Comparison of corneal epitheliotrophic capacities among human platelet lysates and other blood derivatives.

PURPOSE: To evaluate the corneal epitheliotropic abilities of two commercialized human platelet lysates (HPLs) and to compare the results with other blood derivatives, including human peripheral serum (HPS) and bovine fetal serum (FBS). METHODS: In vitro, human corneal epithelial cells were incubated in various concentrations (0%, 3%, 5% and 10%) of blood derivatives. Two commercialized HPLs, including UltraGRO TM (Helios, Atlanta, GA) and PLTMax (Mill Creek, Rochester, MI), were tested and compared with HPS and FBS. Scratch-induced directional wounding assay was performed to evaluate cellular migration. MTS assay was used to evaluate cellular proliferation. Cellular differentiation was examined by scanning electron microscopy, inverted microscopy and transepithelial electrical resistance. Sprague-Dawley rats were used to evaluate the effects of the blood derivatives on corneal epithelial wound healing in vivo. Different blood derivatives were applied topically every 2 hours for 2 days after corneal epithelial debridement. The concentrations of epidermal growth factor (EGF), transforming growth factor -ß1 (TGF-ß1), fibronectin, platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, and hyaluronic acid in different blood derivatives were evaluated by enzyme-linked immunosorbent assay (ELISA). RESULTS: In vitro experiments demonstrated statistically comparable epitheliotropic characteristics in cellular proliferation, migration, and differentiation for the two commercialized HPLs compared to FBS and HPS. Cells cultured without any serum were used as control group. The epitheliotropic capacities were statistically higher in the two commercialized HPLs compared to the control group (p<0.05). Among the different concentrations of blood derivatives, the preparations with 3% yielded better outcomes compared to 5% and 10%. In rats, HPLs also caused improved but not statistically significant wound healing compared to HPS. All the blood derivatives had better wound healing ratios than the control group (p<0.05). In the quantification of epitheliotropic factors, UltraGRO and PLTMax had significantly higher levels of EGF, TGF- ß1, fibronectin than human peripheral serum (p<0.05). CONCLUSIONS: Both commercialized HPLs showed comparable corneal epitheliotropic abilities and wound healing rates compared to HPS and FBS in the in vivo and in vitro studies. Our results suggest that HPLs may have the potential to replace HPS in the treatment of corneal epithelial problems.

Surgical Management of Limbal Dermoids Using Anterior Corneal Buttons From Descemet Stripping Automated Endothelial Keratoplasty Donor Tissue as Patch Grafts.

PURPOSE: To assess the surgical and clinical outcomes of anterior lamellar keratoplasty using anterior corneal buttons from Descemet stripping automated endothelial keratoplasty (DSAEK) donor tissue. METHODS: Retrospective data from 8 patients with unilateral limbal dermoids, treated between February 2011 and January 2016 at National Taiwan University Hospital, were analyzed. Donor corneas for DSAEK were divided into anterior and posterior lamellae using a 350-µm microkeratome. Anterior corneal buttons were stored for up to 4 weeks in storage media before being used as patch grafts for anterior lamellar keratoplasty. RESULTS: Corneoscleral integrity was preserved in all cases. Three of the 8 patients showed improved best-corrected visual acuity after surgery. Three patients' astigmatism reduced by more than 0.75 diopters. All 8 patients had satisfactory cosmesis after surgery. Neovascularization at the graft-host junction and graft edema was noted in 1 patient and was treated using bevacizumab injection and topical steroid. CONCLUSIONS: Anterior corneal buttons obtained from DSAEK can be used as patch grafts for surgical management of limbal dermoids. This procedure achieved satisfactory cosmetic and visual outcomes in our study. This procedure may potentially allow one corneal tissue to be received by multiple patients.

Diagnostic reliability and normative values of stereoacuity tests in preschool-aged children.

