Corneal tattoo with tea infusion.

Except in animal models of cataractogenesis, the literature on the effects of tea infusion on ocular tissue is scant. In our patient, prolonged exposure to tea infusion may have led to a hypesthetic cornea with secondary limbal stem cell loss. In turn, the eye developed keratinization and corneal neovascularization.

Vitreoretinal alterations following laser in situ keratomileusis: clinical and experimental studies.

BACKGROUND: The presence of vitreoretinal changes following laser in situ keratomileusis in myopia is evaluated. METHODS: Clinically, 50 patients (100 eyes) with marked anisometropic myopia, 50 low-myopic eyes (<4.00 D) and 50 high-myopic eyes (>7.00 D) were prospectively evaluated pre- and postoperatively for the presence of newly recognized entoptic phenomena (vitreous floaters, light flashes, or both), and for vitreoretinal changes using indirect depressed fundus examination, a +90 D preset lens, Goldman three-mirror contact lens, and kinetic ultrasound (KU) before and after bilateral LASIK. Patients with previous partial or total posterior vitreous cortex detachment (PVD) were excluded. Experimentally, groups of adult pigs underwent KU, retinal fluorescein angiography (FA), and electroretinography (ERG) before and after applying the microkeratome suction ring for 30 s. RESULTS: Clinically, 8% (4 eyes) had positive perception of postoperative vitreous floaters in the low myopia group, and 32% (16 eyes) in the high myopia group. Postoperative light flashes were noted only in the high myopia group, in 12% of cases. Partial or total posterior vitreous cortex detachment was detected by biomicroscopy in 2% (1 eye) of the low and in 10% (5 eyes) of the high myopia group and by KU in 4% (2 eyes) of the low and in 24% (12 eyes) of the high myopia group. Experimentally, 2 pig eyes out of 12 developed partial PVD by KU, immediately after microkeratome suction ring application. All pig eyes showed significantly diminished ERG amplitudes during and immediately after suction ring application. No FA changes or delays in retinal circulation time were noted during or immediately after removal of the suction ring. CONCLUSIONS: Vitreoretinal alterations after LASIK were demonstrated clinically mainly by KU in high myopes. Experimentally, PVD were also demonstrated. Diminished ERG recordings with normal retinal circulation following suction ring application may suggest some transient choroidal circulation abnormalities.

The role of matrix metalloproteinases in ulcerative keratolysis associated with perioperative diclofenac use.

OBJECTIVE: To investigate the role of matrix metalloproteinases (MMPs) in the pathogenesis of ulcerative keratolysis associated with topical use of generic diclofenac preoperatively and postoperatively. To characterize the inflammatory response of the cornea in this case of ulcerative keratolysis. DESIGN: Case report with clinicopathologic correlation. MAIN OUTCOME MEASURES: Corneal culture for microbial growth. Clinical and histopathologic examinations including routine histolopathologic, immunofluorescent, and immunohistochemical studies. RESULTS: Microscopic examination of the corneal button disclosed fibrinous material with neutrophils and mononuclear inflammatory cells. The corneal epithelial basement membrane was irregularly thickened and patchy. Immunohistochemical staining detected weak staining of MMP-1 and a strong presence of MMP-8 in the epithelium. MMP-8 and 9 were also present in areas of leukocytic infiltration. MMP-2 appeared in a few stromal cells. Macrophages and leukocytes were the predominant infiltrating cells. CONCLUSIONS: A nonspecific inflammatory response occurred in this case of ulcerative keratolysis. Corneal epithelial cells are capable of secreting MMP-1 and 8 and may participate in the stromal degradation and repair process of the ulcerative keratolysis associated with topical nonsteroidol antiinflammatory use.

Long-term survival of allogeneic donor cell-derived corneal epithelium in limbal deficient rabbits.

