First aid therapy for corrosive chemical eye burns: results of a 30-year longitudinal study with two different decontamination concepts.

PURPOSE: There is currently uncertainty about the most efficacious decontamination solution for corrosive chemical eye burns. This 30-year longitudinal study evaluated the relative efficacy of two different decontamination methods. Passive decontamination consists of rinsing with tap water, 0.9% normal saline, isotonic buffered phosphate solution, or Ringer's lactate. Active decontamination adds an amphoteric, polyvalent, and chelating component with Previn® (Diphoterine®) solution (Laboratoire Prevor, Valmondois, France). METHODS: A prospective evaluation of patients treated in two specialized eye clinics for eye burns was begun in 1988. Recorded data included exposure circumstances, type of corrosive, different types of first therapy, and clinical treatment and outcome. Patients were treated from clinic admission and up to 24 h after the corrosive chemical burn with rinsing for 15 min using two different protocols. From 1988 to 2005, sterile 0.9% normal saline or Ringer's lactate was used. Since 2006, sterile, hypertonic, amphoteric Previn® solution was used. Comparative statistical analysis was done with the Fisher contingency tables and Wilcoxon tests. RESULTS: There were a total of 1495 patients with 2194 chemically burned eyes. In 1988-2005, the annual incidence was 66.1/year; in 2006-2017, it was 65.5/year. Similar incidences were noted when initial rinsing was with tap water or isotonic buffered phosphate solutions. There was a significantly more severe outcome of corrosive chemical eye burns with any first aid rinsing solutions other than Previn® solution or tap water was used (p < 0.001). Previn® solution or tap water rinsing in the pre-hospital setting and secondary rinsing with Previn® solution in the hospital decreased lesion severity in comparison with all other rinsing solutions (p < 0.001). CONCLUSION: The frequency of corrosive chemical eye burns was comparatively high despite tightening of occupational health and safety regulations over the past 30 years. The severity of corrosive chemical eye burns has been dramatically decreased since the introduction of Previn® solution for initial and secondary rinsing. A new protocol for immediate Previn® solution use by the Cologne Fire Brigade and secondary Previn® solution rinsing in hospital has reduced the frequency of severe corrosive chemical eye burns to less than 60% as compared to the period of 1988-2005 when other rinsing solutions were utilized.

[HES 130 as a continuous supplement for organ culture of human corneas?]. / HES 130 als Dauerzusatz in der Organkultur humaner Hornhäute?

BACKGROUND: During organ culture, corneas swell and have to be de-swollen prior to transplantation using a medium. Both swelling and de-swelling lead to increased endothelial cell loss. Furthermore, dextran, the standard de-swelling substance, is toxic and deposited in the cornea. Whether HES is suitable as a continuous supplement for organ culture and keeps the corneas thin was investigated in this study. METHODS: Forty-five human corneas were stored in MEM plus 7.5% HES 130 for 7, 15, 21, and 28 days. Endothelial cell count was determined before and after organ culture. After storage the water content and amount of adenosine phosphates were measured. RESULTS: Water content was 82.29% after 7 days, 82.98% after 15 days, 81.15% after 21 days, and 83.21% after 28 days. The endothelial cell count decreased by 1.20% after 7 days, 0.60% after 15 days, 4.29% after 21 days, and 6.89% after 28 days. ATP was 0.159 micromol/g dry weight after 28 days of organ culture. CONCLUSION: The water content of corneas stored in HES-containing medium remained constant even after 21 days of organ culture. Endothelial cell loss was less than in comparable studies using a standard medium containing 10% FCS; however, ATP concentrations were worse. HES 130 keeps the corneas thin and can be used as a continuous supplement. It facilitates the handling of corneas during organ culture, making dehydration before transplantation unnecessary, and thus also reduces potential stress factors for the cornea.

[Acute therapy for eye burns]. / Akuttherapie von Augenverätzungen.