AIM: To establish the range of normal stereoacuity thresholds and evaluate the diagnostic reliability of stereoacuity tests in preschool-aged children. METHODS: 1606 children, aged 24-72 months, had detailed eye examinations and stereoacuity testing. Lang-Stereotest II (LangII) was attempted on all children, Stereo Smile Stereoacuity II Test (SSST) was conducted on children aged < 30 months and on older children who could not complete the Randot Preschool Stereoacuity Test (RPST). The RPST was conducted on children aged ≥ 30 months and on some younger children who passed both the LangII and SSST. RESULTS: Modes for the age groups 24-47 months and 48-72 months were: 200 arcsec for both age groups with the LangII test; 120 arcsec and 60 arcsec, respectively, with the SSST; 100 arcsec and 60 arcsec, respectively, with the RPST. Age-adjusted areas under the curve for detecting amblyopia, strabismus and anisometropia were: for the LangII test, 0.72, 0.68 and 0.60, respectively; for the SSST, 0.73, 0.80 and 0.57, respectively; for the RPST, 0.92, 0.82 and 0.73, respectively. CONCLUSIONS: Normative data for the LangII, RPST and SSST stereoacuity tests were determined for children aged 24-72 months. Sensitivity and specificity at individual disparity levels for detecting anisometropia, amblyopia and strabismus were also determined for RPST and SSST. Using area under age-adjusted receiver operating curves, the RPST was found to be the most reliable in detecting ocular conditions compared with the LangII and SSST tests.

Testability of refraction, stereopsis, and other ocular measures in preschool children: the Sydney Paediatric Eye Disease Study.

PURPOSE: To determine the testability and lower age limits for applying common eye tests to preschool children. METHODS: Investigators from the Sydney Paediatric Eye Disease Study examined 2,461 children aged 6 to 72 months between 2007 and 2009. Cycloplegic autorefraction was measured with Retinomax and Canon autorefractors. Ocular biometry was measured by the use of IOLMaster in children aged >30 months. The Randot Preschool Stereoacuity test, Lang-Stereotest II, and the Stereo Smile II test were administered to assess stereoacuity. Fundus photography was performed with the subjects' pupils dilated. Testability was defined as the ability to successfully complete tests in both eyes. RESULTS: There were 2,189 children with complete data. Most were testable with the Retinomax (71.8%) and Canon (66.0%) autorefractors. Testability improved with age (P for trend <0.0001) for both, and Retinomax achieved >70% testability when a subject was 24 months of age, half the age limit (48 months) found for Canon. IOLMaster was mostly testable in children aged 48+ months. Lang-Stereotest II could be used in children aged 6 months and achieved the greatest testability (94.4%) of all stereotests. White children performed better than children of some other ethnicities on Randot (P = 0.007), with girls performing better than boys (P = 0.01). Bilateral photography was achieved in >70% of preschool children 48 months of age. CONCLUSIONS: The testability of all measures was strongly age related, with mostly no sex or ethnicity effects found. The handheld Retinomax could be tested in >70% of children aged 24 months, younger than that found for the stationary Canon autorefractor (48 months). Testability measures for most eye tests in this preschool sample are comparable to other preschool studies.

Amblyopia prevalence and risk factors in Australian preschool children.

PURPOSE: To determine the prevalence of and factors associated with amblyopia in a sample of Australian preschool children. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: The Sydney Paediatric Eye Disease Study examined 2461 (73.8% participation) children aged between 6 and 72 months from 2007 to 2009. METHODS: Visual acuity (VA) was assessed in children aged ≥ 30 months using the Electronic Visual Acuity system, and a subset using the logarithm of the minimum angle of resolution chart. Amblyopia was categorized into unilateral and bilateral subtypes: Unilateral amblyopia was defined as a 2-line difference in reduced VA between the 2 eyes, in addition to strabismus, anisometropia, and/or visual axis obstruction; bilateral amblyopia was defined as bilateral reduced VA with either bilateral visual axis obstruction or significant bilateral ametropia. Information on ethnicity, birth parameters, and measures of socioeconomic status were collected in questionnaires completed by parents. MAIN OUTCOME MEASURES: Amblyopia. RESULTS: We included 1422 children aged 30 to 72 months, of whom 27 (1.9%) were found to have amblyopia or suspected amblyopia. Mean spherical equivalent for the amblyopic eyes was +3.57 diopters, with a mean VA of 20/50. Only 3 of the 27 amblyopic children had previous diagnoses or treatments for amblyopia. In regression analysis controlling for age, gender, and ethnicity, amblyopia was significantly associated with hyperopia (odds ratio [OR], 15.3; 95% confidence interval [CI], 6.5-36.4), astigmatism (OR, 5.7; 95% CI, 2.5-12.7), anisometropia (OR, 27.8; 95% CI, 11.2-69.3), and strabismus (OR, 13.1; 95% CI, 4.3-40.4). There were no significant associations of amblyopia with low birthweight (<2500 g), preterm birth (<37 weeks), maternal smoking, age, gender, ethnicity, or measures of socioeconomic status (all P>0.05). CONCLUSIONS: Amblyopia was found in 1.9% of this Australian preschool sample, which is comparable with prevalence rates reported by other recent studies in preschool children. Refractive errors, particularly significant hyperopia and astigmatism, in addition to anisometropia and strabismus, were the major amblyogenic factors. There was a low amblyopia detection rate in this preschool population, which suggests that different strategies are required to improve current vision screening strategies in preschoolers. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Prevalence and risk factors for visual impairment in preschool children the sydney paediatric eye disease study.

