Evaluation of the toxicity of triamcinolone acetonide and dexamethasone sodium phosphate on human lens epithelial cells (HLE B-3).

PURPOSE: The purpose of this study was to compare the in vitro effects of triamcinolone acetonide (TA) and dexamethasone sodium phosphate (DEX) on human lens epithelial cells (HLE B-3). METHODS: HLE B-3 cells were exposed for 24 h to commercially available TA (c-TA) and dimethylsulfoxide-solubilized TA (s-TA). The cells were treated with 1,000 (clinical dose), 750, 500, 200, and 100 µg/mL concentrations of c-TA, s-TA, and supernatant for 24 h. The cells were also treated with DEX at 2, 1, 0.5, 0.2, 0.1 (clinical dose), and 0.05 mg/mL. Cell viability, caspase-3/7 activity, and DNA fragmentation analyses were performed. RESULTS: The mean cell viabilities of HLE B-3 after exposure to c-TA at 1,000, 750, 500, 200, and 100 µg/mL were significantly reduced compared with control untreated cells. The s-TA also significantly reduced cell viability at 1,000, 750, and 500 µg/mL compared with dimethylsulfoxide control. The supernatant did not reduce cell viability. Caspase-3/7 activity significantly increased after treatment with c-TA and s-TA. DNA laddering revealed bands at 200 bp intervals with both c-TA at≥100 µg/mL and s-TA at ≥500 µg/mL. The cell viabilities of HLE B-3 after 24 h exposure to DEX were significantly reduced at 2 and 1 mg/mL but not at lower concentrations tested. Caspase-3/7 activities in HLE B-3 cells were not increased significantly after treatment with DEX at any dose tested. DNA laddering did not reveal any band at any dose tested. CONCLUSION: This study showed that TA at its clinical dose (1,000 µg/mL) in both commercial preparation and solubilized forms decrease HLE B-3 cell viability through an apoptotic pathway. DEX at its clinical dose (0.1 mg/mL) does not decrease cell viability or cause any increase of caspase-3/7 activity. This study suggests that for long-term sustained-release devices, DEX may be less damaging to human lens cells than TA.

Use of topical human amniotic fluid in the treatment of acute ocular alkali injuries in mice.

PURPOSE: To evaluate the efficacy of topical human amniotic fluid (HAF) in the treatment of ocular acute alkali burns in mice. DESIGN: Experimental study. METHODS: A chemical burn with 2 microl of sodium hydroxide 0.15 mol/l was created in one eye of 30 mice. The animals were divided into gender- and age-matched groups according to the topical treatment that was administered: group 1 was treated with preterm HAF (n = 10 mice); group 2 was treated with term HAF (n = 10 mice), and group 3 was treated with saline solution (n = 10 mice). Treatment consisted of one drop that was applied to the burned eye five times per day (week one), and three times per day (week two). The epithelial defect was photographed and measured on days two and four. Ocular burn damage was assessed at days two, seven, and 14 after a pre-established classification. On day 14, both eyes of each mouse were enucleated and assessed histopathologically. RESULTS: Median epithelial defect (interquartile range [IQR], 25th, 75th percentile) at day four was 9.93% (IQR, 8.57, 11.27) for group 1, 7.30% (IQR, 5.96, 8.97) for group 2, and 18.92% (IQR, 11.71, 27.64) for group 3 (P < .0076). The overall change (difference in slope) in ocular burn score between days 2 and 14 was -0.127 (P = .009) in group 1 vs 3, -0.134 (P = .012) in group 2 vs 3, and 0.007 (P = .88) in group 1 vs 2. On histologic examination saline solution-treated corneas had more inflammatory cells and blood vessels than HAF-treated corneas. CONCLUSION: Topical preterm/term HAF was an effective topical therapy for limiting the damage after acute alkali burns of the eye in this animal model.

Genu varum in achondroplasia.

The etiology of genu varum in achondroplasia is the subject of much speculation. The purpose of the current study was to investigate the association between fibular overgrowth and genu varum in achondroplasia. A retrospective analysis was performed on the long-leg radiographs of 48 pediatric patients with achondroplasia. All patients were skeletally immature, and the average age was 7.7 years (range, 3-16 years). Boys were significantly more likely to have varus mechanical tibiofemoral angles than girls (Fisher exact test, P=0.038 for the right leg and P=0.008 for the left leg). The distance from the proximal and distal fibula to the proximal tibia knee and ankle joint orientation lines, respectively, was not associated with the alignment of the lower extremity. We conclude that fibular overgrowth does not correlate with the severity of genu varum.

Modified microkeratome-assisted posterior lamellar keratoplasty using a tissue adhesive.

