Corneal complications of intraoperative Mitomycin C in glaucoma surgery.

PURPOSE: To report corneal toxicity of Mitomycin C application during filtering glaucoma surgery in two patients. CASE REPORTS: An elderly woman, 81 years of age, developed diffuse corneal epitheliopathy with subepithelial stromal oedema seven weeks after a trabeculectomy with Mitomycin C application. Another patient, a 76-year-old man, first developed a central epithelium defect and stromal oedema in the second postoperative week after a similar procedure. Later the corneal stroma melted, what resulted in perforation in the second postoperative month. RESULTS: Intraoperative Mitomycin C application during trabeculectomy induced serious corneal complications several weeks after the surgery. CONCLUSIONS: Although infrequent, serious corneal complications may arise following the intraoperative use of Mitomycin C in filtering surgery for glaucoma. The possible contributing factors to the development of the corneal toxicity will be discussed.

Neuroparalytic keratopathy as the first sign of a cerebral meningioma.

We report a case of a cavernous sinus meningioma in a young woman presenting with a neuroparalytic corneal ulcer as the only sign of the tumour. Clinical ophthalmic examination revealed a trophic corneal ulcer in the left eye of the patient accompanied by corneal anaesthesia and loss of sensation to touch and pain stimuli in the ipsilateral dermatomes supplied by the ophthalmic and maxillary divisions of the trigeminal nerve. A MRI scan of the head revealed a left cavernous sinus meningioma. Neuroparalytic keratopathy or corneal ulcer is an infrequent presenting sign of intracranial pathology. The diagnosis can be missed if the neuroparalytic nature of corneal condition is not detected by the ophthalmologist.

Late opacification of hydroview intraocular lenses: report of 11 cases.

PURPOSE: To report on the clinical and light microscopic analyses of Hydroview intraocular lenses (lOLs) explanted for late postoperative IOL opacification. MATERIAL AND METHODS: Retrospective study of all cases with secondary lensimplantation performed at the University Hospital Leuven during a period of one year (2003-2004) for postoperative opacification of Hydroview IOLs. Further analyses on some of the explanted IOLs included gross and light microscopic evaluation. RESULTS: Lens exchange for late-onset IOL opacification was performed in eleven eyes of eight patients. IOL opacification became apparent between 12 and 24 months after uneventful phacoemulsification and lens implantation. Visual acuity varied from < 0.05 to 0.6 before explantation. In 9 out of the 11 eyes postoperative visual acuity improved to the pre-opacification level. Light microscopic analyses showed a granular anterior lenssurface morphology composed of calcium. CONCLUSION: Late postoperative opacification of Hydroview IOLs may cause severe visual impairment, requiring explantation. Calcium is involved in the formation of these opacifications. Reporting on this type of complications is mandatory according to the Belgian and European directives for medical devices.

Amino-terminal truncation of CXCR3 agonists impairs receptor signaling and lymphocyte chemotaxis, while preserving antiangiogenic properties.

The interferon (IFN)-inducible chemokines, specifically, IFN-gamma-inducible protein-10 (IP-10), monokine induced by IFN-gamma (Mig), and IFN-inducible T-cell alpha-chemoattractant (I-TAC), share a unique CXC chemokine receptor (CXCR3). Recently, the highly specific membrane-bound protease and lymphocyte surface marker CD26/dipeptidyl peptidase IV (DPP IV) was found to be responsible for posttranslational processing of chemokines. Removal of NH(2)-terminal dipeptides by CD26/DPP IV alters chemokine receptor binding and signaling, and hence inflammatory and anti-human immunodeficiency virus (HIV) activities. CD26/DPP IV and CXCR3 are both markers for Th1 lymphocytes and, moreover, CD26/DPP IV is present in a soluble, active form in human plasma. This study reports that at physiologic enzyme concentrations CD26/DPP IV cleaved 50% of I-TAC within 2 minutes, whereas for IP-10 and Mig the kinetics were 3- and 10-fold slower, respectively. Processing of IP-10 and I-TAC by CD26/DPP IV resulted in reduced CXCR3-binding properties, loss of calcium-signaling capacity through CXCR3, and more than 10-fold reduced chemotactic potency. Moreover, IP-10 and I-TAC cleaved by CD26/DPP IV acted as chemotaxis antagonists and CD26/DPP IV-truncated IP-10 and Mig retained their ability to inhibit the angiogenic activity of interleukin-8 in the rabbit cornea micropocket model. These data demonstrate a negative feedback regulation by CD26/DPP IV in CXCR3-mediated chemotaxis without affecting the angiostatic potential of the CXCR3 ligands IP-10 and Mig.