BACKGROUND: Eye rinsing is the major therapeutic measure with a decisive impact on prognosis after chemical or thermal eye irritation. Several different major targets are addressed by this measure. AIM OF THE STUDY: Up to now emphasis in research was placed mostly on the neutralisation of chemical products. Newer experimental results on the basis of biological experiments interpreted against the background of basic chemical reactions may enhance clinical treatment by introducing new mechanisms of intervention. MATERIALS AND METHODS: Experiments on the modification of osmolarity, buffering capacity and solubility products show new possibilities of therapy in eye rinsing after eye irritation. These mechanisms are demonstrated by means of key experiments. RESULTS: The official recommendation of rinsing a burnt eye with water seems to be insufficient against the background of actual experimental data. Measurements of pH after eye burns indicate no buffering effects for water, or aqueous saline solution. There was weak buffering for phosphate buffer in alkali burns and a high capacity for neutralisation for diphoterine in alkali and acid burns. Ionic contents and osmolarities of the rinsing solutions have a decisive influence on the ionic composition and osmolarity of the burnt cornea after rinsing. Cellular damage is enhanced in unaffected healthy cell cultures by hyposomolar rinsing. CONCLUSION: We recommend buffered solutions with high buffer capacities for initial eye rinsing. The advantage or disadvantage of the elevated concentration of ions in the buffered rinsing solutions determining osmolarity cannot be confirmed or refuted up to now. It seems to us to be certain that osmolarity is a decisive future factor in initial rinsing.

Chlorite-hemoprotein interaction as key role for the pharmacological activity of the chlorite-based drug WF10.

WF10 is a chlorite-based drug that modulates macrophages functional states and can be safely administered to humans. WF10 potentially modulates disease-related up-regulation of immune responses both in vitro and in vivo. Thus immune response is influenced in a way that inappropriate inflammatory reactions are downregulated. The molecular mechanisms involved are not completely understood. Biochemical data suggest the reaction of chlorite with hemoproteins as the central step in the activation process of the drug. Thereby a chlorinating agent is generated, resulting in the oxidation of reduced sulfur-containing molecules and in the conversion of amino residues into more or less stable chloramines. The most prominent chloramine in vivo is taurine chloramine. Taurine chloramine is a long-lived molecule with immunomodulatory properties. For instance, taurine chloramine inhibits the generation of macrophage inflammatory mediators such as nitric oxide, prostaglandin E2 (PGE2), tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). This study on the biochemical mechanism of WF10 gives evidence that hemoprotein dependent chlorination of taurine is not only observed in vitro but also very likely in vivo. To characterize the oxidant, generated during heme activation, different methods were used: Chemiluminescence, EPR-spectroscopy, UV/VIS-spectroscopy, gas (GC) and size exclusion chromatography. In summary, the results indicate as the first products of hemoprotein catalyzed chlorite activation a chloroxygen-species (probably HOCl/OCl-) and a ferryl-oxygen species at the hemoprotein active site in analogy to the known peroxidase (compound I and II) intermediates. Moreover, hydrogen peroxide and chlorite seem to react in a similar way with heme centers. It is proposed that WF10 represents an "inactive" transport form of potentially active chlorine. Reactivity of the latter is restricted unless heme moieties in proteins or enzymes activate the "transport form" to perform reactions in analogy to peroxidases (i.e. myeloperoxidase-catalyzed formation of HOCl/OCl-).

Interactions between ocular surface fluid and cornea related to contact lenses.

PURPOSE: To improve the quantification of damage to the ocular surface, metabolite levels, electrolyte concentrations, and enzyme activities were assayed in corneal epithelium, stroma and tears. METHODS: In rabbits, rinsing or contact lenses were used to induce microtrauma. For more severe trauma, experimental injuries were induced with 1 N NaOH. Human accidents included epithelial lesions and mild chemical burns. Enzymatic test systems and electron dispersive X-ray analyses (EDXA) were employed. Corneal hydration was assessed by wet and dry weights. Interleukins were analysed with ELISA. RESULTS: In contrast to normal eyes, in ocular surface trauma the interaction between tear fluid and cornea played an important part. After wearing contact lenses or rinsing, glucose and lactate levels in the cornea and in tears increased, and ATP and glycogen in the cornea decreased. After epithelial lesions, N-acetylglucose aminidase (NAcGA, E.C.3.2.1.50) was released into the tears. Epithelial defects alone and--much more--rinsing the denuded stromal surface produced an increase of lactate and glucose in tears and a dramatic fall in Na, Cl, and S levels in the stroma. Rinsing with phosphate induced corneal calcification. IL-1 and IL-6 were increased in human corneal buttons from patients with trauma and inflammation. CONCLUSIONS: Biochemical analyses may be useful to quantify trauma to the ocular surface.

