DOCSLIB.ORG

Avellino Corneal Dystrophy After LASIK

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Avellino Corneal Dystrophy After LASIK Avellino Corneal Dystrophy after LASIK Roo Min Jun, MD,1,4 Hungwon Tchah, MD,2 Tae-im Kim, MD,2 R. Doyle Stulting, MD, PhD,3 Seung Eun Jung, MS,4,6 Kyoung Yul Seo, MD,4 Dong Ho Lee, MD,5 Eung Kweon Kim, MD, PhD4,6 Objective: To report cases of Avellino corneal dystrophy (ACD) exacerbated by LASIK for myopia. Design: Retrospective, noncomparative, interventional case series and review of the literature. Participants: Seven patients. Intervention: Six patients with exacerbation of granular corneal deposits after LASIK were examined for TGFBI mutations by polymerase chain reaction sequencing of DNA. One previously reported patient who was heterozygous for the ACD gene was followed up for 16 months after mechanical removal of granular deposits from the interface after LASIK. Main Outcome Measures: Slit-lamp examination, visual acuity, manifest refraction, and DNA sequencing analysis. Results: All patients were heterozygous for the Avellino dystrophy gene. Corneal opacities appeared 12 months or more after LASIK. Best spectacle-corrected visual acuity decreased as the number and density of the opacities increased. One patient underwent mechanical removal of granules from the interface and had a severe recurrence within 16 months. Another patient had removal of the granules from the interface with PTK, followed by treatment with topical mitomycin C. In this patient, the cornea has remained relatively clear for 6 months. Conclusions: Laser in situ keratomileusis increases the deposition of visually significant corneal opacities and is contraindicated in patients with ACD. Mechanical removal of the material from the interface does not prevent further visually significant deposits. Mitomycin C treatment, in conjunction with surgical removal of opacities, may be an effective treatment. Ophthalmology 2004;111:463–468 © 2004 by the American Academy of Ophthalmology. Avellino corneal dystrophy (ACD) is an autosomal domi- generally is slow, and good visual acuity is maintained until nant dystrophy with clinical features of both granular and later life despite an increasing number of granular opacities lattice dystrophy. Originally described in patients from in the cornea. Patients with homozygous ACD typically Avellino, Italy, it has now been reported around the have an earlier onset of visual symptoms and granular world.1–5 opacities, with increasing latticelike deposits in later life.1,11 Its appearance is variable, and it is often misdiagnosed as We recently reported a patient with heterozygous ACD granular dystrophy.6–8 The diagnosis can be confirmed by in whom corneal deposits increased after LASIK.12 In that genetic analysis, demonstrating the replacement of histidine case report, the deposits appeared in the interface and were by arginine at codon 124 of the TGFBI gene.9,10 In patients removed 21 months after LASIK, with an improvement in with heterozygous ACD, the deposition of corneal opacities best spectacle-corrected visual acuity (BSCVA).12 The purpose of this study was to report 6 additional Originally received: March 21, 2003. patients with ACD who underwent LASIK and to provide Accepted: June 25, 2003. Manuscript no. 230164. additional follow-up on the previously reported patient. 1 Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea. 2 Department of Ophthalmology, University of Ulsan, College of Medi- cine, Seoul, Korea. Patients and Methods 3 Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia. Seven patients with white granular opacities in the interface be- 4 tween the flap and stromal bed after uneventful LASIK are the Institute of Vision Research, Department of Ophthalmology, Yonsei subjects of this report. Preoperative characteristics of each and University College of Medicine, Seoul, Korea. details of the surgeries are shown in Table 1. 