Effect of non-steroidal anti-inflammatory drugs (NSAID) on the rabbit corneal epithelium studied by scanning electron microscopy.

We investigated the effect of 6 commercially available non-steroidal anti-inflammatory drug (NSAID) eye drops on the normal corneal epithelium of rabbits. Each drug was instilled into both eyes of 2 rabbits, 5 times a day, for 5 consecutive days. Two additional corneas of one rabbit, without any treatment, served as control. After treatment, the corneas were excised and processed for scanning electron microscopic evaluation. The epithelial changes induced by the drugs were graded by an empirical score system. All test compounds caused alterations in the cell membranes and surface microvilli, or even exfoliation and necrosis of surface cells. The extent of cell damage appeared to be related to the active ingredient in the eye drops, the pH of the solution, and the constituents of the vehicle, especially the type of preservative used.

Modulation of fibroblast growth factor-2 receptor binding, signaling, and mitogenic activity by heparin-mimicking polysulfonated compounds.

Basic fibroblast growth factor (FGF-2) interacts with high-affinity tyrosine-kinase fibroblast growth factor receptors (FGFRs) and low-affinity heparan sulfate proteoglycans (HSPGs) in target cells. Both interactions are required for FGF-2-mediated biological responses. Here we report the FGF-2 antagonist activity of novel synthetic sulfonic acid polymers with distinct chemical structures and molecular masses (MMs). PAMPS [poly(2-acrylamido-2-methyl-1-propanesulfonic acid)], (MM approximately 7,000-10,000), PAS [poly(anetholesulfonic acid)], (MM approximately 9,000-11,000), PSS [poly(4-styrenesulfonic acid)], (MM = 70,000), and poly(vinylsulfonic acid) (MM = 2,000), inhibited FGF-2 binding to HSPGs and FGFRs in fetal bovine aortic endothelial GM 7373 cells. They also abrogated the formation of the HSPG/FGF-2/FGFR ternary complex, as evidenced by their capacity to prevent FGF-2-mediated cell-cell attachment of FGFR-1-overexpressing, HSPG-deficient Chinese hamster ovary cells to wild-type HSPG-bearing cells. Direct interaction of the polysulfonates with FGF-2 was demonstrated by their ability to protect the growth factor from proteolytic cleavage. Accordingly, molecular modeling, based on the crystal structure of the interaction of FGF-2 with a heparin hexamer, showed the feasibility of docking PAMPS into the heparin-binding domain of FGF-2. In agreement with their FGF-2-binding capacity, PSS, PAS, and PAMPS inhibited FGF-2-induced cell proliferation in GM 7373 cells and murine brain microvascular endothelial cells. The antiproliferative activity of these compounds was associated with the abrogation of FGF-2-induced tyrosine phosphorylation of FGFR-1. Moreover, the polysulfonates PSS and PAS inhibited FGF-2-induced activation of mitogen-activated protein kinase-1/2, involved in FGF-2 signal transduction. In conclusion, sulfonic acid polymers bind FGF-2 by mimicking heparin interaction. These compounds may provide a tool to inhibit FGF-2-induced endothelial cell proliferation in angiogenesis and tumor growth.

Keratoplasty à chaud in severe keratitis.

We have analysed the results of 19 penetrating keratoplasties à chaud performed in 18 patients presenting with imminent perforation or perforated corneas. Infectious disease was eradicated in all cases except in those patients suffering from acanthamoeba keratitis. Secondary bacterial infection was observed in three grafts. Six eyes required a second keratoplasty; two of them were regrafted several times but finally enucleated. Six patients (32%) reached a visual acuity between 10/10 and 5/10, four patients (21%) between 5/10 and 1/10 and nine patients (47%) less than 1/10.

Ocular burn caused by soft brown soap.

