Microbiologic and histopathologic assessment of corneal biopsies in the evaluation of microbial keratitis.

PURPOSE: To investigate the utility of corneal biopsy in the evaluation of infectious keratitis; to compare results of culture and histopathologic examination of the same specimens; to investigate potential factors related to positive biopsy results. DESIGN: Retrospective, observational case series. METHODS: We reviewed medical records for all patients who underwent corneal biopsy because of infectious keratitis at the Jules Stein Eye Institute from June 1989 through June 2009. In general, biopsy specimens were both cultured and examined histopathologically. Lesion size, lesion progression, and interval from presentation to biopsy were analyzed as possible predictors of positive biopsies. RESULTS: Organisms were identified in 20 of 48 (42%) consecutive biopsies (positive cultures in 9 of 47 cases [19%]; positive histopathologic examination in 19 of 47 cases [40%]). Culture and histopathologic results were concordant in 30 of 46 biopsies (65%) for which both techniques were performed; 10 of the 16 discordant cases were culture-negative/histopathology-positive, while the remaining 6 had positive but discordant results for the 2 techniques (cultures all showed bacteria; histopathologic examination showed fungi or cysts consistent with Acanthamoeba sp.). Corneal biopsy revealed microorganisms in 12 of 27 patients (44%) with negative cultures of corneal scrapings obtained at presentation. None of the potential risk factors was statistically associated with positive biopsies. CONCLUSIONS: Corneal biopsy can be useful for identifying the cause of infectious keratitis in selected cases. Culture and histopathologic examination can provide complementary information, but discordant results may occur. Acanthamoebic and fungal infections are more likely to be identified by histopathologic examination.

Terahertz sensing in corneal tissues.

This work introduces the potential application of terahertz (THz) sensing to the field of ophthalmology, where it is uniquely suited due to its nonionizing photon energy and high sensitivity to water content. Reflective THz imaging and spectrometry data are reported on ex-vivo porcine corneas prepared with uniform water concentrations using polyethylene glycol (PEG) solutions. At 79% water concentration by mass, the measured reflectivity of the cornea was 20.4%, 14.7%, 11.7%, 9.6%, and 7.4% at 0.2, 0.4, 0.6, 0.8, and 1 THz, respectively. Comparison of nine corneas hydrated from 79.1% to 91.5% concentration by mass demonstrated an approximately linear relationship between THz reflectivity and water concentration, with a monotonically decreasing slope as the frequency increases. The THz-corneal tissue interaction is simulated with a Bruggeman model with excellent agreement. THz applications to corneal dystrophy, graft rejection, and refractive surgery are examined from the context of these measurements.

Corneal biomechanical properties in normal, forme fruste keratoconus, and manifest keratoconus after statistical correction for potentially confounding factors.

PURPOSE: To evaluate the difference in corneal biomechanical properties, after controlling for potentially confounding factors, along the spectrum of keratoconic disease as measured by the keratoconus severity score. METHODS: The corneal biomechanical properties of 73 keratoconic (KCN) eyes of 54 patients, 42 forme fruste keratoconic (FFKCN) eyes of 32 patients, and 115 healthy eyes of 115 age- and sex-matched patients were reviewed retrospectively. The main outcome measures were corneal hysteresis (CH) and corneal resistance factor (CRF). RESULTS: In the normal group, the mean CH was 11.0 ± 1.4 mm Hg and mean CRF was 11.1 ± 1.6 mm Hg. The FFKCN mean CH was 8.8 ± 1.4 mm Hg and mean CRF was 8.6 ± 1.3 mm Hg. The KCN mean CH was 7.9 ± 1.3 mm Hg and mean CRF was 7.3 ± 1.4 mm Hg. There were statistically significant differences in the mean CH and CRF in the normal group compared with the FFKCN and the KCN groups (P < 0.001) after statistically controlling for differences in central corneal thickness, age, and sex. CONCLUSIONS: There is a significant difference in the mean CH and CRF between normal and FFKCN corneas after controlling for differences in age, sex, and central corneal thickness. However, there is a significant overlap in the distribution of CH and CRF values among all groups. The biomechanical parameters CH and CRF cannot be used alone but may be a useful clinical adjunct to other diagnostic tools, such as corneal tomography, in distinguishing normal from subclinical keratoconic corneas.

Differences in the corneal biomechanical effects of surface ablation compared with laser in situ keratomileusis using a microkeratome or femtosecond laser.

PURPOSE: To compare the effects of different flap creation techniques on the biomechanical properties of the cornea in patients having myopic laser refractive surgery. SETTING: UCLA Laser Refractive Center of the Jules Stein Eye Institute, Los Angeles, California, USA. METHODS: In this retrospective case series, eyes that had myopic laser refractive surgery were categorized according to the type of flap creation: mechanical microkeratome (MK) LASIK (n=32), femtosecond laser (FSL) LASIK (n=32), or no flap creation (PRK) (n=33). The preoperative central corneal thickness, intraoperative flap thickness, and planned ablation depth (AD),and the preoperative and postoperative manifest refraction spherical equivalent, corneal hysteresis (CH), and corneal resistance factor (CRF) were recorded. RESULTS: The mean change in CH (DeltaCH) was 2.2 mm Hg, 1.9 mm Hg, and 2.3 mm Hg in the MK, FSL, and PRK groups, respectively. There were no significant differences in AD, DeltaCH, or DeltaCRF between the 3 groups. The correlation between AD and DeltaCH was significant in all 3 groups. The correlation was strongest in the FSL group (r=0.82, P<.0001) and weaker in the PRK group (r=0.47, P= .006) and MK group (r=0.46, P= .008). CONCLUSIONS: The biomechanical measures of CH and CRF decreased similarly after PRK and LASIK using laser or mechanical flap creation. However, LASIK using femtosecond laser flap creation caused a significantly more predictable change in corneal biomechanics, which correlated strongly with AD, than the change with PRK and LASIK with microkeratome flap creation.