5 Yonsei Eye Center, Seoul, Korea. DNA analysis was performed from peripheral blood as previ- 6 The Brain Korea 21 Project for Medical Science, Yonsei University, ously described.12 The TGFBI gene was analyzed by sequencing Seoul, Korea. exon 4 for ACD (R124H mutation) and exon 12 for granular Supported by a grant of the Korea Health 21 R&D Project, Ministry of corneal dystrophy (R555W mutation). The primer pairs used to Health & Welfare, Republic of Korea (grant no.: 02-PJ1-PG1-CH02-0003). amplify the 2 exons were purified with a polymerase chain reaction The authors have no proprietary interests. purification kit (Qiagen, Hilden, Germany) and were sequenced Correspondence to Eung Kweon Kim, MD, PhD, Department of Ophthal- with an automatic fluorescent DNA sequencer (ABI Prism 377; mology, Yonsei University College of Medicine, Seodaemoongu Shin- Applied Biosystems, Foster City, CA) and a dry terminator cycle chondong 134, C.P.O. Box 8044, Seoul, Korea. E-mail: sequencing kit (Perkin Elmer, Foster City, CA). All 7 patients were [email protected]. heterozygous for the ACD gene. © 2004 by the American Academy of Ophthalmology ISSN 0161-6420/04/$–see front matter 463 Published by Elsevier Inc. doi:10.1016/j.ophtha.2003.06.026 Ophthalmology Volume 111, Number 3, March 2004 Table 1. Clinical Characteristics of Patients with Recurrent Avellino Corneal Dystrophy after LASIK Refractive Error before LASIK Detection Best Spectacle-corrected Eyes Treated (Spherical Deposits before Duration of Visual Acuity after No Gender Age* with LASIK Equivalent) LASIK Microkeratome Excimer Laser Recurrence† Recurrence 1 M 27 Both Right, Ϫ9.25 Unknown ACS Mel 60 14 mo 20/30 Left, Ϫ9.50 Unknown 20/50 2 F 22 Left Right, Ϫ6.75 Yes SCMD VISX 20/20 Ͻ5 yrs No operation Left, Ϫ10.75 Yes 20/100 3 F 28 Both Right, Ϫ3.50 Yes SCMD VISX S2 Ͻ4 yrs 20/40 Left, Ϫ5.25 Yes 20/20 4 F 32 Both Right, Ϫ10.25 Yes Moria C&B Nidek EC5000 Ͻ2 yrs 20/20 Left, Ϫ8.75 Yes 20/20 5 F 27 Both Right, Ϫ9.75 Yes ACS Telco 13 mos 20/30 Left, Ϫ9.88 Yes 20/30 6 F 27 Both Right, Ϫ9.50 Yes ACS VISX S2 12 mos 20/25 Left, Ϫ8.50 Yes 20/25 7 F 22 Both Right, Ϫ3.00 Yes ACS Kerator 217 12 mos 20/30 Left, Ϫ3.00 Yes 20/30 ACS, Automated Corneal Shaper (Bausch & Lomb Surgical, Claremont, CA); Kerator 217, Kerator 217 excimer laser (Bausch & Lomb Surgical, Claremont, CA); Mel 60, Meditec MEL 60 excimer laser (Aesculap-Meditec, Heroldsberg, Germany); Moria C&B, Moria C&B (Moria Surgical, Antony, France); Nidek EC5000, Nidek EC5000 (Nidek, Gamagori, Japan); SCMD, SCMD manual microkeratome (SCMD, Doylestown, PA); VISX 20/20, VISX 20/20 (VISX Excimer Laser System, Santa Clara, CA); VISX S2, VISX Star S2 (VISX Excimer Laser System, Santa Clara, CA); Telco, Telco (Telco Medical Technologies, Perth, Australia). *Age at which LASIK surgery was performed. †The time of appearance of deposits in patients 2, 3, and 4 is not certain, because they were not examined for several years after LASIK. This study was performed in accordance with the Helsinki Before LASIK, MR was Ϫ6.00 Ϫ1.50ϫ180 in the right eye Agreement, and informed consent was obtained from all subjects. and Ϫ9.50 Ϫ2.50ϫ5 in the left eye, yielding 20/20 in the right eye and 20/25 in the left eye. A few granular corneal opacities were observed before LASIK in both eyes. Surgery was performed Patient 1 uneventfully, and uncorrected visual acuity in the left eye was A 33-year-old Korean male underwent LASIK in 1996. An oph- 20/25 4 months after LASIK. The ethics committee of that hospital thalmic examination performed 6 years previously did not docu- prohibited the surgeon from performing LASIK on the opposite ment corneal opacities. Manifest refraction (MR) before LASIK eye because of the appearance of granular opacities in the operated was Ϫ9.00 Ϫ0.50ϫ90 in the right eye and Ϫ9.50 in the left eye, eye. yielding 20/20 in the right eye and 20/25 in the left eye. Fourteen In January 2002, the patient noted blurred vision in the left eye. months after surgery, the surgeon noted white opacities in the On presentation, there were several discrete granular opacities in interface between the flap and the residual stromal bed in both the anterior stroma of right cornea. Manifest refraction and eyes, even though the BSCVA was 20/20 in both eyes. The patient BSCVA of the right eye were unchanged from 5 years previously. (Fig 1) visited another physician, who removed some of the In the operated left cornea, numerous dense, confluent granular opacities from the interface of the left cornea on September 9, opacities were noted centrally in the interface between the flap and 2002. residual stroma (Fig 2). Manifest refraction was Ϫ1.50 in the left On presentation on October 24, 2002, granular deposits were eye, yielding 20/100 BSCVA. observed centrally in the interface beneath the flap of both eyes, more numerous in the right than the left. Manifest refraction was Ϫ3.25 Ϫ0.50ϫ40 in the right eye and Ϫ2.50 Ϫ1.00ϫ90 in the left Patient 3 eye, yielding 20/30 