: Mitomycin C treatment induces apoptosis of keratocytes and myofibroblasts, but the predominate effect in inhibiting or treating haze appears to be at the level of blocked replication of keratocytes or other progenitor cells of myofibroblasts. Treatment with 0.002% mitomycin C for 12 seconds to 1 minute appears to be just as effective as higher concentrations for longer duration in the rabbit model. However, a persistent decrease in keratocyte density in the anterior stroma could be a warning sign for future complications and treatment should be reserved for patients with significant risk of developing haze after PRK.
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Apoptosis/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Córnea/patología , Opacidad de la Córnea/prevención & control , Mitomicina/administración & dosificación , Inhibidores de la Síntesis del Ácido Nucleico/administración & dosificación , Animales , Recuento de Células , Córnea/efectos de los fármacos , Opacidad de la Córnea/etiología , Opacidad de la Córnea/patología , Modelos Animales de Enfermedad , Femenino , Estudios de Seguimiento , Técnicas In Vitro , Láseres de Excímeros , Miopía/cirugía , Queratectomía Fotorrefractiva , Complicaciones Posoperatorias , Conejos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose of this article was to study the prevalence of strabismus and astigmatism in children with nonsyndromic plagiocephaly. Children with deformational plagiocephaly do not have an increased prevalence of strabismus compared with the general population but do have an increased prevalence of astigmatism, whereas children with nonsyndromic craniosynostotic plagiocephaly have an increased prevalence of strabismus and astigmatism. This observational cohort study retrospectively reviewed patients in a multidisciplinary craniofacial clinic between 1993 and 2001. Patients were referred for evaluation and management of plagiocephaly or craniosynostosis. One hundred eleven patients had deformational plagiocephaly, and 45 had synostotic plagiocephaly. Patients with lambdoid craniosynostosis, hemifacial microsomia, any syndromic form of craniosynostosis, or without a formal diagnosis were excluded. All patients underwent detailed ophthalmologic, ocular motility, and craniofacial examinations. Diagnosis was based on clinical and radiographic findings. Patients were evaluated between birth and age 14 years (mean = 13 months; SD = 22 months). Only 1 of 111 (<1%) patients with deformational plagiocephaly had an esodeviation, and none had an exodeviation. Three of 45 patients (7%) with synostotic plagiocephaly had an exodeviation, and none had an esodeviation. Eight of 93 patients (9%) with deformational plagiocephaly had unilateral astigmatism, and 14 (15%) had bilateral astigmatism (mean = 1.82 diopters). Three of 43 patients (7%) with synostotic plagiocephaly had unilateral astigmatism, and 9 (21%) had bilateral astigmatism (mean = 1.83 diopters). Patients with deformational plagiocephaly do not appear to have a higher prevalence of horizontal strabismus than the normal population. Exotropia is more common in patients with nonsyndromic craniosynostotic plagiocephaly than in the general population. The prevalence of astigmatism in patients with nonsyndromic craniosynostotic plagiocephaly appears to be greater than in the general population, but this higher prevalence requires further study.