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Sample records for bullous keratopathy corneas

  1. Extracellular matrix alterations in human corneas with bullous keratopathy.

    Science.gov (United States)

    Ljubimov, A V; Burgeson, R E; Butkowski, R J; Couchman, J R; Wu, R R; Ninomiya, Y; Sado, Y; Maguen, E; Nesburn, A B; Kenney, M C

    1996-05-01

    To uncover abnormalities of extracellular matrix (ECM) distribution in human corneas with pseudophakic and aphakic bullous keratopathy (PBK/ABK). Indirect immunofluorescence with antibodies to 27 ECM components was used on frozen sections of 14 normal and 20 PBK/ABK corneas. Fibrillar deposits of an antiadhesive glycoprotein tenascin in the anterior and posterior stroma, epithelial basement membrane (BM), bullae and subepithelial fibrosis (SEF) areas, and posterior collagenous layer (PCL) were revealed in disease corneas. Tenascin in midstroma, which was observed in some cases, correlated with decreased visual acuity. In normal central corneas, tenascin was never found. Other major ECM abnormalities in PBK/ABK corneas compared to normals included: discontinuous epithelial BM straining for laminin-1 (alpha 1 beta 1 gamma 1), entactin/nidogen and fibronectin; accumulation of fibronectin and alpha 1-alpha 2 type IV collagen on the endothelial face of the Descemet's membrane; and abnormal deposition of stromal ECM (tenascin, fibronectin, decorin, types I, III, V, VI, VIII, XII, XIV collagen) and BM components (type IV, collagen, perlecan, bamacan, laminin-1, entactin-nidogen, fibronectin) in SEF areas and in PCL. The study provides a molecular description of an ongoing fibrosis on the epithelial, stomal, and endothelial levels in PBK/ABK corneas. These fibrotic changes may follow initial endothelial damage after cataract surgery, may be caused by the upregulation of fibrogenic cytokines, and may play a significant role in the progression of bullous keratopathy.

  2. Extracellular matrix alterations in human corneas with bullous keratopathy

    DEFF Research Database (Denmark)

    Ljubimov, A V; Burgeson, R E; Butkowski, R J

    1996-01-01

    PURPOSE. To uncover abnormalities of extracellular matrix (ECM) distribution in human corneas with pseudophakic and aphakic bullous keratopathy (PBK/ABK). METHODS. Indirect immunofluorescence with antibodies to 27 ECM components was used on frozen sections of 14 normal and 20 PBK/ABK corneas....... RESULTS. Fibrillar deposits of an antiadhesive glycoprotein tenascin in the anterior and posterior stroma, epithelial basement membrane (BM), bullae and subepithelial fibrosis (SEF) areas, and posterior collagenous layer (PCL) were revealed in disease corneas. Tenascin in midstroma, which was observed...... in some cases, correlated with decreased visual acuity. In normal central corneas, tenascin was never found. Other major ECM abnormalities in PBK/ABK corneas compared to normals included: discontinuous epithelial BM straining for laminin-1 (alpha 1 beta 1 gamma 1), entactin/nidogen and fibronectin...

  3. Bullous Keratopathy

    Science.gov (United States)

    ... cloudy cornea with blisters on the surface. Treatment Salty eye drops Drugs to lower pressure in the ... and treatment—surgical and nonsurgical—of eye disorders). Salty eye drops (hypertonic saline) and salty ointments are ...

  4. Abnormalities of stromal structure in the bullous keratopathy cornea identified by second harmonic generation imaging microscopy.

    Science.gov (United States)

    Morishige, Naoyuki; Yamada, Norihiro; Zhang, Xu; Morita, Yukiko; Yamada, Naoyuki; Kimura, Kazuhiro; Takahara, Atsushi; Sonoda, Koh-Hei

    2012-07-27

    To identify structural alterations in collagen lamellae and the transdifferentiation of keratocytes into myofibroblasts in the corneal stroma of bullous keratopathy (BK) patients and to examine the relation of such changes to the duration of stromal edema or the underlying cause of BK. Six normal human corneas and 16 BK corneas were subjected to second harmonic generation (SHG) imaging microscopy to allow three-dimensional (3-D) reconstruction of collagen lamellae. Expression of α-smooth muscle actin (αSMA) was examined by immunofluorescence analysis and conventional laser confocal microscopy. Collagen lamellae were interwoven at the anterior stroma and uniformly aligned at the posterior stroma, whereas αSMA was not detected throughout the entire stroma of the normal cornea. Nine (56%) and 7 (44%) of the 16 BK corneas showed abnormal collagen structure at the anterior and posterior stroma, respectively. Expression of αSMA was detected in the anterior or posterior stroma of 7 (44%) and 6 (38%) of the 16 BK corneas, respectively. Disorganization of collagen lamellae and myofibroblastic transdifferentiation were detected only in corneas with a duration of stromal edema of at least 12 months. Corneas with BK as a result of birth injury showed abnormal collagen structure at the posterior stroma, whereas those with BK resulting from laser iridotomy did not. Changes in the structure of the entire stroma were detected in BK corneas with a duration of stromal edema of at least 12 months, suggesting that such changes may be progressive. In addition, the underlying cause of BK may influence structural changes at the posterior stroma.

  5. Pseudophakic bullous keratopathy.

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    Taylor, D M; Atlas, B F; Romanchuk, K G; Stern, A L

    1983-01-01

    Pseudophakic bullous keratopathy (PBK) is a relatively new disease that is rapidly becoming the prime indication for penetrating keratoplasty. From 1977 thru 1981 we performed 81 corneal transplants on 66 eyes for this condition. In our experience, the incidence of PBK, with iris-supported lenses, is five times greater than aphakic bullous keratopathy (ABK). A series of 800 intracapsular cataract extractions (ICCE) with implantation of iris-supported lenses (1975-1979) were reviewed. Thirty-four patients (4.3%) developed PBK (average two years after surgery). In a series of 3,000 simple ICCEs (1955-1980), 24 patients (0.8%) developed ABK. Etiologic factors, methods of prevention, and the results of penetrating keratoplasty are considered. PBK following ICCE is a serious disease entity, usually of multifactorial origin. Though 88% of the patients have clear grafts, a high incidence of associated posterior segment disease tends to nullify the visual result. Planned extracapsular cataract extraction and posterior chamber lens insertion (1979-1982) has reduced our incidence of PBK to 0.3% (1/300). These results are promising but premature.

  6. A COMPREHENSIVE STUDY OF BULLOUS KERATOPATHY

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    Pramila Balasubramaniam

    2016-10-01

    extracapsular extraction with PCIOL implantation. The bullae were mostly found in centre and superior part of cornea corresponding well with surgical endothelial damage. Bullous Keratopathy associated with raised IOP was seen in 18 out of 98 cases. In these, 15 cases were found to be following ocular surgeries while only 3 cases were due to primary glaucoma. 80 cases were treated with hyperosmotic agents. 24 patients out of 98 cases of Bullous Keratopathy had undergone penetrating keratoplasty. In 19 patients of painful Bullous Keratopathy, anterior stromal puncture was tried. The procedure was repeated in 5 patients. Of the 19 patients, 7 showed the symptomatic relief while 7 patients who had worsening of pain and other symptoms underwent PKP subsequently. CONCLUSION Bullous Keratopathy occurs more commonly in sixth decade followed by fifth decade in this study correlates well with the incidences of senile cataract. Pachymetry was the most useful indicator of endothelial decompensation in this study. Patient who underwent extracapsular extraction with posterior chamber IOL implantation were found to be most susceptible for development of Bullous Keratopathy.

  7. Half-top-hat keratoplasty is effective method for bullous keratopathy treatment

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    S. V. Trufanov

    2012-01-01

    Full Text Available Purpose: to evaluate outcomes of the half-top-hat keratoplasty.Methods: the study included 58 eyes that had bullous keratopathy and underwent half-top-hat keratoplasty.Results: 40 (69% patients had clear corneas whole period of observation. Graft rejection occurred in 1 eye. Mean BSCVA was0.47±0.21. Average astigmatism was 5.0±2.1 D. Mean cell endothelial count in 2 years was 2189±399 cell/mm2.Conclusion: Half-top-hat keratoplasty is effective method for bullous keratopathy surgical treatment. the operation is equal pen- etration keratoplasty in refractive results and operation time. But time of rehabilitation is shorter, sealing is better, cell endothelialcount is greater.

  8. Half-top-hat keratoplasty is effective method for bullous keratopathy treatment

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    S. V. Trufanov

    2014-07-01

    Full Text Available Purpose: to evaluate outcomes of the half-top-hat keratoplasty.Methods: the study included 58 eyes that had bullous keratopathy and underwent half-top-hat keratoplasty.Results: 40 (69% patients had clear corneas whole period of observation. Graft rejection occurred in 1 eye. Mean BSCVA was0.47±0.21. Average astigmatism was 5.0±2.1 D. Mean cell endothelial count in 2 years was 2189±399 cell/mm2.Conclusion: Half-top-hat keratoplasty is effective method for bullous keratopathy surgical treatment. the operation is equal pen- etration keratoplasty in refractive results and operation time. But time of rehabilitation is shorter, sealing is better, cell endothelialcount is greater.

  9. [Evaluation of corneal biomechanics before and after up-to-date keratoplasty in patients with bullous keratopathy].

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    Trufanov, S V; Antonov, A A; Malozhen, S A; Siplivyy, V I

    2015-01-01

    Aim - to study biomechanical properties of the cornea in patients with bullous keratopathy before and after keratoplasty. Ocular response analyzer (ORA, Reichert) indices were studied in 37 patients (37 eyes) with bullous keratopathy before and after surgery - in 1, 2, and 6 months and then in 1, 2, 3, and 5 years. The following keratoplasty modifications were performed: ultrathin Descemet's stripping automated endothelial keratoplasty (UTDSAEK) - in 17 cases, microkeratome-assisted posterior keratoplasty (MAPK) - in 13 cases, half top-hat penetrating keratoplasty (HTH PK) - in 7 cases. Corneal hysteresis (CH) and corneal resistance factor (CRF) values were significantly decreased in non-operated bullous keratopathy eyes as compared to healthy ones (pkeratoplasty the difference between IOPcc and IOPg was 2.7, 4.3, and 3.6 mmHg in the MAPK, UTDSAEK, and HTH PK group, respectively; in 6 months - 2.6; 2.4 and 3.6 mmHg, respectively (pkeratoplasty, regardless of the exact modification, these parameters partially recover, but remain lower than normal for at least 5 years as it was in our study. Neither before the surgery (when the cornea is chronically swollen), nor after, does corneal thickness correlate with its biomechanical indices. Postoperative reduction in corneal rigidity in eyes with bullous keratopathy may be confusing and lead to underestimation of the true level of IOP, thus, causing delays in diagnosis of concomitant glaucoma.

  10. The results descemet-stripping automated endothelial keratoplasty at bullous keratopathy

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    S. V. Trufanov

    2012-01-01

    Full Text Available Purpose: to evaluate outcomes of the descemet-stripping automated endothelial keratoplasty using eye drops Kombinil-Duo dur- ing postoperative period.Methods: 26 patients suffered from bullous keratopathy underwent descemet-stripping automated endothelial keratoplasty using our own technique. We applied eye drops Kombinil-Duo during postoperative period.Results: 25 patients had clear corneas whole period of observation. Graft rejection occurred in 1 eye. Mean BSCVA was 0.47±0.21.Conclusion: Kombinil-Duo has been allowed to avoid infectious complication and to increase efficiency of the operative interven-tion during postoperative period.

  11. STERILE HYPOPYON IRIDOCYCLITIS DURING THE TREATMENT OF PSEUDOPHAKIC BULLOUS KERATOPATHY WITH HYDROPHYLIC BANDAGE LENS

    OpenAIRE

    Toker, Ebru; Bavbek, Tayfun; Kazokoğlu, Haluk; Yenice, Özlem

    2016-01-01

    Hydrophilic bandage lenses have proven to be a useful treatment modality in bullous keratopathy for pain relief and visual improvement. Some complications may arise after the application of bandage lenses. We present a sterile hypopyon iridocyclitis case in a pseudophakic bullous keratopathy using a bandage contact lens.Key Words: Hypopyon iridocyclitis, Bandage contact lens

  12. [Implantation of intraocular lenses. Bullous keratopathy in pseudophakos].

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    Alberth, B

    1982-09-01

    The author presents his views on the implantation of intraocular lenses, in connection with two pseudophakic bullous keratopathy cases. There is no medical indication for implantation. The question is whether the most important function of the eye, object vision, may be risked in order to avoid aniseikonia or to restore binocular vision? Knowing that vision can be restored with glasses or contact lenses, is it ethical to induce more or less severe postoperative complications by means of intraocular lenses? In view of the considerable success often achieved immediately after the operation, complications which may not arise years later should also be taken into consideration.

  13. Descemet-stripping automated endothelial keratoplasty for vitrectomized cases with traumatic aniridia and aphakic bullous keratopathy

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    Eguchi H

    2012-09-01

    Full Text Available Hiroshi Eguchi, Tatsuro Miyamoto, Fumika Hotta, Machiko Tomida, Masayuki Inoue, Yoshinori MitamuraDepartment of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, JapanAbstract: The surgical indication for Descemet-stripping automated endothelial keratoplasty (DSAEK is largely limited to phakic or pseudophakic cases of endothelial dysfunction with normal pupils, because the endothelial lenticule is generally attached to the recipient cornea by use of gas tamponade into the anterior chamber. Although it may be desirable for vitrectomized cases with aniridia and aphakic bullous keratopathy without capsule support to undergo DSAEK, one of the major problems is lenticule detachment during surgery or in the postoperative period. To perform DSAEK in such cases, special surgical techniques are needed in order to facilitate adhesion of the lenticule. Herein, we describe a suture technique for attaching the endothelial lenticule in DSAEK for aniridic and aphakic cases that have undergone vitrectomy for traumatic vitreoretinal disease.Keywords: traumatic aniridia, aphakic bullous keratopathy, Descemet-stripping automated endothelial keratoplasty, vitrectomy

  14. Corneal collagen cross-linking effects on pseudophakic bullous keratopathy

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    Mohammad Mirzaei

    2014-05-01

    Full Text Available AIM: To evaluate the efficacy of riboflavin administration and ultraviolet A(UVAcross-linking on advanced symptomatic bullous keratopathy. METHODS: Fifteen patients with symptomatic pseudophakic bullous keratopathy(PBKwere included. Slit-lamp examination, visual acuity, foreign body sensation(FBSquestionnaire, corneal clarity grading, ocular pain intensity scale and corneal thickness measures with Pentacam and ultrasound pachymetry(UP, were performed before corneal cross-linking and 1 and 6mo thereafter. After using sodium chloride solution, for one week, the central 8mm(diameterof the corneal epithelium was removed, and cross-linking, with riboflavin instillation every 3min for 30min, and UVA irradiation for 30min was performed. RESULTS: Five males and 10 females with mean age of 66±13y were included. Mean follow up time was 6.2mo. Corneal transparency in all eyes was statistically significantly better 1 month after treatment than preoperatively(PP= 0.218. Foreign body sensation subsided in 70% of patients. The average CCT decreased within 1mo after the procedure(PP=0.006. The improvement in mean CDVA from preoperatively to 1mo postoperatively was statistically significant(P=0.010. At 6mo, no significant differences were observed(P=0.130. The pain scores at 1mo were statistically significantly better than preoperatively(P=0.007. At 6mo, however the mean pain score was higher than at 1mo and not statistically significantly different from the preoperative score(P=0.070. CONCLUSION: Corneal CXL significantly improved corneal transparency, corneal thickness, and ocular pain 1 month postoperatively. However, it did not seem to have a long-lasting effect in decreasing pain and maintaining corneal transparency in patients with PBK. This procedure extends the time interval for corneal transplantation and increases visualization at DSAEK procedure.

  15. Non-Descemet’s stripping automated endothelial keratoplasty for bullous keratopathy secondary to iridoschisis

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    Minezaki T

    2013-07-01

    Full Text Available Teruumi Minezaki, Takaaki Hattori, Hayate Nakagawa, Shigeto Kumakura, Hiroshi GotoDepartment of Ophthalmology, Tokyo Medical University, Shinjukuku, Tokyo, JapanPurpose: To report a case of bullous keratopathy secondary to iridoschisis treated by non-Descemet's stripping automated endothelial keratoplasty (nDSAEK.Case report: A 79-year-old woman was referred to our hospital with loss of vision in the left eye. Slit lamp examination of her left eye showed a shallow anterior chamber with cataract and schisis in the inferior quadrant of iris stroma. Bullous keratopathy secondary to iridoschisis was diagnosed. Cataract surgery with iridectomy succeeded to deepen the anterior chamber and remove the floating iris leaf, although corneal edema remained. Four days later, nDSAEK was performed, which resolved corneal edema and restored visual acuity.Conclusion: The two-step surgery of cataract surgery plus iridectomy followed by nDSAEK may be an effective strategy for treating bullous keratopathy secondary to iridoschisis.Keywords: iridoschisis, bullous keratopathy, non-Descemet's stripping automated endothelial keratoplasty

  16. Corneal stromal acupuncture combined with amniotic membrane transplantation for treating bullous keratopathy

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    Chao-Qing Wang

    2014-06-01

    Full Text Available AIM: To investigate the clinical effect for treating bullous keratopathy(BKby anterior corneal stromal acupuncture combined with amniotic membrane transplantation.METHODS: Totally 35 patients(35 eyeswith bullous keratopathy were treated by corneal stromal acupuncture combined with amniotic membrane transplantation. All patients preoperative and postoperative underwent anterior segment OCT, corneal topography, corneal sensitivity and confocal microscopy. To observe postoperative ocular symptoms in patients with BK, recurrence of bulla, changes in corneal thickness, corneal sensitivity and changes in the organizational structure of the layers of the cornea.RESULTS: Thirty-five were followed up for 6-18mo. The symptom of pain disappeared in 32 cases(91%in the first day after operation and did not recur during follow-up. The symptom of pain relieved in 3 cases(9%in the first day after operation and disappeared in 3 days. Corneal epithelium of 9 cases(26%were all healed within 1wk, 21 cases(60%were all healed within 2wk, and 5 cases(14%were all healed within 3wk. Following up for 6-18mo, there was no recurrence of symptoms or bulla. A small amount of tiny bubbles in the surrounding area appeared in 2 cases after 3 and 4wk. All patients had no neovascularization, and had smooth corneal surface. The amnions of 30 cases(86%were thinning after 2mo, partially dissolved and absorped, not seen with the naked eye after 3mo. Thirty-four cases(97%had no changes in vision, one case(3%was from the light to front of the manual. After 2mo, corneal sensation decreased in 30 cases(86%, corneal thickness increased from preoperative 788±35μm to 940±43μm. After 12mo, corneal thickness increased to 1060±27μm. Results of confocal microscopy: after 3mo, the number density of the trigeminal nerve fibers under corneal basement membrane reduced, shallow stromal cells became into fibrotic stroma, deep stroma was more loose, and cells swelled significantly. The number of

  17. Changes in Corneal Biomechanical Properties After Descemet Stripping Automated Endothelial Keratoplasty for Pseudophakic Bullous Keratopathy.

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    Faramarzi, Amir; Feizi, Sepehr; Najdi, Danial; Ghiasian, Leila; Karimian, Farid

    2016-01-01

    To compare corneal biomechanical properties and intraocular pressure (IOP) in eyes with pseudophakic bullous keratopathy (PBK) before and after Descemet stripping automated endothelial keratoplasty (DSAEK). This prospective nonrandomized intrasubject comparative study was conducted on 44 eyes of 22 patients with the diagnosis of PBK who underwent DSAEK in one eye. IOP was measured by Goldmann applanation tonometer, and central corneal thickness was measured by ultrasound pachymetry. The ocular response analyzer was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-related IOP, and cornea-compensated IOP. The same measurements were performed in the normal fellow eyes which served as controls. All measurements were performed preoperatively and 6 months postoperatively. The mean patient age was 67 ± 14 years. Mean preoperative CH and CRF values in the DSAEK group were 5.77 ± 2.94 and 6.39 ± 2.72 mm Hg, respectively, which were significantly lower than those measured in the control group (8.2 ± 2.47 and 8.43 ± 2.49 mm Hg, respectively, P = 0.001 for both comparisons). Postoperatively, CH and CRF demonstrated a significant increase (7.09 ± 3.68 mm Hg, P = 0.05 and 8.21 ± 3.84 mm Hg, P = 0.03, respectively) in operated eyes approaching the normal values measured in the control eyes. Corneal biomechanical parameters were significantly lower in PBK eyes than in the normal fellow eyes. These metrics significantly increased after DSAEK and reached values measured in the normal fellow eyes.

  18. An atypical case of herpes simplex virus endotheliitis presented as bullous keratopathy.

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    Papaioannou, Lamprini; Tsolkas, Georgios; Theodossiadis, Panagiotis; Papathanassiou, Miltiadis

    2013-12-01

    To present an atypical case of herpes simplex virus (HSV) endotheliitis. The authors report the case of a 62-year-old female patient who presented with unilateral diffuse corneal edema with Descemet's membrane folds and bullae, without keratic precipitates, iritis, significant anterior chamber reaction, or intraocular pressure (IOP) elevation. The patient had no documented positive history of ocular surgery and no abnormal findings were present in the fellow eye. Endotheliitis of viral origin was suspected and Goldmann-Witmer coefficient for HSV, cytomegalovirus, and varicela zoster virus was calculated. Goldmann-Witmer coefficient was positive for HSV. Treatment with oral valacyclovir and topical dexamethasone resulted in complete resolution of corneal edema within 1 week. HSV endotheliitis can present with bullous keratopathy as the only clinical manifestation, without typical findings such as keratic precipitates, iritis, and IOP elevation.

  19. Descemet stripping automated endothelial keratoplasty in Fuchs′ endothelial dystrophy versus pseudophakic bullous keratopathy

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    Mohammad Ali Javadi

    2016-01-01

    Full Text Available Purpose: To compare clinical and confocal scan outcomes after Descemet stripping automated endothelial keratoplasty (DSAEK performed for Fuchs′ endothelial dystrophy (FED versus pseudophakic bullous keratopathy (PBK. Methods: This retrospective comparative study included 47 consecutive eyes of 39 patients with the diagnosis of FED (n = 29, group 1 or PBK (n = 18, group 2 that underwent DSAEK. Clinical outcomes were compared between the study groups. At the final follow-up examination, confocal microscopy was used to measure and compare central corneal and graft thickness as well as endothelial cell density and morphology between the two groups. Results: Mean age at the time of surgery was 65.2 ± 11.8 and 69.4 ± 12.5 years in groups 1 and 2, respectively (P = 0.27. Follow-up period was 23.6 ± 14.0 months in group 1 and 25.6 ± 15.7 months in group 2 (P = 0.79. Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 until postoperative month 6. Afterwards, the two study groups were comparable in this regard. At the final follow-up examination, spherical equivalent refractive error was + 0.39 ± 1.46 diopters (D in group 1 and + 0.80 ± 1.47 D in group 2 (P = 0.45. Postoperative keratometric astigmatism was 1.02 ± 0.83 D and 2.36 ± 0.67 D, respectively (P < 0.001. Mean central graft thickness was 98.0 ± 33.3 μm in group 1 and 107.6 ± 28.0 μm in group 2 (P = 0.45. No statistically significant difference was observed between the two groups in terms of the postoperative endothelial cell density. Conclusion: The outcomes of DSAEK surgery were comparable between FED and PBK. All grafts were clear despite the lower than normal endothelial cell counts.

  20. Transplante de membrana amniótica na ceratopatia bolhosa Amniotic membrane transplantation for bullous keratopathy

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    Alessandra Guerra Daros Castellano

    2004-12-01

    pain relief and improvement of the recurrent epithelial side effects in patients with symptomatic bullous keratopathy and poor vision. METHODS: A prospective survey was conducted with 9 patients, from April/2000 to December/2001 at the "Hospital Universitário Evangélico de Curitiba - HUEC". Before the surgery, the medical records of each patient were studied and a complete ocular examination was performed. The patients were evaluated once a week or more frequently, including the first postoperative (PO, seventh PO, fourteenth PO and thirtieth PO day. A monthly evaluation was performed at the sixth month after the operation. RESULTS: The group consisted of 3 (33.3% males and 6 (66.6% females, with age from 29 to 74 years. All patients complained of pain in their eyes, 7 (77.7% had teary eyes, 8 (88.8% patients had photophobia and 4 (44.4% had red eyes. The visual acuity in the preoperative was finger counting in 6 (66.6% of the patients, hand moving in 2 (22.2% of the patients and amaurosis in 1 (11.1% patient. After the procedure, there was a reepithelialization in all patients between the twelfth and the twenty-first postoperative day. The patients seemed to recover from pain and photophobia in the first week after the amniotic membrane transplantation and remained well until the end of follow-up. CONCLUSION: The amniotic membrane has the potential to restore corneal surface in patients with symptomatic bullous keratopathy, reducing very quickly pain in these patients. However, the number of studied patients is small, but this treatment is an alternative that has encouraged us, as well as other researchers, due to the excellent obtained result.

  1. Micropuntura com radiofrequência no tratamento da ceratopatia bolhosa sintomática Micropuncture with radiofrequency for the treatment of symptomatic bullous keratopathy

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    José Ricardo Carvalho Lima Rehder

    2010-06-01

    Full Text Available OBJETIVO: Avaliar o efeito da micropuntura com radiofrequência no tratamento dos pacientes portadores de ceratopatia bolhosa sintomática. MÉTODOS: Estudo prospectivo em 10 pacientes com ceratopatia bolhosa sintomática e baixa acuidade visual. Micropunturas com radiofrequência foram realizadas em estroma anterior nas áreas com descompensação epitelial. A evolução dos pacientes foi realizada através de dados clínicos (biomicroscopia, paquimetria, tonometria e estesiometria e graduação de sintomas (intensidade da dor, sensação de corpo estranho, fotofobia e insônia devido à dor. RESULTADOS: A comparação dos sintomas antes do tratamento e no pós-operatório apresentou redução da sensação de corpo estranho, da intensidade da dor e na insônia em mais de 90% dos pacientes. A medida da sensibilidade corneana pelo estesiômetro de Cocher Bonnet apresentou uma redução da sensibilidade, entre o pré tratamento e o pós de 1 semana, entre 0,5 a 2, em 5 pacientes . A comparação do pré-tratamento com o pós-tardio apresentou aumento na sensibilidade corneana em 07 pacientes variando de 0,5 a 2. A avaliação de espessura corneana através do exame de paquimetria ultra- sônica e a medida de pressão intraocular dos pacientes através do tonômetro de aplanação de Goldman não obtiveram diferenças significativas. CONCLUSÃO: A micropuntura com radiofrequência mostrou-se um tratamento válido no controle dos sintomas da ceratopatia bolhosa principalmente na redução de sintomas como dor e sensação de corpo estranho.PURPOSE: Evaluate the effect of micro puncture with radiofrequency as treatment of symptomatic patients with bullous keratopathy. METHODS: Prospective study in 10 pacients with syntomatic bullous keratopathy and low vision. Micro puncture with radiofrequency was made in areas of the anterior stromal that had an epithelial descompensation. The evaluation of the patients was realized trough clinical examinations

  2. Electrocauterización de la membrana de Bowman para el tratamiento de la queratopatía bullosa dolorosa Electrocauterization of Bowman's membrane for the treatment of painful bullous keratopathy

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    Elizabeth Escalona Leyva

    2002-12-01

    Full Text Available El propósito en este trabajo es evaluar la electrocauterización de la membrana de Bowman como alternativa quirúrgica en el tratamiento de la queratopatía bullosa dolorosa. Se estudiaron 30 ojos de 30 pacientes con diagnóstico de queratopatía bullosa dolorosa que no habían logrado mejoría con los tratamientos habituales. Se tomaron como variables fundamentales la edad, el sexo, la etiología, el tiempo de evolución, la epitelización, las complicaciones y el alivio sintomático, los datos se tabularon de forma manual teniendo en cuenta el universo de pacientes. Predominó la queratopatía bullosa posquirúrgica (afáquicas y pseudofáquicas en el 83,3 % de los pacientes. Las edades más afectadas fueron los mayores de 60 años (63,3 %; no se encontraron diferencias significativas en cuanto al sexo. El tiempo de epitelización fue de 7 a 14 días en el 93,3 % de los pacientes y solo se encontraron complicaciones en el 14 % que no fueron de gravedad. El alivio de los síntomas se produjo en el 66,6 % en la primera semana del posoperatorio. La electrocauterización de la membrana de Bowman constituye un método eficaz, sencillo y con resultados satisfactorios en el tratamiento de la queratopatía bullosa dolorosaThe purpose of this paper is to evaluate the electrocauterization of Bowman's membrane as a surgical alternative in the treatment of painful bullous keratopathy. 30 eyes from 30 patients who were diagnosed painful bullous keratopathy and had not improved with the habitual treatments were studied. Age, sex, ethiology, time of evolution, epithelialization, complications and the symptomatic relief were taken as fundamental variables. Data were manually tabulated, taking into account the number of patients. The psotsurgical bullous keratopathy (aphakic y pseudophakic prevailed in 83.3 % of the patients. The most affected were those over 60 (63.3 %. No significant differences were found in relation to sex. The time of epithelialization

  3. [Evaluation of Iris Morphology Viewed through Stromal Edematous Corneas by Infrared Camera].

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    Kobayashi, Masaaki; Morishige, Naoyuki; Morita, Yukiko; Yamada, Naoyuki; Kobayashi, Motomi; Sonoda, Koh-Hei

    2016-02-01

    We reported that the application of infrared camera enables us to observe iris morphology in Peters' anomaly through edematous corneas. To observe the iris morphology in bullous keratopathy or failure grafts with an infrared camera. Eleven bullous keratopathy or failure grafts subjects (6 men and 5 women, mean age ± SD; 72.7 ± 13.0 years old) were enrolled in this study. The iris morphology was observed by applying visible light mode and near infrared light mode of infrared camera (MeibomPen). The detectability of pupil shapes, iris patterns and presence of iridectomy was evaluated. Infrared mode observation enabled us to detect the pupil shapes in 11 out of 11 cases, iris patterns in 3 out of 11 cases, and presence of iridetomy in 9 out of 11 cases although visible light mode observation could not detect any iris morphological changes. Applying infrared optics was valuable for observation of the iris morphology through stromal edematous corneas.

  4. Quantitative analysis of immunogold labellings of collagen types I, III, IV and VI in healthy and pathological human corneas.

    Science.gov (United States)

    Delaigue, O; Arbeille, B; Rossazza, C; Lemesle, M; Roingeard, P

    1995-06-01

    We studied the distribution of collagen types I, III, IV and VI in one healthy human cornea and in seven pathological human corneas, in which the disorders were three cases of pseudophakic bullous keratopathy (two severe, one moderate) and one case each of stage IV keratoconus, chronic ulcer, vascularized cornea and disciform keratitis. Transmission electron microscopy examinations were performed on post-embedding immunogold-labelled sections. The staining was evaluated by gold particle count in the different tissues. The presence or absence of a given antigen was determined by statistical analysis, using a d-value test. Our results on healthy corneal tissues corroborate the data available from previous studies, except for collagen type VI, which we found to be absent in Bowman's layer. In pathological corneas with a collagenous layer posterior to Descemet's membrane, collagen types I, III and especially IV were detected in this collagenous layer. Collagen types I, III and VI were detected in the anterior healed stroma of other pathological corneas, except for the keratoconus cornea, in which intense collagen III staining was observed. The presence of collagen types I and III in the posterior collagenous layer of our pseudophakic bullous keratopathy corneas suggests that this layer corresponds to scar tissue secreted by stimulated endothelial cells.

  5. Decorin and biglycan of normal and pathologic human corneas

    Science.gov (United States)

    Funderburgh, J. L.; Hevelone, N. D.; Roth, M. R.; Funderburgh, M. L.; Rodrigues, M. R.; Nirankari, V. S.; Conrad, G. W.

    1998-01-01

    PURPOSE: Corneas with scars and certain chronic pathologic conditions contain highly sulfated dermatan sulfate, but little is known of the core proteins that carry these atypical glycosaminoglycans. In this study the proteoglycan proteins attached to dermatan sulfate in normal and pathologic human corneas were examined to identify primary genes involved in the pathobiology of corneal scarring. METHODS: Proteoglycans from human corneas with chronic edema, bullous keratopathy, and keratoconus and from normal corneas were analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), quantitative immunoblotting, and immunohistology with peptide antibodies to decorin and biglycan. RESULTS: Proteoglycans from pathologic corneas exhibit increased size heterogeneity and binding of the cationic dye alcian blue compared with those in normal corneas. Decorin and biglycan extracted from normal and diseased corneas exhibited similar molecular size distribution patterns. In approximately half of the pathologic corneas, the level of biglycan was elevated an average of seven times above normal, and decorin was elevated approximately three times above normal. The increases were associated with highly charged molecular forms of decorin and biglycan, indicating modification of the proteins with dermatan sulfate chains of increased sulfation. Immunostaining of corneal sections showed an abnormal stromal localization of biglycan in pathologic corneas. CONCLUSIONS: The increased dermatan sulfate associated with chronic corneal pathologic conditions results from stromal accumulation of decorin and particularly of biglycan in the affected corneas. These proteins bear dermatan sulfate chains with increased sulfation compared with normal stromal proteoglycans.

  6. Transient band keratopathy associated with ocular inflammation and systemic hypercalcemia

    Directory of Open Access Journals (Sweden)

    Anat Galor

    2008-10-01

    Full Text Available Anat Galor, Henry A Leder, Jennifer E Thorne, James P DunnThe Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of MedicinePurpose: To report a case of visually significant band keratopathy associated with ocular inflammation and systemic hypercalcemia which markedly decreased in severity after treatment of these underlying factors.Methods: Retrospective case report.Results: A 53-year-old Asian female with granulomatous panuveitis in the left eye presented with diffuse band keratopathy through the central cornea. The serum calcium was elevated. The patient was treated with topical prednisolone acetate 1% and oral prednisone with marked improvement in inflammation. The band keratopathy lessened in severity with clearing of the central cornea and improvement in visual acuity.Conclusions: Early medical treatment of underlying factors may allow reversal of band keratopathy.Keywords: ocular inflammation, transient band keratopathy

  7. Calcific band keratopathy in an alpaca.

    Science.gov (United States)

    Pucket, Jonathan D; Boileau, Melanie J; Sula, Mee Ja M

    2014-07-01

    A 4-year-old female Suri alpaca was presented for evaluation of acute onset weakness, lethargy, and recent development of opacities in both eyes. On ophthalmic examination, bilaterally symmetrical corneal opacities were noted along the interpalpebral fissures with a few corneal blood vessels intermingled. A presumed diagnosis of calcific band keratopathy was made based on location and appearance. The patient was euthanized a short while after diagnosis due to reasons unrelated to the eyes and histologic examination of the corneas revealed subepithelial calcium and vascularization, consistent with calcific band keratopathy. This case report is the first to document this ocular condition in an alpaca. © 2013 American College of Veterinary Ophthalmologists.

  8. Quantitative & qualitative analysis of endothelial cells of donor cornea before & after penetrating keratoplasty in different pathological conditions

    Directory of Open Access Journals (Sweden)

    Aruna K.R. Gupta

    2016-01-01

    Full Text Available Background & objectives: Endothelial cells of the donor cornea are known to be affected quantitatively and qualitatively in different pathological conditions after penetrating keratoplasty (PK and this has direct effect on the clarity of vision obtained after PK. This study was undertaken to analyze the qualitative and quantitative changes in donor endothelial cells before and after PK in different pathological conditions. Methods: A prospective investigational analysis of 100 consecutive donor corneas used for penetrating keratoplasty between June 2006 and June 2008, was conducted. The patients were evaluated on the first day, at the end of first week, first month, third and six months and one year. Results: A decrease was observed in endothelial cell count in all pathological conditions. After one year of follow up the loss was 33.1 per cent in corneal opacity, 45.9 per cent in acute infective keratitis (AIK, 58.5 per cent in regrafts, 28.5 per cent in pseudophakic bullous keratopathy (PBK, 37 per cent in descemetocele, 27 per cent in keratoconus and 35.5 per cent in aphakic bullous keratopathy (ABK cases. Interpretation & conclusions: The endothelial cell loss was highest in regraft cases which was significant (P<0.05, while the least endothelial cell loss was seen in keratoconus cases. The cell loss was associated with increase in coefficient of variation (CV, i.e. polymegathism and pleomorphism. Inspite of this polymegathism and pleomorphism, the clarity of the graft was maintained.

  9. One donor cornea for 3 recipients: a new concept for corneal transplantation surgery.

    Science.gov (United States)

    Vajpayee, Rasik B; Sharma, Namrata; Jhanji, Vishal; Titiyal, Jeewan S; Tandon, Radhika

    2007-04-01

    To describe the use of a single donor corneal tissue in 3 patients with corneal pathologic conditions. A donor corneal tissue was divided into 3 parts using a microkeratome and a trephine. The anterior lamellar disc was transplanted into a patient with macular corneal dystrophy using the automated lamellar therapeutic keratoplasty technique. The posterior lamellar disc was transplanted into a patient with pseudophakic bullous keratopathy using the Descemet stripping automated endothelial keratoplasty technique. The peripheral corneoscleral rim was used for limbal stem cell transplantation in a child with limbal stem cell deficiency. All surgical procedures were performed successfully. At 3 months, the best-corrected visual acuities achieved following automated lamellar therapeutic keratoplasty, Descemet stripping automated endothelial keratoplasty, and limbal stem cell transplantation were 20/60, 20/40, and 20/200, respectively. The advent of customized component corneal transplantation techniques may allow the use of 1 donor cornea to treat multiple patients.

  10. Transplantation of cultured rhesus monkey vascular endothelial cells to allogeneic cornea concomitant with stripping of Descemet's membrane

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    Qin Zhu

    2015-01-01

    Full Text Available Context: In cases of damaged corneal endothelium cells (CECs of the eye, transplantation of cultured vascular endothelial cells (VECs may be a viable method to restore transparency. Aims: To evaluate the viability of replacing damaged primate CECs with cultured allogeneic VECs. Subjects and Methods: Rhesus monkey VECs (RMVECs were cultured and proliferating cells were labeled with bromodeoxyuridine (BrdU in vitro. RMs of the experimental group (n = 6 underwent manual Descemettt membrane stripping with transplantation of RMVECs labeled with BrdU; those in the control group received manual Descemetnt membrane stripping without transplantation. Postoperative evaluations included the transparency and appearance of the corneal graft; distribution and ultrastructural changes of RMVECs on the inner surface of the cornea using scanning and transmission electron microscopy, and immunohistological identification of BrdU. Results: At 90 days postsurgery, the corneal grafts of the monkeys in the experimental group retained better transparency than those of the controls, without corneal neovascularization or bullous keratopathy. A layer of cells with positive BrdU staining was found on the posterior surface of the treated corneas in the experimental group, while there was no VEC structure in corneal grafts from the monkeys of the control group. Conclusions: RMVECs can grow on the posterior surface of the cornea without Descemet's membrane. Cultured and transplanted RMVECs appeared similar in ultrastructure. VECs can provide a barrier to maintain corneal dehydration and transparency to some extent.

  11. Transplantation of cultured rhesus monkey vascular endothelial cells to allogeneic cornea concomitant with stripping of Descemet's membrane.

    Science.gov (United States)

    Zhu, Qin; Wu, Min; Sun, Xiaomei; Zhang, Wenjia; Hu, Zhulin; Liu, Hai

    2015-08-01

    In cases of damaged corneal endothelium cells (CECs) of the eye, transplantation of cultured vascular endothelial cells (VECs) may be a viable method to restore transparency. To evaluate the viability of replacing damaged primate CECs with cultured allogeneic VECs. Rhesus monkey VECs (RMVECs) were cultured and proliferating cells were labeled with bromodeoxyuridine (BrdU) in vitro. RMs of the experimental group (n = 6) underwent manual Descemettt membrane stripping with transplantation of RMVECs labeled with BrdU; those in the control group received manual Descemetnt membrane stripping without transplantation. Postoperative evaluations included the transparency and appearance of the corneal graft; distribution and ultrastructural changes of RMVECs on the inner surface of the cornea using scanning and transmission electron microscopy, and immunohistological identification of BrdU. At 90 days postsurgery, the corneal grafts of the monkeys in the experimental group retained better transparency than those of the controls, without corneal neovascularization or bullous keratopathy. A layer of cells with positive BrdU staining was found on the posterior surface of the treated corneas in the experimental group, while there was no VEC structure in corneal grafts from the monkeys of the control group. RMVECs can grow on the posterior surface of the cornea without Descemet's membrane. Cultured and transplanted RMVECs appeared similar in ultrastructure. VECs can provide a barrier to maintain corneal dehydration and transparency to some extent.

  12. A serious adverse surgical event: Management of suspected HSV-1 keratitis in a donor cornea.

    Science.gov (United States)

    Kaye, Rebecca; Steger, Bernhard; Chen, Jern Y; Romano, Vito

    2017-01-01

    To describe the management of a serious adverse event in a patient undergoing penetrating keratoplasty (PK). A 68-year-old man underwent PK for an aphakic bullous keratopathy following previous complicated cataract surgery. He had no past history of herpetic disease. Storage of the corneoscleral disc in the transport bottle precluded microscopic examination. After placement of the trephined donor cornea on the open eye of the recipient, a large dendritiform geographic ulcer was noted on the donor cornea. A replacement cornea was used after changing potentially contaminated instruments. Intravenous antiviral treatment was commenced intraoperatively to reduce the risk of infection to the central nervous system. Postoperatively, oral and topical antiviral treatment was commenced and 6 months following surgery the patient developed a geographic corneal ulcer at the graft host interface. Containers to transport corneoscleral discs should enable microscopic examination by the surgeon prior to use. High dose systemic antivirals may reduce the risk of herpetic disease involving the posterior segment of the eye and neuroretina in the aphakic eye and spread to the central nervous system.

  13. Cornea Transplant

    Science.gov (United States)

    ... Swelling of the cornea Signs and symptoms of cornea rejection In some cases, your body's immune system ... the risks of the procedure. Finding a donor cornea Most corneas used in cornea transplants come from ...

  14. Scleral contact lens management of bilateral exposure and neurotrophic keratopathy.

    Science.gov (United States)

    Grey, Fiona; Carley, Fiona; Biswas, Susmito; Tromans, Cindy

    2012-12-01

    We report an interesting case of therapeutic scleral lens management of bilateral exposure and neurotrophic keratopathy resulting from bilateral cranial nerve (CN) palsies including V, VI and VII, which caused lagophthalmos and anaesthetic corneas. Subsequent development of severe exposure keratitis with vascularisation and keratinisation of the inferior cornea was previously treated with intensive ocular lubrication, botulinum toxin injections to the upper eyelid levator muscle, temporary tarsorrhophies, bilateral amniotic membrane grafts, punctal plugs, lid taping, gold eyelid weights and soft bandage contact lenses. Corneal integrity was re-established but visual acuity remained significantly compromised by corneal vascularisation, scarring and keratin deposits. Visions on presentation to the contact lens department were R 1.90 logMAR, L 1.86 logMAR. Therapeutic, high Dk, non-fenestrated, saline filled, scleral lenses were fitted. Daily wear of these lenses have protected and hydrated the cornea, enabling corneal surface recovery whilst retaining visual and social function. The visual acuities 6 months post-scleral fitting with lenses in situ are R 0.90 logMAR and L logMAR 0.70. Copyright © 2012 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  15. Toxic Keratopathy Secondary to Topical Proparacaine

    OpenAIRE

    Anıl Kubaloğlu; Esin Söğütlü Sarı; Pınar Sorgun Evcili; Sibel Akyol; Arif Koytak; Yusuf Özertürk

    2012-01-01

    Pur po se: To evaluate the clinical findings of toxic keratopathies secondary to topical proparacaine (Alcaine, Alcon) abuse and the results of medical and/or surgical treatment options. Ma te ri al and Met hod: We retrospectively analyzed twenty-two eyes of 25 patients who developed toxic keratopathy secondary to topical anesthetic abuse between March 2005 and December 2009. Severe pain unresponsive to medical treatment with persistent epithelial defects (PED) and stromal ulcers wer...

  16. Analysis of corneal morphologic and pathologic changes in early-stage congenital aniridic keratopathy

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    Juan Du

    2017-03-01

    Full Text Available AIM: To determine typical corneal changes of congenital aniridic keratopathy (CAK using corneal topography and confocal systems, and to identify characteristics that might assist in early diagnosis. METHODS: Patients with CAK and healthy control subjects underwent detailed ophthalmic examinations including axial length, corneal thickness, tear film condition, corneal topography, and laser-scanning in vivo confocal microscopy (IVCM. RESULTS: In early stage aniridic keratopathy, Schirmer I test (SIT, break-up time (BUT, mean keratometry (mean K and simulated keratometry (sim K were reduced relative to controls (P<0.05, while simulation of corneal astigmatism (sim A and corneal thickness were increased (P<0.05. In addition, significantly more eyes exhibited flat cornea compared with the control group. Inflammatory dendritic cells were present in the aniridic epithelium, with significantly increased density relative to controls (P<0.05. Palisade ridge-like features and abnormal cell morphology were observed in six out of sixteen CAK cases. In central cornea area, the aniridic corneas had the increased subbasal nerve density. CONCLUSION: These changes in corneal morphology in borderline situations can be useful to confirm the diagnosis of CAK.

  17. Bullous lichen planus - a review.

    Science.gov (United States)

    Liakopoulou, Angeliki; Rallis, Efstathios

    2017-03-31

    Bullous lichen planus is a rare variant of lichen planus. It is characterized by vesicles or bullae, which usually develop in the context of pre-existing LP lesions. It is often misdiagnosed and should be differentiated from other subepidermal bullous diseases especially lichen planus pemphigoides. The diagnosis is based on clinical suspicion and is confirmed by histopathology and immunofluoresence. The clinical features of bullous lichen planus include typical lichen planus lesions, accompanied by the formation of bullae on the affected or perilesional skin. This is evident on histology, with alteration of the dermo-epidermal junction and intrabasal bullae as a consequence of extensive inflammation. The histologic features in conjunction with the negative immunofluoresence indicate that bullous lichen planus is a form of "hyper-reactive lichen planus" rather than a distinct entity. There is no standard treatment of bullous lichen planus. Topical and systemic corticosteroids, dapsone and acitretin have been described as effective choices.

  18. Comparison of conventional and silicone hydrogel contact lenses for bullous keratoplasty.

    Science.gov (United States)

    Lim, Natasha; Vogt, Ursula

    2006-09-01

    To compare the efficacy and safety of conventional lenses and silicone hydrogel lenses in the treatment of bullous keratopathy. The silicone hydrogel bandage contact lenses used were Focus NIGHT & DAY and PureVision. The conventional lens used was Sauflon 85%. This was a prospective, comparative study of 22 patients with painful bullous keratopathy in one eye. Patients visited a specialty contact lens department and were fitted with all three different lens types in their affected eye for 1 month each, for a total duration of 3 months. The main outcome measures were comfort and pain relief, which patients scored on a scale that ranged from 1 to 5, with 1 being very poor and 5 being excellent. Doctors assessed the fit of the lens, its movement, and any deposit buildup. The statistical tests applied were the Kruskal-Wallis test and the Mann-Whitney test. Sixteen of the 22 patients (24 eyes) successfully completed 1 month's wear of all three bandage contact lenses. The median comfort score was 3.9 for PureVision, 3.8 for Focus NIGHT & DAY, and 2.8 for Sauflon 85%; there was a statistical significance among the three groups (P=0.031). Silicone hydrogel lenses performed better than conventional lenses for comfort. The Mann-Whitney test showed that there was no statistically significant difference for comfort scores of Focus NIGHT & DAY versus PureVision (Plenses for pain relief score. All three lens types were similarly good with regard to contact lens fit, movement, and deposit buildup. The use of silicone hydrogel lenses are a safe and effective alternative to conventional contact lenses for the treatment of bullous keratopathy.

  19. Perfil epidemiológico dos pacientes na lista de espera para transplante de córnea no Estado de Sergipe Epidemiological profile of the patients on the waiting list for cornea transplantation in the State of Sergipe , Brazil

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    Ângelo Augusto Araújo

    2004-08-01

    analyzed data were: corneal disease, age, sex, visual acuity and the time spent on the waiting list until the transplantation was performed. RESULTS: Pseudophakic and aphakic bullous keratopathy was the most common disease (39.1%, followed by leukoma (22.5%, keratoconus (14.1%, "other diseases" (10.6%, regraft (7.8% and ulcerative conditions (5.6%. Mean age was 52.16 years and there was no significant difference between the sexes. "Hand motion" and "light perception" were the most common visual acuities. The 110 patients who had their cornea transplanted waited, on average, six months. The ones who were indicated for transplant due to ulcerative conditions and regraft had priority and waited less time. Those who had bullous keratopathy were 68.5 years old on average whereas the ones with keratoconus were 23.6 years old. CONCLUSIONS: It is possible to conclude that bullous keratopathy is the main indication for corneal transplant in our state. There is no difference in the frequency concerning sex; the mean age of the most common disease is in agreement with the time of its development. Visual acuity is as expected and the time spent on the waiting list is long and inappropriate.

  20. Immunofluorescence of Autoimmune Bullous Diseases

    NARCIS (Netherlands)

    Diercks, Gilles F; Pas, Hendri H; Jonkman, Marcel F

    Autoimmmune bullous diseases of skin and mucosa are uncommon, disabling, and potentially lethal diseases. For a quick and reliable diagnosis immunofluorescence is essential. This article describes two variants of immunofluorescence. The direct method uses a skin or mucosal biopsy of the patient to

  1. Toxic Keratopathy Secondary to Topical Proparacaine

    Directory of Open Access Journals (Sweden)

    Anıl Kubaloğlu

    2012-01-01

    Full Text Available Pur po se: To evaluate the clinical findings of toxic keratopathies secondary to topical proparacaine (Alcaine, Alcon abuse and the results of medical and/or surgical treatment options. Ma te ri al and Met hod: We retrospectively analyzed twenty-two eyes of 25 patients who developed toxic keratopathy secondary to topical anesthetic abuse between March 2005 and December 2009. Severe pain unresponsive to medical treatment with persistent epithelial defects (PED and stromal ulcers were managed with amniotic membrane transplantation (AMT. Some cases have undergone optical penetrating keratoplasty (PK. Clinical findings and complications were assessed, and visual acuities were measured before and after treatment. At the sixthmonth follow-up visit, endothelial cell densities (ECD were determined with specular microscopy in both affected and unaffected eyes for statistical comparison. Re sults: The mean time interval between the initiation of topical anesthetic use and admission to our clinic was 2.26 months. Epithelial defects, circular stromal keratitis and corneal edema were present in all eyes. Epithelial defects were healed with medical treatment in 15 eyes (60%. AMT was performed in 10 eyes, following a mean of 26.1 days after initiation of medical treatment. Visual acuity before the treatment was 0.1 or below in all eyes. At the last control visit including 3 eyes having had PK, best-corrected visual acuities were 0.5 or better in 13 eyes (52%, between 0.2 and 0.4 in 7 eyes (28% and 0.1 or worse in 5 eyes (20%. No statistically significant difference was found between ECD of affected and unaffected eyes of 13 patients in whom specular microscopy was possible. Dis cus si on: Topical anesthetic abuse may cause severe toxic keratopathy and lead to significant visual loss related to stromal opacities despite intensive treatment. AMT was found effective and successful in healing PED and stromal ulcers as well as in breaking the vicious circle of

  2. Bullous Pemphigoid Induced by Vildagliptin

    OpenAIRE

    Bengür Taşkıran Bahattin; Erdoğan Canan Solak; Şişman Güven; Barış Cansu

    2016-01-01

    Bullous pemphigoid (BP) is an uncommon chronic, autoimmune, and subepidermal disease. Tense blisters occur on normal or erythematous skin. It can be induced by medications. There is a number of reports on BP induced by dipeptidyl peptidase 4 (DPP-4) inhibitors (vildagliptin, sitagliptin, saxagliptin). DPP-4 (CD26), present as a cell surface molecule on immune cells, also plays an important costimulatory role in immune activation. BP more commonly affects elderly men. We present a case of BP i...

  3. Linear IgA Bullous Dermatosis

    DEFF Research Database (Denmark)

    Lings, Kristina; Bygum, Anette

    2015-01-01

    Linear IgA bullous dermatosis (LAD) is an autoimmune, chronic bullous disease affecting primarily young children and adults. Studies on LAD are relatively sparse and from Scandinavia we could only find a few case reports. Therefore we decided to conduct a retrospective investigation of patients...

  4. Widespread bullous fixed drug eruption.

    Science.gov (United States)

    Patell, Rushad D; Dosi, Rupal V; Shah, Purav C; Joshi, Harshal S

    2014-02-07

    A 53-year-old man developed a widespread erythematous eruption which rapidly evolved into fluid-filled bulla mostly involving the distal areas of all four limbs and erosions on the oral as well as anogenital mucosa. Based on clinical presentation, chronology of drug exposure, past events and histopathology as diagnosis of widespread bullous fixed drug eruption was made over Steven Johnson-toxic epidermal necrolysis syndrome. Steroids were deferred and the lesions healed with minimal pigmentation within a week. Differentiating between the two entities has been historically difficult, and yet can have significant therapeutic and prognostic implications.

  5. [Bullous lichen sclerosus after radiotherapy].

    Science.gov (United States)

    Tournillac, I; Dandurand, M; Guillot, B

    1998-02-01

    Bullous lichen sclerosus is an uncommon observation after radiotherapy and can be misdiagnosed as a radiodermitis or recurrence of the neoplasia. Two women developed bullous lichen sclerosus after radiotherapy. The delay after radiotherapy was 4 months and 10 years respectively. Irradiation dose was 60 and 64 grays. The lesions covered more than the irradiated zone in one case. Stabilization or regression of the lesions was obtained with cases I topical corticosteroids, with acitretine in one case. These cases, and similar cases reported in the literature, underline the fact that the condition has only been reported in women. This is probably because of the nature of the neoplasias treated (breast cancer in 20 cases and cervical cancer in 1). The delay to onset of the skin lesions are quite variable. Lichen sclerosus or morphea may be observed in the irradiated zone but may also appear at a distance. These lesions are not associated with recurrence of the initial cancer. As no association between breast cancer and localized sclerodermia has been found, the causal role is probably played by radiotherapy, producing a Koebner phenomena in predisposed tissue.

  6. Bullous leukemia cutis mimicking facial cellulitis*

    Science.gov (United States)

    Caldato, Luciana de Sales; Britto, Juliana de Sousa; Niero-Melo, Ligia; Miot, Hélio Amante

    2016-01-01

    Bullous leukemia cutis is an uncommon clinical manifestation of cutaneous infiltration by leukemic cells, from B-cell chronic lymphocytic leukemia. We present the case of a 67-year-old, female, chronic lymphocytic leukemia patient. She was taking chlorambucil and developed facial edema with erythema and warmth, misjudged as facial cellulitis. Two days later, she developed bullous lesions in the arms, legs, neck and face. The histopathology of facial and bullous lesions confirmed leukemia cutis. All lesions disappeared following the administration of rituximab combined with cycles of fludarabine and cyclophosphamide. Although soft tissue infections are common complications in patients undergoing chemotherapy, leukemia cutis can also resemble cellulitis. PMID:27192532

  7. Tropical-wood-induced bullous erythema multiforme.

    Science.gov (United States)

    Shimizu, S; Chen, K R; Pratchyapruit, W O; Shimizu, H

    2000-01-01

    We report a case of bullous erythema multiforme caused by an exotic wood, pao ferro (Machaerium scleroxylon). A 25-year-old female, a luthier (guitar maker) who often handles a variety of woods, developed bullous erythema multiforme. A patch test confirmed a positive reaction to one of the exotic woods, pao ferro. A subsequent accidental short contact with pao ferro 5 months following the first incidence induced a similar exudative erythema. Exotic woods such as pao ferro should be added to the list of contact allergens that can induce bullous erythema multiforme. Copyright (R) 2000 S. Karger AG, Basel.

  8. Bullous pemphigoid associated with prostate adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Öztürkcan Serap

    2004-01-01

    Full Text Available Bullous pemphigoid is a common autoimmune skin disease characterized by the presence of subepidermal blisters. It has been associated with underlying neoplasia in isolated reports. A 78-year-old man with generalized blisters was diagnosed as bullous pemphigoid on clinical, histopathological and direct immunofluorescence grounds. His free and total prostate specific antigen (PSA levels were high and histopathological examination of a prostate specimen revealed prostate adenocarcinoma. We present this rare case to discuss the possible association between bullous pemphigoid and prostate adenocarcinoma.

  9. Enucleaton of the right eye due to large choroidal melanoma with simultaneous penetrating cornea transplantation from OD to OS (Case report.

    Directory of Open Access Journals (Sweden)

    E. A. Korchuganova

    2014-07-01

    Full Text Available There is presentation case report of 75‑year old woman with choroidal melanoma (T3N0M0 on the right eye and failed graft on the left pseudophakic eye with far advanced glaucoma and ARMD. No treatment was given to the leading eye with VA 0,2. VA of OS = 1 / ∞ pr.l.certa; PKP OS in 2008 for pseudophakic bullous keratopathy on the eye with far advanced glaucoma. IOP was normal after previous filtering surgery. After PKP VA = 0,04; clear graft during 2 years; then gradually opacification and vascularization occurred. VA dropped to light perception. Echography OD — tumor h 8,29 mm, d 21,77 mm. No ingrowth of tumor into anterior segment of the eye; VA OD = 0 (no light perception. Concerning the need to enucleate the right eye with large choroidal melanoma, the advantage of using corneal autograft from OD to OS, location of tumor in the posterior pole with no ingrowth in anterior segment, the decision was made to perform the following operation — to enucleate the right eye and transplant simultaneously corneal graft from OD on OS. Patient was discharged from the Ophthalmology Hospital with VA OS = 0,01, during next week VA improved to 0,02. 8,0 mm graft isclear, fixed with 8 interruptured and continious suture 10 / 0‑nylon. Anterior chamber — normal depth, atrophic iris, stable position of PC IOL. Optic nerve head is pale with subtotal deep glaucomatous excavation. Conclusion: presented case report demonstrates the rarepossibility to use cornea after enucleation the eye with large malignant tumor (located in the posterior pole for grafting in the only eye with failed vascularised graft. It was the only possibility for this patient to restore some vision.

  10. Enucleaton of the right eye due to large choroidal melanoma with simultaneous penetrating cornea transplantation from OD to OS (Case report.

    Directory of Open Access Journals (Sweden)

    E. A. Korchuganova

    2013-01-01

    Full Text Available There is presentation case report of 75‑year old woman with choroidal melanoma (T3N0M0 on the right eye and failed graft on the left pseudophakic eye with far advanced glaucoma and ARMD. No treatment was given to the leading eye with VA 0,2. VA of OS = 1 / ∞ pr.l.certa; PKP OS in 2008 for pseudophakic bullous keratopathy on the eye with far advanced glaucoma. IOP was normal after previous filtering surgery. After PKP VA = 0,04; clear graft during 2 years; then gradually opacification and vascularization occurred. VA dropped to light perception. Echography OD — tumor h 8,29 mm, d 21,77 mm. No ingrowth of tumor into anterior segment of the eye; VA OD = 0 (no light perception. Concerning the need to enucleate the right eye with large choroidal melanoma, the advantage of using corneal autograft from OD to OS, location of tumor in the posterior pole with no ingrowth in anterior segment, the decision was made to perform the following operation — to enucleate the right eye and transplant simultaneously corneal graft from OD on OS. Patient was discharged from the Ophthalmology Hospital with VA OS = 0,01, during next week VA improved to 0,02. 8,0 mm graft isclear, fixed with 8 interruptured and continious suture 10 / 0‑nylon. Anterior chamber — normal depth, atrophic iris, stable position of PC IOL. Optic nerve head is pale with subtotal deep glaucomatous excavation. Conclusion: presented case report demonstrates the rarepossibility to use cornea after enucleation the eye with large malignant tumor (located in the posterior pole for grafting in the only eye with failed vascularised graft. It was the only possibility for this patient to restore some vision.

  11. PROSE treatment for lagophthalmos and exposure keratopathy.

    Science.gov (United States)

    Gire, Anisa; Kwok, Alan; Marx, Douglas P

    2013-01-01

    Prosthetic replacement of the ocular surface ecosystem is a treatment developed by the Boston Foundation for Sight that uses a Food and Drug Administration-approved prosthetic device for the treatment of severe ocular surface disease to improve vision and discomfort in addition to supporting the ocular surface. Facial nerve paralysis has multiple causes including trauma, surgery, tumor, stroke, and congenital lagophthalmos. Subsequent lagophthalmos leading to exposure keratitis has been treated with copious lubrication, tarsorrhapy, eyelid weights, chemodenervation to yield protective ptosis, and palpebral spring insertion. Each of these treatments, however, has limitations and potential complications. The prosthetic replacement of the ocular surface ecosystem device provides a liquid bandage to protect the cornea from eyelid interaction and dessication in addition to improving vision. This report describes 4 patients with exposure keratitis who were successfully treated with prosthetic replacement of the ocular surface ecosystem devices at 2 clinical sites.

  12. Molecular biological aspects of acquired bullous diseases

    DEFF Research Database (Denmark)

    Dabelsteen, Erik

    1998-01-01

    of the bullous lesions. In this article, updated topics of the immune-mediated bullous lesions which involve oral mucosa and skin are reviewed. Pemphigus antigens, which are desmosomal-associated proteins and belong to the cadherin superfamily of cell adhesion proteins, have been isolated, and their genes have......Bullous diseases of the oral mucosa and skin were originally classified on the basis of clinical and histological criteria. The discovery of autoantibodies in some of these patients and the introduction of molecular biology have resulted in a new understanding of the pathological mechanisms of many...... to be the target for mutations seen in patients with the inherited type of epidermolysis bullosa in which bullous lesions are a prominent clinical feature....

  13. Linear IgA Bullous Dermatosis

    DEFF Research Database (Denmark)

    Lings, Kristina; Bygum, Anette

    2015-01-01

    Linear IgA bullous dermatosis (LAD) is an autoimmune, chronic bullous disease affecting primarily young children and adults. Studies on LAD are relatively sparse and from Scandinavia we could only find a few case reports. Therefore we decided to conduct a retrospective investigation of patients s...... is a rare but characteristic condition which in most cases can be effectively treated with dapsone or sulphapyridine....

  14. Amiodarone-induced exudative bullous lesion and hepatotoxicity in a patient with ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Ahmet Karakurt

    2015-09-01

    Full Text Available Amiodarone is a potent, iodine rich, highly lipophilic class III antiarrhythmic drug widely used for the management of both supraventricular and ventricular arrhythmias. It tends to concentrate in tissues including fat, lung, liver cornea and skin. Several side effects have been reported in patients taking amiodarone. The mechanisms of amiodarone-induced side effects are poorly understood. Accumulation of amiodarone in tissues and organs has been suggested as a possible mechanism. The most frequent dermatologic side effects are photosensitivity, skin discoloration and erythema. This article presents the case of a patient who developed amiodarone-induced bullous skin lesions and hepatotoxicity.

  15. Scabies masquerading as bullous pemphigoid: scabies surrepticius

    Directory of Open Access Journals (Sweden)

    Cohen PR

    2017-08-01

    Full Text Available Philip R Cohen Department of Dermatology, University of California San Diego, La Jolla, CA, USA Abstract: Scabies, a parasitic infestation caused by the mite Sarcoptes scabiei, is diagnosed by observing either the mite, its ova, or its excrement. The mite tracts, known as burrows and a characteristic presentation of the pruritic condition, are typically found on the web spaces between the fingers. Other cutaneous lesions include excoriated papules, pustules, and vesicles. However, atypical clinical variants of scabies, such as bullous, crusted, hidden, incognito, nodular, and scalp forms of the parasitic infestation, mimic the morphologic features of other non-parasitic dermatoses. A 76-year-old man presented with pruritic blisters and urticarial plaques that demonstrated not only pathology changes, but direct immunofluorescence also showed findings of bullous pemphigoid. His condition improved, but did not resolve, with topical corticosteroid cream for the management of the primary autoimmune blistering disorder. When other family members subsequently developed scabies, the correct diagnosis for his condition, bullous scabies, was established by demonstrating mites, ova, and scybala on a mineral oil preparation from a skin scraping of a newly appearing burrow. Bullous scabies can masquerade not only clinically, but also both pathologically and immunologically as bullous pemphigoid. Scabies serrupticius is introduced as a unifying term to designate all of the non-classic presentations of S. scabiei mite infestation. Keywords: bullous, crusted, egg, hidden, incognito, masquerade, mimic, mite, nodular, Norwegian, pemphigoid, Sarcoptes scabiei, scabies, scalp, scybala, surrepticius

  16. SCREENING METHODS FOR THE HYPOXIC KERATOPATHY EVALUATION IN THE REFRACTIVE SURGERY

    Directory of Open Access Journals (Sweden)

    N. V. Maychuk

    2016-01-01

    Full Text Available background. Hypoxic keratopathy (HK is the most common cause of dysregenerative conditions after corneal refractive surgery in case of long-term contact lenses wears. purpose: to study the correlation between the tears osmolarity, OSDI index and in vivo histo-morphological lesions in the corneas in patients with long-term contact lenses use. patients and methods. 3 groups of patients with mild (34 people, moderate (32 people and severe (29 people degrees of HK were examined. Control group consisted with 34 healthy volunteers. In all patients we performed the confocal microscopy of the cornea, the tears osmolarity assess and the calculation of the OSDI index. results and discussion. According to the confocal microscopy the intact corneas were visualized in the controls as well as the mean OSDI index was 5.1±0.9 points, and the tears osmolarity was 291,3 of ±9.8 mOsm/l, which corresponded to the norm. In the mild degree of HK the moderate pseudo-keratinization of the corneal epithelium was noted, the OSDI index was 20.8±4.4 points, which corresponded to the initial lesion of the ocular surface, and the tears osmolarity was 308.9±23 (most patients were within the limits of the norm values. In the moderate degree of HK cornea showed the changes in all layers with a prevalence of noninfectious inflammation signs; mean OSDI index was 22.9±7.2 points that was not significantly different from the mild HK, and osmolality greatly exceeded the mild HK (332,3±14,2, p<0.05. Severe HK was characterized by the significant changes in all corneal layers with a prevalence of autoimmune inflammatory and degenerative processes; mean OSDI index was significantly higher than in moderate degree of the HK (62,5±9,7, p<0.001, and the value of the tears osmolarity (364,9±26,7 mOsm/l corresponds to the moderate or severe dry eye syndrome. Conclusion. The screening methods for the HK evaluation in refractive surgery will provide a rapid assessment of the ocular

  17. Bullous Pemphigoid Induced by Vildagliptin

    Directory of Open Access Journals (Sweden)

    Bengür Taşkıran Bahattin

    2016-12-01

    Full Text Available Bullous pemphigoid (BP is an uncommon chronic, autoimmune, and subepidermal disease. Tense blisters occur on normal or erythematous skin. It can be induced by medications. There is a number of reports on BP induced by dipeptidyl peptidase 4 (DPP-4 inhibitors (vildagliptin, sitagliptin, saxagliptin. DPP-4 (CD26, present as a cell surface molecule on immune cells, also plays an important costimulatory role in immune activation. BP more commonly affects elderly men. We present a case of BP induced by vildagliptin. A 59-year-old male patient who was diagnosed with type 2 diabetes mellitus had initial hemoglobin A1c level of 12.90%. Initial therapy with premix biphasic aspart insulin bid was switched to metformin and vildagliptin 50/1000 mg combo pill bid after A1c level dropped to 5.7% at 9 months of insulin therapy, Five months after vildagliptin was started, tense vesicles 8-10 in number with an erythematous base developed on the forearms and cruris. Histological examination of the lesions confirmed the diagnosis of BP. Oral antidiabetics were discontinued. He was followed up with diet alone. The lesions regressed spontaneously after cessation of antidiabetics and clobetasol propionate cream bid treatment. A1c was 5.7% 5 months after discontinuation of vildagliptin and metformin. In the literature, it has been reported that onset of BP lesions took 10 days to 2 years. Mostly the patients were on combo therapy with metformin. The lesions improved dramatically after cessation of DPP-4 inhibitors avoiding necessity for systemic treatment for BP. This is the first case of BP induced by DPP-4 inhibitors in Turkey.

  18. Bullous pemphigoid with prominent milium formation

    OpenAIRE

    Tsuruta, Daisuke; Brzezinski, Piotr; Koga, Hiroshi; Ohata, Chika; Furumura, Minao; Hashimoto, Takashi

    2013-01-01

    Milia are very common superficial keratinous cysts, and are clinically pearly white dome-shaped lesions with diameter of 1-2 mm.  Bullous pemphigoid (BP) is an autoimmune bullous disease, characterized clinically by tense bullae on the extremities and trunk.  The major target autoantigens of BP are BP180 and BP230.  We report a 55-year-old Polish BP patient presented prominent milium formation.  The physical examination revealed multiple tense bullae on the erythemas scattered on the extremit...

  19. Topical anesthetic abuse keratopathy: a commonly overlooked health care problem.

    Science.gov (United States)

    Yagci, Ayse; Bozkurt, Banu; Egrilmez, Sait; Palamar, Melis; Ozturk, Banu Turgut; Pekel, Hamiyet

    2011-05-01

    To evaluate the clinical course, treatment modality, factors affecting the epithelization period, and visual outcome in patients with topical anesthetic abuse keratopathy. The medical records of 19 patients with a confirmed diagnosis of topical anesthetic abuse keratopathy were retrospectively examined; occupation, initiating event, biomicroscopic findings, treatment modality, epithelization period, and best-corrected visual acuity (BCVA) were noted. The Wilcoxon signed rank test was used to compare BCVA before and after treatment; P values antibiotics (fluoroquinolones or combined fortified cephalosporins and aminoglycosides), preservative-free lubricants/autologous serum, and bandage contact lens/eye patches were used for treatment. Mean epithelization period was 19.96 ± 11.16 days (range: 6-50 days). Mean pretreatment and posttreatment BCVA was 0.12 ± 0.16 (range: 0.001-0.7) and 0.66 ± 0.30 (range: 0.0-1.0), respectively (P abuse keratopathy in young male manual laborers specialized in welding business and foundry work presenting with persistent epithelial defects, ring-shaped keratitis, and accompanying severe ocular pain.

  20. Bullous Lupus Erythematosus Manifesting As Erythema Multiforme

    Directory of Open Access Journals (Sweden)

    Dhurat Rachita

    2004-01-01

    Full Text Available Bullous SLE has a distinctive clinical, histopathologic and immunopathologic features that together constitute a unique bullous disease phenotype. We report a 33 year old female presenting with multiple tense vesicles and bullae on normal and erythematous skin over the body and oral erosions. Palms and extremities showed typical target lesions. She had consumed NSAIDs intermittently for joint pains. She was diagnosed as bullous erythema multiforme and started on oral prednisolone but lesions failed to heal. Patient recollected a history of low grade fever and a photosensitive rash in the past. Investigations revealed positive ANA with a peripheral pattern. A skin biopsy of a vesicle showed a subepidemal blisher. Perilesional direct immunofluorescence studies showed a linear deposition of IgG, IgA and fibrin along the basement membrane zone and perivascular deposition of IgG. Lapus band test showed a linear deposition of IgG, C3, IgM and fibrin at BMZ clinching the diagnosis of bullous lupus erythematosus.

  1. Corneal thickness and intraocular pressure in edematous corneas before and after Descemet stripping with automated endothelial keratoplasty.

    Science.gov (United States)

    Chang, Diane T W; Pantcheva, Mina B; Noecker, Robert J

    2010-10-01

    It is important to accurately measure intraocular pressure (IOP) in eyes with corneal endothelial dysfunction both before and after Descemet stripping with automated endothelial keratoplasty (DSAEK). Glaucoma is a common comorbidity in this population, and IOP elevation can worsen corneal edema. Additionally, preexisting glaucoma and steroid-responsive ocular hypertension are significant risk factors for graft rejection after DSAEK. Accurate tonometry is limited by variations in central corneal thickness (CCT) and corneal hydration that may affect corneal biomechanical properties. We analyzed CCT and IOP in eyes before and after DSAEK to determine whether changes in corneal biomechanics because of edema, grafted tissue, and subsequent stromal deturgescence affect IOP measurement. A retrospective chart review was performed on 32 eyes from 31 patients with corneal edema secondary to Fuchs endothelial dystrophy, bullous keratopathy, or prior graft failure, or rejection that received uncomplicated DSAEK with no evidence of persistent corneal edema or steroid-induced ocular hypertension. IOP was measured by Tono-Pen XL, and CCT was measured by ultrasound pachymetry before and approximately 3 months after surgery. We used paired t tests to evaluate changes in CCT and IOP after DSAEK and linear regression to determine the relationship between CCT and IOP before and after surgery. CCT significantly decreased from 703 ± 82 to 650 ± 52 μm after DSAEK (P = 0.0026), but there was no significant change in measured IOP (16.7 ± 3.4 mm Hg preoperatively and 16.3 ± 4.1 mm Hg postoperatively; P = 0.61). There was no significant relationship between CCT and IOP before (slope = 0.10 ± 0.07 mm Hg/10 μm; r = 0.062; P = 0.17) or after (slope = 0.21 ± 0.14 mm Hg/10 μm; r = 0.072; P = 0.14) DSAEK. CCT is significantly reduced by DSAEK but remains well above the normal range. IOP remains near the preoperative level 3 months after DSAEK. Furthermore, no correction is required for

  2. Tarsorrhaphy: clinical experience from a cornea practice.

    Science.gov (United States)

    Cosar, C B; Cohen, E J; Rapuano, C J; Maus, M; Penne, R P; Flanagan, J C; Laibson, P R

    2001-11-01

    To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients. In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up. Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 +/- 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 +/- 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant ( p = 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid. Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only

  3. Childhood-onset bullous systemic lupus erythematosus.

    Science.gov (United States)

    Lourenço, D M R; Gomes, R Cunha; Aikawa, N E; Campos, L M A; Romiti, R; Silva, C A

    2014-11-01

    Bullous systemic lupus erythematosus has rarely been described in pediatric lupus population and the real prevalence of childhood-onset bullous systemic lupus erythematosus has not been reported. From January 1983 to November 2013, 303 childhood-onset SLE (c-SLE) patients were followed at the Pediatric Rheumatology Unit of the Childreńs Institute of Hospital das Clínicas da Faculdade de Medicina Universidade da Universidade de São Paulo, three of them (1%) diagnosed as childhood-onset bullous systemic lupus erythematosus. All three cases presented tense vesiculobullous lesions unassociated with lupus erythematosus lesions, with the median duration of 60 days (30-60). All patients fulfilled bullous systemic lupus erythematosus criteria. Two had nephritis and serositis and presented specific autoantibodies. The histological pattern demonstrated subepidermal blisters with neutrophils-predominant infiltrates within the upper dermis. Direct immunofluorescence (DIF) showed deposits of IgG and complement along the epidermal basement membrane, in the presence or absence of IgA and/or IgM. A positive indirect immunofluorescence on salt-split skin demonstrating dermal binding was observed in two cases. All of them had moderate/severe disease activity at diagnosis with median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) of 18 (14-24). Two patients received dapsone and one with severe nephritis received immunosuppressive drugs. In conclusion, in the last 30 years the prevalence of bullous lupus in childhood-onset lupus population was low (1%) in our tertiary University Hospital. A diagnosis of SLE should always be considered in children with recurrent tense vesiculobullous lesions with or without systemic manifestations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. In vivo morphology of the limbal palisades of vogt correlates with progressive stem cell deficiency in aniridia-related keratopathy.