in the right eye and 20/40 in the left eye. His 61-year-old father and 1 of his 2 sisters had corneal A 32-year-old Korean female was referred in July 2002 with opacities consistent with ACD. Another surgeon had declined to decreased visual acuity in her right eye. She had undergone LASIK perform LASIK on that sister with ACD 4 years previously at her in both eyes 4 years previously, without complications. Several age of 26 because white granules were observed in the corneal granular corneal opacities had been observed in both eyes before stroma. That same surgeon performed LASIK on the other sister, surgery. Two years after LASIK, she noted progressive loss of who was 24 years old at the time, because no stromal opacities vision.
Load more

Recommended publications
  • Understanding Corneal Blindness
    Understanding Corneal Blindness The cornea copes very well with minor injuries or abrasions. If the highly sensitive cornea is scratched, healthy cells slide over quickly and patch the injury before infection occurs and vision is affected. If the scratch penetrates the cornea more deeply, however, the healing process will take longer, at times resulting in greater pain, blurred vision, tearing, redness, and extreme sensitivity to light. These symptoms require professional treatment. Deeper scratches can also cause corneal scarring, resulting in a haze on the cornea that can greatly impair vision. In this case, a corneal transplant may be needed. Corneal Diseases and Disorders that May Require a Transplant Corneal Infections. Sometimes the cornea is damaged after a foreign object has penetrated the tissue, such as from a poke in the eye. At other times, bacteria or fungi from a contaminated contact lens can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called keratitis. These infections can reduce visual clarity, produce corneal discharges, and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant. Fuchs' Dystrophy. Fuchs' Dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma (the middle layers of the cornea). This causes the cornea to swell and distort vision. Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment. Epithelial swelling damages vision by changing the cornea's normal curvature, and causing a sightimpairing haze to appear in the tissue.
    [Show full text]
  • Peripheral Hypertrophic Subepithelial Corneal Degeneration Presenting
    Eye (2015) 29, 88–97 & 2015 Macmillan Publishers Limited All rights reserved 0950-222X/15 www.nature.com/eye 1,2 3 4 CLINICAL STUDY Peripheral MSchargus , C Kusserow ,USchlo¨ tzer-Schrehardt , C Hofmann-Rummelt4, G Schlunck1 hypertrophic and G Geerling1,5 subepithelial corneal degeneration presenting with bilateral nasal and temporal corneal changes Abstract 1 Department of Purpose To characterise the history, clinical transmission electron microscopy showed Ophthalmology, University of Wuerzburg, Wuerzburg, and histopathological features of patients histological features that are similar to Germany with bilateral nasal and temporal peripheral Salzmann’s corneal changes without any hypertrophic subepithelial corneal inflammation. We hypothesise that light 2Department of degeneration in a German population. exposure and a localised limbal insufficiency Ophthalmology, University Methods A detailed ophthalmological and could be involved in the pathogenesis. of Bochum, Bochum, dermatological history and clinical findings Eye (2015) 29, 88–97; doi:10.1038/eye.2014.236; Germany were recorded of nine patients with bilateral published online 3 October 2014 3Department of simultaneous nasal and temporal peripheral Ophthalmology, University corneal degeneration from two centers in of Luebeck, Lu¨ beck, Germany. Excised tissues were studied by Introduction Germany histopathology, immunohistochemistry, and transmission electron microscopy. Salzmann’s nodules (SN) are subepithelial, 4 Department of Results Foreign body sensation and need elevated bluish-white corneal opacities of non- Ophthalmology, University inflammatory origin, with a specific peripheral of Erlangen-Nuernberg, of artificial tear substitutes were the only 1–7 Erlangen, Germany symptoms reported regularly. Schirmer’s and circular pattern. What has been termed Jones-test were normal in all, but fluorescein Salzmann’s degeneration is predominantly 5Department of break-up time of 410 s was found in five eyes unilateral, presenting at any time in life with Ophthalmology, University of four patients.