[Effect of serum and osmotically active substances on metabolism in 262 tissue cultures of pig's corneas--improved preservation of donor tissue for keratoplasty]. / Einfluss von Serum und osmotisch wirksamen Substanzen auf den Stoffwechsel in 262 Organkulturen der Kornea von Schweineaugen--Ein Beitrag zur Verbesserung des Spendermaterials zur Keratoplastik.

BACKGROUND: The storage time of corneal organ cultures in limited in the closed system mainly used in European eye banks. In addition, swelling during storage reduces the quality of the donor material for keratoplasty. Therefore, dextrane was added in concentrations of 2.5%, 5%, 7.5% and 10% to the culture medium, and the energy producing metabolism was investigated. MATERIALS AND METHODS: The experiments were carried out with 262 pig corneas. MEM with some supplements was used at 31 degrees C. No serum was added, because glucose consumption, lactate production and ATP levels proved to be the same or better than with serum supplement. After 6 and 12 days, the corneas from organ cultures were extracted with perchloric acid. The levels of glucose and lactate in the stroma and of ATP and ADP in the epithelium were analysed with enzymatic-optical tests. RESULTS: Dextrane inhibited glycolysis and the production of ATP in corneal organ cultures during twelve days. With 7.5% and 10% dextrane in the medium, lactate levels in the cornea decreased from 6.09 to 4.5 and 4.6 microM/g H2O instead of increasing. At the same time, glucose increased paradoxical from 1.3 to 3.4 and 2.2 microM/g H2O, respectively. With 5% dextrane, glycolysis operated sufficiently producing an increase of lactate levels from 6.0 to 8.8 microM/g H2O and consuming glucose from levels of 1.27 down to 0.57 microM/g H2O. After 12 days with 7.5% and 10.0% dextrane, ATP levels were reduced, from 4.54 to 0.98 and 0.49 microM/g dry weight, and ATP/ADP ratios from 1.9 to 1.1 and 0.7 respectively. With 2.5% dextrane, the ATP was diminished from 4.5 to 2.2 microM/g dry weight. When 5% dextrane were added to the culture medium, the hydration was at optimum by 4.1, and ATP levels were reduced only from 4.5 to 2.6 microM/g dry weight. Moreover, the ATP/ADP ratios were at 2.1 as good as without dextrane. CONCLUSIONS: From the results it was concluded, that serum free medium may be used, and that permanent dewelling proved to be beneficial for the energy producing metabolism of the cornea in organ culture. Such conditions may improve morphological and metabolic quality of donor material. From previous publications, it was recommended, to use instead of toxic dextran the well tolerated HES (hydroxyethyl starch) and to apply a storage temperature of 21 degrees C, which slowed down glucose consumption without impairing the energy producing metabolism.

Chemical and thermal injuries of the eyes. Surgical and medical treatment based on clinical and pathophysiological findings.

Light burns heal well within a few days. Severe chemical and thermal injuries of the eyes destroy surface epithelia and cause ischemic necroses of conjunctiva, cornea, sclera, iris, ciliary body, and lids. An inflammatory response follows with leucocyte infiltration and release of inflammatory mediators. Prostaglandins, lipoxygenase products, cytokines, superoxide radicals and Iysosomal enzymes are known to be active in eye burn disease. Their activities result in corneal, scleral and conjunctival ulceration, tissue proliferation and scarification, which develop within weeks, months and even years after the accident. Pathophysiological events produce defined clinical pictures. Some agents take special actions, e.g. alkali penetrates within seconds into the anterior chamber, sulfuric acid burns as well as quick lime burns forming slaked lime produce considerable heat. Hydrofluoric acid is highly toxic and induces early necroses. Heat causes deep ischemic necroses and lateron strongly shrinking scars. Onset and intensity of first aid decided on the outcome. Immediate rinsing is essential. Cool water, saline, Ringers lactate solution and BSS are good rinsing media. For first aid, buffered Previn seems suitable. Major chemical and thermal injuries need a variety of medical and surgical treatments: Necroses must be excised surgically. Tenon plasty is performed to reconstruct conjunctiva. Amnion-, limbus- and early keratoplasty or artificial epithelium are applied, initially to save the cornea from melting, and later to restore vision. Conjunctical, lid and intraocular surgery may be necessary. The aim of medical treatment is to suppress the inflammatory response and to prevent infection. Corticosteroids, antibiotics, ascorbate and inhibitors of proteolytic enzymes are used. Secondary glaucoma must not be forgotten. Extensive therapy is sometimes rewarding, results are presented.