    Science.gov (United States)

    Lagali, Neil; Edén, Ulla; Utheim, Tor Paaske; Chen, Xiangjun; Riise, Ruth; Dellby, Anette; Fagerholm, Per

    2013-08-07

    To investigate morphologic alterations in the limbal palisades of Vogt in a progressive form of limbal stem cell deficiency. Twenty Norwegian subjects (40 eyes) with congenital aniridia and 9 healthy family members (18 eyes) without aniridia were examined. Clinical grade of aniridia-related keratopathy (ARK) was assessed by slit-lamp biomicroscopy, and tear production and quality, corneal thickness, and sensitivity were additionally measured. The superior and inferior limbal palisades of Vogt and central cornea were examined by laser scanning in vivo confocal microscopy (IVCM). In an aniridia patient with grade 0 ARK, a transparent cornea and normal limbal palisade morphology were found. In grade 1 ARK, 5 of 12 eyes had degraded palisade structures. In the remaining grade 1 eyes and in all 20 eyes with stage 2, 3, and 4 ARK, palisade structures were absent by IVCM. Increasing ARK grade significantly correlated with reduced visual acuity and corneal sensitivity, increased corneal thickness, degree of degradation of superior and inferior palisade structures, reduced peripheral nerves, increased inflammatory cell invasion, and reduced density of basal epithelial cells and central subbasal nerves. Moreover, limbal basal epithelial cell density and central corneal subbasal nerve density were both significantly reduced in aniridia compared to healthy corneas (P = 0.002 and 0.003, respectively). Progression of limbal stem cell deficiency in aniridia correlates with degradation of palisade structures, gradual transformation of epithelial phenotype, onset of inflammation, and a corneal nerve deficit. IVCM can be useful in monitoring early- to late-stage degenerative changes in stem cell-deficient patients.

  5. Epidermal naevi and bullous aplasia cutis congenita in a neonate.

    Science.gov (United States)

    Fryburg, J S; Greer, K E

    1993-01-01

    The case of a neonate with cutaneous lesions consistent with epidermal naevi is presented. In addition to typical epidermal naevi, this baby had an unusual, bullous form of aplasia cutis congenita. Although aplasia cutis has been described as bullous and has been found in association with the epidermal naevus syndrome, both of these occurrences are rare in medical publications. This case illustrates an unusual presentation of epidermal naevi with bullous aplasia cutis congenita and raises difficult diagnostic and counselling issues. Images PMID:8301655

  6. Bullous Pemphigoid as a Harbinger of Metastatic Cholangiocarcinoma - A Rarity.

    Science.gov (United States)

    Mirgh, Sumeet Prakash; Jobanputra, Yash B; Sharma, Purva; Mishra, Vikas A; Shah, Virti D; Sharma, Akhilesh

    2017-05-01

    Bullous pemphigoid (BP) is an autoimmune blistering disorder of the skin first described in 1953. A decade later, antibodies were described targeting the cutaneous basement membrane zone. The association of Bullous pemphigoid with malignancy is debatable1 but reported in many case reports.2-6 We report a 79 year old male with cholangiocarcinoma that presented with bullous pemphigoid as a paraneoplastic phenomenon. © Journal of the Association of Physicians of India 2011.

  7. Bullous skin diseases: classical types of autoimmune diseases.

    Science.gov (United States)

    Damoiseaux, Jan

    2013-01-01

    The prototypic bullous skin diseases, pemphigus vulgaris, pemphigus foliaceus, and bullous pemphigoid, are characterized by the blister formation in the skin and/or oral mucosa in combination with circulating and deposited autoantibodies reactive with (hemi)desmosomes. Koch's postulates, adapted for autoimmune diseases, were applied on these skin diseases. It appears that all adapted Koch's postulates are fulfilled, and, therefore, these bullous skin diseases are to be considered classical autoimmune diseases within the wide and expanding spectrum of autoimmune diseases.

  8. Bullous pemphigoid : Serum antibody titre and antigen specificity

    NARCIS (Netherlands)

    Pas, H H; de Jong, M C; Jonkman, M F; Heeres, K; Slijper-Pal, I J; van der Meer, J B

    1995-01-01

    2 antigens have been identified as possible targets for autoantibody depositions in bullous pemphigoid: a 230-kD protein (BP230) and a 180-kD protein (BP180). We studied the relationship of these 2 antigens with the immunofluorescence determined serum antibody titre: 2 groups of bullous pemphigoid

  9. Pigmentation of the Cornea Secondary to Tinted Soft Contact Lens Wear

    OpenAIRE

    Natasha Spiteri; Anshoo Choudhary; Stephen Kaye

    2012-01-01

    Purpose. To report a case of pigmented corneal iron lines following use of tinted soft contact lenses (CL). Methods. A retrospective case report. Results. A 16-year-old girl was referred with suspected CL-related keratopathy OU, having recently switched to tinted soft monthly disposable CLs (8.4/14.0 −3.00 OD, −3.25 OS Aquamarine SofLens Natural Colours, Bausch and Lomb, New York, USA). Both corneas exhibited symmetric superficial corneal pigmented iron lines, which gradually disappeared foll...

  10. Bullous Mastocytosis Mimicking Congenital Epidermolysis Bullosa

    Directory of Open Access Journals (Sweden)

    Julio Cesar Salas-Alanis

    2014-05-01

    Full Text Available A 2-month-old female infant was referred to DebRA Mexico from the Regional Children's Hospital because of a generalized dermatosis from birth characterized by multiple blisters and erosions on the trunk, face and limbs, associated with minor trauma. A skin biopsy showing subepidermal blisters associated with a dermal infiltrate of Giemsa-positive cells and CD117-positive antibody was consistent with the diagnosis of bullous mastocytosis. Treatment with oral antihistamines, topical steroids, and antibiotics was initiated, leading to a remission of the lesions.

  11. Bullous scabies in an adult: A case report with review of literature

    Directory of Open Access Journals (Sweden)

    Rameshwar M Gutte

    2013-01-01

    Full Text Available Scabies is an infestation caused by Sarcoptes scabiei, characterized by polymorphous lesions that may include burrows, papules, nodules, excoriation, and crusts. Vesicular and bullous lesions are rather rare. Bullous scabies is regarded as a distinct subtype of scabies, closely resembling bullous pemphigoid. Here, we report a case of bullous scabies in an adult male and review the literature.

  12. The Hematologic Definition of Monoclonal Gammopathy of Undetermined Significance in Relation to Paraproteinemic Keratopathy (An American Ophthalmological Society Thesis).

    Science.gov (United States)

    Lisch, Walter; Wasielica-Poslednik, Joanna; Kivelä, Tero; Schlötzer-Schrehardt, Ursula; Rohrbach, Jens M; Sekundo, Walter; Pleyer, Uwe; Lisch, Christina; Desuki, Alexander; Rossmann, Heidi; Weiss, Jayne S

    2016-08-01

    To determine if paraproteinemic keratopathy (PPK) in the setting of monoclonal gammopathy of undetermined significance (MGUS) causes distinct patterns of corneal opacification that can be distinguished from hereditary, immunologic, or inflammatory causes. A retrospective, interventional study of patients showed distinct bilateral opacity patterns of the cornea at the eye clinics of Hanau, Mainz, Helsinki, Marburg, and Berlin between 1993 and 2015. Data on patient characteristics and clinical features on ophthalmic examination were collected, and serum protein profiles were evaluated. A literature review and analysis of all published studies of MGUS with PPK is also presented. The largest group of patients diagnosed with MGUS-induced PPK is analyzed in this study. We studied 22 eyes of 11 patients (6 male, aged 43 to 65, mean age 54; 5 female, aged 49 to 76, mean age 61) with distinct corneal opacities and visual impairment who were first suspected of having hereditary, inflammatory, or immunologic corneal entities. Subsequently, serum protein electrophoresis revealed MGUS to be the cause of the PPK. Literature review revealed 72 patients with bilateral PPK (34 male, mean age 57; 38 female, mean age 58) in 51 studies of MGUS published from 1934 to 2015 and disclosed six additional corneal opacity patterns. This thesis shows that MGUS is not always an asymptomatic disorder, in contrast to the hematologic definition, which has no hint of PPK. The MGUS-induced PPK can mimic many other diseases of the anterior layer of the eye. A new clinical classification for PPK in MGUS is proposed.

  13. Bullous pemphigoid with prominent milium formation.

    Science.gov (United States)

    Tsuruta, Daisuke; Brzezinski, Piotr; Koga, Hiroshi; Ohata, Chika; Furumura, Minao; Hashimoto, Takashi

    2013-01-01

    Milia are very common superficial keratinous cysts, clinically seen as pearly white dome-shaped lesions with a diameter of 1-2 mm. Bullous pemphigoid (BP) is an autoimmune bullous disease characterized clinically by tense bullae on the extremities and trunk. The major target autoantigens of BP are BP180 and BP230. We report a 55-year-old Polish BP patient presenting prominent milium formation. Physical examination revealed multiple tense bullae on the erythemas scattered on the extremities and trunk. Histopathology revealed subepidermal blisters with infiltration of eosinophils in and around the blister. Direct immunofluorescence showed IgG and C3 depositions at basement membrane zone. Although indirect immunofluorescence of normal human skin sections was negative, indirect immunofluorescence of salt-split skin sections showed IgG reactivity with epidermal side. Immunoblotting showed that IgG antibodies in the serum reacted with recombinant protein of the BP180 NC16a domain. ELISA of BP180, but not BP230 and type VII collagen, showed positive results. Several months after oral prednisolone therapy, multiple large milia appeared on the healed BP lesions. Histopathology showed cysts with flaky keratinous inclusions in the mid-dermis. We diagnosed the patient as BP with milia. Since milia are occasionally found in BP, they are not a definite differential criterion from epidermolysis bullosa acquisita.

  14. Bullous pemphigoid in infant post vaccination: Myth or reality?

    Science.gov (United States)

    Neri, Iria; Greco, Antonella; Bassi, Andrea; Orgaz-Molina, Jacinto; Balestri, Riccardo; Oranges, Teresa; Patrizi, Annalisa; de Martino, Maurizio

    2016-06-01

    Bullous pemphigoid is rare in children and even rarer in infants. By presenting two cases of bullous pemphigoid related by their temporal proximity with a previous episode of vaccination, it will be carefully discussed if a relationship is or is not possible. Our final conclusion is that the association is mostly a myth rather than a reality and bullous pemphigoid is not a contraindication to continue with the normal vaccination schedule of infants. It is important to know about this clinical entity in order to perform adequate treatment that avoids any worsening or future relapse of this disease. © The Author(s) 2015.

  15. Bullous Skin Diseases: Classical Types of Autoimmune Diseases

    Directory of Open Access Journals (Sweden)

    Jan Damoiseaux

    2013-01-01

    Full Text Available The prototypic bullous skin diseases, pemphigus vulgaris, pemphigus foliaceus, and bullous pemphigoid, are characterized by the blister formation in the skin and/or oral mucosa in combination with circulating and deposited autoantibodies reactive with (hemidesmosomes. Koch’s postulates, adapted for autoimmune diseases, were applied on these skin diseases. It appears that all adapted Koch’s postulates are fulfilled, and, therefore, these bullous skin diseases are to be considered classical autoimmune diseases within the wide and expanding spectrum of autoimmune diseases.

  16. Metronidazole-Induced Bullous Pemphigoid: A Case Report.

    Science.gov (United States)

    Moitra, Saibal; Sen, Sukanta; Banerjee, Indranil; Sikder, Ayan; Das, Prasanta

    2015-12-01

    Bullous pemphigoid is an autoimmune cutaneous blistering disorder, the exact pathogenesis of which is still not fully elucidated. Drug-induced bullous pemphigoid eruptions are rare but have been reported earlier with the use of frusemide, psoralens, ibuprofen, galantamine hydrobromide, ACE inhibitors like captopril, spironolactone, penicillin, ampicillin, levofloxacin, penicillamine. We hereby report a case of metronidazole induced bullous pemphigoid (BP) in a 52-year-old male patient suffering from liver abscess following 4 days of drug administration. The skin biopsy findings obtained from the patient were consistent with the diagnosis of bullous pemphigoid (BP). Metronidazole was discontinued and symptomatic treatment was offered to the patient. Following withdrawal of metronidazole, the bullae subsided in the next 7-10 days without any significant residual scarring. The causality assessment performed as per the Naranjo algorithm revealed the case to be probable (Naranjo score 7).

  17. Spectrum of autoimmune bullous diseases in Kuwait.

    Science.gov (United States)

    Nanda, Arti; Dvorak, Richard; Al-Saeed, Khloud; Al-Sabah, Humoud; Alsaleh, Qasem A

    2004-12-01

    Autoimmune bullous diseases (ABDs) are a rare but significant group of dermatoses that pose great challenges to the treating dermatologist. Most epidemiological studies have focused on a single ABD. Few surveys have been carried out to describe the whole spectrum of ABDs in a region, and no such studies are available from the Arabian Peninsula. To determine the clinico-epidemiological features of various ABDs in Kuwait, and to compare the results with those reported elsewhere. A total of 128 cases of ABDs were studied over a span of 11.5 years. The diagnosis in all cases was confirmed by histopathology, and direct and indirect immunofluorescence (IMF). The diagnosis of various subepidermal ABDs was further confirmed by indirect IMF on salt-split skin (SSS) and that of pemphigus by desmoglein 1 and 3 enzyme-linked immunosorbent assay (ELISA). Eighty seven per cent of patients were of Arab ethnicity. Pemphigus was observed to be the commonest ABD (47%), followed by pemphigoid (22%), pemphigoid gestationis (PG) (19%), linear IgA bullous disease (LABD) (7%), lichen planus pemphigoides (LPP) (3%), and epidermolysis bullosa acquisita (EBA) (2.3%). The minimum estimated incidence in the local population was 4.6, 2.14, 1.83, 0.69, 0.30, and 0.23 cases per million per year, respectively. Pemphigus patients were observed to have a younger age of onset (36.50 +/- 11.36 years) than reported elsewhere. BP, although the second commonest ABD, was less prevalent than in Europe and Singapore, and BP patients were observed to have a striking female predominance (85%). The prevalence of PG was much higher than that reported elsewhere. LABD was the fourth commonest ABD, and 89% of patients were children. The study suggests that similar surveys from different regions would expand our understanding of ABD.

  18. Facts about the Cornea and Corneal Disease

    Science.gov (United States)

    ... the Cornea and Corneal Disease Facts About the Cornea and Corneal Disease What is the cornea? The cornea is the eye’s outermost layer. It ... your vision. What are the parts of the cornea? Although the cornea may look clear and seem ...

  19. Bullous Pemphigoid Masquerading as Erythema Annulare Centrifugum.

    Science.gov (United States)

    Yu-Yang, Shiang; Chu-Sung Hu, Stephen; Yiao-Lin, Sheng

    2017-10-01

    Dear Editor, Bullous pemphigoid (BP), a relatively common autoimmune blistering disease in the elderly, is characterized by large, tense bullae on urticarial, erythematous, or normal skin. However, atypical BP with polymorphic clinical presentations is rarely encountered, leading to misdiagnosis and delayed treatments (1). BP with lesions resembling erythema gyratum repens or figurate erythema has been regarded as a paraneoplastic phenomenon (1). Herein we report a case with erythema annulare centrifugum-like presentation of BP without evidence of underlying malignancy. A 64-year-old woman first presented with multiple large, tense bullae on the trunk and four extremities. She was diagnosed with BP according to the typical clinical, histopathological, and direct immunofluorescence findings. There were no annular lesions at that time. After a treatment course of systemic corticosteroids and azathioprine, the cutaneous symptoms were controlled. One year after discontinuing her medications, a pruritic bullous eruption reappeared with several annular erythematous plaques (Figure 1, a). The patient reported no mucosal involvement and took no new medications before the onset of skin lesions. On physical examination, multiple circular and arcuate erythematous lesions with slightly raised borders were seen on the trunk and both legs. Some erosions and tiny vesicles were noted on the erythematous edges. There were no other systemic symptoms or abnormalities. Laboratory studies, including complete blood count, liver and renal function tests, electrolytes, antinuclear antibody, complement levels, anti-Ro and anti-La antibodies, urine routine, stool routine, and chest X-ray, were normal. The biopsy specimen obtained from the rim of the annular lesions revealed slight vacuolar change at the dermoepidermal junction and perivascular and interstitial lymphocytic infiltration with numerous eosinophils in the upper dermis (Figure 1, b). Direct immunofluorescence showed linear

  20. Bullous impetigo caused by Streptococcus salivarius: a case report.

    Science.gov (United States)

    Brook, I

    1980-01-01

    A 19-month-old child presented with bullous impetigo around the perineal region, penis, and left foot. Streptococcus salivarius was the only isolate recovered from the lesions. The child was treated with parenteral penicillin, debridement of the bulli, and local application of silver sulphadiazine cream. This case of bullous impetigo illustrates another aspect of the pathogenicity of Strep. salivarius. Images Fig. 1 Fig. 2 PMID:7002959

  1. The cornea in measles

    NARCIS (Netherlands)

    N.W.H.M. Dekkers (Nico)

    1981-01-01

    textabstractThe involvement of the cornea in the acute stage of measles is the subject of the present study. The best study on the measles-keratitis now available is still the one by Trantas in 1903. It seems wo.:thwhile therefore to study this self-limiting keratitis with the investigative tools

  2. CORNEA AND ANTERIOR SEGMENT

    African Journals Online (AJOL)

    2016-11-04

    Nov 4, 2016 ... 24. Nigerian Journal of Ophthalmology / Supplement 1 - 2014 - Volume 22. S24. CORNEA AND ANTERIOR SEGMENT. A Comparison of Visual Outcomes after Extracapsular Cataract. Surgery and Phacoemulsification in Eye Foundation Hospital. Lagos Nigeria. Oderinlo O. O., Hassan A. O., Oluyadi F. O., ...

  3. Neurotrophic Keratopathy: Therapeutic Approach Using a Novel Matrix Regenerating Agent.

    Science.gov (United States)

    Guerra, Marta; Marques, Sara; Gil, João Quadrado; Campos, Joana; Ramos, Paula; Rosa, Andreia Martins; Quadrado, Maria João; Murta, Joaquim Neto

    2017-11-01

    To evaluate the efficacy and tolerance of a new matrix-regenerating agent (RGTA), Cacicol ® , a polymer that mimics heparan sulfates bound to extracellular matrix proteins, avoiding its proteolysis, to treat neurotrophic keratopathy (NK). Uncontrolled prospective clinical study performed between January 2014 and May 2016. Twenty-five patients (25 eyes) with corneal neurotrophic ulcers, nonresponsive to at least 2 weeks of conservative therapy, were treated with Cacicol, instilled once/twice a week. During follow-up, slit-lamp examination, anterior segment photography, fluorescein-dye testing, and best-corrected visual acuity were analyzed. Ulcer evolution was evaluated using image analysis software (ImageJ ® ) and healing defined as decrease of the corneal ulcer area. An independent observer measured ulcer area. All patients had complete corneal healing within an average of 4.13 ± 2.32 weeks. Mean ulcer area decreased significantly (P = 0.001) from 16.51% ± 18.56% (1st day) to 8.68% ± 11.25% at the 7th day and to 4.73% ± 10.75% at the 14th day. Compared with day 1, mean ulcer area decreased 60.24% after 7 days (P = 0.001), 54.92% after 14 days (P = 0.059), and 83.00% after 21 days (P = 0.003). Two cases of recurrence (8.0%) were registered. No systemic or local side effects were noticed. The new regenerating agent, Cacicol, represents an effective and safe therapy to treat NK.

  4. Postpartum bullous pemphigoid – A case report

    Directory of Open Access Journals (Sweden)

    Malar Nisha Raveendran

    2017-04-01

    Full Text Available Bullous pemphigoid (BP is an acquired autoimmune blistering disease occurring in the elderly more than 70 years of age though may occur during young age and childhood. BP is categorized by the development of urticarial plaques surmounted by sub epidermal blisters, and the deposition of immunoglobulin and complement at the basement membrane zone (BMZ of the skin. BP is associated with other diseases, such as diabetes mellitus, thyroid disorders, rheumatoid arthritis and malignancies. Heat shock proteins (HSP are a family of proteins that are produced by cells in response to exposure to stressful conditions. Heat shock protein 90 (HSP90 inhibitors potentially target for the autoimmune disease and chronic inflammatory diseases. We present a case of 21 year old lactating female, a known case of hyperthyroidism with an abrupt onset of fluid filled vesicles and bullae over the abdomen and limbs since 3 days associated with itching. She had similar episodes before and was diagnosed and treated for BP. She had a flare up of the disease due to the personal stress in the patient as Heat shock proteins plays an important role in the pathophysiology of BP. Following treatment upon continuous follow ups, there were no flare up of the disease. Here in this patient, apart from hypothyroidism, stress also acts as a trigger in BP.

  5. Medical image of the week: bullous emphysema

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    Tey KR

    2016-04-01

    Full Text Available No abstract available. Article truncated at 150 words. A 63-year-old gentleman, with a history of 90-pack-years of smoking and stage IV chronic obstructive pulmonary disease was receiving home oxygen at 2 L/min at baseline. He has had multiple prior hospital admissions for respiratory failure. Over the past 2 weeks he has had increased production of sputum, associated with worsening shortness of breath. He is on fluticasone-salmeterol inhaler, albuterol inhaler, and tiotropium as an outpatient. On examination, he was hemodynamically stable, SpO2 was 92% on 4L/min of oxygen. He was in obvious respiratory distress, in a tripod position with tachypnea and using respiratory accessory muscles. Lung examination revealed diffuse expiratory wheezing. Chest radiograph shows severe emphysema (Figure 1. Chest computed tomography showed diffuse centrilobular and bullous emphysema (Figure 2. He was treated as an acute severe exacerbation of COPD and was eventually discharged to follow-up with the pulmonary clinic. Emphysema is defined as alveolar destruction and airspace enlargement distal ...

  6. Diffuse Bullous Eruptions in an Elderly Woman: Late-Onset Bullous Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Prajwal Boddu

    2016-10-01

    Full Text Available Vesiculobullous eruptions in the elderly represent a diverse range of varying pathophysiologies and can present a significant clinical dilemma to the diagnostician. Diagnosis requires a careful review of clinical history, attention to detail on physical and histomorphological examination, and appropriate immunofluorescence testing. We describe the case of a 73-year-old female who presented to our hospital with a painful blistering skin rash developed over 2 days. Examination of the skin was remarkable for numerous flaccid hemorrhagic bullae on a normal-appearing nonerythematous skin involving both the upper and lower extremities. Histopathology of the biopsy lesion showed interface change at the epidermo-dermal region with subepidermal blister formation, mild dermal fibrosis, and sparse interstitial neutrophilic infiltrate. Immunohistological analysis was significant for positive IgG basement membrane zone antibodies with a dermal pattern of localization on direct immunofluorescence and positive IgG antinuclear antibodies on indirect immunofluorescence. Evidence of antibodies to type VII collagen suggested the diagnosis of epidermolysis bullosa acquisita versus bullous systemic lupus erythematosus (BSLE. A diagnosis of BSLE was made based on positive American College of Rheumatology criteria, acquired vesiculo-bullous eruptions with compatible histopathological and immunofluorescence findings. This case illustrates one of many difficulties a physician encounters while arriving at a diagnosis from a myriad of immunobullous dermatoses. Also, it is important for internists and dermatologists alike to be aware of and differentiate this uncommon and nonspecific cutaneous SLE manifestation from a myriad of disorders presenting with vesiculobullous skin eruptions in the elderly.

  7. Clinical Relevance of Autoantibodies in Patients with Autoimmune Bullous Dermatosis

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    Lilla Mihályi

    2012-01-01

    Full Text Available The authors present their experience related to the diagnosis, treatment, and followup of 431 patients with bullous pemphigoid, 14 patients with juvenile bullous pemphigoid, and 273 patients with pemphigus. The detection of autoantibodies plays an outstanding role in the diagnosis and differential diagnosis. Paraneoplastic pemphigoid is suggested to be a distinct entity from the group of bullous pemphigoid in view of the linear C3 deposits along the basement membrane of the perilesional skin and the “ladder” configuration of autoantibodies demonstrated by western blot analysis. It is proposed that IgA pemphigoid should be differentiated from the linear IgA dermatoses. Immunosuppressive therapy is recommended in which the maintenance dose of corticosteroid is administered every second day, thereby reducing the side effects of the corticosteroids. Following the detection of IgA antibodies (IgA pemphigoid, linear IgA bullous dermatosis, and IgA pemphigus, diamino diphenyl sulfone (dapsone therapy is preferred alone or in combination. The clinical relevance of autoantibodies in patients with autoimmune bullous dermatosis is stressed.

  8. Features of oral, pharyngeal, and laryngeal lesions in bullous pemphigoid.

    Science.gov (United States)

    Ohki, Masafumi; Kikuchi, Shigeru; Ohata, Atsushi; Baba, Yuka; Ishikawa, Junichi; Sugimoto, Hirohito

    2016-01-01

    Bullous pemphigoid is an autoimmune bullous disease characterized by skin lesions, with or without oral lesions. The occurrence of pharyngolaryngeal lesions is very rare in affected patients. We conducted a study to investigate the characteristics of oral and pharyngolaryngeal lesions in bullous pemphigoid. Our study population was made up of 6 consecutively presenting outpatients-2 men and 4 women, aged 40 to 83 years (mean: 68.2)-who had been referred to our department over an 11-year period. Presenting symptoms included sore throat in all 6 patients and oral pain in 3. The sites of mucosal lesions included the soft palate, epiglottis, gingiva, hypopharynx, tongue, nasal cavity, and buccal mucosa. These lesions appeared as erosions, erosions with white coating, erythematous patches, and/or blisters. Mucosal lesions preceded skin lesions in 2 patients, appeared after skin lesions in 1 patient, and appeared simultaneously with skin lesions in 3 patients. We conclude that bullous pemphigoid sometimes involves the mucosa, such as that of the laryngopharynx and the oral cavity, and it can manifest as skin lesions. In the differential diagnosis of refractory pharyngolaryngeal lesions, bullous pemphigoid should be considered.

  9. A case of multiple myeloma presenting as a bullous dermatosis

    Directory of Open Access Journals (Sweden)

    Gul Ulker

    2008-01-01

    Full Text Available Multiple myeloma is a malignant plasma cell proliferative disorder that produces a monoclonal immunoglobulin protein. The skin involvement and the development of bullous disease are rarely seen features in multiple myeloma. We present a 55-year-old man with a longstanding, large, tense bullous eruption and hypertrophic scars over his body accompanied recently with weight loss and fatique. He had no response to the previous treatments, which included oral glucocorticoids and dapsone. Histologic examination of the lesions revealed subepidermal bullae, while no immunoflourescence staining was observed. In a further detailed labarotory examination, multiple myeloma was detected. After the treatment of multiple myeloma with chemotherapy, the lesions regressed. Patients with longstanding, recurrent, unusual bullous eruption should be investigated for the development of multiple myeloma.

  10. [Small cell lung cancer associated with paraneoplastic bullous pemphigoid].

    Science.gov (United States)

    Lakhdar, N; El Khattabi, W; Lahroussi, M; Afif, H; Aichane, A

    2014-06-01

    The broncho-pulmonary small cell carcinoma is the most common cancer provider paraneoplastic syndrome especially neurological and endocrine but also cutaneous syndrome. Paraneoplastic dermatosis do not result from a direct extension of cancer and are not metastases, but their presence is suggestive of an underlying tumor. The evolution of the dermatosis is parallel to that of cancer: treating cancer results in the regression of cutaneous manifestations. We report an observation of a 44-year-old smoker, who was hospitalized for a tissue excavated process associated with bullous dermatosis. The transmural puncture biopsy finds small cell carcinoma. The skin biopsy objective bullous pemphigoid. The evolution under chemotherapy was marked regression of bullous lesions and the patient died later after metastatic extension. Cutaneous paraneoplastic syndrome appears only in a minority of cancer patients, but its recognition is very important for early diagnosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Infectious complications in bullous pemphigoid: an analysis of risk factors.

    Science.gov (United States)

    Phoon, Yee Wei; Fook-Chong, Stephanie M C; Koh, Hong Yi; Thirumoorthy, Thamotharampillai; Pang, Shiu Ming; Lee, Haur Yueh

    2015-05-01

    Infections are common in bullous pemphigoid and contribute to significant mortality. We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort. A retrospective cohort study conducted at an academic medical center. In all, 97 patients were included. Infectious complications occurred in 54 patients (56%) and the median duration from diagnosis to first episode of infection was 3 months. Bacteremia occurred in 14 patients (26%) and 26 of 30 deaths (87%) were attributable to infections. On univariate analysis, significant risk factors include low Karnofsky score (risk factors for infectious complications include functional impairment and the presence of dementia, which may allow for better risk stratification and individualized treatment of bullous pemphigoid. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Bullous Kaposiform Hemangioendothelioma Masquerading as Aplasia Cutis Congenita.

    Science.gov (United States)

    Steen, Aaron J; Shin, Joseph H; Pace, Nicole C; Edgar, Mark; Clay, Michael R; Linos, Konstantinos; Barton, Dorothea T; Mann, Julianne A

    2016-09-01

    We present the case of a male infant with violaceous bullae on the scalp that were initially thought to be bullous aplasia cutis but at 3 months of age were diagnosed as a kaposiform hemangioendothelioma. This diagnosis should be considered when evaluating newborns with bullous plaques on the scalp that do not heal in the first 2-3 weeks of life. Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor that typically presents as a violaceous to purpuric plaque at birth or early infancy. It may be associated with Kasabach-Merritt phenomenon (KMP), a potentially life-threatening consumptive coagulopathy. © 2016 Wiley Periodicals, Inc.

  13. Regenerative approaches for the cornea.

    Science.gov (United States)

    Griffith, M; Alarcon, E I; Brunette, I

    2016-09-01

    The cornea is the transparent front part of the eye that transmits light to the back of the eye to generate vision. Loss of corneal transparency, if irreversible, leads to severe vision loss or blindness. For decades, corneal transplantation using human donor corneas has been the only option for treating corneal blindness. Despite recent improvement in surgical techniques, donor cornea transplantation remains plagued by risks of suboptimal optical results and visual acuity, immune rejection and eventually graft failure. Furthermore, the demand for suitable donor corneas is increasing faster than the number of donors, leaving thousands of curable patients untreated worldwide. Here, we critically review the state of the art of biomaterials for corneal regeneration. However, the lessons learned from the use of the cornea as a disease model will allow for extension of the biomaterials and techniques for regeneration of more complex organs such as the heart. © 2016 The Association for the Publication of the Journal of Internal Medicine.

  14. Bullous impetigo associated with Abiotrophia defectiva in an immunocompetent adult.

    Science.gov (United States)

    Anderson, Heather M; Miller, Cathy; Kemp, Earl; Huntington, Mark K

    2012-07-01

    Infection of humans by Abiotrophia defectiva, a nutritionally variant streptococcus, most commonly takes the form of endocarditis, though a variety of other manifestations ranging from central nervous system abscesses to orthopaedic infections have been seen. We report here what we believe is the first case of bullous impetigo associated with this organism.

  15. Bullous pemphigoid resembling erythema gyratum repens – case report

    Directory of Open Access Journals (Sweden)

    Małgorzata P. Dominiak

    2017-09-01

    Full Text Available Introduction. Bullous pemphigoid is one of the most common autoimmune bullous dermatoses. It is typically diagnosed in elderly patients and can have various clinical presentations. So far, only individual cases of erythema gyratum repens-like bullous pemphigoid have been described in literature worldwide. Objective. Presentation of the case of a patient with bullae forming a wood grain arrangement. Case report. A 76-year-old female patient hospitalised at the Department of Dermatology with erythematous and edematous figurate lesions and tense bullae on the trunk and extremities. On direct immunofluorescence, complement deposits at the basement membrane zone were found. BIOCHIP indirect immunofluorescence revealed circulating anti-BP180 IgG antibodies. Conclusions . In patients with suspected bullous pemphigoid, direct and indirect immunofluorescence assays are required. As part of the diagnosis of both pemphigoid and erythema gyratum repens, malignancy needs to be excluded as a potential cause of skin lesions. In the presented patient, medical history and additional tests did not demonstrate the presence of a neoplasm. The patient requires further clinical follow-up.

  16. BULLOUS PEMPHIGOID SUCCESSFULLY CONTROLLED BY TETRACYCLINE AND NICOTINAMIDE

    NARCIS (Netherlands)

    KOLBACH, DN; REMME, JJ; BOS, WH; JONKMAN, MF; DEJONG, MCJM; PAS, HH; VANDERMEER, JB

    In 1986, Berk and Lorincz reported the efficacy of tetracycline and nicotinamide in the treatment of bullous pemphigoid (BP). In the present study of seven patients with BP, we found that a regimen of 2 g tetracycline combined with 2 g nicotinamide daily was effective in clearing the skin lesions.

  17. Dapsone in the management of autoimmune bullous diseases.

    Science.gov (United States)

    Piette, Evan W; Werth, Victoria P

    2012-05-01

    Dapsone is used in the treatment of autoimmune bullous diseases (AIBD), a group of disorders resulting from autoimmunity directed against basement membrane and/or intercellular adhesion molecules on cutaneous and mucosal surfaces. This review summarizes the limited published data evaluating dapsone as a therapy for AIBD. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Dapsone in the management of the autoimmune bullous diseases

    Science.gov (United States)

    Piette, Evan W.

    2013-01-01

    Synopsis Dapsone is occasionally used in the treatment of the autoimmune bullous diseases, a group of disorders resulting from autoimmunity directed against basement membrane and/or intercellular adhesion molecules on cutaneous and mucosal surfaces. This review will summarize the limited published data evaluating dapsone as a therapy for the AIBD. PMID:22560144

  19. Bullous Lichen Planus in an Indian female | Puri | Sudanese Journal ...

    African Journals Online (AJOL)

    We describe bullous lichen planus in an. Indian female who had itchy erythematous papular lesions with vesicles and bullae predominantly over the dorsa of both legs. The patient was subjected to histopathological examination after which the diagnosis was confirmed. The patient was put on oral steroids and dapsone.

  20. Pigmentation of the cornea secondary to tinted soft contact lens wear.

    Science.gov (United States)

    Spiteri, Natasha; Choudhary, Anshoo; Kaye, Stephen

    2012-01-01

    Purpose. To report a case of pigmented corneal iron lines following use of tinted soft contact lenses (CL). Methods. A retrospective case report. Results. A 16-year-old girl was referred with suspected CL-related keratopathy OU, having recently switched to tinted soft monthly disposable CLs (8.4/14.0 -3.00 OD, -3.25 OS Aquamarine SofLens Natural Colours, Bausch and Lomb, New York, USA). Both corneas exhibited symmetric superficial corneal pigmented iron lines, which gradually disappeared following discontinuation of CL wear. Conclusions. Pigmented corneal rings have been reported in normal ageing corneas, in certain pathological conditions, and in association with altered corneal topography following LASIK and orthokeratology. We suspect a poorly fitting CL resulted in localised tear pooling between the CL and cornea, and subsequent iron pigment deposition, similar to that seen with orthokeratology. Cosmetic CLs bought via the Internet can be used in an unsupervised manner, with possible impacts on visual function and potential complications.

  1. Pigmentation of the Cornea Secondary to Tinted Soft Contact Lens Wear

    Directory of Open Access Journals (Sweden)

    Natasha Spiteri

    2012-01-01

    Full Text Available Purpose. To report a case of pigmented corneal iron lines following use of tinted soft contact lenses (CL. Methods. A retrospective case report. Results. A 16-year-old girl was referred with suspected CL-related keratopathy OU, having recently switched to tinted soft monthly disposable CLs (8.4/14.0 −3.00 OD, −3.25 OS Aquamarine SofLens Natural Colours, Bausch and Lomb, New York, USA. Both corneas exhibited symmetric superficial corneal pigmented iron lines, which gradually disappeared following discontinuation of CL wear. Conclusions. Pigmented corneal rings have been reported in normal ageing corneas, in certain pathological conditions, and in association with altered corneal topography following LASIK and orthokeratology. We suspect a poorly fitting CL resulted in localised tear pooling between the CL and cornea, and subsequent iron pigment deposition, similar to that seen with orthokeratology. Cosmetic CLs bought via the Internet can be used in an unsupervised manner, with possible impacts on visual function and potential complications.

  2. Keratopathy, cataract, and dry eye in a survey of aniridia subjects

    Directory of Open Access Journals (Sweden)

    Shiple D

    2015-02-01

    Full Text Available David Shiple,1 Brenton Finklea,1 James D Lauderdale,2 Peter A Netland1 1Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA; 2Department of Cellular Biology, University of Georgia, Athens, GA, USA Purpose: To determine the prevalence of keratopathy, cataract, and dry eye in a group of individuals with aniridia. Methods: We reviewed survey data from the Aniridia Foundation International (AFI registry, which included 99 subjects who self-reported on corneal disease, cataract, and dry eye disease. Results: The average age of respondents was 25.3±18.6 years, with a range of 0 to 67. Of 99 subjects, 46% stated they have corneal disease, 32% stated they did not, and 22% were unsure. The average age of diagnosis of keratopathy was 20.0±12.2 years. Keratolimbal allograft was reported in 20% and penetrating keratoplasty in 9%. Cataract was reported in 65%, with an average age of 9.4±14.0 years at time of diagnosis, and cataract surgery was reported in 32%. The average age of subjects at the time of cataract and corneal surgery was 28.4±13.7 and 33.5±11.4 years, respectively. Symptomatic dry eye was reported in 56% of subjects, with an average age at diagnosis of 23.8±13.3 years. Conclusion: There is a high prevalence of corneal disease in aniridia, with diagnosis in late childhood or early adulthood in nearly one-half of subjects, often requiring corneal surgery. Cataract and dry eye are commonly associated with aniridia. Although aniridia subjects may have been aware of the diagnosis of cataract at an early age, they usually were treated for cataract and keratopathy as adults. Keywords: aniridic keratopathy, ocular surface disease, corneal disease, keratolimbal allograft

  3. Spheroidal Degeneration of the Cornea

    OpenAIRE

    Erdem Dinç; Ufuk Ad›güzel; Bahri Ayd›n; İdil Göksel; Özlem Y›ld›r›m

    2011-01-01

    A thirty-one-year-old male patient presented with bilateral epiphora and stinging sensation in the cornea. Detailed history revealed that a bilateral corneal scraping had been made regarding the initial diagnosis of fungal keratitis. His bestcorrected visual acuities were 20/20 and 20/30 in right and left eyes, respectively. Biomicroscopy showed bilateral amber colored spherules in the anterior stroma of the central cornea. The diagnosis of spheroidal corneal degeneration was esta...

  4. Intertriginous bullous morphea: A clue for the pathogenesis?

    Directory of Open Access Journals (Sweden)

    Kavala Mukaddes

    2007-01-01

    Full Text Available Bullae occurring in lesions of morphea are uncommon. The cause of bullae formation in morphea is multifactorial, although lymphatic obstruction from the sclerodermatous process is considered the likeliest cause. Bullous morphea may be confused clinically with lichen sclerosus et atrophicus since both diseases may cause bullae in sclerodermatous plaques. A 69-year-old woman presented with a history of generalized morphea diagnosed 9 years earlier; and a 1-month history of pruritic bullae on her inframammary folds, axillary regions, lower abdomen, upper extremities and inguinal folds. Physical examination revealed multiple erythematous erosions, hemorrhagic vesicles and eroded bullae with slight scale or crusts overlying hypopigmented, indurated, shiny plaques. Skin biopsy revealed prominent edema in the papillary dermis, resulting in bulla formation and thickening of collagen fibers within the dermis. Direct immunofluorescence was negative. According to histologic and clinical features, the diagnosis of bullous morphea was established.

  5. A case of bullous pemphigoid ınduced by vildagliptin.

    Science.gov (United States)

    Keseroglu, Havva Ozge; Taş-Aygar, Gamze; Gönül, Müzeyyen; Gököz, Ozay; Ersoy-Evans, Sibel

    2017-06-01

    Bullous pemfigoid (BP), an autoimmune disorder, can also be induced by some medications. Vildagliptin is a new drug used to treat diabetes mellitus (DM). Recently, a few cases of vildagliptin-induced BP have been described in the literature. We report a patient with BP in which vildagliptin was thought to be as a possible causative agent. The awareness of BP development risk during gliptin therapy can prevent unnecessary usage of systemic drugs with serious side effects.

  6. Annular bullous lesions with atypical erythema multiforme in leprosy.

    Science.gov (United States)

    Shah, Aishani; Mahajan, Rashmi; Ninama, Kishan; Bilimoria, Freny

    2014-09-01

    Erythema nodosum leprosum (ENL) is an immune complex-mediated reaction that may complicate the course of multibacillary leprosy. Bullous lesions in Type II reaction, though reported, are exceedingly rare. We report the case of a 32 year old female patient who presented initially at our OPD with erythema nodosum. Cutaneous examination revealed impaired sensation over dorsum of right foot and thickened right lateral popliteal nerve. Slit skin smear (SSS) from ear lobes revealed AFB with a bacteriological index of 2+. She was started on MDT, tablet ofloxacin 200 mg twice a day, and 30 mg oral prednisolone. Two months later, she presented with generalised pruritus, large target lesions over the back, and hemorrhagic bullae over lower extremities and annular pattern of bullae, over both arms. A SSS was repeated which was positive for AFB. Histopathology from bullous lesions was consistent with ENL. Direct Immunofluorescence (DIF) study was negative. Our patient improved rapidly after she was started on thalidomide 100 mg twice daily, with withdrawal of ofloxacin. Erythema Multiforme (EMF) and annular bullous lesions have been reported in patients on treatment with ofloxacin. This case is being presented due to the unusual and varied manifestation of Type II lepra reaction in a 34 year old female patient.

  7. Autoimmune bullous skin diseases. Part 1: Clinical manifestations.

    Science.gov (United States)

    Kneisel, Andrea; Hertl, Michael

    2011-10-01

    Autoimmune bullous skin diseases are characterized by autoantibodies against adhesion molecules of the skin. Pemphigus is a disorder with an intraepidermal loss of adhesion and is characterized by fragile blisters and erosions. Pemphigus vulgaris often shows extensive lesions of the oral mucosa, while pemphigus foliaceus is commonly restricted to cutaneous involvement with puff pastry-like scale formation. Paraneoplastic pemphigus is obligatorily associated with malignancies and often presents as hemorrhagic stomatitis with multiforme-like exanthems. IgA pemphigus typically presents with pustules and annular plaques but not with mucosal involvement. The clinical spectrum of the pemphigoids includes tense blisters, urticarial plaques, and prurigo- like eczematous lesions. Pemphigoid gestationis mostly occurs during the last trimester of pregnancy and mucous membrane pemphigoid primarily involves the oral mucosa and conjunctivae and leads to scarring. Linear IgA bullous dermatosis manifests with tense blisters in a "cluster of jewels"-like pattern in childhood and is more heterogeneous in adulthood. Classical epidermolysis bullosa acquisita shows extensive skin fragility. Dermatitis herpetiformis is associated with gluten-sensitive enteropathy and manifests clinically with severe itching and papulovesicles on the extensor surfaces of the extremities and the lumbosacral area. The intention of the review is to demonstrate the heterogeneous clinical spectrum of autoimmune bullous disorders. © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.

  8. Successful treatment of bullous lichen planus with acitretin monotherapy. Review of treatment options for bullous lichen planus and case report.

    Science.gov (United States)

    Rallis, Efstathios; Liakopoulou, Angeliki; Christodoulopoulos, Constantinos; Katoulis, Alexandros

    2016-12-31

    Bullous lichen planus (BLP) is a rare variant of lichen planus, characterized by the development of vesicular and bullous lesions, of skin, nails, hair and/or mucosa. We present a case of 63-year-old woman with BLP, unresponsive to previous therapies with topical corticosteroids, topical calcipotriol, antihistamines and oral cyclosporine (4 mg/kg/day for 4 months). She was already receiving treatment for arterial hypertension, hyperlipidemia, atrial fibrillation and uncontrolled diabetes mellitus. Acitretin was administered for 5 months with complete remission of BLP lesions and no major side effects. This is probably the first reported case of BLP treated with acitretin monotherapy. In this case acitretin was an efficacious and well-tolerated therapeutic option for BLP.

  9. Bullous pemphigoid in a leg affected with hemiparesia: a possible relation of neurological diseases with bullous pemphigoid?

    Science.gov (United States)

    Foureur, N; Descamps, V; Lebrun-Vignes, B; Picard-Dahan, C; Grossin, M; Belaich, S; Crickx, B

    2001-01-01

    We report a typical case of bullous pemphigoid (BP) associated with a neurological disorder and study a possible link between neurological disorders and BP. An 84-year-old hemiplegic woman presented with unilateral BP on the hemiparetic side. BP was confirmed by histological and immunofluorescence data. The medical records of the previous 46 consecutive patients with BP were retrospectively analyzed (average age: 79; median age: 85). Thirty of the 46 patients with BP had neurological disorders. These disorders included dementia, epilepsy, multiple sclerosis, cerebral stroke, Parkinson's disease, gonadotropic adenoma, trembling, dyskinesia, lumbar spinal stenosis. In a control group of the 46 consecutive oldest patients (older than 71; average age: 82,5; median age: 80) with another skin disease referred during the previous two-year-period to our one-day-unit only, 13 patients had a neurological disorder. This study demonstrates that there is a high prevalence of neurological disorders in patients with BP (p = 0.0004). A prospective case control study with neurological examination and psychometrical evaluation is warranted to confirm these data. We speculate that neuroautoimmunity associated with the aging process or neurological disorders may be involved in pemphigoid development via an autoimmune response against dystonin which shares homology with bullous pemphigoid antigen 1. Bullous pemphigoid could be considered to be a marker of neurological disorder.

  10. Efeito terapêutico do "cross-linking" corneano na ceratopatia bolhosa sintomática Therapeutic effect of corneal cross-linking on symptomatic bullous keratophaty

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    Diego Nery Benevides Gadelha

    2009-08-01

    Full Text Available OBJETIVO: Avaliar o efeito do "cross-linking" corneano na ceratopatia bolhosa sintomática e seu impacto na acuidade visual, espessura corneana e sintomatologia dolorosa. MÉTODOS: Doze pacientes com ceratopatia bolhosa sintomática foram incluídos. Exame clínico com questionário específico para a pesquisa com escala de dor (escala visual analógica numérica, acuidade visual e mensuração da espessura corneana foi realizada pré "cross-linking" corneano, 7, 30 e 60 dias após. Em todos os pacientes o tratamento com UVA-crosslinking foi realizado após abrasão do epitélio corneano na lâmpada de fenda e instilação de solução de riboflavina 0,1% a cada 5 minutos por 30 minutos. Após esse período o paciente foi submetido à exposição à luz ultravioleta A (UVA, utilizando riboflavina e anestesia tópica a cada 5 minutos por 30 minutos. O paciente utilizou colírios de ofloxacina 0,3% e lágrima artificial até completa reepitelização. O teste de Friedman foi usado para comparar as médias das frequências da acuidade visual, sintomatologia dolorosa e espessura central da córnea. Os valores de "p" menor que 0,05 foram considerados como estatisticamente significantes. RESULTADOS: Doze olhos de 12 pacientes com erosões epiteliais recorrentes foram tratados. O tempo de seguimento foi de dois meses. Foi observada redução significante da dor (pPURPOSE: To evaluate the corneal cross-linking (CXL effect on symptomatic bullous keratopathy, and its impact on the visual acuity, corneal thickness and pain symptomatology. METHODS: Twelve patients with symptomatic bullous keratophaty were included. A clinical examination with a specific questionnaire (pain scale - visual numeric analog scale, visual acuity, and corneal thickness measures was performed before corneal cross-linking and 7, 30 and 60 days after the procedure. In all patients, the treatment with the UVA-crosslinking was done after corneal abrasion on the slit-lamp and

  11. Keratoprosthesis. Implantation of artificial corneas.

    Science.gov (United States)

    Berta, A

    1997-01-01

    Keratoprosthesis (implantation of artificial, plastic cornea) is indicated in severe cases with corneal leucoma (non-transparent, cicatrized cornea) in which keratoplasty (corneal transplantation) is not possible or has repeatedly failed. In the past 40 years we implanted 37 artificial corneas (7 Cardona type, 29 Konstantinov type, 1 Fjodorov type). The visual acuity increase was temporary (lasting from a few weeks to a few months) in 25 patients. The visual acuity was at least 0.2 three years following the implantation of keratoprosthesis in 12 patients. One patient had 1.0 vision 10 years after surgery. Our results indicate that the implantation of artificial corneal is still an "ultimum refugium", an operation that can be justified only in monocular patients, in eyes that cannot be and/or had unsuccessfully been operated on with repeated keratoplasties. The visual improvement is temporary, but in some cases may last for several years. Still this is the only procedure by which useful vision can be provided, for shorter or longer time intervals, for patients suffering from corneal blindness (nontransparent cornea in otherwise functioning eye) whose only eye cannot be treated with corneal transplantation. Keratoprosthesis with better biocompatibility, better fixation techniques, and wider visual fields have to be developed before the implantation of artificial cornea can be looked upon as a surgical procedure with which full optical rehabilitation can be achieved.

  12. Artificial corneas versus donor corneas for repeat corneal transplants.

    Science.gov (United States)

    Akpek, Esen K; Alkharashi, Majed; Hwang, Frank S; Ng, Sueko M; Lindsley, Kristina

    2014-11-05

    Individuals who have failed one or more full thickness penetrating keratoplasties (PKs) may be offered repeat corneal surgery using an artificial or donor cornea. An artificial or prosthetic cornea is known as a keratoprosthesis. Both donor and artificial corneal transplantations involve removal of the diseased and opaque recipient cornea (or the previously failed cornea) and replacement with another donor or prosthetic cornea. To assess the effectiveness of artificial versus donor corneas in individuals who have had one or more failed donor corneal transplantations. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2013), EMBASE (January 1980 to November 2013), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to November 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 27 November 2013. Two review authors independently assessed reports from the electronic searches to identify randomized controlled trials (RCTs) or controlled clinical trials (CCTs). We resolved discrepancies by discussion or consultation with a third review author. For discussion purposes, we assessed findings from observational cohort studies and non-comparative case series. No data synthesis was performed. We did not identify any RCTs or CCTs comparing artificial corneas with donor corneas for repeat corneal transplantations. The optimal management for those individuals who have failed a conventional corneal transplantation is not known

  13. Artificial corneas versus donor corneas for repeat corneal transplants

    Science.gov (United States)

    Akpek, Esen K; Alkharashi, Majed; Hwang, Frank S; Ng, Sueko M; Lindsley, Kristina

    2014-01-01

    Background Individuals who have failed one or more full thickness penetrating keratoplasties (PKs) may be offered repeat corneal surgery using an artificial or donor cornea. An artificial or prosthetic cornea is known as a keratoprosthesis. Both donor and artificial corneal transplantations involve removal of the diseased and opaque recipient cornea (or the previously failed cornea) and replacement with another donor or prosthetic cornea. Objectives To assess the effectiveness of artificial versus donor corneas in individuals who have had one or more failed donor corneal transplantations. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2013), EMBASE (January 1980 to November 2013), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to November 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 27 November 2013. Selection criteria Two review authors independently assessed reports from the electronic searches to identify randomized controlled trials (RCTs) or controlled clinical trials (CCTs). We resolved discrepancies by discussion or consultation with a third review author. Data collection and analysis For discussion purposes, we assessed findings from observational cohort studies and non-comparative case series. No data synthesis was performed. Main results We did not identify any RCTs or CCTs comparing artificial corneas with donor corneas for repeat corneal transplantations. Authors

  14. The use of skin substrates deficient in basement membrane molecules for the diagnosis of subepidermal autoimmune bullous disease

    NARCIS (Netherlands)

    Vodegel, RM; Kiss, M; De Jong, MCJM; Pas, HH; Altmayer, A; Molnar, K; Husz, S; Van der Meer, JB; Jonkman, MF

    A case is presented of subepidermal, autoimmune bullous disease in which the initial examinations suggested the combination of epidermolysis bullosa acquisita and bullous pemphigoid. The diagnosis of epidermolysis bullosa acquisita was made by indirect immunofluorescence microscopy: the patient's

  15. The filtering, clear-cornea diathermal keratostomy

    DEFF Research Database (Denmark)

    Kessing, Svend Vedel; Nissen, Ole I; Thygesen, John

    2012-01-01

    Is the new micropenetrating, clear-cornea procedure, intrastromal diathermal keratostomy (IDK), an alternative to the intricate "modern trabeculectomy"?......Is the new micropenetrating, clear-cornea procedure, intrastromal diathermal keratostomy (IDK), an alternative to the intricate "modern trabeculectomy"?...

  16. Chronic bullous disease of childhood and a paecilomyces lung infection in chronic granulomatous disease

    NARCIS (Netherlands)

    Sillevis Smitt, J. H.; Leusen, J. H.; Stas, H. G.; Teeuw, A. H.; Weening, R. S.

    1997-01-01

    A 12 year old boy suffering from p67-phox deficient chronic granulomatous disease presented with a bullous skin disease and a lung infection with paecilomyces species. The histopathology of a bullous lesion showed subepidermal blister formation and microabcesses containing eosinophils in the dermal

  17. Clinical features of a toddler with bilateral bullous retinoschisis with a novel RS1 mutation

    Directory of Open Access Journals (Sweden)

    Satoshi Katagiri

    2017-04-01

    Conclusions and importance: We report the detailed retinal structure in a genetically identified case of bullous retinoschisis. The notable finding was that the cavity of bullous retinoschisis contained a number of fiber-like strands as observed in the cavity of typical retinoschisis.

  18. Linear IgA bullous dermatosis in a patient with renal cell carcinoma

    NARCIS (Netherlands)

    Van der Waal, RIF; Van de Scheur, MR; Pas, HH; Jonkman, MF; Van Groeningen, CJ; Nieboer, C; Starink, TM

    Linear IgA bullous dermatosis (LABD) is an autoimmune subepidermal bullous disease with heterogeneous clinical manifestations, characterized by linear deposition of IgA along the epidermal basement membrane zone. We report a patient with a metastasized renal cell carcinoma who developed an extensive

  19. Autoimmune bullous skin diseases. Part 2: diagnosis and therapy.

    Science.gov (United States)

    Kneisel, Andrea; Hertl, Michael

    2011-11-01

    Autoimmune bullous skin diseases represent a heterogenous group of disorders of skin and mucosa which are commonly associated with IgG or IgA autoantibodies against distinct adhesion molecules of the skin. The antibodyinduced loss of adhesion between epidermis and dermis results in blister formation and extensive erosions. There is a great need for rapidly establishing the diagnosis of these disorders since they may run a severe and potentially life-threatening course. In addition, because of their rarity and heterogeneous symptoms, autoimmune bullous skin diseases often pose a major diagnostic challenge. While histopathological examinations provide evidence for the level of blister formation, immunofluorescence microscopy has been established to identify tissue-bound and circulating autoantibodies. Direct immunofluorescence microscopy represents the gold standard for detecting tissue-bound autoantibodies. Indirect immunofluorescence microscopy with defined tissue substrates is considered the first step in detecting circulating autoantibodies. Confirmatory tests such as ELISA, immunoblot or immunoprecipitation analyses are performed utilizing recombinant proteins or keratinocyte extracts. The later assays can be used for primary diagnosis as well as for immunoserological follow-up. Systemic immunosuppressive drugs usually represent the main therapeutic regimen. Initially, systemic corticosteroids are commonly administered in combination with steroid-sparing, immunosuppressive agents. Novel targeted treatments such as immunoadsorption, rituximab or high-dose intravenous immunoglobulins have proven to be highly effective in severe and refractory pemphigus. This review presents a state-of-the-art algorithm for making the diagnosis of autoimmune bullous disorders and provides an overview on currently available therapeutic options. © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.

  20. Case Report of Bullous Pemphigoid following Fundus Fluorescein Angiography

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    Goktug Demirci

    2010-05-01

    Full Text Available Purpose: To report a first case of bullous pemphigoid (BP following intravenous fluorescein for fundus angiography. Clinical Features: A 70-year-old male patient was admitted to the intensive care unit with BP and sepsis. He reported a history of fundus fluorescein angiography with a pre-diagnosis of senile macular degeneration 2 months prior to presentation. At that time, fluorescein extravasated at the antecubital region. Following the procedure, pruritus and erythema began at the wrists bilaterally, and quickly spread to the entire body. The patient also reported a history of allergy to human albumin solution (Plamasteril®; Abbott 15 years before, during bypass surgery. On dermatologic examination, erythematous patches were present on the scalp, chest and anogenital region. Vesicles and bullous lesions were present on upper and lower extremities. On day 2 of hospitalization, tense bullae appeared on the upper and lower extremities. The patient was treated with oral methylprednisolone 48 mg (Prednol®; Mustafa Nevzat, topical clobetasol dipropionate 0.05% cream (Dermovate®; Glaxo SmithKline, and topical 4% urea lotion (Excipial Lipo®; Orva for presumptive bullous pemphigoid. Skin punch biopsy provided tissue for histopathology, direct immunofluorescence examination, and salt extraction, which were all consistent with BP. After 1 month, the patient was transferred to the intensive care unit with sepsis secondary to urinary tract infection; he died 2 weeks later from sepsis and cardiac failure. Conclusions: To our knowledge, this is the first reported case of BP following fundus fluorescein angiography in a patient with known human albumin solution allergy. Consideration should be made to avoid fluorescein angiography, change administration route, or premedicate with antihistamines in patients with known human albumin solution allergy. The association between fundus fluorescein angiography and BP should be further investigated.

  1. Bullous lesions, sweat gland necrosis and rhabdomyolysis in alcoholic coma

    Directory of Open Access Journals (Sweden)

    Neelakandhan Asokan

    2014-01-01

    Full Text Available A 42-year-old male developed hemorrhagic bullae and erosions while in alcohol induced coma. The lesions were limited to areas of the body in prolonged contact with the ground in the comatose state. He developed rhabdomyolysis, progressing to acute renal failure (ARF. Histopathological examination of the skin showed spongiosis, intraepidermal vesicles, and necrosis of eccrine sweat glands with denudation of secretory epithelial lining cells. With supportive treatment and hemodialysis, the patient recovered in 3 weeks time. This is the first reported case of bullous lesions and sweat gland necrosis occurring in alcohol-induced coma complicated by rhabdomyolysis and ARF.

  2. Association of bullous pemphigoid with malignancy: A myth or reality?

    Directory of Open Access Journals (Sweden)

    Joycelin Fernandes

    2014-01-01

    Full Text Available Bullous pemphigoid (BP is an autoimmune sub-epidermal blistering disorder of the skin. The association of BP with internal malignancy has always been a matter of debate with no consensus reached despite many published case reports and clinical trials. However, we report a hitherto unreported association of BP with squamous cell carcinoma of the tongue, wherein the patient had a recalcitrant downhill course despite adequate treatment measures with control of skin lesions being achieved only following excision of the tumor, and relapse coinciding with detection of metastasis. Hence, given the clinical behavior, it is reasonable to speculate that the association of malignancy was more than co-incidental.

  3. PSEUDOSINDACTILIA EN EPIDERMÓLISIS BULLOSA Pseudosyndactylia in bullous epidermolysis

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    Enríque Vergara Amador

    2009-01-01

    Full Text Available La epidermólisis bullosa comprende un grupo de patologías que se caracterizan por la fragilidad de la piel, formación de ampollas, y en las formas distróficas, la formación de pseudosindactilias. Debido a lo exótico de la entidad y la dificultad para el enfoque de tratamiento, se presenta un caso clínico con desarrollo de pseudosindactilias, característico usualmente de las formas distróficas. Se describe en aspectos clínicos de la entidad, el tratamiento quirúrgico de las pseudosindactilias y de las contracturas en las manos, y se discuten aspectos de la enfermedad y de los tipos de tratamientoBullous epidermolysis comprises a group of pathologies characterized by skin fragility, formation of bullae and, in its dystrophic forms, by the formation of pseudosyndactylias. Due to the exotic nature of the disease and the difficulty in focusing its treatment, a case is presented in which pseudosyndactylias developed, a usual characteristic of the dystrophic forms. This article addresses clinical aspects of bullous epidermolysis, surgical treatment of pseudosyndactilia and hand contractures and other aspects of the disease and its treatment

  4. Nursing diagnoses in patients with immune-bullous dermatosis

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    Euzeli da Silva Brandão

    Full Text Available ABSTRACT Objective: identify nursing diagnoses in patients with immune-bullous dermatosis. Method: a quantitative and descriptive research, carried out in three institutions located in Rio de Janeiro and Mato Grosso do Sul, Brazil, using the Client Assessment Protocol in Dermatology during a nursing consultation. Simple descriptive statistics was used for data analysis. Results: 14 subjects participated in the study, nine with a diagnosis of pemphigus vulgaris, pemphigus two and three of bullous pemphigoid. The age ranged between 27 and 82 years, predominantly females (11. 14 nursing diagnoses were discussed and identified from a clinical rationale in all study participants, representing the most common human responses in this sample. The application of the Assessment Protocol in Dermatology facilitated the comprehensive assessment, in addition to providing the identification of diagnostics according to the North American Nursing Diagnosis Association International. Conclusion: the nursing diagnoses presented confirm the necessity of interdisciplinary work during the care for this clientele. For better description of the phenomena related to the client in question, it is suggested the inclusion of two risk factors related in three diagnoses of this taxonomy. It is worth noting the contribution of the findings for the care, education and research in nursing in dermatology.

  5. [Hypocomplementaemic urticarial vasculitis with bullous lesions and pericardial involvement].

    Science.gov (United States)

    Kervarrec, T; Binois, R; Bléchet, C; Estève, É

    2015-10-01

    Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare disease involving urticarial cutaneous vasculitis, hypocomplementaemia and systemic manifestations. Pericardial involvement occurs in very rare cases. We report a case of HUVS associated with specific pericarditis and bullous lesions. A 63-year-old woman consulted for chronic urticaria that had appeared ten months earlier. Her skin lesions were associated with weight loss of 10 kg, deterioration of respiratory function and abdominal pain. Leukocytoclastic vasculitis was seen in the skin biopsy sample. Hypocomplementaemia and anti C1q antibodies were present and a diagnosis of HUVS was made. During hospitalisation, extensive compressive pericardial effusion was identified, and histological examination of the biopsy revealed specific pericardial lymphocytic vasculitis. During follow-up, four episodes of infectious pneumonitis were noted. Bullous skin lesions were also observed. HUVS is a disease caused by an antibody against C1q complement responsible for urticarial lesions and vasculitis antibodies. To our knowledge, there have been only five reports in the literature of pericardial injury associated with HUVS. In our case, histological examination of the pericardium demonstrated lymphocytic vasculitis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. Spheroidal Degeneration of the Cornea

    Directory of Open Access Journals (Sweden)

    Erdem Dinç

    2011-08-01

    Full Text Available A thirty-one-year-old male patient presented with bilateral epiphora and stinging sensation in the cornea. Detailed history revealed that a bilateral corneal scraping had been made regarding the initial diagnosis of fungal keratitis. His bestcorrected visual acuities were 20/20 and 20/30 in right and left eyes, respectively. Biomicroscopy showed bilateral amber colored spherules in the anterior stroma of the central cornea. The diagnosis of spheroidal corneal degeneration was established and symptomatic therapy with artificial tear drops was prescribed. Ultraviolet light is widely accepted to be the main etiological factor in the pathogenesis of spheroidal degeneration. Because of difficulties in the early stages of the diagnostic process of the disease, incorrect diagnoses can be made with inappropriate interventions. (Turk J Ophthalmol 2011; 41: 264-6

  7. In vivo laser scanning confocal microscopy of the cornea in patients with silicone oil tamponade after vitreoretinal surgery.

    Science.gov (United States)

    Le, Qihua; Wang, Xin; Lv, Jiahua; Sun, Xinghuai; Xu, Jianjiang

    2012-08-01

    To evaluate the morphological changes in the cornea by in vivo laser scanning confocal microscopy (LSCM) in a large case series with silicone oil endotamponade after vitreoretinal surgery and to explore the value of LSCM in the early detection of silicone keratopathy (SK). Ninety-nine patients (99 eyes) with silicone oil endotamponade after vitreoretinal surgery were included in the current study. Slit-lamp examination and measurement of intraocular pressure (IOP) were performed first. Then the central corneas of the subjects' eyes were examined by in vivo LSCM. The analysis of images of each corneal layer was performed and the endothelial cellular density (ECD), endothelial cellular area (ECA), coefficient of variation of cell size (CoV), and percentage of hexagonal cells (PHC) were measured. Moreover, the total size of stromal deposits was measured, and the correlation between the size of deposits and the parameters of endothelial cells was analyzed. Clinically recognizable abnormalities involving the cornea were identified in only 12 eyes (12.1%) under slit-lamp biomicroscopy, whereas in vivo LSCM revealed morphological abnormalities in 40 eyes (40.4%). The manifestations of endothelial lesions varied from decreased cellular density, increased polymegathism and pleomorphism to hyperreflective silicone oil membrane or droplets adhering to the endothelium. Moreover, hyperreflective deposits with various shapes could be identified in both posterior and anterior stroma, along with the infiltration of Langerhans cells beneath the epithelium. The average ECD and PHC of eyes with corneal abnormalities were significantly lower than those of normal corneas, whereas the average ECA and CoV were significantly larger (all Ps < 0.001). The patients with corneal abnormalities were significantly older than those others (P = 0.003). The rate of pseudophakic and aphakic eyes having corneal abnormalities was significantly higher than that of phakic eyes (P = 0.045). Interestingly

  8. Cornea and ocular surface treatment.

    Science.gov (United States)

    De Miguel, Maria P; Alio, Jorge L; Arnalich-Montiel, Francisco; Fuentes-Julian, Sherezade; de Benito-Llopis, Laura; Amparo, Francisco; Bataille, Laurent

    2010-06-01

    In addition to being a protective shield, the cornea represents two thirds of the eye's refractive power. Corneal pathology can affect one or all of the corneal layers, producing corneal opacity. Although full corneal thickness keratoplasty has been the standard procedure, the ideal strategy would be to replace only the damaged layer. Current difficulties in corneal transplantation, mainly immune rejection and shortage of organ supply, place more emphasis on the development of artificial corneas. Bioengineered corneas range from prosthetic devices that solely address the replacement of the corneal function, to tissue-engineered hydrogels that allow regeneration of the tissue. Recently, major advances in the biology of corneal stem cells have been achieved. However, the therapeutic use of these stem cell types has the disadvantage of needing an intact stem cell compartment, which is usually damaged. In addition, long ex vivo culture is needed to generate enough cell numbers for transplantation. In the near future, combination of advanced biomaterials with cells from abundant outer sources will allow advances in the field. For the former, magnetically aligned collagen is one of the most promising ones. For the latter, different cell types will be optimal: 1) for epithelial replacement: oral mucosal epithelium, ear epidermis, or bone marrow- mesenchymal stem cells, 2) for stromal regeneration: adipose-derived stem cells and 3) for endothelial replacement, the possibility of in vitro directed differentiation of adipose-derived stem cells towards endothelial cells provides an exciting new approach.

  9. Nummular keratopathy in a patient with Hyper-IgD Syndrome

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    Culican Susan M

    2009-08-01

    Full Text Available Abstract Purpose To report a case of recurrent nummular keratitis in a pediatric patient with Hyperimmunoglobulinemia D syndrome. Methods A retrospective chart review. Results A 14-year-old boy with Hyperimmunoglobulinemia D syndrome (HIDS presented with photophobia and ocular irritation concomitant with disease exacerbation. He was found on exam to have significant nummular keratitis, which responded to a short course of topical steroids. Despite acute response to local immunosuppression, the patient had several recurrent attacks and eventually developed a large corneal scar and decreased vision. After initiation of infliximab therapy his ocular sequelae improved dramatically and his vision returned to 20/20. Conclusion One possible form of end-organ damage associated with HIDS is vision threatening nummular keratopathy.

  10. Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lens Therapy for Exposure Keratopathy.

    Science.gov (United States)

    Chahal, Jasdeep S; Heur, Martin; Chiu, Gloria B

    2017-07-01

    To investigate the utility of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lenses in patients with exposure keratopathy, with outcomes based on changes in visual acuity, visual function, and corneal staining. A retrospective interventional case series of patients evaluated and treated from September 2009 through June 2014 at a single multi-specialty institutional practice. Eighteen of 29 patients with exposure keratoconjunctivitis, lagophthalmos, ectropion, or lid retraction, referred to USC Eye Institute after failing conventional therapies completed PROSE scleral lens fitting and were included in the study. Visual function was assessed before and after PROSE fitting with the Ocular Surface Disease Index (OSDI) survey. Visual acuity (VA) and corneal staining changes were also evaluated before and after treatment. Visual acuity improved from 0.60±0.68 logMAR pre-PROSE to 0.25±0.34 logMAR (Z=-3.81, P=0.00014) post-PROSE, which corresponds to an improvement of about 20/80 to 20/35 on Snellen VA. Ocular Surface Disease Index scores improved from 56.54±29.75 pre-PROSE to 24.98±21.23 post-PROSE (Z=-2.98, P=0.0029), and corneal staining values decreased from 2.17±0.84 pre-PROSE to 0.64±0.70 post-PROSE (Z=-3.27, P=0.011). The results suggest that PROSE scleral lens therapy is effective in patients with exposure keratopathy who had failed conventional therapies and can serve as an alternative to lid surgery.

  11. [An experience of dried cornea transplantation].

    Science.gov (United States)

    Gundorova, R A; Chentsova, E V; Makarov, P V; Kugusheva, A É; Rakova, A V

    2011-01-01

    Sometimes an urgent lamellar keratoplasty remains the only treatment option for corneal defect closure. When fresh donor tissue is absent as it is regular in recent years dried cornea transplantation becomes reasonable. In recent years in ocular trauma department 320 transplantations of dried on silicagel cornea were performed. Analysis of results allows to conclude that use of dried cornea is a promising surgical procedure to preserve the globe and in some cases to prepare the eye with severe trauma for subsequent optic surgery.

  12. Bleb Point: Mimicker of Pneumothorax in Bullous Lung Disease

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    Gelabert, Christopher

    2015-05-01

    Full Text Available In patients presenting with severe dyspnea, several diagnostic challenges arise in distinguishing the diagnosis of pneumothorax versus several other pulmonary etiologies like bullous lung disease, pneumonia, interstitial lung disease, and acute respiratory distress syndrome. Distinguishing between large pulmonary bullae and pneumothorax is of the utmost importance, as the acute management is very different. While multiple imaging modalities are available, plain radiographs may be inadequate to make the diagnosis and other advanced imaging may be difficult to obtain. Ultrasound has a very high specificity for pneumothorax. We present a case where a large pulmonary bleb mimics the lung point and therefore inaccurately suggests pneumothorax. [West J Emerg Med. 2015;16(3:447–449.

  13. Eccrine syringofibroadenomatosis in two patients with bullous pemphigoid.

    Science.gov (United States)

    Nomura, K; Hashimoto, I

    1997-01-01

    A 67-year-old man and an 84-year-old woman developed palmoplantar erythema following resolution of bullous pemphigoid (BP). Clinical manifestations of the palmoplantar lesions in these 2 patients ranged from prominent, well-demarcated erythematous areas with focal erosions and fissures to mild erythema. On histological examination, the palmoplantar erythema in one patient showed thin reticular strands of proliferating cells which connected with the epidermis and extended into the dermis, interwinding and anastomosing irregularly. The second patient showed similar mild changes with duct-like luminal formations. These histological findings were consistent with the diagnosis of eccrine syringofibroadenoma (ESFA). We speculate that these lesions developed as a result of the underlying inflammatory process in BP and conclude that ESFA associated with an inflammatory condition should be considered a new category of ESFA.

  14. Tetracycline and niacinamide control bullous pemphigoid but not pemphigus foliaceus when these conditions coexist.

    Science.gov (United States)

    Shiohara, Junko; Yoshida, Kanako; Hasegawa, Junichi; Uhara, Hisashi; Takata, Minoru; Saida, Toshiaki; Ohyama, Bungo; Oyama, Bungo; Hashimoto, Takashi

    2010-07-01

    Pemphigus and pemphigoid are different types of autoimmune bullous disease and can occur in the same patient. We report a female patient with this condition. At first, we diagnosed her with bullous pemphigoid, and we treated her with tetracycline, niacinamide and a topical steroid. Tense bullas disappeared shortly after that, but crusted erythemas mainly on her head and trunk persisted. We examined BP180 and desmoglein 1 enzyme-linked immunosorbent assays, and also histological features, which showed coexistence of bullous pemphigoid and pemphigus foliaceus concurrently. Therefore, we tried prednisolone, which could control both conditions. This case showed that tetracycline and niacinamide could control bullous pemphigoid, but could not control pemphigus foliaceus, and that prednisolone was effective for both conditions.

  15. Penfigóide bolhoso no lactente Bullous pemphigoid in childhood

    Directory of Open Access Journals (Sweden)

    Ada Lobato Quattrino

    2007-02-01

    Full Text Available O penfigóide bolhoso é doença que comumente acomete pessoas idosas. Desde o primeiro caso na infância, confirmado por imunofluorescência em 1970, cerca de 50 casos foram relatados e poucos ocorreram em crianças com menos de um ano de idade. Apresentase caso de penfigóide bolhoso em lactente de quatro meses de idade e discutem-se as características clínicas e imunopatológicas dessa rara bulose da infância.Bullous pemphigoid typically affects the elderly. Since the first description of bullous pemphigoid in childhood in 1970, about 50 cases have been reported, but only 10 were reported in children under the first year of age. We report a case of bullous pemphigoid in a 4-month-old girl and discuss the clinical and immunopathological features of this rare bullous disease of infancy.

  16. Adhesion complex formation after small keratectomy wounds in the cornea.

    Science.gov (United States)

    Stock, E L; Kurpakus, M A; Sambol, B; Jones, J C

    1992-02-01

    The adhesion complex of the corneal epithelium consists of the hemidesmosome and its associated structures, such as anchoring filaments, lamina densa of the basement membrane, and anchoring fibrils. It contributes to the adhesion of the corneal epithelium to Bowman's layer. To understand the adhesion complex better, an electron microscopic and immunofluorescence analysis was done of the reformation of the adhesion complex in small (1 mm) keratectomy wounds in the guinea pig cornea. In these wounds, the epithelium, hemidesmosomes, basal lamina, anchoring fibrils, and anterior stroma were removed. The wound bed was epithelialized completely by 24 hr after wounding. Immunofluorescence analyses involved the use of antibodies against plaque components of the hemidesmosome, an antibody against laminin, and an antibody against the collagen VII component of anchoring fibrils. At 18 hr after wounding, there was no morphologic evidence of hemidesmosomes at the epithelial-stromal interface. At 24 hr, hemidesmosomes were observed, with or without subjacent lamina densa. Furthermore, plaque components were detected by immunofluorescence in those cells in contact with the wound bed. In contrast, no type VII collagen was detected. On day 7, collagen VII, laminin, and bullous pemphigoid autoantibody markers colocalized along the wound bed as determined by immunofluorescence. However, at the ultrastructural level, even though the lamina densa of the basal lamina was observed primarily where hemidesmosomes were present, it remained incomplete. In this study, the precise temporal sequence in which components are incorporated into the assembling adhesion complex was described during wound healing. Furthermore, the possibility that the hemidesmosomal plaque nucleates the formation of the underlying basal lamina was discussed.