    [Show full text]
  • Its Not Just Dry Eye NCOS2021
    5/31/21 DISCLOSURES CORNEA ENDOTHELIOPATHIES NOPE, THAT’S NOT JUST DRY EYE: PRIMARY SECONDARY OTHER CORNEAL DISEASES • Corneal guttata • Contact lens wear • Fuchs dystrophy • Surgical procedures • Posterior Polymorphous Dystrophy (PPD) • Age related Cecelia Koetting, OD FAAO • Congenital hereditary endothelial dystrophy • Iatrogenic (im munodeficiency) (CHED) • Glaucoma induced Virginia Eye Consultants • Iridocorneal endothelial syndrome (ICE) • Ocular inflammation Norfolk, VA 1 2 3 OTHER CORNEAL CORNEAL FUNCTION • Keratoconus • Central cloudy dystrophy of Francois • Pellucid marginal degeneration • Thiel-Behnke corneal dystrophy • Shields the eye from germs, dust, other harmful matter • Lattice Dystrophy • Ocular Bullous pemphigoid WHY IS THE CORNEA IMPORTANT? • Contributes between 65-75% refracting power to the eye • Recurrent corneal erosion (RCE) • SJS • Filters out some of the most harmful UV wavelengths • Granular corneal dystrophy • Band Keratopathy • Reis-Bucklers corneal dystrophy • Corneal ulcer • Schnyder corneal dystrophy • HSV/HZO • Congenital Stromal corneal dystrophy • Pterygium • Fleck corneal dystrophy • Burns/Scars • Macular corneal dystrophy • Perforations • Posterior amorphous corneal dystrophy • Vascularized cornea 4 5 6 CORNEAL ANATOMY CORNEA Epithelium Bowmans Layer • Cornea is a transparent, avascular structure consisting of 6 layers • A- Anterior Epithelium: non-keratinized stratified squamous epithelium; cells migrate from BRIEF ANATOMY REVIEW Stroma basal layer upward and periphery to center • B- Bowmans Membrane:
    [Show full text]
  • The Latest in Corneal Degenerations and Dystrophies Corneal
    5/20/2014 Epithelial (Anterior) Basement Membrane CORNEAL DEGENERATION Dystrophy (EBMD or ABMD) • Non-familial, late onset • Easy to overlook: The Latest In Corneal • Asymmetric, unilateral, central or peripheral – typically bilateral though often asymmetric, Degenerations and Dystrophies • Changes to the tissue caused by inflammation, – females>males, age, or systemic disease. – often first diagnosed b/w ages of 40-70 Blair B Lonsberry, MS, OD, MEd., FAAO Characterized by a deposition of material, a Diplomate, American Board of Optometry • Clinic Director and Professor thinning of tissue, or vascularization Pacific University College of Optometry Portland, OR [email protected] Epithelial (Anterior) Basement Membrane Epithelial (Anterior) Basement Membrane Dystrophy (EBMD or ABMD) Dystrophy (EBMD or ABMD) • Most common • Primary features of this “dystrophy” are: findings are: – abnormal corneal epithelial regeneration and – chalky patches, maturation, – intraepithelial – abnormal basement membrane microcysts, and • Often considered the most common dystrophy, – fine lines (or any but may actually be an age-related degeneration. combination) in the central 2/3rd of CORNEAL DYSTROPHIES – large number of patients with this condition, cornea – increasing prevalence with increasing age, and – its late onset support a degeneration vs. dystrophy. 2 2 8 Epithelial (Anterior) Basement Membrane Epithelial (Anterior) Basement Membrane Corneal Dystrophies Dystrophy (EBMD or ABMD) Dystrophy (EBMD or ABMD) • Group of corneal diseases that are:
    [Show full text]
  • Bilateral Cataract Surgery in Posterior Polymorphous Corneal Dystrophy