PURPOSE: To investigate the capability of cultivated allogeneic epithelial stem cells to restore a functional ocular surface in a limbal deficient cornea; to verify the long term survival of epithelial allograft; and to examine the host immune response to heterologous cell transplant in a rabbit model. METHODS: Limbal deficiency was established by performing limbectomy on rabbits (n = 100). Corneal epithelial stem cells were obtained from the limbus and replicated in vitro without a supporting layer. The cell (3 x 10(5)) suspension was then transplanted via topical application as eye drops. Animals were divided into allograft, autograft, and control groups. Females were used as recipients and males as donors for the allograft. Corneas were collected at 7, 14, 21, 40 days as well as 2, 3, 7 and 8 months after cell transplantation. Experimental corneas were evaluated by histology, immunofluorescence, immunohistochemistry and Y chromosome analysis. RESULTS: A well-differentiated corneal epithelium was recognized at 14 to 40 days after cell transfer overlying an infiltrated corneal stroma. Corneal re-epitheliazation was confirmed in 31 of 36 allograft corneas. No significant immune rejection was noted. Stromal abnormality caused by previous limbal deficiency was mostly resolved three months after the regeneration of corneal epithelium. CONCLUSIONS: Transplanted corneal epithelial stem cells were able to differentiate into normal corneal epithelium in vivo without the use of membrane scaffolding. This non-autologous donor cell-derived corneal epithelium survived up to 8 months without immunosuppression and was able to reverse the stromal scarring. Thus, cultivated epithelial stem cells have great potential as an alternative to multiple-surgical procedures in the treatment of limbal deficiency states.

Small choroidal melanoma with massive extraocular extension: invasion through posterior scleral emissary channels.

Massive orbital extension arising from a small posterior pole uveal melanoma is rare. A 75-year-old male followed for an asymptomatic choroidal nevus developed a two and a half month history of mild decrease in visual acuity. Upon clinical examination minimal enlargement of the tumor with surrounding serous retinal detachment was observed. Pre-operative magnetic resonance imaging disclosed massive extrascleral extension. Histopathology revealed that the tumor was composed of spindle B malignant melanoma cells. Multiple serial sections of the entire tumor area failed to demonstrate permeation through scleral lamellae. Instead, peripapillary perivascular short posterior ciliary vessel invasion was observed. This route of dissemination may explain the rapid growth and clinically undocumented behavior of small malignant melanomas at this location.

Laser in situ keratomileusis for myopia and hyperopia using the Lasersight 200 laser in 300 consecutive eyes.

PURPOSE: To evaluate effectiveness, safety, predictability, and short-term stability of laser in situ keratomileusis (LASIK) using the LaserSight Compac-200 Mini excimer laser with software version 9.0, for all refractive errors. METHODS: One hundred fifty consecutive patients (300 eyes) that received bilateral LASIK for myopia, hyperopia, and astigmatism were studied prospectively. A new 9.0 software version applying a modified nomogram that takes advantage of bilateral surgery was used. Follow-up at 6 months was available for 267 eyes (89%). RESULTS: Six months postoperatively, 131 eyes (96.32%) in the low to moderate myopia group (-1.00 to -5.99 D; n=136) had a spherical equivalent refraction within +/-1.00 D, and 123 eyes (90.44%) were within +/-0.50 D of emmetropia. In the high to extreme myopia group (-6.00 to -25.00 D; n=114), 97 eyes (87.08%) had a spherical equivalent refraction within +/-1.00 D and 78 eyes (68.42%) were within +/-0.50 D of emmetropia. In the hyperopia group (+1.00 to +6.00 D; n=50), 44 eyes (88%) had a postoperative spherical equivalent refraction within +/-1.00 D, and 31 eyes (62%) were within +/-0.50 D of emmetropia. Mean change in spherical equivalent refraction at 6 months was less than -0.50 D in the low to high myopia groups and -1.16 +/- 0.55 D in the extreme myopia group. At 6 months follow-up, uncorrected visual acuity was 20/20 or better in 73 eyes (54%) in the low to moderate myopia groups and 21 eyes (18%) in the high to extreme myopia groups. In the hyperopia group at 6 months follow-up, uncorrected visual acuity was 20/20 or better in 31 eyes (62%) and 20/40 or better in 41 eyes (82%). Only two eyes had a temporary loss of two or more lines of spectacle-corrected visual acuity due to corneal folds that were surgically treated. Six months after LASIK, no eye had lost any lines of best spectacle-corrected visual acuity in this series. CONCLUSIONS: Our modified LASIK nomogram with the 9.0 software of the LaserSight 200 excimer laser (with a larger and smoother ablation pattern) resulted in safe and effective outcomes for the treatment of low to high myopia, astigmatism, and hyperopia.