OBJECTIVE: To compare graft stability and astigmatic change using suture vs tissue adhesive in an experimental model of microkeratome-assisted posterior lamellar keratoplasty. METHODS: A 300-microm-thick partial flap keratectomy was performed in human donor corneoscleral rims using an artificial anterior chamber and a manual microkeratome. The flap stopped at the left central opening border, providing a wide hinge to add stability. After flap reflection, a 6.25-mm trephination was performed to obtain a disc of posterior stroma, Descemet membrane, and endothelium. The disc was positioned in a sutureless fashion, and the flap secured with either 5 interrupted sutures or a chondroitin-sulfate-aldehyde-based adhesive. Increasing intrachamber pressures were created to detect graft stability. Videokeratographic data were recorded to evaluate astigmatic change. RESULTS: The mean (SD) astigmatic change was 3.08 (0.84) diopters (D) in the sutured group and 1.13 (0.55) D in the glued group (P = .008). Mean (SD) resisted pressures were 95.68 (27.38) mm Hg and 82.45 (18.40) mm Hg in the sutured and glued groups, respectively (P = .97). CONCLUSION: This modified technique of microkeratome-assisted posterior lamellar keratoplasty showed excellent graft stability in both groups. Flaps sealed with the novel tissue adhesive had reduced astigmatic changes in our experimental model. CLINICAL RELEVANCE: Sutureless microkeratome-assisted posterior lamellar keratoplasty using tissue adhesive may become a new alternative in the surgical treatment of corneal endothelial disorders.

Postlaminectomy kyphosis in the skeletally immature achondroplast.

STUDY DESIGN: Retrospective review. OBJECTIVES: To determine the risk of postlaminectomy thoracolumbar kyphosis in skeletally immature achondroplasts and evaluate the need for concurrent fusion at multilevel decompression. SUMMARY OF BACKGROUND DATA: Spinal stenosis is a relatively common complication of achondroplasia. Although most achondroplasts do not develop symptomatic spinal stenosis until the third or fourth decades, some patients become symptomatic before skeletal maturity. While postlaminectomy kyphosis typically does not occur in the adult achondroplast, it is not known if it occurs in the skeletally immature achondroplast. METHODS: The charts and radiographs of 10 consecutive skeletally immature achondroplasts that underwent surgical treatment for symptomatic spinal stenosis during a 10-year period were retrospectively reviewed. The average age of the 6 male and 4 female patients at surgery was 9.2 years (range 6-16). All patients had preoperative lateral radiographs. Decompression consisted of multilevel (5-8) thoracolumbar laminectomies. More than 50% of each medial facet was preserved bilaterally to maintain spinal stability. RESULTS: Postlaminectomy thoracolumbar kyphoses developed in all 10 patients (100%). The postlaminectomy kyphoses ranged from 78 degrees to 135 degrees (mean 94 degrees ). All patients underwent spinal fusions with instrumentation, performed from 10 months to 2.6 years after the decompressions, to stabilize the kyphoses. CONCLUSIONS: Skeletally immature achondroplasts are at high risk for developing postlaminectomy thoracolumbar kyphoses. Therefore, concurrent spinal fusion is indicated in skeletally immature achondroplasts who undergo thoracolumbar laminectomies of at least 5 levels.

Is there an association between diabetes and keratoconus?

PURPOSE: To examine whether there is an association between diabetes mellitus (DM) and keratoconus. DESIGN: A retrospective comparison of the proportion of keratoconus patients with DM versus the proportion of overall patients with DM, and a retrospective cross-sectional study of a cohort consisting of all diabetic keratoconus patients and randomly selected keratoconus patients without DM at a single center. PARTICIPANTS: Patients seen at the Wilmer Eye Institute from January 1, 1995, through March 18, 2004. METHODS: Review of billing data and clinic charts. Eligibility criteria for the cross-sectional study were 1 or more clinic visits, lack of other eye pathologic features (excluding cataract and diabetic retinopathy), and absence of bilateral penetrating keratoplasty (PK) at presentation. Application of novel keratoconus severity index was based on best-corrected visual acuity (BCVA) in the better eye at last visit and defined as: grade 1 (least severe), spectacle wear with BCVA of 20/40 or better; grade 2 (intermediate), spectacle wear with BCVA worse than 20/40 or rigid gas permeable lens wear; grade 3 (most severe), PK. MAIN OUTCOME MEASURES: Prevalence of DM in keratoconus patients and those without keratoconus, odds ratio of having DM on a diagnosis of more severe keratoconus, and prevalence of DM in keratoconus patients and those without keratoconus who underwent corneal transplantation. RESULTS: There was no difference in the prevalence of DM in keratoconus patients and those without keratoconus, and there was no difference in the prevalence of DM in keratoconus patients and those without keratoconus undergoing PK. However, our results suggest a negative association between DM and severity of keratoconus (P = 0.03, Fisher exact test). The odds of being in the most severe group as opposed to the least severe group were lower in DM patients than in those without DM (P = 0.01; odds ratio [OR] = 0.20; 95% confidence interval [CI], 0.05-0.70). Compared with those without DM, DM patients also had lower odds of being in the intermediate group than in the least severe group (P = 0.02; OR = 0.25; 95% CI, 0.08-0.80). After adjustment for age, gender, and race, these differences remained statistically significant. CONCLUSIONS: We found that DM is not associated with a diagnosis of keratoconus, but having DM decreases the odds of having more severe keratoconus.