    J Clin Case Rep Trials 2018 Journal of Volume 1: 1 Clinical Case Reports and Trials Bilateral Cataract Surgery in Posterior Polymorphous Corneal Dystrophy Taha Ayyildiz1* 1Department of Ophthalmology, Ahi Evran University, Kırsehir, Turkey Abstract Article Information Posterior polymorphous corneal dystrophy (PPCD) is an autosomal Article Type: Case Report dominant corneal dystrophy and usually non-progressive which is Article Number: JCCRT101 characterized by metaplasia and excessive growth of the corneal Received Date: 06th-March -2018 endothelium and Descemet’s membrane defects. Biomicroscopic slit Accepted Date: 14th-April -2018 Published Date: 19th-April -2018 lesions are observed. The patients are usually asymptomatic corneal edemalamp examination was observed shows in some isolated advanced or confluent cases. The vesicles evaluation and ofbands 38-year- like *Corresponding author: Dr. Taha Ayyildiz, Department old male patient who admitted to our clinic and it was observed every of Ophthalmology, Ahi Evran University, Kırsehir, Turkey. 2 cornea PPCD that the accompanying dense nuclear sclerosis cataracts. Tel: +90-386-280-42-00; E-mail: [email protected] In this study, we aimed to share the results of uncomplicated cataract surgery. Citation: Ayyildiz T (2018) Bilateral Cataract Surgery in Posterior Polymorphous Corneal Dystrophy. J Clin Case Keywords: Rep Trials. Vol: 1, Issu: 1 (01-03). dystrophy. Phacoemulsification, Cataract, Posterior polymorphous Copyright: © 2018 Ayyildiz T. This is an open-access Introductıon article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the Koeppé in 1916 withwide corneal and anterior segment anomaly [1]. It original author and source are credited.
    [Show full text]
  • Familial Pathologic Myopia, Corneal Dystrophy, and Deafness: a New Syndrome
    Familial Pathologic Myopia, Corneal Dystrophy, and Deafness: A New Syndrome Emin Kurt*, Abdullah Günen†, Yılmaz Sadıkog˘ lu†, Faruk Öztürk*, Serdar Tarhan‡, Refik Ali Sarı§, Tevhide Fıstıkʈ and Zeki Arı¶ Departments of *Ophthalmology, †Otorhinolaryngology, ‡Radiology, §Internal Medicine, ʈMedical Genetics, and ¶Biochemistry, School of Medicine, University of Celal Bayar, Manisa, Turkey Background: Numerous syndromes with myopia and hearing loss have been described up to now. We present a family with pathologic myopia, corneal dystrophy, and deafness distinct from these syndromes. Cases: Ten patients in the same Turkish family were evaluated by ophthalmologic, audio- logic, physical, radiologic, genetic, serologic, and biochemical examinations. Observations: Ophthalmic examination indicated that all the cases had myopia, 7 of them had pathologic myopia, 1 had intermediate, and 2 had mild. Four of the patients with patho- logic myopia had corneal dystrophy that was bilaterally manifest as white opacities in the posterior stroma near Descemet’s membrane in an axial distribution; 1 of these 4 patients also had a tilted disc. Otolaryngologic examination revealed conductive hearing loss in 3 cases, mixed hearing loss in 2, and sensorineural hearing loss in 1. The results of karyotypic analyses of all cases were normal. The pedigree analysis showed the disease was inherited through successive generations as an autosomal dominant trait. The results of biochemical, serologic, and radiologic investigations were normal. The same pathophysiologic process in all cases seemed to account for the myopia, the corneal dystrophy and the deafness. Conclusions: To our knowledge, this type of case has not been reported in the literature. Therefore, we named this syndrome “familial pathologic myopia, corneal dystrophy and deafness.” Jpn J Ophthalmol 2001;45:612–617 ©2001 Japanese Ophthalmological Society Key Words: Corneal dystrophy, hearing loss, pathologic myopia, tilted disc, syndrome.