  17. Time-dependent fracture toughness of cornea.

    Science.gov (United States)

    Tonsomboon, Khaow; Koh, Ching Theng; Oyen, Michelle L

    2014-06-01

    The fracture and time-dependent properties of cornea are very important for the development of corneal scaffolds and prostheses. However, there has been no systematic study of cornea fracture; time-dependent behavior of cornea has never been investigated in a fracture context. In this work, fracture toughness of cornea was characterized by trouser tear tests, and time-dependent properties of cornea were examined by stress-relaxation and uniaxial tensile tests. Control experiments were performed on a photoelastic rubber sheet. Corneal fracture resistance was found to be strain-rate dependent, with values ranging from 3.39±0.57 to 5.40±0.48kJm(-2) over strain rates from 3 to 300mmmin(-1). Results from stress-relaxation tests confirmed that cornea is a nonlinear viscoelastic material. The cornea behaved closer to a viscous fluid at small strain but became relatively more elastic at larger strain. Although cornea properties are greatly dependent on time, the stress-strain responses of cornea were found to be insensitive to the strain rate when subjected to tensile loading. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Dermatoses bolhosas auto-imunes Autoimmune bullous dermatoses

    Directory of Open Access Journals (Sweden)

    Paulo R. Cunha

    2009-04-01

    Full Text Available Dermatoses bolhosas autoimunes são doenças cuja manifestação cutânea primária e fundamental consiste em vesículas e bolhas. Classificam-se conforme a localização da bolha, em intraepidérmica e subepidérmica. Os pacientes produzem autoanticorpos contra estruturas específicas da pele detectáveis por técnicas de imunofluorescência, immunobloting e Elisa. Os recentes avanços da biologia molecular e celular têm permitido conhecer esses autoantígenos, contra os quais os pacientes se sensibilizam e que estão localizados na epiderme ou na junção dermoepidérmica. São doenças de baixa incidência, porém de elevada morbidade e por vezes letais. O objetivo deste trabalho é revisar e descrever os progressos nos conhecimentos de quatro doenças vésico-bolhosas autoimunes: pênfigo foliáceo endêmico (fogo selvagem, pênfigo vulgar, penfigóide bolhoso e dermatite herpetiforme.Autoimmune bullous dermatoses are diseases in which blisters and vesicles are the primary and fundamental types of skin lesion. Their classification is based on the location of the blister: intraepidermal and subepidermal. Patients produce autoantibodies against self-specific structures of the skin detectable by immunofluorescence techniques, immunoblotting and ELISA. Recent advances in molecular and cellular biology have brought to knowledge these self-antigens, against which patients are sensitized, and which are found in epidermis or in the dermo-epidermal junction. These are low incidence, but high morbidity diseases that may be fatal. The aim of this article is to review and describe the progress of four autoimmune vesiculobullous disorders: endemic pemphigus foliaceous (wild fire, pemphigus vulgaris, bullous pemphigoid and dermatitis herpetiformis.

  19. Bullous impetigo in homosexual men--a risk marker for HIV-1 infection?

    Science.gov (United States)

    Donovan, B; Rohrsheim, R; Bassett, I; Mulhall, B P

    1992-01-01

    OBJECTIVE--To determine the incidence of bullous impetigo in a group of homosexual men at high risk of HIV-1 infection. DESIGN--A longitudinal descriptive study (1984-9). SETTING--A private primary care and STD clinic in Sydney, Australia. SUBJECTS--88 homosexual men documented to seroconvert to HIV-1, and 37 homosexual controls who had practised unprotected anal intercourse with another man known to be HIV-1 positive but who remained HIV-1 negative. MAIN OUTCOME MEASURE--Incidence of bullous impetigo. RESULTS--The crude annual incidence of bullous impetigo was 0.015 in subjects while they remained HIV-1 negative (10 cases) and 0.045 in early HIV-1 positive subjects (2 cases). Overall, 9% of the HIV-1 seroconverters and 9% of the HIV-1 negative controls were documented as suffering bullous impetigo over a mean of 29.2 and 39.3 months, respectively. CONCLUSIONS--Bullous impetigo in an adult could prove to be a clinical indication that a person is either infected with HIV-1 or is in close (possibly sexual) contact with a person with HIV-1 infection. If true, the recognition of bullous impetigo could provide an opportunity for behavioural intervention to limit the spread of HIV-1. Images PMID:1607190

  20. Synthetic cornea: biocompatibility and optics

    Science.gov (United States)

    Parel, Jean-Marie A.; Kaminski, Stefan; Fernandez, Viviana; Alfonso, E.; Lamar, Peggy; Lacombe, Emmanuel; Duchesne, Bernard; Dubovy, Sander; Manns, Fabrice; Rol, Pascal O.

    2002-06-01

    Purpose. Experimentally find a method to provide a safe surgical technique and an inexpensive and long lasting mesoplant for the restoration of vision in patients with bilateral corneal blindness due to ocular surface and stromal diseases. Methods. Identify the least invasive and the safest surgical technique for synthetic cornea implantation. Identify the most compatible biomaterials and the optimal shape a synthetic cornea must have to last a long time when implanted in vivo. Results. Penetrating procedures were deemed too invasive, time consuming, difficult and prone to long term complications. Therefore a non-penetrating delamination technique with central trephination was developed to preserve the integrity of Descemet's membrane and the anterior segment. Even though this approach limits the number of indications, it is acceptable since the majority of patients only have opacities in the stroma. The prosthesis was designed to fit in the removed tissue plane with its skirt fitted under the delaminated stroma. To improve retention, the trephination wall was made conical with the smallest opening on the anterior surface and a hat-shaped mesoplant was made to fit. The skirt was perforated in its perimeter to allow passage of nutrients and tissues ingrowths. To simplify the fabrication procedure, the haptic and optic were made of the same polymer. The intrastromal biocompatibility of several hydrogels was found superior to current clinically used PMMA and PTFE materials. Monobloc mesoplants made of 4 different materials were implanted in rabbits and followed weekly until extrusion occurred. Some remained optically clear allowing for fundus photography. Conclusions. Hydrogel synthetic corneas can be made to survive for periods longer than 1 year. ArF excimer laser photoablation studies are needed to determine the refractive correction potential of these mesoplants. A pilot FDA clinical trial is needed to assess the mesoplant efficacy and very long-term stability.

  1. Epikeratophakia on pediatric traumatized corneas.

    Science.gov (United States)

    Vila-Coro, A A; Goosey, J D; Mazow, M L; Martin, D I

    1987-01-01

    Four children ranging from 4 to 6 years of age with unilateral aphakia and corneal scarring secondary to penetrating injuries were treated with epikeratophakia. One child had undergone a rotational penetrating keratoplasty to displace the corneal scar from the visual axis prior to the epikeratophakia procedure. In all of the cases, nonlyophilized donor tissue was utilized. The procedure was successful in all four cases. The average best corrected postoperative visual acuity was 20/45. These results confirm prior studies suggesting that epikeratophakia can be performed successfully on partially opaque and scarred corneas in pediatric aphakic eyes.

  2. The benefit of preventing exposure keratopathy in icu patient: a case ...

    African Journals Online (AJOL)

    The ocular surface is protected by the tear film, the blinking of eyelids and the lid closure. The tear film provides lubrication of the cornea and also contains antimicrobial substances. Use of muscle relaxants and sedation in patients on ventilator contributes to inadequate lid closure by decreasing the tonic contraction of ...

  3. Cytochrome P450 Activity in Ex Vivo Cornea Models and a Human Cornea Construct.

    Science.gov (United States)

    Kölln, Christian; Reichl, Stephan

    2016-07-01

    The pharmacokinetic behaviors of novel ophthalmic drugs are often preliminarily investigated in preclinical studies using ex vivo animal cornea or corneal cell culture models. During transcorneal passage, topically applied drugs may be affected by drug metabolizing enzymes. The knowledge regarding the functional expression of metabolic enzymes in corneal tissue is marginal; thus, the aim of this study was to investigate cytochrome P450 activity in an organotypic three-dimensional human cornea construct and to compare it with porcine and rabbit corneas, which are commonly used ex vivo cornea models. The total cytochrome P450 activity was determined by measuring the transformation of 7-ethoxycoumarin. Furthermore, the expression of the cytochrome P450 enzyme 2D6 (CYP2D6) was investigated at the protein level using immunohistochemistry and western blotting. CYP2D6 activity measurements were performed using a d-luciferin-based assay. In summary, similar levels of the total cytochrome P450 activity were identified in all 3 cornea models. The protein expression of CYP2D6 was confirmed in the human cornea construct and porcine cornea, whereas the signals in the rabbit cornea were weak. The analysis of the CYP2D6 activity indicated similar values for the human cornea construct and porcine cornea; however, a distinctly lower activity was observed in the rabbit cornea. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  4. In vivo ultrathin Descemet stripping automated endothelial keratoplasty with a low-energy and high-frequency femtosecond laser

    Directory of Open Access Journals (Sweden)

    Gustavo Victor

    2014-04-01

    Full Text Available This case report describes the production of an ultrathin endothelial donor corneal lamella using a femtosecond laser with low energy and a high frequency. In addition, we report its use in vivo in an eye with pseudophakic bullous keratopathy. The outcomes were observed 3 months after surgery in terms of the change in endothelial donor lamella and full cornea thickness (including pachymetric mapping, visual acuity, and endothelial cell count.

  5. Architectural and Biochemical Expressions of Mustard Gas Keratopathy: Preclinical Indicators and Pathogenic Mechanisms

    Science.gov (United States)

    2012-08-10

    weeks in all corneas: focal swelling of the anterior stroma that was associated with destabilization of the overlying basal epithelial cells (Figure 4C...extracellular matrices. A possible example of this can be observed in Figure 3B, in which uneven stromal swelling at the basement membrane is associated...Burns Wounds 4: e1. 9. Anumolu SS, DeSantis AS, Menjoge AR, Hahn RA, Beloni JA, et al. (2010) Doxycycline loaded poly(ethylene glycol) hydrogels for

  6. Characteristics of, prevalence of, and risk factors for corneal pigmentation (pigmentary keratopathy) in Pugs.

    Science.gov (United States)

    Labelle, Amber L; Dresser, Christine B; Hamor, Ralph E; Allender, Matthew C; Disney, Julia L

    2013-09-01

    To determine the characteristics of, prevalence of, and risk factors for corneal pigmentation (CP) in Pugs. Prospective cross-sectional study. 295 Pugs > 16 weeks old. Ophthalmic examination of the anterior segment of each eye was performed, including determination of tear film characteristics (Schirmer tear test and tear film breakup time) and corneal sensitivity. Digital photographs of the head and each eye were obtained. Corneal pigmentation of eyes was graded as absent, very mild, mild, moderate, or severe. Signalment and medical history information and American Kennel Club registration status were recorded. Results-CP was detected in at least 1 eye of 243 of the 295 (82.4%) Pugs; CP was typically very mild or mild. Detection of CP was not significantly associated with coat color, age, eyelid conformation, or tear film characteristics but was significantly associated with sex of dogs. The severity of CP was not significantly associated with American Kennel Club registration status or age, but was significantly associated with sex, tear film characteristics, and coat color. Iris hypoplasia was detected in 72.1% of the Pugs. Iris-to-iris persistent pupillary membranes were detected in 85.3% of the Pugs. Prevalence of CP in Pugs in this study was high. Unexpectedly high prevalences of iris hypoplasia and persistent pupillary membranes were also identified. The condition identified in these Pugs was a pigmentary keratopathy, rather than pigmentary keratitis or corneal melanosis. This condition may have a genetic basis, and further studies are warranted to determine etiology.

  7. Mediators of Mast Cells in Bullous Pemphigoid and Dermatitis Herpetiformis

    Directory of Open Access Journals (Sweden)

    Agnieszka Zebrowska

    2014-01-01

    Full Text Available Bullous pemphigoid (BP and dermatitis herpetiformis (DH are skin diseases associated with inflammation. However, few findings exist concerning the role of mast cells in autoimmune blistering disease. Skin biopsies were taken from 27 BP and 14 DH patients, as well as 20 healthy individuals. Immunohistochemistry was used to identify the localization and mast cell expression of TNFα and MMP9 in skin lesions and perilesional skin. The serum concentrations of TNFα, MMP9, chymase, tryptase, PAF, and IL-4 were measured by immunoassay. TNFα and MMP9 expression in the epidermis and in inflammatory influxed cells in the dermis was detected in skin biopsies from patients. Although these mediators were found to be expressed in the perilesional skin of all patients, the level was much lower than that in lesional skin. Increased serum PAF levels were observed in BP patients. Mast cells may play an essential role in activating inflammation, which ultimately contributes to the tissue damage observed in BP and DH. Our findings suggest that differences in the pattern of cytokine expression directly contribute to variations in cellular infiltration in DH and BP.

  8. Bullous impetigo and pregnancy: Case report and review of blistering conditions in pregnancy.

    Science.gov (United States)

    Cohen, Philip R

    2016-04-18

     Bullous impetigo results from Staphylococcus aureus (S. aureus) release of exfoliative toxins type A and type B thatresults in flaccid, easily ruptured, bullae in the upper layers of the epidermis.  Physiologic, gestation-associated, and incidental skin changes can occur in pregnancy.  Blisters in pregnant women can occur secondary to either common skin disorders orspecific dermatoses of pregnancy.  To describe a pregnant woman with bullous impetigo and review bullous conditions in pregnant women.  PubMed was used to search the following terms, separately and in combination:  blister, blistering, bullous, gestationis, herpes, herpetiformis, impetigo, pemphigoid, pregnancy, pregnant, psoriasis, pustular, virus. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated.  Flaccid, easily rupturing, pustules, which developed into superficial annular erosions with peripheral scale and central healing appeared in a woman of 7-weeks gestation and allergy to penicillin on her lower abdomen, suprapubic region, perineum, buttocks, and proximal legs.  A bacterial culture subsequently isolated methicillin-susceptible S. aureus.  All of the lesions resolved after treatment with clindamycin.  Bullous impetigo should be considered in the differential diagnosis of common skin diseases presenting as blistersin pregnant women.

  9. Concurrent pyogenic granuloma and bullous impetigo of a pregnant woman's finger.

    Science.gov (United States)

    Qin, Rosie; Cohen, Philip R

    2017-03-15

    Bullous impetigo is a superficial skininfection caused by Staphylococcus aureus (S.aureus). Pyogenic granuloma is a common benigntumor frequently associated with prior trauma.Bullous impetigo and pyogenic granuloma may occurin pregnant women. The features of a pregnant womanwith pyogenic granuloma and bullous impetigoconcurrently present in a lesion on her finger aredescribed. PubMed was used to search the followingterms: bullous impetigo, pregnancy, and pyogenicgranuloma. All papers were reviewed; relevantarticles, along with their references, were evaluatedResults: A red ulcerated nodule with a collaretteof epithelium around the tumor and surroundingbullae appeared on the fifth digit of the left hand of a31-year-old woman who was at 36 weeks gestation. Abacterial culture grew methicillin sensitive S. aureus.An excisional biopsy was performed. Histologicfindings revealed not only a benign vascular tumorwith an infiltrate of mixed inflammatory cells, butalso an intraepidermal blister. She received oralantibiotics and there was complete resolution of thefinger lesion and infection with preservation of digitfunction. Albeit uncommon, pyogenic granulomaand bullous impetigo may concurrently occur in thesame lesion. Therapeutic intervention should focuson treating both the benign skin tumor and theinfection.

  10. Management of bullous pemphigoid : the European Dermatology Forum consensus in collaboration with the European Academy of Dermatology and Venereology

    NARCIS (Netherlands)

    Feliciani, C.; Joly, P.; Jonkman, M. F.; Zambruno, G.; Zillikens, D.; Ioannides, D.; Kowalewski, C.; Jedlickova, H.; Karpati, S.; Marinovic, B.; Mimouni, D.; Uzun, S.; Yayli, S.; Hertl, M.; Borradori, L.

    Bullous pemphigoid is the most common autoimmune subepidermal blistering disease of the skin and mucous membranes. This disease typically affects the elderly and presents with itch and localized or generalized bullous lesions. In up to 20% of affected patients, bullae may be completely absent, and

  11. Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High‐Risk Patients

    National Research Council Canada - National Science Library

    Buznyk, Oleksiy; Pasyechnikova, Nataliya; Islam, M. Mirazul; Iakymenko, Stanislav; Fagerholm, Per; Griffith, May

    2015-01-01

    .... In this early observational study, we grafted bioengineered corneal implants made from recombinant human collagen and synthetic phosphorylcholine polymer into three patients for whom donor cornea...

  12. Suggested Guidelines for Reporting Keratoprosthesis Results: Consensus Opinion of the Cornea Society, Asia Cornea Society, EuCornea, PanCornea, and the KPRO Study Group.

    Science.gov (United States)

    Belin, Michael W; Güell, Jose L; Grabner, Günther

    2016-02-01

    To propose a series of standardized guidelines for reporting keratoprosthesis (KPRO) results. At the most recent KPRO Study Group Meeting (Barcelona, 2015), representatives of the 4 multinational corneal societies (Cornea Society, Asia Cornea Society, EuCornea, and PanCornea) and the KPRO Study Group agreed to propose consistent terminology for reporting KPRO results, especially in describing the length of follow-up and in the description of the KPRO itself. Consensus was reached for minimal reporting guidelines. The 4 multinational corneal societies and the KPRO Study Group agreed to standardized terminology for reporting the length of follow-up, preoperative diagnosis grouping, and data stratification based on the KPRO type used. Guidelines suggesting minimal reporting standards will assist in both data collection and reporting and will allow for better comparative analysis and pooling of the available data.

  13. Bullous pemphigoid associated with acquired hemophilia a: a rare association of autoimmune disease.

    Science.gov (United States)

    Aljasser, Mohammed I; Sladden, Chris; Crawford, Richard I; Au, Sheila

    2014-01-01

    Acquired hemophilia (AH) is a rare autoimmune disease with an annual incidence of one per million and has a mortality rate of up to 22%. It is caused by the development of autoantibodies against factor VIII. Approximately half of the reported cases are associated with autoimmune disorders, pregnancy, malignancies, and adverse drug reactions. Autoimmune diseases are the most frequently associated disorders and include rheumatoid arthritis, systemic lupus erythematosus, cryoglobulinemia, pemphigus vulgaris, and bullous pemphigoid. There are a few reports of acquired hemophilia and bullous pemphigoid in the literature. We report a 73-year-old male who presented with cutaneous blistering, upper gastrointestinal bleeding, and hemoptysis. He later developed right flank pain secondary to a retroperitoneal hematoma. He had a prolonged partial thromboplastin time, a low factor VIII level, and a high factor VIII inhibitor level, all consistent with acquired hemophilia. Skin biopsies were diagnostic for bullous pemphigoid. He was treated successfully with prednisone, cyclophosphamide, rituximab, and intravenous immunoglobulin.

  14. Interactions between bovine cornea proteoglycans and collagen.

    OpenAIRE

    Speziale, P.; Bardoni, A; Balduini, C.

    1980-01-01

    Two types of proteoglycan subunits were obtained from bovine cornea, the first mainly composed of proteochondroitin sulphate and the second of proteokeratan sulphate. These two fractions can be obtained from the tissue as an aggregate, and are able to recombine each other after separation, to re-form the original structure. In order to investigate collagen-proteoglycan interactions, type-I collagen was isolated from bovine cornea by pepsin digestion followed by 3.5% (w/v) NaCl precipitation, ...

  15. Bullous lung diseases as a risk factor for lung cancer: A case report

    Directory of Open Access Journals (Sweden)

    Nagorni-Obradović Ljudmila

    2016-01-01

    Full Text Available Introduction. A possible association between lung cancer and bullous lung disease has been suggested and recently supported by the results of genetic studies. Case report. A previously healthy 43-year-old man, smoker, was diagnosed with bullous lung disease at the age of 31 years. He was followed up for 12 years when lung cancer (adenocarcinoma was found at the site. In the meantime, he was treated for recurrent respiratory infections. Conclusion. There is the need for active approach in following up the patients with pulmonary bulla for potential development of lung cancer.

  16. Living-related conjunctival-limbal allograft for chronic or delayed-onset mustard gas keratopathy.

    Science.gov (United States)

    Javadi, Mohammad-Ali; Baradaran-Rafii, Alireza

    2009-01-01

    To determine the long-term outcomes of living-related stem cell transplantation in patients with delayed or chronic mustard gas keratopathy (MGK). In this noncomparative interventional case series, 21 consecutive patients with advanced delayed or chronic MGK received living-related conjunctival-limbal allograft and were followed up for at least 1 year. All subjects received immunosuppression with systemic cyclosporine. Main outcome measures were reduction of subjective complaints, corneal epithelial healing, and regression of corneal neovascularization adjacent to the transplant area. Twenty-five eyes of 21 patients (all male), including 4 patients who received bilateral grafts, were operated. Mean age at the time of surgery was 35.8 +/- 3.8 years, mean interval between mustard gas exposure and surgery was 12.2 +/- 3.5 years, and mean follow-up was 37.2 +/- 18.5 months. Average size of the donor lenticule was 71.16 +/- 17.34 degrees. Simultaneous penetrating and lamellar keratoplasty were performed in 5 and 2 eyes, respectively. All patients consistently reported marked subjective improvement. Mean time for epithelial healing was 7.76 +/- 3.2 days. Visual acuity was 1.35 +/- 0.81 LogMAR before surgery, which improved to 0.59 +/- 0.34 LogMAR 3 months after the procedure (P < 0.001). Mean visual acuity at final examination was 0.82 +/- 0.49 LogMAR (P = 0.001). Acute stem cell rejection was observed in 10 (40%) eyes, which improved by increasing the dose of topical and systemic steroids. Chronic stem cell rejection was diagnosed in 8 (32%) eyes, which led to failure in 5 (20%) eyes. Living-related conjunctival-limbal allograft is effective in stabilizing the ocular surface in patients with delayed or chronic MGK.

  17. Early cystic bleb needling revision after glaucoma filtering surgery with toxic keratopathy

    Directory of Open Access Journals (Sweden)

    S. Yu. Petrov

    2015-01-01

    Full Text Available Clinical case of high thin-wall cystic limited filtering bleb needling revision in the early post-op period after trabeculectomy with sinusotomy accompanied by toxic keratopathy is presented. Optical coherence tomography (OCT demonstrated that filtering bleb height was 2700 μm and bleb wall thickness was 70 μm. Bleb needling revision with its lateralwall dissection and subconjunctival injection of dexamethasone, fluorouracil, and ranibizumab near to the bleb site was performed. In 1.5 hours after the procedure, bleb height decreased to 550 μm (by 5 times while bleb wall thickness increased up to 100 μm. Topical antibacterial, steroid, and non-steroid anti-inflammatory therapy was recommended. The next day IOP level reduced from 11 mm Hg to 4.5 mm Hg. It was accompanied by choroidal effusion that was managed conservatively with cycloplegic agents (drops and injections for 3 days. On day 6, central corneal edema affecting all layers, Descemet’s membrane folds, and ocular hypertension were revealed. Metabolic therapy resolved corneal edema within 3 days. Re-needling bleb revision decreased IOP level to 6.2 mm Hg. This resulted in transient Descemet’s membrane folds. This paper describes filtering bleb needling revision with its lateral wall dissection and anti-inflammatory, cytostatic, and anti-VEGF agents use to prolong glaucoma filtering surgery effect in excessive scarring. The procedure was accompanied by toxic corneal endothelium decompensation with corneal edema and Descemet’s membrane folds treated with active metabolic therapy.

  18. Effective management of exposure keratopathy developed in intensive care units: the impact of an evidence based eye care education programme.

    Science.gov (United States)

    Demirel, Soner; Cumurcu, Tongabay; Fırat, Penpegül; Aydogan, Mustafa Said; Doğanay, Selim

    2014-02-01

    To assess the impact of eye care education on the incidence of corneal exposure in intensive care units (ICU). Approximately 300 ICU personnel were educated about eye care to reduce the incidence of corneal exposure. The patients were divided into two groups: pre-training (Group 1: Between February 1, 2011 and March 31, 2011 [2 months]) and post-training periods (Group 2: Between April 1, 2011 and April 1 2012 [1 year]). We compared the groups for keratopathy incidence to evaluate the efficacy of this education. The number of patients were 762 in Group 1 and 6196 in Group 2 (p = 0.335). Medians of patients followed in pre training ICU and post training ICU for each month were found to be 476 (interquartile range, 433-539) and 515 (interquartile range, 490-528). Exposure keratopathy was identified in 8 eyes of 6 patients (3 males and 3 females) in pre training ICU with the mean age of 27.6 ± 31.8 years and 5 eyes of 3 patients (1 male and 2 females) in post training ICU with the mean age of 41.3 ± 32.1 years. No significant difference was noticed between two groups in terms of the medians of patients followed in ICUs for each month (p=0.335). The time of hospitalisation in ICU when the patients were consulted for the first ocular assessment in pre training ICU and post training ICU were found to be 13 ± 8.7 days and 8 ± 1.7 days, respectively. After the training, the decrease in incidence of exposure keratopathy was found to be highly significant (p < 0.001). We observed a highly significant reduction in the incidence of corneal exposure, following the eye-care education programme. Copyright © 2013. Published by Elsevier Ltd.

  19. Thermal and biomechanical parameters of porcine cornea.

    Science.gov (United States)

    Kampmeier, J; Radt, B; Birngruber, R; Brinkmann, R

    2000-05-01

    New methods in refractive surgery require a considerable understanding of the material "cornea" and are often studied by theoretical modeling in order to gain insight into the procedure and an optimized approach to the technique. The quality of these models is highly dependent on the preciseness of its input parameters. Porcine cornea often is used as a model in preclinical studies because of its similarity to man and its availability. The important physical parameters for biomechanical deformation, heat conduction, and collagen denaturation kinetics have been determined for porcine cornea. Experimental methods include densitometry, calorimetry, turbidimetry, tensile tests, stress relaxation, and hydrothermal isometric tension measurements. The density of porcine cornea was measured as p = 1062+/-5 kg/m3, the heat capacity gave c = 3.74+/-0.05 J/gK. The stress-strain relation for corneal strips is represented by a third order approximation where the secant modulus yields about Esec approximately equal to 0.4 MPa for small strains less than 2%. The normalized stress relaxation is described by an exponential fit over time. The denaturation process of cornea is characterized by specific temperatures which can be related to the change of the mechanical properties. Denaturation kinetics are described according to the model of Arrhenius yielding the activation energy deltaEa = 106 kJ/mol and the phase transition entropy deltaS = 39 J/(mol x K). The established set of parameters characterizes the porcine cornea in a reliable way that creates a basis for corneal models. It furthermore gives direct hints of how to treat cornea in certain refractive techniques.

  20. A 12-year retrospective review of bullous systemic lupus erythematosus in cutaneous and systemic lupus erythematosus patients.

    Science.gov (United States)

    Chanprapaph, K; Sawatwarakul, S; Vachiramon, V

    2017-10-01

    Objective The aim of this study was to investigate the clinical features, laboratory findings, systemic manifestations, treatment and outcome of patients with bullous systemic lupus erythematosus in a tertiary care center in Thailand. Methods We performed a retrospective review from 2002 to 2014 of all patients who fulfilled the diagnostic criteria for bullous systemic lupus erythematosus to evaluate for the clinical characteristics, extracutaneous involvement, histopathologic features, immunofluorescence pattern, serological abnormalities, internal organ involvement, treatments and outcome. Results Among 5149 patients with cutaneous lupus erythematosus and/or systemic lupus erythematosus, 15 developed vesiculobullous lesions. Ten patients had validation of the diagnosis of bullous systemic lupus erythematosus, accounting for 0.19%. Bullous systemic lupus erythematosus occurred after the diagnosis of systemic lupus erythematosus in six patients with a median onset of 2.5 months (0-89). Four out of 10 patients developed bullous systemic lupus erythematosus simultaneously with systemic lupus erythematosus. Hematologic abnormalities and renal involvement were found in 100% and 90%, respectively. Polyarthritis (40%) and serositis (40%) were less frequently seen. Systemic corticosteroids, immunosuppressants, antimalarials and dapsone offered resolution of cutaneous lesions. Conclusion Bullous systemic lupus erythematosus is an uncommon presentation of systemic lupus erythematosus. Blistering can occur following or simultaneously with established systemic lupus erythematosus. We propose that clinicians should carefully search for systemic involvement, especially hematologic and renal impairment, in patients presenting with bullous systemic lupus erythematosus.

  1. Association between bullous pemphigoid and neurologic diseases: a case-control study.

    Science.gov (United States)

    Casas-de-la-Asunción, E; Ruano-Ruiz, J; Rodríguez-Martín, A M; Vélez García-Nieto, A; Moreno-Giménez, J C

    2014-11-01

    In the past 10 years, bullous pemphigoid has been associated with other comorbidities and neurologic and psychiatric conditions in particular. Case series, small case-control studies, and large population-based studies in different Asian populations, mainland Europe, and the United Kingdom have confirmed this association. However, no data are available for the Spanish population. This was an observational, retrospective, case-control study with 1:2 matching. Fifty-four patients with bullous pemphigoid were selected. We compared the percentage of patients in each group with concurrent neurologic conditions, ischemic heart disease, diabetes, chronic obstructive pulmonary disease, and solid tumors using univariate logistic regression. An association model was constructed with conditional multiple logistic regression. The case group had a significantly higher percentage of patients with cerebrovascular accident and/or transient ischemic attack (odds ratio [OR], 3.06; 95% CI, 1.19-7.87], dementia (OR, 5.52; 95% CI, 2.19-13.93), and Parkinson disease (OR, 5; 95% CI, 1.57-15.94). A significantly higher percentage of cases had neurologic conditions (OR, 6.34; 95% CI, 2.89-13.91). Dementia and Parkinson disease were independently associated with bullous pemphigoid in the multivariate analysis. Patients with bullous pemphigoid have a higher frequency of neurologic conditions. Copyright © 2013 Elsevier España, S.L.U. and AEDV. All rights reserved.

  2. Definitions and outcome measures for bullous pemphigoid : Recommendations by an international panel of experts

    NARCIS (Netherlands)

    Murrell, Dedee F.; Daniel, Benjamin S.; Joly, Pascal; Borradori, Luca; Amagai, Masayuki; Hashimoto, Takashi; Caux, Frederic; Marinovic, Branka; Sinha, Animesh A.; Hertl, Michael; Bernard, Philippe; Sirois, David; Cianchini, Giuseppe; Fairley, Janet A.; Jonkman, Marcel F.; Pandya, Amit G.; Rubenstein, David; Zillikens, Detlef; Payne, Aimee S.; Woodley, David; Zambruno, Giovanna; Aoki, Valeria; Pincelli, Carlo; Diaz, Luis; Hall, Russell P.; Meurer, Michael; Mascaro, Jose M.; Schmidt, Enno; Shimizu, Hiroshi; Zone, John; Swerlick, Robert; Mimouni, Daniel; Culton, Donna; Lipozencic, Jasna; Bince, Benjamin; Grando, Sergei A.; Bystryn, Jean-Claude; Werth, Victoria P.

    Our scientific knowledge of bullous pemphigoid (BP) has dramatically progressed in recent years. However, despite the availability of various therapeutic options for the treatment of inflammatory diseases, only a few multicenter controlled trials have helped to define effective therapies in BP. A

  3. Whole body application of a potent topical corticosteroid for bullous pemphigoid

    NARCIS (Netherlands)

    Terra, J. B.; Potze, W. J. B.; Jonkman, M. F.

    BackgroundCurrent standard of treatment of bullous pemphigoid (BP) is systemic oral corticosteroids (CS). However, significant iatrogenic morbidity and mortality is reported. Studies have shown that topical potent CS is safer than oral prednisolone in BP. ObjectivesTo examine the local and systemic

  4. Systemic Lupus Erythematosus and Bullous Pemphigoid with Dramatic Response to Dapsone.

    Science.gov (United States)

    Maggio, Maria Cristina; Corsello, Giovanni; Prinzi, Eugenia; Cimaz, Rolando

    2017-03-29

    BACKGROUND Bullous pemphigoid is an autoimmune blistering disease, with relapses, isolated or associated with other autoimmune diseases such as systemic lupus erythematosus (SLE). Joint manifestations rapidly respond to small or moderate doses of corticosteroids, whereas skin manifestations usually respond to antimalarial drugs. CASE REPORT We describe the clinical case of an 11-year-old girl with SLE. She showed bullous skin lesions with arthralgia, mild proteinuria, resolved after steroid treatment. At the tapering of her prednisone dose, the patient had new skin lesions requiring an increased dose of prednisone. She started dapsone at the dosage of 1 mg/kg/day, maintaining low dose prednisone; this treatment was successfully followed by the dramatic disappearance of skin lesions and limb pain. CONCLUSIONS Bullous skin lesions can represent the first clinical presentation of pediatric SLE and could influence the treatment and the outcome of these patients. This case showed an atypical course as both skin manifestations and arthritis promptly and persistently resolved with dapsone without the use of high-dose glucocorticoids. Only a few cases of patients with SLE associated with bullous pemphigoid have been reported in the literature, and very few in the pediatric population.

  5. Bullous Pemphigoid in Iranian Patients: A Descriptive Study on 122 Cases

    Directory of Open Access Journals (Sweden)

    Cheyda Chams Davatchi

    2012-05-01

    Full Text Available Bullous pemphigoid is an immunobullous disease with high mortality and morbidity. Different aspects and characteristics in the patients vary in different areas in the world. Our objective was to study clinical and demographic characteristics of bullous pemphigoid in Iranian patients. In a retrospective descriptive study, we reviewed 122 patients with bullous pemphigoid within 1987-2007. Demographic characteristics, clinical manifestations, treatment, relapses and outcome were evaluated. The mean age of 122 patients was 65 ± 18.11 years including 35.2% male and 64.8% female. The most common manifestations were cutaneous bullae (97.5%. 27% had oral lesions. 30.3% had eosinophillia. 90 patients(73.8% received oral prednisolone, 29 patients (23.8% topical steroid, 2 patients tetracycline and 1 patient dapsone. 89 patients were followed after admission. Out of them 44 patients experienced first relapse and 22 patients second relapse. 41 cases (46% were completely controlled. 11 cases (12% were not controlled. Clinical and general characteristics of bullous pemphigoid patients differ in various regions in the world.

  6. Nursing diagnoses in patients with immune-bullous dermatosis.

    Science.gov (United States)

    Brandão, Euzeli da Silva; Santos, Iraci Dos; Lanzillotti, Regina Serrão; Ferreira, Adriano Menis; Gamba, Mônica Antar; Azulay-Abulafia, Luna

    2016-08-15

    identify nursing diagnoses in patients with immune-bullous dermatosis. a quantitative and descriptive research, carried out in three institutions located in Rio de Janeiro and Mato Grosso do Sul, Brazil, using the Client Assessment Protocol in Dermatology during a nursing consultation. Simple descriptive statistics was used for data analysis. 14 subjects participated in the study, nine with a diagnosis of pemphigus vulgaris, pemphigus two and three of bullous pemphigoid. The age ranged between 27 and 82 years, predominantly females (11). 14 nursing diagnoses were discussed and identified from a clinical rationale in all study participants, representing the most common human responses in this sample. The application of the Assessment Protocol in Dermatology facilitated the comprehensive assessment, in addition to providing the identification of diagnostics according to the North American Nursing Diagnosis Association International. the nursing diagnoses presented confirm the necessity of interdisciplinary work during the care for this clientele. For better description of the phenomena related to the client in question, it is suggested the inclusion of two risk factors related in three diagnoses of this taxonomy. It is worth noting the contribution of the findings for the care, education and research in nursing in dermatology. identificar diagnósticos de enfermagem em clientes com dermatoses imunobolhosas. pesquisa quantitativa e descritiva, realizada em três instituições localizadas no Rio de Janeiro e no Mato Grosso do Sul-Brasil, aplicando o Protocolo de Avaliação do Cliente em Dermatologia, durante consulta de enfermagem. Utilizou-se a estatística descritiva simples para análise dos dados. participaram do estudo 14 sujeitos, nove com diagnóstico médico de pênfigo vulgar, dois de foliáceo e três de penfigoide bolhoso. A idade variou entre 27 e 82 anos, predominando 11 pessoas do sexo feminino. Foram discutidos 14 diagnósticos de enfermagem

  7. Introduction to biomechanics of the cornea.

    Science.gov (United States)

    Buzard, K A

    1992-01-01

    As refractive procedures involving the cornea have proliferated, concerns over the long-term stability and predictability of these procedures have occupied a more prominent role. Procedures and principles of mechanical engineering to mathematically model the cornea can provide valuable insight into the biomechanics of the cornea, and this approach can be used to predict corneal behavior. In order to utilize these advanced methods, some basic knowledge concerning limitations, assumptions, and techniques regarding the finite element method is needed. The principles of mechanical measurement of deformable bodies are discussed, as are the quantities stress, strain, Poisson's ratio, and creep as they are measured and used in the modeling of biologic systems. The finite element modeling procedure is discussed in a simplified geometric system. While work remains to be done in this area, it is seen that useful and predictive models can be created which significantly improve our understanding and predictability of corneal procedures.

  8. Ipsilateral supraorbital nerve transfer in a case of recalcitrant neurotrophic keratopathy with an intact ipsilateral frontal nerve: A novel surgical technique

    Directory of Open Access Journals (Sweden)

    Frances Jacinto

    2016-12-01

    Conclusions and importance: We present the first successful case of corneal neurotization with ipsilateral supraorbital nerve in a patient with corneal anesthesia from a local injury to the long ciliary nerves. Our case demonstrates that the described method of corneal neurotization is a viable option for patients with recalcitrant neurotrophic keratopathy and an intact ipsilateral frontal nerve.

  9. Engineering copolymeric artificial cornea with salt porogen.

    Science.gov (United States)

    Zellander, Amelia; Wardlow, Melissa; Djalilian, Ali; Zhao, Chenlin; Abiade, Jeremiah; Cho, Michael

    2014-06-01

    Artificial corneas or keratoprostheses (KPros) are designed to replace diseased or damaged cornea. Although many synthetic KPros have been developed, current products are often inappropriate or inadequate for long term use due to ineffective host integration. This study presents an alternative approach of engineering a KPro that comprises a combination of poly (2-hydroxyethyl methacrylate) (PHEMA), poly (methyl methacrylate) (PMMA), and sodium chloride (NaCl) as porogen. Based on the core-skirt model for KPro, the porous outer portion of artificial cornea (skirt) was engineered by combining NaCl with HEMA and MMA monomers to promote tissue ingrowth from the host. The central optic (core) was designed to provide >85% light transmission in the visible wavelength range and securely attached to the skirt. Mechanical tensile data indicated that our KPro (referred to as salt porogen KPro) is mechanically stable to maintain its structure in the ocular environment and during implantation. Using human corneal fibroblasts (HCFs), we demonstrate that the cells grew into the pores of the skirt and proliferated, suggesting biointegration is adequately achieved. This novel PHEMA-PMMA copolymeric salt porogen KPro may offer a cornea replacement option that leads to minimal risk of corneal melting by permitting sufficient tissue ingrowth and mass transport. Copyright © 2013 Society of Plastics Engineers.

  10. Biomechanical analysis of the keratoconic cornea.

    Science.gov (United States)

    Gefen, Amit; Shalom, Ran; Elad, David; Mandel, Yossi

    2009-07-01

    Keratoconus is a non-inflammatory disease characterized by irregular thinning and gradual bulging of the cornea, which results in distortion of the corneal surface that causes blurred vision. We conducted three-dimensional finite element (FE) simulations to analyze the biomechanical factors contributing to the distorted shape of a keratoconic cornea. We assumed orthotropic linear elastic tissue mechanical properties, and simulated localized tissue thinning (reduction from 0.5 mm to 0.35 or 0.2 mm). We analyzed tissue deformations, stresses and theoretical dioptric power maps predicted by the models, for intraocular pressure (IOP) of 10, 15 20 and 25 mmHg. The analyses revealed that three factors affect the shape distortion of keratoconic corneas: (i) localized thinning, and (ii) reduction in the tissue's meridian elastic modulus or (iii) reduction in the shear modulus perpendicular to the corneal surface, whereas thinning showed the most predominant effect. Maximal stress levels occurred at the centers of the bulged regions, at the thinnest points. The IOP levels had little influence on dioptric power in the healthy cornea, but a substantial influence in keratoconic conditions. The present FE studies allowed characterization of the biomechanical interactions in keratoconus, toward understanding the aetiology of this poorly studied malady.

  11. Biomechanics and Wound Healing in the Cornea

    OpenAIRE

    Dupps, William J.; Wilson, Steven E.

    2006-01-01

    The biomechanical and wound healing properties of the cornea undermine the predictability and stability of refractive surgery and contribute to discrepancies between attempted and achieved visual outcomes after LASIK, surface ablation and other keratorefractive procedures. Furthermore, patients predisposed to biomechanical failure or abnormal wound healing can experience serious complications such as keratectasia or clinically significant corneal haze, and more effective means for the identif...

  12. [Structural analysis of normal corneas and diseased corneas by applying second harmonic generation].

    Science.gov (United States)

    Morishige, Naoyuki

    2011-11-01

    We have established a second harmonic generation (SHG) microscopy system for imaging of the human cornea with a mode-locked femtosecond laser and a laser confocal microscope. This SHG microscopy system has allowed us to scan corneal tissue noninvasively ex vivo and to obtain three-dimensional images of corneal collagen lamellae. Such three-dimensional imaging of the normal anterior cornea revealed that collagen lamellae at the anterior stroma are inter-woven and adhere to Bowman membrane with these adherent lamellae being designated "sutural lamellae." Sutural lamellae adhere to Bowman membrane at an angle of approximately 19 degrees, whereas the angle of lamellae in the mid-stroma relative to Bowman membrane is smaller. We hypothesize that the structural unit consisting of both Bowman membrane and the sutural lamellae contributes to the rigidity and anterior curvature of the cornea. SHG imaging of keratoconic corneas revealed an either abnormal or a total lack of structure of the sutural lamellae, suggesting that this abnormality might be related to that of the corneal anterior curvature in such corneas. Furthermore, SHG imaging of corneas affected by stromal edema showed that the structure of the sutural lamellae was maintained, although abnormal collagen signals both above and below Bowman membrane were detected in corneas affected by clinical stromal edema for more than 12 months. SHG imaging of the structure of collagen lamellae in normal and diseased corneas thus has the potential to provide insight both into the mechanism for maintenance of corneal curvature as well as into the pathophysiology of corneal diseases.

  13. Enzyme-linked immunosorbent assay for the combination of bullous pemphigoid antigens 1 and 2 in the diagnosis of bullous pemphigoid.

    Science.gov (United States)

    Roussel, Aude; Benichou, Jacques; Randriamanantany, Zely Arivelo; Gilbert, Danièle; Drenovska, Kossara; Houivet, Estelle; Tron, François; Joly, Pascal

    2011-03-01

    To assess the usefulness of enzyme-linked immunosorbent assay (ELISA) assessment of the combination of bullous pemphigoid antigen 1 (BPAG1) and BPAG2 in the diagnosis of bullous pemphigoid (BP). Retrospective study of serum samples from patients with BP. Tertiary care center. A total of 190 patients with newly diagnosed BP and 78 controls with other autoimmune bullous diseases. Serum samples were tested using commercialized BPAG1 and BPAG2 ELISA and indirect immunofluorescence (IIF). The sensitivity and specificity of ELISA for the combination of BPAG1 and BPAG2 in the diagnosis of BP were contrasted with ELISA for each of the antigens alone and with IIF. The sensitivity and specificity of ELISA for the combination of BPAG1 and BPAG2 were 87% and 88%, respectively, compared with 79% and 90% for BPAG2 ELISA, 61% and 96% for BPAG1 ELISA, and 81% and 63% for IIF. The combination of BPAG1 ELISA and BPAG2 ELISA permitted 8% and 16% gains in sensitivity compared with each of BPAG2 ELISA and BPAG1 ELISA alone, respectively. Anti-BPAG1 antibodies were detected in 15 of 40 BP serum samples with no anti-BPAG2 antibodies (38%) and in 8 of 13 serum samples from patients with BP and mucosal involvement (62%) compared with 2 of 22 samples of cicatricial pemphigoid (P = .002) and 0 of 16 epidermolysis bullosa acquisita serum samples (P ELISA values were more closely correlated with initial extent of BP lesions (r = 0.44, P ELISA values (r = 0.16, P = .03). Since the combination of BPAG1 and BPAG2 ELISA only slightly increases the sensitivity of BP diagnosis over BPAG2 ELISA alone, BPAG1 ELISA could be adequately proposed in a minority of BP cases with mucosal involvement and in those with no circulating anti-BPAG2 antibodies.

  14. Impact of the Cornea Donor Study (CDS) on Acceptance of Corneas from Older Donors

    Science.gov (United States)

    Sugar, Alan; Montoya, Monty M.; Beck, Roy; Cowden, John W.; Dontchev, Mariya; Gal, Robin L.; Kollman, Craig; Malling, Jackie; Mannis, Mark J.; Tennant, Bradley

    2014-01-01

    Purpose Evaluate retrospectively whether findings from the Cornea Donor Study (CDS) led to changes in the transplantation of corneas from older donors. Methods United States eye banks 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 time 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 vs. outside the United States. Results For corneal tissues transplanted in the United States, the percentage of donors ≥66 years old increased from 19% before CDS to 21% during CDS and 25% after CDS (pcorneas distributed outside the United States with the percentage of donors ≥66 years old 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 five-year evidence generated by the CDS. PMID:22262218

  15. Impact of the cornea donor study on acceptance of corneas from older donors.

    Science.gov (United States)

    Sugar, Alan; Montoya, Monty M; Beck, Roy; Cowden, John W; Dontchev, Mariya; Gal, Robin L; Kollman, Craig; Malling, Jackie; Mannis, Mark J; Tennant, Bradley

    2012-12-01

    To evaluate retrospectively whether the findings from the Cornea Donor Study (CDS) led to changes in the transplantation of corneas from older donors. 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. 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 (Pcorneas 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. 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.

  16. Crystalline-Like Keratopathy after Intravenous Immunoglobulin Therapy with Incomplete Kawasaki Disease: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Elif Erdem

    2013-01-01

    Full Text Available A 7-year-old girl had presented with high body temperature and joint pain which continued for 3 days. Because of the prolonged history of unexplained fever, rash, bilateral nonpurulent conjunctival injection, oropharyngeal erythema, strawberry tongue, and extreme of age, incomplete Kawasaki disease was considered and started on an intravenous immunoglobulin infusion. Six days after this treatment, patient was referred to eye clinic with decreased vision and photophobia. Visual acuity was reduced to 20/40 in both eyes. Slit-lamp examination revealed bilateral diffuse corneal punctate epitheliopathy and anterior stromal haze. Corneal epitheliopathy seemed like crystal deposits. One day after presentation, mild anterior uveitis was added to clinical picture. All ocular findings disappeared in one week with topical steroid and unpreserved artificial tear drops. We present a case who was diagnosed as incomplete Kawasaki disease along with bilateral diffuse crystalline-like keratopathy. We supposed that unusual ocular presentation may be associated with intravenous immunoglobulin treatment.

  17. Bullous aplasia cutis congenita: case report and review of the literature.

    Science.gov (United States)

    Garcia-Romero, Maria Teresa; Narvóez-Rosales, Veránica; Hojyo-Tomoka, Maria Teresa

    2011-05-01

    Aplasia cutis congenita is a rare condition characterized by the absence of skin and sometimes other underlying structures such as bone or dura. It can be a part of various syndromes and can be associated with multiple genetic diseases, malformation patterns, or a combination of all. It is even considered as a form frustre of a neural tube defect in several literatures. Bullous aplasia cutis congenita is a clinical subtype of the condition, with extremely few cases reported in the literature. It presents as a cystic or bullous lesion at birth, which eventually transforms into an atrophic, flat scar covered by a thin epithelium. Some cases present with a dark collar hair sign around the lesion, which can be even more indicative of an underlying neural tube defect. Management remains controversial and depends on the characteristics of the lesion, but conservative treatment is usually chosen.

  18. Balloon Dilatation of Esophageal Strictures in Children With Bullous Epidermolysis: Description of Case Series

    Directory of Open Access Journals (Sweden)

    A. V. Tupylenko

    2017-01-01

    Full Text Available Esophageal strictures are the most common complications of bullous epidermolysis in children. Strictures cause the development of dysphagia that prevents oral alimentation and receipt of an adequate amount of nutrients that is accompanied by a violation of nutritional status, weight loss, and delayed physical development of a child. Disturbed swallowing can also cause aspiration syndrome, pneumonia, and airway obstruction. To eliminate dysphagia and reduce the risk of complications, it is necessary to restore esophageal patency. The article describes the results of X-ray with assisted balloon dilatation in 19 children with bullous epidermolysis and dysphagia. It is shown that this method of esophagus recanalization allows to effectively and safely restore oral alimentation of children already in the first day after intervention with a gradual expansion of the diet.

  19. Bullous aplasia cutis congenita: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Maria Teresa Garcia-Romero

    2011-01-01

    Full Text Available Aplasia cutis congenita is a rare condition characterized by the absence of skin and sometimes other underlying structures such as bone or dura. It can be a part of various syndromes and can be associated with multiple genetic diseases, malformation patterns, or a combination of all. It is even considered as a form frustre of a neural tube defect in several literatures. Bullous aplasia cutis congenita is a clinical subtype of the condition, with extremely few cases reported in the literature. It presents as a cystic or bullous lesion at birth, which eventually transforms into an atrophic, flat scar covered by a thin epithelium. Some cases present with a dark collar hair sign around the lesion, which can be even more indicative of an underlying neural tube defect. Management remains controversial and depends on the characteristics of the lesion, but conservative treatment is usually chosen.

  20. Autoimmune Subepidermal Bullous Diseases of the Skin and Mucosae: Clinical Features, Diagnosis, and Management.

    Science.gov (United States)

    Amber, Kyle T; Murrell, Dedee F; Schmidt, Enno; Joly, Pascal; Borradori, Luca

    2017-08-04

    Autoimmune subepidermal blistering diseases of the skin and mucosae constitute a large group of sometimes devastating diseases, encompassing bullous pemphigoid, gestational pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, and anti-p200 pemphigoid. Their clinical presentation is polymorphic. These autoimmune blistering diseases are associated with autoantibodies that target distinct components of the basement membrane zone of stratified epithelia. These autoantigens represent structural proteins important for maintenance of dermo-epidermal integrity. Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering disease of the skin and mucosae. Although the disease typically presents with a generalized blistering eruption associated with itch, atypical variants with either localized bullous lesions or "non-bullous" presentations are observed in approximately 20% of patients. A peculiar form of BP typically associated with pregnancy is pemphigoid gestationis. In anti-p200 pemphigoid, patients present with tense blisters on erythematosus or normal skin resembling BP, with a predilection for acral surfaces. These patients have antibodies targeting the 200-kDa basement membrane protein. Epidermolysis bullosa is a rare autoimmune blistering disease associated with autoantibodies against type VII collagen that can have several phenotypes including a classical form mimicking dystrophic epidermolysis bullosa, an inflammatory presentation mimicking BP, or mucous membrane pemphigoid-like lesions. Mucous membrane pemphigoid (MMP) is the term agreed upon by international consensus for an autoimmune blistering disorder, which affects one or more mucous membrane and may involve the skin. The condition involves a number of different autoantigens in the basement membrane zone. It may result in severe complications from scarring, such as blindness and strictures. Diagnosis of these diseases relies on direct immunofluorescence microscopy studies

  1. Detection of type VII collagen autoantibodies before onset of bullous systemic lupus erythematosus

    Science.gov (United States)

    Grabell, Daniel A.; Matthews, Loderick A.; Yancey, Kim B.; Chong, Benjamin F.

    2016-01-01

    Importance Anti-type VII collagen autoantibodies are often detectable in patients with bullous systemic lupus erythematosus (BSLE); however their timing of appearance preceding onset of disease is unknown. Observations We report the case of a 50-year-old female with a history of systemic lupus erythematosus who presented with vesicles and bullae around her lips, trunk, axillae, arms, and thighs. Histologic analysis as well as immunofluorescence and immunoblot studies confirmed the diagnosis of BSLE. Immunoblotting and ELISA studies of the patient’s serum obtained three months prior to the onset of BSLE showed presence of anti-type VII collagen autoantibodies. Levels of anti-type VII collagen IgG increased after bullous lesions appeared. Within one month after initiating dapsone and increasing the dose of prednisone, skin lesions promptly resolved. A year after onset of BSLE, her anti-type VII collagen IgG decreased below levels observed prior to the inception of her bullous lesions. Conclusions and Relevance This study shows that anti-type VII collagen autoantibodies can precede the clinical appearance of BSLE. The subsequent increase and decrease in the levels of circulating anti-type VII collagen autoantibodies, which mirrored skin disease activity, support a potential role in their initiation of disease. PMID:25671758

  2. Visualization of Immune Responses in the Cornea.

    Science.gov (United States)

    Perez, Victor L

    2017-11-01

    The eye has become a useful site for the investigation and understanding of local and systemic immune responses. The ease of access and transparency of the cornea permits direct visualization of ocular structures, blood vessels, and lymphatic vessels, allowing for the tracking of normal and pathological biological processes in real time. As a window to the immune system, we have used the eye to dissect the mechanisms of corneal inflammatory reactions that include innate and adaptive immune responses. We have identified that the ocular microenvironment regulates these immune responses by recruiting different populations of inflammatory cells to the cornea through local production of selected chemokines. Moreover, crosstalk between T cells and macrophages is a common and crucial step in the development of ocular immune responses to corneal alloantigens. This review summarizes the data generated by our group using intravital fluorescent confocal microscopy to capture the tempo, magnitude, and function of innate and adaptive corneal immune responses.

  3. Expression of SFRP Family Proteins in Human Keratoconus Corneas.

    Directory of Open Access Journals (Sweden)

    Jingjing You

    Full Text Available We investigated the expression of the secreted frizzled-related proteins (SFRPs in keratoconus (KC and control corneas. KC buttons (∼8 mm diameter (n = 15 and whole control corneas (n = 7 were fixed in 10% formalin or 2% paraformaldehyde and subsequently paraffin embedded and sectioned. Sections for histopathology were stained with hematoxylin and eosin, or Periodic Acid Schiff's reagent. A series of sections was also immunolabelled with SFRP 1 to 5 antibodies, visualised using immunofluorescence, and examined with a Zeiss LSM700 scanning laser confocal microscope. Semi-quantitative grading was used to compare SFRP immunostaining in KC and control corneas. Overall, KC corneas showed increased immunostaining for SFRP1 to 5, compared to controls. Corneal epithelium in all KC corneas displayed heterogeneous moderate to strong immunoreactivity for SFRP1 to 4, particularly in the basal epithelium adjacent to cone area. SFRP3 and 5 were localised to epithelial cell membranes in KC and control corneas, with increased SFRP3 cytoplasmic expression observed in KC. Strong stromal expression of SFRP5, including extracellular matrix, was seen in both KC and control corneas. In control corneas we observed differential expression of SFRP family proteins in the limbus compared to more central cornea. Taken together, our results support a role for SFRPs in maintaining a healthy cornea and in the pathogenesis of epithelial and anterior stromal disruption observed in KC.

  4. Expression of SFRP Family Proteins in Human Keratoconus Corneas

    Science.gov (United States)

    You, Jingjing; Wen, Li; Roufas, Athena; Madigan, Michele C.; Sutton, Gerard

    2013-01-01

    We investigated the expression of the secreted frizzled-related proteins (SFRPs) in keratoconus (KC) and control corneas. KC buttons (∼8 mm diameter) (n = 15) and whole control corneas (n = 7) were fixed in 10% formalin or 2% paraformaldehyde and subsequently paraffin embedded and sectioned. Sections for histopathology were stained with hematoxylin and eosin, or Periodic Acid Schiff’s reagent. A series of sections was also immunolabelled with SFRP 1 to 5 antibodies, visualised using immunofluorescence, and examined with a Zeiss LSM700 scanning laser confocal microscope. Semi-quantitative grading was used to compare SFRP immunostaining in KC and control corneas. Overall, KC corneas showed increased immunostaining for SFRP1 to 5, compared to controls. Corneal epithelium in all KC corneas displayed heterogeneous moderate to strong immunoreactivity for SFRP1 to 4, particularly in the basal epithelium adjacent to cone area. SFRP3 and 5 were localised to epithelial cell membranes in KC and control corneas, with increased SFRP3 cytoplasmic expression observed in KC. Strong stromal expression of SFRP5, including extracellular matrix, was seen in both KC and control corneas. In control corneas we observed differential expression of SFRP family proteins in the limbus compared to more central cornea. Taken together, our results support a role for SFRPs in maintaining a healthy cornea and in the pathogenesis of epithelial and anterior stromal disruption observed in KC. PMID:23825088

  5. Tuna cornea as biomaterial for cardiac applications.

    Science.gov (United States)

    Parravicini, Roberto; Cocconcelli, Flavio; Verona, Alessandro; Parravicini, Valeriano; Giuliani, Enrico; Barbieri, Alberto

    2012-01-01

    Among available biomaterials, cornea is almost completely devoid of cells and is composed only of collagen fibers oriented in an orderly pattern, which contributes to low antigenicity. Thunnus thynnus, the Atlantic bluefin tuna, is a fish with large eyes that can withstand pressures of approximately 10 MPa. We evaluated the potential of this tuna cornea in cardiac bioimplantation. Eyes from freshly caught Atlantic bluefin tuna were harvested and preserved in a fixative solution. Sterilized samples of corneal stroma were embedded in paraffin and stained with hematoxylin and eosin, and the histologic features were studied. Physical and mechanical resistance tests were performed in comparison with bovine pericardial strips and porcine mitral valves. Corneal material was implanted subcutaneously in 7 rats, to evaluate in vivo calcification rates. Mitral valves made from tuna corneal leaflets were implanted in 9 sheep. We found that the corneal tissue consisted only of parallel collagen fibers without evidence of vascular or neural structures. In tensile strength, the tuna corneal specimens were substantially similar to bovine pericardium. After 23 days, the rat-implanted samples showed no calcium or calcium salt deposition. Hydrodynamic and fatigue testing of valve prototypes yielded acceptable functional and long-term behavioral results. In the sheep, valvular performance was stable during the 180-day follow-up period, with no instrumental sign of calcification at the end of observation. We conclude that low antigenicity and favorable physical properties qualify tuna cornea as a potential material for durable bioimplantation. Further study is warranted.

  6. The collagens of the developing bovine cornea.

    Science.gov (United States)

    Lee, R E; Davison, P F

    1984-11-01

    The morphology of the developing bovine eye has been examined and the collagens in fetal bovine eyes from three months' gestation to maturity have been solubilized by pepsin treatment and analyzed to determine the ratios of the predominant types of collagen. The type I collagen decreased, while the type V collagen increased with age. Type III collagen comprised less than 1% of all the corneas, except for the three-month fetal calf. The anterior to posterior thickness of the paraffin-embedded fetal calf cornea increased from the third to the seventh month, decreased from the seventh month to birth, and then increased after birth. Descemet's membrane increased in thickness with age. Analysis of dissected regions of the calf cornea showed a uniform distribution of the collagen populations from the center to the limbus (89% type I, 10% type V and less than 1% type III collagen) and uniformity through the depth of the stroma, except that type III was concentrated around Bowman's layer, and type IV in Descement's membrane. The localization of the different collagens was consistent with the immunofluorescent staining studies with anticollagen antibodies, but the ratios of the intensities of the fluorescence did not correspond to the quantitative analyses. These results are concordant with other studies that have shown that antibody binding may be masked or diminished in certain tissues and therefore immunofluorescence cannot be used reliably for quantitative measurements.

  7. Biomechanical characterization of keratoconus corneas ex vivo with Brillouin microscopy.

    Science.gov (United States)

    Scarcelli, Giuliano; Besner, Sebastien; Pineda, Roberto; Yun, Seok Hyun

    2014-06-17

    Loss of corneal strength is a central feature of keratoconus progression. However, it is currently difficult to measure corneal mechanical changes noninvasively. The objective of this study is to evaluate if Brillouin optical microscopy can differentiate the mechanical properties of keratoconic corneas versus healthy corneas ex vivo. We obtained eight tissue samples from healthy donor corneas used in Descemet's stripping endothelial keratoplasty (DSEK) and 10 advanced keratoconic corneas from patients undergoing deep anterior lamellar keratoplasty (DALK). Within 2 hours after surgery, a confocal Brillouin microscope using a monochromatic laser at 532 nm was used to map the Brillouin frequency shifts of the corneas. The mean Brillouin shift in the anterior 200 μm of the keratoconic corneas at the cone was measured to be 7.99 ± 0.10 GHz, significantly lower than 8.17 ± 0.06 GHz of the healthy corneas (P < 0.001). The Brillouin shift in the keratoconic corneas decreased with depth from the anterior toward posterior regions with a steeper slope than in the healthy corneas (P < 0.001). Within keratoconic corneas, the Brillouin shift in regions away from the apex of the cone was significantly higher than within the cone region (P < 0.001). Brillouin measurements revealed notable differences between healthy and keratoconic corneas. Importantly, Brillouin imaging showed that the mechanical loss is primarily concentrated within the area of the keratoconic cone. Outside the cone, the Brillouin shift was comparable with that of healthy corneas. The results demonstrate the potential of Brillouin microscopy for diagnosis and treatment monitoring of keratoconus. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  8. DISTRIBUTION OF REFRACTIVE INDEX AND CHROMATIC DISPERSION OF THE CORNEA

    OpenAIRE

    渡邉, 千博

    1999-01-01

    Many refractive surgeries of the cornea (radial keratotomy RK, photore- fractive keratectomy PRK, laser in situ keratomileusis LASIK) are done routinely in an increasing number of patients in many countries. However, few analyses of the cornea related to the corneal configuration change and refractive index distribution, which affect the postoperative visual outcomes, have been reported. We have analyzed the refractive index and chromatic dispersion of the cornea as a function of the temperat...

  9. Prevention of Exposure Keratopathy in Critically Ill Patients: A Single-Center, Randomized, Pilot Trial Comparing Ocular Lubrication With Bandage Contact Lenses and Punctal Plugs.

    Science.gov (United States)

    Bendavid, Itai; Avisar, Inbal; Serov Volach, Irena; Sternfeld, Amir; Dan Brazis, Idit; Umar, Lewaa; Yassur, Yiftach; Singer, Pierre; Cohen, Jonathan David

    2017-11-01

    To compare the effectiveness of bandage contact lenses and punctal plugs with ocular lubricants in preventing corneal damage in mechanically ventilated and sedated critically ill patients. Single-center, prospective, randomized, pilot study. Sixteen-bed, general ICU at a tertiary academic medical center. Adults admitted to the ICU and anticipated to require mechanical ventilation and continuous sedation for greater than or equal to 4 days. Patients were randomized to receive eye care with ocular lubricants (n = 38), bandage contact lenses (n = 33), or punctal plugs (n = 33). The bandage contact lenses were changed every 4 days, whereas the punctal plugs remained in situ for the entire study. The primary endpoint was the presence or absence of corneal damage as assessed by the grade of keratopathy. Patients were examined by an ophthalmologist blinded to the study group every 4 days and at the time of withdrawal from the study, due to cessation of sedation, discharge from the ICU, or death. The mean duration of the study was 8.6 ± 6.2 days. The grade of keratopathy in the ocular lubricant group increased significantly in both eyes (p = 0.01 for both eyes) while no worsening was noted in either the lens or punctal plugs groups. In a post hoc analysis of patients with an initially abnormal ophthalmic examination, significant healing of keratopathy was noted in the lens group (p = 0.02 and 0.018 for left and right eyes, respectively) and in the right eye of the plugs group (p = 0.005); no improvement was noted in the ocular lubricant group. Compared with ocular lubrication, bandage contact lenses and punctal plugs were more effective in limiting keratopathy, and their use, particularly of bandage contact lenses, was associated with significant healing of existing lesions.

  10. Altered organization of collagen in the apex of keratoconus corneas.

    Science.gov (United States)

    Radner, W; Zehetmayer, M; Skorpik, C; Mallinger, R

    1998-01-01

    In 15 keratoconus corneas, the three-dimensional arrangement of collagen lamellae was investigated by means of scanning electron microscopy. Keratoconus corneas without visible scars were obtained during perforating keratoplasty. The noncollagenous matrix of the stroma was removed with sodium hydroxide. Descemet's membrane was removed mechanically and deeper layers of the stroma were exposed by cutting the tissue tangentially to the corneal surface with an ultramicrotome. The apical and the para-apical regions of keratoconus were compared the central regions of normal corneas. In the apical regions of 11 out of the 15 keratoconus corneas (73%), the arrangement of the collagen lamellae differs from those of the para-apical regions and normal corneas. Their collagen fibrils from uniform layers and no delimited collagen lamellae can be differentiated. Interlacing between adjacent layers in extremely decreased or even absent. In the para-apical region of keratoconus corneas the three-dimensional arrangement of collagen lamellae does not differ from that in normal corneas. Stromal thinning and conical ectasia in the apex of keratoconus corneas alters the organization of collagen. This will certainly affect the biomechanical properties of the cornea and further lead to a progression of keratoconus irrespective of its primary pathogenesis.

  11. Ultrastructure features of camel cornea--collagen fibril and proteoglycans.

    Science.gov (United States)

    Almubrad, Turki; Akhtar, Saeed

    2012-01-01

      The uniform distribution of collagen fibrils and proteoglycans maintain the transparency of normal cornea. We describe the ultrastructural features of camel cornea including collagen fibrils and proteoglycans (PGs).   Camel corneas (of 6-, 8-, and 10-month-old animals) were fixed in 2.5% glutaraldehyde containing cuprolinic blue in sodium acetate buffer and processed for electron microscopy. The 'AnalySIS LS Professional' program was used to analyze the collagen fibril diameter.   The camel cornea consists of four layers: the epithelium (227 μm), stroma (388 μm), Descemet's membrane (DM), and endothelium. The epithelium constituted 36% of the camel cornea, whereas corneal stroma constituted 62% of the corneal thickness (629 μm). The PGs in the posterior stroma were significantly larger in number and size compared with the anterior and middle stroma. The collagen fibril diameter was 25 nm and interfibrillar spacing 40 nm. Fibrillar structures are present throughout the DM.   The structure of the camel cornea is very different from human and other animals. The unique structure of the cornea might be an adaptation to help the camel to survive in a hot and dry climate. The camel cornea may also be a good model to study the effect of hot and dry climates on the cornea. © 2011 American College of Veterinary Ophthalmologists.

  12. Measurement of an Elasticity Map in the Human Cornea.

    Science.gov (United States)

    Mikula, Eric R; Jester, James V; Juhasz, Tibor

    2016-06-01

    The biomechanical properties of the cornea have an important role in determining the shape of the cornea and visual acuity. Since the cornea is a nonhomogeneous tissue, it is thought that the elastic properties vary throughout the cornea. We aim to measure a map of corneal elasticity across the cornea. An acoustic radiation force elasticity microscope (ARFEM) was used to create a map of corneal elasticity in the human cornea. This ARFEM uses a low frequency, high intensity acoustic force to displace a femtosecond laser-generated microbubble, while using a high frequency, low intensity ultrasound to monitor the position of the microbubble within the cornea. From the displacement of the bubble and the magnitude of the acoustic radiation force, the local value of corneal elasticity is calculated in the direction of the displacement. Measurements were conducted at 6 locations, ranging from the central to peripheral cornea at anterior and posterior depths. The mean anterior elastic moduli were 4.2 ± 1.2, 3.4 ± 0.7, and 1.9 ± 0.7 kPa in the central, mid, and peripheral regions, respectively, while the posterior elastic moduli were 2.3 ± 0.7, 1.6 ± 0.3, and 2.9 ± 1.2 kPa in the same radial locations. We found that there is a unique distribution of elasticity axially and radially throughout the cornea.

  13. Gamma-Irradiated Sterile Cornea for Use in Corneal Transplants in a Rabbit Model.

    Science.gov (United States)

    Yoshida, Junko; Heflin, Thomas; Zambrano, Andrea; Pan, Qing; Meng, Huan; Wang, Jiangxia; Stark, Walter J; Daoud, Yassine J

    2015-01-01

    Gamma irradiated corneas in which the donor keratocytes and endothelial cells are eliminated are effective as corneal lamellar and glaucoma patch grafts. In addition, gamma irradiation causes collagen cross inking, which stiffens collagen fibrils. This study evaluated gamma irradiated corneas for use in corneal transplantations in a rabbit model comparing graft clarity, corneal neovascularization, and edema. Penetrating keratoplasty was performed on rabbits using four types of corneal grafts: Fresh cornea with endothelium, gamma irradiated cornea, cryopreserved cornea, and fresh cornea without endothelium. Slit lamp examination was performed at postoperative week (POW) one, two, and four. Corneal clarity, edema, and vascularization were graded. Confocal microscopy and histopathological evaluation were performed. A P cornea with endothelium compared to the other three groups (P cornea scored better than the cryopreserved and fresh cornea without endothelium groups in clarity (0.9 vs. 1.5 and 2.6, respectively), and edema (0.6 vs. 0.8 and 2.0, respectively). The gamma irradiated corneas, cryopreserved corneas and the fresh corneas without endothelium, developed haze and edema after POW 2. Gamma irradiated cornea remained statistically significantly clearer than cryopreserved and fresh cornea without endothelium during the observation period (P cornea. Gamma irradiated corneas remained clearer and thinner than the cryopreserved cornea and fresh cornea without endothelium. However, this outcome is transient. Gamma irradiated corneas are useful for lamellar and patch grafts, but cannot be used for penetrating keratoplasty.

  14. Circulating cornea-specific antibodies in corneal disease and cornea transplantation

    NARCIS (Netherlands)

    Jager, M. J.; Vos, A.; Pasmans, S.; Hoekzema, R.; Broersma, L.; van der Gaag, R.

    1994-01-01

    In order to establish the significance of circulating cornea-specific antibodies, we determined the presence of anti-corneal antibodies in the serum of 100 patients with corneal disease and in 50 healthy controls, and subsequently followed the pattern of antibody reactivity in 46 patients who

  15. A cross-sectional study of clinical, histopathological and direct immmunofluorescence diagnosis in autoimmune bullous diseases

    Directory of Open Access Journals (Sweden)

    Anchal Jindal

    2014-01-01

    Full Text Available Background: Immunobullous diseases are morphologically heterogeneous and the differentiation between various subtypes is essential for proper treatment and prognosis. Aim of our study was to analyze and correlate clinical, histopathological and immunofluorescence findings in autoimmune bullous diseases. Materials and Methods: A cross-sectional study was done over a period of two years (2010-2012 after approval of the ethics committee. Sixty patients, who met the inclusion criteria of immunobullous disease, were included in the study. Skin biopsy for histopathology and direct immunofluorescence (DIF examination was taken. DIF using salt-split technique was done in few of the cases. The final diagnosis was based on clinical, histopathology and DIF findings. Pearson′s coefficient of correlation (r was calculated. Statistical Analysis was done using Epi info version. 7.0. Results: Fifty-three cases with clinical diagnosis of autoimmune bullous diseases were evaluated. In 88.6% of cases, histopathology diagnosis was consistent with clinical diagnosis and in 75.5% of cases, DIF findings were consistent with clinical diagnosis. A positive relation was seen between clinical and DIF findings with r = 0.65 and between histopathology and DIF findings with r = 0.75. DIF positivity was seen in 100% cases of bullous pemphigoid (BP and pemphigus foliaceous and 94.7% cases of pemphigus vulgaris, which was statistically significant with p < 0.05. In DIF salt-split test, deposition was seen on roof of blister in BP whereas on floor in epidermolysis bullosa acquisita. Conclusion: Our study provides evidence-based guidance for the diagnosis and classification of various immunobullous disorders. DIF test should be done in conjunction with histopathology for definitive diagnosis and to minimize both: False-positive and false-negative results.

  16. Cornea Optical Topographical Scan System (COTSS)

    Science.gov (United States)

    1986-01-01

    The Cornea Optical Topographical Scan System (COTSS) is an instrument designed for use by opthalmologist to aid in performing surgical procedures such as radial keratotomy and to provide quick accurate data to aid in prescribing contact lenses and eyeglasses. A breadboard of the system was built and demonstrated in June of 1984. Additional refinements to the breadboard are needed to meet systems requirements prior to proceeding with prototype development. The present status of the COTSS instrument is given and the areas in which system refinements are required, are defined.

  17. Bullous Exudative Retinal Detachment after Retinal Pattern Scan Laser Photocoagulation in Diabetic Retinopathy

    Directory of Open Access Journals (Sweden)

    Shohei Nishikawa

    2017-10-01

    Full Text Available Laser retinal photocoagulation is the gold standard treatment for diabetic retinopathy. We describe 3 cases in which bullous exudative retinal detachment (ERD developed after pattern scan laser photocoagulation (PASCAL in diabetic retinopathy. ERD spontaneously resolved in all 3 cases with various visual courses. This case series highlights 2 key points: first, ERD can occur regardless of gender, age, glycemic control, or vitreous status and despite a moderate number of laser shots, even with PASCAL; second, ERD in nonvitrectomized eyes may cause irreversible visual loss, even if the ERD resolves within 1 month.