Heridas oculares químicas y térmicas. Tratamiento quirúrgico y médico basado en hallazgos clínicos y patofisiológicos / Chemical and thermal injuries of the eyes. Surgical and medical treatment based on clinical and pathophysiological findings

Las quemaduras ligeras se curan bien en pocos días. Las quemaduras químicas y térmicas graves de los ojos destruyen el epitelio superficial y causan necrosis isquémica de la conjuntiva, la córnea, la esclera, el iris, el cuerpo ciliar y los párpados. Se produce una respuesta inflamatoria con infiltración de leucocitos y liberación de mediadores inflamatorios. En las enfermedades por quemaduras oculares participan prostaglandinas, productos de lipoxigenasa, citoquinas, radicales superóxido y enzimas lisosomales, cuya actividad produce ulceraciones corneales, esclerales y conjuntivales, proliferación y escarificación de tejidos que se desarrollan en plazos de semanas, meses e incluso años después del accidente. Los eventos patofisiológicos producen cuadros clínicos definidos. Algunos agentes asumen acciones especiales. Por ejemplo, el álcali penetra en segundos en la cámara anterior y las quemaduras de ácido sulfúrico y cal viva producen un calor considerable. El ácido clorhídrico es muy tóxico e induce necrosis tempranas. El calor causa necrosis isquémicas profundas y más adelante cicatrices con un pronunciado encogimiento. La aplicación y la intensidad de los primeros auxilios influyen en el resultado. El lavado inmediato es fundamental. El agua fresca, la solución salina, la solución de lactato de Ringer y BSS son buenos medios de lavado. Para los primeros auxilios, el Previn amortiguado parece adecuado. Las heridas químicas y térmicas grandes requieren una variedad de tratamientos médicos y quirúrgicos: las necrosis deben ser extirpadas con cirugía. Se realizan tenoplastias para reconstruir la conjuntiva. Se aplica amnioplastia, limboplastia y queratoplastia temprana o epitelio artificial, inicialmente para salvar la córnea de la lisis y luego para restablecer la visión. Podría ser necesaria la cirugía conjuntival, del párpado e intraocular. El objetivo del tratamiento médico es suprimir la respuesta inflamatoria y prevenir la infección. Se utilizan corticosteroides, antibióticos, ascorbato e inhibidores de enzimas proteolíticas. No se debe olvidar el glaucoma secundario. La terapia extensiva a veces produce resultados. Se incluyen resultados. (AU)

Eye burns: an emergency and continuing problem.

Adequate treatment of eye burns is an essential task of rescue teams. Clinical and occupational medicine studies have shown that efficient emergency treatment can prevent severe eye damage, but therapy is frequently delayed or inadequate. When initial therapy has been delayed or missed, several treatment strategies, including surgery, are available that may improve the outcome of an injury with poor visual prognosis. Discussed in this review are common accident mechanisms, causative agents and biophysical/pathogenetic aspects of eye burns, together with emergency and long-term treatment strategies including surgical procedures, and factors influencing outcome.

Microbiopsy in healthy rabbit corneas. A long-term study.

PURPOSE: Corneal biopsies are important in diagnosing multiple corneal diseases. They were previously performed by way of keratectomy, a method that causes corneal opacity and topographic changes due to scarring. Microbiopsy is a new way to perform corneal biopsies. Before microbiopsy may be performed on human corneas, the safety of this procedure has to be proved concerning clinical development, histological changes and topographic changes after multiple biopsies. METHODS: The healthy right cornea of 24 rabbits was punctured. 12 microtrephinations in 4 different symmetric patterns were performed. The clinical development of the bioptic sites as well as the topographic changes were observed over 5 months. After enucleation, serial sections of the corneas were analysed histologically. RESULTS: Out of 294 performed biopsies, 291 samples could be collected. 4 perforations occurred. The initial epithelial defect closed within 3 days. A pale stromal scar remained. The histological analysis of these scars showed a facette underlined by a dense hypocellular fibrous layer and a typical star-shaped figure consisting of a loose hypercellular stromal tissue. Only dioptric power of corneas with circle-pattern showed a statistically significant decrease. CONCLUSION: Micropuncture is a safe and efficient bioptic procedure. Even 12 micropunctures do not lead to significant changes of dioptric power in most patterns. Further studies are necessary to evaluate the reproducibility of refractive changes by circle patterns and corrections of astigmatisms.