    [Show full text]
  • The Outcome of Penetrating Keratoplasty for Corneal Scarring
    ORIGINAL ARTICLE The outcome of penetrating keratoplasty for corneal scarring due to herpes simplex keratitis O resultado da ceratoplastia penetrante para cicatriz de córnea consequente à ceratite por herpes simplex YESIM ALTay1, SEMA TAMER1, ABDULLAH SENCER Kaya1, OZGUR BALTA1, AYSE BURCU1, FIRDEVS ORNEK1 ABSTRACT RESUMO Purpose: To determine the outcomes of penetrating keratoplasty (PK) for treatment Objetivo: Determinar os resultados da ceratoplastia penetrante (PK) para o trata- of corneal scarring caused by Herpes simplex virus (HSV) keratitis, and whether mento da cicatriz da córnea consequente à ceratite por Herpes simplex vírus (HSV), the corneal scar type affects treatment outcome. e se o tipo de cicatriz na córnea afeta o resultado cirúrgico. Methods: A retrospective analysis of patients who underwent PK for HSV-related Métodos: Foi realizada análise retrospectiva dos pacientes, submetidos à PK para corneal scarring between January 2008 and July 2011 was performed. The patients a cicatriz da córnea relacionados com o HSV entre janeiro de 2008 e julho de 2011. were categorized into two groups. Group 1 consisted of patients with a quiescent Os pacientes foram divididos em dois grupos. Grupo 1 consistiu de pacientes que herpetic corneal scar and group 2 consisted of patients who developed a corneal tiveram cicatriz corneana herpética quiescente e grupo 2 consistiu de pacientes que descemetocele or perforation secondary to persistent epithelial defects with no desenvolveram descemetocele ou perfuração córnea secundária a defeitos epiteliais active stromal inflammation. The mean follow-up was 21.30 ± 14.59 months. The persistentes sem inflamação estromal ativa. O seguimento médio foi de 21,30 ± 14,59 main parameters evaluated were recurrence of herpetic keratitis, graft rejection, meses.
    [Show full text]
  • Coincident Pellucid Marginal Degeneration and Fuchs’ Endothelial Dystrophy 1James Mckelvie, 2Cameron Andrew Mclintock, 3Samer Hamada
    IJKECD James McKelvie et al. 10.5005/jp-journals-10025-1170 CASE REPORT Coincident Pellucid Marginal Degeneration and Fuchs’ Endothelial Dystrophy 1James McKelvie, 2Cameron Andrew McLintock, 3Samer Hamada ABSTRACT BACKGROUND Aim: We report a rare case of coincident pellucid marginal Pellucid marginal degeneration (PMD) is a rare, bilateral, degeneration and Fuchs’ endothelial dystrophy. non-inflammatory corneal ectatic disorder characterized 1 Background: As far as the authors are aware there have been by a band of inferior corneal thinning. PMD has a 3:1 male no previous reports of this combination of corneal disorders predominance and typically presents between the ages of in the same patient. 20–50 years with declining vision, irregular astigmatism, and inferior steepening and thinning noted on corneal Case description: A 45-year-old woman presented with tomography.2-4 Fuchs’ endothelial corneal dystrophy (FECD) progressive pellucid marginal degeneration and Fuchs’ endo- thelial dystrophy. Progressive changes in corneal topography is the most common corneal dystrophy and the most common 5 and specular microscopy imaging have been documented dystrophy-related indication for corneal transplantation. over 13 years since presentation. Declining vision has been FECD is characterized by progressive loss of corneal endothe- successfully managed in this patient, to date, with serial cres- lial cells, a formation of guttae and decreased vision typically centic corneal wedge excision biopsies to maintain acceptable associated with corneal edema.6 In contrast to PMD, FECD spectacle-corrected visual acuity. has a 2.5–3:1 female predominance and presentation is typi- Conclusion: This rare combination of corneal disorders pre- cally either as an early onset subtype in the third decade, or 5 sents an interesting and unique challenge for surgical manage- a late onset subtype in the fifth decade of life.