  18. Place of human amniotic membrane immunoblotting in the diagnosis of autoimmune bullous dermatoses.

    Science.gov (United States)

    Grootenboer-Mignot, S; Descamps, V; Picard-Dahan, C; Nicaise-Roland, P; Prost-Squarcioni, C; Leroux-Villet, C; Champagnat, C; Delaval, A; Aucouturier, F; Crickx, B; Chollet-Martin, S

    2010-04-01

    Fine analysis of antiskin autoantibodies can contribute to the differential diagnosis of autoimmune bullous dermatoses. To develop a high-performance immunoblotting method using human amniotic membrane as the antigen source, and to compare it with current laboratory methods. Sera from 113 patients were tested by immunoblotting (IB), rat and monkey oesophagus and salt-split skin indirect immunofluorescence (IIF), and enzyme-linked immunosorbent assay (ELISA) quantification of anti-BP180-NC16a and anti-BP230, or antidesmoglein (Dsg) 1 and 3 antibodies. There were 56 cases of bullous pemphigoid (BP), 22 cases of mucous membrane pemphigoid (MMP), eight cases of epidermolysis bullosa acquisita (EBA), two cases of bullous systemic lupus erythematosus (BSLE), 17 cases of pemphigus vulgaris (PV), and four cases each of pemphigus foliaceus (PF) and paraneoplastic pemphigus (PNP). In BP, the three methods had similar sensitivity (84-89%) for both anti-BP180-NC16a and anti-BP230 antibody detection. In MMP, autoantibodies (mainly directed against BP180 or laminin 332 subunits) were detected in 77% of patients by IB, compared with only 9% by IIF on rat and monkey oesophagus and 36% on salt-split skin, and 14% by anti-BP180-NC16a and anti-BP230 ELISA. In patients with pemphigus, ELISA had 92% sensitivity for anti-Dsg1 and 3, but IB and rat bladder IIF were necessary to confirm PNP by revealing specific and rare patterns (antidesmoplakin I/II, antienvoplakin and antiperiplakin antibodies). IB also revealed anticollagen VII antibodies in 60% of patients with EBA and BSLE, and antibodies to BP180, BP230 and Dsg3 in a few patients who were negative using the other two techniques. Amniotic membrane immunoblotting is an interesting diagnostic tool for bullous diseases, as the entire panel of autoantibodies can be detected with a single extract. This method improves the identification of complex and heterogeneous autoimmune processes in conjunction with IIF and ELISA, and is

  19. Bullous mycosis fungoides associated with an extensive ulcer and a severe leukemoid reaction

    Directory of Open Access Journals (Sweden)

    Shuei Sato

    2011-12-01

    Full Text Available This report presents a case of bullous mycosis fungoides associated with an extensive ulcer and a severe leukemoid reaction. The rash began as indurated erythema which was always followed by ulceration. The rashes initially responded to radiation therapy, but multiple recurrences appeared. Several bullae appeared on the trunk during the course of the illness, without any evidence of paraneoplastic pemphigus. Finally, the ulcer covered a large part of the trunk, and the patient died of sepsis with an extreme leukocyte count of 118,000/μL. A bone marrow analysis revealed a leukemoid reaction and an autopsy revealed pseudomembranous colitis.

  20. Photodynamic therapy effective for the treatment of actinic keratosis and basal cell carcinoma in bullous pemphigoid patients.

    Science.gov (United States)

    Canavan, Theresa N; de la Feld, Salma Faghri; Huang, Conway; Sami, Naveed

    2017-06-01

    Treating skin cancers and extensive actinic keratosis in patients with bullous pemphigoid (BP) can be challenging. Treatment options pose unique risks in these patients as surgical wounds can have delayed wound healing and photodynamic therapy (PDT) may exacerbate their blistering disease. We report the successful use of PDT to treat actinic keratosis and skin cancers in two patients with BP, both of whom had excellent response to PDT and tolerated treatment without any bullous disease flares. Carefully selected patients with skin cancers and stable, well controlled BP can be safely considered for treatment using PDT. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Investigation of Friction-induced Damage to the Pig Cornea

    NARCIS (Netherlands)

    da Cruz Barros, Raquel; Van Kooten, Theo G.; Veeregowda, Deepak Halenahally

    2015-01-01

    Mechanical friction causes damage to the cornea. A friction measurement device with minimal intervention with the pig cornea tear film revealed a low friction coefficient of 0.011 in glycerine solution. Glycerine molecules presumably bind to water, mucins, and epithelial cells and therewith improve

  2. Biomechanics and wound healing in the cornea.

    Science.gov (United States)

    Dupps, William J; Wilson, Steven E

    2006-10-01

    The biomechanical and wound healing properties of the cornea undermine the predictability and stability of refractive surgery and contribute to discrepancies between attempted and achieved visual outcomes after LASIK, surface ablation and other keratorefractive procedures. Furthermore, patients predisposed to biomechanical failure or abnormal wound healing can experience serious complications such as keratectasia or clinically significant corneal haze, and more effective means for the identification of such patients prior to surgery are needed. In this review, we describe the cornea as a complex structural composite material with pronounced anisotropy and heterogeneity, summarize current understanding of major biomechanical and reparative pathways that contribute to the corneal response to laser vision correction, and review the role of these processes in ectasia, intraocular pressure measurement artifact, diffuse lamellar keratitis (DLK) and corneal haze. The current understanding of differences in the corneal response after photorefractive keratectomy (PRK), LASIK and femtosecond-assisted LASIK are reviewed. Surgical and disease models that integrate corneal geometric data, substructural anatomy, elastic and viscoelastic material properties and wound healing behavior have the potential to improve clinical outcomes and minimize complications but depend on the identification of preoperative predictors of biomechanical and wound healing responses in individual patients.

  3. Biomechanical properties of axially myopic cornea.

    Science.gov (United States)

    Altan, Cigdem; Demirel, Berna; Azman, Engin; Satana, Banu; Bozkurt, Ercüment; Demirok, Ahmet; Yilmaz, Omer Faruk

    2012-01-01

    To investigate biomechanical parameters of the cornea measured with ocular response analyzer (ORA) in myopic eyes with high axial length and the relationship between these parameters and axial length (AL). A total of 165 eyes of 165 consecutive patients were included. Eyes with AL greater than 26 mm were named group 1 and eyes with AL shorter than 26 mm were named group 2. Axial length and keratometric values were measured by intraocular lens (IOL) Master optical biometry. Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the ORA. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). The mean age of total subjects was 43.0 ± 15.6 years. Eighty-three eyes were included in group 1; 82 eyes were included in group 2. The CH and CRF of group 1 were significantly lower than group 2. The IOPcc was significantly higher in group 1 than group 2. When group 1 and group 2 were combined for analysis, CH was negatively correlated with age. Both CH and CRF were significantly correlated with SE. However, CH and CRF were negatively correlated with AL. Also, there was significant correlation between AL and IOPcc (pbiomechanical properties of the cornea change with elongation of the eye and this may have an impact on IOP measurement.

  4. Electrolytes in the cornea: a therapeutic challenge.

    Science.gov (United States)

    Schrage, N F; Flick, S; Redbrake, C; Reim, M

    1996-12-01

    Reported here are the results of electrolyte measurements in different layers of 70 apparently normal human corneas. Samples were examined by energy-dispersive X-ray analysis under calibrated conditions in a scanning electron microscope. The method allows the simultaneous quantitative analysis of, among others, sodium (Na), chloride (Cl), phosphorus (P) and potassium (K). The results are related to the dry weight of the analyzed samples. Four distinct layers, subepithelium, middle stroma, posterior stroma and Descemet's membrane, were analysed in each cornea. In the middle stroma we found concentrations of: sodium 0.609 +/- 0.13, chloride 0.557 +/- 0.115, potassium 0.058 +/- 0.02 and phosphorus 0.038 +/- 0.01 (mol/kg dry weight) [corrected]. The collation of normal electrolyte concentrations provides reference values for future studies on changes of the corneal electrolyte composition in diseased or injured eyes. The electrolyte composition of rinsing fluids or eye drops should be adjusted to that of the corneal stroma. Phosphate buffer, for example, is not a good vehicle for topical eye treatments and should be replaced by organic buffering systems.

  5. Selenoprotein P controls oxidative stress in cornea.

    Directory of Open Access Journals (Sweden)

    Akihiro Higuchi

    Full Text Available The ocular surface is always attacked by oxidative stress, and cornea epithelial cells are supposed to have their own recovery system against oxidative stress. Therefore we hypothesized that tears supply key molecules for preventing oxidative stress in cornea. The potential target key molecule we focused is selenoprotein P (SeP. SeP is a carrier of selenium, which is an essential trace element for many animals, for oxidative stress metabolism in the organism, and was extremely expressed in lacrimal gland. An experiment was performed with SeP eye drops in a rat dry eye model, prepared by removing the lacrimal glands. The anticipated improvement in corneal dry eye index and the suppression of oxidative stress markers were observed in SeP eye drop group. Furthermore, the concentration of SeP was significantly higher in dry eye patients compared with normal volunteers. Collectively, we concluded that tear SeP is a key molecule to protect the ocular surface cells against environmental oxidative stress.

  6. Biomechanics and Wound Healing in the Cornea

    Science.gov (United States)

    Dupps, William J.; Wilson, Steven E.

    2009-01-01

    The biomechanical and wound healing properties of the cornea undermine the predictability and stability of refractive surgery and contribute to discrepancies between attempted and achieved visual outcomes after LASIK, surface ablation and other keratorefractive procedures. Furthermore, patients predisposed to biomechanical failure or abnormal wound healing can experience serious complications such as keratectasia or clinically significant corneal haze, and more effective means for the identification of such patients prior to surgery are needed. In this review, we describe the cornea as a complex structural composite material with pronounced anisotropy and heterogeneity, summarize current understanding of major biomechanical and reparative pathways that contribute to the corneal response to laser vision correction, and review the role of these processes in ectasia, intraocular pressure measurement artifact, diffuse lamellar keratitis (DLK) and corneal haze. The current understanding of differences in the corneal response after photorefractive keratectomy (PRK), LASIK and femtosecond-assisted LASIK are reviewed. Surgical and disease models that integrate corneal geometric data, substructural anatomy, elastic and viscoelastic material properties and wound healing behavior have the potential to improve clinical outcomes and minimize complications but depend on the identification of preoperative predictors of biomechanical and wound healing responses in individual patients. PMID:16720023

  7. Mechanical Modeling of a Keratoconic Cornea.

    Science.gov (United States)

    Perone, Jean Marc; Conart, Jean Baptiste; Bertaux, Pierre-Jean; Sujet-Perone, Nicolas; Ouamara, Nadia; Sot, Maxime; Henry, Jean Jacques

    2017-10-01

    We created a laboratory model of a cornea that was subjected to various pressures and thermal and mechanical factors to better understand the genesis of keratoconus deformation. A steel base allowed for fixation of circular multilaminated patches of araldite (10 cm in diameter, 5 mm thick) in which the corneal anatomy was modeled. The model was plunged into a steam room (374°F/3 bars of pressure for 1 h) to ensure thermal homogeneity and was subjected to pressure using compressed air. Three models were assessed: a fault-free model with no lesion (model 1), and 2 models with a defect. The first of the defective models (model 2) had an external crack-type lesion (1 cm long; 1 mm deep). The second defective model (model 3) had one quarter thinned down using abrasive sandpaper (thickness reduced by 30%-40%). For model 1, which represented a healthy cornea, homogeneous modification was noted when examined under polarized light. In model 2, no excessive deformation was noticed, but there were stress lines at the edge of the lesion. Model 3 had a deformity, similar to keratoconic deformation. Our findings suggest that the disease progresses under environmental stresses, but only when there is an initial defect, and especially when there is a thinning down defect. This thinning down defect may be induced by continual eye rubbing.

  8. Finite element modelling of cornea mechanics: a review.

    Science.gov (United States)

    Nejad, Talisa Mohammad; Foster, Craig; Gongal, Dipika

    2014-01-01

    The cornea is a transparent tissue in front of the eye that refracts light and facilitates vision. A slight change in the geometry of the cornea remarkably affects the optical power. Because of this sensitivity, biomechanical study of the cornea can reveal much about its performance and function. In vivo and in vitro studies have been conducted to investigate the mechanics of the cornea and determine its characteristics. Numerical techniques such as the finite element method (FEM) have been extensively implemented as effective and noninvasive methods for analyzing corneal mechanics and possible disorders. This article reviews the use of FEM for assessing the mechanical behavior of the cornea. Different applications of FEM in corneal disease studies, surgical predictions, impact simulations, and clinical applications have been reviewed. Some suggestions for the future of this type of modeling in the area of corneal mechanics are also discussed.

  9. [The 2009 performance report of the German cornea banks].

    Science.gov (United States)

    Schrage, N; Reinhard, T; Seitz, B; Hermel, M; Böhringer, D; Reinshagen, H

    2011-03-01

    In Germany, human tissue for corneal and amniotic transplantation is supplied by 27 cornea banks. The Section for Tissue Transplantation and Biotechnology of the German Ophthalmological Society records the cornea banks' activities by means of an annual questionnaire. In 2009, a total of 4,818 corneal grafts were processed by 21 responding cornea banks, and 57% were deemed suitable for transplantation. This ratio is slightly higher than the European average. In addition, German cornea banks released 1,257 amniotic grafts in 2009. German cornea banks are currently facing new regulatory issues due to updated legislation regarding tissue transplantation. Recent updates in European law have limited the cutoff time for postmortem blood sampling to 24 h, and this regulation may lead to a significant reduction in potential donors.

  10. Finite element modelling of cornea mechanics: a review

    Directory of Open Access Journals (Sweden)

    Talisa Mohammad Nejad

    2014-01-01

    Full Text Available The cornea is a transparent tissue in front of the eye that refracts light and facilitates vision. A slight change in the geometry of the cornea remarkably affects the optical power. Because of this sensitivity, biomechanical study of the cornea can reveal much about its performance and function. In vivo and in vitro studies have been conducted to investigate the mechanics of the cornea and determine its characteristics. Numerical techniques such as the finite element method (FEM have been extensively implemented as effective and noninvasive methods for analyzing corneal mechanics and possible disorders. This article reviews the use of FEM for assessing the mechanical behavior of the cornea. Different applications of FEM in corneal disease studies, surgical predictions, impact simulations, and clinical applications have been reviewed. Some suggestions for the future of this type of modeling in the area of corneal mechanics are also discussed.

  11. UV Crosslinking of Donor Corneas Confers Resistance to Keratolysis

    Science.gov (United States)

    Arafat, Samer N.; Robert, Marie-Claude; Shukla, Anita N.; Dohlman, Claes H.; Chodosh, James; Ciolino, Joseph B.

    2014-01-01

    Purpose To develop a modified ex vivo corneal crosslinking method that increases stromal resistance to enzymatic degradation for use as a carrier for the Boston keratoprosthesis. Methods Ex vivo crosslinking of human corneas was performed using Barron® artificial anterior chambers. The corneas were de-epithelialized, pre-treated with riboflavin solution (0.1% riboflavin/20% dextran) and irradiated with ultraviolet A (UVA) light (λ=370nm, irradiance=3mW/cm2) for various durations. The combined effect of UVA and gamma (γ) irradiation was also assessed using the commercially available γ-irradiated corneal donors. The corneas were then trephined and incubated at 37 degrees Celsius with 0.3% collagenase A solution. The time to dissolution of each cornea was compared across treatments. Results De-epithelialized corneas (no UV light, no riboflavin) dissolved in 5.8 ± 0.6 hours. Crosslinked corneas demonstrated increased resistance to dissolution, with a time to dissolution of 17.8 +/− 2.6 hours (p corneas did not provide added resistance when compared to crosslinking the anterior corneas only (p>0.05). γ-irradiated corneas dissolved as readily as de-epithelialized controls regardless of whether they were further crosslinked (5.6 ± 1.2 hours) or not (6.1 ± 0.6 hours) (p=0.43) Conclusions Collagen crosslinking of the de-epithelialized anterior cornea surface for 30 minutes conferred optimal resistance to in vitro keratolysis by collagenase A. PMID:25014151

  12. Salt split technique: A useful tool in the diagnosis of subepidermal bullous disorders

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    De Abhishek

    2010-01-01

    Full Text Available Background: Direct immunofluorescence (DIF is the gold standard in the diagnosis of immunobullous diseases. However, it cannot reliably differentiate various subtypes of subepidermal immune- bullous diseases (SIBD. Salt split technique (SST could be used under such circumstances to differentiate them. There is paucity of reports in the Indian literature regarding the SST. Aim: This study was designed to evaluate the utility of direct SST in subepidermal blistering diseases. Materials and Methods: Fourteen clinically diagnosed cases of subepidermal blistering diseases were included in the study. Two perilesional punch biopsies were taken one each for DIF and salt split study. Results: Linear basement membrane zone band with IgG and/or C 3 was seen in 14 cases of patients BP. Salt split study showed epidermal or mixed pattern of deposits in 12 patients and exclusive floor pattern in two patients. The diagnosis was revised in these two patients to epidermolysis bullosa acquisita. Conclusion: SST is a simple, inexpensive procedure and should be routinely employed in the diagnosis of subepidermal bullous diseases.

  13. Aberrant expression and secretion of heat shock protein 90 in patients with bullous pemphigoid.

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    Stefan Tukaj

    Full Text Available The cell stress chaperone heat shock protein 90 (Hsp90 has been implicated in inflammatory responses and its inhibition has proven successful in different mouse models of autoimmune diseases, including epidermolysis bullosa acquisita. Here, we investigated expression levels and secretory responses of Hsp90 in patients with bullous pemphigoid (BP, the most common subepidermal autoimmune blistering skin disease. In comparison to healthy controls, the following observations were made: (i Hsp90 was highly expressed in the skin of BP patients, whereas its serum levels were decreased and inversely associated with IgG autoantibody levels against the NC16A immunodominant region of the BP180 autoantigen, (ii in contrast, neither aberrant levels of circulating Hsp90 nor any correlation of this protein with serum autoantibodies was found in a control cohort of autoimmune bullous disease patients with pemphigus vulgaris, (iii Hsp90 was highly expressed in and restrictedly released from peripheral blood mononuclear cells of BP patients, and (iv Hsp90 was potently induced in and restrictedly secreted from human keratinocyte (HaCaT cells by BP serum and isolated anti-BP180 NC16A IgG autoantibodies, respectively. Our results reveal an upregulated Hsp90 expression at the site of inflammation and an autoantibody-mediated dysregulation of the intracellular and extracellular distribution of this chaperone in BP patients. These findings suggest that Hsp90 may play a pathophysiological role and represent a novel potential treatment target in BP.

  14. Association of Autoantibodies to BP180 with Disease Activity in Greek Patients with Bullous Pemphigoid

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    Aikaterini Patsatsi

    2012-01-01

    Full Text Available 39 bullous pemphigoid (BP patients were studied to assess the clinical significance of anti-BP180 and anti-BP230 circulating autoantibodies of BP and correlate their titers with the clinical scores of the BP Disease Area Index (BPDAI and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS as well as with the intensity of pruritus measured by the BPDAI pruritus component. All parameters were evaluated by the time of diagnosis (baseline, month 3, and month 6. Titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (, and ABSIS (, values, as well as with BPDAI component for the intensity of pruritus (, at baseline. At month 3, titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (, and ABSIS (, values, as well as with the BPDAI component for the intensity of pruritus (, . At month 6, titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (, and ABSIS (, values, as well as with the BPDAI component for the intensity of pruritus (, . There was no statistically significant correlation between titers of anti-BP230 autoantibodies and the BPDAI, ABSIS, and BPDAI component for the intensity of pruritus at the same time points.

  15. Cannabis-induced bullous lung disease leading to pneumothorax: Case report and literature review.

    Science.gov (United States)

    Mishra, Rashmi; Patel, Ravi; Khaja, Misbahuddin

    2017-05-01

    Marijuana use has been increasing in the United States among college students and young adults. Marijuana use has been associated with bullous lung disease which can lead to pneumothorax. There are other recreational drugs like methylphenidate, cocaine and heroin which have been associated with pneumothorax. We present a case of a 30-year-old man with spontaneous pneumothorax associated with marijuana use. The patient had no medical conditions and presented to the emergency room with chest pain. The physical examination revealed decreased breath sound on the right side of the chest. Bed side ultrasound of chest showed stratosphere sign, absent lung sliding; consistent with right-sided pneumothorax. The patient underwent placement of a chest tube. Computed tomography chest scans performed on day two also showed bullous lung disease in the right lung. Serial x-rays of the chest showed re-expansion of the lung. Despite the beneficial effects of Marijuana there are deleterious effects which are emphasized here. This case highlights the need for further studies to establish the relationship between marijuana use and lung diseases in the absence of nicotine use.

  16. A Rare Case of Vancomycin-Induced Linear Immunoglobulin A Bullous Dermatosis

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    Pinky Jha

    2017-01-01

    Full Text Available Linear IgA bullous dermatosis (LABD is an autoimmune vesiculobullous disease, which is typically idiopathic but can also rarely be caused by medications or infections. Vancomycin is the most common drug associated with LABD. Lesions typically appear 24 hours to 15 days after the first dose of vancomycin. It is best characterized pathologically by subepidermal bulla (blister formation with linear IgA deposition at the dermoepidermal junction. Here we report an 86-year-old male with a history of left knee osteoarthritis who underwent a left knee arthroplasty and subsequently developed a prosthetic joint infection. This infection was treated with intravenous vancomycin as well as placement of a vancomycin impregnated joint spacer. Five days following initiation of antibiotic therapy, he presented with a vesiculobullous eruption on an erythematous base over his trunk, extremities, and oral mucosa. The eruption resolved completely when intravenous vancomycin was discontinued and colchicine treatment was begun. Curiously, complete resolution occurred despite the presence of the vancomycin containing joint spacer. The diagnosis of vancomycin-induced linear IgA bullous dermatosis was made based on characteristic clinical and histopathologic presentations.

  17. Rudolf Virchow's medical school dissertation on rheumatism and the cornea: overlooked tribute to the cornea in biomedical research.

    Science.gov (United States)

    Margo, Curtis E; Harman, Lynn E

    2015-02-01

    To critique Rudolf Virchow's medical school dissertation on rheumatism and the cornea and to determine whether it might have anticipated his remarkable career in medicine. Review of the English translation of Rudolf Virchow's de Rheumate Praesertim Corneae written in 1843. The dissertation was more than 7000 words long. Virchow considered rheumatism as an irritant disorder not induced by acid as traditionally thought but by albumin. He concluded that inflammation was secondary to a primary irritant and that the "seat" of rheumatism was "gelatinous" (connective) tissues, which included the cornea. He divided kerato-rheumatism into different varieties. The prognosis of keratitis was variable, and would eventually lapse into "scrofulosis, syphilis, or arthritis of the cornea." Virchow's dissertation characterizes rheumatism in terms of chemical and tissue interactions that make little sense in the context of today's knowledge of rheumatic disease and keratitis. Ironically, many of these concepts were made obsolete by the cellular model of disease that Virchow championed. Virchow decided to pursue the study of rheumatism through the cornea because he thought that the cornea was an ideal tissue to study disease. This discernment was passed on to his students whose seminal contributions to general pathology were based on research with the cornea. It is debatable whether Virchow's insight into the importance of the cornea in biomedical research at such an early stage of his career could have predicted his monumental contributions to medicine.

  18. The cornea and disorders of lipid metabolism.

    Science.gov (United States)

    Barchiesi, B J; Eckel, R H; Ellis, P P

    1991-01-01

    Disorders of lipid metabolism, either hyperlipidemia or hypolipidemia, are associated with the formation of corneal opacities. Corneal arcus, the most commonly encountered peripheral corneal opacity, is frequently associated with abnormal serum lipid levels, but may occur without any predisposing factors. Reports also have linked corneal arcus with alcoholism, diabetes mellitus and atherosclerotic heart disease. Unilateral arcus is a rare entity that is associated with carotid artery disease or ocular hypotony. Diffuse corneal opacities associated with hypolipidemic disorders such as LCAT deficiency, fish eye disease and Tangier disease, may be the initial manifestation of these disorders and puts the ophthalmologist in a position to make an early diagnosis. Corneal arcus, along with a central corneal opacity, is seen in Schnyder's crystalline stromal distrophy. The association of the disorder with a dyslipidemia remains controversial. A review of lipid metabolism, corneal arcus and several disorders of lipid metabolism that affect the cornea are presented.

  19. Customized Finite Element Modelling of the Human Cornea

    Science.gov (United States)

    Simonini, Irene; Pandolfi, Anna

    2015-01-01

    Aim To construct patient-specific solid models of human cornea from ocular topographer data, to increase the accuracy of the biomechanical and optical estimate of the changes in refractive power and stress caused by photorefractive keratectomy (PRK). Method Corneal elevation maps of five human eyes were taken with a rotating Scheimpflug camera combined with a Placido disk before and after refractive surgery. Patient-specific solid models were created and discretized in finite elements to estimate the corneal strain and stress fields in preoperative and postoperative configurations and derive the refractive parameters of the cornea. Results Patient-specific geometrical models of the cornea allow for the creation of personalized refractive maps at different levels of IOP. Thinned postoperative corneas show a higher stress gradient across the thickness and higher sensitivity of all geometrical and refractive parameters to the fluctuation of the IOP. Conclusion Patient-specific numerical models of the cornea can provide accurate quantitative information on the refractive properties of the cornea under different levels of IOP and describe the change of the stress state of the cornea due to refractive surgery (PRK). Patient-specific models can be used as indicators of feasibility before performing the surgery. PMID:26098104

  20. Customized Finite Element Modelling of the Human Cornea.

    Directory of Open Access Journals (Sweden)

    Irene Simonini

    Full Text Available To construct patient-specific solid models of human cornea from ocular topographer data, to increase the accuracy of the biomechanical and optical estimate of the changes in refractive power and stress caused by photorefractive keratectomy (PRK.Corneal elevation maps of five human eyes were taken with a rotating Scheimpflug camera combined with a Placido disk before and after refractive surgery. Patient-specific solid models were created and discretized in finite elements to estimate the corneal strain and stress fields in preoperative and postoperative configurations and derive the refractive parameters of the cornea.Patient-specific geometrical models of the cornea allow for the creation of personalized refractive maps at different levels of IOP. Thinned postoperative corneas show a higher stress gradient across the thickness and higher sensitivity of all geometrical and refractive parameters to the fluctuation of the IOP.Patient-specific numerical models of the cornea can provide accurate quantitative information on the refractive properties of the cornea under different levels of IOP and describe the change of the stress state of the cornea due to refractive surgery (PRK. Patient-specific models can be used as indicators of feasibility before performing the surgery.

  1. Customized Finite Element Modelling of the Human Cornea.

    Science.gov (United States)

    Simonini, Irene; Pandolfi, Anna

    2015-01-01

    To construct patient-specific solid models of human cornea from ocular topographer data, to increase the accuracy of the biomechanical and optical estimate of the changes in refractive power and stress caused by photorefractive keratectomy (PRK). Corneal elevation maps of five human eyes were taken with a rotating Scheimpflug camera combined with a Placido disk before and after refractive surgery. Patient-specific solid models were created and discretized in finite elements to estimate the corneal strain and stress fields in preoperative and postoperative configurations and derive the refractive parameters of the cornea. Patient-specific geometrical models of the cornea allow for the creation of personalized refractive maps at different levels of IOP. Thinned postoperative corneas show a higher stress gradient across the thickness and higher sensitivity of all geometrical and refractive parameters to the fluctuation of the IOP. Patient-specific numerical models of the cornea can provide accurate quantitative information on the refractive properties of the cornea under different levels of IOP and describe the change of the stress state of the cornea due to refractive surgery (PRK). Patient-specific models can be used as indicators of feasibility before performing the surgery.

  2. [The macrophage contribution for maintaining lymphatic vessel in cornea].

    Science.gov (United States)

    Maruyama, Kazuichi

    2014-11-01

    The presence of antigen-presenting cells and hem- and lymphangiogenesis in the cornea are risk factors for the rejection of corneal transplants. We previously reported that antigen-presenting cells such as macrophages (MPs) play an important role in the induction of lymphatic endothelial cells during inflammation. This prompted us to inquire whether the existence of lymphatic vessels in the cornea is associated with the activation of MPs during inflammation. To investigate this question, we performed suture placement on the cornea to induce inflammation. We found that a large number of MPs were recruited and that lymphatic vessels were formed in response. Next, as C57BL/6 mice have a higher rejection rate after corneal transplantation than BALB/c mice, we compared the corneas of C57BL/6 and BALB/c mice under normal and inflamed conditions. We found that the number of spontaneously formed lymphatic vessels in the C57BL/6 corneas was significantly greater than in the BALB/c corneas, and that there were more activated MPs in the C57BL/6 corneas than in the BALB/c corneas. Additionally, to confirm that activated MPs induced and maintained lymphatic vessels in the cornea, we depleted the number of MPs in C57BL/6 mice via clodronate liposomes. We found that MP depletion reduced the spontaneous formation of lymphatic vessels and reduced inflammation-induced lymphangiogenesis relative to control mice. Finally, we found that mice deficient in MP markers had fewer spontaneously formed lymphatic vessels and less lymphangiogenesis than control C57BL/6 mice. The evidence gathered in this study leads us to conclude that activated MPs appear to play an important role in the formation of new lymphatic vessels and in their maintenance.

  3. Effects on collagen orientation in the cornea after trephine injury.

    Science.gov (United States)

    Kamma-Lorger, Christina S; Hayes, Sally; Boote, Craig; Burghammer, Manfred; Boulton, Michael E; Meek, Keith M

    2009-01-01

    Structural changes are well known to occur in the cornea after injury. The aim of this study was to investigate collagen orientation changes in the cornea during a short-term wound healing process. Seven bovine corneas were injured using a penetrating 5 mm biopsy punch and were subsequently organ cultured for up to two weeks. Six uninjured corneas acted as controls. The trephine wounded samples were snap frozen in liquid nitrogen either immediately after injury (0 h) or after 1 or 2 weeks in culture. Control/uninjured samples were snap frozen on arrival (0 h) or after 1 or 2 weeks in culture. Wide angle X-ray diffraction data were collected from each cornea at the UK Synchrotron Radiation Source or at the European Synchrotron Radiation Facility. Data analysis revealed information about collagen orientation and distribution in the corneal stroma during wound healing. For histology, two trephine wounded corneas at 0 h and 1 week and one control/uninjured cornea at 0 h were fixed in 10% neutral buffered formalin and processed for wax embedding. Wax sections were subsequently counterstained with haematoxylin and eosin to observe tissue morphology and the time course of complete re-epithelialization. Immediately after injury, collagen organization was altered in a small area inside the wound but remained similar to the control/uninjured sample in the remainder of the tissue. After one week, the trephine wounded corneas showed complete re-epithelialization and evidence of swelling while collagen adopted a radial arrangement inside and outside the wound. Remarkable changes in collagen fibril orientation were observed in trephine wounded corneas. Orientation changes immediately after wounding are likely to be due to the mechanical deformation of the tissue during the wounding process. However, tissue swelling and changes in collagen orientation at later stages probably reflect the processes of tissue repair. These differences will determine corneal stability and strength

  4. Simulation analysis of the transparency of cornea and sclera

    Science.gov (United States)

    Yang, Chih-Yao; Tseng, Snow H.

    2017-02-01

    Both consist of collagen fibrils, sclera is opaque whereas cornea is transparent for optical wavelengths. By employing the pseudospectral time-domain (PSTD) simulation technique, we model light impinging upon cornea and sclera, respectively. To analyze the scattering characteristics of light, the cornea and sclera are modeled by different sizes and arrangements of the non-absorbing collagen fibrils. Various factors are analyzed, including the wavelength of incident light, the thickness of the scattering media, position of the collagen fibrils, size distribution of the fibrils.

  5. Bullous Pemphigoid

    Science.gov (United States)

    ... Our Fellowship Programs Residency Training Resident Calendar Board Certification Grand Rounds Resident Awards AOCD Residency Leadership Award ... at all ages. It is an autoimmune disorder, meaning it is caused when the body's immune system ...

  6. Frequent Occurrence of Aplasia Cutis Congenita in Bullous Dermolysis of the Newborn.

    Science.gov (United States)

    Diociaiuti, Andrea; Castiglia, Daniele; Giancristoforo, Simona; Guerra, Liliana; Proto, Vittoria; Dotta, Andrea; Boldrini, Renata; Zambruno, Giovanna; El Hachem, Maya

    2016-08-23

    Bullous dermolysis of the newborn (BDN) is a subtype of dystrophic epidermolysis bullosa characterized by rapid improvement in skin fragility within the first months of life, associated with typical immunofluorescence and ultrastructural features. Inheritance can be autosomal dominant or recessive. We report here 4 cases of BDN, 2 of which presented with aplasia cutis congenita of the lower extremities. All patients improved rapidly and blister formation ceased by the third month of life in 3 cases. In these patients only residual milia, nail dystrophies and atrophic scarring at sites of aplasia cutis were visible by one year. Family history indicated dominant inheritance in 2 cases, confirmed by identification of COL7A1 mutation. Molecular analysis also revealed recessive inheritance in the 2 sporadic cases. A literature search identified several patients with BDN born with skin defects localized to the lower extremities. In conclusion, these findings indicate that aplasia cutis congenita is not an infrequent manifestation of BDN.

  7. Development of bullous pemphigoid during treatment of psoriatic onycho-pachydermo periostitis with ustekinumab.

    Science.gov (United States)

    Nakayama, Chihiro; Fujita, Yasuyuki; Watanabe, Mika; Shimizu, Hiroshi

    2015-10-01

    Ustekinumab is a human monoclonal antibody that specifically binds to the p40 subunit of interleukin (IL)-12 and IL-23, inhibiting the activity of both cytokines, thereby blocking the T-helper (Th)1 and Th17 inflammatory pathways. While biologic agents have dramatically changed the strategies of psoriasis treatment, increasing cases of autoimmune diseases during the use of such agents have been reported. We experienced a case of bullous pemphigoid occurring during treatment of a rare variant of psoriatic arthritis, psoriatic onycho-pachydermo periostitis with ustekinumab. Only six cases of autoimmune blistering diseases during treatment with biologic agents have ever been reported including our case, and we herein review the published work of these cases. Dermatologists must be attentive to the possibility of autoimmune blistering diseases during ustekinumab treatment. © 2015 Japanese Dermatological Association.

  8. Herpes Simplex Virus Infection Mimicking Bullous Disease in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Anne L.Y. Lecluse

    2010-06-01

    Full Text Available Immunodeficient patients are at risk of developing extended or atypical herpes simplex virus infections, which can be easily misdiagnosed. We present the case of a 79-year-old, treatment-induced (oral corticosteroid, immunocompromised female with an extensive atypical herpes simplex virus infection. This patient presented with multiple erosions and vesicles on the trunk with a subacute onset. The clinical differential diagnosis was herpes simplex infection, herpes zoster infection, pemphigus vulgaris or bullous pemphigoid. Due to the atypical clinical presentation and negative Tzanck test, suspicion of viral infection was low. High-dose steroid treatment was initiated. Subsequent histopathology, however, showed a herpes simplex virus infection. After discontinuing steroid treatment and initiating antiviral treatment, the patient recovered within a week. Emphasis must be placed on the importance of clinical awareness of extended and clinically atypical herpes simplex infections in immunocompromised patients. A negative Tzanck test does not rule out the possibility of a herpes infection.

  9. Generalized bullous fixed drug eruption imitating toxic epidermal necrolysis: a case report and literature review.

    Science.gov (United States)

    Mitre, Victoria; Applebaum, Danielle S; Albahrani, Yasser; Hsu, Sylvia

    2017-07-15

    Fixed drug eruption (FDE) is defined as sharply demarcated erythematous patches or plaques that occur secondary to systemic exposure to a causative medication. Eruptions are deemed "fixed" because upon repeated exposure they recur at previously affected sites. Generalized bullous fixed drug eruption (GBFDE) is a rare FDE variant occurring in patients with a previous history of FDE. Given the extensive cutaneous involvement and the frequent mucosal ulcerations associated with GBFDE, it is challenging to discern these lesions from Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The presence of significantly elevated lesional and serum granulysin in SJS/TEN is an important discriminating factor because granulysin levels remain significantly lower in GBFDE. The implementation of an immunochromatographic test for rapid detection of elevated granulysin levels could therefore facilitate the early diagnosis of SJS/TEN. We report a case of GBFDE to elucidate the characteristic differences in clinical presentation, histopathology, and immunohistochemistry that can facilitate diagnosis.

  10. Bullous Dermatosis in an End-Stage Renal Disease Patient: A Case Report and Literature Review

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    Zeenat Yousuf Bhat

    2016-01-01

    Full Text Available Patients with advanced chronic kidney disease including ESRD patients may present with a wide spectrum of cutaneous abnormalities, ranging from xerosis to hyperpigmentation to severe deforming necrotizing lesions. Skin problems are not uncommon in this population of patients, with a clinical presentation that can be quite bizarre, mandating a long list of differential diagnostic possibilities, and subsequent rise of a puzzling diagnostic challenge. We describe an ESRD patient who presented with blistering, nonhealing ulcerative lesions with a diagnostic skin biopsy revealing a mixed pattern of linear IgA bullous dermatosis and dermatitis herpetiformis. A clinical remission could be achieved with pulse intravenous steroids followed by oral maintenance in combination with dapsone, with no evidence of recurrence.

  11. Autoimmune bullous disease and Hashimoto's disease complicated by acquired hemophilia A.

    Science.gov (United States)

    Nishiura, Nobuko; Ujimoto, Daisuke; Fujita, Jiro; Maeda, Tetsuo; Nakagawa, Yukinobu; Kashiwagi, Hirokazu; Oritani, Kenji; Tomiyama, Yoshiaki; Kanakura, Yuzuru

    2017-01-01

    A 67-year-old man was admitted with a 1-month history of spontaneous hematoma in his right back and severe anemia. He had suffered from rashes with blisters involving both legs for 10 years, which had shown worsening and extended to his entire body concurrently with the hematoma. APTT was markedly prolonged to 119 seconds, and Factor VIII:C and FVIII inhibitor levels were less than 1% and 153.1 BU/ml, respectively, confirming the diagnosis of acquired hemophilia A (AHA). Skin biopsy revealed his rashes to be caused by autoimmune bullous disease (ABD), and laboratory and physical findings showed that he also had autoimmune hypothyroidism (Hashimoto's disease). Recombinant FVIIa was effective for management of his bleeding; in addition, FVIII inhibitor reduction and FVIII:C recovery, in parallel with improvement of the skin lesions, were achieved by administering prednisolone and cyclophosphamide. To our knowledge, this is the first report of AHA associated with ABD and Hashimoto's disease.

  12. Bullous aplasia cutis congenita with hair collar sign: A case report

    Directory of Open Access Journals (Sweden)

    Ömer Faruk Elmas

    2014-09-01

    Full Text Available Aplasia cutis congenita is a rare embryologic disorder characterized by localized or generalized absence of skin. The disease is frequently sporadic, however, it may also be familial. It usually affects the scalp, but, even rarely, it may be seen on other body areas. Skin may be affected with or without some congenital anomalies, especially bone anomalies. An 8-month-old girl presented with skin defect at the vertex since birth. A hair collar sign was observed around the lesion. In our case, bone and other systemic abnormalities were not associated with skin defect. Here, we report the case of a patient clinically diagnosed with bullous aplasia cutis congenita with hair collar sign which is a rare entity.

  13. Linear IgA Bullous Dermatosis Secondary to Infliximab Therapy in a Patient with Ulcerative Colitis.

    Science.gov (United States)

    Hoffmann, Jochen; Hadaschik, Eva; Enk, Alexander; Stremmel, Wolfgang; Gauss, Annika

    2015-01-01

    Linear IgA bullous disease (LABD) is a rare vesiculobullous autoimmune skin disorder whose etiology and pathogenesis are not completely understood. Its occurrence has been related to malignancies, inflammatory diseases and several drugs. This report describes a 49-year-old Caucasian male with a 14-year history of ulcerative colitis who received infliximab to treat the refractory course of his bowel disease. During induction therapy with infliximab, he developed LABD. Treatment with infliximab was discontinued, and the skin lesions were successfully treated with oral steroids and dapsone. Considering the close chronological relation between administration of the tumor necrosis factor-α inhibitor and onset of the skin disease, we hypothesize that this is the first reported case of infliximab-induced LABD. Similar to psoriasis, it may represent a 'paradoxical' autoimmune reaction triggered by anti-tumor necrosis factor-α therapy.

  14. [Mutation analysis of KRT10 gene in a patient with bullous congenital ichthyosiform erythroderma].

    Science.gov (United States)

    Zhang, Shi-de; Liu, Jing-jing; Tian, Wei; Zhao, Zheng-juan; Zhao, Jing-jun

    2011-08-01

    To investigate the gene mutation in one sporadic case of bullous congenital ichthyosiform erythroderma (BCIE), and to explore the relationship between the genotype and phenotype. DNA was extracted from the blood samples of the patient with BCIE, unaffected members of the pedigree, and 50 unrelated healthy controls. PCR was used to amplify the hot spot fragment of keratin 1 (KRT1) and keratin 10 (KRT10) gene. The PCR products were directly sequenced to detect the mutations. A heterozygous 467G>A mutation was found in the patient, resulting in the substitution of arginine (R) by histidine (H) in codon 156 (R156H) in the 1A domain of the KRT10 protein but not in the healthy individuals from the family and the 50 unrelated individuals. The mutation of 467G>A in exon 1 of KRT10 gene identified may play a major role in the pathogenic mechanism of this case of BCIE.

  15. Development of a disease registry for autoimmune bullous diseases: initial analysis of the pemphigus vulgaris subset.

    Science.gov (United States)

    Shah, Amit Aakash; Seiffert-Sinha, Kristina; Sirois, David; Werth, Victoria P; Rengarajan, Badri; Zrnchik, William; Attwood, Kristopher; Sinha, Animesh A

    2015-01-01

    Pemphigus vulgaris (PV) is a rare, potentially life threatening, autoimmune blistering skin disease. The International Pemphigus and Pemphigoid Foundation (IPPF) has recently developed a disease registry with the aim to enhance our understanding of autoimmune bullous diseases with the long-term goal of acquiring information to improve patient care. Patients were recruited to the IPPF disease registry through direct mail, e-mail, advertisements, and articles in the IPPF-quarterly, -website, -Facebook webpage, and IPPF Peer Health Coaches to complete a 38-question survey. We present here the initial analysis of detailed clinical information collected on 393 PV patients. We report previously unrecognized gender differences in terms of lesion location, autoimmune comorbidity, and delay in diagnosis. The IPPF disease registry serves as a useful resource and guide for future clinical investigation.

  16. Accuracy of indirect immunofluorescence on sodium chloride-split skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita

    National Research Council Canada - National Science Library

    Yang, Baoqi; Wang, Chong; Chen, Shengli; Chen, Xuechao; Zhou, Guizhi; Tian, Hongqing; Yu, Meiling; Zhang, Dizhan; Shi, Zhongxiang; Zhang, Furen

    2011-01-01

    ...) is helpful to differentiate epidermolysis bullosa acquisita (EBA) from bullous pemphigoid (BP). Antibodies of BP may bind to the epidermal side of SSS, while antibodies of EBA bind to the dermal side...

  17. Biomechanical properties of the keratoconic cornea: a review

    National Research Council Canada - National Science Library

    Vellara, Hans R; Patel, Dipika V

    2015-01-01

    ... ). This review discusses the effects of keratoconus on the biomechanical properties of the cornea and the current techniques used to detect these changes both in the laboratory and clinical setting...

  18. ANALYSIS OF DONOR CORNEA RETRIEVAL DATA- HOSPITAL AND RESIDENCES

    Directory of Open Access Journals (Sweden)

    Rekha Gyanchand

    2017-07-01

    Full Text Available BACKGROUND The voluntary eye donation is still the most popular methods of eye donation in our country. Since last three decades, the voluntary eye donation is promoted by a number of NGOs and Government of India. The meaning of voluntary eye donation is that an individual has prior knowledge about eye donation and also has the contact number of the eye bank. When they come across any death in their community, they will contact the eye bank for eye donation. As per Eye Bank Association of India, the incidence of total blindness is 8.9 million and 1% of this is corneal blindness. Each year, 25,000 to 30,000/new corneal blind patients are added. The voluntary eye donation is not sufficient in providing transplantable corneas to the corneal blind. As our concentration is mainly on voluntary eye collections, this is one of the main reasons that we are unable reach our target of sight restoration in the management of corneal blindness. In this study, we have analysed the voluntary eye donations procured from residence and hospital. The aim of the study is to compare corneas procured by hospital eye donations and residence eye donations to look into all factors that contribute to a transplantable cornea. MATERIALS AND METHODS The donor corneas retrieved from the year 2005-2010 were analysed. The hospital eye donations and residential eye donations were divided into two study groups. The factors analysed were number of corneas collected, donor age and gender, serology test result, death to preservation time (DPT, optical grade cornea, utilisation of corneas for transplantation and role of pledging in eye donation. Study Type- Retrospective study. Study Done- At Lions International Eye Bank, Bangalore. RESULTS The total number of donor eyes collected from the year 2005-2010 were 7362 of which residence collections was 50.73% and hospital collections was 49.26%. The 5-year period between from 2005 to 2010 in spite of not conducting a Hospital Cornea

  19. Fibronectin promotes epithelial migration of cultured rabbit cornea in situ

    OpenAIRE

    1983-01-01

    We investigated the effect of fibronectin on epithelial migration onto the stroma in cultured rabbit cornea. Rabbit plasma fibronectin was purified by affinity chromatography using gelatin-Sepharose 4B, and its purity was confirmed by SDS polyacrylamide slab gel electrophoresis. Antibody against rabbit plasma fibronectin raised in guinea pigs formed a single precipitin line against rabbit plasma and purified rabbit plasma fibronectin by Ouchterlony double diffusion test. When rabbit cornea wa...

  20. Biomechanical Measurement of Rabbit Cornea by a Modified Scheimpflug Device

    OpenAIRE

    Bo Zhang; Jianjun Gu; Xiaoxiao Zhang; Bin Yang; Zheng Wang; Danying Zheng

    2016-01-01

    Purpose. To explore the probability and variation in biomechanical measurements of rabbit cornea by a modified Scheimpflug device. Methods. A modified Scheimpflug device was developed by imaging anterior segment of the model imitating the intact eye at various posterior pressures. The eight isolated rabbit corneas were mounted on the Barron artificial chamber and images of the anterior segment were taken at posterior pressures of 15, 30, 45, 60, and 75 mmHg by the device. The repeatability an...

  1. Experimental allogenic transplantation of cornea endothelial cells in cats.

    Science.gov (United States)

    Kiełbowicz, Z; Kuryszko, J; Strzadała, L

    2010-01-01

    The aim of the present study was assessing the possibility of experimental allogenic transplantation of cat cornea endothelial cells, multiplied in vitro, into the anterior chamber of the eyeball in recipient cats. The reason for undertaking the research is the need to develop a method that would help in the cornea treatment in animals with corneal opacification following cataract surgery, as well as lens dislocation, injuries and endothelium degeneration. Cats aged 10-12 months were used in the experiment. Cornea fragments consisting of the posterior limiting membrane and posterior epithelium were placed in Iscove's medium with addition of 10% foetal calf serum. Multiplied in vitro cells were injected into the anterior chamber of recipient cats. The cornea was subject to histological, histometric and SEM examination on the 3rd, 7th, 20th and 30th day after the surgery. Micromorphological examination of the cornea showed full restitution of its endothelium 30 days after transplantation. Complete regeneration of structures indispensable for normal functioning of the posterior epithelium occurred as a result of implantation. In this study the results show that implantation of the cells of posterior corneal epithelium of donor cats, multiplied into vitro and injected into the anterior chamber of recipient cats. The cornea regained its full function, the layer of the posterior epithelium was regenerated and the stroma stabilized, presenting the image of full and proper corneal translucency.

  2. Nerves and Neovessels Inhibit Each Other in the Cornea

    Science.gov (United States)

    Ferrari, Giulio; Hajrasouliha, Amir R.; Sadrai, Zahra; Ueno, Hiroki; Chauhan, Sunil K.; Dana, Reza

    2013-01-01

    Purpose. To evaluate the regulatory cross-talk of the vascular and neural networks in the cornea. Methods. b-FGF micropellets (80 ng) were implanted in the temporal side of the cornea of healthy C57Bl/6 mice. On day 7, blood vessels (hemangiogenesis) and nerves were observed by immunofluorescence staining of corneal flat mounts. The next group of mice underwent either trigeminal stereotactic electrolysis (TSE), or sham operation, to ablate the ophthalmic branch of the trigeminal nerve. Blood vessel growth was detected by immunohistochemistry for PECAM-1 (CD31) following surgery. In another set of mice following TSE or sham operation, corneas were harvested for ELISA (VEGFR3 and pigment epithelium-derived factor [PEDF]) and for quantitative RT-PCR (VEGFR3, PEDF, and CD45). PEDF, VEGFR3, beta-3 tubulin, CD45, CD11b, and F4/80 expression in the cornea were evaluated using immunostaining. Results. No nerves were detected in the areas subject to corneal neovascularization, whereas they persisted in the areas that were neovessel-free. Conversely, 7 days after denervation, significant angiogenesis was detected in the cornea, and this was associated with a significant decrease in VEGFR3 (57.5% reduction, P = 0.001) and PEDF protein expression (64% reduction, P cornea. When vessel growth is stimulated, nerves disappear and, conversely, denervation induces angiogenesis. This phenomenon, here described in the eye, may have far-reaching implications in understanding angiogenesis. PMID:23307967

  3. Collagen cross-linking in thin corneas

    Directory of Open Access Journals (Sweden)

    Prema Padmanabhan

    2013-01-01

    Full Text Available Collagen cross-linking (CXL has become the standard of care for progressive keratoconus, after numerous clinical studies have established its efficacy and safety in suitably selected eyes. The standard protocol is applicable in eyes which have a minimum corneal thickness of 400 μm after epithelial debridement. This prerequisite was stipulated to protect the corneal endothelium and intraocular tissues from the deleterious effect of ultraviolet-A (UVA radiation. However, patients with keratoconus often present with corneal thickness of less than 400 μm and could have otherwise benefited from this procedure. A few modifications of the standard procedure have been suggested to benefit these patients without a compromise in safety. Transepithelial cross-linking, pachymetry-guided epithelial debridement before cross-linking, and the use of hypoosmolar riboflavin are some of the techniques that have been attempted. Although clinical data is limited at the present time, these techniques are worth considering in patients with thin corneas. Further studies are needed to scientifically establish their efficacy and safety.

  4. Collagen cross-linking in thin corneas

    Science.gov (United States)

    Padmanabhan, Prema; Dave, Abhishek

    2013-01-01

    Collagen cross-linking (CXL) has become the standard of care for progressive keratoconus, after numerous clinical studies have established its efficacy and safety in suitably selected eyes. The standard protocol is applicable in eyes which have a minimum corneal thickness of 400 μm after epithelial debridement. This prerequisite was stipulated to protect the corneal endothelium and intraocular tissues from the deleterious effect of ultraviolet-A (UVA) radiation. However, patients with keratoconus often present with corneal thickness of less than 400 μm and could have otherwise benefited from this procedure. A few modifications of the standard procedure have been suggested to benefit these patients without a compromise in safety. Transepithelial cross-linking, pachymetry-guided epithelial debridement before cross-linking, and the use of hypoosmolar riboflavin are some of the techniques that have been attempted. Although clinical data is limited at the present time, these techniques are worth considering in patients with thin corneas. Further studies are needed to scientifically establish their efficacy and safety. PMID:23925328

  5. Discovery of a patient with strongly suspected bullous pemphigoid in a ward by oral health care providers

    OpenAIRE

    Kanda, N; SOGA, Y; Meguro, M.; Tanabe, A; Yagi, Y; Himuro, Y; Fujiwara, Y.; Takashiba, S; Kobayashi, N.

    2011-01-01

    Objectives: Oral health care providers may discover systemic diseases incidentally from signs observed in the oral cavity. Here, we report a case in which oral health care providers in a hospital discovered a patient with strongly suspected bullous pemphigoid (BP), which is a relatively rare but important disease, in a ward. Methods: The patient was a 78-year-old Japanese woman admitted to our hospital because of severe Alzheimer's disease. We discovered recurrent ulcers in the oral mucosa an...

  6. Portable light transmission measuring system for preserved corneas

    Directory of Open Access Journals (Sweden)

    de Jesus Gabriel

    2005-12-01

    Full Text Available Abstract Background The authors have developed a small portable device for the objective measurement of the transparency of corneas stored in preservative medium, for use by eye banks in evaluation prior to transplantation. Methods The optical system consists of a white light, lenses, and pinholes that collimate the white light beams and illuminate the cornea in its preservative medium, and an optical filter (400–700 nm that selects the range of the wavelength of interest. A sensor detects the light that passes through the cornea, and the average corneal transparency is displayed. In order to obtain only the tissue transparency, an electronic circuit was built to detect a baseline input of the preservative medium prior to the measurement of corneal transparency. The operation of the system involves three steps: adjusting the "0 %" transmittance of the instrument, determining the "100 %" transmittance of the system, and finally measuring the transparency of the preserved cornea inside the storage medium. Results Fifty selected corneas were evaluated. Each cornea was submitted to three evaluation methods: subjective classification of transparency through a slit lamp, quantification of the transmittance of light using a corneal spectrophotometer previously developed, and measurement of transparency with the portable device. Conclusion By comparing the three methods and using the expertise of eye bank trained personnel, a table for quantifying corneal transparency with the new device has been developed. The correlation factor between the corneal spectrophotometer and the new device is 0,99813, leading to a system that is able to standardize transparency measurements of preserved corneas, which is currently done subjectively.

  7. Biomechanical properties of the keratoconic cornea: a review.

    Science.gov (United States)

    Vellara, Hans R; Patel, Dipika V

    2015-01-01

    There has been a recent surge of interest in assessing corneal biomechanical properties due to potential clinical applications, particularly in the early detection of keratoconus (KC). This review discusses the effects of keratoconus on the biomechanical properties of the cornea and the current techniques used to detect these changes both in the laboratory and clinical setting. Specific structural changes occurring in the corneal stroma as part of the disease process can be linked to alterations in the viscous and elastic properties of the cornea in keratoconus. Although there are extensive ex vivo studies using techniques such as extensometry and inflation testing to analyse the biomechanical properties of the normal cornea, few have investigated the keratoconic cornea using the same methods. There are a number of ex vivo studies that confirm the effectiveness of collagen cross-linking in increasing Young's modulus in healthy corneas. Recently, research has focussed on measuring corneal biomechanical parameters in vivo using two commercially available instruments: the Ocular Response Analyser (ORA) and the CorVis ST (CST). Both instruments analyse the dynamic behaviour of the cornea, when temporarily deformed by an air puff; however, the outputs of these instruments are not directly comparable due to differences in the characteristics of the air puff and output parameters. Studies using these instruments have reported significant differences between keratoconic and healthy corneas; however, neither instrument can currently be used in isolation to reliably diagnose keratoconus. Further research analysing the outputs of these instruments may enhance their diagnostic capabilities. © 2014 The Authors. Clinical and Experimental Optometry © 2014 Optometry Australia.

  8. Corneal epithelium in penetrating keratoplasty.

    Science.gov (United States)

    Meyer, R F; Bobb, K C

    1980-08-01

    We studied corneal epithelium in 66 patients with bullous keratopathy treated with penetrating keratoplasty using McCarey-Kaufman stored donor corneas. Epithelium was evaluated at times of storage, surgery, and postoperative dressing changes. Epithelium was intact in 43 of the donor corneas at storage, and 23 had 5 to 100% (median, 50%) epithelium missing. At the end of the keratoplasty procedure, 16 grafts had epithelium intact, and 50 had 5 to 100% (median, 20%) epithelium missing. Postoperative epithelial healing time ranged from one to 12 days, with a median of two days. Postoperative healing was significantly prolonged when donor corneal epithelium was missing at keratoplasty. As the amount of epithelium intact at the end of surgery decreased, the number of days to heal postoperatively increased. We found that donor corneas could be stored as long as 79 hours, with 63 hours in McCarey-Kaufman medium, and still have epithelium intact at the end of the keratoplasty procedure.

  9. Effect of genipin collagen crosslinking on porcine corneas.

    Science.gov (United States)

    Avila, Marcel Y; Navia, José L

    2010-04-01

    To evaluate the effect of genipin, a natural crosslinker, on porcine corneas. Department of Ophthalmology, Universidad Nacional de Colombia, Bogota, Colombia. Corneal strips (12.0 mm x 2.3 mm) were harvested from porcine eyes and treated by incubation with genipin at concentrations of 1.00%, 0.25%, and 0.10%. Parallel corneal strips from the same eye were used as untreated controls. After treatment at 20 degrees C for 40 minutes, tensile strain measurements were performed in a biomaterial tester. Porcine button corneas were treated with genipin 0.25% for 15 minutes and then digested by bacterial collagenase. Treated and untreated corneas were evaluated by light microscopy. Young modulus and stiffness in treated corneas increased in a concentration-dependent manner. Genipin increased resistance to corneal collagenase 5-fold in comparison with the controls. A decrease in the interlamellar space in treated corneas was also observed. Corneal collagen crosslinking induced with genipin produced a significant increase in biomechanical strength and resistance to bacterial collagenase. This crosslinker could be useful in treating corneal ectasia and corneal infectious and noninfectious diseases involving corneal melting. Copyright (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  10. A case report of central toxic keratopathy in a patient post TransPRK (followed by corneal collagen cross-linking

    Directory of Open Access Journals (Sweden)

    Davey N

    2017-04-01

    Full Text Available Nicholas Davey, Ioannis M Aslanides, Vasilis Selimis Emmetropia Mediterranean Eye Institute, Heraklion, Crete, Greece Purpose: The purpose of this article is to report a case of central toxic keratopathy in a patient post transepithelial photorefractive keratectomy (TransPRK, followed immediately by corneal collagen cross-linking.Methods: This article describes the case of a 26-year-old male after bilateral aberration-free, TransPRK laser (Schwind Amaris 750S. The procedure was performed for compound myopic astigmatism in November 2015, followed immediately by accelerated corneal collagen cross-linking for early keratoconus.Results: From day 3 post-op, tear film debris underneath both contact lenses with corneal haze and early, progressive central anterior stromal opacity formation only in the left eye were noted. At 2 weeks post-op, the left eye was noted to have a significant hyperopic shift with central corneal thinning in the anterior stroma. A central anterior stromal dense opacity had formed in the left eye with the surrounding superficial stromal haze. As of month 2, the opacity gradually started to improve in size and density. The hyperopic shift peaked at 2 months and continued to improve, largely due to epithelial compensation with a gradual recovery of stromal thickness.Conclusion: The question remains as to what provokes the typical central corneal necrosis/thinning in central toxic keratopathy. We hypothesize that the space between the contact lens and the corneal surface post TransPRK is prone to a “pseudo-interface pathology” that could mimic diffuse lamellar keratitis-like pathology. Suboptimal lid hygiene, resulting in tear film combinations of bacteria, inflammatory cells, matrix metalloproteinases and other proteolytic enzymes, contributes to the degradation of vulnerable, exposed collagen stromal tissue post TransPRK or any surface corneal ablation. Refractive surgeons should maintain a healthy lid margin and tear

  11. Risk factors for donor cornea contamination: retrospective analysis of 4546 procured corneas in a single eye bank.

    Science.gov (United States)

    Linke, Stephan J; Fricke, Otto H; Eddy, Mau-Thek; Bednarz, Jürgen; Druchkiv, Vasyl; Kaulfers, Paul-Michael; Wulff, Birgit; Püschel, Klaus; Richard, Gisbert; Hellwinkel, Olaf J C

    2013-02-01

    Microbiological contamination is a common cause for elimination of organ-cultured donor corneas. The aims of the present study were to analyze contamination rates and identify risk factors for contamination. Retrospectively, the contamination rates of 4546 organ-cultured corneas and the causative species were studied. The impact of sex, age, death-to-explantation interval, explantation technique, cause of death, and mean monthly temperature on contamination rate was analyzed. The median annual contamination rate was 5.3% (range: 3%-19%). Most contaminations were of fungal origin (61.9%), with Candida species (45%) being predominant. Bacterial contaminations (34.4%) were dominated by Staphylococcus species (12.8%). Sex, donor age, and mean monthly temperature had no statistically significant influence on the contamination rate. The median death-to-explantation interval of contaminated corneas (44 hours) was longer than that of sterile corneas (39 hours; P < 0.001; n = 4437). Cardiopulmonary failure was associated with the highest contamination rate (13.6%) of all death causes. The switch from whole globe to in situ excision was followed by a temporary increase in contamination rate (12.5%-19.4%). Although the genesis of donor cornea contamination seems to be multifactorial, resident species from physiological skin flora are the main contaminants indicating that the donor corpses could be the main source of microbiological contamination. A change in the explantation technique was followed by an increase in the contamination rate.

  12. Estimation of surface wave propagation in mouse cornea

    Science.gov (United States)

    Manapuram, Ravi Kiran; Menodiado, Floredes M.; Truong, Phiet; Aglyamov, Salavat; Emelianov, Stanislav; Twa, Michael; Larin, Kirill V.

    2012-03-01

    In this paper, we report the use of phase stabilized swept source optical coherence tomography (PhSSSOCT) for the measurement of surface mechanical wave propagation in ocular tissue in-situ. Mechanical wave propagation was measured in the mouse cornea for both young and older mice to assess tissue properties as a function of age. The measurements were performed by inducing low amplitude (cornea and 0.37 μm/mm for 9 month old mice (and presumably of different stiffness for 1 month and 9 months old). Results also suggest that PhS-SSOCT is capable of measuring the changes in the wave amplitude as small as 0.03 μm (limited by the phase stability of the system) that allowed the measurements with a very low amplitude excitation wave, thus making the method minimally invasive. Therefore, this method could potentially be used to assess tissue biomechanical properties and to reconstruct stiffness maps of the cornea.

  13. Molecular mechanisms of blister formation in bullous impetigo and staphylococcal scalded skin syndrome

    Science.gov (United States)

    Hanakawa, Yasushi; Schechter, Norman M.; Lin, Chenyan; Garza, Luis; Li, Hong; Yamaguchi, Takayuki; Fudaba, Yasuyuki; Nishifuji, Koji; Sugai, Motoyuki; Amagai, Masayuki; Stanley, John R.

    2002-01-01

    Bullous impetigo due to Staphylococcus aureus is one of the most common bacterial infections of man, and its generalized form, staphylococcal scalded skin syndrome (SSSS), is a frequent manifestation of staphylococcal epidemics in neonatal nurseries. Both diseases are mediated by exfoliative toxins (ETs), which show exquisite pathologic specificity in blistering only the superficial epidermis. We show that these toxins act as serine proteases with extremely focused molecular specificity to cleave mouse and human desmoglein 1 (Dsg1) once after glutamic acid residue 381 between extracellular domains 3 and 4. Mutation of the predicted catalytically active serine to alanine completely inhibits cleavage. The mutated ETs bind specifically to Dsg1 by immunofluorescence colocalization and by coimmunoprecipitation. Thus, ETs, through specific recognition and proteolytic cleavage of one structurally critical peptide bond in an adhesion molecule, cause its dysfunction and allow S. aureus to spread under the stratum corneum, the main barrier of the skin, explaining how, although they circulate through the entire body in SSSS, they cause pathology only in the superficial epidermis. PMID:12093888

  14. Quality of life, depression, anxiety and loneliness in patients with bullous pemphigoid. A case control study.

    Science.gov (United States)

    Kouris, Anargyros; Platsidaki, Eftychia; Christodoulou, Christos; Armyra, Kalliopi; Korkoliakou, Panagiota; Stefanaki, Christina; Tsatovidou, Revekka; Rigopoulos, Dimitrios; Kontochristopoulos, George

    2016-01-01

    Bullous pemphigoid (BP) is a chronic, autoimmune blistering skin disease that affects patients' daily life and psychosocial well-being. The aim of the study was to evaluate the quality of life, anxiety, depression and loneliness in BP patients. Fifty-seven BP patients and fifty-seven healthy controls were recruited for the study. The quality of life of each patient was assessed using the Dermatology Life Quality Index (DLQI) scale. Moreover, they were evaluated for anxiety and depression according to the Hospital Anxiety Depression Scale (HADS-scale), while loneliness was measured through the Loneliness Scale-Version 3 (UCLA) scale. The mean DLQI score was 9.45±3.34. Statistically significant differences on the HADS total scale and in HADS-depression subscale (p=0.015 and p=0.002, respectively) were documented. No statistically significant difference was found between the two groups on the HADS-anxiety subscale. Furthermore, significantly higher scores were recorded on the UCLA Scale compared with healthy volunteers (p=0.003). BP had a significant impact on quality of life and the psychological status of patients, probably due to the appearance of unattractive lesions on the skin, functional problems and disease chronicity.

  15. Treatment of Intraepidermal Autoimmune Bullous Diseases Sürekli Eğitim

    Directory of Open Access Journals (Sweden)

    Tamer İrfan Kaya

    2011-06-01

    Full Text Available Pemfigus is an autoimmune bullous skin disease, characterized by intraepidermal blisters. It is a severe and potentially life-threatening chronic disease with blisters and erosions on the mucosae and the skin. Treatment options do not differ for two most common types of pemphigus, pemphigus vulgaris and pemphigus foliaceus, except that the latter is usually less resistant to treatment and corticosteroids can often be started at lower doses. Systemic corticosteroids are still the most widely used drugs in the treatment of pemphigus and continue to be the mainstay of therapy for this disease. Adjuvant drugs are commonly used in combination with the aims of increasing efficacy and of having a steroid-sparing action, thereby allowing reduced corticosteroid side-effects. Mortality and complete remission rates have improved since the introduction of adjuvant drugs to pemphigus. Adjuvant drugs include immunoadsorbtion, corticosteroid pulse therapy, intravenous immunoglobulin (IVIG, immunosuppressive agents such as azathioprine, cyclophosphamide, mycophenolate mofetil and and anti-CD20 monoclonal antibody (rituximab. The lack of consensus in the published literature about the treatment of this disorder is responsible for different treatment strategies. Treatments need to be chosen after careful consideration of the potential benefits and side effects according to the patients’ medical condition. Here, both conventional therapies and novel treatment regimens for pemphigus are discussed. (Turkderm 2011; 45 Suppl 1: 44-53

  16. Morphological and Biochemical Analysis of Intact and Opaque Cornea in Dogs

    OpenAIRE

    HIROOKA, Masamitsu; Igarashi, Osamu; NAGAYASU, Aya; MINAGUCHI, Jyun; HOSAKA, , Yoshinao Z.; UEDA, Hiromi; TANGKAWATTANA, Prasarn; TAKEHANA, Kazushige

    2010-01-01

    The arrangement of collagen fibrils and glycosaminoglycans (GAGs) in substantia propria are important for maintaining transparency of the cornea. Interferences in collagen fibrils and GAG production could be adversative to corneal integrity. In this study, six dogs consisting of four Beagles with normal cornea (normal), one Beagles with opaque cornea (sample No.1) and one Shih Tzu with neovascularization opaque cornea (sample No.2) were used. All samples were observed morphologically by light...

  17. Localization of collagen type VIII in normal and pathological human cornea

    OpenAIRE

    Zenklová, Kateřina

    2007-01-01

    The aim of this work was to localize collagen type VIII in different layers of the cornea and to compare it's localization in normal corneas with pathological corneas obtained from patients with Fuchs endothelial dystrophy, posterior polymorphous dystrophy or keratoconus.The only comercially available antibody did not proove sufficient specifiky for collagen type VIII. With use of the antibody 9H3 anti alCVIII was collagen VIII evidenced in the cornea. This antibody can be used for detection ...

  18. Construction of tissue-engineered cornea composed of amniotic epithelial cells and acellular porcine cornea for treating corneal alkali burn.

    Science.gov (United States)

    Luo, Hailang; Lu, Yongbo; Wu, Tiantian; Zhang, Mi; Zhang, Yongjie; Jin, Yan

    2013-09-01

    Although acellular corneas have been reported to be a potential substitute for allogeneic cornea transplantation to treat corneal injury, severe corneal injury is hard to repair due to inflammation and neovascularization. The use of the amniotic membrane as a graft in ocular surface reconstruction has become widespread because of the anti-inflammatory and anti-angiogenic properties of amniotic epithelial cells (AECs). Our objective was to construct a tissue-engineered cornea (TEC) composed of an acellular porcine cornea (APC) and AECs to repair severe corneal injury. Corneal cells were completely removed from the prepared APC, and the microstructure, mechanical properties, and stability of a natural porcine cornea (NPC) was maintained. In vitro, MTT and flow cytometry analyses showed that the APC did not negatively affect cell viability and apoptosis. In vivo, corneal pocket and subcutaneous transplantation demonstrated that the APC was incapable of trigging accepted immune response. AECs isolated from the human amniotic membrane have proliferation potential and present healthy morphology before 6 passages. After 7 days of culture on the surface of the APC, the AECs were stratified into 5-6 layers. We found that the AECs reconstituted the basement membrane that had been disrupted by the decellularization process. ELISA results showed that after culturing the TEC, the culture medium contained anti-inflammatory and anti-angiogenic growth factors, such as MIF, IL6, Fas-L, and PDEF. Finally, the results of lamellar keratoplasty to treat an alkali burn showed that the transplanted TEC was transparent and completely inoculated into the host cornea. However, the transplanted APC was degraded due to host rejection. Therefore, we conclude that a TEC composed of AECs and an APC holds great potential for the repair of severe corneal injury. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. File list: ALL.Oth.05.AllAg.Cornea [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  20. File list: ALL.Oth.20.AllAg.Cornea [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Oth.20.AllAg.Cornea mm9 All antigens Others Cornea SRX437637,SRX437636,SRX24830...2,SRX248301,SRX437638 http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/ALL.Oth.20.AllAg.Cornea.bed ...

  1. File list: ALL.Oth.50.AllAg.Cornea [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Oth.50.AllAg.Cornea mm9 All antigens Others Cornea SRX437637,SRX437636,SRX24830...2,SRX248301,SRX437638 http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/ALL.Oth.50.AllAg.Cornea.bed ...

  2. File list: ALL.Oth.10.AllAg.Cornea [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Oth.10.AllAg.Cornea mm9 All antigens Others Cornea SRX437637,SRX248302,SRX43763...6,SRX248301,SRX437638 http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/ALL.Oth.10.AllAg.Cornea.bed ...

  3. [Expression and function of microRNAs in the cornea].

    Science.gov (United States)

    Ru, Yusha; Zhang, Yan; Zhao, Shaozhen

    2015-03-01

    MicroRNAs (miRNAs) are a class of small (21-2i nucleotictes), single-stranded, noncoding RNA molecules that regulate gene expression at the post-transcriptional or translational level by binding to the 3'-untranslated region of the target mRNAs. miRNAs ubiquitously exist in the genome of an organism. More than two hundred miRNA species are expressed in the eye, of which 25% are found in the cornea. miRNAs play important roles in corneal development, differentiation, glycogen metabolism, post-injury regeneration, and maintenance of homeostasis. On the other hand, miRNAs are involved in the regulation of pathological processes in the cornea, such as keratoconus, corneal neovascularization caused by corneal transplantation, herpes simplex virus infection and alkali burns. Therefore, miRNAs are expressed in a tissue-specific manner and regulate physiological and pathological processes in the cornea. The study of miRNA expression and regulation in the cornea would provide a theoretical basis for exploring pathogenic mechanisms and novel therapeutic targets for corneal diseases.

  4. Human cornea modeling using artificial collagen

    OpenAIRE

    Bukanina, V.; Khokhlov, A.; Lovetskiy, K.

    2011-01-01

    This article focuses on spectrophotometric analysis of thin films of synthetic collagen with subsequent use of the received data to recover the optical properties of collagen and modeling a multilayer optical structure similar to the properties of human cornea.

  5. Giant inclusion cyst of the cornea following filtering surgery

    Directory of Open Access Journals (Sweden)

    Kothari Mihir

    2006-01-01

    Full Text Available Various trans-conjunctival ophthalmic procedures are reported to cause inclusion cyst of conjunctiva, due to the accidental inclusion of viable conjunctival epithelium, under intact conjunctiva. We report a case of histopathologically confirmed inclusion cyst of the cornea following filtering surgery. There was no recurrence in 24 months of postoperative period.

  6. Advanced Squamous Cell Carcinoma of Cornea in a Child with ...

    African Journals Online (AJOL)

    tumors such as squamous cell carcinomas, (SCCs) basal cell carcinoma, malignant melanoma, fibrosarcoma, etc.,. The pathogenesis in a majority of these cases involve. Advanced Squamous Cell Carcinoma of. Cornea in a Child with Xeroderma Pigmentosa. Misra Somen, Bhandari Akshay Jawahirlal, Neeta Misra, Dipti ...

  7. Mechanical Interferometry Imaging for Creep Modeling of the Cornea

    OpenAIRE

    Yoo, Lawrence; Reed, Jason; Gimzewski, James K; Demer, Joseph L.

    2011-01-01

    Nanoindentation by magnetic microspheres imaged by optical interferometry permits determination of the viscoelastic properties of fine local regions of each layer of the cornea. This approach provides robust biomechanical data on corneal creep behavior that scales reliably with the magnitude of applied force throughout the tissue.

  8. Biomechanical Measurement of Rabbit Cornea by a Modified Scheimpflug Device

    Directory of Open Access Journals (Sweden)

    Bo Zhang

    2016-01-01

    Full Text Available Purpose. To explore the probability and variation in biomechanical measurements of rabbit cornea by a modified Scheimpflug device. Methods. A modified Scheimpflug device was developed by imaging anterior segment of the model imitating the intact eye at various posterior pressures. The eight isolated rabbit corneas were mounted on the Barron artificial chamber and images of the anterior segment were taken at posterior pressures of 15, 30, 45, 60, and 75 mmHg by the device. The repeatability and reliability of the parameters including CCT, ACD, ACV, and CV were evaluated at each posterior pressure. All the variations of the parameters at the different posterior pressures were calculated. Results. All parameters showed good intraobserver reliability (Cronbach’s alpha; intraclass correlation coefficient, α, ICC > 0.96 and repeatability in the modified Scheimpflug device. With the increase of posterior pressures, the ratio of CCT decreased linearly and the bulk modulus gradually reduced to a platform. The increase of ACD was almost linear with the posterior pressures elevated. Conclusions. The modified Scheimpflug device was a valuable tool to investigate the biomechanics of the cornea. The posterior pressure 15–75 mmHg range produced small viscoelastic deformations and nearly linear pressure-deformation response in the rabbit cornea.

  9. Three-Dimensional Ultrasonic Imaging Of The Cornea

    Science.gov (United States)

    Heyser, Rrichar C.; Rooney, James A.

    1988-01-01

    Proposed technique generates pictures of curved surfaces. Object ultrasonically scanned in raster pattern generated by scanning transmitter/receiver. Receiver turned on at frequent intervals to measure depth variations of scanned object. Used for medical diagnoses by giving images of small curved objects as cornea. Adaptable to other types of reflection measurementsystems such as sonar and radar.

  10. Gender and Age Related Variation in Cornea Power | Azonobi | East ...

    African Journals Online (AJOL)

    Objective: To determine the mean cornea power for this population and how it varies with gender and age. Design: A retrospective study. Setting: The eye clinic of the Niger Delta University Teaching Hospital. Subjects: All patients referred to the Optometric unit by the duty optometrist using a Carl Zeiss 599 ...

  11. Riboflavin/ultraviolet a crosslinking of the paracentral cornea.

    Science.gov (United States)

    Koller, Tobias; Schumacher, Silvia; Fankhauser, Franz; Seiler, Theo

    2013-02-01

    The depth of corneal crosslinking (CXL) does not seem homogeneous within the treatment area but shows a reduction toward the periphery of the cornea. This study was undertaken to investigate this reduction effect and to look for possible solutions. Ten corneas were investigated by means of an optical coherence tomography system (SS-100; Tomey, Nagoya, Japan) 1 month after standard CXL (epithelium off, 0.1% riboflavin for 30 minutes, ultraviolet A radiation 365 nm, 3 mW/cm). The depth of the demarcation line was measured as a function of the radial distance from the apex. These curves were compared with a theoretical curve derived from a standard model of photopolymerization. The CXL depth 3 mm away from the center decreases on average to 65% of the central depth (range: 52%-78%). Polymerization theory predicts this decay, however, underestimates the effect. The intended depth of CXL using current light sources is achieved only within the central area of the cornea. To provide CXL to the peripheral cornea, the ultraviolet beam either should have an improved intensity profile or may have to be decentered.