Functionally adapted surfaces on a silicone keratoprosthesis.

BACKGROUND: Silicone intraocular lenses as well as silicone sponges and encircling bands on the bulbar surface are widely used and are well tolerated. The aim of this project is a new one-piece silicone keratoprosthesis with enhanced cell adhesion in the haptic region to optimize the keratoprosthesis stability. These investigations show how enhanced profileration of conjunctival fibroblasts and, therefore, improved tissue compatibility can be achieved by hydrophilizing and by protein immobilisation on a hydrophobic silicone surface. This allows a combination of desired chemical and mechanical properties of the silicone bulk material with surfaces of improved tissue compatibility. METHODS: Silicone foils with surface modifications of different kinds were tested. Experiments were done using cell cultures with murine fibroblasts L-929 and human conjuctival fibroblasts. Cytotoxicity assays were carried out with cells grown on the material in direct contact, as well as in indirect contact, with extracts (EN 30993-5). Viability stains by means of fluoresceindiacetate and ethidiumbromide together with morphology analyses by hemalaun-staining were performed. RESULTS: For the unmodified and modified foils themselves and their extracts any negative influence on cell cultures of murine and human cells could be excluded. There was a gradual improvement of cell morphology, spreading and proliferation dependent on the degree of surface modification. Covalently immobilised fibronectin showed the best results in contrast to adsorptive binding. CONCLUSIONS: Silicone surfaces can be modified chemically with bioactive proteins. These modifications are cell compatible and do not result in toxic reactions. The degree and type of silicone hydrophilization results in improved development of cell morphology, spreading and proliferation. Even better results are obtained after covalent binding of bioactive proteins like fibronectin. Improved biocompatibility with enhanced cellular overgrowth has been demonstrated in vitro for the modified silicone of the haptic region. We believe that this type of modification will help in reducing extrusion problems observed with former keratoprostheses.

Metabolic changes of the human donor cornea during organ-culture.

PURPOSE: To study metabolic changes of the human cornea during organ-culture. Morphological changes have been extensively studied, whereas changes in human corneal metabolism have not been investigated yet. MATERIAL AND METHODS: 106 human corneas were stored for 1, 7, 15, 18, 21 and 28 days in a closed-system under standard eyebank conditions. After storage, glucose, lactate, ATP, ADP and AMP concentrations were determined in each cornea. RESULTS: Glucose concentration decreased during the first two weeks with a minimum on day 15. ATP and ADP concentrations increased during the same period of time, but had their minimum later, on day 18. Lactate increased during the culture period up to day 21 and decreased thereafter. CONCLUSION: From these data we conclude that the human cornea recovers during organ-culture, especially during the first two weeks. The changes occurring after a fortnight might be related to the artificial culture conditions. Nevertheless, the metabolic status is better than in post-mortem corneas. The changes may be partly avoided by changing the medium after at least two weeks of organ-culture.

The "Aachen" keratoprosthesis: a new approach towards successful keratoprosthesis-surgery.

BACKGROUND: None of the keratoprostheses available today is absolutely successful in the long term, neither the problems of extrusion, retroprosthetic membrane formation and intraocular pressure rise are yet solved. A new type of keratoprosthesis is required which can show improved ingrowth characteristics and allow intraocular pressure measurements. In order to possibly meet the above mentioned requirements we developed a flexible silicone keratoprosthesis with scleral fixation and chemical surface modification. METHODS: The one-piece keratoprosthesis is made of silicone rubber. Its optical zone has a diameter of 11 mm and is 0.3 mm thick. The surface-modified haptic consists of a scleral rim and eight branches for scleral fixation. A ridge at the back of the keratoprosthesis fitting into the trephination hole shall avoid leakage and retroprosthetic membrane formation. Optical and mechanical qualities are characterised by tensile tests, spectrophotometry and topography. RESULTS: A method for keratoprosthesis-production was established. The optical quality of the device was improved by submicron lathing of the mould. Spectrophotometry showed high visible and ultraviolet light transmission of the silicone. Mechanical tests with silicone samples revealed high tensile strength and elongation at break. The mechanical properties were not impaired by surface modification. CONCLUSIONS: The production of a flexible silicone keratoprosthesis with high optical and mechanical properties was established. Its use both for the treatment of permanently opacified corneas and as temporary keratoprosthesis seems to be possible.