[Bilateral surgery: an efficient manner of creating LASIK nomograms]. / Cirugía bilateral: el mejor modo de realizar nomogramas personalizados de LASIK.

OBJECTIVE: Taking advantage of bilateral surgery, an efficient and predictable manner of doing Laser-assisted-in situ keratomileusis (LASIK) nomograms, is described. METHODS: We used our current technique of nomogram development with an example to described it. To evaluate a change made in the software of our LaserSight excimer laser unit: sixteen consecutive patients, operated on bilaterally, by the same surgeon, within statistically similar clinical, refractive, and surgical settings, were randomized with different nomogram for the right (OD), with a newer ablation pattern randomized in the (OS) the older sequential. Pattern. (Sequential overlapping burns) The refractive results were studied for statistical significance at 4 weeks and 6 months. The data was analyzed, using a student T test and two way Anova. RESULTS: Pre-operative refractive data showed a mean sphere in OD of -10.917 +/- 1.749, and OS of -10.89 +/- 1.717, p < NS. The mean preoperative spherical equivalent OD was -9.81 +/- 1.62 and OS of -9.93 +/- 2.02, p < NS. Post-operative mean spherical equivalent at 4 weeks in OD was +1.54 +/- 1.52, and in OS was +0.43 +/- 1.9, p < 0.05. At 6 months OD randomized was of +1.20 +/- 1.24 and, OS sequential of +0.14 +/- 1.70, p < 0.05. On the cylinder component of the refraction the values were equally corrected at both time points with p < NS. CONCLUSION: In a small group of patients, one current technique we use for nomogram development is described. Having similar statistical parameters, a significant overcorrecting with the new randomized ablation was observed, when surgery is carried out bilaterally. The change to the nomogram need then to be applied, so final refractive results are equal or better than the previous older sequential pattern. Four weeks results appeared to be time enough, since no statistical difference were observed at 6 months.

Cirugía bilateral: el mejor modo de realizar nomogramas personalizados de LASIK. / [Bilateral surgery: an efficient manner of creating LASIK nomograms]

OBJECTIVE: Taking advantage of bilateral surgery, an efficient and predictable manner of doing Laser-assisted-in situ keratomileusis (LASIK) nomograms, is described. METHODS: We used our current technique of nomogram development with an example to described it. To evaluate a change made in the software of our LaserSight excimer laser unit: sixteen consecutive patients, operated on bilaterally, by the same surgeon, within statistically similar clinical, refractive, and surgical settings, were randomized with different nomogram for the right (OD), with a newer ablation pattern randomized in the (OS) the older sequential. Pattern. (Sequential overlapping burns) The refractive results were studied for statistical significance at 4 weeks and 6 months. The data was analyzed, using a student T test and two way Anova. RESULTS: Pre-operative refractive data showed a mean sphere in OD of -10.917 +/- 1.749, and OS of -10.89 +/- 1.717, p < NS. The mean preoperative spherical equivalent OD was -9.81 +/- 1.62 and OS of -9.93 +/- 2.02, p < NS. Post-operative mean spherical equivalent at 4 weeks in OD was +1.54 +/- 1.52, and in OS was +0.43 +/- 1.9, p < 0.05. At 6 months OD randomized was of +1.20 +/- 1.24 and, OS sequential of +0.14 +/- 1.70, p < 0.05. On the cylinder component of the refraction the values were equally corrected at both time points with p < NS. CONCLUSION: In a small group of patients, one current technique we use for nomogram development is described. Having similar statistical parameters, a significant overcorrecting with the new randomized ablation was observed, when surgery is carried out bilaterally. The change to the nomogram need then to be applied, so final refractive results are equal or better than the previous older sequential pattern. Four weeks results appeared to be time enough, since no statistical difference were observed at 6 months.