Inflow of ocular surface fluid into the anterior chamber after phacoemulsification through sutureless corneal cataract wounds.

PURPOSE: To report inflow of extraocular fluid after phacoemulsification with use of sutureless corneal incisions. DESIGN: Interventional case series. METHODS: setting: Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland. patients: Eight patients (three women), aged 58 to 91 years, showing minimal bleeding from the limbal capillary bed during phacoemulsification. intervention: Surgery was performed through a 2.8-mm limbal incision. External pressure simulating patient manipulation was applied before and after wound hydrosealing with an irrigation cannula. main outcome measures: Inflow of blood-tinged tear fluid into the anterior chamber through the wound was monitored by using digital video. RESULTS: Inflow of extraocular fluid was observed in all eyes when the cannula was released, even after wound hydrosealing. Two patients showed spontaneous fluid inflow. CONCLUSIONS: Tested sutureless corneal incisions allow inflow of extraocular fluid into the anterior chamber after phacoemulsification. This may permit intraocular contamination leading to endophthalmitis.

A modified chondroitin sulfate aldehyde adhesive for sealing corneal incisions.

PURPOSE: To compare a modified chondroitin sulfate aldehyde adhesive with standard sutures for sealing corneal incisions. METHODS: A keratome knife was used to create non-self-sealing, uniplanar, 3-mm, clear corneal incisions in enucleated rabbit eyes (n = 18). The wounds were sealed with either a chondroitin sulfate-aldehyde adhesive (n = 8), three 10-0 nylon sutures (n = 5), or one 10-0 nylon suture (n = 5). Wound stability was tested by filling the globes with balanced salt solution through an anterior chamber port and slowly increasing the IOP. The pressure changes were monitored with a digital manometer connected to the anterior chamber, and leak pressure was recorded for each eye. Confocal microscopy was performed on the glued eyes, to document the glue distribution along the wound. RESULTS: The mean leak pressures in the single-suture and three-suture subgroups were 26.4 +/- 6.0 and 44.3 +/- 8.2 mm Hg (SD), respectively. The maximum IOP achieved in eyes that received the glue was 104.7 mm Hg with a mean of 101.4 +/- 3.2 mm Hg. None of the eyes in which glue was used showed leakage. At confocal microscopy, the glue was distributed inside the wound edges as a homogeneous thin layer of a less dense signal than that of the stroma. CONCLUSIONS: A novel chondroitin sulfate-aldehyde adhesive was shown to be effective ex vivo for sealing corneal incisions in rabbit eyes and was superior to sutures for this purpose.

Pilomatrixoma: a review of 346 cases.

Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a benign skin neoplasm that arises from hair follicle matrix cells. Pilomatrixoma is a common skin neoplasm in the pediatric population that is often misdiagnosed as other skin conditions. This study reviews an 11-year experience at a tertiary children's hospital, examining the cause, clinical and histopathological presentation, management, and treatment outcomes of pilomatrixoma. A review of the pathology database at Children's Hospital Los Angeles revealed 346 pilomatrixomas excised from 336 patients between 1991 and 2001. The hospital charts, pathology records, and plastic surgery clinic charts were reviewed with respect to variables such as sex, age at the time of presentation, clinical and histopathological presentation, preoperative diagnosis, management, recurrence, and treatment outcome. The main presenting symptom was a hard, subcutaneous, slowly growing mass. The preoperative diagnosis was accurate and consistent with the pathological diagnosis of pilomatrixoma in only 100 cases (28.9 percent). This entity should be considered with other benign or malignant conditions in the clinical differential diagnosis of solitary firm skin nodules, especially those on the head, neck, or upper limbs. The diagnosis can generally be made with a clinical examination. Imaging studies are not required unless symptoms or the location of the lesion warrants such diagnostic assessments. The treatment of choice is surgical excision, and the recurrence rate is low.