Acute effect of metipranolol on the retinal circulation.

AIM: To assess the effect of topical and systemic application of a beta adrenergic receptor blocker on retinal haemodynamics. METHODS: 24 healthy subjects were included in this double masked, randomised, placebo controlled crossover study. Metipranolol, a non-selective beta adrenergic receptor blocking agent was used as test drug. In all subjects arm-retina time, arteriovenous passage time, arterial mean dye velocity, the arterial vessel diameters, and capillary flow velocity were quantified from digital video fluorescein angiograms. RESULTS: A significant effect was observed on the arteriovenous passage time (p < 0.05), the arterial mean dye bolus velocity (p < 0.05), and capillary blood velocity (p < 0.05), but not on the arterial vessel diameter. The arterial mean dye bolus velocity and capillary blood velocity increased after application of the test drug (topical and systemic). In tandem with this a decrease of the arteriovenous passage time was observed. The perfusion pressure increased after topical application and remained unchanged after systemic application of metipranolol. CONCLUSIONS: This study shows that systemic as well as topical application of metipranolol leads to increased retinal blood flow velocities. The implications of these results for treatment with beta adrenergic receptor blockers is not clear. However, in view of these data it is very unlikely that treatment with metipranolol has a negative effect on retinal blood flow.

Assessment of conjunctival epithelium after severe burns and surgical reconstruction with Tenon plasty by means of a modified impression cytology procedure.

PURPOSE: Tenon plasty has been used to reconstruct the conjunctival surface in severe burns in which ischemic sclera was exposed or undergoing ulceration. A modified impression cytology procedure was applied to investigate the conjunctival epithelium. The quality of the regenerated epithelium on the advanced Tenon sheets was assessed. METHODS: The 63 conjunctival samples of eye-burn patients were investigated. Among these, 41 patients had very severe bums. Conjunctival samples were collected from 6 weeks after surgery to 5 years after the accident. They were compared with conjunctival epithelia obtained from 53 normal eyes of healthy volunteers. A 25-mm2 Biopore membrane (Millipore Catalogue PICM 01250) was placed on the bulbar conjunctiva surface in the lower temporal quadrant, at a distance of 3-5 mm from the limbus, till it was soaked with fluid. The ablated cell sheets were stained with periodic acid-Schiff (PAS). RESULTS: In all cases, an intact conjunctival epithelium was observed. In healthy eyes, 2,338 epithelial cells/mm2 and 155 goblet cells/ mm2 were found. Eyes after a surgical reconstruction with Tenon plasty resulted only in 1,575 epithelial cells/mm2 and 72 goblet cells/mm2. The differences were highly significant. The ratio of epithelial to goblet cell counts revealed an increase of goblet cells during the postoperative period. CONCLUSION: Conjunctival epithelium as well as goblet cell densities were reduced after heat, lime, alkali, and acid burns. However, after concrete burns, cell densities were increased. Tenon plasty provided the regeneration of the fully intact conjunctival epithelium. Goblet cells were present from 6 weeks after the surgery on; their number increased gradually. The stimulation of the goblet cell mucous secretion is discussed.

Changes in mineral composition of rabbit corneas after alkali burn.

BACKGROUND: Mineral balance is essential for maintaining corneal transparency. In preliminary investigations, we found alterations of mineral concentrations in the human cornea after chemical burns. In this prospective study the mineral content of the rabbit cornea was quantified after experimental alkali burns. METHODS: Thirty-two eyes of rabbits were burnt for 30 s with 1 M NaOH. A short period of saline rinsing followed, but no further therapy was given. The eyes of 20 healthy rabbits served as a control. We measured the water content by weighing the cornea before and after drying. The mineral content of the cornea was determined in different stromal layers using energy-dispersive X-ray analysis in the scanning electron microscope. Groups of eight rabbits were examined on days 0, 1, 4 and 8 after the experimental burns. RESULTS: After alkali burns the mineral composition of the corneal stroma changed considerably. Sodium was present in high concentrations immediately after burning, up to 708 mmol/kg dry weight, and returned to normal on day eight. Chlorine increased significantly throughout the whole period. Sulphur concentrations stayed almost normal, showing only a minute loss of ground substance after alkali burn. A considerable and increasing edema could be concluded from the water content. CONCLUSIONS: Alkali burns resulted in a dramatic change of the corneal mineral content. Therapeutic intervention with appropriate solutions is required to restore and maintain the normal mineral composition of the denuded corneal stroma.