Laser in situ keratomileus using the LaserSight 200 laser: results of 950 consecutive cases.

PURPOSE: To examine the refractive outcome in 950 consecutive eyes having laser in situ keratomileusis (LASIK) by 1 surgeon with experience in keratomileusis. SETTING: Outpatient excimer laser surgical facility. METHODS: This study comprised 950 consecutive eyes of 475 patients having LASIK as a primary procedure with a LaserSight 200 excimer laser (8.51 software). A nasal hinged flap and a Chiron microkeratome were used. Preoperative cycloplegic refraction was done only in patients younger than 25 years and in all hyperopic cases. Subjective preoperative and postoperative manifest refractions were done after autorefractometry in all cases. In cases of hyperopia, the software was modified by adding 30% to the refractive error. Enhancement results are not included. RESULTS: Of the 950 eyes, 893 (94.00%) were myopic and 57 (6.00%), hyperopic. In the low myopia group (1.00 to 3.99 D) of 223 eyes (24.97%), mean spherical equivalents (SEs) were -2.90 D +/- 0.56 (SD) preoperatively, -0.46 +/- 0.6 D 3 months postoperatively, and -0.41 +/- 0.5 D 6 months postoperatively. In the moderate myopia group (4.00 to 5.99 D) of 205 eyes (22.96%), respective mean SEs were -4.90 +/- 0.7 D, -0.90 D +/- 0.9 D, and -0.67 +/- 0.7 D. In the high myopia group (6.00 to 9.99) of 266 eyes (25.30%), the respective means were -7.70 +/- 1.3 D, -0.76 +/- 0.99 D, and -0.60 +/- 0.8 D. In the extreme myopia group (10.21 to 30.00) of 199 eyes (22.28%), the respective means were -13.30 +/- 2.9 D, -1.30 +/- 1.4 D, and -1.13 +/- 1.3 D. For the entire myopic group, the mean astigmatism was +1.55 +/- 1.38 D, +1.09 +/- 0.92 D, and +0.87 +/- 0.77 D, respectively. The low hyperopia group (1.00 to 2.99 D) of 39 eyes (68.42%) had a mean preoperative SE of +1.80 +/- 0.59 D and mean postoperative SEs of +1.00 +/- 0.76 D at 3 months and +1.16 +/- 0.52 D at 6 months. The respective means in the moderate hyperopia group (3.00 to 6.00) of 18 eyes (31.57%) were +4.62 +/- 1.19 D, +3.71 +/- 1.12 D, and +4.00 +/- 1.07 D. CONCLUSIONS: Laser in situ keratomileus for myopia using the LaserSight 200 excimer laser was stable with time and safe for the correction of different degrees of myopia. In the hyperopic group, marked regression occurred in a large percentage of patients. Thus, we will not perform LASIK for hyperopia until the software improves.

Bilateral macular hemorrhage after laser in situ keratomileusis.

BACKGROUND: This is the first report of a bilateral submacular hemorrhage after LASIK surgery in an extreme myo pic patient. A 31-year-old man underwent bilateral surgery for correction of -16.75+0.75x70 degrees and -16.50+0.50x55 degrees. METHODS: Case report. RESULTS: One day after surgery the patient's uncorrected visual acuity was in the 20/50 range OU and by 17 days after surgery his visual acuity had declined to 20/200 range. Fundus examination showed multifocal subretinal macular and posterior pole hemorrhages. Fluorescein angiography showed some macular lesions compatible with lacquer cracks. CONCLUSIONS: Preoperative and postoperative fundus examination is important to detect this phenomenon. Patients should be informed of this rare complication.