  12. GENDER AND AGE RELATED VARIATION IN CORNEA POWER

    African Journals Online (AJOL)

    2014-05-01

    May 1, 2014 ... Objective: To determine the mean cornea power for this population and how it varies with gender and age. Design: A retrospective study. Setting: The eye clinic of the Niger Delta University. Teaching Hospital. Subjects: All patients referred to the Optometric unit by the duty optometrist using a. Carl Zeiss ...

  13. IgG antibodies from patients with bullous pemphigoid bind to fusion proteins encoded by BPAg1 cDNA.

    Science.gov (United States)

    Miller, J E; Rico, M J; Hall, R P

    1993-12-01

    Bullous pemphigoid (BP) is an autoimmune blistering skin disease characterized in part by the presence of circulating and tissue-bound IgG antibodies directed against the epidermal basement membrane zone. IgG from over 95% of patients with BP have been shown to immunoprecipitate a 230-kD epidermal protein, BPAg1, which has been cloned and sequenced. Although sera from almost all patients with BP react with the 230-kD BP antigen the specific epitope(s) of BPAg1 that IgG binds is not known. We have generated fusion proteins from the 230-kD BP antigen cDNA and analyzed sera from patients with BP for binding to these fusion proteins by immunoblot. Sera from 21 of 30 (70%) patients with BP reacted with FP3A (amino acid 873-1193) compared to four of 13 (30%) normal subjects (p FP9). Twenty-four of 30 (80%) patients with BP reacted to at least one of three fusion proteins (FP3, FP3A, FP7) compared to three of 11 (27%) of the control subjects (p < 0.003). Fusion proteins FP3, FP3A, and FP7 are at the amino- or carboxyl-terminal regions of the putative central alpha-helical coiled-coil rod domain of BPAg1, which has been postulated to be involved in the self-aggregation of BPAg1. These findings demonstrate that patients with bullous pemphigoid react with multiple regions of BPAg1 and suggest that part of the pathologic consequences of these auto-antibodies in patients with bullous pemphigoid may be by the disruption of the normal self-aggregation of the BPAg1.

  14. Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor?

    Directory of Open Access Journals (Sweden)

    Kanellopoulos AJ

    2012-05-01

    Full Text Available Anastasios John Kanellopoulos,1,2 Ioannis M Aslanides,3 George Asimellis11Laservision Eye Institute, Athens, 2Emmetropia Mediterranean Eye Clinic, Crete, Greece, 3New York University School of Medicine, NY, USAPurpose: To determine and correlate epithelial corneal thickness (pachymetric measurements taken with a digital arc scanning very high frequency ultrasound biomicroscopy (HF UBM imaging system (Artemis-II, and compare mean and central epithelial thickness among normal eyes, untreated keratoconic eyes, and keratoconic eyes previously treated with collagen crosslinking (CXL.Methods: Epithelial pachymetry measurements (topographic mapping were conducted on 100 subjects via HF UBM. Three groups of patients were included: patients with normal eyes (controls, patients with untreated keratoconic eyes, and patients with keratoconic eyes treated with CXL. Central, mean, and peripheral corneal epithelial thickness was examined for each group, and a statistical study was conducted.Results: Mean, central, and peripheral corneal epithelial thickness was compared between the three groups of patients. Epithelium thickness varied substantially in the keratoconic group, and in some cases there was a difference of up to 20 µm between various points of the same eye, and often a thinner epithelium coincided with a thinner cornea. However, on average, data from the keratoconic group suggested an overall thickening of the epithelium, particularly over the pupil center of the order of +3 µm, while the mean epithelium thickness was on average +1.1 µm, compared to the control population (P = 0.005. This overall thickening was more pronounced in younger patients in the keratoconic group. Keratoconic eyes previously treated with CXL showed, on average, virtually the same average epithelium thickness (mean –0.7 µm, –0.2 µm over the pupil center, –0.9 µm over the peripheral zone as the control group. This finding further reinforces our novel theory of the

  15. Prothrombotic state and impaired fibrinolysis in bullous pemphigoid, the most frequent autoimmune blistering disease.

    Science.gov (United States)

    Marzano, A V; Tedeschi, A; Polloni, I; Crosti, C; Cugno, M

    2013-01-01

    Bullous pemphigoid (BP) is a potentially life-threatening autoimmune blistering disease that is burdened with an increased risk of cardiovascular events. In BP, there is an interplay between inflammation and coagulation both locally, which contributes to skin damage, and systemically, which leads to a prothrombotic state. Fibrinolysis is an important defence mechanism against thrombosis, but has only been studied locally in BP and no systemic data are available. The aim of this observational study was to evaluate systemic fibrinolysis and coagulation activation in patients with BP. We measured parameters of fibrinolysis and coagulation by immunoenzymatic methods in plasma from 20 patients with BP in an active phase and during remission after corticosteroid treatment. The controls were 20 age- and sex-matched healthy subjects. Plasma levels of plasminogen activator inhibitor type 1 (PAI-1) antigen, PAI-1 activity and tissue plasminogen activator (t-PA) antigen were significantly higher in the BP patients with active disease than in healthy controls (P = 0·0001 for all), as were the plasma levels of the fibrin fragment d-dimer and prothrombin fragment F1+2 (P = 0·0001 for both). During remission after treatment, levels of PAI-1 antigen and PAI-1 activity decreased significantly (P = 0·008 and P = 0·006, respectively), and there was also a significant decrease in plasma levels of d-dimer (P = 0·0001) and F1+2 (P = 0·0001). Fibrinolysis is inhibited in patients with active BP, due mainly to an increase in plasma levels of PAI-1. Corticosteroids not only induce the regression of BP lesions, but also reduce the inhibition of fibrinolysis, which may contribute to decreasing thrombotic risk. © 2012 British Society for Immunology.

  16. Three-year observation of the patients with bullous pemphigoid: 29 cases

    Directory of Open Access Journals (Sweden)

    Özlem Ekiz

    2013-12-01

    Full Text Available Background and Design: Bullous pemphigoid (BP is a chronic, autoimmune, subepidermal blistering disease. The aim of this study was to determine the clinico-epidemiologic data’s of patients diagnosed as BP in our clinic and compare these data with other studies in our country and in the world. Material and Method: We researched the documents of BP cases diagnosed by clinical and histopathological examinations from January 2009 to January 2013, retrospectively. We evaluated clinical and dermographical characteristics of all patients such as age, sex, existence of oral mucosal lesions, association of pruritus, duration of disease, presence of triggering factors, features of skin lesions, results of direct immunofluorescence (DIF investigation, drug intake, recurrence and mortality rates and causes of detected mortality. Results: Of the 29 patients included in the study %48,3 were female, %51,7 were male. The average age was 70,17 and the mean duration of disease was 15.41 months. In five cases oral mucosal involvement and in 24 cases pruritus was detected. Drugs in three cases and malignity in one case were assessed as triggering factors. The results of DIF investigation revealed the linear IgG and C3 deposition at the dermoepidermal junction in 12 cases, C3 deposition in 10 cases. The initial treatment was topical corticosteroid in 11, tetracycline and nicotinamide combination in six, systemic corticosteroid in 10 individuals. After initial therapy recurrence appeared in 7 patients in one year. Mortality during hospitalization was observed in 2 cases. Conclusions: We presented the clinical and epidemiological features of patients diagnosed as BP in our clinics in the last three years. Because of having different ethnical originated, heterogeneous population of our city, we believe that our investigation will contribute to having opinion about epidemiology of BP in our country. Nevertheless, prospective, long term and multicentre studies based on

  17. Successful Treatment of Hemorrhagic Bullous Henoch-Schönlein Purpura with Oral Corticosteroid: A Case Report

    Directory of Open Access Journals (Sweden)

    Celebi Kocaoglu

    2013-01-01

    Full Text Available Henoch-Schönlein purpura (HSP is a vasculitis of small-sized blood vessels, resulting from immunoglobulin-A-mediated inflammation. It is the most common acute systemic vasculitis in childhood and mainly affects skin, gastrointestinal tract, joints, and kidneys. The characteristic rash of HSP consists of palpable purpuric lesions 2 to 10 mm in diameter concentrating in the buttocks and lower extremities. The occurrence of hemorrhagic bullae in children with HSP is rarely encountered. This report describes a 4.5-year-old female patient with HSP associated with hemorrhagic bullous lesions.

  18. Thermomechanical behavior of collagen-cross-linked porcine cornea.

    Science.gov (United States)

    Spoerl, Eberhard; Wollensak, Gregor; Dittert, Dag-Daniel; Seiler, Theo

    2004-01-01

    Collagen cross-linking using combined riboflavin/UVA treatment has been shown to increase the biomechanical rigidity of the cornea and has been used successfully for the treatment of progressive keratoconus. From morphological and biochemical investigations, a different degree of cross-linking for the anterior and posterior stroma by the treatment is suggested. The present study was undertaken to better evaluate this effect by testing the thermomechanical behavior. Ten 10 x 5 mm corneal strips from porcine cadaver eyes enucleated within 5 h post mortem were cross-linked using the photosensitizer riboflavin and UVA irradiation (370 nm, irradiance = 3 mW/cm(2)) for 30 min and compared to ten untreated corneal strips and ten corneal strips cross-linked with 0.1% glutaraldehyde. The temperature in a water bath was raised from 60 to 95 degrees C with temperature increments of 1 degrees C per minute. The hydrothermal shrinkage of the corneal strips was measured in 2.5 degrees C steps using a micrometer. In addition, six 10-mm whole corneal buttons were cross-linked with riboflavin/UVA and immersed into water at 70 or 75 degrees C. The maximal hydrothermal shrinkage for the untreated control specimens and the posterior portion of the riboflavin/UVA-treated corneas was at 70 degrees C, for the anterior portion of the cornea cross-linked by riboflavin/UVA at 75 degrees C and for glutaraldehyde-cross-linked cornea at 90 degrees C. In the cross-linked corneal buttons, a typical mushroom-like shape was observed at 70 degrees C and a cylinder shape at 75 degrees C. The different degree of collagen cross-linking in the corneal stroma after riboflavin/UVA treatment is reflected by the differences in the maximal shrinkage temperature of the anterior and posterior portion. Therefore, in the corneas cross-linked with riboflavin/UVA a higher shrinkage temperature was observed for the anterior portion of the cornea (75 degrees C) compared to the posterior stroma (70 degrees C) due to

  19. Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor?

    Science.gov (United States)

    Kanellopoulos, Anastasios John; Aslanides, Ioannis M; Asimellis, George

    2012-01-01

    To determine and correlate epithelial corneal thickness (pachymetric) measurements taken with a digital arc scanning very high frequency ultrasound biomicroscopy (HF UBM) imaging system (Artemis-II), and compare mean and central epithelial thickness among normal eyes, untreated keratoconic eyes, and keratoconic eyes previously treated with collagen crosslinking (CXL). Epithelial pachymetry measurements (topographic mapping) were conducted on 100 subjects via HF UBM. Three groups of patients were included: patients with normal eyes (controls), patients with untreated keratoconic eyes, and patients with keratoconic eyes treated with CXL. Central, mean, and peripheral corneal epithelial thickness was examined for each group, and a statistical study was conducted. Mean, central, and peripheral corneal epithelial thickness was compared between the three groups of patients. Epithelium thickness varied substantially in the keratoconic group, and in some cases there was a difference of up to 20 μm between various points of the same eye, and often a thinner epithelium coincided with a thinner cornea. However, on average, data from the keratoconic group suggested an overall thickening of the epithelium, particularly over the pupil center of the order of +3 μm, while the mean epithelium thickness was on average +1.1 μm, compared to the control population (P = 0.005). This overall thickening was more pronounced in younger patients in the keratoconic group. Keratoconic eyes previously treated with CXL showed, on average, virtually the same average epithelium thickness (mean -0.7 μm, -0.2 μm over the pupil center, -0.9 μm over the peripheral zone) as the control group. This finding further reinforces our novel theory of the "reactive" component of epithelial thickening in corneas that are biomechanically unstable, becoming stable when biomechanical rigidity is accomplished despite persistence of cornea topographic irregularity. A highly irregular epithelium may be

  20. Evaluation of corneal cell growth on tissue engineering materials as artificial cornea scaffolds

    Directory of Open Access Journals (Sweden)

    Hai-Yan Wang

    2013-12-01

    Full Text Available The keratoprosthesis (KPro; artificial cornea is a special refractive device to replace human cornea by using heterogeneous forming materials for the implantation into the damaged eyes in order to obtain a certain vision. The main problems of artificial cornea are the biocompatibility and stability of the tissue particularly in penetrating keratoplasty. The current studies of tissue-engineered scaffold materials through comprising composites of natural and synthetic biopolymers together have developed a new way to artificial cornea. Although a wide agreement that the long-term stability of these devices would be greatly improved by the presence of cornea cells, modification of keratoprosthesis to support cornea cells remains elusive. Most of the studies on corneal substrate materials and surface modification of composites have tried to improve the growth and biocompatibility of cornea cells which can not only reduce the stimulus of heterogeneous materials, but also more importantly continuous and stable cornea cells can prevent the destruction of collagenase. The necrosis of stroma and spontaneous extrusion of the device, allow for maintenance of a precorneal tear layer, and play the role of ensuring a good optical surface and resisting bacterial infection. As a result, improvement in corneal cells has been the main aim of several recent investigations; some effort has focused on biomaterial for its well biological properties such as promoting the growth of cornea cells. The purpose of this review is to summary the growth status of the corneal cells after the implantation of several artificial corneas.

  1. Evaluation of corneal cell growth on tissue engineering materials as artificial cornea scaffolds.

    Science.gov (United States)

    Wang, Hai-Yan; Wei, Rui-Hua; Zhao, Shao-Zhen

    2013-12-18

    The keratoprosthesis (KPro; artificial cornea) is a special refractive device to replace human cornea by using heterogeneous forming materials for the implantation into the damaged eyes in order to obtain a certain vision. The main problems of artificial cornea are the biocompatibility and stability of the tissue particularly in penetrating keratoplasty. The current studies of tissue-engineered scaffold materials through comprising composites of natural and synthetic biopolymers together have developed a new way to artificial cornea. Although a wide agreement that the long-term stability of these devices would be greatly improved by the presence of cornea cells, modification of keratoprosthesis to support cornea cells remains elusive. Most of the studies on corneal substrate materials and surface modification of composites have tried to improve the growth and biocompatibility of cornea cells which can not only reduce the stimulus of heterogeneous materials, but also more importantly continuous and stable cornea cells can prevent the destruction of collagenase. The necrosis of stroma and spontaneous extrusion of the device, allow for maintenance of a precorneal tear layer, and play the role of ensuring a good optical surface and resisting bacterial infection. As a result, improvement in corneal cells has been the main aim of several recent investigations; some effort has focused on biomaterial for its well biological properties such as promoting the growth of cornea cells. The purpose of this review is to summary the growth status of the corneal cells after the implantation of several artificial corneas.

  2. Collagen Fibrils and Proteoglycans of Macular Dystrophy Cornea: Ultrastructure and 3D Transmission Electron Tomography.

    Science.gov (United States)

    Akhtar, Saeed; Alkatan, Hind M; Kirat, Omar; Khan, Adnan A; Almubrad, Turki

    2015-06-01

    We report the ultrastructure and 3D transmission electron tomography of collagen fibrils (CFs), proteoglycans (PGs), and microfibrils within the CF of corneas of patients with macular corneal dystrophy (MCD). Three normal corneas and three MCD corneas from three Saudi patients (aged 25, 31, and 49 years, respectively) were used for this study. The corneas were processed for light and electron microscopy studies. 3D images were composed from a set of 120 ultrastructural images using the program "Composer" and visualized using the program "Visuliser Kai". 3D image analysis of MCD cornea showed a clear organization of PGs around the CF at very high magnification and degeneration of the microfibrils within the CF. Within the MCD cornea, the PG area in the anterior stroma was significantly larger than in the middle and posterior stroma. The PG area in the MCD cornea was significantly larger compared with the PG area in the normal cornea. The CF diameter and inter-fibrillar spacing of the MCD cornea were significantly smaller compared with those of the normal cornea. Ultrastructural 3D imaging showed that the production of unsulfated keratin sulfate (KS) may lead to the degeneration of micro-CFs within the CFs. The effect of the unsulfated KS was higher in the anterior stroma compared with the posterior stroma.

  3. Donor risk factors for graft failure in the cornea donor study.

    Science.gov (United States)

    Sugar, Joel; Montoya, Monty; Dontchev, Mariya; Tanner, Jean Paul; Beck, Roy; Gal, Robin; Gallagher, Shawn; Gaster, Ronald; Heck, Ellen; Holland, Edward J; Kollman, Craig; Malling, Jackie; Mannis, Mark J; Woody, Jason

    2009-10-01

    The purpose of this study was to assess the relationship between donor factors and 5-year corneal graft survival in the Cornea Donor Study. Donor corneas met criteria established by the Eye Bank Association of America, had an endothelial cell density of 2300 to 3300/mm, and were determined to be of good to excellent quality by the eye banks. Donor corneas were assigned using a random approach and surgeons were masked to information about the donor cornea including donor age. Surgery and postoperative care were performed according to the surgeons' usual routines and subjects were followed for 5 years. Donor and donor cornea factors were evaluated for their association with graft failure, which was defined as a regraft or a cloudy cornea that was sufficiently opaque to compromise vision for a minimum of 3 consecutive months. Graft failure was not significantly associated with the type of tissue retrieval (enucleation versus in situ), processing factors, timing of use of the cornea, or characteristics of the donor or the donor cornea. Adjusting for donor age did not affect the results. Donor and donor cornea characteristics do not impact graft survival rates for corneas comparable in quality to those used in this study.

  4. Management of chemical burns of the canine cornea

    OpenAIRE

    Christmas, Richard

    1991-01-01

    Significant clinical signs and general principles of treatment for chemical burns of the canine cornea are presented using three typical case studies for illustration. Alkali burns are more common in dogs than acid burns. The sources of alkali in this study were soap, cement, and mortar dust. Common signs of chemical burns are ocular pain, corneal ulceration, tear film inadequacy, corneal edema, and marked corneal neovascularity. Successful treatment requires thorough ocular lavage, treatment...

  5. Customized finite element modelling of the human cornea

    OpenAIRE

    Irene Simonini; Anna Pandolfi

    2015-01-01

    Aim To construct patient-specific solid models of human cornea from ocular topographer data, to increase the accuracy of the biomechanical and optical estimate of the changes in refractive power and stress caused by photorefractive keratectomy (PRK). Method Corneal elevation maps of five human eyes were taken with a rotating Scheimpflug camera combined with a Placido disk before and after refractive surgery. Patient-specific solid models were created and discretized in finite elements to esti...

  6. The biomechanical properties of the cornea and anterior segment parameters

    OpenAIRE

    Hwang, Ho Sik; Park, Seh Kwang; Kim, Man Soo

    2013-01-01

    Background To investigate the biomechanical properties of the cornea measured with the Ocular Response Analyzer (ORA) and their association with the anterior segment parameters representing the geometric dimensions including the corneal volume and anterior chamber volume. Methods A retrospective review of 1020 patients who visited the BGN Eye Clinic was done. The mean radius of the corneal curvature, corneal astigmatism, corneal volume, anterior chamber depth, and anterior chamber volume were...

  7. [The glaucoma pharmacological treatment and biomechanical properties of the cornea].

    Science.gov (United States)

    Liehneová, I; Karlovská, S

    2014-10-01

    To evaluate and compare the impact of long-term use of intraocular pressure lowering medication on the biomechanical properties of the cornea. Group of 305 eyes of 154 patients newly diagnosed with primary open angle glaucoma (POAG, n = 68) or ocular hypertension (OH, n = 6) was enrolled in prospective cohort study. The control group was established of 80 untreated eyes of 40 patients with ocular hypertension and 80 eyes of 40 patients with no ocular pathology. Following parameters were evaluated: intraocular pressure (IOPg,IOPcc), hysteresis (CH), corneal resistance factor (CRF) and central corneal thickness (CCT). The parameters were evaluated at baseline (untreated) and in follow up periods of 3, 6, 9 and 12 months. The same schedule was used for eyes in the control group. Eyes with POAG or OH were sorted into two groups depending on the type of applied medication: prostaglandin analogues, carboanhydrase inhibitors alone or combined with betablockers. We did not prove any statistically significant difference in hysteresis in patients with newly diagnosed POAG (yet untreated) in comparison with normal eyes in control group (p = 0.238). We proved significantly higher values of CRF (p = 0.032) and CCT (p = 0.013) in the control group of untreated patients with ocular hypertension. This result confirms higher number of patients with stiffer and thicker corneas. Statistically significant difference of CH and CRF was proved (p eyes treated by prostaglandin analogues during follow up period. In these eyes we also demonstrated reduction of CCT (p < 0.001). We did not record any other statistically significant change in remaining followed parameters. Increase of CH and CRF can show change of biomechanical properties of the cornea after long-term use of prostaglandin analogues. The biomechanical properties of the cornea were not impacted by carboanhydrase inhibitors. Further studies are required to establish the effect of long-term use prostaglandin analogues on accuracy

  8. Polymicrobial Infection of the Cornea Due to Contact Lens Wear

    OpenAIRE

    Selçuk Sızmaz; Filiz Kibar; Soner Koltaş

    2016-01-01

    A 38-year-old male presented with pain and redness in his left eye. He had a history of wearing contact lenses. His ophthalmic examination revealed a large corneal ulcer with surrounding infiltrate. Cultures were isolated from the contact lenses, lens solutions, storage cases, and conjunctivae of both eyes and also corneal scrapings of the left eye. Fortified vancomycin and amikacin drops were started hourly. Culture results of conjunctivae of each eye and left cornea were positive f...

  9. Acellular ostrich corneal stroma used as scaffold for construction of tissue-engineered cornea

    Directory of Open Access Journals (Sweden)

    Xian-Ning Liu

    2016-03-01

    Full Text Available AIM: To assess acellular ostrich corneal matrix used as a scaffold to reconstruct a damaged cornea. METHODS: A hypertonic saline solution combined with a digestion method was used to decellularize the ostrich cornea. The microstructure of the acellular corneal matrix was observed by transmission electron microscopy (TEM and hematoxylin and eosin (H&E staining. The mechanical properties were detected by a rheometer and a tension machine. The acellular corneal matrix was also transplanted into a rabbit cornea and cytokeratin 3 was used to check the immune phenotype. RESULTS: The microstructure and mechanical properties of the ostrich cornea were well preserved after the decellularization process. In vitro, the methyl thiazolyl tetrazolium results revealed that extracts of the acellular ostrich corneas (AOCs had no inhibitory effects on the proliferation of the corneal epithelial or endothelial cells or on the keratocytes. The rabbit lamellar keratoplasty showed that the transplanted AOCs were transparent and completely incorporated into the host cornea while corneal turbidity and graft dissolution occurred in the acellular porcine cornea (APC transplantation. The phenotype of the reconstructed cornea was similar to a normal rabbit cornea with a high expression of cytokeratin 3 in the superficial epithelial cell layer. CONCLUSION: We first used AOCs as scaffolds to reconstruct damaged corneas. Compared with porcine corneas, the anatomical structures of ostrich corneas are closer to those of human corneas. In accordance with the principle that structure determines function, a xenograft lamellar keratoplasty also confirmed that the AOC transplantation generated a superior outcome compared to that of the APC graft.

  10. Type XVII Collagen Regulates Lamellipod Stability, Cell Motility, and Signaling to Rac1 by Targeting Bullous Pemphigoid Antigen 1e to alpha 6 beta 4 Integrin

    NARCIS (Netherlands)

    Hamill, Kevin J.; Hopkinson, Susan B.; Jonkman, Marcel F.; Jones, Jonathan C. R.

    2011-01-01

    Rac1 activity, polarity, lamellipodial dynamics, and directed motility are defective in keratinocytes exhibiting deficiency in beta 4 integrin or knockdown of the plakin protein Bullous Pemphigoid Antigen 1e (BPAG1e). The activity of Rac, formation of stable lamellipodia, and directed migration are

  11. Bullous pemphigoid and linear IgA dermatosis sera recognize a similar 120-kDa keratinocyte collagenous glycoprotein with antigenic cross-reactivity to BP180

    NARCIS (Netherlands)

    Pas, HH; Kloosterhuis, GJ; Heeres, K; vanderMeer, JB; Jonkman, MF

    Circulating IgG from a large subset of bullous pein; phigoid (SP) patients reacted on immunoblot with a 120-kDa protein in conditioned keratinocyte culture medium and in keratinocyte cell extracts, A protein with a similar molecular weight was recognized by circulating IgA from a subset of patients

  12. Nerve Repulsion by the Lens and Cornea during Cornea Innervation is Dependent on Robo-Slit Signaling and Diminishes with Neuron Age

    Science.gov (United States)

    Schwend, Tyler; Lwigale, Peter Y.; Conrad, Gary W.

    2012-01-01

    The cornea, the most densely innervated tissue on the surface of the body, becomes innervated in a series of highly coordinated developmental events. During cornea development, chick trigeminal nerve growth cones reach the cornea margin at embryonic day (E)5, where they are initially repelled for days from E5-8, instead encircling the corneal periphery in a nerve ring prior to entering on E9. The molecular events coordinating growth cone guidance during cornea development are poorly understood. Here we evaluated a potential role for the Robo-Slit nerve guidance family. We found that Slit 1, 2 and 3 expression in the cornea and lens persisted during all stages of cornea innervation examined. Robo1 expression was developmentally regulated in trigeminal cell bodies, expressed robustly during nerve ring formation (E5-8), then later declining concurrent with projection of growth cones into the cornea. In this study we provide in vivo and in vitro evidence that Robo-Slit signaling guides trigeminal nerves during cornea innervation. Transient, localized inhibition of Robo-Slit signaling, by means of beads loaded with inhibitory Robo-Fc protein implanted into the developing eyefield in vivo, led to disorganized nerve ring formation and premature cornea innervation. Additionally, when trigeminal explants (source of neurons) were oriented adjacent to lens vesicles or corneas (source of repellant molecules) in organotypic tissue culture both lens and cornea tissues strongly repelled E7 trigeminal neurites, except in the presence of inhibitory Robo-Fc protein. In contrast, E10 trigeminal neurites were not as strongly repelled by cornea, and presence of Robo-Slit inhibitory protein had no effect. In full, these findings suggest that nerve repulsion from the lens and cornea during nerve ring formation is mediated by Robo-Slit signaling. Later, a shift in nerve guidance behavior occurs, in part due to molecular changes in trigeminal neurons, including Robo1 downregulation, thus

  13. Determination of the modulus of elasticity of the human cornea.

    Science.gov (United States)

    Elsheikh, Ahmed; Wang, Defu; Pye, David

    2007-10-01

    To determine the material behavior of the human cornea in the form of simple relationships between the modulus of elasticity and intraocular pressure (IOP) and to establish the effect of age on the material behavior. Human corneal specimens with age between 50 and 95 years were tested under inflation conditions to determine their behavior. The corneas were subjected to two extreme load rates to represent dynamic and static loading conditions. The pressure-deformation results were analyzed using shell theory to derive the relationship between the modulus of elasticity and IOP. The corneas demonstrated a nonlinear hyperelastic behavior pattern with an initial low stiffness stage and a final high stiffness stage. Despite the nonlinearity of the pressure deformation results, the relationship between the modulus of elasticity and the applied pressure was almost linear. A considerable increase was noted in the values of the modulus of elasticity associated with both age and load rate. General equations were derived to calculate the values of the secant and tangent moduli of elasticity in terms of IOP for any age greater than 50 years, and these equations are presented in a simple form suitable for use in numerical simulations. Adequate representation of corneal material behavior is essential for the accurate predictive modeling of corneal biomechanics. The material models developed in this work could be implemented in numerical simulations of refractive surgery procedures, corneal shape changes due to contact lens wear, and other applications.

  14. Ultrastructural changes in the developing chicken cornea following caffeine administration.

    Directory of Open Access Journals (Sweden)

    Bartel Hieronim

    2010-11-01

    Full Text Available Caffeine is one of the most frequently consumed psychoactive substances. It has been known for many years that caffeine at high concentrations exerts harmful effects on both women's and laboratory animals' fertility, moreover it may impair normal development of many organs in the prenatal period. So far there have been few studies performed that demonstrate teratogenic effects of caffeine on structures of the developing eye, particularly the cornea. The aim of the study was to show ultrastructural changes in the developing cornea, as the effect of caffeine administration to chicken embryos. The experimental materials were 26 chicken embryos from incubated breeding eggs. Eggs were divided into two groups: control (n=30 in which Ringer liquid was administrated, and experimental (n=30 in which teratogenic dose of caffeine 3.5mg/egg was given. In 36th hour of incubation solutions were given with cannula through hole in an egg shell directly onto amniotic membrane. After closing the hole with a glass plate and paraffine, eggs were put back to incubator. In 10th and 19th day of incubation corneas were taken for morphological analysis with a use of electron microscopy. Administration of caffeine during chicken development causes changes of collagen fibers of Bowman's membrane patterns and of the corneal stroma but it also changes proportion of amount of collagen fibers and of the stromal cells.

  15. Femtosecond laser lenticule transplantation in rabbit cornea: experimental study.

    Science.gov (United States)

    Liu, Huiying; Zhu, Wenqing; Jiang, Alice C; Sprecher, Alicia J; Zhou, Xingtao

    2012-12-01

    To evaluate the feasibility of femtosecond laser-induced lenticule transplantation in the rabbit cornea and to observe the relative histologic characteristics of corneal tissue and nerve repair after transplantation. Eight healthy, purebred, New Zealand white rabbits underwent femtosecond laser small-incision lenticule extraction (SMILE) surgery in the right eye. Lenticules were inserted into a femtosecond laser-created corneal stromal pocket in the left eye, which was defined as femtosecond laser corneal lenticule transplantation. Postoperative observation and examination were completed to evaluate the surgery. In the early postoperative period, inflammation of the cornea was noted, tissue around the lenticule was edematous, and cells were activated. Tissue edema remained at postoperative day 10. By 1 month, edema had resolved, activated cells gradually became quiescent, and nerve fiber regeneration was observed. By 3 months, the lenticule integrated into the recipient cornea, extracellular matrix gradually cleared, and thicker nerve fibers were noted. By 6 months postoperative, morphology and distribution of the corneal stromal fibers were close to normal, and the number of nerve fibers was reduced. Femtosecond laser corneal lenticule transplantation in rabbits is feasible, as the lenticule was shown to thrive and integrate with the recipient stroma. Nerve regeneration begins after 1 month. Copyright 2012, SLACK Incorporated.

  16. Stratification of Antigen-presenting Cells within the Normal Cornea

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    Jared E. Knickelbein

    2009-11-01

    Full Text Available The composition and location of professional antigen presenting cells (APC varies in different mucosal surfaces. The cornea, long considered an immune-privileged tissue devoid of APCs, is now known to host a heterogeneous network of bone marrow-derived cells. Here, we utilized transgenic mice that express enhanced green fluorescent protein (EGFP from the CD11c promoter (pCD11c in conjunction with immunohistochemical staining to demonstrate an interesting stratification of APCs within non-inflamed murine corneas. pCD11c+ dendritic cells (DCs reside in the basal epithelium, seemingly embedded in the basement membrane. Most DCs express MHC class II on at least some dendrites, which extend up to 50 µm in length and traverse up 20 µm tangentially towards the apical surface of the epithelium. The DC density diminishes from peripheral to central cornea. Beneath the DCs and adjacent to the stromal side of the basement membrane reside pCD11c-CD11b+ putative macrophages that express low levels of MHC class II. Finally, MHC class IIpCD11c-CD11b+ cells form a network throughout the remainder of the stroma. This highly reproducible stratification of bone marrow-derived cells is suggestive of a progression from an APC function at the exposed corneal surface to an innate immune barrier function deeper in the stroma.

  17. Importance of accurately assessing biomechanics of the cornea.

    Science.gov (United States)

    Roberts, Cynthia J

    2016-07-01

    This article summarizes the state-of-the-art in clinical corneal biomechanics, including procedures in which biomechanics play a role, and the clinical consequences in terms of error in estimating intraocular pressure (IOP). Corneal biomechanical response to refractive surgery can be categorized into either stable alteration of surface shape and thus visual outcome, or unstable biomechanical decompensation. The stable response is characterized by central flattening and peripheral steepening that is potentiated in a stiffer cornea. Two clinical devices for assessing corneal biomechanics do not yet measure classic biomechanical properties, but rather provide assessment of corneal deformation response. Biomechanical parameters are a function of IOP, and both the cornea and sclera become stiffer as IOP increases. Any assessment of biomechanical parameters must include IOP, and one value of stiffness does not adequately characterize a cornea. Corneal biomechanics plays a role in the outcomes of any procedure in which lamellae are transected. Once the corneal structure has been altered in a manner that includes central thinning, IOP measurements with applanation tonometry are likely not valid, and other technologies should be used.

  18. Corneal decompensation following filtering surgery with the Ex-PRESS® mini glaucoma shunt device

    Directory of Open Access Journals (Sweden)

    Tojo N

    2015-03-01

    Full Text Available Naoki Tojo, Atsushi Hayashi, Akio Miyakoshi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan Purpose: To report a case of corneal decompensation due to the Ex-PRESS® mini glaucoma shunt device (Ex-PRESS.Patient and methods: A 75-year-old man had pseudoexfoliation glaucoma in his right eye. He underwent filtration surgery with Ex-PRESS. His intraocular pressure was 7 mmHg after 9 months.Results: We observed partial decompensation of the corneal endothelium adjacent to the filtering bleb. Specular microscopy revealed a marked decrease in the endothelial cell density at the center of the cornea.Conclusion: Anterior segment optical coherence tomography is very useful for evaluating corneal edema and the position of Ex-PRESS. It is important to follow up with an examination of the corneal endothelial cells. Keywords: Ex-PRESS, bullous keratopathy, trabeculectomy, complication, cornea 

  19. Climatic Droplet Keratopathy in Argentina: Involvement of Environmental Agents in Its Genesis Which Would Open the Prospect for New Therapeutic Interventions

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    María Fernanda Suárez

    2015-01-01

    Full Text Available Climatic droplet keratopathy (CDK is a degenerative corneal disease of unknown etiology. We described CDK for the first time in Latin America in the Argentinean Patagonia (El Cuy. A deeper knowledge of CDK pathogenic mechanisms will provide new therapeutic strategies. For that reason we investigated the prevalence of CDK in El Cuy and its existence in other 3 provinces with similar climate. Patients eyes were examined, habits throughout lives were inquired about, and serum ascorbate (sAA was determined. All individuals work outdoors for most of the day. All regions had normal O3 levels. Individuals from regions 1, 2, and 3 had very low consumption of vegetables/fruits and low sAA levels. Conversely, region 4 individuals had balanced diet and higher sAA concentrations. CDK was only found in region 3 where individuals had partial deficiency of sAA and did not use eye protection. No CDK was found in regions 1 and 2 where individuals had similar work activities and dietary habits to those in region 3 but wear eye protection. No disease was found in region 4 where individuals work outdoors, have balanced diet, and use eye protection. To summarize, the CDK existence was related not only to climate but also to the dietary habits and lack of protection from sunlight.

  20. Climatic Droplet Keratopathy in Argentina: Involvement of Environmental Agents in Its Genesis Which Would Open the Prospect for New Therapeutic Interventions

    Science.gov (United States)

    Suárez, María Fernanda; Correa, Leandro; Crim, Nicolás; Espósito, Evangelina; Monti, Rodolfo; Urrets-Zavalía, Julio Alberto; Serra, Horacio Marcelo

    2015-01-01

    Climatic droplet keratopathy (CDK) is a degenerative corneal disease of unknown etiology. We described CDK for the first time in Latin America in the Argentinean Patagonia (El Cuy). A deeper knowledge of CDK pathogenic mechanisms will provide new therapeutic strategies. For that reason we investigated the prevalence of CDK in El Cuy and its existence in other 3 provinces with similar climate. Patients eyes were examined, habits throughout lives were inquired about, and serum ascorbate (sAA) was determined. All individuals work outdoors for most of the day. All regions had normal O3 levels. Individuals from regions 1, 2, and 3 had very low consumption of vegetables/fruits and low sAA levels. Conversely, region 4 individuals had balanced diet and higher sAA concentrations. CDK was only found in region 3 where individuals had partial deficiency of sAA and did not use eye protection. No CDK was found in regions 1 and 2 where individuals had similar work activities and dietary habits to those in region 3 but wear eye protection. No disease was found in region 4 where individuals work outdoors, have balanced diet, and use eye protection. To summarize, the CDK existence was related not only to climate but also to the dietary habits and lack of protection from sunlight. PMID:26451372

  1. Cornea preservation time study: methods and potential impact on the cornea donor pool in the United States.

    Science.gov (United States)

    Lass, Jonathan H; Szczotka-Flynn, Loretta B; Ayala, Allison R; Benetz, Beth A; Gal, Robin L; Aldave, Anthony J; Corrigan, Michelle M; Dunn, Steven P; McCall, Ty L; Pramanik, Sudeep; Rosenwasser, George O; Ross, Kevin W; Terry, Mark A; Verdier, David D

    2015-06-01

    The aim of this study was to describe the aims, methods, donor and recipient cohort characteristics, and potential impact of the Cornea Preservation Time Study (CPTS). The CPTS is a randomized clinical trial conducted at 40 clinical sites (70 surgeons) designed to assess the effect of donor cornea preservation time (PT) on graft survival 3 years after Descemet stripping automated endothelial keratoplasty (DSAEK). Eyes undergoing surgery for Fuchs endothelial corneal dystrophy or pseudophakic/aphakic corneal edema were randomized to receive donor corneas stored ≤7 days or 8 to 14 days. Donor and patient characteristics, tissue preparation and surgical parameters, recipient and donor corneal stroma clarity, central corneal thickness, intraocular pressure, complications, and a reading center-determined central endothelial cell density were collected. Surveys were conducted to evaluate pre-CPTS PT practices. The 1330 CPTS donors were: 49% >60 years old, 27% diabetic, had a median eye bank-determined screening endothelial cell density of 2688 cells/mm, and 74% eye bank prepared for DSAEK. A total of 1090 recipients (1330 eyes including 240 bilateral cases) had: median age of 70 years, were 60% female, 90% white, 18% diabetic, 52% phakic, and 94% had Fuchs endothelial corneal dystrophy. Before the CPTS, 19 eye banks provided PT data on 20,852 corneas domestically placed for DSAEK in 2010 to 2011; 96% were preserved ≤7 days. Of 305 American Academy of Ophthalmology members responding to a pre-CPTS survey, 233 (76%) set their maximum PT preference at 8 days or less. The CPTS will increase understanding of factors related to DSAEK success and, if noninferiority of longer PT is shown, will have great potential to extend the available pool of endothelial keratoplasty donors.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01537393.

  2. The biomechanical properties of the cornea and anterior segment parameters.

    Science.gov (United States)

    Hwang, Ho Sik; Park, Seh Kwang; Kim, Man Soo

    2013-10-02

    To investigate the biomechanical properties of the cornea measured with the Ocular Response Analyzer (ORA) and their association with the anterior segment parameters representing the geometric dimensions including the corneal volume and anterior chamber volume. A retrospective review of 1020 patients who visited the BGN Eye Clinic was done. The mean radius of the corneal curvature, corneal astigmatism, corneal volume, anterior chamber depth, and anterior chamber volume were measured with an anterior segment tomographer. The central corneal thickness (CCT) was measured with an ultrasonic pachymeter. The corneal diameter was measured with an Orbscan as White to White. Cornea hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg), and cornea-compensated IOP (IOPcc) were measured with an ORA. Multiple linear regression models were constructed with CH and CRF as the dependent variables and age, gender, and the anterior segment parameters as the covariates. 958 eyes from 958 patients (mean age 26.7 years; male 43.4%) were included in this study after excluding some eyes according to the exclusion criteria. The mean CH and CRF were 10.1 and 9.9 mmHg, respectively. The mean IOPg and IOPcc were 14.8 and 15.8 mmHg. The multivariate analysis showed that CH was negatively associated with the mean radius of the cornea curvature (regression coefficient = -0.481, p = 0.023) and positively associated with CCT (regression coefficient = 0.015, p corneal volume (regression coefficient =0.059, p = 0.014). The association between CH and the corneal diameter, anterior chamber depth, and anterior chamber volume were not statistically significant. The evaluation of CRF showed that CRF was negatively associated with the mean radius of the cornea curvature (regression coefficient = -0.540, p = 0.013), and positively associated with CCT (β = 0.026, p corneal diameter, corneal volume, anterior chamber depth, and anterior chamber volume were not

  3. Characterization of Inhibitor of differentiation (Id) proteins in human cornea.

    Science.gov (United States)

    Mohan, Rajiv R; Morgan, Brandie R; Anumanthan, Govindaraj; Sharma, Ajay; Chaurasia, Shyam S; Rieger, Frank G

    2016-05-01

    Inhibitor of differentiation (Id) proteins are DNA-binding transcription factors involved in cellular proliferation, migration, inflammation, angiogenesis and fibrosis. However, their expression and role in the cornea is unknown. The present study was undertaken to characterize the expression of Id proteins and their interactions with the pro-fibrotic cytokine Transforming Growth Factor β1 (TGFβ1) and anti-fibrotic cytokine, bone morphogenic protein 7 (BMP7) in human cornea. Human donor corneas procured from Eye Bank were used. Id proteins were localized in human corneal sections using immunofluorescence. Primary cultures of human corneal fibroblasts (HCF) were established and treated with either TGFβ1 (5 ng/ml) or BMP7 (10 ng/ml) for 24 h in serum free medium. Expression of Id's in response to TGFβ1, BMP7 and TGFβ1 + BMP7 was analyzed by quantitative real time PCR (qRT-PCR) and western blot analysis. Id1 and Id2 proteins were ubiquitously expressed in the epithelial cells and stromal keratocytes in human cornea. The Id1 was localized to the basal epithelial cells as seen by immunohistochemistry. HCF expressed all known mammalian Id genes (Id1-Id4). In addition, Id1 and Id2 are selectively expressed in HCF. Treatment of human recombinant TGFβ1 (5 ng/ml) to serum-starved HCF showed a significant increase in Id genes (Id1, Id2 and Id4) at 2 h time point compared to BMP7 treatment, which showed time dependent increase in the expression of Id1-Id3 at 24-48 h. Combined treatment with TGFβ1 + BMP7 to HCF showed a significant increase in Id1 transcript and an increasing trend in Id3 and Id4 expression. The results of this study suggest that Id family of genes (Id1-Id4) are localized in the human cornea and expressed in the corneal fibroblasts. Also, Id's were differentially regulated with TGFβ1 and/or BMP7 in a time dependent manner and might serve as a therapeutic target in corneal fibrosis. Published by Elsevier Ltd.

  4. Clinical and epidemiological aspects of cornea transplant patients of a reference hospital

    Directory of Open Access Journals (Sweden)

    Giovanna Karinny Pereira Cruz

    Full Text Available ABSTRACT Objective: clinically characterizing cornea transplant patients and their distribution according to indicated and post-operative conditions of cornea transplantation, as well as estimating the average waiting time. Method: a cross-sectional, descriptive and analytical study performed for all cornea transplants performed at a reference service (n=258. Data were analyzed using Statistical Package for the Social Sciences, version 20.0. Results: the main indicator for cornea transplant was keratoconus. The mean waiting time for the transplant was approximately 5 months and 3 weeks for elective transplants and 9 days for urgent cases. An association between the type of corneal disorder with gender, age, previous surgery, eye classification, glaucoma and anterior graft failure were found. Conclusion: keratoconus was the main indicator for cornea transplant. Factors such as age, previous corneal graft failure (retransplantation, glaucoma, cases of surgeries prior to cornea transplant (especially cataract surgery may be related to the onset corneal endothelium disorders.

  5. [Nondestructive applanation technique to measure the elasticity moduli and creep properties of ocular cornea in vivo].

    Science.gov (United States)

    Zhang, Xueyong; Liu, Dong; Tang, Zhen; Liao, Rongfeng; Ma, Jianguo

    2015-02-01

    Due to lack of the practical technique to measure the biomechanical properties of the ocular cornea in vivo, clinical ophthalmologists have some difficulties in understanding the deformation mechanism of the cornea under the action of physiological intraocular pressures. Using Young's theory analysis of the corneal deformation during applanation tonometry, the relation between the elasticity moduli of the cornea and the applanated corneal area and the measured and true intraocular pressures can be obtained. A new applanation technique has been developed for measuring the biomechanical properties of the ocular cornea tissue in vivo, which can simultaneously acquire the data of the applanation area and displacement of the corneal deformation as well as the exerted applanation force on the cornea. Experimental results on a rabbit's eyeball demonstrated that the present technique could be used to measure the elasticity moduli and creep properties of the ocular cornea nondestructively in vivo.

  6. Descemet stripping automated endothelial keratoplasty (DSAEK with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity

    Directory of Open Access Journals (Sweden)

    S. V. Trufanov

    2014-07-01

    Full Text Available Purpose: To evaluate the results of DSAEK with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity.Methods: DSAEK with thin grafts the thickness of which was 150‑70 μm was fulfilled in 47 patients (47 eyes suffered bullous keratophaty without visible leukomas in the corneal stroma. Visual acuity prior to the operation with a maximum spectacle correction accounted for an average of 0.05±0.04. Tear film osmolarity of 20 patients (20 eyes who participated in the research was measured. Results: In follow-up period graft kept transparency in 39 patients. Visual acuity in 3 months after the operation, on average, without correction was 0.38±0.16, with a maximum of spectacle correction is 0.51± 0.18. The spherical component varied in the range from 0 to 3.75 D, with an average of 1.63 per±1.1 D. Corneal astigmatism was from 0.5 to 4.0 D, an average of 1.8±0.98 D. At preoperative osmolarity indicators were within the normal reference for both operated and non-operated eyes — 292.3±10.4 и 279.3±3.51. In a first postoperative week osmolarity was not detected while on a non-operated eye it was 278.4±1.4. After 1, 3 and 6 months osmolarity indicators on both eyes were within normal reference. Spherical component ranged from 0 to 3.75 D, averaging 1.1±1.63 D. Corneal astigmatism ranged from 0.5 to 4.0 (D, with an average of 1.8±0.98 D 1.63 per±1.1 D.Conclusion: DSAEK with thin grafts is an effective modern methods of surgical treatment of bullous keratophaty. For old patients with severe ocular pathology — concomitant eye diseases, repeated surgery of the eye, the developed stage of the keratophaty — we have not noted the apparent correlation between the thickness of the transplant, visual acuity and the time of recovery of visual functions after keratoplasty. Osmolarity in an early postoperative period is a non-informative method of diagnostics. Restoration of osmolarity level to preoperative

  7. Descemet stripping automated endothelial keratoplasty (DSAEK with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity

    Directory of Open Access Journals (Sweden)

    S. V. Trufanov

    2013-01-01

    Full Text Available Purpose: To evaluate the results of DSAEK with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity.Methods: DSAEK with thin grafts the thickness of which was 150‑70 μm was fulfilled in 47 patients (47 eyes suffered bullous keratophaty without visible leukomas in the corneal stroma. Visual acuity prior to the operation with a maximum spectacle correction accounted for an average of 0.05±0.04. Tear film osmolarity of 20 patients (20 eyes who participated in the research was measured. Results: In follow-up period graft kept transparency in 39 patients. Visual acuity in 3 months after the operation, on average, without correction was 0.38±0.16, with a maximum of spectacle correction is 0.51± 0.18. The spherical component varied in the range from 0 to 3.75 D, with an average of 1.63 per±1.1 D. Corneal astigmatism was from 0.5 to 4.0 D, an average of 1.8±0.98 D. At preoperative osmolarity indicators were within the normal reference for both operated and non-operated eyes — 292.3±10.4 и 279.3±3.51. In a first postoperative week osmolarity was not detected while on a non-operated eye it was 278.4±1.4. After 1, 3 and 6 months osmolarity indicators on both eyes were within normal reference. Spherical component ranged from 0 to 3.75 D, averaging 1.1±1.63 D. Corneal astigmatism ranged from 0.5 to 4.0 (D, with an average of 1.8±0.98 D 1.63 per±1.1 D.Conclusion: DSAEK with thin grafts is an effective modern methods of surgical treatment of bullous keratophaty. For old patients with severe ocular pathology — concomitant eye diseases, repeated surgery of the eye, the developed stage of the keratophaty — we have not noted the apparent correlation between the thickness of the transplant, visual acuity and the time of recovery of visual functions after keratoplasty. Osmolarity in an early postoperative period is a non-informative method of diagnostics. Restoration of osmolarity level to preoperative

  8. Wound healing in rabbit corneas after photorefractive keratectomy and laser in situ keratomileusis.

    Science.gov (United States)

    Miyamoto, Takeshi; Saika, Shizuya; Yamanaka, Akio; Kawashima, Yoshiji; Suzuki, Yoshitaka; Ohnishi, Yoshitaka

    2003-01-01

    To compare the wound-healing process in the rabbit cornea after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) with the same refractive correction. Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan. Adult albino rabbits (N = 24) were used. One eye of each animal had PRK or LASIK with the same refractive correction. Each animal was killed after an interval of up to 6 months. The expression pattern of corneal stromal injury-related molecules with the 2 treatments were compared. Paraffin sections of the cornea were processed immunohistochemically for alpha-smooth muscle actin (alpha-SMA), collagen type IV [alpha1(IV)](2),alpha2(IV), and heat shock protein (HSP) 47 as well as other HSPs. Sections were also examined after hematoxylin and eosin or periodic acid-Schiff staining. Hematoxylin and eosin staining showed the central epithelium to be thick in PRK-treated corneas. The thick epithelium was restricted to the area around the corneal flap edge adhesion in LASIK-treated corneas at 3 months. Periodic acid-Schiff staining showed an absence of or interruption in the epithelial basement membrane in PRK-treated corneas for up to 6 months. Heat shock protein 47 was detected in keratocytes on day 3 but not after that in PRK-treated corneas. There was no difference in the expression of other HSPs. Alpha-smooth muscle actin was expressed in keratocytes repopulated in the central anterior cornea of PRK-treated corneas at 28 days. Keratocytes with immunoreactivity for these 2 proteins were not seen in LASIK-treated corneas. Collagen IV [alpha1(IV)](2),alpha2(IV) was not detected in either group of corneas. The central epithelium became transiently thicker in PRK-treated corneas. Keratocyte responses to laser stromal ablation were more marked in corneas treated with PRK than in those treated with LASIK.

  9. Cultivation and characterization of a bovine in vitro model of the cornea.

    Science.gov (United States)

    Tegtmeyer, S; Reichl, S; Müller-Goymann, C C

    2004-06-01

    The aim of this study was to develop an in vitro model of the cornea of bovine cells, to characterise the model by histochemical methods and to investigate permeation of ophthalmic drugs through the model. As in the in vivo situation, an in vitro model of the cornea should consist of all three different types of cells. In the current study, the construction of the in vitro cornea was performed using cells prepared from primary cultures. To investigate the state of the cells in the cultures, growth curves were established. Immunocytochemical determination of keratin and vimentin was performed for all three isolated and sub-cultivated cell types of the bovine cornea. To further simulate the in vivo conditions, corneal epithelial cells were seeded onto the collagen-gel base containing the stromal cells with an underlying sheet of endothelium. Permeation experiments were performed with pilocarpine hydrochloride and timolol hydrogen maleate as model drugs and excised bovine cornea and the in vitro cornea as permeation barriers. The immunohistochemical investigations show that excised bovine cornea and the in vitro model of the cornea are comparable with respect to the expression of keratin K3, indicating that the primarily isolated cells correspond to the different cell types of the cornea. Culturing of the epithelial cells on the complex basis has led to the formation of a corneal epithelium with several layers, closely resembling the morphology of the in vivo epithelium. Although the permeation rates of the drug through the in vitro cornea were always higher, the sequence in which the drugs permeate through the two types of barriers was the same. The drug permeation through the in vitro cornea may therefore be a useful predictive tool to estimate the permeability coefficients of drugs through excised cornea.

  10. Physical and Biological Characterization of the Gamma-Irradiated Human Cornea.

    Science.gov (United States)

    Chae, J Jeremy; Choi, Joseph S; Lee, Justin D; Lu, Qiaozhi; Stark, Walter J; Kuo, Irene C; Elisseeff, Jennifer H

    2015-10-01

    To compare the physical and biological characteristics of commercial gamma-irradiated corneas with those of fresh human corneas and to determine suitability for transplantation. The physical properties of gamma-irradiated and fresh corneas were evaluated with respect to light transmittance, hydration (swelling ratio), elastic modulus (compressive modulus by the indentation method), matrix organization (differential scanning calorimetry), and morphology (light and transmission electron microscopy). The biological properties of the gamma-irradiated cornea, including residual cell content and cellular biocompatibility, were evaluated by quantifying DNA content and measuring the proliferation rate of human corneal epithelial cells, respectively. The hydration, light transmittance, elastic modulus, and proliferation rate of human corneal epithelial cells were not significantly different between fresh and gamma-irradiated corneas. However, differences were observed in tissue morphology, DNA content, and thermal properties. The density of collagen fibrils of the gamma-irradiated corneal sample (160.6 ± 33.2 fibrils/μm) was significantly lower than that of the fresh corneal sample (310.0 ± 44.7 fibrils/μm). Additionally, in the gamma-irradiated corneas, cell fragments-but not viable cells-were observed, supported by lower DNA content of the gamma-irradiated cornea (1.0 ± 0.1 μg/mg) than in fresh corneas (1.9 μg/mg). Moreover, the denaturation temperature of gamma-irradiated corneas (61.8 ± 1.1 °C) was significantly lower than that of fresh corneas (66.1 ± 1.9 °C). Despite structural changes due to irradiation, the physical and biological properties of the gamma-irradiated cornea remain similar to the fresh cornea. These factors, combined with a decreased risk of rejection and longer shelf life, make the gamma-irradiated tissue a viable and clinically desired option in various ophthalmic procedures.

  11. The Ets Transcription Factor EHF as a Regulator of Cornea Epithelial Cell Identity*

    Science.gov (United States)

    Stephens, Denise N.; Klein, Rachel Herndon; Salmans, Michael L.; Gordon, William; Ho, Hsiang; Andersen, Bogi

    2013-01-01

    The cornea is the clear, outermost portion of the eye composed of three layers: an epithelium that provides a protective barrier while allowing transmission of light into the eye, a collagen-rich stroma, and an endothelium monolayer. How cornea development and aging is controlled is poorly understood. Here we characterize the mouse cornea transcriptome from early embryogenesis through aging and compare it with transcriptomes of other epithelial tissues, identifying cornea-enriched genes, pathways, and transcriptional regulators. Additionally, we profiled cornea epithelium and stroma, defining genes enriched in these layers. Over 10,000 genes are differentially regulated in the mouse cornea across the time course, showing dynamic expression during development and modest expression changes in fewer genes during aging. A striking transition time point for gene expression between postnatal days 14 and 28 corresponds with completion of cornea development at the transcriptional level. Clustering classifies co-expressed, and potentially co-regulated, genes into biologically informative categories, including groups that exhibit epithelial or stromal enriched expression. Based on these findings, and through loss of function studies and ChIP-seq, we show that the Ets transcription factor EHF promotes cornea epithelial fate through complementary gene activating and repressing activities. Furthermore, we identify potential interactions between EHF, KLF4, and KLF5 in promoting cornea epithelial differentiation. These data provide insights into the mechanisms underlying epithelial development and aging, identifying EHF as a regulator of cornea epithelial identity and pointing to interactions between Ets and KLF factors in promoting epithelial fate. Furthermore, this comprehensive gene expression data set for the cornea is a powerful tool for discovery of novel cornea regulators and pathways. PMID:24142692

  12. Research of cornea section's shape ablated by 193-nm ArF laser spots

    Science.gov (United States)

    Zhu, Zhiqiang; Yu, Yinshan; Deng, Guoqing

    2005-11-01

    The ablation theory of cornea and biology effect by 193-nm ArF excimer laser are introduced. The ablation tracks model is put forward to make laser spots scan around cornea by many steps and many areas to change cornea curvature. The corneal average ablation curve is calculated by software so as to explain the feasibility of the ablation tracks model. By analyzing the actual ablation shapes of many arbitrary cornea sections, the optimal ablation method for deciding the random position of every laser spot in every ablation track is obtained. Experiments combining the ablation model with the device testify the energy stability of laser spots and the accuracy of rectifying anisometropia.

  13. Influx of immunoglobulins from the vascular compartment into a grafted cornea.

    Science.gov (United States)

    Van der Veen, G; Broersma, L; Bruyne, I; Verhagen, C; Ruijter, J; Van Rij, G; Van der Gaag, R

    1997-04-01

    To determine the effect of a fresh corneal wound or a healed corneal scar on the immunodiffusion of immunoglobulins into the cornea. F344 rats were immunized with human serum albumin (HSA) 1 week before an autologous rotational keratoplasty of the right cornea or 1 year after an autograft was performed. One group of rats also was treated with gentamicin-dexamethasone ointment in the grafted eye for 1 week after transplantation to reduce the postsurgical inflammatory signs. A serum sample was drawn every week and booster injections with HSA were given after 2 and 3 weeks. At various times after immunization, groups of rats were killed, blood and aqueous humor samples were taken, and the corneas of both eyes were removed. The corneas were divided into the graft or a 3-mm central button and the peripheral rim and weighed. The anti-HSA titer was determined in serum, aqueous humor, and both parts of the corneas. Up to 5 weeks after transplantation, the grafted cornea contained more anti-HSA immunoglobulins than did the control eye. One year postgrafting, no difference was seen. In the first weeks after keratoplasty, influx of anti-HSA from the peripheral into the central cornea was, however, neither obstructed nor enhanced. Surgical trauma in itself causes increased influx of anti-HSA immunoglobulins into the cornea. Within the cornea, a wound or a scar does not appear to be a barrier for centripetal immunoglobulin diffusion.

  14. Mid-term clinical outcomes of collagen-phosphorylcholine cornea substitutes for therapeutic anterior lamellar keratoplasty

    National Research Council Canada - National Science Library

    O Buznyk; MM Islam; S Iakymenko; N Pasyechnikova; M Griffith

    2016-01-01

    Purpose To assess safety and efficacy of biosynthetic collagen-phosphorylcholine implants as corneal substitutes in patients with severe pathologies for whom human donor cornea transplantation carries...

  15. Distribution of specific collagen types and fibronectin in normal and keratoconus corneas.

    Science.gov (United States)

    Tsuchiya, S; Tanaka, M; Konomi, H; Hayashi, T

    1986-01-01

    The distribution of five types of collagen and fibronectin in 6 normal and 9 keratoconus corneas was examined, using immunofluorescent staining and the enzyme-labeled antibody method. Types I, III and V collagens were detected in the corneal stroma. There was essentially no difference between normal and keratoconus corneas in their distribution. Type IV collagen and fibronectin were detected in the basement membrane of the normal corneal epithelium, while in the keratoconus corneas the disruption of the basement membrane as well as the excrescence of basement membrane materials was observed. The abnormal distribution of the type IV collagen and fibronectin was also observed in the anterior stromal area of keratoconus corneas.

  16. Expression of glutathione transferases in corneal cell lines, corneal tissues and a human cornea construct.

    Science.gov (United States)

    Kölln, Christian; Reichl, Stephan

    2016-06-15

    Glutathione transferase (GST) expression and activity were examined in a three-dimensional human cornea construct and were compared to those of excised animal corneas. The objective of this study was to characterize phase II enzyme expression in the cornea construct with respect to its utility as an alternative to animal cornea models. The expression of the GSTO1-1 and GSTP1-1 enzymes was investigated using immunofluorescence staining and western blotting. The level of total glutathione transferase activity was determined using 1-chloro-2,4- dinitrobenzene as the substrate. Furthermore, the levels of GSTO1-1 and GSTP1-1 activity were examined using S-(4-nitrophenacyl)glutathione and ethacrynic acid, respectively, as the specific substrates. The expression and activity levels of these enzymes were examined in the epithelium, stroma and endothelium, the three main cellular layers of the cornea. In summary, the investigated enzymes were detected at both the protein and functional levels in the cornea construct and the excised animal corneas. However, the enzymatic activity levels of the human cornea construct were lower than those of the animal corneas. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Dual illumination for cornea and retina imaging using spectral domain optical coherence tomography

    Science.gov (United States)

    Shirazi, Muhammad Faizan; Wijesinghe, Ruchire Eranga; Ravichandran, Naresh Kumar; Jeon, Mansik; Kim, Jeehyun

    2017-04-01

    A dual illumination system is proposed for cornea and retina imaging using spectral domain optical coherence tomography (SD-OCT). The system is designed to acquire cornea and retina imaging with dual illumination with limited optics and using a single spectrometer. The beam propagation for cornea and retina imaging in dual illumination enables to acquire the images of different segments. This approach will reduce the imaging time for separate corneal and retinal imaging. The in vivo imaging of both the cornea and retina of a health volunteer shows the feasibility of the system for clinical applications

  18. Successful Management of Acquired Hemophilia A Associated with Bullous Pemphigoid: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Quentin Binet

    2017-01-01

    Full Text Available Background. Acquired hemophilia A (AHA is a rare condition, due to the spontaneous formation of neutralizing antibodies against endogenous factor VIII. About half the cases are associated with pregnancy, postpartum, autoimmune diseases, malignancies, or adverse drug reactions. Symptoms include severe and unexpected bleeding that may prove life-threatening. Case Study. We report a case of AHA associated with bullous pemphigoid (BP, a chronic, autoimmune, subepidermal, blistering skin disease. To our knowledge, this is the 25th documented case of such an association. Following treatment for less than 3 months consisting of methylprednisolone at decreasing dose levels along with four courses of rituximab (monoclonal antibody directed against the CD20 protein, AHA was completely cured and BP well-controlled. Conclusions. This report illustrates a rare association of AHA and BP, supporting the possibility of eradicating the inhibitor with a well-conducted short-term treatment.

  19. A 14-year paraneoplastic rash: urticarial vasculitis and dermal binding bullous pemphigoid secondary to chronic lymphocytic leukaemia.

    Science.gov (United States)

    Kassim, J M; Igali, L; Levell, N J

    2015-06-01

    A 72-year-old woman with a 14-year history of urticarial vasculitis (UV) and a 13-year history of bullous pemphigoid (BP) presented with associated progressive chronic lymphocytic leukaemia (CLL). Both skin conditions responded poorly to treatment, until chemotherapy for CLL was commenced. The skin features showed a clear paraneoplastic course, resolving with chemotherapy and recurring when the CLL relapsed and the lymphocyte count rose above 5 × 10(9)/L. No case of UV secondary to CLL, and very few cases of BP related to CLL have been reported, and no paraneoplastic rash of any type lasting 14 years has been reported previously. © 2014 British Association of Dermatologists, North American Clinical Dermatologic Society and St Johns Dermatological Society.

  20. Epidermolysis bullosa acquisita and anti-p200 pemphigoid as major subepidermal autoimmune bullous diseases diagnosed by floor binding on indirect immunofluorescence microscopy using human salt-split skin

    Directory of Open Access Journals (Sweden)

    Nupur Goyal

    2017-01-01

    Conclusion: In this study, we report three cases of anti-p200 pemphigoid from India. These cases, though indistinguishable clinically from bullous pemphigoid, revealed a floor-binding pattern on indirect immunofluorescence using salt-split skin.

  1. Fitting the post-keratoplasty cornea with hydrogel lenses.

    Science.gov (United States)

    Katsoulos, Costas; Nick, Vasileiou; Lefteris, Karageorgiadis; Theodore, Mousafeiropoulos

    2009-02-01

    We report two cases who have undergone penetrating keratoplasty (three eyes total), and who were fitted with hydrogel lenses. In the first case, a 28-year-old male presented with an interest in contact lens fitting. He had undergone corneal transplantation in both eyes, about 5 years ago. After topographies and trial fitting were performed, it was decided to be fitted with reverse geometry hydrogel lenses, due to the globular geometry of the cornea, the resultant instability of RGPs, and personal preference. In the second case, a 26-year-old female who had also penetrating keratoplasty was fitted with a hydrogel toric lens of high cylinder in the right eye. The final hydrogel lenses for the first subject incorporated a custom tricurve design, in which the second curve was steeper than the base curve and the third curve flatter than the second but still steeper than the first. Visual acuity was 6/7.5 RE and a mediocre 6/15 LE (OU 6/7.5). The second subject achieved 6/4.5 acuity RE with the high cylinder hydrogel toric lens. In corneas exhibiting extreme protrusion, such as keratoglobus and some cases after penetrating keratoplasty, curvatures are so extreme and the cornea so globular leading to specific fitting options: sclerals, small diameter RGPs and reverse geometry hydrogel lenses, in order to improve lens and optical stability. In selected cases such as the above, large diameter inverse geometry RGP may be fitted only if the eyelid shape and tension permits so. The first case demonstrates that the option of hydrogel lenses is viable when the patient has no interest in RGPs and in certain cases can improve vision to satisfactory levels. In other cases, graft toricity might be so high that the practitioner will need to employ hydrogel torics with large amounts of cylinder in order to correct vision. In such cases, the patient should be closely monitored in order to avoid complications from hypoxia.

  2. Effect of diabetes mellitus on biomechanical parameters of the cornea.

    Science.gov (United States)

    Goldich, Yakov; Barkana, Yaniv; Gerber, Yariv; Rasko, Adi; Morad, Yair; Harstein, Morris; Avni, Isaac; Zadok, David

    2009-04-01

    To compare parameters of biomechanical response of the human cornea measured as corneal hysteresis (CH) and corneal resistance factor (CRF) in patients with diabetes mellitus and healthy control subjects. Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel. In the right eye of each participant, the CH, CRF, Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured with the Ocular Response Analyzer. Central corneal thickness (CCT) was measured by ultrasonic pachymetry and intraocular pressure by Goldmann applanation tonometry (IOP GAT). Findings were compared between the 2 groups (control and diabetic). Forty diabetic patients (17 women, 23 men) and 40 healthy subjects (19 women, 21 men) were prospectively recruited. The mean CH was 9.3 mm Hg +/- 1.4 (SD) and 10.7 +/- 1.6 mm Hg and the mean CRF was 9.6 +/- 1.6 mm Hg and 10.9 +/- 1.7 mm Hg in the control group and diabetic group, respectively (both P corneas were significantly thicker (P = .019); the mean CCT was 530.3 +/- 35.9 microm in the control group and 548.7 +/- 33.0 microm in the diabetic group. The CH and CRF remained significantly different in multivariate analysis that included CCT. There was no statistically significant difference between the 2 groups in IOPcc, IOPg, or IOP GAT measurements. Diabetes mellitus affected biomechanical parameters of the human corneas, including increased CH, CRF, and CCT. Whether this observation has implications in the clinical management and understanding of corneal ectasia and glaucoma requires further study.

  3. Axial Lengths in Children with Recessive Cornea Plana.

    Science.gov (United States)

    Al Hazimi, Amro; Khan, Arif O

    2015-06-01

    While flat keratometry contributes to the hyperopia and associated refractive accommodative esotropia that is part of recessive cornea plana, whether or not axial lengths are abnormally short in the disease is unclear. In this study we assess this possibility. Prospective (2010-2012) axial length measurement (IOLmaster; Carl Zeiss, Oberkochen, Germany) of affected right eyes and comparison to right eyes with refractive accommodative esotropia only. Keratometry and refraction were also performed. For eight affected right eyes (age 10-12 years; seven families) axial length ranged from 21.46-24.80 mm (mean 23.34). Best corrected visual acuity ranged from 20/25 to 20/50, keratometry from 25.33-39.80 diopters (D) [mean 31.80], and refraction from +2.00 to +14.00 D (mean +7.22). For 50 control right eyes (age 4-12 years), axial length ranged from 19.87-23.66 mm (mean 21.6). Best-corrected visual acuity was 20/25 or better, keratometry ranged from 39.81-46.25 D (mean 42.42), and refraction from +2.25 to +8.00 D (mean 4.71). Axial lengths were longer in the affected group (2-tailed unpaired t-test p value 0.000005) despite greater hyperopia (2-tailed unpaired t-test p value 0.001). Despite greater hyperopia, axial lengths were longer in eyes with recessive cornea plana, evidence that axial lengths are not shortened by the disease. Keratometry in children with cornea plana was below the range of controls and was the major factor underlying the phenotype's hyperopia.

  4. Effects of polysialic acid on sensory innervation of the cornea.

    Science.gov (United States)

    Mao, Xiuli; Zhang, Yuntao; Schwend, Tyler; Conrad, Gary W

    2015-02-15

    Sensory trigeminal growth cones innervate the cornea in a coordinated fashion during embryonic development. Polysialic acid (polySia) is known for its important roles during nerve development and regeneration. The purpose of this work is to determine whether polySia, present in developing eyefronts and on the surface of sensory nerves, may provide guidance cues to nerves during corneal innervation. Expression and localization of polySia in embryonic day (E)5-14 chick eyefronts and E9 trigeminal ganglia were identified using Western blotting and immunostaining. Effects of polySia removal on trigeminal nerve growth behavior were determined in vivo, using exogenous endoneuraminidase (endoN) treatments to remove polySia substrates during chick cornea development, and in vitro, using neuronal explant cultures. PolySia substrates, made by the physical adsorption of colominic acid to a surface coated with poly-d-lysine (PDL), were used as a model to investigate functions of the polySia expressed in axonal environments. PolySia was localized within developing eyefronts and on trigeminal sensory nerves. Distributions of PolySia in corneas and pericorneal regions are developmentally regulated. PolySia removal caused defasciculation of the limbal nerve trunk in vivo from E7 to E10. Removal of polySia on trigeminal neurites inhibited neurite outgrowth and caused axon defasciculation, but did not affect Neural Cell Adhesion Molecule (NCAM) expression or Schwann cell migration in vitro. PolySia substrates in vitro inhibited outgrowth of trigeminal neurites and promoted their fasciculation. In conclusion, polySia is localized on corneal nerves and in their targeting environment during early developing stages of chick embryos. PolySias promote fasciculation of trigeminal axons in vivo and in vitro, whereas, in contrast, their removal promotes defasciculation. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. [Comparing cryopreserved with fresh corneas on clinical application in penetrating keratoplasty].

    Science.gov (United States)

    Xu, L; Chen, J; Hung, T

    2001-06-01

    To evaluate the role of cryopreserved corneas on penetrating keratoplasty (PKP) by comparing them with fresh corneas on clinical application. Third-six excellent condition patients were chosen and randomly divided into two groups. They were performed PKP by using fresh and cryopreserved corneas respectively. The graft transparency, epithelial healing speed of graft, tear membrane, graft thickness, endothelium density and visual acurity were emphasized respectively. When fresh and cryopreserved corneas were used on PKP as the donor respectively, postoperative time to recover normal break-up time (BUT) was two to six months average (4.7 +/- 0.3) months and two to eight months, average (5.6 +/- 0.4) months and time to recover normal Schirmer's test was one to four months average (2.1 +/- 0.3) months and 1-3.5 months, average (1.7 +/- 0.5) months. The graft's thickness, stabilized visual acurity and graft's rejective rate were 0.56-0.68 mm (average 0.62 mm) vs 0.54-0.62 mm (average 0.59 mm), (0.46 +/- 0.03) vs (0.44 +/- 0.05) and 20% vs 19% respectively when fresh vs cryoperserved corneas. No statistical significance between fresh and cryopreserved corneas (P > 0.05). But the grafts behaved intact epithelium and continuing transparency when fresh corneas as donors, while the graft's epithelial defects healed after three to five days of the operation and edematous grafts were reclear after two to three weeks of the operation when cryopreserved corneas as donors. Graft's endothelium density in fresh corneas group 2,043-2,210 cells/mm2 (average 2,135 cells/mm2) was high than in cryopreserved corneas 1,240-1,860 cells/mm2 (average 1,672 cells/mm2) (P healing was delayed and endothelium density was lower when cryopreserved corneas as donors.

  6. The lens regenerative competency of limbal vs. central regions of mature Xenopus cornea epithelium

    Science.gov (United States)

    Hamilton, Paul W.; Henry, Jonathan J.

    2016-01-01

    The frog, Xenopus laevis, is capable of completely regenerating a lens from the cornea epithelium. Because this ability appears to be limited to the larval stages of Xenopus, virtually all the work to understand the mechanisms regulating this process has been limited to pre-metamorphic tadpoles. It has been reported that the post-metamorphic cornea is competent to regenerate under experimental conditions, despite the fact that the in vivo capacity to regenerate is lost; however, that work didn’t examine the regenerative potential of different regions of the cornea. A new model suggests that cornea-lens regeneration in Xenopus may be driven by oligopotent stem cells, and not by transdifferentiation of mature cornea cells. We investigated the regenerative potential of the limbal region in post-metamorphic cornea, where the stem cells of the cornea are thought to reside. Using EdU (5-Ethynyl-2’-deoxyuridine), we identified long-term label retaining cells in the basal cells of peripheral post-metamorphic Xenopus cornea, consistent with slow-cycling stem cells of the limbus that have been described in other vertebrates. Using this data to identify putative stem cells of the limbal region in Xenopus, we tested the regenerative competency of limbal regions and central cornea. All three regions showed a similarly high ability for the cells of the basal epithelium to express lens proteins when cultured in proximity to larval retina. Thus, the regenerative competency in post-metamorphic cornea is not restricted to stem cells of the limbal region, but also occurs in the transit amplifying cells throughout the basal layer of the cornea epithelium. PMID:27569373

  7. Cost Minimization Analysis of Precut Cornea Grafts in Descemet Stripping Automated Endothelial Keratoplasty.

    Science.gov (United States)

    Yong, Kai-Ling; Nguyen, Hai V; Cajucom-Uy, Howard Y; Foo, Valencia; Tan, Donald; Finkelstein, Eric A; Mehta, Jodhbir S

    2016-02-01

    Descemet stripping automated endothelial keratoplasty (DSAEK) is the most common corneal transplant procedure. A key step in the procedure is preparing the donor cornea for transplantation. This can be accomplished via 1 of 3 alternatives: surgeon cuts the cornea on the day of surgery, the cornea is precut ahead of time in an offsite facility by a trained technician, or a precut cornea is purchased from an eye bank. Currently, there is little evidence on the costs and effectiveness of these 3 strategies to allow healthcare providers decide upon the preferred method to prepare grafts.The aim of this study was to compare the costs and relative effectiveness of each strategy.The Singapore National Eye Centre and Singapore Eye Bank performed both precut cornea and surgeon-cut cornea transplant services between 2009 and 2013.This study included 110 subjects who received precut cornea and 140 who received surgeon-cut cornea. Clinical outcomes and surgical duration were compared across the strategies using the propensity score matching. The cost of each strategy was estimated using the microcosting and consisted of facility costs and procedural costs including surgical duration. One-way sensitivity analysis and threshold analysis were performed.The cost for DSAEK was highest for the surgeon-cut approach ($13,965 per procedure), followed by purchasing precut corneas ($12,659) and then setting up precutting ($12,421). The higher procedural cost of the surgeon-cut approach was largely due to the longer duration of the procedure (surgeon-cut = 72.54 minutes, precut = 59.45 minutes, P cornea from eye bank. If there were more than 290 cases annually, the cheapest option would be to setup precutting facility.Our findings suggest that it is more efficient for centers that are performing a large number of cornea transplants (more than 290 cases) to set up their own facility to conduct precutting.