Retinal capillary density in patients with arterial hypertension: 2-year follow-up.

BACKGROUND: Arterial hypertension is known to be an important risk factor for cerebral and cardiovascular disease. Previous studies have demonstrated a decrease of capillary density in the perifoveal network in tandem with decreased capillary flow velocity in patients with essential hypertension. In a prospective study we quantified the retinal microcirculation in order to evaluate the time course of changes in the perifoveal network. METHODS: Thirty-three patients with essential hypertension (mean age 45 +/- 14 years) underwent video-fluorescein angiographic studies at baseline and at 2 years 28 +/- 6 months) thereafter. The angiograms were obtained with a scanning laser ophthalmoscope and were digitally recorded. By means of digital image analysis we quantified off-line the mean area of perifoveal intercapillary areas (PIA) and the mean capillary flow velocity. RESULTS: At baseline, the patients with hypertension showed significantly increased PIA and a significantly decreased capillary flow velocity compared with reference values. During the follow-up period the capillary flow velocity decreased further significantly, whereas the PIA showed no significant change. CONCLUSIONS: The continuous decrease of capillary flow velocity demonstrates a progression of altered microcirculation in patients with essential hypertension whose blood pressure was believed to be well controlled. Further studies with this technique may be useful to determine the influence of antihypertensive therapy and may help to identify patients at risk for cerebrovascular events.

Development of a surface modified silicone-keratoprosthesis with scleral fixation.

BACKGROUND: Many attempts have been made to create artificial corneas. The keratoprostheses currently available do not allow measurements of the intraocular pressure (IOP) and restrict the visual field. The main problem is extrusion due to an insufficient connection between implant and surrounding tissue. It is our aim to create a flexible keratoprosthesis with a wide field optic allowing measurements of the IOP. Surface modification will improve cell adhesion and therefore stability between implant and tissue. METHODS: The keratoprosthesis is made of silicone rubber. The optical zone is 11 mm in diameter with a thickness of 0.3 mm. The surface modified haptic consists of a scleral rim and 8 branches for scleral fixation. Optical and mechanical qualities were tested by tensile tests, spectrophotometry and topography. RESULTS: A method to produce one-piece silicone keratoprostheses was established. Submicron lathing of the mould led to an excellent optical quality. Spectrophotometry showed high degree of visible and ultraviolet light transmission of the silicone. Mechanical tests revealed high tensile strength and elongation at break which were not impaired by surface modification. CONCLUSION: The production of a flexible silicone keratoprosthesis with high optical and mechanical properties was accomplished, with possible use as both permanent and temporary keratoprosthesis.

The corneal stroma: an inhomogeneous structure.

PURPOSE: This study was conducted to determine the elemental composition of the human cornea. Special attention was paid to corneal stroma inhomogeneity. METHODS: Seventy human corneas were examined by means of energy-dispersive X-ray analysis. Epithelium, subepithelium, middle stroma, sub-Descemet layer, Descemet's membrane and endothelium were subjected to repeated measurements. RESULTS: In the cellular layers the phosphorus concentrations were high [0.35 mol/kg dry weight (dw) in the epithelium and 0.403 mol/kg dw in the endothelium]. Similar concentrations were found for sulphur (0.38 mol/kg dw in the epithelium). Stromal layers showed high contents of sulphur: 0.26 mol/kg dw. The phosphorus concentration was found to be higher in the subepithelium than in the middle stroma. Sulphur concentrations were highest in Descemet's membrane, followed by the subepithelium and the middle stroma. DISCUSSION: Nucleic acids and energy-containing phosphates explain the high levels of phosphorus in the cellular layers. The high sulphur concentrations may be related to the phosphoadenosinphosphosulfate and protein turnover in the epithelium. We interpret the inhomogeneous distribution of phosphorus in the stroma as a function of the density of keratocytes. An evaluation of all known sulphur-containing biochemical components of the stroma (0.217 mol sulphur/kg dw) corresponds to our measurements. In contrast to former results we find the corneal stroma to be an inhomogeneous structure.