PURPOSE: To assess the prevalence and associations of visual impairment (VI) in preschool children. DESIGN: Cross-sectional, population-based study. PARTICIPANTS: A total of 2461 children (73.8% participation rate), aged 6 to 72 months, were examined in the Sydney Paediatric Eye Disease Study during 2007-2009; of whom 1188, aged 30 to 72 months, with complete visual acuity (VA) data in both eyes, were included in this report. METHODS: Measurement of VA was attempted on all children using the Electronic Visual Acuity (EVA) system or a logarithm of the minimum angle of resolution (logMAR) chart. Visual impairment was defined as presenting VA <20/40 in children aged ≥48 months and <20/50 in those aged <48 months. Post-cycloplegic refraction was measured, and myopia was defined as spherical equivalent (SE) ≤-0.50 diopters (D), hyperopia was defined as SE ≥2.00 D, astigmatism was defined as cylinder ≥1.00 D, and anisometropia was defined as SE difference ≥1.00 D between 2 eyes. Ethnicity, birth parameters, and sociodemographic information were collected in questionnaires completed by parents. MAIN OUTCOME MEASURES: Visual impairment prevalence and its associations with child demographic factors and birth parameters. RESULTS: Visual impairment was found in 6.4% of the worse eye and 2.7% of the better eye in our sample. Refractive errors (69.7%) and amblyopia (26.3%) were the principal causes of VI in the worse eye. Astigmatism (51.3%) and hyperopia (28.9%) were the main refractive errors causing VI. In regression analysis controlling for other factors, VI was independently associated with low birthweight of <2500 g (odds ratio 2.4, 95% confidence interval, 1.1-5.3), but not with age, gender, ethnicity, or measures of socioeconomic status (P > 0.05). CONCLUSIONS: Visual impairment in at least 1 eye was found in 6.4% of Australian preschool children, with bilateral VI found in 2.7%. Uncorrected refractive errors and amblyopia were the principal ocular conditions associated with VI. Low birthweight was a significant risk factor independent of age, gender, and ethnicity. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Complement factor H and the bilaterality of age-related macular degeneration.

OBJECTIVE: To determine whether complement factor H (CFH Y402H) genotype influences bilateral involvement of age-related macular degeneration (AMD) lesions. METHODS: The Blue Mountains Eye Study (BMES) followed up 3654 participants 49 years and older (BMES 1, 1992-1994), including 2335 (75.3% of survivors) at the 5-year (BMES 2, 1997-1999) and 1952 (76.5%) at the 10-year (BMES 3, 2002-2004) examinations. Age-related macular degeneration retinal photographic grading used the Wisconsin system. Early and late AMD included prevalent and incident cases from all visits. CFH genotyping used TaqMan assays. RESULTS: Of 767 AMD cases, 53.3% of early and 53.1% of late AMD cases were bilateral. After adjusting for age and other covariants, the CFH CC (Y402H polymorphism) genotype was associated with an increased likelihood of bilateral compared with unilateral involvement by any soft drusen (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.4-4.5), distinct soft drusen (OR, 2.8; 95% CI, 1.0-8.1), and pigmentary abnormalities (OR, 1.7; 95% CI, 1.0-2.8). We could not establish significant associations between this genotype and the bilaterality of late AMD (OR, 1.8; 95% CI, 0.4-7.7), either geographic atrophy (OR, 0.6; 95% CI, 0.07-4.6) or neovascular AMD (OR, 3.4; 95% CI, 0.3-41.4). CONCLUSIONS: Persons with the CFH CC genotype at any given age have an increased likelihood of bilateral compared with unilateral involvement of some early AMD lesions.