  8. Prevalence and clinical consequences of herpes simplex virus type 1 DNA in human cornea tissues

    NARCIS (Netherlands)

    L. Remeijer (Lies); R. Duan (Rui); J.M. van Dun (Jessica); M.A.W. Bettink; A.D.M.E. Osterhaus (Albert); G.M.G.M. Verjans (George)

    2009-01-01

    textabstractBackground. We determined the prevalence and clinical consequences of herpes simplex virus (HSV) type 1 (HSV-1), HSV type 2 (HSV-2), and varicella-zoster virus (VZV) in cornea tissues obtained after penetrating keratoplasty (PKP) was performed. Methods. The excised corneas of 83 patients

  9. [Biomechanical condition of the cornea as a new indicator for pathological and structural changes].

    Science.gov (United States)

    Spörl, E; Terai, N; Haustein, M; Böhm, A G; Raiskup-Wolf, F; Pillunat, L E

    2009-06-01

    Several methods permit the measurement of geometric parameters of the cornea, but until now biomechanical conditions of the cornea have been ignored (e.g. in refractive corneal surgery). Besides the geometric condition, biomechanical properties of the cornea have been shown to influence applanation measurement of intra-ocular pressure (IOP) and epidemiological studies have identified corneal thickness as an independent risk factor for the development and progression of glaucoma. The aim of this investigation was to characterize the biomechanical properties of the cornea using the ocular response analyzer (ORA). The ocular response analyzer (ORA) is a new method available for non-contact measurement of the biomechanical properties of the cornea. We evaluated the reproducibility of measurements, the difference between static and dynamic factors and the impact of independent factors (e.g. IOP, age, CCT, swelling of the cornea) on 2,500 measurements of corneal hysteresis (CH) and corneal resistance factor (CRF). In a large sample size we observed changes in CH and CRF after refractive surgery procedures (LASIK, UV-A cross-linking, keratoplasty) and in other corneal disorders (keratoconus, corneal dystrophies). CRF and CH changes may reflect structural changes of the cornea. Thus, the ORA provides valuable information for a better understanding and characterization of the biomechanical condition of the cornea, especially with regard to diseases such as keratoconus and glaucoma.

  10. Identification of biomechanical properties of the cornea: the ocular response analyzer.

    Science.gov (United States)

    Terai, Naim; Raiskup, Frederik; Haustein, Michael; Pillunat, Lutz E; Spoerl, Eberhard

    2012-07-01

    Several methods have been devised for measuring geometric parameters of the cornea but, until now, the biomechanics of the cornea have been largely ignored. The relatively new Ocular Response Analyzer (ORA) provides such biomechanical information. In order to correctly interpret the underlying biomechanics of ORA data, we review reported ORA measurements and provide a compendium of factors influencing these measurements, with discussion of possible explanations for ORA measurement results. This review comprised a literature search using "ocular response analyzer" and "ocular response analyser" as keywords. We reviewed and compared reported results from recent ORA studies so obtained, with an eye to understanding corneal biomechanics. Several ORA biomechanical parameters of the cornea - corneal hysteresis (CH) and corneal resistant factor (CRF) - characterize the viscoelastic properties of the cornea, especially those of the ground substance. The impact on CH and CRF values of various independent factors, e.g. intraocular pressure (IOP), age, central corneal thickness (CCT), and corneal swelling, are discussed. The impact on CH and CRF of treatment-related structural changes of the cornea, i.e. those occurring after refractive surgical procedures, placement of intracorneal rings, and collagen crosslinking (CXL), as well as pathological changes of the cornea, e.g. those resulting from keratoconus, edema, and glaucoma, are discussed. Changes in CRF and CH may be reflective of structural changes in the ground substance of the cornea. Thus, ORA provides invaluable information for delineating biomechanical conditions pertaining to the cornea, with special regard to ocular diseases, e.g. keratoconus and glaucoma.

  11. Molecular cloning of a new angiopoietinlike factor from the human cornea

    NARCIS (Netherlands)

    Peek, R; van Gelderen, BE; Bruinenberg, M; Kijlstra, A

    PURPOSE. To isolate tissue-specific gene products that contribute to corneal integrity. METHODS. A cDNA library was constructed and differentially hybridized. Cornea-specific clones were purified and further characterized. RESULTS. In this study cornea-specific gene products were isolated by

  12. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study

    DEFF Research Database (Denmark)

    Christoffersen, Mette; Frikke-Schmidt, Ruth; Schnohr, Peter

    2011-01-01

    To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population.......To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population....

  13. In silico investigation of cornea deformation during irrigation/aspiration in phacoemulsification in cataract surgery.

    Science.gov (United States)

    Bayatpour, Dariush; Abouali, Omid; Ghaffarieh, Alireza; Ahmadi, Goodarz

    2017-05-01

    To analyze the stress, strain and displacement of the human cornea under the action of negative intraocular pressure, which occurs during phacoemulsification in cataract surgery, a multidisciplinary approach including biomedical engineering, solid mechanics, numerical analysis, and fluid dynamics was used. Fluid-structure interaction method was implemented using 3-dimensional nonlinear finite element analysis of cornea tissue in conjunction with CFD analysis of anterior chamber fluid flow to study the deformation of the cornea under negative gage pressure during irrigation and aspiration (I/A). The computational model of the eye includes both cornea and sclera. To increase the accuracy of the computational model, both cornea hyperelasticity and thickness variation were included in the analysis. The simulation was performed for both coaxial and bimanual I/A systems with different flow rates. The cornea deformations for various flow rates were evaluated, and the possibility of an unstable anterior chamber was assessed. The results show that the critical pressure in the anterior chamber, which may lead to the surge condition due to buckling of the cornea, is sub-ambient (below zero gauge pressure). Anterior chamber instability occurs at higher volume flow rates for coaxial I/A system compared with that for bimanual system, but the deformation of the cornea is more intense for the bimanual system. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  14. Method for optical coherence elastography of the cornea

    Science.gov (United States)

    Ford, Matthew R.; Dupps, William J.; Rollins, Andrew M.; Roy, Abhijit Sinha; Hu, Zhilin

    2011-01-01

    The material properties of the cornea are important determinants of corneal shape and refractive power. Corneal ectatic diseases, such as keratoconus, are characterized by material property abnormalities, are associated with progressive thinning and distortion of the cornea, and represent a leading indication for corneal transplantation. We describe a corneal elastography technique based on optical coherence tomography (OCT) imaging, in which displacement of intracorneal optical features is tracked with a 2-D cross-correlation algorithm as a step toward nondestructive estimation of local and directional corneal material properties. Phantom experiments are performed to measure the effects of image noise and out-of-plane displacement on effectiveness of displacement tracking and demonstrated accuracy within the tolerance of a micromechanical translation stage. Tissue experiments demonstrate the ability to produce 2-D maps of heterogeneous intracorneal displacement with OCT. The ability of a nondestructive optical method to assess tissue under in situ mechanical conditions with physiologic-range stress levels provides a framework for in vivo quantification of 3-D corneal elastic and viscoelastic resistance, including analogs of shear deformation and Poisson's ratio that may be relevant in the early diagnosis of corneal ectatic disease.

  15. Tectonic Lamellar Keratoplasty Using Cryopreserved Cornea in a Large Descemetocele.

    Science.gov (United States)

    Kim, Kang Yoon; Jung, Ji Won; Kim, Eung Kweon; Seo, Kyoung Yul; Kim, Tae Im

    2016-01-01

    We describe herein a case of an impending corneal perforation with a large descemetocele in a patient with previous penetrating keratoplasty (PKP) that subsequently was treated with an emergent lamellar keratoplasty using frozen preserved cornea. A 76-year-old male patient, who had a PKP, presented with a completely whitish and edematous graft accompanied by large epithelial defects. Although antibiotics and antiviral agents were tried for three days, the corneal stroma abruptly melted, except for the Descemet's membrane and endothelium. Cryopreserved corneal tissue that was kept at -80°C was thawed and sutured on top of the remaining Descemet's membrane and endothelium. Pathological and microbiological tests were conducted using the remaining donor and recipient corneal tissues. After tectonic corneal transplantation on top of a large descemetocele, a healthy graft and relatively clear interfaces between graft-host junctions were maintained without serious adverse reactions throughout 6 month follow-up period. Microbiological evaluations of donor tissue at the time of thawing and tissue preparation were done, and the results were all negative. Tissue that was taken intraoperatively from the recipient cornea also showed negative microbiological results. In conclusion, tectonic lamellar keratoplasty, using cryopreserved corneal tissue, only onto the remaining Descemet's membrane and endothelium in an emergent condition, was a safe and effective treatment.

  16. Biomechanical model of human cornea based on stromal microstructure.

    Science.gov (United States)

    Studer, H; Larrea, X; Riedwyl, H; Büchler, P

    2010-03-22

    The optical characteristics of the human cornea depends on the mechanical balance between the intra-ocular pressure and intrinsic tissue stiffness. A wide range of ophthalmic surgical procedures alter corneal biomechanics to induce local or global curvature changes for the correction of visual acuity. Due to the large number of surgical interventions performed every day, a deeper understanding of corneal biomechanics is needed to improve the safety of these procedures and medical devices. The aim of this study is to propose a biomechanical model of the human cornea, based on stromal microstructure. The constitutive mechanical law includes collagen fiber distribution based on X-ray scattering analysis, collagen cross-linking, and fiber uncrimping. Our results showed that the proposed model reproduced inflation and extensiometry experimental data [Elsheikh et al., Curr. Eye Res., 2007; Elsheikh et al., Exp. Eye Res., 2008] successfully. The mechanical properties obtained for different age groups demonstrated an increase in collagen cross-linking for older specimens. In future work such a model could be used to simulate non-symmetric interventions, and provide better surgical planning. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  17. Flattening of the cornea after collagen crosslinking for keratoconus.

    Science.gov (United States)

    Koller, Tobias; Pajic, Bojan; Vinciguerra, Paolo; Seiler, Theo

    2011-08-01

    To identify preoperative parameters that may predict flattening of the keratoconic cornea after collagen crosslinking (CXL). Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland. Cohort study. Patients with verified progressive primary keratectasia received standard corneal CXL. Factors such as corrected distance visual acuity (CDVA) and Scheimpflug tomography (Pentacam) were used to follow the evolution from preoperatively to 12 months after CXL. Statistical analysis included U tests and Spearman rank correlation tests to detect risk factors for flattening of the keratoconus. The study enrolled 151 eyes of 151 patients; more than 80% completed the 12-month follow-up. The flattening rate (flattening of the maximum curvature >1.00 diopter [D]) was 37.7%. A preoperative maximum keratometry (K) reading of more than 54.00 D was identified as the only significant risk factor for this effect (odds ratio, 1.88; 95% confidence interval, 1.01-3.51). A restriction to corneas with a maximum K value greater than 54.00 D would have resulted in a significant flattening in 51% of the cases. Statistically significant flattening occurred during 1 year after CXL in more than 50% of cases when the preoperative maximum K reading was more than 54.00 D. None of the other preoperative parameters evaluated (eg, age, sex, diagnosis, CDVA, corneal shape factors) had a statistically significant impact on corneal flattening after CXL. Copyright © 2011. Published by Elsevier Inc.

  18. Laser thermokeratoplasty: determination of biomechanical properties of the cornea

    Science.gov (United States)

    Kampmeier, Juergen; Brinkmann, Ralf; Birngruber, Reginald

    1996-01-01

    Laser thermokeratoplasty (LTK) is a minimally invasive method to correct hyperopia and astigmatism. The alteration in refractive power of the eye is achieved by thermally induced shrinkage of stromal collagen in the corneal periphery with a mid-IR laser system ((lambda) equals 1.4 - 2.5 micrometers ) and thereby mechanically increasing the central corneal curvature. In order to evaluate the best choice of laser parameters and exposure geometry a mechanical model of the cornea, which is highly dependent on the material parameters of the corneal tissue, is to be developed. For this reason uniaxial tensile tests were performed on specimens of porcine cornea to determine their nonlinear stress-strain relations and their viscoelastic behavior. Laser induced stress has been measured while corneal stripes were being exposed to a pulsed Cr:Tm:Ho:YAG laser ((lambda) equals 2.12 micrometers ) system. The stresses observed correlated just beyond the threshold qualitatively well with the number of applied pulses. For larger pulse energies the stress stabilized after a few pulses, which means further laser application could neither increase nor decrease the level of stress. After the end of the last laser pulse the specimens relaxed within several minutes down to a level of residual stress, which is probably to be held responsible for the refractive change in LTK.

  19. Spectral optical coherence tomography: a novel technique for cornea imaging.

    Science.gov (United States)

    Kaluzny, Bartłomiej J; Kaluzy, Bartłomiej J; Kałuzny, Jakub J; Szkulmowska, Anna; Gorczyńska, Iwona; Szkulmowski, Maciej; Bajraszewski, Tomasz; Wojtkowski, Maciej; Targowski, Piotr

    2006-09-01

    Spectral optical coherence tomography (SOCT) is a new, noninvasive, noncontact, high-resolution technique that provides cross-sectional images of the objects that weakly absorb and scatter light. SOCT, because of very short acquisition time and high sensitivity, is capable of providing tomograms of substantially better quality than the conventional OCT. The aim of this paper is to show the application of the SOCT to cross-sectional imaging of the cornea and its pathologies. Eleven eyes with different corneal pathologies were examined with a slit lamp and the use of a prototype SOCT instrument constructed in the Institute of Physics, Nicolaus Copernicus University, Toruń, Poland. Our SOCT system provides high-resolution (4 microm axial, 10 microm transversal) tomograms composed of 3000-5000 A-scans with an acquisition time of 120-200 ms. The quality of the images is adequate for detailed cross-sectional evaluation of various corneal pathologies. Objective assessment of the localization, size, shape, and light-scattering properties of the changed tissue is possible. Corneal and epithelial thickness and the depth and width of lesions can be estimated. SOCT technique allows acquiring clinically valuable cross-sectional optical biopsy of the cornea and its pathologies.

  20. Ultrastructural analysis of the decellularized cornea after interlamellar keratoplasty and microkeratome-assisted anterior lamellar keratoplasty in a rabbit model

    OpenAIRE

    Yoshihide Hashimoto; Shinya Hattori; Shuji Sasaki; Takako Honda; Tsuyoshi Kimura; Seiichi Funamoto; Hisatoshi Kobayashi; Akio Kishida

    2016-01-01

    The decellularized cornea has received considerable attention for use as an artificial cornea. The decellularized cornea is free from cellular components and other immunogens, but maintains the integrity of the extracellular matrix. However, the ultrastructure of the decellularized cornea has yet to be demonstrated in detail. We investigated the influence of high hydrostatic pressure (HHP) on the decellularization of the corneal ultrastructure and its involvement in transparency, and assessed...

  1. Aqueous humour dynamics in anterior chamber under influence of cornea indentation

    Science.gov (United States)

    Zuhaila, I.; Jiann, L. Y.; Sharidan, S.; Fitt, A.

    2017-04-01

    The existing temperature different between the cornea and the pupil induces the aqueous humour (AH) to circulate in the anterior chamber (AC). The buoyancy forces produced by the temperature gradient has driven the AH to flow. Previous studies have shown that cornea indentation changes the structure of the AC. This imply that the cornea indentation may change the fluid flow behaviour in the AC. A mathematical model of AH flow has been developed in order to analyse the fluid mechanics concerning the indentation of the cornea. Naiver-Stokes equations is used to describe the flow of AH in the AC. The governing equations have been solved numerically using finite element method. The results show that the cornea indentation has slow down the circulation the AH in the AC.

  2. Lúpus eritematoso sistêmico bolhoso na infância: relato de caso Bullous systemic lupus erythematosus in the childhood: case report

    Directory of Open Access Journals (Sweden)

    Mariana Discacciati Chiminazzo

    2007-06-01

    Full Text Available É apresentado caso de lúpus eritematoso bolhoso na infância. Doente do sexo feminino, com nove anos, apresentava erupção vesicobolhosa no tronco, região cervical, genital e membros. O exame anatomopatológico mostrou bolha subepidérmica com neutrófilos, a imunofluorescência direta revelou depósito linear de IgA, IgM, IgG e C3 na zona da membrana basal, e a indireta foi negativa. Os anticorpos antinucleares e o anti-Sm estavam positivos. Houve regressão do quadro com dapsona e prednisona. Trata-se de caso raro de lúpus eritematoso sistêmico (LES na infância que se iniciou com bolhas disseminadas. O LES bolhoso deve ser incluído no diagnóstico diferencial das erupções bolhosas na infância.We report a case of bullous systemic lupus erythematosus in a 9-year-old female, with a vesiculobullous eruption on the trunk, neck, genitals and limbs. A skin biopsy specimen showed subepidermal blister with neutrophils. Direct immunofluorescence revealed deposition of IgA, IgG, IgM and C3 at the epithelial basement membrane zone and indirect immunofluorescence was negative. Antinuclear antibodies and anti-Sm were positive. Resolution of the blisters occurred following treatment with dapsone and prednisone. This is a rare case of systemic lupus erythematous (SLE in the childhood, whose initial manifestation was a bullous eruption. Bullous SLE should be considered in the differential diagnosis of children presenting with generalized bullous eruption.

  3. Evaluation of the efficacy of excimer laser ablation of cross-linked porcine cornea.

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    Shihao Chen

    Full Text Available BACKGROUND: Combination of riboflavin/UVA cross-linking (CXL and excimer laser ablation is a promising therapy for treating corneal ectasia. The cornea is strengthened by cross-linking, while the irregular astigmatism is reduced by laser ablation. This study aims to compare the efficacy of excimer laser ablation on porcine corneas with and without cross-linking. METHODS AND FINDINGS: The porcine cornea was de-epithelialized and treated with 0.1% riboflavin solution for 30 minutes. A half of the cornea was exposed to UVA-radiation for another 30 minutes while the controlled half of the cornea was protected from the UVA using a metal shield. Photo therapeutic keratectomy (PTK was then performed on the central cornea. Corneal thickness of 5 paired locations on the horizontal line, ± 0.5, ± 1.0, ± 1.5, ± 2.0, and ± 2.5 mm from the central spot, were measured using optical coherence tomography prior to and after PTK. The ablation depth was then determined by the corneal thickness. There was a 9% difference (P<0.001 in the overall ablation depth between the CXL-half corneas (158 ± 22 µm and the control-half corneas (174 ± 26 µm. The ablation depths of all 5 correspondent locations on the CXL-half were significantly smaller (P<0.001. CONCLUSION: The efficacy of the laser ablation seems to be lower in cross-linked cornea. Current ablation algorithms may need to be modified for cross-linked corneas.

  4. The location- and depth-dependent mechanical response of the human cornea under shear loading.

    Science.gov (United States)

    Sloan, Stephen R; Khalifa, Yousuf M; Buckley, Mark R

    2014-10-30

    To characterize the depth-dependent shear modulus of the central and peripheral human cornea along the superior-inferior and nasal-temporal directions with a high spatial resolution. Cylindrical explants from the central and peripheral corneas of 10 human donors were subjected to a 5% shear strain along the superior-inferior and nasal-temporal directions using a microscope-mounted mechanical testing device. Depth-dependent shear strain and shear modulus were computed through force measurements and displacement tracking. The shear modulus G of the human cornea varied continuously with depth, with a maximum occurring roughly 25% of the way from the anterior surface to the posterior surface. G also varied with direction in the superior region and (at some depths) was significantly higher for superior-inferior shear loading. In the anterior half of the cornea, the shear modulus along the nasal-temporal direction (GNT) did not vary with location; however, the superior region had significantly higher GNT in posterior cornea. In contrast, the shear modulus along the superior-inferior direction (GSI) was independent of location at all depths. This study demonstrates that the peak shear modulus of the human cornea occurs at a substantial distance within the corneal stroma. Depth-dependent differences between central and peripheral cornea possibly reflect the location-dependent mechanical environment of the cornea. Moreover, the cornea is not a transverse isotropic material, and must be characterized by more than a single shear modulus due to its dependence on loading direction. The material properties measured in this study are critical for developing accurate mechanical models to predict the vision-threatening morphological changes that can occur in the cornea. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  5. Pemphigus disease activity measurements: pemphigus disease area index, autoimmune bullous skin disorder intensity score, and pemphigus vulgaris activity score.

    Science.gov (United States)

    Rahbar, Ziba; Daneshpazhooh, Maryam; Mirshams-Shahshahani, Mostafa; Esmaili, Nafiseh; Heidari, Kazem; Aghazadeh, Nessa; Hejazi, Pardis; Ghajarzadeh, Mahsa; Chams-Davatchi, Cheyda

    2014-03-01

    Recently, the clinical pemphigus disease activity indexes of Pemphigus Disease Area Index (PDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), and Pemphigus Vulgaris Activity Score (PVAS) were validated to correlate with physician global assessment. The antidesmoglein (anti-Dsg) autoantibodies are known to correlate mostly with pemphigus disease activity. The correlation between these indexes and anti-Dsg1 and anti-Dsg3 enzyme-linked immunosorbent assay values has not been previously evaluated. To evaluate the PDAI, ABSIS, and PVAS in a large number of patients with pemphigus vulgaris and to compare the interrater reliability of these indexes and the convergent validity according to anti-Dsg values. A cross-sectional study was performed in 2012 in a referral university center for autoimmune bullous diseases. One hundred patients with confirmed diagnoses of pemphigus vulgaris and clinical pemphigus lesions (mean [SD] age, 43.3 [1.7] years; age range, 14-77 years; female-male ratio, 1:3) were studied. Three dermatologists familiar with immunobullous diseases and the indexes rated the patients. All 100 patients were evaluated with the PDAI, ABSIS, and PVAS. Three dermatologists independently rated all 3 indexes for each of the patients on the same day. Serum anti-Dsg1 and anti-Dsg3 enzyme-linked immunosorbent assay values were measured simultaneously. Analyses of interrater reliabilities, convergent validities according to anti-Dsg titers, correlation between the distribution and types of lesions with disease activity, predictors of higher titers of antibody (multiple regression analysis), and cutoff values of measures for 2 titers of anti-Dsg with optimal area under the curve, sensitivity, and specificity were performed. The interrater reliabilities were highest for the PDAI, followed by the ABSIS and the PVAS (intraclass correlation coefficients of 0.98 [95% CI, 0.97-0.98], 0.97 [95% CI, 0.96-0.98], and 0.93 [95% CI, 0.90-0.95], respectively). The

  6. Hard contact lens-induced metabolic changes in rabbit corneas.

    Science.gov (United States)

    Tsubota, K; Kenyon, K R; Cheng, H M

    1989-11-01

    The biochemistry of contact lens-cornea interaction is not well understood, although previous studies have suggested that corneal metabolic changes may be the underlying factor in morphological alterations. Using a rabbit model, this interaction has been examined with 31P nuclear magnetic resonance (NMR) spectroscopy, which detects signals principally from the epithelium. The examination was supplemented with electron microscopy and histochemistry. Polymethylmethacrylate lenses caused reversible changes, including activation of anaerobic glycolysis and disturbance of membrane metabolite levels. These changes were far more severe than those occurring during prolonged eye closure. There appears to be an association between cellular deterioration and loss of membrane metabolites. On the other hand, oxygen-permeable silicone lenses allowed maintenance of nearly normal metabolic patterns. These results show multifaceted corneal response to hard contact lens wear.

  7. Polymicrobial Infection of the Cornea Due to Contact Lens Wear.

    Science.gov (United States)

    Sızmaz, Selçuk; Bingöllü, Sibel; Erdem, Elif; Kibar, Filiz; Koltaş, Soner; Yağmur, Meltem; Ersöz, Reha

    2016-04-01

    A 38-year-old male presented with pain and redness in his left eye. He had a history of wearing contact lenses. His ophthalmic examination revealed a large corneal ulcer with surrounding infiltrate. Cultures were isolated from the contact lenses, lens solutions, storage cases, and conjunctivae of both eyes and also corneal scrapings of the left eye. Fortified vancomycin and amikacin drops were started hourly. Culture results of conjunctivae of each eye and left cornea were positive for Pseudomonas aeruginosa; cultures from the contact lenses, lens solution and storage case of both eyes revealed Pseudomonas aeruginosa and Alcaligenes xylosoxidans. Polymerase chain reaction of the corneal scraping was positive for Acanthameoba. The topical antibiotics were changed with ones that both bacteria were sensitive to and anti-amoebic therapy was added. The patient had two recurrences following initial presentation despite intensive therapy. Keratitis occurred due to multiple pathogens; the relapsing course despite adequate therapy is potentially associated with this polymicrobial etiology.

  8. Tissue Engineering the Cornea: The Evolution of RAFT

    Directory of Open Access Journals (Sweden)

    Hannah J. Levis

    2015-01-01

    Full Text Available Corneal blindness affects over 10 million people worldwide and current treatment strategies often involve replacement of the defective layer with healthy tissue. Due to a worldwide donor cornea shortage and the absence of suitable biological scaffolds, recent research has focused on the development of tissue engineering techniques to create alternative therapies. This review will detail how we have refined the simple engineering technique of plastic compression of collagen to a process we now call Real Architecture for 3D Tissues (RAFT. The RAFT production process has been standardised, and steps have been taken to consider Good Manufacturing Practice compliance. The evolution of this process has allowed us to create biomimetic epithelial and endothelial tissue equivalents suitable for transplantation and ideal for studying cell-cell interactions in vitro.

  9. Homozygous ALOXE3 Nonsense Variant Identified in a Patient with Non-Bullous Congenital Ichthyosiform Erythroderma Complicated by Superimposed Bullous Majocchi’s Granuloma: The Consequences of Skin Barrier Dysfunction

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2015-09-01

    Full Text Available Non-bullous congenital ichthyosiform erythroderma (NBCIE is a hereditary disorder of keratinization caused by pathogenic variants in genes encoding enzymes important to lipid processing and terminal keratinocyte differentiation. Impaired function of these enzymes can cause pathologic epidermal scaling, significantly reduced skin barrier function. In this study, we have performed a focused, genetic analysis of a probrand affected by NBCIE and extended this to his consanguineous parents. Targeted capture and next-generation sequencing was performed on NBCIE associated genes in the proband and his unaffected consanguineous parents. We identified a homozygous nonsense variant c.814C>T (p.Arg272* in ALOXE3 (NM_001165960.1 in the proband and discovered that his parents are both heterozygous carriers of the variant. The clinical manifestations of the proband’s skin were consistent with NBCIE, and detailed histopathological assessment revealed epidermal bulla formation and Majocchi’s granuloma. Infection with Trichophyton rubrum was confirmed by culture. The patient responded to oral terbinafine antifungal treatment. Decreased skin barrier function, such as that caused by hereditary disorders of keratinization, can increase the risk of severe cutaneous fungal infections and the formation of Majocchi’s granuloma and associated alopecia. Patients with NBCIE should be alerted to the possible predisposition for developing dermatophytoses and warrant close clinical follow-up.

  10. Cornea donors who have had prior refractive surgery: data from the Eye Bank Association of America.

    Science.gov (United States)

    Fargione, Robert A; Channa, Prabjot

    2016-07-01

    Millions of Americans have undergone refractive surgeries, including radial keratotomy, photorefractive keratectomy, and laser-assisted in situ keratomileusis. Eye Bank Association of America medical standards do not permit corneas from patients who have undergone refractive procedures to be used in penetrating keratoplasty, anterior lamellar keratoplasty, or tectonic grafting procedures. Such corneas, can, however, be used for endothelial corneal transplantation. The objective of this article is to provide an update on current trends for the screening and usage of corneas that have undergone refractive surgery. Several case reports have highlighted the difficulty in using postrefractive surgery corneas in penetrating keratoplasty. However, tissue with anterior stromal flaws, including a history of refractive surgery, has been used in endothelial keratoplasty with equivalent outcomes in topography, endothelial cell count, and visual acuity. Many modalities for proper identification of postmortem donor corneas that have undergone refractive surgery have been studied. Corneas with a history of refractive surgery have found use in endothelial keratoplasty. Multiple objective methods of tissue identification have been investigated to avoid the use of these corneas in penetrating or anterior keratoplasty surgeries.

  11. Development and characterization of a full-thickness acellular porcine cornea matrix for tissue engineering.

    Science.gov (United States)

    Du, Liqun; Wu, Xinyi

    2011-07-01

    Our aim was to produce a natural, acellular matrix from porcine cornea for use as a scaffold in developing a tissue-engineered cornea replacement. Full-thickness, intact porcine corneas were decellularized by immersion in 0.5% (wt/vol) sodium dodecyl sulfate. The resulting acellular matrices were then characterized and examined specifically for completeness of the decellularization process. Histological analyses of decellularized corneal stromas showed that complete cell and α-Gal removal was achieved, while the major structural proteins including collagen type I and IV, laminin, and fibronectin were retained. DAPI staining did not detect any residual DNA within the matrix, and the DNA contents, which reflect the presence of cellular materials, were significantly diminished in the decellularized cornea. The collagen content of the decellularized cornea was well maintained compared with native tissues. Uniaxial tensile testing indicated that decellularization did not significantly compromise the ultimate tensile strength of the tissue (P > 0.05). In vitro cytotoxicity assays using rabbit corneal fibroblast cultures excluded the presence of soluble toxins in the biomaterial. In vivo implantation to rabbit interlamellar stromal pockets showed good biocompability. In summary, a full-thickness natural acellular matrix retaining the major structural components and strength of the cornea has been successfully developed. The matrix is biocompatible with cornea-derived cells and has potential for use in corneal transplantation and tissue-engineering applications. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  12. [Relationship between corneal neovascularization and various relevant biological factors in surrounding cornea stroma of rats].

    Science.gov (United States)

    Wang, Ting; Shi, Wei-yun; Li, Su-xia; Liu, Ming-na

    2009-02-01

    To study the relationship between corneal neovascularization and various biological factors in corneal stroma of rats. It was an experimental study. Corneal neovascularization was induced by alkali burn in 40 rats. Transforming growth factor-beta1 (TGF-beta1), alpha-smooth muscle actin (alpha-SMA) and fibroblast activation protein (FAP) in the stroma surrounding corneal neovascularization were detected by immunohistochemical studies on day 1, 3 and 7 after chemical burn. Platelet-endothelial cell adhesion molecule-1 (CD31) was used to identify the vascular endothelial cells. RT-PCR was used to identify FAP in the cornea 3 and 7 days after chemical burn. Picrosirius staining and polarization microscopy were used to detect changes of collagen types I and III in the cornea. After alkali burn, TGF-beta1 was first expressed in the cornea stroma. Then, some stroma cells expressed both alpha-SMA and FAP. The FAP(+) keratocytes were found surrounding the CD31(+) endothelium of angiogenesis. RT-PCR study showed that FAP mRNA was only present in neovascularized cornea and not in normal cornea. Polarization microscopy revealed that the collagen types I and III were rearranged in neovascularized cornea. Various biological factors in corneal stroma are changed when the cornea shows neovascularization. FAP(+) keratocytes are present in the stroma, and the appearance of these cells parallels the growth of vascular endothelial cells. Collagen types I and III are rearranged during the process of angiogenesis.

  13. Preliminary study on the effect of stiffness on lamb wave propagation in bovine corneas.

    Science.gov (United States)

    Zhang, Xin-Yu; Yin, Yin; Guo, Yan-Rong; Diao, Xian-Fen; Chen, Xin

    2013-01-01

    The viscoelastic properties of human cornea could provide valuable information for various clinical applications. Particularly, it will be helpful to achieve a patient-specific biomechanical optimization in LASIK refractive surgery, early detection of corneal ecstatic disease or improved accuracy of intraocular pressure (IOP) measurement. However, there are few techniques that are capable of accurately assessing the corneal elasticity in situ in a nondestructive fashion. In order to develop a quantitative method for assessing both elasticity and viscosity of the cornea, we use ultrasound radiation force to excite Lamb waves in cornea, and a pulse echo transducer to track the tissue vibration. The fresh postmortem bovine eyes were treated via collagen cross-linking to make the cornea stiff. The effect of stiffness was studied by comparing the propagation of Lamb waves in normal and treated corneas. It was found that the waveform of generated Lamb waves changed significantly due to the increase in higher modes in treated corneas. This result indicated that the generated waveform was a complex of multiple harmonics and the varied stiffness will affect the energy distribution over different components. Therefore, it is important for assessing the viscoelastic properties of the cornea to know the components of Lamb wave and calculate the phase velocity appropriately.

  14. In vitro evaluation of the effect of tobacco smoke on rat cornea function.

    Science.gov (United States)

    Marzec, Ewa; Olszewski, Jan; Piątek, Jacek; Samborski, Włodzimierz; Sosnowski, Przemysław; Oleśków, Beata; Zawadziński, Jarosław; Florek, Ewa

    2012-01-01

    The influence of tobacco smoke on the dielectric properties of rat cornea were measured in vitro over the frequency range of the electric field of 500Hz-100kHz and in temperatures of the air from 25 to 150°C. The temperature dependencies of the loss tangent for both healthy and smoky cornea represent the relation between the energy lost and the energy stored in the epithelium-stromal-endothelium systems of the cornea. The differences between the healthy and the smoky cornea concerned the temperature ranges in which there appeared the decomposition of loosely-bound water and β-relaxation associated with polar side-chains relaxations on protein molecules of this tissue. The effect of smoke is manifested as a shift of the loss tangent peaks of these two processes towards higher temperatures, when compared with the control. The results are interpreted as caused by the toxic compounds of the tobacco smoke leading to higher ion transport in the nonhomogeneous structure of the cornea when compared to that of the control tissue. The activation energy of conductivity were similar for the healthy and smoky cornea as a consequence of the braking of hydrogen and Van der Waals bonds between loosely bound water, and the proteins of channels in the epithelium and endothelium. Recognition of the effect of frequency and temperature on the dielectric behaviour of the smoky cornea may be of interest for disease characterization of this tissue.

  15. Histological evaluation and biomechanical characterisation of an acellular porcine cornea scaffold.

    Science.gov (United States)

    Du, Liqun; Wu, Xinyi; Pang, Kunpeng; Yang, Yongmei

    2011-03-01

    To optimise a protocol to produce an acellular porcine cornea scaffold and investigate its mechanical integrity and biocompatibility. Fresh porcine corneas were decellularised with different detergents over a range of concentrations. Morphological and histological examinations were carried out to detect the major structure of the cornea. Completely acellular cornea scaffolds were subjected to uniaxial tensile testing and reseeding assay. Most protocols resulted in the retention of large numbers of whole cells and cell fragments. Only sodium dodecyl sulfate (SDS; 0.5% or 1%) resulted in total decellularisation at 24h. Histological analysis of the acellular matrix showed that the corneal stromal cells had been completely removed, collagen fibres were arranged in an orderly fashion, and Bowman's layer and Descemet's membrane were both intact after decellularisation. The ultimate tensile strength of acellular matrix treated with 0.5% SDS for 24h was not affected significantly compared with that of fresh cornea (p>0.05), whereas there was a significant difference between fresh cornea and cornea treated with 1% SDS (pcornea decellularisation. Biomechanical analysis and recellularisation showed that treatment with 0.5% SDS for 24h was optimal.

  16. Expression of cholecystokinin, gastrin, and their receptors in the mouse cornea.

    Science.gov (United States)

    Gonzalez-Coto, Ana F; Alonso-Ron, Carlos; Alcalde, Ignacio; Gallar, Juana; Meana, Álvaro; Merayo-Lloves, Jesús; Belmonte, Carlos

    2014-03-28

    Cholecystokinin (CCK) is a neuropeptide that has been identified in trigeminal ganglion neurons. Gastrin (GAST) is a related peptide never explored in the cornea. The presence and role of both gastrointestinal peptides in the cornea and corneal sensory neurons remain to be established. We explored here in mice whether CCK, GAST, and their receptors CCK1R and CCK2R are expressed in the corneal epithelium and trigeminal ganglion neurons innervating the cornea. We used RT-PCR analysis to detect mRNAs of CCK, GAST, CCK1R, and CCK2R in mouse cornea epithelium, trigeminal ganglia, and primary cultured corneal epithelial cells. Immunofluorescence microscopy was used to localize these peptides and their receptors in the cornea, cultured corneal epithelial cells, and corneal nerves, as well as in the cell bodies of corneal trigeminal ganglion neurons identified by retrograde labeling with Fast Blue. Mouse corneal epithelial cells in the cornea in situ and in cell cultures expressed CCK and GAST. Only the receptor CCK2R was found in the corneal epithelium. In addition, mouse corneal afferent sensory neurons expressed CCK and GAST, and the CCK1R receptors. The presence of CCK, GAST, and their receptors in the mouse corneal epithelium, and in trigeminal ganglion neurons supplying sensory innervation to the cornea, opens the possibility that these neuropeptides are involved in corneal neurogenic inflammation and in the modulation of repairing/remodeling processes following corneal injury.

  17. HSP47 expression in cornea after excimer laser photoablation.

    Science.gov (United States)

    Kasagi, Yasuo; Yamashita, Hidetoshi

    2002-01-01

    The expression of heat shock protein 47 (HSP47) was observed histologically to investigate the spatial and chronological effects of excimer laser photoablation. HSP47 expression after radial keratotomy (RK) was also investigated and compared with the effects after excimer laser photoablation. Twenty-eight male rabbits were used. The rabbits were divided with two groups and treated with either excimer laser photoablation or four radial incisions to simulate corneal refractive surgery. The chronological and spatial changes in the expression of HSP47 were observed immunohistochemically. In eyes that underwent excimer laser photoablation, HSP47 was detected in the basal layer of the epithelial cells and in the superficial stromal layer 3 days after surgery. After 5 and 7 days, HSP47 expression extended to the deep layer of the stroma and to the endothelial cells. After 14 days, HSP47 was detected only in the deep layer of the stroma and in the endothelial cells. After 28 days, HSP47 expression was reduced. In eyes that underwent RK, HSP47 was detected in the basal layer of the epithelial cells and in the stroma surrounding the wound 1 day after surgery. After 3 and 7 days, HSP47 expression did not expand further. After 28 days, HSP47 expression diminished. Excimer laser photoablation affects the whole layer of the cornea, and may be caused by the shock wave that occurs as a result of photoablation. In addition, interaction among the keratocytes may propagate the stress-induced response to the whole layer of the cornea. With RK, the wound is smaller and deeper. HSP47 expression occurs earlier, but is limited to the area surrounding the wound.

  18. PROSE for irregular corneas at a tertiary eye care center.

    Science.gov (United States)

    Arumugam, Amudha Oli; Rajan, Rajni; Subramanian, Madhumathi; Mahadevan, Rajeswari

    2014-03-01

    The aim of this study was to report and discuss the clinical experience with PROSE (Prosthetic Replacement of Ocular Surface Ecosystem) practice at a tertiary eye care hospital. Retrospective data of patients who were prescribed PROSE during April 2011 to March 2012 in a tertiary eye care center in south India were analyzed. Data collected include patient demographics, indications of scleral lens fitting, previous correction modality, PROSE parameters, best-corrected visual acuity (BCVA) with spectacles, and BCVA with PROSE at initial assessment and few hours of wear. The BCVA before (with glasses) and after PROSE fitting was recorded in logMAR units. The age of the patients ranged between 13 and 68 years (male:female 60:25) with a mean age of 32.44±13.45 years. Mean BCVA improved by 0.3 logMAR units (3 lines) after fitting with PROSE. There was a statistically significant difference between pre- and post-PROSE BCVA (P=0.0001). Failure of rigid gas-permeable lens fitting or intolerance was the common indication for PROSE in corneas with irregular astigmatism (refractive conditions). The other reasons for which PROSE was prescribed were pain, photophobia, comfort, ghosting of images, and frequent loss of smaller lenses. Toric scleral haptic was indicated in 62 eyes. The diameter, vault, and haptic measurements of PROSE in ocular surface disorders were much less and flatter than that of refractive conditions. PROSE device is a very useful alternative for irregular corneas to improve visual acuity, to improve comfort, and for symptomatic relief.

  19. Extracellular matrix changes in human corneas after radial keratotomy.

    Science.gov (United States)

    Ljubimov, A V; Alba, S A; Burgeson, R E; Ninomiya, Y; Sado, Y; Sun, T T; Nesburn, A B; Kenney, M C; Maguen, E

    1998-09-01

    Extracellular matrix and basement membrane alterations were identified in human corneas after radial keratotomy. Ten normal and five radial keratotomy autopsy corneas (two at 6 months post surgery, and three at 3 years post surgery) were studied by immunofluorescence with antibodies to 28 extracellular matrix and basement membrane components. Outside of radial keratotomy scars, all studied components had a normal distribution. Of stromal extracellular matrix, only type III collagen accumulated around the scars. The basement membrane around epithelial plugs had a normal composition except for type IV collagen. Its alpha1-alpha2 chains, normally present only in the limbal basement membrane, appeared around all plugs. alpha3 and alpha4 chains were very weak or absent in these areas, contrary to nonscarred areas. This basement membrane pattern was similar to the normal limbal but not to the central corneal pattern. Keratin 3 also had a limbal-like, suprabasal expression in the plug epithelium. The stroma around the scars accumulated tenascin-C, fibrillin-1, types VIII and XIV collagen, all of which were absent from normal corneal basement membrane and extracellular matrix. Only tenascin-C showed less staining in anterior scars 3 years post surgery than 6 months post surgery, but still persisted in posterior scars. Incomplete scar healing was evident even 3 years post radial keratotomy. It was manifested by the accumulation of abnormal extracellular matrix in the anterior and posterior scars and by the limbal-like pattern of type IV collagen isoforms in the basement membrane around epithelial plugs. Copyright 1998 Academic Press.

  20. Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas

    Directory of Open Access Journals (Sweden)

    Spadea L

    2012-11-01

    Full Text Available Leopoldo Spadea,1 Rita Mencucci21University of L'Aquila, Department of Biotechnological and Applied Clinical Sciences, Eye Clinic, L'Aquila, 2University of Florence, Department of Oto-Neuro-Ophthalmological Surgical Sciences, Eye Clinic, Florence, ItalyBackground: The purpose of this paper was to report the results of transepithelial corneal collagen cross-linking (CXL with modified riboflavin and ultraviolet A irradiation in patients affected by keratoconus, each with thinnest pachymetry values of less than 400 µm (with epithelium and not treatable using standard de-epithelialization techniques.Methods: Sixteen patients affected by progressive keratoconus with thinnest pachymetry values ranging from 331 µm to 389 µm underwent transepithelial CXL in one eye using a riboflavin 0.1% solution in 15% Dextran T500 containing ethylenediamine tetra-acetic acid 0.01% and trometamol to enhance epithelial penetration. The patients underwent complete ophthalmological examination, including endothelial cell density measurements and computerized videokeratography, before CXL and at one day, one week, and one, 6, and 12 months thereafter.Results: Epithelial healing was complete in all patients after one day of use of a soft bandage contact lens. No side effects or damage to the limbal region was observed during the follow-up period. All patients showed slightly improved uncorrected and spectacle-corrected visual acuity; keratometric astigmatism showed reductions (up to 5.3 D and apical ectasia power decreased (Kmax values reduced up to 4.3 D. Endothelial cell density was unchanged.Conclusion: Application of transepithelial CXL using riboflavin with substances added to enhance epithelial permeability was safe, seemed to be moderately effective in keratoconic eyes with ultrathin corneas, and applications of the procedure could be extended to patients with advanced keratoconus.Keywords: keratoconus, pachymetry, topography, transepithelial corneal collagen

  1. Collagen synthesized in fluorocarbon polymer implant in the rabbit cornea.

    Science.gov (United States)

    Drubaix, I; Legeais, J M; Malek-Chehire, N; Savoldelli, M; Ménasche, M; Robert, L; Renard, G; Pouliquen, Y

    1996-04-01

    The integration of microporous polymer into tissues is of great interest for the production of keratoprosthetic devices. Our previous studies showed functional differentiated cells and collagen synthesis in the pore of an expanded polytetrafluoroethylene implant. This study identifies and quantifies collagen types synthesized in the implant. Expanded polytetrafluoroethylene polymers were implanted in the rabbit corneas. The collagen extracted from the polymer and implanted stroma after 1, 3 and 6 months was quantified by measuring hydroxyproline. The relative proportions of collagen types were determined by densitometric analysis after SDS-PAGE. The collagen-to-protein ratio in the polymer increased from 0.22 to 0.70 between the first and third month after implantation becoming similar to control cornea. So that of the protein and collagen densities in the polymer and implanted stroma were similar to the control from the third month. The collagen synthesized in the polymer was mainly type I (87%) plus a small amount of type III (8%) 1 month after implantation. The collagen distribution from the third month after implantation was similar to that of the controls and remained constant thereafter in the polymer implant and in the implanted stroma. Immunogold labelling techniques confirmed these results. Implantation of this PTFE disc induced no obvious modification of the corneal stroma, confirming that this polymer is a good interface that is compatible with the native corneal stroma. The keratocytes in this polymer rapidly adopted a corneal phenotype, distinct from the dermal or scaring phenotype as shown by the collagen types produced in the implant.

  2. Irregular Corneas: Improve Visual Function With Scleral Contact Lenses.

    Science.gov (United States)

    de Luis Eguileor, Beatriz; Etxebarria Ecenarro, Jaime; Santamaria Carro, Alaitz; Feijoo Lera, Raquel

    2016-10-20

    To assess visual function in patients with irregular cornea who do not tolerate gas permeable (GP) corneal contact lenses and are fitted with GP scleral contact lenses (Rose K2 XL). In this prospective study, we analyzed 15 eyes of 15 patients who did not tolerate GP corneal contact lenses and were fitted with scleral contact lenses (Rose K2 XL). We assessed visual function using visual acuity and the visual function index (VF-14); we used the VF-14 as an indicator of patient satisfaction. The measurements were taken with the optical correction used before and 1 month after the fitting of the Rose K2 XL contact lenses. We also recorded the number of hours lenses had been worn over the first month. Using Rose K2 XL contact lenses, visual acuity was 0.06±0.07 logMAR. In all cases, visual acuity had improved compared with the measurement before fitting the lenses (0.31±0.18 logMAR; P=0.001). VF-14 scores were 72.74±12.38 before fitting of the scleral lenses, and 89.31±10.87 after 1 month of lens use (P=0.003). Patients used these scleral lenses for 9.33±2.99 comfortable hours of wear. Both visual acuity and VF-14 may improve after fitting Rose K2 XL contact lenses in patients with irregular corneas. In addition, in our patients, these lenses can be worn for a longer period than GP corneal contact lenses.

  3. Optically Sectioning Ocular Fluorometer Microscope: Applications To The Cornea

    Science.gov (United States)

    Masters, Barry R.

    1988-06-01

    An optically sectioning ocular fluorometer microscope is described with the capability of measuring the emission spectra of molecules in planes along the microscope axis. Its unique feature is that the objective is attached to a piezoelectric driver and scans from the tear film to the aqueous humor. This permits measurements on living animals and adoption for clinical use. The excitation light from a laser (nitrogen, dye, argon or helium cadmium) couples to the microscope via a quartz optical fiber. The light is projected through a 100 PM slit on the excitation side, through one half of the objective. The emitted light is collected by the second half of the objective and passes a second 100 pm slit in the conjugate plane of the eyepiece. The depth resolution is 6 um with an 100x objective, and 18 PM with a 50 power objective. The fluorescence is coupled by a quartz fiber to an optical spectrum analyzer. It consists of a monochromator with two microchannel plates attached to a linear diode array. The photocathode of the detector is gated for use with pulsed lasers or it can operate in the continuous mode. The applications include fluorescence measurements on thin layered structures. The present study involves the noninvasive measurement of oxidative metabolism of the component layers of the in vivo cornea. This is based on fluorescence measurements of the reduced pyridine nucleotide in the cornea. The fluorescence signals from the corneal epithelial (30 μm) and endothelial (4 μm) are clearly defined. Other applications to ophthalmology include studies of the fluorescence form the component layers of the ocular lens. Support from N.I.I. EY06958.

  4. Melatonin Entrains PER2::LUC Bioluminescence Circadian Rhythm in the Mouse Cornea.

    Science.gov (United States)

    Baba, Kenkichi; Davidson, Alec J; Tosini, Gianluca

    2015-07-01

    Previous studies have reported the presence of a circadian rhythm in PERIOD2::LUCIFERASE (PER2::LUC) bioluminescence in mouse photoreceptors, retina, RPE, and cornea. Melatonin (MLT) modulates many physiological functions in the eye and it is believed to be one of the key circadian signals within the eye. The aim of the present study was to investigate the regulation of the PER2::LUC circadian rhythm in mouse cornea and to determine the role played by MLT. Corneas were obtained from PER2::LUC mice and cultured to measure bioluminescence rhythmicity in isolated tissue using a Lumicycle or CCD camera. To determine the time-dependent resetting of the corneal circadian clocks in response to MLT or IIK7 (a melatonin type 2 receptor, MT2, agonist) was added to the cultured corneas at different times of the day. We also defined the location of the MT2 receptor within different corneal layers using immunohistochemistry. A long-lasting bioluminescence rhythm was recorded from cultured PER2::LUC cornea and PER2::LUC signal was localized to the corneal epithelium and endothelium. MLT administration in the early night delayed the cornea rhythm, whereas administration of MLT at late night to early morning advanced the cornea rhythm. Treatment with IIK7 mimicked the MLT phase-shifting effect. Consistent with these results, MT2 immunoreactivity was localized to the corneal epithelium and endothelium. Our work demonstrates that MLT entrains the PER2::LUC bioluminescence rhythm in the cornea. Our data indicate that the cornea may represent a model to study the molecular mechanisms by which MLT affects the circadian clock.

  5. Angiopoietin 2 expression in the cornea and its control of corneal neovascularisation.

    Science.gov (United States)

    Ferrari, Giulio; Giacomini, Chiara; Bignami, Fabio; Moi, Davide; Ranghetti, Anna; Doglioni, Claudio; Naldini, Luigi; Rama, Paolo; Mazzieri, Roberta

    2016-07-01

    To define proangiogenic angiopoietin 2 (ANG2) expression and role(s) in human and mouse vascularised corneas. Further, to evaluate the effect of ANG2 inhibition on corneal neovascularisation (CNV). CNV was induced in FVB mice by means of intrastromal suture placement. One group of animals was sacrificed 10 days later; corneas were immunostained for ANG2 and compared with (i) mouse non-vascularised corneas and (ii) human vascularised and non-vascularised corneas. A second group of CNV animals was treated systemically with an anti-ANG2 antibody. After 10 days, the corneas were whole-mounted, stained for CD31 and LYVE1 and lymphatic/blood vessels quantified. In another set of experiments, the corneal basal Bowman membrane was either (i) removed or (ii) left in place. After 2 or 10 days the corneas were removed and immunostained for collagen IV, ANG2, CD31, LYVE1, CD11b and MRC1 markers. In human beings and mice, ANG2 is expressed only in the epithelium, and, mildly, in the endothelium, of the avascular cornea. Instead, it is expressed in the epithelium, endothelium and stroma of vascularised corneas. Disruption of the Bowman membrane is associated with a significant increase of (i) ANG2 stromal expression and (ii) proangiogenic macrophage infiltration in the corneal stroma. Finally, blocking ANG2 significantly reduced hemangiogenesis, lymphangiogenesis and macrophage infiltration. Balancing proper healing and good vision is crucial in the cornea, constantly exposed to potential injuries. In this paper, we suggest the existence of a mechanism regulating the onset of inflammation (and associated CNV) depending on injury severity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Dual-path handheld system for cornea and retina imaging using optical coherence tomography

    Science.gov (United States)

    Shirazi, Muhammad Faizan; Wijesinghe, Ruchire Eranga; Ravichandran, Naresh Kumar; Kim, Pilun; Jeon, Mansik; Kim, Jeehyun

    2017-04-01

    A dual-path handheld system is proposed for cornea and retina imaging using spectral domain optical coherence tomography. The handheld sample arm is designed to acquire two images simultaneously. Both eyes of a person can be imaged at the same time to obtain the images of the cornea of one eye and the retina of the other eye. Cornea, retina, and optic disc images are acquired with the proposed sample arm. Experimental results demonstrate the usefulness of this system for imaging of different eye segments. This system reduces the time required for imaging of the two eyes and is cost effective.

  7. The use of typing methods and infection prevention measures to control a bullous impetigo outbreak on a neonatal ward

    Directory of Open Access Journals (Sweden)

    Koningstein Maike

    2012-11-01

    Full Text Available Abstract Background We describe an outbreak of Bullous Impetigo (BI, caused by a (methicillin susceptible, fusidic acid resistant Staphylococcus aureus (SA strain, spa-type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011. Methods We performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of SA isolates. Spa typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates. Results Nineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers (HCW with SA t408 was detected. These strains were MecA-, PVL-, Exfoliative Toxin (ETA-, ETB+, ETAD-, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak. Conclusions We conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates.

  8. A CONTROVERSIAL ON THE DIAGNOSIS OF CHRONIC BULLOUS TYPE MUCOCUTANEOUS DISEASE INVOLVING ORAL MUCOSA (A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Isadora Gracia

    2006-04-01

    Full Text Available A case of chronic bullous type mucocutaneous disease involving oral mucosa was reported from a 56 years old man with never healing oral ulcers and wound on the perianal skin for three years. There were also red and black spots on the limb and back skin and a lesion on nail. Painful oral lesion consisted of mucous erosion, desquamative gingivitis, and sloughing area on palate and tongue. The patient is diabetic. The first perianal skin diagnosis was granulomatous candidasis with differential diagnosis pemphigus vegetates and acuminarum condiloma. However the histopathologic examination did not support these diagnosis. After several histopathologic examinations, the latest perianal skin diagnosis was lichen planus with differential diagnosis granulomatous vasculitis, bowenoid papulosis and pyodema gangrenosum. Other skin diagnosis was erythema multiforme. Oral diagnosis was mucous membrane pemphigoid with differential diagnosis lichen planus, Behçet's syndrome and erythema multiforme. Oral histopathologic examinations showed a sub-epithelial blister, which supported mucous membrane pemphigoid. A lip balm, prednisone 5 mg oral rinse and multivitamins were given but oral improvement started after blood sugar level was controlled. Conclusion: It is not yet known whether skin and oral mucous lesions are from the same disease or not.

  9. Pioderma gangrenoso bolhoso e síndrome mielodisplásica Bullous pyoderma gangrenosum and myelodysplastic syndrome

    Directory of Open Access Journals (Sweden)

    Mariana Dias Batista

    2006-10-01

    Full Text Available O pioderma gangrenoso pode apresentar-se como manifestação paraneoplásica. Relata-se um caso de pioderma gangrenoso, da variante bolhosa, acompanhado de bicitopenia, em que foi evidenciado, por meio de mielograma, biópsia de medula óssea e cariótipo, padrão compatível com síndrome mielodisplásica, subtipo citopenia refratária com displasia de multilinhagens. Foi tratado com dapsona, obtendo cicatrização das lesões. O pioderma gangrenoso pode associar-se a doenças sistêmicas, devendo a síndrome mielodisplásica ser considerada nos casos acompanhados de citopenias. Portanto, o pioderma gangrenoso pode ser um marcador cutâneo de doença sistêmica de prognóstico reservado.Pyoderma gangrenosum can present as a cutaneous manifestation of paraneoplastic syndromes. A case of bullous pyoderma gangrenosum associated with bicytopenia is described. During the complementary investigation, myelogram, bone marrow biopsy and karyotype were performed, and showed a pattern consistent with myelodysplastic syndrome. The patient was treated with dapsone with improvement. Pyoderma gangrenosum can be a manifestation of systemic diseases. The possibility of myelodysplastic syndrome should always be considered in patients with pyoderma gangrenosum associated with cytopenia. Pyoderma gangrenosum could indicate poorer prognosis in patients with systemic diseases.

  10. Subepidermal blistering induced by human autoantibodies to BP180 requires innate immune players in a humanized bullous pemphigoid mouse model.

    Science.gov (United States)

    Liu, Zhi; Sui, Wen; Zhao, Minglang; Li, Zhuowei; Li, Ning; Thresher, Randy; Giudice, George J; Fairley, Janet A; Sitaru, Cassian; Zillikens, Detlef; Ning, Gang; Marinkovich, M Peter; Diaz, Luis A

    2008-12-01

    Bullous pemphigoid (BP) is a cutaneous autoimmune inflammatory disease associated with subepidermal blistering and autoantibodies against BP180, a transmembrane collagen and major component of the hemidesmosome. Numerous inflammatory cells infiltrate the upper dermis in BP. IgG autoantibodies in BP fix complement and target multiple BP180 epitopes that are highly clustered within a non-collagen linker domain, termed NC16A. Anti-BP180 antibodies induce BP in mice. In this study, we generated a humanized mouse strain, in which the murine BP180NC14A is replaced with the homologous human BP180NC16A epitope cluster region. We show that the humanized NC16A (NC16A+/+) mice injected with anti-BP180NC16A autoantibodies develop BP-like subepidermal blisters. The F(ab')(2) fragments of pathogenic IgG fail to activate the complement cascade and are no longer pathogenic. The NC16A+/+ mice pretreated with mast cell activation blocker or depleted of complement or neutrophils become resistant to BP. These findings suggest that the humoral response in BP critically depends on innate immune system players.

  11. Altered expression of type XIII collagen in keratoconus and scarred human cornea: Increased expression in scarred cornea is associated with myofibroblast transformation.

    Science.gov (United States)

    Määttä, Marko; Väisänen, Timo; Väisänen, Marja-Riitta; Pihlajaniemi, Taina; Tervo, Timo

    2006-05-01

    Type XIII collagen (ColXIII) is a transmembrane protein thought to be involved in cell-cell and cell-matrix interactions. We report here on its presence in the normal human cornea and compare the results for keratoconus and scarred corneas. Immunohistochemistry and in situ hybridization were applied to human corneal samples obtained by penetrating keratoplasty. In the normal human cornea, ColXIII was immunolocalized to the corneal epithelial cells, and to a lesser degree to the stromal keratocytes. The keratoconus cases showed otherwise similar results, but in areas containing Bowman membrane disruptions showed thinned epithelial cells reduced immunostaining for ColXIII, whereas occasionally pronounced immunoreactivity was seen in the stromal keratocytes. The corneal scar samples contained highly increased ColXIII immunostaining by stromal cells in the fibrotic foci, whereas the peripheral areas showed less intense immunostaining. In situ hybridization confirmed that the corneal epithelium and keratocytes actively synthesize the transcript. Immunostaining with alphaSMA revealed that a substantial proportion of the ColXIII mRNA-expressing cells in the stromal scar tissues was myofibroblasts and that these areas lack CD34 immunoreactivity. The results indicate that ColXIII, which is predominantly confined to the basal corneal cells in the normal cornea, may have a role in the adhesion of corneal epithelial cells to each other and to the underlying basement membrane. Additionally, highly increased expression in scarred corneas suggests that it participates in the corneal wound healing process.

  12. 'An eye, for eyes - mission' - From dream to reality

    Directory of Open Access Journals (Sweden)

    Parikumar P

    2013-10-01

    Full Text Available Corneal transplantation has been in routine practice to treat corneal endothelial diseases like Bullous Keratopathy, in which either the whole cornea or the partial cornea (the endothelium alone is transplanted from the cadaver donor to the recipient with the endothelial disease [1]. In whole corneal or partial corneal transplant one cadaver donor's cornea can be used to treat one recipient cornea only, which leads to a huge global shortage of donor corneas [2]. At this juncture Yokoo et al isolated and expanded corneal endothelial precursors using the sphere forming assay in vitro [3] and demonstrated the in vivo transplantation of these corneal endothelial precursors in a rabbit model of bullous keratopathy [4]. Following this, we studied the transportation of cadaver donor derived corneal endothelial tissue (CET from human cadaver donors in a thermoreversible gelation polymer (TGP (4 based transportation cocktail without cool preservation and demonstrated the viability of human corneal endothelial precursor (HCEP cells isolated from these CETs even after 72 hours of transportation without cool preservation [5]. This was done to suit the conditions existing in developing nations like India where hospitals might be located far from eye banks and maintaining cold chain preservation is relatively difficult. Further, these HCEPs were expanded in vitro using a polymer based expansion protocol [5]. This was the first step in the realisation of the dream of 'Eye for eyes' in a manner suitable for Indian conditions. Corneal transplantation has been in routine practice to treat corneal endothelial diseases like Bullous Keratopathy, in which either the whole cornea or the partial cornea (the endothelium alone is transplanted from the cadaver donor to the recipient with the endothelial disease [1]. In whole corneal or partial corneal transplant one cadaver donor's cornea can be used to treat one recipient cornea only, which leads to a huge global

  13. Preliminary results of femtosecond laser-assisted descemet stripping endothelial keratoplasty.

    NARCIS (Netherlands)

    Cheng, Y.Y.; Hendrikse, F.; Pels, E.; Wijdh, R.J.; Cleynenbreugel, H. van; Eggink, C.A.; Rij, G. van; Rijneveld, W.J.; Nuijts, R.M.

    2008-01-01

    OBJECTIVE: To evaluate the preliminary visual results of femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK). METHODS: We prospectively analyzed results of 20 consecutive patients with Fuchs endothelial dystrophy or aphakic/pseudophakic bullous keratopathy who underwent

  14. Techniques for posterior lamellar keratoplasty through a scleral incision

    NARCIS (Netherlands)

    Melles, GRJ; Kamminga, N

    Purpose. To describe several techniques for posterior lamellar keratoplasty through a scleral incision, for management of corneal endothelial disorders like pseudophacic bullous keratopathy and Fuchs' endothelial dystrophy, and to report the mid-term clinical results. Methods. Three techniques have

  15. New strategy to study corneal endothelial cell transplantation: the chick cornea model.

    Science.gov (United States)

    Mangioris, Georgios; Chiodini, Florence; Dosso, Andre

    2011-12-01

    To set up a culture assay of chick corneal endothelial cells (CECs) for transplantation into host corneas. Histology sections were performed at 6, 9, 12, 15, and 18 embryonic days of development of the chick embryo. Visualization of the gross morphology of CECs and of epithelium, stroma, and Descemet membrane was performed. Transplantation of CECs at 18 embryonic days of development into explanted, denuded from endothelial cell, host corneas of the same stage was attempted. The results from the histological sections clearly indicate that after embryonic day 12, the endothelial cells are well differentiated and the proliferation is complete. Transplanted CECs were able to migrate and integrate into the denuded host corneas. This study demonstrated its feasibility using an easy accessible model of chick cornea. With this technique, sufficient CECs may be obtained for biochemical and functional investigations using only nonhatched chickens that are easily accessible and easy to manipulate.

  16. Successful treatment of Fusarium keratitis with cornea transplantation and topical and systemic voriconazole.

    NARCIS (Netherlands)

    Klont, R.R.; Eggink, C.A.; Rijs, A.J.M.M.; Wesseling, P.; Verweij, P.E.

    2005-01-01

    A case of invasive Fusarium keratitis in a previously healthy male patient was treated successfully with cornea transplantation and systemic and topical voriconazole after treatment failure with topical amphotericin B and systemic itraconazole. Topical voriconazole was well tolerated, and, in

  17. Air-puff OCE for assessment of mouse cornea in vivo

    Science.gov (United States)

    Li, Jiasong; Wang, Shang; Singh, Manmohan; Aglyamov, Salavat; Emelianov, Stanislav; Twa, Michael; Larin, Kirill V.

    2014-02-01

    We characterize the relaxation rates of deformations created by focused air puffs with the use of phasestabilized swept source optical coherence elastography (PhS-SSOCE) in tissue-mimicking gelatin phantoms of various concentrations and mouse corneas of different ages in vivo. The results indicate that gelatin of varying concentrations and corneas from different aged mice have different relaxation rates. In addition, the results show that phantoms with higher concentration gelatin and corneas of older mice have higher relaxation rates, which can be attributed to stiffer material. Because this method is non-contact, noninvasive, and utilizes a minimal force which induces a deformation on the scale of μm, this method can be used to study the biomechanical properties of sensitive tissues, such as the cornea.

  18. Second Harmonic Generation Imaging Analysis of Collagen Arrangement in Human Cornea

    OpenAIRE

    Park, Choul Yong; Lee, Jimmy K.; Chuck, Roy S.

    2015-01-01

    In this paper, we imaged human cornea using a second harmonic generation imaging technique. The horizontal collagen bundle arrangement of corneal stroma as a function of depth and location was analyzed.

  19. Constructing an in vitro cornea from cultures of the three specific corneal cell types.

    Science.gov (United States)

    Schneider, A I; Maier-Reif, K; Graeve, T

    1999-10-01

    This paper presents a reliable method for establishing pure cultures of the three types of corneal cells. This is believed to be the first time, corneal cells have been cultured from fetal pig corneas. Cell growth studies were performed in different media. Subcultures of the three corneal cell types were passaged until the 30th generation without their showing signs of senescence. For engineering an in vitro cornea, corneal epithelial cells were cultured over corneal stromal cells in an artificial biomatrix of collagen with an underlying layer of corneal endothelial cells. The morphology, histology, and differentiation of the in vitro cornea were investigated to determine the degree of comparability to the cornea in vivo. The in vitro construct displayed signs of transition to an organotypic phenotype of which the most prominent was the formation of two basement membranes.

  20. Keratan sulfate and dermatan sulfate proteoglycans associate with type VI collagen in fetal rabbit cornea

    National Research Council Canada - National Science Library

    Takahashi, T; Cho, HI; Kublin, CL; Cintron, C

    1993-01-01

    .... Because certain cytochemical data suggested that proteoglycans are associated with type VI collagen in the fetal rabbit cornea, we developed polyclonal antibodies specific to the core proteins of rabbit corneal KSPG...

  1. Accelerating repaired basement membrane after bevacizumab treatment on alkali-burned mouse cornea

    Directory of Open Access Journals (Sweden)

    Koon-Ja Lee

    2013-04-01

    Full Text Available To understand the corneal regeneration induced by bevacizumab,we investigated the structure changes of stroma andbasement membrane regeneration. A Stick soaked in 0.5 NNaOH onto the mouse cornea and 2.5 mg/ml of bevacizumabwas delivered into an alkali-burned cornea (2 μl by subconjunctivalinjections at 1 hour and 4 days after injury. At 7 daysafter injury, basement membrane regeneration was observedby transmission electron microscope. Uneven and thin epithelialbasement membrane, light density of hemidesmosomes,and edematous collagen fibril bundles are shown in thealkali-burned cornea. Injured epithelial basement membraneand hemidesmosomes and edematous collagen fibril bundlesresulting from alkali-burned mouse cornea was repaired bybevacizumab treatment. This study demonstrates that bevacizumabcan play an important role in wound healing in thecornea by accelerating the reestablishment of basementmembrane integrity that leads to barriers for scar formation.[BMB Reports 2013; 46(4: 195-200

  2. Damage Threshold of In Vivo Rabbit Cornea by 2 micron Laser Irradiation

    National Research Council Canada - National Science Library

    Chen, Bo; Oliver, Jeffery; Dutta, Soumak; Rylander, III, Grady H; Thomsen, Sharon L; Welch, Ashley J

    2007-01-01

    To support refinement of the Maximum Permissible Exposure (MPE) safety limits, a series of experiments were conducted in vivo on Dutch Belted rabbit corneas to determine corneal minimum visible lesion thresholds...

  3. The filtering, clear-cornea diathermal keratostomy: a minor Danish multicenter study

    DEFF Research Database (Denmark)

    Kessing, S.V.; Nissen, O.I.; Thygesen, J.

    2008-01-01

    PURPOSE: Is the new micropenetrating, clear-cornea procedure, intrastromal diathermal keratostomy (IDK), an alternative to the intricate "modern trabeculectomy"? METHODS: Prospective multicenter study. Four surgeons from 4 Danish eye departments attended an IDK course and subsequently decided when...

  4. Mottled cyan opacification of the posterior cornea in contact lens wearers.

    Science.gov (United States)

    Holland, E J; Lee, R M; Bucci, F A; Janda, A M; Doughman, D J; Harris, J K; Krachmer, J H

    1995-05-01

    We studied patients who had mottled cyan-colored opacities of the cornea to better understand the cause and prognosis of this entity. We reviewed examinations of patients who had a mottled cyan opacification of the cornea. Risk factors, including contact lens wear and exposure to heavy metals, were analyzed. Clinical findings, pachymetry specular microscopy, and progression of the abnormality were noted. Six patients who had a mottled cyan opacification at the level of Descemet's membrane were identified. These opacities were located in the peripheral and midperipheral cornea. All patients had bilateral findings, had visual acuities of 20/20 or better, and were asymptomatic. All patients had worn soft contact lenses bilaterally for periods ranging from seven to 14 years. All patients had the similar clinical appearance of a mottled cyan opacification at the level of Descemet's membrane in the peripheral cornea. Long-term contact lens wear appears to be associated; however, the exact cause is unclear.

  5. Structure of corneal layers, collagen fibrils, and proteoglycans of tree shrew cornea.

    Science.gov (United States)

    Almubrad, Turki; Akhtar, Saeed

    2011-01-01

    The stroma is the major part of the cornea, in which collagen fibrils and proteoglycans are distributed uniformly. We describe the ultrastructure of corneal layers, collagen fibrils (CF), and proteoglycans (PGs) in the tree shrew cornea. Tree shrew corneas (5, 6, and 10 week old animals) and normal human corneas (24, 25, and 54 years old) were fixed in 2.5% glutaraldehyde containing cuprolinic blue in a sodium acetate buffer. The tissue was processed for electron microscopy. The 'iTEM Olympus Soft Imaging Solutions GmbH' program was used to measure the corneal layers, collagen fibril diameters and proteoglycan areas. The tree shrew cornea consists of 5 layers: the epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium. The epithelium was composed of squamous cells, wing cells and basal cells. The Bowman's layer was 5.5±1.0 µm thick and very similar to a normal human Bowman's layer. The stroma was 258±7.00 µm thick and consisted of collagen fibril lamellae. The lamellae were interlaced with one another in the anterior stroma, but ran parallel to one another in the middle and posterior stroma. Collagen fibrils were decorated with proteoglycan filaments with an area size of 390 ±438 nm(2). The collagen fibril had a minimum diameter of 39±4.25 nm. The interfibrillar spacing was 52.91±6.07 nm. Within the collagen fibrils, very small electron-dense particles were present. The structure of the tree shrew cornea is very similar to that of the normal human cornea. As is the case with the human cornea, the tree shrew cornea had a Bowman's layer, lamellar interlacing in the anterior stroma and electron-dense particles within the collagen fibrils. The similarities of the tree shrew cornea with the human cornea suggest that it could be a good structural model to use when studying changes in collagen fibrils and proteoglycans in non-genetic corneal diseases, such as ectasia caused after LASIK (laser-assisted in situ keratomileusis).

  6. Structure of corneal layers, collagen fibrils, and proteoglycans of tree shrew cornea

    Science.gov (United States)

    Almubrad, Turki

    2011-01-01

    Purpose The stroma is the major part of the cornea, in which collagen fibrils and proteoglycans are distributed uniformly. We describe the ultrastructure of corneal layers, collagen fibrils (CF), and proteoglycans (PGs) in the tree shrew cornea. Methods Tree shrew corneas (5, 6, and 10 week old animals) and normal human corneas (24, 25, and 54 years old) were fixed in 2.5% glutaraldehyde containing cuprolinic blue in a sodium acetate buffer. The tissue was processed for electron microscopy. The ‘iTEM Olympus Soft Imaging Solutions GmbH’ program was used to measure the corneal layers, collagen fibril diameters and proteoglycan areas. Results The tree shrew cornea consists of 5 layers: the epithelium, Bowman’s layer, stroma, Descemet’s membrane, and endothelium. The epithelium was composed of squamous cells, wing cells and basal cells. The Bowman’s layer was 5.5±1.0 µm thick and very similar to a normal human Bowman’s layer. The stroma was 258±7.00 µm thick and consisted of collagen fibril lamellae. The lamellae were interlaced with one another in the anterior stroma, but ran parallel to one another in the middle and posterior stroma. Collagen fibrils were decorated with proteoglycan filaments with an area size of 390 ±438 nm2. The collagen fibril had a minimum diameter of 39±4.25 nm. The interfibrillar spacing was 52.91±6.07 nm. Within the collagen fibrils, very small electron-dense particles were present. Conclusions The structure of the tree shrew cornea is very similar to that of the normal human cornea. As is the case with the human cornea, the tree shrew cornea had a Bowman's layer, lamellar interlacing in the anterior stroma and electron-dense particles within the collagen fibrils. The similarities of the tree shrew cornea with the human cornea suggest that it could be a good structural model to use when studying changes in collagen fibrils and proteoglycans in non-genetic corneal diseases, such as ectasia caused after LASIK (laser

  7. Comparison of different methods of glycerol preservation for deep anterior lamellar keratoplasty eligible corneas.

    Science.gov (United States)

    Li, Jinyang; Shi, Shuai; Zhang, Xin; Ni, Shouxiang; Wang, Yu; Curcio, Christine A; Chen, Wei

    2012-08-17

    To compare different methods of glycerol-preserved corneas intended for deep anterior lamellar keratoplasty (DALK). We analyzed transparency, transmittance, thickness, biomechanics, morphology, and antigenicity of donor corneas preserved by four different glycerol-based methods (n = 6 per group) for 3 months, as follows: tissues in anhydrous glycerol without aluminosilicate molecular sieves at room temperature (GRT); tissues in anhydrous glycerol with aluminosilicate molecular sieves at room temperature (SRT); tissues in anhydrous glycerol without aluminosilicate molecular sieves at -78°C (G78); and tissues in anhydrous glycerol without aluminosilicate molecular sieves at -20°C (G20). Slit lamp images and transmittance curves obtained by spectrophotometer show that the G78 cornea was the most transparent tissue. Stress-strain behavior indicated that corneas in the G78 group were the most pliable, and SRT corneas were the stiffest. Electron microscopy analysis indicated that corneal cytoarchitecture and keratocyte integrity was destroyed in all glycerol-preserved corneas. Disorganized stromal collagen fibers were evident in groups stored at RT. Especially in SRT corneas, parallelism was lost, fibrils were extremely tortuous and discontinuous, and widespread fibril degeneration could be found. Antigenicity of tissue, assessed via immunohistochemistry for CD45-positive cells, HLA-ABC and HLA-DR, was lowered after glycerol preservation relative to fresh cornea tissues, and immunoreactivity was located mainly on corneal epithelium and limbus rather than stroma. Anhydrous glycerol preservation without molecular sieves in a -78°C freezer was the best method to obtain DALK-eligible tissues that were both transparent and pliable.

  8. Autologous conjunctiva transplantation with stem cells on edge of cornea for recurrent pterygium

    OpenAIRE

    Yun Wang

    2013-01-01

    AIM: To observe the clinical effectiveness and practicality the autologous conjunctiva transplantation with stem cells on edge of cornea for recurrent pterygium.METHODS: Of the 53 recurrent pterygium patients(57 eyes), after all pathological tissues were removed, underwent the autologous conjunctiva transplantation with stem cells on edge of cornea which were locked above conjunctival transplantation of the operated eye.RESULTS: Postopretive follow-up was 1-12 months for all 57 eyes, of which...