PURPOSE: To report the danger of serious chemical ocular burn caused by common household soap. CASE HISTORY: A 20 year old male developed an extensive burn of the right eye after the commonly used soft brown soap (also called floor soap) fell into his face and right eye. The burn caused conjunctival ischemia and necrosis. The cornea was oedematous and denuded of epithelium. The pH of the soap was 11.8. The patient received treatment for alkali burn of the eye. Stem cell transplantation was needed to heal the corneal surface defect. Scar formation and peripheral neovascularisation have reduced the visual acuity to counting fingers at 75 cm. CONCLUSION: This case of serious alkali burn caused by the common soft brown soap demonstrates the potential hazard to the eyes. The manufacturer was sought to write the pH and a warning on the exterior of the container that the "soft brown soap" may cause serious ocular injury.

Bromovinyldeoxyurdine treatment of outer retinal necrosis due to varicella-zoster virus: a case-report.

In December 1995, a 70-years old male was referred to us because of rapid visual loss in the right eye, one month after a central retinal artery occlusion in the left eye. This renal transplant patient, with limited renal function, was on immunosuppressive therapy. The diagnosis of bilateral progressive outer retinal necrosis (PORN) due to varicella-zoster virus (VZV) was confirmed by polymerase chain reaction (PCR) detection of VZV DNA in the aqueous fluid. As retinitis progressed despite of intravenous acyclovir administration, the antiviral therapy was switched to oral bromovinyldeoxyuridine (BVDU). This case-report demonstrates that oral BVDU can be a good alternative to acyclovir for the treatment of VZV retinal infections.

Transsclerally sutured versus ciliary sulcus lenses.

We evaluated retrospectively the results of 39 eyes in which the implantation of a lens in the capsular bag was not possible. Due to the loss of capsule a transsclerally sulcus sutured lens (TSSL) was implanted in 9 eyes. In 30 eyes a ciliary sulcus supported lens (SSL) could be implanted using residual capsule support. Lens implantation in the ciliary sulcus resulted in improved vision in 33/39 eyes (7/9 TSSLs, 26/30 SSLs). Postoperatively slight decentration of the implant lens was observed in 3 eyes, 6 eyes developed glaucoma, 5 eyes developed hyphema after surgery and 2 patients developed retinal detachment in the late postoperative period.

Absence of infectious retinitis after injection of human cytomegalovirus into rabbit eyes.

The rabbit model of human cytomegalovirus (HCMV) retinitis was evaluated by preretinal and intravitreal injection of HCMV into rabbit eyes. Ocular disease was evaluated by indirect ophthalmoscopy, histopathology, and immunohistochemistry. Vitritis, optic nerve congestion, multiple small white infiltrates in the cortical vitreous or on the retinal surface, and retinal detachments were seen. Histopathologic examination showed inflammatory cell infiltration in the preretinal vitreous, optic nerve, and transiently in the superficial inner retina. Retinal structure was preserved except for changes in areas of retinal detachment. No necrosis or destruction of the retina was seen. Immunohistochemistry showed no evidence of cytomegalovirus infection. Inoculation of culture medium containing fetal calf serum caused a similar reaction. It is concluded that vitreous and retinal inoculation of HCMV in the rabbit eye caused nonspecific inflammation without evidence of infection, so this is not a suitable model for HCMV retinitis.

An ocular model of Adenovirus type 5 infection in the rabbit.

Adenoviruses are a common cause of viral eye disease in humans. Recently, new antiviral drugs have been developed, which possess promising anti-adenovirus activity. In order to test these drugs, an ocular model of adenovirus infection was developed in 10 Hollander rabbits following topical, intrastromal and subconjunctival inoculation with a standard laboratory serotype (Adenovirus type 5 from The American Type Culture Collection). Clinical signs of infection-conjunctivitis, keratitis, corneal edema, subepithelial opacities, anterior chamber reaction and iritis-were evaluated. Adenovirus was isolated from the eye several days after inoculation and intra-epithelial viral replication was detected using the replica-technique. Reproducible ocular infection was clinically demonstrated in all rabbits.

Synthesis and antiviral activity of 5-thien-2-yl-2'-deoxyuridine analogues.

