[Techniques for preparing postmortem human eyes to perform anterior segment intraocular surgery]. / Técnicas para la preparación de ojos de cadáver utilizadas para practicar cirugía intraocular del segmento anterior.

We describe different methods to prepare postmortem human or animal eyes used at the Center for Research in Ocular Therapeutics and Biodevices at the Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA. These techniques have been utilized for performing different surgical procedures (phacoemulsification, extracapsular cataract extraction, etc.), and for training of surgeons in-transition. Performing these techniques in the wet-laboratory contributed to improve surgical skills to perform the critical steps of the phacoemulsification surgery. Pathological evaluation of pseudophakic postmortem human eyes using the Miyake-Apple posterior view and histology was helpful to analyze postoperative complications of cataract surgery (anterior capsule opacification and posterior capsule opacification) secondary to postoperative proliferation of lens epithelial cells into the capsular bag. Modifications in the surgical techniques and/or lens design may be helpful to reduce these postoperative complications. Implantation of various aphakic and phakic intraocular lenses in postmortem human eyes as well as animal eyes was helpful to analyze the sizing and fitting of new lens designs within the eye.

Dye-enhanced cataract surgery. Part 3: posterior capsule staining to learn posterior continuous curvilinear capsulorhexis.

PURPOSE: To evaluate the use of 2 dyes for staining the posterior capsule to enhance visualization during posterior continuous curvilinear capsulorhexis (PCCC). SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Indocyanine green 0.5% (ICG) and trypan blue 0.1% were used to stain the posterior capsule for performing PCCC in 8 human eyes obtained postmortem. The eyes were prepared according to the posterior video technique of Miyake-Apple. After CCC and hydrodissection/delineation were performed, the nucleus was carefully delivered by hydroexpression. Cortical cleanup was completed by irrigation/aspiration. The posterior capsule was stained by instilling 1 microdrop of ICG (4 eyes) or trypan blue (4 eyes) in the capsular bag. A PCCC was then performed by 2 independent surgeons (4 eyes/surgeon) not familiar with this technique. Each surgeon also performed PCCC in 2 eyes without the use of dye. RESULTS: Both dyes facilitated the performance of PCCC after staining the otherwise transparent posterior capsule. It was easier to differentiate the stained posterior capsule flap from the underlying transparent anterior hyaloid phase of the vitreous. In addition, optic capture of an intraocular lens, with or without anterior vitrectomy, was easily accomplished because of the enhanced visualization by posterior capsule staining. CONCLUSIONS: Posterior capsule staining can be successfully used to learn and perform the PCCC procedure, combined with optic capture, anterior vitrectomy, or both.

Confocal microscopy in Bowman and stromal corneal dystrophies.

OBJECTIVE: To use confocal microscopy to demonstrate the similarity among three autosomal-dominant corneal dystrophies and the diversity of the deposit patterns within a single dystrophy. DESIGN: A prospective, comparative case series. PARTICIPANTS: Twenty patients (40 eyes) from 10 families suffering from Bowman or stromal dystrophy agreed to take part: 3 with Reis-Bückler dystrophy, 12 with granular dystrophy, and 5 with lattice type-I dystrophy. Of these, nine had recurrence in their grafts or after phototherapeutic keratectomy before the confocal examination. The confocal images of affected corneas were compared with those of ten normal control eyes (ten subjects). INTERVENTION: All patients were examined by slit-lamp biomicroscopy. Confocal microscopy was performed with Achroplan 40x/numeric aperture (NA) = 0.75 and 63x/NA = 0.9 water immersion objectives. Image analysis was used to identify the corneal epithelial and stromal deposits correlated with each disorder. MAIN OUTCOMES MEASURES: Selected images of the corneal layers were evaluated qualitatively for the size, shape, light scattering, and reflection of the deposits. RESULTS: Slit-lamp biomicroscopy showed stromal involvement in all affected eyes. Confocal microscopy identified epithelial deposits in 30% of the eyes and stromal deposits in all eyes. The deposits within the epithelium were revealed more clearly with the 63x/NA = 0.9 objective (higher numeric aperture). Some of the confocal findings near the Bowman layer were common for all three dystrophies. Normal control eyes showed no epithelial or stromal deposits, either by biomicroscopy or confocal microscopy. CONCLUSIONS: Confocal microscopy provides an in vivo evaluation of the deposits in the cornea, with a higher resolution than biomicroscopy. The confocal findings common to the three dystrophies may agree with previous hypotheses of the same genetic origin. It may be a useful adjunct to slit-lamp biomicroscopy, particularly when histopathologic studies cannot be performed.

Dacryocystographic examination does not identify early seventh nerve failure in leprosy patients.