  9. Visualizing Micro-anatomical Structures of the Posterior Cornea with Micro-optical Coherence Tomography

    OpenAIRE

    Chen, Si; Liu, Xinyu; Wang, Nanshuo; Wang, Xianghong; Xiong, Qiaozhou; Bo, En; Yu, Xiaojun; Chen, Shufen; Liu, Linbo

    2017-01-01

    Diagnosis of corneal disease and challenges in corneal transplantation require comprehensive understanding of corneal anatomy, particularly that of the posterior cornea. Micro-optical coherence tomography (?OCT) is a potentially suitable tool to meet this need, owing to its ultrahigh isotropic spatial resolution, high image acquisition rate and depth priority scanning mode. In this study, we explored the ability of ?OCT to visualize micro-anatomical structures of the posterior cornea ex vivo ...

  10. Hyperglycemia-induced abnormalities in rat and human corneas: the potential of second harmonic generation microscopy.

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    Gaël Latour

    Full Text Available BACKGROUND: Second Harmonic Generation (SHG microscopy recently appeared as an efficient optical imaging technique to probe unstained collagen-rich tissues like cornea. Moreover, corneal remodeling occurs in many diseases and precise characterization requires overcoming the limitations of conventional techniques. In this work, we focus on diabetes, which affects hundreds of million people worldwide and most often leads to diabetic retinopathy, with no early diagnostic tool. This study then aims to establish the potential of SHG microscopy for in situ detection and characterization of hyperglycemia-induced abnormalities in the Descemet's membrane, in the posterior cornea. METHODOLOGY/PRINCIPAL FINDINGS: We studied corneas from age-matched control and Goto-Kakizaki rats, a spontaneous model of type 2 diabetes, and corneas from human donors with type 2 diabetes and without any diabetes. SHG imaging was compared to confocal microscopy, to histology characterization using conventional staining and transmitted light microscopy and to transmission electron microscopy. SHG imaging revealed collagen deposits in the Descemet's membrane of unstained corneas in a unique way compared to these gold standard techniques in ophthalmology. It provided background-free images of the three-dimensional interwoven distribution of the collagen deposits, with improved contrast compared to confocal microscopy. It also provided structural capability in intact corneas because of its high specificity to fibrillar collagen, with substantially larger field of view than transmission electron microscopy. Moreover, in vivo SHG imaging was demonstrated in Goto-Kakizaki rats. CONCLUSIONS/SIGNIFICANCE: Our study shows unambiguously the high potential of SHG microscopy for three-dimensional characterization of structural abnormalities in unstained corneas. Furthermore, our demonstration of in vivo SHG imaging opens the way to long-term dynamical studies. This method should be easily

  11. Increased Biomechanical Efficacy of Corneal Cross-linking in Thin Corneas Due to Higher Oxygen Availability.

    Science.gov (United States)

    Kling, Sabine; Richoz, Olivier; Hammer, Arthur; Tabibian, David; Jacob, Soosan; Agarwal, Amar; Hafezi, Farhad

    2015-12-01

    To compare the currently available ultraviolet-A (UV-A) corneal cross-linking (CXL) treatment protocols for thin corneas with respect to oxygen, UV fluence, and osmotic pressure. Freshly enucleated murine (n = 16) and porcine (n = 16) eyes were used. The dependency on oxygen and the amount of UV absorption were evaluated using different CXL protocols, including standard CXL, contact lens-assisted CXL (caCXL), and CXL after corneal swelling. The CXL protocol was adapted from the treatment parameters of the human cornea to fit the thickness of murine and porcine corneas. Immediately after CXL, the corneas were subjected to biomechanical testing, including preconditioning, stress relaxation at 0.6 MPa, and stress-strain extensiometry. A two-element Prony series was fitted to the relaxation curves for viscoelastic characterization. Standard CXL was most efficient; prior corneal swelling reduced the long-term modulus by 6% and caCXL by 15% to 20%. Oxygen reduction decreased the long-term modulus G∞ by 14% to 15% and the instantaneous modulus G0 by 2% to 5%, and increased the short-term modulus G2 by 22% to 31%. Reducing the amount of absorbed UV energy decreased the long-term modulus G∞ by 5% to 34%, the instantaneous modulus G0 by 7% to 29%, and the short-term modulus G2 by 17% to 20%. The amount of absorbed UV light was more important in porcine than in murine corneas. The higher oxygen availability in thin corneas potentially increases the overall efficacy of riboflavin UV-A CXL compared to corneas of standard thickness. Clinical protocols for thin corneas should be revised to implement these findings. Copyright 2015, SLACK Incorporated.

  12. Gamma-irradiated sterile cornea for use in corneal transplants in a rabbit model

    OpenAIRE

    Junko Yoshida; Thomas Heflin; Andrea Zambrano; Qing Pan; Huan Meng; Jiangxia Wang; Stark, Walter J.; Daoud, Yassine J.

    2015-01-01

    Purpose: Gamma irradiated corneas in which the donor keratocytes and endothelial cells are eliminated are effective as corneal lamellar and glaucoma patch grafts. In addition, gamma irradiation causes collagen cross inking, which stiffens collagen fibrils. This study evaluated gamma irradiated corneas for use in corneal transplantations in a rabbit model comparing graft clarity, corneal neovascularization, and edema. Methods: Penetrating keratoplasty was performed on rabbits using four ty...

  13. Differential gene expression patterns of the developing and adult cornea compared to the lens and tendon

    OpenAIRE

    Wu, Feng; Lee, Seakwoo; Schumacher, Michael; Jun, Albert; Chakravarti, Shukti

    2008-01-01

    The cornea continues to mature after birth to develop a fully functional, refractive and protective barrier tissue. Here we investigated the complex biological events underlying this process by profiling global genome-wide gene expression patterns of the immature postnatal day 10 and seven week-old adult mouse cornea. The lens and tendon were included in the study to increase the specificity of genes identified as up regulated in the corneal samples. Notable similarities in gene expression be...

  14. Distribution of non-gal antigens in pig cornea: relevance to corneal xenotransplantation.

    Science.gov (United States)

    Cohen, David; Miyagawa, Yuko; Mehra, Ruhina; Lee, Whayoung; Isse, Kumiko; Long, Cassandra; Ayares, David L; Cooper, David K C; Hara, Hidetaka

    2014-04-01

    The aim of this study was to investigate the distribution of antigens other than galactose-α-1,3-galactose (Gal) (non-Gal) recognized by human and rhesus monkey serum antibodies in the α-1,3-galactosyltransferase gene-knockout (GTKO) pig cornea. The distribution of non-Gal, specifically N-glycolylneuraminic acid (NeuGc), in the corneas from wild-type (WT) and GTKO pigs was identified. Corneal sections from WT and GTKO pigs were incubated with human or rhesus monkey serum to determine immunoglobulin (Ig)M and IgG binding to corneal tissue by means of fluorescent microscopy. Strong expression of NeuGc was found in all layers of both WT and GTKO pig corneas. In both humans and monkeys, antibody binding (IgG > IgM) to GTKO was found to be weaker than that to entire WT pig corneas, but in both, most antibody binding, especially IgG, was to the epithelium. There was weak diffuse antibody binding, especially of IgG, to the corneal stroma, suggesting binding to antigens expressed on collagen. There was no or minimal binding of IgM/IgG to the corneal endothelium. Although the cornea is avascular, antibodies in primate serum can bind to pig antigens, especially on epithelial cells and stromal collagen. Although the binding to entire GTKO corneas was weaker than that to WT corneas, deletion of the expression of NeuGc and expression of human complement-regulatory proteins in the pig cornea will be important if prolonged clinical corneal xenograft survival is to be achieved.

  15. Two-Photon Microscopy of the Mouse Peripheral Cornea Ex Vivo.

    Science.gov (United States)

    Lee, Jun Ho; Kim, Ki Hean; Lee, Seunghun; Jeong, Hyerin; Kim, Myoung Joon

    2016-11-01

    To investigate the 3-dimensional (3D) cell and extracellular matrix (ECM) structure of mouse peripheral corneas in normal and corneal neovascularization tissues using 2-photon microscopy (TPM) based on both intrinsic and extrinsic moxifloxacin contrasts. Peripheral corneas in freshly enucleated mouse eyes were imaged by TPM based on both intrinsic and extrinsic contrasts. Intrinsic autofluorescence and second harmonic generation were used to image cells and ECM collagen, respectively. Moxifloxacin ophthalmic solution was applied to image cells. The peripheral cornea, limbus, and sclera were imaged in 3D. In addition to normal mice, mouse models of suture-induced corneal neovascularization were imaged to visualize changes in the microstructure. Complex 3D cell and ECM structures in the cornea, limbus, and sclera were visualized by TPM. TPM images based on intrinsic contrasts visualized both cell and ECM structures, and TPM images based on moxifloxacin visualized cell structures with enhanced contrast. On the limbus side of the mouse peripheral cornea, TPM images visualized the vasculature in the limbus, the trabecular meshwork/Schlemm canal, iris, and ciliary body. On the scleral side, TPM images visualized cell and ECM structures in the sclera and multiple cell layers below the sclera. TPM images of the peripheral cornea in the corneal neovascularization condition visualized the extension of vasculature from the limbus to the cornea. TPM imaging based on both intrinsic and external moxifloxacin contrasts visualized detailed 3D cell and ECM microstructures in the mouse peripheral cornea. TPM based on moxifloxacin might be advantageous for studying cell structures by enhancing image contrast.

  16. Outcome of transplanted donor corneas with more than 6 h of death-to-preservation time

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    Ashik Mohamed

    2016-01-01

    Full Text Available Purpose: In tropical countries, physicians are skeptic in using corneas with death-to-preservation time (DTPT >6 h, concerns being endothelial cell viability and microbial contamination on prolonged DTPT. The objective of the study was to investigate these concerns by analyzing the outcomes of corneal transplants performed using donor corneas with DTPT >6 h. Materials and Methods: The study was a retrospective case series of 65 transplants performed in 2013 with donor corneas that had DTPT >6 h (range, 6.1–9.8 h. The information on donor cornea tissues and the recipient details were collected from the eye bank and the medical records department of our tertiary eye care center. The main outcome measures were slit lamp assessment of the donor corneas, primary graft failure, graft survival, and postoperative adverse reactions, especially infections, if any. Results: Median DTPT was 7 h. Forty-four (67.7% corneas were evaluated as optical grade and 21 (32.3% were deemed as therapeutic grade; 36 (55.4% were used for optical indications. There was no relationship between DTPT and the tissue grading of corneas or endothelial cell density. Of the 23 keratoplasties for purely optical indications with a minimum follow-up of 3 months, 15 (65.2% remained clear whereas 7 (30.4% failed (mean follow-up 15.1 ± 6.7 months. The causes of failure were primary graft failure (n = 1 and secondary graft failure (n = 6. Conclusion: The donor corneas with DTPT 6 h to 10 h can be utilized for optical indications provided that they meet the criteria of tissue acceptance for optical use.

  17. Outcome of transplanted donor corneas with more than 6 h of death-to-preservation time.

    Science.gov (United States)

    Mohamed, Ashik; Chaurasia, Sunita; Garg, Prashant

    2016-09-01

    In tropical countries, physicians are skeptic in using corneas with death-to-preservation time (DTPT) >6 h, concerns being endothelial cell viability and microbial contamination on prolonged DTPT. The objective of the study was to investigate these concerns by analyzing the outcomes of corneal transplants performed using donor corneas with DTPT >6 h. The study was a retrospective case series of 65 transplants performed in 2013 with donor corneas that had DTPT >6 h (range, 6.1-9.8 h). The information on donor cornea tissues and the recipient details were collected from the eye bank and the medical records department of our tertiary eye care center. The main outcome measures were slit lamp assessment of the donor corneas, primary graft failure, graft survival, and postoperative adverse reactions, especially infections, if any. Median DTPT was 7 h. Forty-four (67.7%) corneas were evaluated as optical grade and 21 (32.3%) were deemed as therapeutic grade; 36 (55.4%) were used for optical indications. There was no relationship between DTPT and the tissue grading of corneas or endothelial cell density. Of the 23 keratoplasties for purely optical indications with a minimum follow-up of 3 months, 15 (65.2%) remained clear whereas 7 (30.4%) failed (mean follow-up 15.1 ± 6.7 months). The causes of failure were primary graft failure (n = 1) and secondary graft failure (n = 6). The donor corneas with DTPT 6 h to 10 h can be utilized for optical indications provided that they meet the criteria of tissue acceptance for optical use.

  18. A role for smoothened during murine lens and cornea development.

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    Janet J Y Choi

    Full Text Available Various studies suggest that Hedgehog (Hh signalling plays roles in human and zebrafish ocular development. Recent studies (Kerr et al., Invest Ophthalmol Vis Sci. 2012; 53, 3316-30 showed that conditionally activating Hh signals promotes murine lens epithelial cell proliferation and disrupts fibre differentiation. In this study we examined the expression of the Hh pathway and the requirement for the Smoothened gene in murine lens development. Expression of Hh pathway components in developing lens was examined by RT-PCR, immunofluorescence and in situ hybridisation. The requirement of Smo in lens development was determined by conditional loss-of-function mutations, using LeCre and MLR10 Cre transgenic mice. The phenotype of mutant mice was examined by immunofluorescence for various markers of cell cycle, lens and cornea differentiation. Hh pathway components (Ptch1, Smo, Gli2, Gli3 were detected in lens epithelium from E12.5. Gli2 was particularly localised to mitotic nuclei and, at E13.5, Gli3 exhibited a shift from cytosol to nucleus, suggesting distinct roles for these transcription factors. Conditional deletion of Smo, from ∼E12.5 (MLR10 Cre did not affect ocular development, whereas deletion from ∼E9.5 (LeCre resulted in lens and corneal defects from E14.5. Mutant lenses were smaller and showed normal expression of p57Kip2, c-Maf, E-cadherin and Pax6, reduced expression of FoxE3 and Ptch1 and decreased nuclear Hes1. There was normal G1-S phase but decreased G2-M phase transition at E16.5 and epithelial cell death from E14.5-E16.5. Mutant corneas were thicker due to aberrant migration of Nrp2+ cells from the extraocular mesenchyme, resulting in delayed corneal endothelial but normal epithelial differentiation. These results indicate the Hh pathway is required during a discrete period (E9.5-E12.5 in lens development to regulate lens epithelial cell proliferation, survival and FoxE3 expression. Defective corneal development occurs

  19. In situ cornea harvesting through the Red Cross Organization: a new approach to relieving severe cornea donor shortage in Chinese eye banks

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    Su-Xia Li

    2017-10-01

    Full Text Available Corneal diseases are currently the second main cause of blindness in China. Although most of the corneal blindness could be treated by corneal transplantation, only about 10 000 operations were carried out each year owing to the severe shortage of corneal donors and limited eye bank programs. A feasible cornea donation program was established through the organization of the Red Cross, and in situ corneal removal techniques were developed to avoid conflicts with Chinese traditions of keeping the deceased intact. The number of donated corneas, which had a safe and secure quality, increased significantly year by year.

  20. In situ cornea harvesting through the Red Cross Organization: a new approach to relieving severe cornea donor shortage in Chinese eye banks.

    Science.gov (United States)

    Li, Su-Xia; Wang, Fu-Hua; Wang, Ting; Han, Sha-Sha; Shi, Wei-Yun

    2017-01-01

    Corneal diseases are currently the second main cause of blindness in China. Although most of the corneal blindness could be treated by corneal transplantation, only about 10 000 operations were carried out each year owing to the severe shortage of corneal donors and limited eye bank programs. A feasible cornea donation program was established through the organization of the Red Cross, and in situ corneal removal techniques were developed to avoid conflicts with Chinese traditions of keeping the deceased intact. The number of donated corneas, which had a safe and secure quality, increased significantly year by year.

  1. Use of Fish Scale-Derived BioCornea to Seal Full-Thickness Corneal Perforations in Pig Models.

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    Shih-Cheng Chen

    Full Text Available The aim of this study was to test the use of BioCornea, a fish scale-derived collagen matrix for sealing full-thickness corneal perforations in mini-pigs. Two series of experiments were carried out in 8 Lan-Yu and 3 Göttingen mini-pigs, respectively. A 2mm central full thickness corneal perforation was made with surgical scissors and 2mm trephines. The perforations were sealed immediately by suturing BioCornea to the wounded cornea. The conditions of each patched cornea were followed-up daily for 3 or 4 days. Status of operated eyes was assessed with slit lamp examination or optical coherence tomography (OCT. Animals were sacrificed after the study period and the corneas operated were fixated for histological examination. Both OCT imaging and handheld slit lamp observations indicated that a stable ocular integrity of the perforated corneas was maintained, showing no leakage of aqueous humor, normal depth of anterior chamber and only mild swelling of the wounded cornea. Hematoxylin and eosin staining of the patched cornea showed no epithelial ingrowths to the perforated wounds and no severe leucocyte infiltration of the stroma. The fish scale-derived BioCornea is capable to seal full-thickness corneal perforation and stabilize the integrity of ocular anterior chamber in pre-clinic mini-pig models. BioCornea seems to be a safe and effective alternative for emergency treatment of corneal perforations.

  2. Biomechanical and optical behavior of human corneas before and after photorefractive keratectomy.

    Science.gov (United States)

    Sánchez, Paolo; Moutsouris, Kyros; Pandolfi, Anna

    2014-06-01

    To evaluate numerically the biomechanical and optical behavior of human corneas and quantitatively estimate the changes in refractive power and stress caused by photorefractive keratectomy (PRK). Athineum Refractive Center, Athens, Greece, and Politecnico di Milano, Milan, Italy. Retrospective comparative interventional cohort study. Corneal topographies of 10 human eyes were taken with a scanning-slit corneal topographer (Orbscan II) before and after PRK. Ten patient-specific finite element models were created to estimate the strain and stress fields in the cornea in preoperative and postoperative configurations. The biomechanical response in postoperative eyes was computed by directly modeling the postoperative geometry from the topographer and by reproducing the corneal ablation planned for the PRK with a numerical reprofiling procedure. Postoperative corneas were more compliant than preoperative corneas. In the optical zone, corneal thinning decreased the mechanical stiffness, causing local resteepening and making the central refractive power more sensitive to variations in intraocular pressure (IOP). At physiologic IOP, the postoperative corneas had a mean 7% forward increase in apical displacement and a mean 20% increase in the stress components at the center of the anterior surface over the preoperative condition. Patient-specific numerical models of the cornea can provide quantitative information on the changes in refractive power and in the stress field caused by refractive surgery. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  3. Assessment of the ex vivo biomechanical properties of porcine cornea with inflation test for corneal xenotransplantation.

    Science.gov (United States)

    Bao, F; Jiang, L; Wang, X; Zhang, D; Wang, Q; Zeng, Y

    2012-01-01

    This study aims to obtain the biomechanical properties of porcine cornea so as to provide necessary biomechanical experimental basis for pig-to-human corneal xenotransplantation. Seventeen fresh porcine corneal specimens obtained from pigs aged 4-6 months were examined under inflation conditions to determine the constitutive relationships of the material through dynamic loading conditions (pressure range: 1.47-42.66 mmHg). The forward deflection of porcine anterior corneal apex was measured by the laser displacement sensor. The pressure deformation results were analysed on the basis of shell theory to estimate Young's modulus of the cornea and derive its relationship with intraocular pressure (IOP). The porcine corneas showed a nonlinear corneal forward displacement/IOP and stress/strain relationship with an initial low stiffness stage and a later high stiffness stage. In spite of the nonlinearity between the internal pressure and apex forward deflection, the relationship between the Young's modulus and the IOP was almost linear. Compared with human corneas, porcine corneas exhibited a similar nonlinear behaviour but lower stiffness values. The biomechanical parameters of porcine cornea obtained from this test could be applied to numerical simulations of refractive surgery procedures and lay a foundation for pig-to-human corneal xenotransplantation. Copyright © 2012 Informa UK, Ltd.

  4. A microscopy study of the structural features of post-LASIK human corneas.

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    Mohammad Abahussin

    Full Text Available PURPOSE: To study the structural features of human post-LASIK corneas. METHODS: A pair of post-mortem donor corneas, from a 55-year old patient who underwent uncomplicated LASIK surgery five years previously, were bisected and fixed in 4% paraformaldehyde. The right cornea and one half of the left cornea were processed for light microscopy and scanning electron microscopy. One half of the right cornea was also examined by transmission electron microscopy. RESULTS: The flap-bed interface could be easily detected several years after LASIK and, although the flap appeared to be in close association with the stromal bed, there was a noticeable absence of reconnection between adjacent severed lamellae. Tissue gaps were evident at the flap margin, which once free of cellular components revealed the presence of a few bridging fibres. CONCLUSION: Examination of corneas five years after LASIK revealed evidence of primitive reparative scar development at the wound interface, but no reconnection of severed collagen lamellae. Such findings may explain the occurrence of flap dislocation following trauma in some patients months or years after surgery.

  5. Dendritic cells in the cornea during Herpes simplex viral infection and inflammation.

    Science.gov (United States)

    Kwon, Min S; Carnt, Nicole A; Truong, Naomi R; Pattamatta, Ushasree; White, Andrew J; Samarawickrama, Chameen; Cunningham, Anthony L

    2017-11-10

    Herpes simplex keratitis is commonly caused by Herpes simplex virus type 1, which primarily infects eyelids, corneas, or conjunctiva. Herpes simplex virus type 1-through sophisticated interactions with dendritic cells (DCs), a type of antigen-presenting cell)-initiates proinflammatory responses in the cornea. Corneas were once thought to be an immune-privileged region; however, with the recent discovery of DCs that reside in the cornea, this long-held conjecture has been overturned. Therefore, evaluating the clinical, preclinical, and cell-based studies that investigate the roles of DCs in corneas infected with Herpes simplex virus is critical. With in vivo confocal microscopy, animal models, and cell culture experiments, we may further the understanding of the sophisticated interactions of Herpes simplex virus with DCs in the cornea and the molecular mechanism associated with it. It has been shown that specific differentiation of DCs using immunohistochemistry, flow cytometry, and polymerase chain reaction analysis in both human and mice tissues and viral tissue infections are integral to increasing understanding. As for in vivo confocal microscopy, it holds promise as it is the least invasive and a real-time investigation. These tools will facilitate the discovery of various targets to develop new treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. In Vitro Corneal Tomography of Donor Cornea Using Anterior Segment OCT.

    Science.gov (United States)

    Janunts, Edgar; Langenbucher, Achim; Seitz, Berthold

    2016-05-01

    The aim of this study was to establish a tomographic screening method for revealing potential pathologies in corneal donors before keratoplasty so they may be excluded as candidates for corneal transplantation. Donor corneal tomographies were measured in a viewing chamber filled with preservation medium and with the use of a clinical optical coherence tomography (OCT) device. Custom-written software was developed to extract corneal surfaces from the raw data, which were analyzed in the central and peripheral regions. An adaptive nonlinear edge-enhancement algorithm was used to observe scars within the corneal volume. The thickness distribution map was analyzed to detect keratoconus and corneas with extreme topographic irregularities. Measurements were repeated 5 times to assess reproducibility. Eight corneas were investigated: 6 randomly selected intact donors, unsuitable for implantation because of low endothelial cell densities, and 2 keratoconus corneas, excised from patients during corneal transplantation. A major thickness abnormality was detected in one of the intact donor corneas, so it was excluded from further analysis. The keratoconus corneas were clearly evident in optical coherence tomography cross-sectional images, and similarly, they could easily be identified by analyzing the thickness map. Overall, the measurements were reliable and had a Cronbach's alpha coefficient greater than 0.8. Donor corneal examination using sterile viewing chambers was found to be suitable as a pre-keratoplasty advanced screening routine. A proof of concept was demonstrated, which could identify both irregular corneas and those affected by keratoconus.

  7. Biomechanical simulation of needle insertion into cornea based on distortion energy failure criterion.

    Science.gov (United States)

    Su, Peng; Yang, Yang; Zhang, Leiyu; Huang, Long

    2016-01-01

    This paper is mainly about biomechanical behavior of needle insertion into cornea, and proposes a failure criterion to simulate the insertion process which has attracted considerable attention due to its importance for the minimally invasive treatment. In the process of needle insertion into cornea, tiny and complex insertion force is generated due to contact between needle and soft tissue. Based on the distortion energy theory, there is proposed a failure criterion of corneal material that can solve contact problem between rigid body and biological tissue in insertion simulation, where Cauchy stress of corneal material is the key to numerical calculation. A finite element model of in vivo cornea is built, and the cornea constrained by sclera is simplified to two layers containing epithelium and stroma. Considering the hyper-viscoelastic property of corneal material, insertion simulation is carried out. By insertion experiment, the insertion force increases with insertion depth accompanying obvious fluctuations. Different insertion forces are generated at different speeds. The punctured locations are obvious in the force-displacement curves. The results of insertion simulation are generally consistent with experimental data. Maps of von Mises stress reflect the tissue injury of the cornea during insertion process, and punctured status corresponds to the point in the curves. The ability of this study to reproduce the behavior of needle insertion into cornea opens a promising perspective for the control of robotic surgery operation as well as the real-time simulation of corneal suture surgery.

  8. Intrastromal Injection of China Painting Ink in Corneas of Male Rabbits: Clinical and Histological Study

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    Alahmady Hamad Alsmman Hassan

    2016-01-01

    Full Text Available Background. Many patients with corneal opacity or complicated cataract in blind eye ask for cosmoses. In this study we tried to investigate the staining of corneas of male rabbits by Rotring China painting ink and to study the histological changes. Method. 10 eyes of 10 male Baladi Egyptian rabbits were injected (0.1 mL intrastromally in the cornea by the use of China painting ink (Rotring Tinta China through insulin syringe (27-gauge needle by single injection; clinical follow-up is for 6 months and lastly the rabbits were scarified and the stained eyes were enucleated for histological analysis. Results. Clinically the stain was stable in color and distribution in corneas with no major complications. Histological results of the stained rabbit corneas showed blackish pigmentation in the corneal stroma without any inflammatory cellular infiltration. Some fibroblast cells had pigment granules in their cytoplasm in the adjacent layers. Conclusion. Corneal staining by China painting ink is effective and safe in staining of male rabbits cornea; however further study in human corneas with longer follow-up period is advisable.

  9. Effect of glaucoma tube shunt parameters on cornea endothelial cells in patients with Ahmed valve implants.

    Science.gov (United States)

    Koo, Euna B; Hou, Jing; Han, Ying; Keenan, Jeremy D; Stamper, Robert L; Jeng, Bennie H

    2015-01-01

    The aim of this study was to assess the effect of various tube parameters on corneal endothelial cell density (ECD) after insertion of Ahmed valves. Thirty-nine eyes of 33 patients with previous superotemporal (ST) Ahmed valve implantation and 20 eyes of 13 participants with previous uncomplicated phacoemulsification and intraocular lens implantation but no history of glaucoma surgery were evaluated. Various tube parameters were measured with anterior segment optical coherence tomography. ST, central, and inferonasal (IN) ECD and pachymetry were measured. Endothelial cell loss and corneal thickness in the ST cornea was compared with those in the IN cornea. The mean age of the operated patients was 58 ± 22 years, and the mean time since glaucoma surgery was 2.5 ± 2.6 years. Thirty-two of the 39 study eyes were pseudophakic. The ECD was significantly lower in the ST endothelium than in the IN endothelium in eyes with glaucoma tube surgery (P cornea and distance from the tip of the tube to the cornea were significant risk factors for decreased ST endothelial cell loss when assessed relative to the IN ECD (P = 0.01 and P = 0.02, respectively). In multivariate analysis, only the distance of the tube tip to the cornea remained significantly associated with ST endothelial cell loss. Although this was a retrospective study with inherent limitations, tubes that are closer to the cornea seem to lead to increased loss of adjacent endothelial cells.

  10. Polymicrobial Infection of the Cornea Due to Contact Lens Wear

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    Selçuk Sızmaz

    2016-04-01

    Full Text Available A 38-year-old male presented with pain and redness in his left eye. He had a history of wearing contact lenses. His ophthalmic examination revealed a large corneal ulcer with surrounding infiltrate. Cultures were isolated from the contact lenses, lens solutions, storage cases, and conjunctivae of both eyes and also corneal scrapings of the left eye. Fortified vancomycin and amikacin drops were started hourly. Culture results of conjunctivae of each eye and left cornea were positive for Pseudomonas aeruginosa; cultures from the contact lenses, lens solution and storage case of both eyes revealed Pseudomonas aeruginosa and Alcaligenes xylosoxidans. Polymerase chain reaction of the corneal scraping was positive for Acanthameoba. The topical antibiotics were changed with ones that both bacteria were sensitive to and anti-amoebic therapy was added. The patient had two recurrences following initial presentation despite intensive therapy. Keratitis occurred due to multiple pathogens; the relapsing course despite adequate therapy is potentially associated with this polymicrobial etiology.

  11. Cornea Society nomenclature for ocular surface rehabilitative procedures.

    Science.gov (United States)

    Daya, Sheraz M; Chan, Clara C; Holland, Edward J

    2011-10-01

    In the past 20 years, there has been tremendous development in ocular surface rehabilitation and, through better understanding and improvements in analytic and culture techniques, a variety of new procedures have been developed. Differing techniques have been used internationally and often similar terminology is used when procedures could be considered to be quite different or vice versa. To communicate clearly and to compare techniques and outcomes, it was determined that an agreed international nomenclature was necessary. A subcommittee was established by The Cornea Society. An initial steering group of international experts with special interest in ocular surface was assembled and established broad principles for the nomenclature based on a previous nomenclature. The nomenclature for procedures was based on several parameters, including a) anatomic source of tissue transplanted, for example conjunctival, keratolimbal or mucosal, b) whether the source was autologous or allogeneic (cadaveric or living related), and c) cell culture techniques. For example, an expanded cell culture of cadaveric limbal tissue was named ex-vivo cultivated cadaveric limbal allograft (EvC-LAL). Agreed nomenclature for transplantation procedures used in ocular surface rehabilitation has been developed, and use of this common terminology should help communication among those involved in this field.

  12. Changes of extracellular matrix of the cornea in diabetes mellitus.

    Science.gov (United States)

    Hager, A; Wegscheider, K; Wiegand, W

    2009-10-01

    Differences in corneal viscoelasticity due to diabetes have been reported to have a protective effect on the progression of glaucoma and the development and progression of keratoconus. Due to longterm changes of tissue in diabetes mellitus, biomechanical changes of the cornea because of glycation and modified extracellular matrix may be detectable. The purpose of the study was to determine whether there is a difference in corneal biomechanical properties, characterized by corneal hysteresis (CH) and central corneal thickness (CCT), between diabetic and normal subjects, and relate these to the duration of diabetes. In a cross sectional study, a group of 484 eyes including 99 eyes of diabetic individuals was evaluated. CH as measured with the Ocular Response Analyzer, CCT (Orbscan II), Goldmann applanation tonometry (GAT) and slit-lamp examination were obtained from each patient. Linear mixed models were applied for statistical evaluation. CH showed a significant decrease with age (-0.036 mmHg/year, p age, IOP and CCT). This was not related to the duration of diabetes (mean 12.6 +/- 9.0y, p = 0.522). CCT did not differ with regard to diabetes. Intraclass correlation coefficients were 81% and 50% for CCT and CH respectively. CH is assumed to be an indicator for acquired changes of tissue such as diabetes-mediated. CCT is a more characteristic parameter for the individual patient. CH may provide more information about changes of the extracellular matrix in diabetes, and therefore offer a new monitoring parameter.

  13. Biomechanical properties of the cornea in high myopia.

    Science.gov (United States)

    Shen, Meixiao; Fan, Fan; Xue, Anquan; Wang, Jianhua; Zhou, Xiangtian; Lu, Fan

    2008-09-01

    To determine corneal biomechanical properties in patients with high myopia. Observational study. High myopia patients (n=45, age: 37.0+/-12.6 years) with refractive errors of spherical equivalent (SE) greater than -9.00D were recruited in this study along with healthy subjects (n=90, age: 33.7+/-12.4 years) with refractive errors of SE ranging from 0D to -3.00D. Only the right eye was studied. Central corneal thickness (CCT) was measured by optical coherence tomography (OCT). Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the Ocular Response Analyzer (ORA). The ORA also determined the values of intraocular pressure (IOP(g)) and corneal compensated IOP (IOP(cc)). No significant differences of CCT and CRF were present between the two groups (P=.15 and 0.35 for CCT and CRF, respectively); however, CH in the high myope group was lower than that in the controls (Page in either the control group or the high myope group (P>.05). There was a significant correlation between CH and SE when the two groups were combined for analysis. CH, but not CRF, was significantly lower in high myopia patients compared to that in normal subjects. The results indicate that some compromised aspects of the biomechanical properties of cornea may exist in people with high myopia.

  14. Cross-linking da cornea: protocolo padrão

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    Marcony R. Santhiago

    Full Text Available RESUMO O objetivo desta revisão é de determinar as indicações e eficácia da cirurgia que promove novas ligações covalentes entre as fibras de colágeno da córnea, conhecida como Cross-Linking (CXL, assim como esclarecer seus objetivos. O ceratocone é uma doença ectasica da córnea, bilateral, assimétrica, que, principalmente, cursa com encurvamento e afinamentos progressivo, e se inicia em geral na segunda década de vida. O uso primário do CXL tem sido na interrupção da progressão do Ceratocone. Apesar do conhecido encurvamento no estroma da córnea ocorrer nesses pacientes, a fisiopatologia por trás do ceratocone ainda é desconhecida e parece ser multifatorial. Pela evidencia literária disponível até o momento, o CXL da córnea esta, portanto indicado nos pacientes com doença em progressão. Concluímos que existe evidencia suficiente para afirmar que o CXL da córnea é eficaz na estabilização da doença ectásica da cornea.

  15. Collagen cross-linking: Strengthening the unstable cornea

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    Oren Tomkins

    2008-05-01

    Full Text Available Oren Tomkins, Hanna J GarzoziDepartment of Ophthalmology, Bnai Zion Medical Center, Haifa, IsraelAbstract: Corneal ectasia, a weakening of corneal integrity, occurs both due to acquired and congenital conditions such as keratoconus. It is a progressing condition that affects both visual acuity, and corneal stability. Various methods exist for correcting this impairment, however none address the inherit pathology, an increase laxity of the corneal stroma. Collagen crosslinking, a new, minimally invasive method, aims to strengthen the stroma by inducing cross links between neighboring collagen fibers. This method results in an increase in corneal tensile strength, with no medium term adverse effects on its normal architecture. Clinically, treated patients display improvement in both visual acuity and keratometric readings. This method may provide clinicians with easily accessible tools to stop the progression, and even correct visual deterioration due to corneal ectasia. Here we review the current information regarding this new method, as well as discuss its potential benefits and downfalls.Keywords: corneal cross-linking, corneal ectasia, keratoconus, stroma, cornea

  16. The IL-8 release from cultured human keratinocytes, mediated by antibodies to bullous pemphigoid autoantigen 180, is inhibited by dapsone

    Science.gov (United States)

    Schmidt, E; Reimer, S; Kruse, N; Bröcker, E-B; Zillikens, D

    2001-01-01

    Bullous pemphigoid (BP) is a subepidermal blistering disease associated with autoantibodies to the hemidesmosomal 180 kD BP autoantigen (BP180). However, the binding of autoantibodies to BP180 alone is not sufficient for blister formation in this disease and the infiltration of neutrophils into the skin is required. Dapsone and nicotinamide inhibit neutrophil chemotaxis and are used effectively in treating BP. IL-8 is a known chemoattractant for neutrophils and has been implicated in the inflammatory process of both human and experimental murine BP. We have recently shown that antibodies to BP180 mediate a dose and time-dependent release of IL-6 and IL-8 from cultured normal human epidermal keratinocytes (NHEK). In the present study, we addressed the question whether dapsone or nicotinamide influence this cytokine release. We demonstrate that dapsone, but not nicotinamide, in its pharmacological range, inhibits the IL-8, but not the IL-6 release from NHEK, induced by anti-BP180 IgG, in a dose-dependent fashion as detected by ELISA. IL-8 mRNA levels, as determined by RT-PCR, were the same in cells treated with BP IgG alone compared to cells treated with BP IgG plus dapsone. This observation suggests that dapsone inhibits the BP IgG-induced IL-8 release from cultured NHEK by mechanisms at the post-transcriptional level. Our findings contribute to the understanding how dapsone leads to a reduced influx of neutrophils into BP lesions and, finally, to the cessation of blister formation in this disease. PMID:11359455

  17. Retrospective analysis of the forty-six patients with bullous pemphigoid followed-up in our clinic

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    Serkan Yazıcı

    2016-09-01

    Full Text Available Background and Design: Bullous pemphigoid (BP is an autoimmune disease characterised by widespread itchy plaques and subepithelial blisterings and usually affects the elderly population. Due to the chronic nature of the disease, to prevent the side effects of chronic steroid treatment, adjuvant immunosuppressive (mycophenolate mofetil, azathioprine, methotrexate and anti-inflammatory (tetracycline, nicotinamide, dapsone agents may be used. In this study, we retrospectively evaluated the clinical and demographic characteristics and applied treatments of 46 patients with the diagnosis of BP and compared with literature data. Materials and Methods: We retrospectively evaluated the records of 46 patients who received clinical and histopathological diagnosis of BP and followed up in our clinic between 2006 and 2013. Results: Of the 46 patients, 22 were female and 24 male. The mean age of onset was 69.54 years (range: 18-105. The duration of the lesion ranged from 1 week to 10 months with a median duration of 8 weeks. The most frequent comorbid chronic disease was hypertension detected in 28 (60.8% patients. Only four patients had a history of malignancy before the onset of the disease. Nineteen patients (42% used more than 5 agents for comorbid diseases. Thirty-two patients (69.5% used systemic corticosteroids alone and ten (22% patients needed additional adjuvant therapies. Conclusion: BP is a major cause of morbidity in the elderly population receiving multiple drug treatment. To avoid the side effects of steroid therapy, especially in patients with severe disease, short-term use of additional immunosuppressive agents appears to be safe and effective.

  18. Macropinocytosis of type XVII collagen induced by bullous pemphigoid IgG is regulated via protein kinase C.

    Science.gov (United States)

    Iwata, Hiroaki; Kamaguchi, Mayumi; Ujiie, Hideyuki; Nishimura, Machiko; Izumi, Kentaro; Natsuga, Ken; Shinkuma, Satoru; Nishie, Wataru; Shimizu, Hiroshi

    2016-12-01

    Macropinocytosis is an endocytic pathway that is involved in the nonselective fluid uptake of extracellular fluid. Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease associated with autoantibodies to type XVII collagen (COL17), which is a component of hemidesmosome. When keratinocytes are treated with BP-IgG, COL17 internalizes into cells by way of the macropinocytosis. We investigated the mechanism of COL17 macropinocytosis using DJM-1 cells, a cutaneous squamous cell carcinoma cell line. First, non-hemidesmosomal COL17 was preferentially depleted by stimulation with the BP-IgG in the DJM-1 cells. To investigate the signaling involved in COL17-macropinocytosis, the inhibition of small GTPase family members Rac1 and Cdc42 was found to strongly repress COL17 internalization; in addition, the Rho inhibitor also partially blocked that internalization, suggesting these small GTPases are involved in signaling to mediate COL17-macropinocytosis. Western blotting using Phostag-SDS-PAGE demonstrated high levels of COL17 phosphorylation in DJM-1 cells under steady-state condition. Treatment with BP-IgG increased the intracellular calcium level within a minute, and induced the overabundant phosphorylation of COL17. The overabundant phosphorylation of COL17 was suppressed by a protein kinase C (PKC) inhibitor. In addition, PKC inhibitor repressed COL17 endocytosis using cell culture and organ culture systems. Finally, the depletion of COL17 was not observed in the HEK293 cells transfected COL17 without intracellular domain. These results suggest that COL17 internalization induced by BP-IgG may be mediated by a PKC pathway. In summary, BP-IgG initially binds to COL17 distributed on the plasma membrane, and COL17 may be internalized by means of a macropinocytic pathway related to the phosphorylation of the intracellular domain by PKC.

  19. [Therapeutic contact lenses and the advantages of high Dk materials].

    Science.gov (United States)

    Coral-Ghanem, Cleusa; Ghanem, Vinícius Coral; Ghanem, Ramon Coral

    2008-01-01

    Therapeutic contact lenses are useful in a variety of ocular surface diseases. Their main indications are: to relieve the pain; protect ocular surface; promote corneal healing and epithelial regeneration; seal a leaking corneal wound and deliver ophthalmic drugs on the ocular surface. There are several kinds of lens designs and materials, and their choice is dependent on the specific disease to be treated, the duration of treatment and the physiologic needs of the diseased cornea. Bullous keratopathy, recurrent epithelial erosion syndrome, dry eye and postoperative epithelial defects are amongst their indications. Therapeutic contact lenses should not be indicated in the presence of active infectious keratitis or when the patient is not compliant. Corneal neovascularization, giant papillary conjunctivitis and infectious keratitis are serious complications, which can be prevented by correctly fitting and maintaining the therapeutic contact lenses. Silicon-hydrogel therapeutic contact lenses, due to their higher oxygen permeability, allow extended wear schedules, decreasing the need for frequent lens replacement.

  20. Update on phototherapeutic keratectomy.

    Science.gov (United States)

    Stasi, Kalliopi; Chuck, Roy S

    2009-07-01

    To review all recent publications on the use of phototherapeutic keratectomy (PTK). Recent studies confirm the beneficial outcomes of PTK in a variety of anterior corneal disorder: anterior stromal scars, dystrophies of the corneal epithelium and the anterior stroma, and elevated corneal lesions. They also try to evaluate the biomechanical properties of eyes with granular corneal dystrophy undergoing PTK, in an effort to prevent iatrogenic ectasia. The different genotypes in patients with transforming growth factor, beta-induced linked corneal dystrophies have recently been correlated to the surgical outcome after PTK. An extensive review of recurrent corneal erosion syndrome identified PTK as the most effective treatment. In the developing world, the most common indication for PTK is still bullous keratopathy, as PTK can be successfully used while waiting for penetrating keratoplasty. PTK can successfully treat a variety of conditions of the anterior cornea. New studies may further expand its use.

  1. Toxic Anterior Segment Syndrome following Phacoemulsification Secondary to Overdose of Intracameral Gentamicin

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    Yaran Koban

    2014-01-01

    Full Text Available Objective. To report a case of toxic anterior segment syndrome (TASS that was caused by inadvertent anterior chamber and cornea stromal injection with high dose gentamicin following cataract surgery. Methods. Case report. Results. We report a 72-year-old female patient who developed TASS that was caused by high dose gentamicin (20 mg/0.5 mL, which was inadvertently used during the formation of the anterior chamber and hydration of the corneal incision. Unlike previous cases, hyphema and hemorrhagic fibrinous reaction were seen in the anterior chamber. Despite treatment, bullous keratopathy developed and penetrating keratoplasty was performed. The excised corneal button was sent for histopathological examination. Conclusions. Subconjunctival gentamicin is highly toxic to the corneal endothelium and anterior chamber structures. Including it on the surgical table carries a potentially serious risk for contamination of the anterior chamber.

  2. Customised component corneal transplantation: a blessing for three patients.

    Science.gov (United States)

    Sati, Alok; Shankar, Sandeep; Jha, Ashok; Gurunadh, Velamakanni Satyanarayana

    2014-08-21

    The existing acute shortage of good quality donor corneas in a developing country like India, prompted us to attempt customised component corneal transplantation. Using this surgical strategy, one corneoscleral button was used for three recipients. Anterior and posterior lamellar discs were used for anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty in patients with superficial corneal scar and pseudophakic bullous keratopathy, respectively. From the remnant peripheral corneoscleral rim, a patch graft was taken and used for a case of perforated corneal ulcer. Postoperatively, the two earlier mentioned cases achieved visual acuities of 20/30 and 20/60, respectively, whereas the latter mentioned patient with the patch graft achieved good tectonic stability. This case report highlights the optimal utilisation of a corneoscleral button by customising it for three recipients. Moreover, a patch graft has been introduced in the armamentarium of customised component corneal transplantation for the first time. 2014 BMJ Publishing Group Ltd.

  3. Simultaneous bilensectomy and endothelial keratoplasty for angle-supported phakic intraocular lens-induced corneal decompensation

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    Vikas Mittal

    2011-01-01

    Full Text Available A 40-year-old lady presented with severe endothelial cell loss in both eyes 14 years after angle-supported phakic intraocular lens (AS PIOL implantation. The left eye had severe corneal edema with bullous keratopathy. The right eye had markedly reduced endothelial cell count (655 cells/mm 2 although the cornea was clear. She underwent simultaneous bilensectomy (AS PIOL explantation and phacoemulsification and Descemet′s stripping and endothelial keratoplasty (DSEK in the left eye. Explanted AS PIOL was identified as ZSAL-4 (Morcher, Stuttgart, Germany model. Corneal edema cleared completely in 2 months with a best corrected visual acuity (-2.25 D sph of 20/60. No intervention was done in the right eye. The present case illustrates that AS PIOL-induced endothelial decompensation can be effectively managed by simultaneous bilensectomy and endothelial keratoplasty.

  4. Biomechanical properties of human corneas following low- and high-intensity collagen cross-linking determined with scanning acoustic microscopy.

    Science.gov (United States)

    Beshtawi, Ithar M; Akhtar, Riaz; Hillarby, M Chantal; O'Donnell, Clare; Zhao, Xuegen; Brahma, Arun; Carley, Fiona; Derby, Brian; Radhakrishnan, Hema

    2013-08-07

    To assess and compare changes in the biomechanical properties of the cornea following different corneal collagen cross-linking protocols using scanning acoustic microscopy (SAM). Ten donor human corneal pairs were divided into two groups consisting of five corneal pairs in each group. In group A, five corneas were treated with low-fluence (370 nm, 3 mW/cm(2)) cross-linking (CXL) for 30 minutes. In group B, five corneas were treated with high-fluence (370 nm, 9 mW/cm(2)) CXL for 10 minutes. The contralateral control corneas in both groups had similar treatment but without ultraviolet A. The biomechanical properties of all corneas were tested using SAM. In group A, the mean speed of sound in the treated corneas was 1677.38 ± 10.70 ms(-1) anteriorly and 1603.90 ± 9.82 ms(-1) posteriorly, while it was 1595.23 ± 9.66 ms(-1) anteriorly and 1577.13 ± 8.16 ms(-1) posteriorly in the control corneas. In group B, the mean speed of sound of the treated corneas was 1665.06 ± 9.54 ms(-1) anteriorly and 1589.89 ± 9.73 ms(-1) posteriorly, while it was 1583.55 ± 8.22 ms(-1) anteriorly and 1565.46 ± 8.13 ms(-1) posteriorly in the untreated control corneas. The increase in stiffness between the cross-linked and control corneas in both groups was by a factor of 1.051×. SAM successfully detected changes in the corneal stiffness after application of collagen cross-linking. A higher speed-of-sound value was found in the treated corneas when compared with the controls. No significant difference was found in corneal stiffness between the corneas cross-linked with low- and high-intensity protocols.

  5. Biomechanical Properties of Human Corneas Following Low- and High-Intensity Collagen Cross-Linking Determined With Scanning Acoustic Microscopy

    Science.gov (United States)

    Beshtawi, Ithar M.; Akhtar, Riaz; Hillarby, M. Chantal; O'Donnell, Clare; Zhao, Xuegen; Brahma, Arun; Carley, Fiona; Derby, Brian; Radhakrishnan, Hema

    2013-01-01

    Purpose. To assess and compare changes in the biomechanical properties of the cornea following different corneal collagen cross-linking protocols using scanning acoustic microscopy (SAM). Methods. Ten donor human corneal pairs were divided into two groups consisting of five corneal pairs in each group. In group A, five corneas were treated with low-fluence (370 nm, 3 mW/cm2) cross-linking (CXL) for 30 minutes. In group B, five corneas were treated with high-fluence (370 nm, 9 mW/cm2) CXL for 10 minutes. The contralateral control corneas in both groups had similar treatment but without ultraviolet A. The biomechanical properties of all corneas were tested using SAM. Results. In group A, the mean speed of sound in the treated corneas was 1677.38 ± 10.70 ms−1 anteriorly and 1603.90 ± 9.82 ms−1 posteriorly, while it was 1595.23 ± 9.66 ms−1 anteriorly and 1577.13 ± 8.16 ms−1 posteriorly in the control corneas. In group B, the mean speed of sound of the treated corneas was 1665.06 ± 9.54 ms−1 anteriorly and 1589.89 ± 9.73 ms−1 posteriorly, while it was 1583.55 ± 8.22 ms−1 anteriorly and 1565.46 ± 8.13 ms−1 posteriorly in the untreated control corneas. The increase in stiffness between the cross-linked and control corneas in both groups was by a factor of 1.051×. Conclusions. SAM successfully detected changes in the corneal stiffness after application of collagen cross-linking. A higher speed-of-sound value was found in the treated corneas when compared with the controls. No significant difference was found in corneal stiffness between the corneas cross-linked with low- and high-intensity protocols. PMID:23847309

  6. [Investigation of the biomechanical properties of the cornea by bidirectional applanation: new approaches to interpreting the results].

    Science.gov (United States)

    Avetisov, S E; Novikov, I A; Bubnova, I A; Antonov, A A; Siplivyĭ, V I

    2008-01-01

    This study deals with the biomechanical properties of the cornea, which is essential in solving different problems of clinical ophthalmology, specifically in predicting the potential complications of keratorefraction operations, in early diagnosing keratoconus, and interpreting the measurements of intraocular pressure. The investigations confirmed the efficiency of using bidirectional applanation of the cornea to define its strength characteristics. A procedure has been also developed to estimate the elasticity coefficient which reflects the elastic properties of the cornea irrespective of intraocular pressure values.

  7. The maintenance of lymphatic vessels in the cornea is dependent on the presence of macrophages.

    Science.gov (United States)

    Maruyama, Kazuichi; Nakazawa, Toru; Cursiefen, Claus; Maruyama, Yuko; Van Rooijen, Nico; D'Amore, Patricia A; Kinoshita, Shigeru

    2012-05-31

    It has been shown previously that the presence in the cornea of antigen-presenting cells (APC), such as macrophages (MPS) and lymphangiogenesis, is a risk for corneal transplantation. We sought to determine whether the existence of lymphatic vessels in the non-inflamed cornea is associated with the presence of MPS. Flat mounts were prepared from corneas of untreated C57BL/6, CD11b(-/-), F4/80(-/-), and BALB/c mice, and after suture placement or corneal transplantation, observed by immunofluorescence for the presence of lymphatic vessels using LYVE-1 as a marker of lymphatic endothelium. Innate immune cells were detected in normal mouse corneas using CD11b, F4/80, CD40, as well as MHC-class II. Digital images of the flat mounts were taken using a spot image analysis system, and the area covered by lymphatic vessels was measured using NIH Image software. The number of spontaneous lymphatic vessels in C57BL/6 corneas was significantly greater than in BALB/c corneas (P = 0.03). There were more CD11b(+) (P lymphatic vessels and reduced inflammation-induced lymphangiogenesis relative to control mice. Mice deficient in CD11b or F4/80 had fewer spontaneous lymphatic vessels and less lymphangiogenesis than control C57BL/6 mice. C57BL/6 mouse corneas have more endogenous CD11b(+) cells and lymphatic vessels. The endogenous lymphatic vessels, along with pro-inflammatory MPS, account for the high risk of corneal graft rejection in C57BL/6 mice. CD11b(+) and F4/80(+) MPS appear to have an important role in of the formation of new lymphatic vessels.

  8. Oestrogen-induced changes in biomechanics in the cornea as a possible reason for keratectasia.

    Science.gov (United States)

    Spoerl, Eberhard; Zubaty, Viktoria; Raiskup-Wolf, Frederik; Pillunat, Lutz E

    2007-11-01

    The risk of regression after photorefractive keratectomy (PRK) and the tendency to develop keratectasia after laser-assisted in situ keratomileusis (LASIK) procedure is higher in women than men. Currently, interest is focused on the influence of oestrogen on corneal stability after corneal refractive surgery. The aim of this experimental study was to investigate the change in biomechanical properties of the cornea induced by oestrogen. The influence of oestrogen was investigated in 12 fresh porcine corneas incubated in culture medium with 10 micromol/l beta-oestradiol for 7 days. A group of 12 porcine corneas incubated in culture medium without oestradiol for the same time served as a control group. Strips of cornea were cut and the stress-strain was measured in a biomaterial tester. The Young's modulus was calculated. During incubation the thickness of the cornea changed in the control group by only 6.4% and in the oestradiol group by 12%. However, the difference in the biomechanical stress values at 10% strain was significantly larger. In the control group the stress value was 120.18+/-28.93 kPa and in the oestradiol group 76.87+/-34.63 kPa (p = 0.002), representing a reduction of the corneal stiffness by 36% due to the oestradiol treatment. Oestrogen is a modulating factor of the biomechanical properties of the cornea that is not explainable only by an increased swelling. The significance of the hormone status of patients and its influence on the biomechanical stability of the cornea, a determining factor after refractive surgery, have been underestimated and may contribute to the development of keratectasia.

  9. Organization of fibrillar collagen in the human and bovine cornea: collagen types V and III.

    Science.gov (United States)

    White, J; Werkmeister, J A; Ramshaw, J A; Birk, D E

    1997-01-01

    The localization and fibrillar organization of collagen types V and III in the human and bovine corneal stromas were studied. In the chicken cornea, type V co-assembles with type I collagen as heterotypic fibrils and this interaction is involved in the regulation of fibril diameter necessary for corneal transparency. To determine whether this is a regulatory mechanism common to the corneas of different species the human and bovine corneal stroma were studied. Collagen type V was found in the epithelium and Bowman's membrane in the untreated adult human and bovine cornea using immunofluorescence microscopy. In the absence of any treatment, there was no type V reactivity within the stroma. However, type V collagen was detected homogeneously throughout the corneal stroma after treatments that partially disrupt fibril structure. The reactivity was strongest in the cornea, weaker in the limbus and weakest in the sclera. Fetal corneas showed similar reactivity for type V collagen, but unlike the adult, the stroma was slightly reactive. Immunoelectron microscopy demonstrated that type V collagen was associated with disrupted, but not with intact, fibrils in both human and bovine corneal stroma. Type III collagen reactivity was not detected in the cornea, but was present subepithelially in the limbus and in the scleral stroma. These data indicate that type V collagen is a component of striated collagen fibrils throughout the human and bovine corneal stromas. The interaction of type I and V collagen as heterotypic fibrils masks the helical epitope recognized by the monoclonal antibody against type V collagen. The heterotypic interactions of collagen type V indicate a role in the regulation of fibril diameter analogous to that described in the avian cornea.

  10. Elastic modulus and collagen organization of the rabbit cornea: epithelium to endothelium.

    Science.gov (United States)

    Thomasy, Sara M; Raghunathan, Vijay Krishna; Winkler, Moritz; Reilly, Christopher M; Sadeli, Adeline R; Russell, Paul; Jester, James V; Murphy, Christopher J

    2014-02-01

    The rabbit is commonly used to evaluate new corneal prosthetics and study corneal wound healing. Knowledge of the stiffness of the rabbit cornea would better inform the design and fabrication of keratoprosthetics and substrates with relevant mechanical properties for in vitro investigations of corneal cellular behavior. This study determined the elastic modulus of the rabbit corneal epithelium, anterior basement membrane (ABM), anterior and posterior stroma, Descemet's membrane (DM) and endothelium using atomic force microscopy (AFM). In addition, three-dimensional collagen fiber organization of the rabbit cornea was determined using nonlinear optical high-resolution macroscopy. The elastic modulus as determined by AFM for each corneal layer was: epithelium, 0.57 ± 0.29 kPa (mean ± SD); ABM, 4.5 ± 1.2 kPa, anterior stroma, 1.1 ± 0.6 kPa; posterior stroma, 0.38 ± 0.22 kPa; DM, 11.7 ± 7.4 kPa; and endothelium, 4.1 ± 1.7 kPa. The biophysical properties, including the elastic modulus, are unique for each layer of the rabbit cornea and are dramatically softer in comparison to the corresponding regions of the human cornea. Collagen fiber organization is also dramatically different between the two species, with markedly less intertwining observed in the rabbit vs. human cornea. Given that the substratum stiffness considerably alters the corneal cell behavior, keratoprosthetics that incorporate mechanical properties simulating the native human cornea may not elicit optimal cellular performance in rabbit corneas that have dramatically different elastic moduli. These data should allow for the design of substrates that better mimic the biomechanical properties of the corneal cellular environment. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  11. Modelling with a meshfree approach the cornea-aqueous humor interaction during the air puff test.

    Science.gov (United States)

    Montanino, Andrea; Angelillo, Maurizio; Pandolfi, Anna

    2018-01-01

    The air puff test is an in-vivo investigative procedure commonly utilized in ophthalmology to estimate the intraocular pressure. Potentially the test, quick and painless, could be combined with inverse analysis methods to characterize the patient-specific mechanical properties of the human cornea. A rapid localized air jet applied on the anterior surface induces the inward motion of the cornea, that interacts with aqueous humor-the fluid filling the narrow space between cornea and iris-with a strong influence on the dynamics of the cornea. While models of human cornea reproduce accurately patient-specific geometries and have reached a considerable level of complexity in the description of the material, yet scant attention has been paid to the aqueous humor, and no eye models accounting for the physically correct fluid-solid interaction are currently available. The present study addresses this gap by proposing a fluid-structure interaction approach based on a simplified two-dimensional axis-symmetric geometry to simulate the anterior chamber of the eye undergoing the air puff test. We regard the cornea as a membrane described through an analytical model and discretize the fluid with a mesh-free particle approach. The membrane is assumed to be nonlinear elastic and isotropic, and the fluid weakly compressible Newtonian. Numerical analyses reveal a marked influence of the fluid on the dynamics of the cornea. We perform a parametric analysis to assess the quantitative influence of geometrical and material parameters on the mechanical response of the model. Additionally, we investigate the possibility to use the dynamics of the test to estimate the intraocular pressure. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Detection of differentially expressed genes in healing mouse corneas, using cDNA microarrays.

    Science.gov (United States)

    Cao, Zhiyi; Wu, Helen K; Bruce, Amenda; Wollenberg, Kurt; Panjwani, Noorjahan

    2002-09-01

    To identify differentially expressed genes in healing mouse corneas by using cDNA microarrays. Transepithelial excimer laser ablations were performed on mouse corneas, and the wounds were allowed to heal partially in vivo for 18 to 22 hours. Total RNA was isolated from both normal and healing corneas and was used for synthesis of cDNA probes. 33P-labeled exponential cDNA probes were hybridized to mouse cDNA nylon arrays. Of the 1176 genes on the nylon arrays, the expression of 37 was upregulated and that of 27 was downregulated more than fivefold in the healing corneas compared with the normal, uninjured corneas. Interleukin (IL)-1beta, laminin-5, and thrombospondin-1, which have been shown to be upregulated in healing corneas, were all found to be induced in the corneas in response to excimer laser treatment. Many genes were identified for the first time to be differentially regulated during corneal wound healing. Among the upregulated genes were intercellular adhesion molecule (ICAM)-1, macrophage inflammatory proteins, suppressors of cytokine signaling proteins (SOCS), IL-10 receptor, and galectin-7. Among the downregulated genes were connexin-31, a gap junction protein; ZO1 and occludin, tight junction proteins; and Smad2, a key component in the TGFbeta signaling pathway. Microarray data were validated on a limited number of genes by semiquantitative RT-PCR and Western blot analyses. Gene array technology was used to identify for the first time many genes that are differentially regulated during corneal wound healing. These differentially expressed genes have not previously been investigated in the context of wound healing and represent novel factors for further study of the mechanism of wound healing.

  13. Evaluation of the shape symmetry of bilateral normal corneas in a Chinese population.

    Science.gov (United States)

    Bao, Fangjun; Chen, Hao; Yu, Ye; Yu, Jiguo; Zhou, Shi; Wang, Jing; Wang, QinMei; Elsheikh, Ahmed

    2013-01-01

    To investigate the bilateral symmetry of the global corneal topography in normal corneas with a wide range of curvature, astigmatism and thickness values. Cross-Sectional Study. Topography images were recorded for the anterior and posterior surfaces of 342 participants using a Pentacam. Elevation data were fitted to a general quadratic model that considered both translational and rotational displacements. Comparisons between fellow corneas of estimates of corneal shape parameters (elevation, radius in two main directions, Rx and Ry, and corresponding shape factors, Qx and Qy) and corneal position parameters (translational displacements: x0, y0 and z0, and rotational displacements: α, β and γ) were statistically analyzed. The general quadratic model provided average RMS of fit errors with the topography data of 1.7±0.6 µm and 5.7±1.3 µm in anterior and posterior corneal surfaces. The comparisons showed highly significant bilateral correlations with the differences between fellow corneas in Rx, Ry, Qx and Qy of anterior and posterior surfaces remaining insignificantly different from zero. Bilateral differences in elevation measurements at randomly-selected points in both corneal central and peripheral areas indicated strong mirror symmetry between fellow corneas. The mean geometric center (x0, y0, z0) of both right and left corneas was located on the temporal side and inferior-temporal side of the apex in anterior and posterior topography map, respectively. Rotational displacement angle α along X axis had similar distributions in bilateral corneas, while rotation angle β along Y axis showed both eyes tilting towards the nasal side. Further, rotation angle γ along Z axis, which is related to corneal astigmatism, showed clear mirror symmetry. Analysis of corneal topography demonstrated strong and statistically-significant mirror symmetry between bilateral corneas. This characteristic could help in detection of pathological abnormalities, disease diagnosis

  14. Clinical transplantation of individualized recipient serum-adapted cornea reduces the risk of graft rejection after keratoplasty.

    Science.gov (United States)

    Thanos, Solon; Gatzioufas, Zissis; Schallenberg, Maurice; König, Simone; Meyer-Rüsenberg, Hans-Werner; Busse, Holger

    2013-01-01

    Corneal diseases cause severe visual impairment that necessitates corneal transplantation and frequently repetitive procedures due to graft rejection. We tested the hypothesis that exposure of donor corneas to recipient serum-derived factors during eye banking triggers a preoperative adaptation that is beneficial for postoperative tolerance. Donor corneas were incubated in a medium containing human serum (HS) obtained in each case from the prospective graft recipient in order to individually expose the donor cornea to the recipient's serum. All recipient serum-adapted corneas (RSACs) fulfilled the clinical criteria required by the national law and were transplanted successfully. The postoperative ophthalmological examination extended up to 8 years. All RSACs were tolerated by their recipients and did not cause postoperative complications and no rejection. Proteomic analysis of corneas cultivated in culture medium containing either fetal calf serum (FCS) that is routinely used for cornea banking or HS revealed different patterns of proteins. HS-cultured corneas showed a greater proteomic similarity with native human corneas than did the FCS-cultured corneas, indicating a differential nutrification of the cultured corneal tissue by HS-derived factors. The clinical results show for the first time that postoperative complications such as tissue intolerance and graft rejection might be managed if the corneal tissue is individually adapted to the recipient's serum trophic factors. This new donor tissue treatment procedure offers incontrovertible advantages and could be adapted for low-risk eyes as well as other transplantable tissues.

  15. 3D collagen orientation study of the human cornea using X-ray diffraction and femtosecond laser technology.

    Science.gov (United States)

    Abahussin, Mohammad; Hayes, Sally; Knox Cartwright, Nathaniel E; Kamma-Lorger, Christina S; Khan, Yasir; Marshall, John; Meek, Keith M

    2009-11-01

    To study the distribution and predominant orientations of fibrillar collagen at different depths throughout the entire thickness of the human cornea. This information will form the basis of a full three-dimensional reconstruction of the preferred orientations of corneal lamellae. Femtosecond laser technology was used to delaminate the central zones of five human corneas into three separate layers (anterior, mid, and posterior stroma), each with predetermined thicknesses. Wide-angle x-ray diffraction was used to study the gross collagen fibril orientation and distribution within each layer. The middle and posterior parts of the human cornea demonstrated a preferential orthogonal arrangement of collagen fibrils, directed along the superior-inferior and nasal-temporal meridians, with an increase in the number of lamellae toward the periphery. However, the anterior cornea (33% of total corneal thickness) showed no systematic preferred lamellar orientation. In the posterior two thirds of the human cornea, collagen lies predominantly in the vertical and horizontal meridians (directed toward the four major rectus muscles), whereas collagen in the anterior third of the cornea is more isotropic. The predominantly orthogonal arrangement of collagen in the mid and posterior stroma may help to distribute strain in the cornea by allowing it to withstand the pull of the extraocular muscles, whereas the more isotropic arrangement in the anterior cornea may play an important role in the biomechanics of the cornea by resisting intraocular pressure while at the same time maintaining corneal curvature.

  16. Case report: a novel KERA mutation associated with cornea plana and its predicted effect on protein function

    DEFF Research Database (Denmark)

    Roos, Laura; Bertelsen, Birgitte; Harris, Pernille

    2015-01-01

    Background: Cornea plana (CNA) is a hereditary congenital abnormality of the cornea characterized by reduced corneal curvature, extreme hypermetropia, corneal clouding and hazy corneal limbus. The recessive form, CNA2, is associated with homozygous or compound heterozygous mutations...... of the keratocan gene (KERA) on chromosome 12q22. To date, only nine different disease-associated KERA mutations, including four missense mutations, have been described. Case presentation: In this report, we present clinical data from a Turkish family with autosomal recessive cornea plana. In some of the affected......, and this knowledge will ease the interpretation of future findings of mutations in these areas in other families with cornea plana....

  17. Biomechanical profile of the cornea in primary congenital glaucoma.

    Science.gov (United States)

    Gatzioufas, Zisis; Labiris, Georgios; Stachs, Oliver; Hovakimyan, Marine; Schnaidt, Arnulf; Viestenz, Arne; Käsmann-Kellner, Barbara; Seitz, Berthold

    2013-02-01

    The aim of our study was to investigate the biomechanical properties of the cornea in primary congenital glaucoma (PCG) and to identify the potential ocular determinants, which affect the corneal biomechanical metrics. Corneal hysteresis (CH), corneal resistance factor (CRF) and central corneal thickness (CCT) were measured in 26 patients with PCG (40 eyes) with the aid of ocular response analyser. In vivo laser-scanning confocal microscopy was used for the estimation of stromal keratocyte density (KD) and the evaluation of corneal endothelium. Twenty normal subjects (40 eyes) served as controls. Student's t-test and Pearson's correlation coefficients were used for statistical analysis. p Values Corneal hysteresis, CRF and CCT were significantly reduced in patients with PCG (all p Corneal hysteresis and CRF negatively correlated with the corneal diameter in both groups (r(1) = -0.53, r(2) = -0.66, p corneal stroma in patients with PCG (764 ± 162 and 362 ± 112 cells/mm(2) , respectively) compared with controls (979 ± 208 and 581 ± 131 cells/mm(2) , respectively) (p corneal endothelium of patients with PCG.   Our results showed a significant reduction in CH and CRF in PCG. Both CH and CRF were negatively correlated with corneal diameter. A significant correlation of CH and CRF with CCT was identified in both groups. Keratocyte density was decreased in PCG, but did not have a significant impact on CH and CRF. Mean endothelial density was also decreased in PCG. Our results suggest that reduced CCT and increased corneal diameter are major ocular determinants for the modified corneal biomechanical profile in PCG, while cellular alterations in corneal stroma and endothelium have no significant biomechanical impact. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

  18. Topographic and biomechanical evaluation of cornea in patients with acromegaly.

    Science.gov (United States)

    Altinkaynak, Hasan; Duru, Necati; Ersoy, Reyhan; Kalkan Akcay, Emine; Ugurlu, Nagihan; Cagil, Nurullah; Cakir, Bekir

    2015-01-01

    The aim of this study was to compare topographic and biomechanical properties of corneas in patients with acromegaly with those of healthy individuals. Thirty-five patients with acromegaly (study group) and 35 healthy individuals (control group) were enrolled in this prospective study. Topographic measurements, including central corneal thickness (CCT), mean keratometry (K) value, K1, K2, surface asymmetry index, corneal volume (CV), and anterior chamber depth in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius; Costruzione Strumenti Oftalmici). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-corelated intraocular pressure (IOPg) were measured using Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments). Mean CCT, CV, CH, CRF, and IOPg values were higher in acromegalic eyes (549.3 ± 30.2 μm, 59.1 ± 3.1 μm, 11.3 ± 1.2 mm Hg, 11.3 ± 1.2 mm Hg, and 17.5 ± 2.9 mm Hg, respectively) than in healthy eyes (531.4 ± 33.6 μm, 57.4 ± 2.7 μm, 10.4 ± 1.2 mm Hg, 10.2 ± 1.6 mm Hg, and 14.8 ± 3.1 mm Hg, respectively; CCT, P = 0.042; CV, P = 0.032; CH, P = 0.044; CRF, P = 0.035; IOPg, P < 0.001). CCT, CV, CH, CRF, IOPg, and IOP with Goldmann applanation tonometry were significantly higher in acromegalic eyes. These corneal topographic and biomechanical properties, disease duration, and disease status should be considered when planning corneal refractive surgery and determining accurate intraocular pressure in patients with acromegaly.

  19. Use of glycerol-preserved corneas for corneal transplants

    Directory of Open Access Journals (Sweden)

    Neeti Gupta

    2017-01-01

    Full Text Available Purpose: This study was carried out to see the results of glycerol-preserved cornea (GPC in emergency situation when fresh corneal tissue was not available. The aim was to study the outcome of corneal transplantation using GPC. Methods: This was a retrospective study. The medical records of all the patients were reviewed, who underwent keratoplasty using “GPC” during the period from October 2011 to December 2015. The indication of keratoplasty, duration of preservation of the GPC, and its outcome were analyzed. Descriptive statistics were applied. Results: Out of the 222 penetrating keratoplasty (PKP performed over the study period, the GPC was used in 34 patients (males = 31, 91.2% aged 15–74 years. Therapeutic keratoplasty was performed in all cases in this cohort except one in which tectonic keratoplasty was done. The primary indication of PKP (91.2% was infectious keratitis. Of these, 20 (64.5% patients presented with perforated corneal ulcers. Post-PKP, ocular anatomy was preserved in 91.2%, and visual acuity of perception of light positive and accurate projection of rays in all the quadrants was obtained in 76.5% cases. Complications included glaucoma (n = 12, 35.1%, phthisis bulbi (n = 2, 5.9%, and graft reinfection and endophthalmitis after PKP (n = 1, 2.9%. The secondary procedure post-GPC and PKP were trabeculectomy with mitomycin C (n = 7, 58.3% in patients not controlled on topical antiglaucoma medication. Optical keratoplasty was performed in (n = 3 8.8% patients and triple procedure in (n = 2 5.8% patients with good visual acuity postprocedure. Conclusions: Acellular GPCs are useful in emergency keratoplasty to avoid loss of vision and can save the eye.

  20. Use of the frozen section 'jelly-roll' technique to aid in the diagnosis of bullous congenital ichthyosiform erythroderma (epidermolytic hyperkeratosis).

    Science.gov (United States)

    Galler, Blake; Bowen, Casey; Arnold, Jason; Kobayashi, Todd; Dalton, Scott R

    2016-05-01

    Frozen section is a valuable tool that is often underutilized in the setting of in-patient dermatology. Traditionally, frozen section has been used in dermatology to diagnose toxic epidermal necrolysis, with some additional utility in staphylococcal scalded skin syndrome in the new born period. We report a newborn female with ruptured bullae on the face, chest, back and extremities with a clinical differential diagnosis that included staphylococcal scalded skin, bullous congenital ichthyosiform erythroderma/epidermolytic hyperkeratosis and epidermolysis bullosa. A thin detached skin sample ('jelly-roll') taken from a ruptured bulla on the abdomen was prepared for frozen section analysis. Characteristic findings of epidermolytic hyperkeratosis were seen which included hyperkeratosis with granular layer degeneration, vacuolization and eosinophilic globules. The 'jelly-roll' technique can be used for quick diagnosis with minimal trauma to the patient. Epidermolytic hyperkeratosis was subsequently confirmed by a biopsy fixed in formalin and by genetic testing. A novel missense mutation in KRT1 (I479N) was identified. Herein, we discuss the use of the frozen section 'jelly roll' technique for rapid diagnosis in a case of bullous congenital ichthyosis erythroderma/epidermolytic hyperkeratosis. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  1. [Amyopathic dermatomyositis (DM) with anti-MDA5 antibodies, associated with bullous pemphigoid, Sjögren syndrome and gastric MALT lymphoma].

    Science.gov (United States)

    Garcia, B; Dabouz, F; Pascal, L; Gillard, M; Modiano, P

    2017-10-01

    The inflammatory myopathies are a heterogeneous group of muscle diseases and comprise polymyositis, dermatomyositis (DM), myopathies associated with cancers, necrotising myositis and inclusion body myositis. DM occasionally exhibits few or no muscular signs: i.e. hypomyopathic/amyopathic DM. Anti-MDA5 dermatomyositis (DM) is a rare form of dermatomyositis that is frequently amyopathic; the prognosis is linked mainly to pulmonary involvement. A 69-year-old woman treated for mucosa-associated lymphoid tissue (MALT) gastric lymphoma was referred for a bullous eruption. Based on the investigations performed, a diagnosis was made of bullous pemphigoid. At the same time, amyopathic dermatomyositis was discovered together with interstitial lung disease. Systemic steroids were introduced in combination with rituximab. A favourable outcome was achieved. Anti-MDA5 dermatomyositis must be considered systematically in all cases of pulmonary involvement associated with cutaneous signs of dermatomyositis, in which no muscular involvement is generally seen. This condition accounts for up to 7% of DM and carries a severe prognosis due to pulmonary involvement. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Ex vivo rabbit and human corneas as models for bacterial and fungal keratitis.

    Science.gov (United States)

    Pinnock, Abigail; Shivshetty, Nagaveni; Roy, Sanhita; Rimmer, Stephen; Douglas, Ian; MacNeil, Sheila; Garg, Prashant

    2017-02-01

    In the study of microbial keratitis, in vivo animal models often require a large number of animals, and in vitro monolayer cell culture does not maintain the three-dimensional structure of the tissues or cell-to-cell communication of in vivo models. Here, we propose reproducible ex vivo models of single- and dual-infection keratitis as an alternative to in vivo and in vitro models. Excised rabbit and human corneoscleral rims maintained in organ culture were infected using 108 cells of Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans or Fusarium solani. The infection was introduced by wounding with a scalpel and exposing corneas to the microbial suspension or by intrastromal injection. Post-inoculation, corneas were maintained for 24 and 48 h at 37 °C. After incubation, corneas were either homogenised to determine colony-forming units (CFU)/cornea or processed for histological examination using routine staining methods. Single- and mixed-species infections were compared. We observed a significant increase in CFU after 48 h compared to 24 h with S. aureus and P. aeruginosa. However, no such increase was observed in corneas infected with C. albicans or F. solani. The injection method yielded an approximately two- to 100-fold increase (p keratitis, particularly when this might be due to two infective organisms.