A number of 5-heteroaromatic-substituted 2'-deoxyuridines were synthesized from 5-iodo-2'-deoxyuridine using tetraorganotin reagents and palladium complexes as catalyst. The palladium-catalyzed cross-coupling reaction between 5-iodo-2'-deoxyuridine and stannylated heteroaromatics was optimized for the synthesis of the 5-thien-3-yl-2'-deoxyuridine and 5-furan-3-yl-2'-deoxyuridine. 5-(5-Iodothien-2-yl)-2'-deoxyuridine was used as starting material for the synthesis of 5-(5-methylthien-2-yl)-2'-deoxyuridine, 5-(5-vinylthien-2-yl)-2'-deoxyuridine, and 5-(5-ethynylthien-2-yl)-2'- deoxyuridine. 5-(5-Nitrothien-2-yl)-2'-deoxyuridine was synthesized using ceric ammonium nitrate as reagent. 5-(Isoxazol-5-yl)-2'-deoxyuridine was synthesized from 5-(3-oxopropyn-1-yl)-2'-deoxyuridine. Finally, 5-(5-chlorothien-2-yl)-beta-D-arabinofuranosyluracil and 5-(5-bromothien-2-yl)-beta-D-arabinofuranosyluracil were obtained by halogenation of 5-thien-2-yl-beta-D-arabinofuranosyluracil. Introduction of an alkyl substituent in the 5-position of the thienyl group of 5-thien-2-yl-2'-deoxyuridine or substitution of the 2-deoxyribofuranose ring by an arabinofuranose moiety gave decreased activity against HSV-1 and VZV replication when compared with the 5"-halogenated-5-thien-2-yl-2'-deoxyuridines. 5-(5-Bromothien-2-yl)-2'-deoxyuridine caused prompt healing of HSV-1 keratitis when administered as eye drops (0.2%) to rabbits.

Chronic blepharitis, meibomitis and corneal lesions.

We have observed seven patients with longstanding complaints of ocular irritation who had blepharitis and/or meibomitis associated with corneal involvement. Corneal lesions varied from severe pannus formation, destruction of the limbal structure to marginal infiltrates and peripheral corneal melting. The corneal lesions did not regress until blepharitis was treated. The pathogenesis of chronic blepharitis with corneal involvement is discussed.

Characteristics and implantation of Maudgal compressible disc lens.

A 10 mm overall diameter one-piece compressible-disc lens was developed for in the bag implantation after cataract surgery performed by envelop technique or by phacoemulsification. The lens consists of an outer ring connected to a 6 mm diameter optical zone by two compressible loops. The loops and the outer ring are 10 degrees angulated with respect to the optic. The lens can be implanted through a 6 mm tunnel incision and a 5 mm diameter capsulorrhexis. In cadaver eyes, this lens was found to fit snugly in the capsular bag after implantation, leaving no room for decentration. The lens is also suitable for implantation in cases of anterior capsule radial tears. When sectorial zonulolysis is present, the introduction of this lens into the capsular bag stretches the detached bag to the periphery, thus facilitating the lens implantation.

Evaluation of Maudgal lens six months after implantation.

We studied the implantation and follow-up of Maudgal compressible disc lens in 102 eyes with a follow-up of at least six months. The degree and incidence of decentration of this lens in the bag is remarkably low. A postoperative visual acuity of 5/10 or more was achieved in 96% patients and 7/10 or better in 86.2% cases without having an associated pathology at the time of surgery.

Acanthamoeba keratitis.

During the last year we came across three cases of Acanthamoeba keratitis. They were all contact lens wearers. The diagnosis of Acanthamoeba keratitis was established by the history, clinical picture and the culture of corneal and conjunctival swabs. The patients were treated with metronidazole (Flagyl) 0.5% eyedrops, propamidine isethionate (Brolene) 0.1% eyedrops, Neomycin eyedrops, topical corticosteroids, mydriatics and beta-blockers. One tablet or itraconazole (Sporanox) a day was given orally. Infection subsided in two patients. The third patient still suffers from recurrent corneal erosions and shows a pronounced corneal immune reaction.

The use of the first locally manufactured epikeratolens for keratoconus in Leuven.

We adapted a lathe to the production of keratolenses. A cornea is mounted on a chuck and frozen at minus 40 degrees C. Hereafter we can cut the desired posterior radius and diameter. The first plano keratolens produced was used to correct keratoconus. The favourable result encouraged us to manufacture keratolenses for the correction of refractive errors.