Dacryocystographic examination was performed in two groups of patients: patients having leprosy and those not having leprosy, in order to look for early failure of the facial nerve. The results of this study show that this kind of examination does not improve diagnosis of leprosy.

Toxicity of Xylocaine to rabbit corneal endothelium.

PURPOSE: To assess the toxicity of lidocaine hydrochloride (Xylocaine) to the corneal endothelium. SETTING: Department of Ophthalmology, Hôtel-Dieu Hospital, Paris, France. METHODS: Rabbit corneas were excised and the endothelium was exposed to balanced salt solution (BSS), Xylocaine 1%, or Xylocaine 5% (5 corneas/group) for 20 minutes. The endothelium was then stained with trypan blue and alizarin red, and 5 photomicrographs were taken of each cornea at a standard magnification and analyzed with a digital imaging system (Biocom 200). RESULTS: Xylocaine solutions produced changes in endothelial cell morphology, but there was no cell staining with trypan blue. Corneas exposed to Xylocaine 5% had more marked cell alterations. Small areas of cells were lost from all 15 corneas, mainly at the periphery, but the differences among the 3 groups of corneas were not significant. CONCLUSION: Exposure of rabbit corneal endothelium to Xylocaine solutions in vitro was not associated with trypan blue staining of endothelial cells.

In vivo study of a fluorocarbon polymer-coated intraocular lens in a rabbit model.

PURPOSE: To evaluate the biocompatibility in rabbit eyes of poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) that were surface modified using Teflon AF. SETTING: Hôtel-Dieu Hospital, Paris Cedex, France. METHODS: The IOLs were coated with Teflon AF, an amorphous, transparent, and highly hydrophobic fluorocarbon polymer, by immersing them in Teflon AF 5% and evaporating the solvent (C8F18). The surface quality of the Teflon-coated IOLs was evaluated by scanning electron microscopy (SEM). Teflon-coated (n = 20) and control PMMA (n = 10) IOLs were implanted in rabbit eyes. The presence of iris-IOL synechias and the number of deposits on the IOL surfaces were clinically evaluated in both groups to assess the antiadhesive effect of Teflon AF. The Teflon-coated IOLs were removed, their surfaces were evaluated by SEM, and their elemental composition was checked by EDXA and Raman spectrometry. RESULTS: The PMMA IOLs were completely coated with Teflon AF. The Teflon group had no iris-IOL synechias and the control group, two extensive synechias. There were significantly fewer deposits on the surfaces of Teflon-coated IOLs than on the control IOLs 30 and 60 days postoperatively (P < .0001). Scanning electron microscopy showed lens epithelium proliferation and spindle-shaped cells on the surfaces of the PMMA IOLs and cell deposits on the irregular regions of the Teflon-coated IOLs. White-yellow spots were present on the surfaces of both IOL types. The elemental composition of Teflon-coated IOLs was stable. CONCLUSION: Teflon AF had an antiadhesive effect that increased the biocompatibility of PMMA IOLs in vivo.

Endothelial damage caused by uncoated and fluorocarbon-coated poly(methyl methacrylate) intraocular lenses.

PURPOSE: To assess endothelial damage induced by poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) coated with a fluorocarbon polymer, Teflon AF, to make them highly hydrophobic. SETTING: Department of Ophthalmology. Hôtel-Dieu Hospital, Paris, France. METHODS: Ten Teflon-coated and 10 uncoated PMMA IOLs were used in an in vitro static touch model. The corneal endothelium was placed in direct contact with the IOL for 15 seconds and then stained with trypan blue and alizarin red. The endothelial damage produced by each IOL in the area of contact was assessed semiquantitatively and quantitatively. RESULTS: Teflon-coated IOLs produced significantly less endothelial damage than uncoated PMMA IOLs (P < .0001). Endothelial cells in contact with Teflon-coated IOLs did not usually adhere to the IOL surface. In contrast, the uncoated IOLs produced large areas of endothelial cell loss. CONCLUSION: Teflon-coated PMMA IOLs have an antiadhesive effect that reduced endothelial damage after IOL insertion in an in vitro model.

[Trilateral retinoblastoma: clinical and diagnostic imaging]. / Rétinoblastome trilatéral: diagnostic clinique et par imagerie.

A case of trilateral retinoblastoma in a male child of 29 months is described, using a clinical and imaging approach. The patient was first presented with a proptosis, more pronounced in the left eye and with signs of a bilateral glaucoma. Ophthalmologic examination, echography and computed tomography were used to confirm the diagnosis. The importance of clinical examination associated with an imaging approach to evaluate intraocular tumors was emphasized and also the necessity of identifying trilateral retinoblastoma as a distinct entity and to differentiate it from intracranial metastasis or from a single retinoblastoma associated with pineal tumors.