  3. Cornea nerve fiber quantification and construction of phenotypes in patients with fibromyalgia.

    Science.gov (United States)

    Oudejans, Linda; He, Xuan; Niesters, Marieke; Dahan, Albert; Brines, Michael; van Velzen, Monique

    2016-03-23

    Cornea confocal microscopy (CCM) is a novel non-invasive method to detect small nerve fiber pathology. CCM generally correlates with outcomes of skin biopsies in patients with small fiber pathology. The aim of this study was to quantify the morphology of small nerve fibers of the cornea of patients with fibromyalgia in terms of density, length and branching and further phenotype these patients using standardized quantitative sensory testing (QST). Small fiber pathology was detected in the cornea of 51% of patients: nerve fiber length was significantly decreased in 44% of patients compared to age- and sex-matched reference values; nerve fiber density and branching were significantly decreased in 10% and 28% of patients. The combination of the CCM parameters and sensory tests for central sensitization, (cold pain threshold, mechanical pain threshold, mechanical pain sensitivity, allodynia and/or windup), yielded four phenotypes of fibromyalgia patients in a subgroup analysis: one group with normal cornea morphology without and with signs of central sensitization, and a group with abnormal cornea morphology parameters without and with signs of central sensitization. In conclusion, half of the tested fibromyalgia population demonstrates signs of small fiber pathology as measured by CCM. The four distinct phenotypes suggest possible differences in disease mechanisms and may require different treatment approaches.

  4. Expression of HGF and c-Met Proteins in Human Keratoconus Corneas

    Directory of Open Access Journals (Sweden)

    Jingjing You

    2015-01-01

    Full Text Available Keratoconus (KC is a progressive degenerative inflammatory-related disease of the human cornea leading to decreased visual function. The pathogenesis of KC remains to be understood. Recent genetic studies indicate that gene variants of an inflammation-related molecule, hepatocyte growth factor (HGF, are associated with an increased susceptibility for developing KC. However HGF protein expression in KC has not been explored. In this initial study, we investigated late-stage KC and control corneas for the expression of HGF and its receptor mesenchymal-epithelial transition factor (c-Met/Met. KC buttons (~8 mm diameter (n=10 and whole control corneas (n=6 were fixed in 10% formalin or 2% paraformaldehyde, paraffin embedded and sectioned. Sections were immunolabelled with HGF and c-Met antibodies, visualised using immunofluorescence, and examined with scanning laser confocal microscopy. Semiquantitative grading was used to compare HGF and c-Met immunostaining in KC and control corneas. Overall, KC corneas showed increased HGF and c-Met immunostaining compared to controls. KC corneal epithelium displayed heterogeneous moderate-to-strong immunoreactivity for HGF and c-Met, particularly in the basal epithelium adjacent to the cone area. Taken together with the recent genetic studies, our results further support a possible role for HGF/c-Met in the pathogenesis of KC.

  5. Expression of HGF and c-Met Proteins in Human Keratoconus Corneas

    Science.gov (United States)

    You, Jingjing; Wen, Li; Roufas, Athena; Hodge, Chris; Sutton, Gerard; Madigan, Michele C.

    2015-01-01

    Keratoconus (KC) is a progressive degenerative inflammatory-related disease of the human cornea leading to decreased visual function. The pathogenesis of KC remains to be understood. Recent genetic studies indicate that gene variants of an inflammation-related molecule, hepatocyte growth factor (HGF), are associated with an increased susceptibility for developing KC. However HGF protein expression in KC has not been explored. In this initial study, we investigated late-stage KC and control corneas for the expression of HGF and its receptor mesenchymal-epithelial transition factor (c-Met/Met). KC buttons (~8 mm diameter) (n = 10) and whole control corneas (n = 6) were fixed in 10% formalin or 2% paraformaldehyde, paraffin embedded and sectioned. Sections were immunolabelled with HGF and c-Met antibodies, visualised using immunofluorescence, and examined with scanning laser confocal microscopy. Semiquantitative grading was used to compare HGF and c-Met immunostaining in KC and control corneas. Overall, KC corneas showed increased HGF and c-Met immunostaining compared to controls. KC corneal epithelium displayed heterogeneous moderate-to-strong immunoreactivity for HGF and c-Met, particularly in the basal epithelium adjacent to the cone area. Taken together with the recent genetic studies, our results further support a possible role for HGF/c-Met in the pathogenesis of KC. PMID:26697215

  6. The structural response of the cornea to changes in stromal hydration

    Science.gov (United States)

    White, Tomas; Boote, Craig; Kamma-Lorger, Christina S.; Bell, James; Sorenson, Thomas; Terrill, Nick; Shebanova, Olga; Meek, Keith M.

    2017-01-01

    The primary aim of this study was to quantify the relationship between corneal structure and hydration in humans and pigs. X-ray scattering data were collected from human and porcine corneas equilibrated with polyethylene glycol (PEG) to varying levels of hydration, to obtain measurements of collagen fibril diameter, interfibrillar spacing (IFS) and intermolecular spacing. Both species showed a strong positive linear correlation between hydration and IFS2 and a nonlinear, bi-phasic relationship between hydration and fibril diameter, whereby fibril diameter increased up to approximately physiological hydration, H = 3.0, with little change thereafter. Above H = 3.0, porcine corneas exhibited a larger fibril diameter than human corneas (p hydration in a bi-phasic manner but reached a maximum value at a lower hydration (H = 1.5) than fibril diameter. Human corneas displayed a higher intermolecular spacing than porcine corneas at all hydrations (p hydration, suggesting that the total fixed charge that gives rise to the swelling pressure is the same. The difference in their structural responses to hydration can be explained by variations in molecular cross-linking and intra/interfibrillar water partitioning. PMID:28592658

  7. Distribution of types I, II, III, IV and V collagen in normal and keratoconus corneas.

    Science.gov (United States)

    Nakayasu, K; Tanaka, M; Konomi, H; Hayashi, T

    1986-01-01

    By using type-specific antibodies to types I, II, III, IV and V collagens, distribution of distinct types of collagen in normal human cornea as well as keratoconus cornea were examined by indirect immunofluorescence microscopy. In normal human cornea, immunohistochemical evidence supported the previous biochemical finding that type I collagen was the major type of collagen in human corneal stroma. No reaction was observed to anti-type II collagen antibody in the whole cornea. Anti-type III collagen antibody reacted with the corneal stroma in a similar fashion as that of anti-type I collagen antibody. Type IV collagen was observed in the basement membrane of the corneal epithelium and in Descemet's membrane. Anti-type V collagen antibody also reacted with the corneal stroma diffusely. Bowman's membrane was strongly stained only with he anti-type V collagen antibody. For further details of the distribution of type I, type III and V collagens in human corneal stroma, immunoelectron microscopic study was undertaken. The positive reaction products of anti-type I and anti-type III collagen antibodies were located on the collagen fibrils, while that of anti-type V collagen antibody was either on or close to collagen fibrils. In keratoconus cornea, no difference was observed in terms of the distribution of type I, III and V collagens, while the disruptive and excrescent distribution of type IV collagen was noted in the basement membrane of the corneal epithelium.

  8. Development of a reconstructed cornea from collagen-chondroitin sulfate foams and human cell cultures.

    Science.gov (United States)

    Vrana, N Engin; Builles, Nicolas; Justin, Virginie; Bednarz, Jurgen; Pellegrini, Graziella; Ferrari, Barbara; Damour, Odile; Hulmes, David J S; Hasirci, Vasif

    2008-12-01

    To develop an artificial cornea, the ability to coculture the different cell types present in the cornea is essential. Here the goal was to develop a full-thickness artificial cornea using an optimized collagen-chondroitin sulfate foam, with a thickness close to that of human cornea, by coculturing human corneal epithelial and stromal cells and transfected human endothelial cells. Corneal extracellular matrix was simulated by a porous collagen/glycosaminoglycan-based scaffold seeded with stromal keratocytes and then, successively, epithelial and endothelial cells. Scaffolds were characterized for bulk porosity and pore size distribution. The performance of the three-dimensional construct was studied by histology, immunofluorescence, and immunohistochemistry. The scaffold had 85% porosity and an average pore size of 62.1 microm. Keratocytes populated the scaffold and produced a newly synthesized extracellular matrix as characterized by immunohistochemistry. Even though the keratocytes lost their CD34 phenotype marker, the absence of smooth muscle actin fibers showed that these cells had not differentiated into myofibroblasts. The epithelial cells formed a stratified epithelium and began basement membrane deposition. An endothelial cell monolayer beneath the foam was also apparent. These results demonstrate that collagen-chondroitin sulfate scaffolds are good substrates for artificial cornea construction with good resilience, long-term culture capability, and handling properties.

  9. Corneal collagen cross-linking: a confocal, electron, and light microscopy study of eye bank corneas.

    Science.gov (United States)

    Dhaliwal, Jasmeet S; Kaufman, Stephen C

    2009-01-01

    The purpose of this study was to evaluate morphological changes induced by corneal collagen cross-linking in a human ex vivo cornea, using confocal, electron, and light microscopy. The central epithelium was partially removed from ex vivo human corneal buttons. Riboflavin 0.1% solution was applied before ultraviolet A light treatment and then for every 2 minutes for 30 minutes while the corneas were exposed to ultraviolet A light at a wavelength of 370 nm and intensity of 3 mW/cm(2). Each cornea was evaluated using confocal, electron, and light microscopy. Confocal microscopy demonstrated normal-appearing corneas on their initial pretreatment examination, with reduced stromal detail. After treatment, a superficial layer of highly reflective spherical structures (4-10 microm) was observed. Many of these hyperreflective structures appeared up to a depth of 300 microm. The remainder of the corneal stroma and endothelium appeared normal. Electron microscopy showed keratocyte apoptotic changes to a depth of 300 microm. No observable pathologic changes were seen on histology. Based on clinical studies, corneal cross-linking is a promising treatment that appears to be safe and to halt ectatic corneal disease progression. Initial European studies used animal models to extrapolate human protocols. In conjunction with clinical studies, we believe that human ex vivo corneal studies provide a means to evaluate the structural and morphological changes associated with this procedure, within human corneas, in a manner that cannot be accomplished in vivo.

  10. Prevalence and Associations of Steep Cornea/Keratoconus in Greater Beijing. The Beijing Eye Study

    Science.gov (United States)

    Xu, Liang; Wang, Ya Xing; Guo, Yin; You, Qi Sheng; Jonas, Jost B.

    2012-01-01

    Purpose To evaluate the prevalence and associated factors of steep cornea/keratoconus in the adult Chinese population. Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50–93 years). A detailed ophthalmic examination was performed including optical low-coherence reflectometry. Steep cornea/keratoconus were defined as an anterior corneal refractive power exceeding 48 diopters. Results Mean refractive power of the cornea was 43.16±1.45 diopters (range: 36.51 to 48.46 diopters; flattest meridian) and 43.98±1.52 diopters (range: 37.00 to 52.88 diopters; steepest meridian). A steep cornea/keratoconus defined as corneal refractive power of ≥48 diopters and ≥49 diopters was detected in 27 subjects (prevalence rate: 0.9±0.2%) and 6 (0.2± 0.1%) subjects, respectively. Presence of steep cornea/keratoconus was associated with shorter axial length (Pkeratoconus defined as corneal refractive power of 48+ diopters has a prevalence of 0.9±0.2% among Chinese aged 50 years and above. Its prevalence was significantly associated with the ocular parameters of shorter axial length, smaller interpupillary distance, higher cylindrical and myopic refractive error and lower best corrected visual acuity, however, with none of the systemic parameters tested. PMID:22792169

  11. Quantification of collagen organization in the peripheral human cornea at micron-scale resolution.

    Science.gov (United States)

    Boote, Craig; Kamma-Lorger, Christina S; Hayes, Sally; Harris, Jonathan; Burghammer, Manfred; Hiller, Jennifer; Terrill, Nicholas J; Meek, Keith M

    2011-07-06

    The collagen microstructure of the peripheral cornea is important in stabilizing corneal curvature and refractive status. However, the manner in which the predominantly orthogonal collagen fibrils of the central cornea integrate with the circumferential limbal collagen is unknown. We used microfocus wide-angle x-ray scattering to quantify the relative proportion and orientation of collagen fibrils over the human corneolimbal interface at intervals of 50 μm. Orthogonal fibrils changed direction 1-1.5 mm before the limbus to integrate with the circumferential limbal fibrils. Outside the central 6 mm, additional preferentially aligned collagen was found to reinforce the cornea and limbus. The manner of integration and degree of reinforcement varied significantly depending on the direction along which the limbus was approached. We also employed small-angle x-ray scattering to measure the average collagen fibril diameter from central cornea to limbus at 0.5 mm intervals. Fibril diameter was constant across the central 6 mm. More peripherally, fibril diameter increased, indicative of a merging of corneal and scleral collagen. The point of increase varied with direction, consistent with a scheme in which the oblique corneal periphery is reinforced by chords of scleral collagen. The results have implications for the cornea's biomechanical response to ocular surgeries involving peripheral incision. Copyright © 2011 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  12. Quantification of Collagen Organization in the Peripheral Human Cornea at Micron-Scale Resolution

    Science.gov (United States)

    Boote, Craig; Kamma-Lorger, Christina S.; Hayes, Sally; Harris, Jonathan; Burghammer, Manfred; Hiller, Jennifer; Terrill, Nicholas J.; Meek, Keith M.

    2011-01-01

    The collagen microstructure of the peripheral cornea is important in stabilizing corneal curvature and refractive status. However, the manner in which the predominantly orthogonal collagen fibrils of the central cornea integrate with the circumferential limbal collagen is unknown. We used microfocus wide-angle x-ray scattering to quantify the relative proportion and orientation of collagen fibrils over the human corneolimbal interface at intervals of 50 μm. Orthogonal fibrils changed direction 1–1.5 mm before the limbus to integrate with the circumferential limbal fibrils. Outside the central 6 mm, additional preferentially aligned collagen was found to reinforce the cornea and limbus. The manner of integration and degree of reinforcement varied significantly depending on the direction along which the limbus was approached. We also employed small-angle x-ray scattering to measure the average collagen fibril diameter from central cornea to limbus at 0.5 mm intervals. Fibril diameter was constant across the central 6 mm. More peripherally, fibril diameter increased, indicative of a merging of corneal and scleral collagen. The point of increase varied with direction, consistent with a scheme in which the oblique corneal periphery is reinforced by chords of scleral collagen. The results have implications for the cornea's biomechanical response to ocular surgeries involving peripheral incision. PMID:21723812

  13. Localization of type XII collagen in normal and healing rabbit cornea by in situ hybridization.

    Science.gov (United States)

    Zhan, Q; Burrows, R; Cintron, C

    1995-05-01

    To identify the cell types responsible for type XII collagen synthesis in normal and healing rabbit cornea, a partial cDNA sequence of rabbit type XII collagen, obtained from an adult rabbit cornea cDNA library, was used to develop highly specific oligonucleotide probes for Northern blot analysis and in situ hybridization. Approximately 2000 bases of a type XII collagen 2.2 kb cDNA clone were sequenced. Comparative sequence analysis of the bases showed a 74% identity with chick alpha 1 (XII) chain of type XII collagen. The deduced amino acid sequence indicated a 72% identity with chick type XII collagen. Northern blot analysis showed that cultures of cornea stromal and endothelial cells each contain two RNA species, greater than 10 kb, that hybridize to rabbit type XII collagen oligonucleotide probes. Although normal stromal cells failed to show type XII collagen mRNA, normal endothelial cells contain mRNA for this collagen. These results indicate that endothelium of normal rabbit cornea has a potential to synthesize type XII collagen. During corneal wound healing, both endothelium-derived and stroma-derived cells in the developing scar tissue contained type XII mRNA. In view of the known presence of type XII collagen in corneal stromas from chick and mouse, the distribution of mRNA in normal cornea is puzzling.

  14. Cholesterol biosynthesis by the cornea. Comparison of rates of sterol synthesis with accumulation during early development

    Energy Technology Data Exchange (ETDEWEB)

    Cenedella, R.J.; Fleschner, C.R. (Kirksville College of Osteopathic Medicine, MO (USA))

    1989-07-01

    The origin of the cholesterol needed by the cornea for growth and cell turnover was addressed by comparing absolute rates of sterol synthesis with rates of sterol accumulation during early development of the rabbit. Linearity of incorporation of {sup 3}H{sub 2}O and ({sup 14}C)mevalonate into digitonin-precipitable sterols with time of incubation in vitro and a lack of accumulation of {sup 14}C in intermediates of sterol biosynthesis indicated that tritiated water can validly be used to measure rates of sterol synthesis by the cornea. The rate of sterol synthesis per unit weight of rabbit cornea was constant between 14 and 60 days of age at an average 1.03 nmol of {sup 3}H of {sup 3}H{sub 2}O incorporated/mg dry cornea per 8 h. Essentially all of the synthesized cholesterol and most of the cholesterol mass was present in corneal epithelium. The cumulative sterol synthesized over the 46-day period studied exceeded the observed rate of cholesterol accumulation by sixfold. Cholesterol synthesized in excess of the growth requirement was likely used to support turnover of the epithelium which was estimated at 9 days. Removal of cholesterol from the cornea by excretion into tear fluid and clearance by high density lipoproteins are also considered.

  15. Transient Ingrowth of Lymphatic Vessels into the Physiologically Avascular Cornea Regulates Corneal Edema and Transparency.

    Science.gov (United States)

    Hos, Deniz; Bukowiecki, Anne; Horstmann, Jens; Bock, Felix; Bucher, Franziska; Heindl, Ludwig M; Siebelmann, Sebastian; Steven, Philipp; Dana, Reza; Eming, Sabine A; Cursiefen, Claus

    2017-08-03

    Lymphangiogenesis is essential for fluid homeostasis in vascularized tissues. In the normally avascular cornea, however, pathological lymphangiogenesis mediates diseases like corneal transplant rejection, dry eye disease, and allergy. So far, a physiological role for lymphangiogenesis in a primarily avascular site such as the cornea has not been described. Using a mouse model of perforating corneal injury that causes acute and severe fluid accumulation in the cornea, we show that lymphatics transiently and selectively invade the cornea and regulate the resolution of corneal edema. Pharmacological blockade of lymphangiogenesis via VEGFR-3 inhibition results in increased corneal thickness due to delayed drainage of corneal edema and a trend towards prolonged corneal opacification. Notably, lymphatics are also detectable in the cornea of a patient with acute edema due to spontaneous Descemet´s (basement) membrane rupture in keratoconus, mimicking this animal model and highlighting the clinical relevance of lymphangiogenesis in corneal fluid homeostasis. Together, our findings provide evidence that lymphangiogenesis plays an unexpectedly beneficial role in the regulation of corneal edema and transparency. This might open new treatment options in blinding diseases associated with corneal edema and transparency loss. Furthermore, we demonstrate for the first time that physiological lymphangiogenesis also occurs in primarily avascular sites.

  16. Biomechanical Changes of Collagen Cross-Linking on Human Keratoconic Corneas Using Scanning Acoustic Microscopy.

    Science.gov (United States)

    Beshtawi, Ithar M; Akhtar, Riaz; Hillarby, M Chantal; O'Donnell, Clare; Zhao, Xuegen; Brahma, Arun; Carley, Fiona; Derby, Brian; Radhakrishnan, Hema

    2016-05-01

    To assess the biomechanical changes of collagen cross-linking on keratoconic corneas in vitro. Six keratoconic corneal buttons were included in this study. Each cornea was divided into two halves, where one half was cross-linked and the other half was treated with riboflavin only and served as control. The biomechanical changes of the corneal tissue were measured across the stroma using scanning acoustic microscopy (SAM). In the cross-linked corneas, there was a steady decrease in the magnitude of speed of sound from the anterior region through to the posterior regions of the stroma. The speed of sound was found to decrease slightly across the corneal thickness in the control corneas. The increase in speed of sound between the cross-linked and control corneas in the anterior region was by a factor of 1.039×. A higher speed of sound was detected in cross-linked keratoconic corneal tissue when compared with their controls, using SAM. This in vitro model can be used to compare to the cross-linking results obtained in vivo, as well as comparing the results obtained with different protocols.

  17. Sorption of sodium hydroxide by type I collagen and bovine corneas.

    Science.gov (United States)

    Whikehart, D R; Edwards, W C; Pfister, R R

    1991-01-01

    There are no quantitative studies on the uptake of alkali into corneal tissues. To study this phenomenon, both type I collagen and bovine corneas were incubated in sodium hydroxide (NaOH) under varying conditions for periods up to 27.5 h. The sorption (absorption or adsorption) of the alkali to protein and tissue was measured as the quantity of NaOH no longer available for titration to neutrality with hydrochloric acid. Sorption was found to be dependent on the concentration of NaOH (0.01-1 N) but independent of the incubation temperature (4-35 degrees C). In whole cornea, sorption of 1 N NaOH began immediately and increased with time up to 6 h. After 6 h, sorption decreased, together with the observed degradation and solubilization of the tissue. Stripping of the corneal endothelium alone or of the endothelium and epithelium increased sorption in a similar manner when compared to whole corneas for periods up to 4 h. These observations are compatible with ionic and nonionic bonding of hydroxide ions to collagen (including that of the cornea) and the subsequent release of hydroxide ions during hydrolysis of the protein itself. Indirect evidence also suggests the inclusion of quantities of unbound hydroxide ions in hydrated gels of glycosaminoglycans. It is proposed that in a chemical burn of the cornea, alkali is both stored in the tissue (by sorption) and reacted with it (by hydrolysis), without any net consumption of alkali taking place.

  18. Keratoconus prediction using a finite element model of the cornea with local biomechanical properties.

    Science.gov (United States)

    Carvalho, Luis Alberto; Prado, Marcelo; Cunha, Rodivaldo H; Costa Neto, Alvaro; Paranhos, Augusto; Schor, Paulo; Chamon, Wallace

    2009-01-01

    The ability to predict and understand which biomechanical properties of the cornea are responsible for the stability or progression of keratoconus may be an important clinical and surgical tool for the eye-care professional. We have developed a finite element model of the cornea, that tries to predict keratoconus-like behavior and its evolution based on material properties of the corneal tissue. Corneal material properties were modeled using bibliographic data and corneal topography was based on literature values from a schematic eye model. Commercial software was used to simulate mechanical and surface properties when the cornea was subject to different local parameters, such as elasticity. The simulation has shown that, depending on the corneal initial surface shape, changes in local material properties and also different intraocular pressures values induce a localized protuberance and increase in curvature when compared to the remaining portion of the cornea. This technique provides a quantitative and accurate approach to the problem of understanding the biomechanical nature of keratoconus. The implemented model has shown that changes in local material properties of the cornea and intraocular pressure are intrinsically related to keratoconus pathology and its shape/curvature.

  19. The influence of the geometry of the porcine cornea on the biomechanical response of inflation tests.

    Science.gov (United States)

    Pandolfi, Anna; Boschetti, Federica

    2015-01-01

    To withstand the high probability of success, the growing diffusion of laser surgery for the correction of visual defects, corneal surgeons are regarding with interest numerical tools able to provide reliable predictions of the intervention outcomes. The main obstacle to the definition of a predictive numerical instrument is the objective difficulty in evaluating the in vivo mechanical properties of the human cornea. In this study, we assess the ability of a parametrised numerical model of the cornea (Pandolfi and Manganiello 2006) to describe individual pressurisation tests on whole porcine corneas once the mechanical parameters of the model have been calibrated over average data. We also aim at estimating the sensitivity of the mechanical response with the variation of basic geometrical parameters, such as the central corneal thickness, the curvature and the in-plane diameter. We conclude that the actual geometry of a cornea has a minor role in the overall mechanical response, and therefore the material properties must be considered carefully and individually in any numerical application. This study makes use of the data obtained from a wide experimental program, where a set of 21 porcine corneas has been fully characterised in terms of mechanical and geometrical properties (Boschetti et al. 2012).

  20. Optical coherence tomography analysis of hydrofluoric acid decontamination of human cornea by mannitol solution.

    Science.gov (United States)

    Nosé, Ricardo M; Daga, Fabio B; Nosé, Walton; Kasahara, Niro

    2017-03-01

    To evaluate the efficacy of mannitol solution as a decontamination agent on the chemical burn of the human corneas. Eight donor corneas from an eye bank were exposed to 25μl of 2.5% hydrofluoric acid (HF) solution on a filter paper for 20s. Three eyes were rinsed with 1000ml of mannitol 20% for 15min immediately after removal of the filter paper, 3 other were rinsed with sodium chloride (NaCl) 0.9% (1000ml for 15min) and two eyes were not rinsed. Microstructural changes were monitored in the time domain by optical coherence tomography (OCT) imaging for 75min. NaCl reduced the penetration depth to approximately half the thickness of the cornea at 15min; scattering within the anterior cornea was higher than that for the unrinsed eye. With mannitol, no increased scattering was observed in the posterior part of the corneal stroma within a time period of 1h after rinsing. OCT images revealed low-scattering intensity within the anterior stroma at the end of the rinsing period. In eye bank human corneas, mannitol proved to be an efficient agent to decontaminate HF burn. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  1. Raman Microscopy: A Noninvasive Method to Visualize the Localizations of Biomolecules in the Cornea.

    Science.gov (United States)

    Kaji, Yuichi; Akiyama, Toshihiro; Segawa, Hiroki; Oshika, Tetsuro; Kano, Hideaki

    2017-11-01

    In vivo and in situ visualization of biomolecules without pretreatment will be important for diagnosis and treatment of ocular disorders in the future. Recently, multiphoton microscopy, based on the nonlinear interactions between molecules and photons, has been applied to reveal the localizations of various molecules in tissues. We aimed to use multimodal multiphoton microscopy to visualize the localizations of specific biomolecules in rat corneas. Multiphoton images of the corneas were obtained from nonlinear signals of coherent anti-Stokes Raman scattering, third-order sum frequency generation, and second-harmonic generation. The localizations of the adhesion complex-containing basement membrane and Bowman layer were clearly visible in the third-order sum frequency generation images. The fine structure of type I collagen was observed in the corneal stroma in the second-harmonic generation images. The localizations of lipids, proteins, and nucleic acids (DNA/RNA) was obtained in the coherent anti-Stokes Raman scattering images. Imaging technologies have progressed significantly and been applied in medical fields. Optical coherence tomography and confocal microscopy are widely used but do not provide information on the molecular structure of the cornea. By contrast, multiphoton microscopy provides information on the molecular structure of living tissues. Using this technique, we successfully visualized the localizations of various biomolecules including lipids, proteins, and nucleic acids in the cornea. We speculate that multiphoton microscopy will provide essential information on the physiological and pathological conditions of the cornea, as well as molecular localizations in tissues without pretreatment.

  2. Inhibition of matrix metalloproteins 9 attenuated Candida albicans induced inflammation in mouse cornea.

    Science.gov (United States)

    Dong, C; Yang, M G

    2016-10-31

    Since the severe corneal ulceration of mouse cornea is known to occur with inflammation. As one of imperative matrix metalloproteinase, the potential roles of matrix metalloproteins 9 (MMP9) in corneal ulceration and keratitis are still unveiled caused by fungal invasion. In this study, Candida albicans (CA) inoculated wild-type KM mice cornea was used as a model pathogen in corneal inflammation.  CA invasion significantly stimulated the expression of collagen IV and MMP9 detected by RT-PCR, Real-time PCR and Immunofluorescent staining in mouse cornea as soon as 6 hours post infection, and relatively decreased at 1 day post infection. For examining the role of MMP9 in fungal keratitis, the mice corneas were subconjunctivally injected MMP9 antibody or recombinant MMP9 protein 6 hours prior to CA inoculation, using rabbit IgG as control. Subconjunctival injection of recombinant MMP9 protein prior to CA inoculation enhanced, whereas MMP9 antibody attenuated corneal ulceration and inflammation, examining basement membrane, fungal load, myeloperoxidase (MPO) and proinflammatory cytokines including Macrophage inflammatory protein 2 (MIP2), Interleukin-1β (IL-1β) and Tumor necrosis factor-α (TNF-α). Inhibition of MMP9 could potentially attenuate Candida albicans induced inflammation in mouse cornea.

  3. Comparable change in stromal refractive index of cat and human corneas following blue-IRIS

    Science.gov (United States)

    Wozniak, Kaitlin T.; Gearhart, Sara M.; Savage, Daniel E.; Ellis, Jonathan D.; Knox, Wayne H.; Huxlin, Krystel R.

    2017-05-01

    Blue intratissue refractive index shaping (blue-IRIS) is a method with potential to correct ocular refraction noninvasively in humans. To date, blue-IRIS has only ever been applied to cat corneas and hydrogels. To test the comparability of refractive index change achievable in cat and human tissues, we used blue-IRIS to write identical phase gratings in ex vivo feline and human corneas. Femtosecond pulses (400 nm) were focused ˜300 μm below the epithelial surface of excised cat and human corneas and scanned to write phase gratings with lines ˜1 μm wide, spaced 5 μm apart, using a scan speed of 5 mm/s. Additional cat corneas were used to test writing at 3 and 7 mm/s in order to document speed dependence of the refractive index change magnitude. The first-order diffraction efficiency was immediately measured and used to calculate the refractive index change attained. Our data show that blue-IRIS induces comparable refractive index changes in feline and human corneas, an essential requirement for further developing its use as a clinical vision correction technique.

  4. Anti-collagen XVII single-chain Fv antibody blocks the autoimmune reaction mediated by pathogenic autoantibodies in bullous pemphigoid.

    Science.gov (United States)

    Wu, Yan; Sun, Na-Na; Dang, Er-Le; Jin, Liang; Liu, Zhen-Feng; Zhang, Wei; Yang, Lu-Ting; Wang, Gang

    2013-10-01

    Pathogenic autoantibodies in bullous pemphigoid (BP) recognize the non-collagenous 16A domain (NC16A) of collagen XVII (COL17), a hemidesmosomal component at the skin membrane. This immune inflammation involves activation of the complement cascade via the classical pathway. With similar antigen binding activity, Fab and single-chain variable fragments (scFv) of pathogenic anti-COL17 antibodies can interfere with COL17 binding of autoantibodies, blocking subsequent complement activation and granulocyte activation. To characterize the biological functions of human anti-COL17 scFv antibody. We constructed scFv antibodies against the corresponding antigen from parental Fab by expression in Escherichia coli. IgG autoantibodies against COL17 were purified by affinity chromatography from serum of BP patients. The inhibitory effects of anti-COL17 scFv on binding of BP autoantibodies to the NC16A domain of human COL17 antigen were observed by inhibition ELISA, immunofluorescence, and inhibition of complement activation. Reactive oxygen production assay and BP cryosection model were performed to assess the inhibitory effect of scFv on granulocyte activation and then the dermal-epidermal separation. ELISA and Western blot showed specific binding of scFv to COL17. We found that anti-COL17 scFv can inhibit the binding of intact IgG purified from BP parents to the corresponding COL17 antigen and then subsequent C1q and C3 activation and granulocyte activation in vitro. Most importantly, we confirmed that recombinant scFv can inhibit BP-IgG induced dermal-epidermal separation by BP cryosection model. The anti-COL17 scFv antibody can inhibit the binding of BP-IgG autoantibodies to COL17, thereby affecting subsequent complement activation and granulocyte activation in vitro. Our results suggest that blocking pathogenic epitopes using engineered scFv is an efficient BP therapy. Copyright © 2013 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All

  5. Interferometric technique to measure biomechanical changes in the cornea induced by refractive surgery.

    Science.gov (United States)

    Jaycock, Philip David; Lobo, Leon; Ibrahim, Jamal; Tyrer, John; Marshall, John

    2005-01-01

    To develop a technique to quantify biomechanical changes in the cornea after microkeratome incisions as would be performed in laser in situ keratomileusis. St Thomas' Hospital, London, and the Wolfson School of Mechanical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom. Corneal displacements of whole sheep eyes were studied under hydrostatic loading using electronic speckle pattern interferometry before and after microkeratome incisions. After hydrostatic loading, there was a 20.7% increase in corneal displacement in corneas with microkeratome incisions compared to unoperated corneas; this was statistically significant (P=.0068, unpaired t test). Results show that in the formation of the microkeratome flap, collagen fibers are severed and minimal biomechanical loading is distributed through the flap. Corneal biomechanical integrity is compromised after microkeratome incisions.

  6. Air-pulse OCE for assessment of age-related changes in mouse cornea in vivo

    Science.gov (United States)

    Li, Jiasong; Wang, Shang; Singh, M.; Aglyamov, S.; Emelianov, S.; Twa, M. D.; Larin, K. V.

    2014-06-01

    We demonstrate the use of phase-stabilized swept source optical coherence elastography (PhS-SSOCE) to assess the relaxation rate of deformation created by a focused air-pulse in tissue-mimicking gelatin phantoms of various concentrations and mouse corneas of different ages in vivo. The results show that the relaxation rate can be quantified and is different for gels with varying concentrations of gelatin and mouse corneas of different ages. The results indicate that gel phantoms with higher concentrations of gelatin as well as older mouse corneas have faster relaxation rates indicating stiffer material. This non-contact and non-invasive measurement technique utilizes low surface displacement amplitude (in µm scale) for tissue excitation and, therefore, can be potentially used to study the biomechanical properties of ocular and other sensitive tissues.

  7. The monoclonal antibody GRC1 produced against human cornea recognizes a common determinant of collagen.

    Science.gov (United States)

    Lopez Nevot, M A; Cardona, L; Doblaré, E; Muñoz, C; Ruiz-Cabello, F; Garrido, F

    1990-02-01

    The monoclonal antibody GRC1 was obtained by immunizing BALB/c mice with human cornea. Screening was performed by indirect immunofluorescence in cryostatic sections of several tissues: cornea, skin, placenta, hyaline cartilage, blood vessels, and nerves. GRC1 was seen to recognize fibrillar structures in all of these tissues. The pattern of reaction was interstitial and membranous. On cornea, GRC1 reacts definitely with Bowman's membrane and diffusely with the stroma, while on skin it shows strongly positive reactivity with the papillary dermis and with the basement membrane. It also reacts on hyaline cartilage at the periphery of the condrocytic lacunae. These immunohistologic results suggest that GRC1 recognized human collagen. In order to investigate further the subtype of collagen defined by GRC1, an ELISA was performed with purified collagens of several types: I, II, III, IV, and V. The monoclonal antibody GRC1 defines a common determinant in types III, IV, and V.

  8. Intra-Ocular Pressure Measurement in a Patient with a Thin, Thick or Abnormal Cornea

    Science.gov (United States)

    Clement, Colin I.; Parker, Douglas G.A.; Goldberg, Ivan

    2016-01-01

    Accurate measurement of intra-ocular pressure is a fundamental component of the ocular examination. The most common method of measuring IOP is by Goldmann applanation tonometry, the accuracy of which is influenced by the thickness and biomechanical properties of the cornea. Algorithms devised to correct for corneal thickness to estimate IOP oversimplify the effects of corneal biomechanics. The viscous and elastic properties of the cornea influence IOP measurements in unpredictable ways, a finding borne out in studies of patients with inherently abnormal and surgically altered corneal biomechanics. Dynamic contour tonometry, rebound tonometry and the ocular response analyzer provide useful alternatives to GAT in patients with abnormal corneas, such as those who have undergone laser vision correction or keratoplasty. This article reviews the various methods of intra-ocular pressure measurement available to the clinician and the ways in which their utility is influenced by variations in corneal thickness and biomechanics. PMID:27014386

  9. Second Harmonic Generation Imaging Analysis of Collagen Arrangement in Human Cornea.

    Science.gov (United States)

    Park, Choul Yong; Lee, Jimmy K; Chuck, Roy S

    2015-08-01

    To describe the horizontal arrangement of human corneal collagen bundles by using second harmonic generation (SHG) imaging. Human corneas were imaged with an inverted two photon excitation fluorescence microscope. The excitation laser (Ti:Sapphire) was tuned to 850 nm. Backscatter signals of SHG were collected through a 425/30-nm bandpass emission filter. Multiple, consecutive, and overlapping image stacks (z-stacks) were acquired to generate three dimensional data sets. ImageJ software was used to analyze the arrangement pattern (irregularity) of collagen bundles at each image plane. Collagen bundles in the corneal lamellae demonstrated a complex layout merging and splitting within a single lamellar plane. The patterns were significantly different in the superficial and limbal cornea when compared with deep and central regions. Collagen bundles were smaller in the superficial layer and larger in deep lamellae. By using SHG imaging, the horizontal arrangement of corneal collagen bundles was elucidated at different depths and focal regions of the human cornea.

  10. Analysis of holographic interferograms of the expanded cornea after refractive surgery procedure

    Science.gov (United States)

    Kasprzak, Henryk T.; Jaronski, Jaroslaw W.; Foerster, Werner; von Bally, Gert

    1994-12-01

    The paper presents results of holographic experiments of expanding bovine cornea in vitro, after different refractive surgery procedure (keratoplasty). The corneas of fresh, enucleated bovine eyes were subjected to different refractive procedures, such as: radial and tangential incisions, mechanical ablation of the corneal layers as well as ablation by means of excimer laser. After keratoplasty, the eyeball was placed into the holographic set-up and the needle connected to a pressure meter was inserted into the anterior chamber of the eye. Double exposure, as well as real time holographic interferograms of expanding corneas were recorded by means of photothermoplastic camera, due to small intraocular pressure differences in order of a few Pa. The holographic interferograms were stored and processed in the computer memory by use of CCD camera and the image processing board. Quantitative results are presented in the form of a 3-D surface plot of the displacement vectors of the corneal surface and respective changes of the corneal curvature.

  11. Utility of Assessing Nerve Morphology in Central Cornea Versus Whorl Area for Diagnosing Diabetic Peripheral Neuropathy.

    Science.gov (United States)

    Pritchard, Nicola; Dehghani, Cirous; Edwards, Katie; Burgin, Edward; Cheang, Nick; Kim, Hannah; Mikhaiel, Merna; Stanton, Gemma; Russell, Anthony W; Malik, Rayaz A; Efron, Nathan

    2015-07-01

    To compare small nerve fiber damage in the central cornea and whorl area in participants with diabetic peripheral neuropathy (DPN) and to examine the accuracy of evaluating these 2 anatomical sites for the diagnosis of DPN. A cohort of 187 participants (107 with type 1 diabetes and 80 controls) was enrolled. The neuropathy disability score (NDS) was used for the identification of DPN. The corneal nerve fiber length at the central cornea (CNFLcenter) and whorl (CNFLwhorl) was quantified using corneal confocal microscopy and a fully automated morphometric technique and compared according to the DPN status. Receiver operating characteristic analyses were used to compare the accuracy of the 2 corneal locations for the diagnosis of DPN. CNFLcenter and CNFLwhorl were able to differentiate all 3 groups (diabetic participants with and without DPN and controls) (P cornea. Quantification of CNFL from the corneal center is as accurate as CNFL quantification of the whorl area for the diagnosis of DPN.

  12. Study of noncontact air-puff applanation tonometry IOP measurement on irregularly-shaped corneas

    Science.gov (United States)

    Wang, Wai W.; Wang, Kuo-Jen; Tsai, Che-Liang; Wang, I.-Jong

    2017-04-01

    Abnormal corneas with corneal tissue defects like ulceration, melting, laceration, thinning scar, keratoconus etc., poses special challenges for ophthalmologist to measure intraocular pressure (IOP) correctly using air-puff noncontact applanation tonometry. Here, we propose an novel model, Abnormal Applanation IOP Model (AAIOP), to simulate IOP in these abnormal corneas on an air-puff noncontact applanation tonometry system, and the simulated IOP results are correctly fit in those of IOP measured database on human eyes of 91,024 patients (174,666 eyes)1). Our simulated IOP indicates that every 10 μm of central corneal thickness change results in 0.36 mmHg of IOP change. Using our simulation model, the IOP on abnormal eyes with irregularly-shaped corneas can be correctly expected and reported.

  13. Systematic assessment of microneedle injection into the mouse cornea

    Directory of Open Access Journals (Sweden)

    Matthaei Mario

    2012-06-01

    Full Text Available Abstract Background Corneal intrastromal injection is an important mode of gene-vector application to subepithelial layers. In a mouse model, this procedure is substantially complicated by the reduced corneal dimensions. Furthermore, it may be difficult to estimate the corneal area reached by the volume of a single injection. This study aimed to investigate intrastromal injections into the mouse cornea using different microneedles and to quantify the effect of injecting varying volumes. A reproducible injection technique is described. Methods Forty eyes of 20 129 Sv/J mice were tested. India ink was intrastromally injected using 30° beveled 33 G needles, tri-surface 25° beveled 35 G needles, or hand-pulled and 25° beveled glass needles. Each eye received a single injection of a volume of 1 or 2 μL. Corneoscleral buttons were fixed and flat mounted for computer-assisted quantification of the affected corneal area. Histological assessment was performed to investigate the intrastromal location of the injected dye. Results A mean corneal area of 5.0 ±1.4 mm2 (mean ± SD and 7.7 ±1.4 mm2 was covered by intrastromal injections of 1 and 2 μL, respectively. The mean percentage of total corneal area reached ranged from 39% to 53% for 1 μL injections, and from 65% to 81% for 2 μL injections. Injections using the 33 G needles tended to provide the highest distribution area. Perforation rates were 8% for 30° beveled 33 G needles and 44% for tri-surface beveled 35 G needles. No perforation was observed with glass needle; however, intrastromal breakage of needle tips was noted in 25% of these cases. Conclusions Intracorneal injection using a 30° beveled 33 G needle was safe and effective. The use of tri-surface beveled 35 G needles substantially increased the number of corneal perforations. Glass needles may break inside the corneal stroma. Injections of 1 μL and 2 μL resulted in an overall mean of 49% and 73% respectively

  14. [Cornea bank of Lyon: from quality diagnosis to ISO 9001 certification].

    Science.gov (United States)

    Pascal, P; Chalochet, A; Damour, O

    2001-12-01

    The tissue and cell bank of the HCL (Hospices Civils de Lyon) has, since 10 June 1999, consisted of two sections with related activities: cell culture for the Skin Substitutes Laboratory (Laboratoire des Substituts Cutanés, LSC) and preservation of corneas at 31 degrees C for the Cornea Bank. As the LSC had been ISO 9001 certified since March 1997 our aim, since merger, was to raise the Cornea Bank to the same level of quality as the LSC, so as to coincide with the renewal of the LSC certificate in February 2000. The methods we used (project, quality control, analysis and process optimization) led us to receive official certification only nine months after the merger. The procedure started with a program of quality control at the Cornea Bank from February 1999 onwards, in order to list the work and equipment required, evaluate its documentation system and what was needed to incorporate this new activity into the existing system of quality assurance at the LSC. On the 7th March 2000, the Tissue and Cell Bank of the HCL obtained an ISO 9001 certificate for its combined functions. As well as achieving our objectives and the strong points highlighted by the auditor during the renewal process, this quality assessment revealed many advantages: improvements in the conservation of corneas, economies in staff replacement and reductions in both the cost of maintaining quality, the cost of the corneas themselves, etc. The decree 'Banque' no. 99-741 of 30th August 1999, which put in place the system of authorization of tissue banks in France, demands quality control. Our application for certification which started in early 1999 had anticipated this regulation. This helped us enormously when compiling the dossier accompanying the official request and was an essential element in obtaining the favourable response of the ASSAPS on 21 June 2000.

  15. Split cornea transplantation for 2 recipients - review of the first 100 consecutive patients.

    Science.gov (United States)

    Heindl, Ludwig M; Riss, Stephan; Laaser, Kathrin; Bachmann, Bjoern O; Kruse, Friedrich E; Cursiefen, Claus

    2011-10-01

    To evaluate the feasibility of split cornea transplantation for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Interventional case series. Fifty consecutive eyes with anterior stromal disease suitable for DALK and 50 eyes with endothelial disease suitable for DMEK were scheduled for split cornea transplantation combining both procedures within 72 hours. Main outcome measures included success of using a single donor cornea for 2 recipients, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months' follow-up. A single donor cornea could be used for 2 recipients in 47 cases (94%). In 3 eyes (6%), the DALK procedure had to be converted to penetrating keratoplasty (PK) requiring a full-thickness corneal graft. Thereby, 47 donor corneas (47%) could be saved. Six months after surgery, mean BSCVA was 20/36 in the 47 eyes that underwent successful DALK, 20/50 in the 3 eyes that underwent conversion from DALK to PK, and 20/29 in the 50 eyes that underwent DMEK. Postoperative complications after DALK included Descemet folds in 5 eyes (11%) and epitheliopathy in 3 eyes (6%). After DMEK, partial graft detachment occurred in 26 eyes (52%) and was managed successfully with intracameral air reinjection. All corneas remained clear up to 6 months after surgery. No intraocular infections occurred. Split use of donor corneal tissue for combined DALK and DMEK procedures in 2 recipients within 3 subsequent days is a feasible approach to reduce donor shortage in corneal transplantation in the future. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Elastic microfibril distribution in the cornea: Differences between normal and keratoconic stroma.

    Science.gov (United States)

    White, Tomas L; Lewis, Philip N; Young, Robert D; Kitazawa, Koji; Inatomi, Tsutomu; Kinoshita, Shigeru; Meek, Keith M

    2017-06-01

    The optical and biomechanical properties of the cornea are largely governed by the collagen-rich stroma, a layer that represents approximately 90% of the total thickness. Within the stroma, the specific arrangement of superimposed lamellae provides the tissue with tensile strength, whilst the spatial arrangement of individual collagen fibrils within the lamellae confers transparency. In keratoconus, this precise stromal arrangement is lost, resulting in ectasia and visual impairment. In the normal cornea, we previously characterised the three-dimensional arrangement of an elastic fiber network spanning the posterior stroma from limbus-to-limbus. In the peripheral cornea/limbus there are elastin-containing sheets or broad fibers, most of which become microfibril bundles (MBs) with little or no elastin component when reaching the central cornea. The purpose of the current study was to compare this network with the elastic fiber distribution in post-surgical keratoconic corneal buttons, using serial block face scanning electron microscopy and transmission electron microscopy. We have demonstrated that the MB distribution is very different in keratoconus. MBs are absent from a region of stroma anterior to Descemet's membrane, an area that is densely populated in normal cornea, whilst being concentrated below the epithelium, an area in which they are absent in normal cornea. We contend that these latter microfibrils are produced as a biomechanical response to provide additional strength to the anterior stroma in order to prevent tissue rupture at the apex of the cone. A lack of MBs anterior to Descemet's membrane in keratoconus would alter the biomechanical properties of the tissue, potentially contributing to the pathogenesis of the disease. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Influence of glucocorticosteroids on the biomechanical properties of in-vivo rabbit cornea.

    Science.gov (United States)

    Yu, Ji-guo; Bao, Fang-jun; Joda, Akram; Fu, Xun-an; Zhou, Shi; Wang, Jing; Hu, Xiu-li; Wang, Qin-mei; Elsheikh, Ahmed

    2014-01-01

    Understanding corneal biomechanical responses during long-term glucocorticosteroids administration is important in clinical practice. The purpose of this study is to investigate the biomechanical influence of fluorometholone 0.1% eye drops on rabbit cornea. Thirty-eight Japanese white rabbits were randomly divided into three groups; a fluorometholone group, a supernatant group and a blank control group. For each rabbit in fluorometholone group, one cornea was treated with fluorometholone 0.1% eye drops four times a day for 8 weeks, while corneas of rabbits in supernatant group were treated in the same frequency with supernatant fraction centrifuged from fluorometholone 0.1% eye drops. The rabbits in the blank control group were not given any treatment. At the end of the 8 week observation period, the rabbits were euthanized and the eyes immediately enucleated and prepared for inflation testing. The experimental pressure-deformation data was used to derive the stress-strain behavior of each eye using an inverse modeling procedure. Comparisons of mechanical stiffness of corneas were conducted among the three groups to determine the influence of fluorometholone. The results showed that corneal stiffness decreased as the fluorometholone administration time prolonged. Comparisons of tangent modulus indicated average stiffness reductions of 34.2% and 33.5% in the fluorometholone group compared to the supernatant and control groups, respectively, at the end of the observation period. The stiffness-reduction effect of fluorometholone on the cornea should be considered in clinical management, especially when administrating it to biomechanically weakened corneas, such as after refractive surgeries and in cases of keratoconus. © 2013 Published by Elsevier Ltd.

  18. Optical system and image processing of endothelial cells of donated cornea

    Science.gov (United States)

    Ventura, Liliane; Caetano, Cesar A. C.; Faria de Sousa, Sidney J.; Lotufo, Roberto A.

    1999-06-01

    A magnifying optical system (250-400X) attached to a Slit Lamp has been developed in order to evaluate the endothelium of donated corneas. The images from the endothelium are captured by a CCD and displayed in a PC monitor. The cost of the system is relatively low compared to the specular microscopes that are on the market for donated corneas (66% less expensive). The system offers two kinds of computer evaluation: interactive and automatic. The interactive counting of the endothelial cells provides a window of any shape and size desired by the clinician, where the cells are clicked by the mouse and the developed software estimates the number of endothelial cells in the cornea as a whole. The automatic counting of the cells is done by an image processing, where the cells are recognized by the developed software, without any interference of the clinician, and counted automatically. The most important features of this system compared to most that are on the market are: there are two ways for the clinical to count the cells and both can be used simultaneously (the automatic provides a quick counting of the cells and the interactive provides a wanted clinical interference on the result); many parts of the cornea can be evaluated and an average counting is provided (usually just the central part of the cornea is analyzed); real time image is provided instead of just a static image, which allows the clinician to have more information about the cornea such as the evaluation of the cells in the snail tracks.

  19. Morphological and biochemical analysis of intact and opaque cornea in dogs.

    Science.gov (United States)

    Hirooka, Masamitsu; Igarashi, Osamu; Nagayasu, Aya; Minaguchi, Jun; Hosaka, Yoshinao Z; Ueda, Hiromi; Tangkawattana, Prasarn; Takehana, Kazushige

    2010-08-01

    The arrangement of collagen fibrils and glycosaminoglycans (GAGs) in substantia propria are important for maintaining transparency of the cornea. Interferences in collagen fibrils and GAG production could be adversative to corneal integrity. In this study, six dogs consisting of four Beagles with normal cornea (normal), one Beagles with opaque cornea (sample No. 1) and one Shih Tzu with neovascularization opaque cornea (sample No.2) were used. All samples were observed morphologically by light and electron microscopes to obtain diameter and distribution of collagen fibrils in substantia propria and were performed biochemically to investigate into GAGs and collagen types. The average diameter of collagen fibrils in the intact cornea of normal, sample No.1 and No.2 was 33.2, 35.0 and 25.0 nm, respectively. The percentage of matrix per unit area was 67% in normal, 87% in sample No.1 and 28.3% in sample No.2. The type III collagen ratio was 25.3% in normal, 21.3% in sample No.1 and 35.8% in sample No.2. The relative amount of heparan sulfate, chondroitin sulfate, dermatan sulfate and keratin sulfate was 1.5, 9.7, 51.1 and 37.7% in normal, 3.3, 26.0, 45.7 and 23.7% in sample No.1 and 1.2, 18.0, 16.6 and 54.1% in sample No.2. Hyaluronic acid was found only in sample No.1 with a relative amount of 1.3%. Since there was some relationship between collagen formation and GAGs composition, it might be speculated that disturbance in arrangement of collagen fibrils and GAG metabolism especially in substantia propria would bring up opacity of the cornea.

  20. Age-related changes and diseases of the ocular surface and cornea.

    Science.gov (United States)

    Gipson, Ilene K

    2013-12-13

    Aging of the ocular surface and corneal tissues, major components of the visual system, causes major eye disease and results in substantial cost in medical and social terms. These diseases include the highly prevalent dry eye disease that affects the ocular surface and its glands, leading to tear film alterations, discomfort, and decreased vision. Studies show that 14.4% of the population in the United States older than 50 years have dry eye disease and demonstrate that it is particularly prevalent among women. Annual medical costs per patient with dry eye in the United States are estimated at $783 per year, with an overall medical cost adjusted to prevalence of $3.84 billion per year. Societal costs, which include loss of productivity, are estimated per patient at $11,302 per year, with overall costs adjusted to prevalence of $55.4 billion per year. Because there are few effective treatments for the disease, more research on its etiology and mechanisms is warranted and needed. Increased public education about risk factors for the disease is also required. Another major age-related eye disease of the cornea that leads to vision impairment and potentially blindness if left untreated is Fuchs' endothelial corneal dystrophy. This disease leads to loss of the endothelial cells on the internal side of the cornea that are responsible for keeping the cornea in the proper hydration state to ensure its transparency to light. The mechanism of cell loss is unknown, and the only treatment available to date is surgical transplantation of the cornea or inner part of the cornea. These medically costly procedures require donor corneas, eye banking, and medical follow-up, with accrued costs. Fuchs' endothelial corneal dystrophy is a major cause of corneal transplantation in the United States; therefore, research support is needed to determine the mechanism of this age-related disease, to develop medical, nonsurgical methods for treatment.

  1. Factors involved in the occurrence of bleeding complications after enucleation for cornea donation.

    Science.gov (United States)

    van Wijk, Marja J; Nijenhuis, Matthijs V; Dorrepaal, Caroline A; Bokhorst, Arlinke G

    2009-10-01

    To identify risk factors for the occurrence of bleeding complications after enucleation for cornea donation, in order to develop preventive activities to reduce the occurrence of bleeding complications and especially the development of ocular hematomas. From all Dutch cornea donors deceased in the year 2006, donor characteristics, retrieval characteristics, and bleeding complication data were collected. First, univariate relations between donor and retrieval factors and bleeding complications were determined. Then, multivariate logistic regression analysis was used to identify factors significantly associated with bleeding complications. In 114 of the 1173 cornea donors (9.7%), bleeding complications occurred, with ocular hematomas developing in 39 (3.3% of all cornea donors). Donor factors significantly associated with bleeding complications were age [odds ratio (OR) 0.96 (95% CI 0.94-0.97)], weight [OR 1.03 (1.02-1.04)], heart failure [OR 2.10 (1.12-3.94)], thrombocyte aggregation inhibitor use [OR 1.64 (1.02-2.64)], and chronic alcoholic liver disease [OR 2.85 (1.11-7.31)]. The most significant factor associated with bleeding complications was the retrieval sequence. If cornea donation was followed by any other tissue retrieval, the risk of bleeding complications was strongly increased. : This study shows that the tissue retrieval sequence in multitissue donors is the most important factor associated with the occurrence of bleeding complications. The risk of bleeding and ocular hematoma is lower if cornea donation is performed after all other retrievals. However, if the tissue retrieval sequence is altered, the effect of prolonged postmortem time on corneal quality must be taken into account.

  2. Differentially expressed wound healing-related microRNAs in the human diabetic cornea.

    Directory of Open Access Journals (Sweden)

    Vincent A Funari

    Full Text Available MicroRNAs are powerful gene expression regulators, but their corneal repertoire and potential changes in corneal diseases remain unknown. Our purpose was to identify miRNAs altered in the human diabetic cornea by microarray analysis, and to examine their effects on wound healing in cultured telomerase-immortalized human corneal epithelial cells (HCEC in vitro. Total RNA was extracted from age-matched human autopsy normal (n=6 and diabetic (n=6 central corneas, Flash Tag end-labeled, and hybridized to Affymetrix® GeneChip® miRNA Arrays. Select miRNAs associated with diabetic cornea were validated by quantitative RT-PCR (Q-PCR and by in situ hybridization (ISH in independent samples. HCEC were transfected with human pre-miR™miRNA precursors (h-miR or their inhibitors (antagomirs using Lipofectamine 2000. Confluent transfected cultures were scratch-wounded with P200 pipette tip. Wound closure was monitored by digital photography. Expression of signaling proteins was detected by immunostaining and Western blot. Using microarrays, 29 miRNAs were identified as differentially expressed in diabetic samples. Two miRNA candidates showing the highest fold increased in expression in the diabetic cornea were confirmed by Q-PCR and further characterized. HCEC transfection with h-miR-146a or h-miR-424 significantly retarded wound closure, but their respective antagomirs significantly enhanced wound healing vs. controls. Cells treated with h-miR-146a or h-miR-424 had decreased p-p38 and p-EGFR staining, but these increased over control levels close to the wound edge upon antagomir treatment. In conclusion, several miRNAs with increased expression in human diabetic central corneas were found. Two such miRNAs inhibited cultured corneal epithelial cell wound healing. Dysregulation of miRNA expression in human diabetic cornea may be an important mediator of abnormal wound healing.

  3. Differential expression and processing of transforming growth factor beta induced protein (TGFBIp) in the normal human cornea during postnatal development and aging

    DEFF Research Database (Denmark)

    Karring, Henrik; Runager, Kasper; Valnickova, Zuzana

    2010-01-01

    Transforming growth factor beta induced protein (TGFBIp, also named keratoepithelin) is an extracellular matrix protein abundant in the cornea. The purpose of this study was to determine the expression and processing of TGFBIp in the normal human cornea during postnatal development and aging....... TGFBIp in corneas from individuals ranging from six months to 86 years of age was detected and quantified by immunoblotting. The level of TGFBIp in the cornea increases about 30% between 6 and 14 years of age, and adult corneas contain 0.7-0.8 microg TGFBIp per mg wet tissue. Two-dimensional (2-D...... and that the processing of TGFBIp changes during postnatal development of the cornea. In addition, TGFBIp appears to be degraded in a highly orchestrated manner in the normal human cornea with the resulting C-terminal fragments being retained in the cornea. The age-related changes in the expression and processing...

  4. Optics of the human cornea influence the accuracy of stereo eye-tracking methods: a simulation study

    NARCIS (Netherlands)

    Barsingerhorn, A.D.; Boonstra, F.N.; Goossens, H.H.L.M.

    2017-01-01

    Current stereo eye-tracking methods model the cornea as a sphere with one refractive surface. However, the human cornea is slightly aspheric and has two refractive surfaces. Here we used ray-tracing and the Navarro eye-model to study how these optical properties affect the accuracy of different

  5. Morphological characterization of keratoconus-affected human corneas by SHG imaging and correlation analysis

    Science.gov (United States)

    Mercatelli, R.; Ratto, F.; Tatini, F.; Rossi, F.; Menabuoni, L.; Nicoletti, R.; Pini, R.; Pavone, Frederick; Cicchi, R.

    2016-03-01

    Keratoconus is an ophthalmic disease in which the cornea acquires an abnormal conical shape that prevents the correct focusing on the retina, causing visual impairment. The late diagnosis of keratoconus is among the principal causes of corneal transplantation surgery. In this study, we characterize the morphology of keratoconic corneas by means of the correlation of SHG images, finding that keratoconus can be diagnosed by analyzing the inclination of lamellae below Bowman's membrane. In addition, imaging performed with both sagittal and "en face" geometry demonstrated that this morphological features can be highlighted both ex vivo and in vivo.

  6. Split cornea transplantation for 2 recipients: a new strategy to reduce corneal tissue cost and shortage.

    Science.gov (United States)

    Heindl, Ludwig M; Riss, Stephan; Bachmann, Bjoern O; Laaser, Kathrin; Kruse, Friedrich E; Cursiefen, Claus

    2011-02-01

    To evaluate the feasibility of using a single donor cornea for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) surgeries on the same day. Single-center, nonrandomized, prospective, interventional case series. Twelve consecutive donor corneas were scheduled for split cornea transplantation combining DALK for a keratoconus patient and DMEK for a Fuchs' endothelial dystrophy patient on the same surgery day. First, a big-bubble DALK procedure was performed for the keratoconus eye. When bare Descemet's membrane was prepared successfully requiring no conversion to penetrating keratoplasty (PK), then during surgery the donor, endothelium-Descemet's membrane layer was removed and stored for subsequent DMEK in a second patient, and the remaining anterior lamella of the donor cornea was used to complete the DALK surgery. Afterward, a DMEK procedure was performed on the second patient with Fuchs' endothelial dystrophy, grafting the stored endothelium-Descemet's membrane layer of the original donor button. Success of using a single donor cornea for 2 recipient eyes, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months follow-up. A single donor cornea could be used for 2 recipients in 10 of 12 donor buttons (83%). In 2 cases (17%), the DALK procedure had to be converted to PK requiring a full-thickness corneal graft. Therefore, 10 donor corneas (45%) could be saved. Six months after surgery, mean BSCVA was 20/35 (range, 20/50-20/25) in 10 eyes that underwent successful DALK, 20/50 (range, 20/63-20/40) in 2 eyes that underwent conversion from DALK to PK, and 20/31 (range, 20/50-20/16) in 10 eyes that underwent DMEK. Postoperative complications after DALK included Descemet's folds in 3 eyes (30%) and epitheliopathy in 2 eyes (20%). After DMEK, partial graft detachment occurred in 5 eyes (50%) and was managed successfully with intracameral air reinjection. All corneas

  7. [A new principle in the investigation of the biomechanical properties of the cornea (a preliminary communication)].

    Science.gov (United States)

    Avetisov, S E; Bubnova, I A; Novikov, I A; Antonov, A A; Siplivyĭ, V I

    2008-01-01

    A new principle in the determination of mechanical stress distribution in the cornea is proposed on the basis of estimation of the polarization of light emitted by luminescence of strained collagen. It has been found, collagen fiber stress is inversely proportional to corneal stress on the intact cornea of a rabbit, and absolute values are determined by intraocular pressure values. After applying keratotomic incisions, the stress distribution map changes, at the same time, the major stress falls on the residual thickness of the stroma at the bottom of a keratotomic scar and close to this area and the central corneal region is subject to the least pressure.

  8. Multiparameter thermo-mechanical OCT-based characterization of laser-induced cornea reshaping

    Science.gov (United States)

    Zaitsev, Vladimir Yu.; Matveyev, Alexandr L.; Matveev, Lev A.; Gelikonov, Grigory V.; Vitkin, Alex; Omelchenko, Alexander I.; Baum, Olga I.; Shabanov, Dmitry V.; Sovetsky, Alexander A.; Sobol, Emil N.

    2017-02-01

    Phase-sensitive optical coherence tomography (OCT) is used for visualizing dynamic and cumulative strains and corneashape changes during laser-produced tissue heating. Such non-destructive (non-ablative) cornea reshaping can be used as a basis of emerging technologies of laser vision correction. In experiments with cartilaginous samples, polyacrilamide phantoms and excised rabbit eyes we demonstrate ability of the developed OCT system to simultaneously characterize transient and cumulated strain distributions, surface displacements, scattering tissue properties and possibility of temperature estimation via thermal-expansion measurements. The proposed approach can be implemented in perspective real-time OCT systems for ensuring safety of new methods of laser reshaping of cornea.

  9. Computer driven optical keratometer and method of evaluating the shape of the cornea

    Science.gov (United States)

    Baroth, Edmund C. (Inventor); Mouneimme, Samih A. (Inventor)

    1994-01-01

    An apparatus and method for measuring the shape of the cornea utilize only one reticle to generate a pattern of rings projected onto the surface of a subject's eye. The reflected pattern is focused onto an imaging device such as a video camera and a computer compares the reflected pattern with a reference pattern stored in the computer's memory. The differences between the reflected and stored patterns are used to calculate the deformation of the cornea which may be useful for pre-and post-operative evaluation of the eye by surgeons.

  10. Brittle Cornea Syndrome Associated with a Missense Mutation in the Zinc-Finger 469 Gene

    DEFF Research Database (Denmark)

    Christensen, Anne Elisabeth; Knappskog, Per Morten; Midtbø, Marit

    2010-01-01

    Purpose: To investigate the diverse clinical manifestations, identify the causative mutation and explain the association with red hair in a family with brittle cornea syndrome (BCS). Methods: Eight family members in three generations underwent ophthalmic, dental, and general medical examination...... mapping with SNP markers, DNA sequencing, and MC1R genotyping. Results: At 42 and 48 years of age, respectively, both affected individuals were blind due to retinal detachment and secondary glaucoma. They had extremely thin and bulging corneas, velvety skin, chestnut colored hair, scoliosis, reduced BMD...

  11. Laser-assisted correction of eye cornea refraction with ring-shaped laser beam

    Science.gov (United States)

    Baum, Olga; Yuzhakov, Aleksey; Omelchenko, Alexander; Bolshunov, Andrey; Siplivy, Vladimir; Sobol, Emil

    2017-07-01

    A new method for non-ablative correction of cornea shape is based on thermo-mechanical effect of laser radiation with ring-shaped laser beam. The results obtained demonstrated that the new method for correction of eye refraction yields a significant alteration in the eye refraction and the ring-shaped laser beam with various ring diameters for correction of the eye refraction allows obtaining controllable alterations of the eye refraction with axial symmetry without any pathological changes in central part of cornea.

  12. Optical properties of an anterior lamellar human cornea model based on fibrin-agarose

    Science.gov (United States)

    Ionescu, Ana M.; Cardona, Juan de la Cruz; Ghinea, Razvan; Garzón, Ingrid; González-Andrades, Miguel; Alaminos, Miguel; Pérez, Maria del Mar

    2017-08-01

    The optical evaluation carried out using the Inverse Adding-Doubling (IAD) method to determine the scattering and the absorption coefficients of the bioengineered human corneal stromas showed that this type of artificial biomaterials shared many similarities with native control cornea after four weeks of development in culture. Their absorption and reduced scattering coefficients values were higher than the ones of the control cornea, but their spectral behaviors of both coefficients were similar. Time of development in culture was an influencing factor on the results.

  13. [Biomechanical properties of the cornea in primary open-angle glaucoma].

    Science.gov (United States)

    Eremina, M V

    2008-01-01

    The paper discusses the impact of some properties of corneal tissue (central corneal thickness, curvature radius, elasticity, etc.). The dynamic bilateral applanation process underlying the ocular analyzer provides exact information on the index determining the viscoelastic properties of the cornea - corneal hysteresis. The author presents the results of detecting corneal hysteresis in individuals without oculopathy and in patients with glaucoma, as well as the association of this index with the central thickness of the cornea, the levels of corneal compensated pressure, and the intraocular value equated to the Goldman tonometric index.

  14. Differential gene expression patterns of the developing and adult mouse cornea compared to the lens and tendon.

    Science.gov (United States)

    Wu, Feng; Lee, Seakwoo; Schumacher, Michael; Jun, Albert; Chakravarti, Shukti

    2008-09-01

    The cornea continues to mature after birth to develop a fully functional, refractive and protective barrier tissue. Here we investigated the complex biological events underlying this process by profiling global genome-wide gene expression patterns of the immature postnatal day 10 and 7-week old adult mouse cornea. The lens and tendon were included in the study to increase the specificity of genes identified as upregulated in the corneal samples. Notable similarities in gene expression between the cornea and the tendon were in the mesenchymal extracellular matrix collagen (types I, III, V, VI) and proteoglycan (lumican, decorin and biglycan) genes. Expression similarities in the cornea and lens were limited to certain epithelial genes and the crystallins. Approximately 76 genes were over expressed in the cornea samples that showed basal expression levels in the lens and tendon. Thirty-two of these were novel with no known functions in the cornea. These include genes with a potential role in protection against oxidative stress (Dhcr24, Cdo1, Akr1b7, Prdx6), inflammation (Ltb4dh, Wdr1), ion transport (Pdzk1ip1, Slc12a2, Slc25a17) and transcription (Zfp36l3, Pdzk1ip1). Direct comparison of the cornea of two ages showed selective upregulation of 50 and 12 genes in the P10 and adult cornea, respectively. Of the upregulated P10 genes several encode extracellular matrix collagens and proteoglycans that are stable components of the adult cornea and their high transcriptional activity at P10 indicate a period of actie corneal growth and matrix deposition in the young cornea. Much less is known about the genes selectively over expressed in the adult cornea; some relate to immune response and innervations (Npy), and possibly to electron transport (Cyp24a1, Cyp2f2) and others of yet unknown functions in the cornea (Rgs10, Psmb8, Xlr4). This study detected expression of genes with known functions in the cornea, providing additional validation of the microarray experiments

  15. The use of human cornea organotypic cultures to study herpes simplex virus type 1 (HSV-1)-induced inflammation.

    Science.gov (United States)

    Drevets, Peter; Chucair-Elliott, Ana; Shrestha, Priyadarsini; Jinkins, Jeremy; Karamichos, Dimitrios; Carr, Daniel J J

    2015-10-01

    To determine the utility of human organotypic cornea cultures as a model to study herpes simplex virus type 1 (HSV-1)-induced inflammation and neovascularization. Human organotypic cornea cultures were established from corneas with an intact limbus that were retrieved from donated whole globes. One cornea culture was infected with HSV-1 (10(4) plaque-forming units), while the other cornea from the same donor was mock-infected. Supernatants were collected at intervals post-culture with and without infection to determine viral titer (by plaque assay) and pro-angiogenic and proinflammatory cytokine concentration by suspension array analysis. In some experiments, the cultured corneas were collected and evaluated for HSV-1 antigens by immunohistochemical means. Another set of experiments measured susceptibility of human three-dimensional cornea fibroblast constructs, in the presence and absence of TGF-β1, to HSV-1 infection in terms of viral replication and the inflammatory response to infection as a comparison to the organotypic cornea cultures. Organotypic cornea cultures and three-dimensional fibroblast constructs exhibited varying degrees of susceptibility to HSV-1. Fibroblast constructs were more susceptible to infection in terms of infectious virus recovered in a shorter period of time. There were changes in the levels of select pro-angiogenic or proinflammatory cytokines that were dictated as much by the cultures producing them as by whether they were infected with HSV-1 or treated with TGF-β1. Organotypic cornea and three-dimensional fibroblast cultures are likely useful for the identification and short-term study of novel antiviral compounds and virus replication, but are limited in the study of the local immune response to infection.

  16. Transient downregulation of microRNA-206 protects alkali burn injury in mouse cornea by regulating connexin 43.

    Science.gov (United States)

    Li, Xiaoyan; Zhou, Huanfen; Tang, Weiqiang; Guo, Qing; Zhang, Yan

    2015-01-01

    Chemical burn in cornea may cause permanent visual problem or complete blindness. In the present study, we investigated the role of microRNA 206 (miR-206) in relieving chemical burn in mouse cornea. An alkali burn model was established in C57BL/6 mice to induce chemical corneal injury. Within 72 hours, the transient inflammatory responses in alkali-treated corneas were measured by opacity and corneal neovascularization (CNV) levels, and the gene expression profile of miR-206 was measured by quantitative real-time PCR (qPCR). Inhibitory oligonucleotides of miR-206, miR-206-I, were intrastromally injected into alkali-burned corneas. The possible protective effects of down-regulating miR-206 were assessed by both in vivo measurements of inflammatory responses and in vitro histochemical examinations of corneal epithelium sections. The possible binding of miR-206 on its molecular target, connexin43 (Cx43), was assessed by luciferase reporter (LR) and western blot (WB) assays. Cx43 was silenced by siRNA to examine its effect on regulating miR-206 modulation in alkali-burned cornea. Opacity and CNV levels, along with gene expression of miR-206, were all transiently elevated within 72 hours of alkali-burned mouse cornea. Intrastromal injection of miR-206-I into alkali-burned cornea down-regulated miR-206 and ameliorated inflammatory responses both in vivo and in vitro. LR and WB assays confirmed that Cx43 was directly targeted by miR-206 in mouse cornea. Genetic silencing of Cx43 reversed the protective effect of miR-206 down-regulation in alkali-burned cornea. miR-206, associated with Cx43, is a novel molecular modulator in alkali burn in mouse cornea.

  17. Model of Mass and Heat Transfer during Vacuum Freeze-Drying for Cornea

    Directory of Open Access Journals (Sweden)

    Zou Huifen

    2012-01-01

    Full Text Available Cornea is the important apparatus of organism, which has complex cell structure. Heat and mass transfer and thermal parameters during vacuum freeze-drying of keeping corneal activity are studied. The freeze-drying cornea experiments were operated in the homemade vacuum freeze dryer. Pressure of the freeze-drying box was about 50 Pa and temperature was about −10°C by controlled, and operating like this could guarantee survival ratio of the corneal endothelium over the grafting normal. Theory analyzing of corneal freeze-drying, mathematical model of describing heat and mass transfer during vacuum freeze-drying of cornea was established. The analogy computation for the freeze-drying of cornea was made by using finite-element computational software. When pressure of the freeze-drying box was about 50 Pa and temperature was about −10°C, time of double-side drying was 170 min. In this paper, a moving-grid finite-element method was used. The sublimation interface was tracked continuously. The finite-element mesh is moved continuously such that the interface position always coincides with an element node. Computational precision was guaranteed. The computational results were agreed with the experimental results. It proved that the mathematical model was reasonable. The finite-element software is adapted for calculating the heat and mass transfer of corneal freeze-drying.

  18. Hydro cone lens visual performance and impact on quality of life in irregular corneas.

    Science.gov (United States)

    Ozek, Dilay; Kemer, Ozlem Evren; Bayraktar, Neslihan

    2016-12-01

    The aim of this study is to evaluate the visual performance (efficiency) of HydroCone (Toris K) soft silicon hydrogel lenses in patients with irregular corneas. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  19. Plume emission, shock wave and surface wave formation during excimer laser ablation of the cornea.

    Science.gov (United States)

    Bor, Z; Hopp, B; Rácz, B; Szabó, G; Ratkay, I; Süveges, I; Füst, A; Mohay, J

    1993-01-01

    Excimer lasers are now used for corneal surgery; however, the physical processes occurring during photoablation of the cornea are incompletely understood. High speed laser-based photographic arrangement was constructed. The temporal resolution was better than 1 ns. The setup could work as a Schlieren arrangement, which is sensitive to the refractive index change caused by the shock wave propagating in the air above the eye. With minor changes the setup was converted into a shadowgraph, which could detect the ablation plume and the waves propagating on the surface of the eye. Due to the impact of the excimer laser pulse onto the surface of the cornea, a shock wave was generated in the air. The shadowgraph clearly showed the ejection of the ablated cornea. The ejection velocity of the plume was found to be over 600 m/s. It was shown for the first time that the recoil forces of the plume are generating a wave on the surface of the eye. The laser-based high speed photographic arrangement is a powerful arrangement in the study of physical effects occurring during photoablation of the cornea.

  20. Age-related differences in the elasticity of the human cornea.

    Science.gov (United States)

    Knox Cartwright, Nathaniel E; Tyrer, John R; Marshall, John

    2011-06-17

    The goal of this study was to determine age-related variation in the elasticity of the human cornea using nondestructive means. Organ cultured human corneoscleral buttons were studied. Changes in strain were measured with a radial shearing speckle pattern interferometer after an increase in intraocular pressure from 15.0 to 15.5 mm Hg. Changes in central corneal displacement were calculated by integration, and a bulk corneal Young's modulus was derived by mathematical analysis. Fifty corneas, including 17 pairs, were studied. Donors were aged between 24 and 102 years (mean, 73.1); 29 (58%) specimens were from male donors and 21 from female donors. Young's modulus of the cornea increased with age, with the line of best fit indicating an approximate doubling from 0.27 MPa at age 20 years (95% confidence interval, 0.22-0.31) to 0.52 (0.50-0.54) MPa at age 100 years (R² = 0.70). The stiffness of the human cornea increases by a factor of approximately two between the ages of 20 and 100 years. This variation is relevant to the algorithms used to predict the response to incisional and ablative refractive surgery and will also affect the formulas used to calculate intraocular pressure by applanation.