    [Show full text]
  • Effects of Intracameral Cefuroxime on Corneal Endothelial Cell Counts and Its Morphology After Cataract Surgery
    Interventional Medicine & Applied Science, Vol. 9 (2), pp. 100–104 (2017) ORIGINAL PAPER Effects of intracameral cefuroxime on corneal endothelial cell counts and its morphology after cataract surgery KOUROSH SHAHRAKI1, MOHAMMAD NAEIM AMINI FARD1,*, FARKHONDEH SHAHRI2, RAMA POURMATIN3, TAFGEH MOHAMMADI1, PARIA GHASEMI BOROUMAND4, KIANOUSH SHAHRAKI5 1Department of Ophthalmology, Alzahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran 2Department of Optometry, School of Rehabilitation, Zahedan University of Medical Sciences, Zahedan, Iran 3Basir Eye Clinic, Tehran, Iran 4Shahid Beheshti University of Medical Sciences, Tehran, Iran 5Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran *Corresponding author: Mohammad Naeim Amini Fard; Department of Ophthalmology, Alzahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran; Phone/Fax: +98 9124357993; E-mail: [email protected] (Received: January 25, 2017; Revised manuscript received: March 9, 2017; Accepted: March 13, 2017) Abstract: Background: Endophthalmitis is one of the most important complications after cataract surgery and in case event can cause many symptoms, such as severe decrease in eyesight and/or even the loss of vision. Employing methods to reduce this problem is very important. The aim of this study was to evaluate the effect of intracameral cefuroxime after cataract surgery on corneal endothelial cell counts and its morphology. Methods: In this study, 32 eyes of 30 patients underwent endothelial cell count and morphology assessment by ConfoScan III device before and 1 month after cataract surgery. All patients undertaken cataract surgery by one surgeon and by one method. Intracameral cefuroxime (1 mg/0.1 ml) was used as prophylaxis of postoperative endophthalmitis at the end of operation.
    [Show full text]
  • Adeno-Associated Virus Mediated Gene Therapy for Corneal Diseases
    pharmaceutics Review Adeno-Associated Virus Mediated Gene Therapy for Corneal Diseases Prabhakar Bastola 1,2 , Liujiang Song 1,2, Brian C. Gilger 1,3 and Matthew L. Hirsch 1,2,* 1 Ophthalmology, University of North Carolina, Chapel Hill, NC 27599, USA; [email protected] (P.B.); [email protected] (L.S.); [email protected] (B.C.G.) 2 Gene Therapy Center, University of North Carolina, Chapel Hill, NC 27599, USA 3 Clinical Sciences, North Carolina State University, Raleigh, NC 27695, USA * Correspondence: [email protected]; Tel.: +1-919-966-0696 Received: 10 July 2020; Accepted: 6 August 2020; Published: 13 August 2020 Abstract: According to the World Health Organization, corneal diseases are the fourth leading cause of blindness worldwide accounting for 5.1% of all ocular deficiencies. Current therapies for corneal diseases, which include eye drops, oral medications, corrective surgeries, and corneal transplantation are largely inadequate, have undesirable side effects including blindness, and can require life-long applications. Adeno-associated virus (AAV) mediated gene therapy is an optimistic strategy that involves the delivery of genetic material to target human diseases through gene augmentation, gene deletion, and/or gene editing. With two therapies already approved by the United States Food and Drug Administration and 200 ongoing clinical trials, recombinant AAV (rAAV) has emerged as the in vivo viral vector-of-choice to deliver genetic material to target human diseases. Likewise, the relative ease of applications through targeted delivery and its compartmental nature makes the cornea an enticing tissue for AAV mediated gene therapy applications. This current review seeks to summarize the development of AAV gene therapy, highlight preclinical efficacy studies, and discuss potential applications and challenges of this technology for targeting corneal diseases.
    [Show full text]
  • Characteristics of Corneal Dystrophies: a Review from Clinical, Histological and Genetic Perspectives
    Characteristicsofcornealdystrophies 窑Review窑 Characteristicsofcornealdystrophies:areviewfrom clinical,histologicalandgeneticperspectives DepartmentofOphthalmology,ShanghaiEastHospital, mechanismsremainunclearinmanycases.AlthoughCDs TongjiUniversitySchoolofMedicine,Shanghai200120, arestillenigmatic,ourknowledgeaboutthemhasbeen China expandedgreatlyinrecentyearsduetothedevelopmentof Correspondence to: Hong-PingCui.Departmentof genesequencingtechniquesand ophthalmological Ophthalmology,ShanghaiEastHospital,TongjiUniversity examinationadvances[ high-definitionopticalcoherence SchoolofMedicine,Shanghai200120,China.hpcui@vip. tomography(OCT),confocalmicroscopy].Thisreview 163.com highlightstheadvancesinourunderstandingofCDsbasedon Received:2015-07-19Accepted:2015-08-16 researchesinrecentyears. MATERIALSANDMETHODS Abstract SearchStrategy Toidentifytherelevantstudies,we searchedPubMedforpapersinvestigatingtheclinical · Cornealdystrophyisacommontypeofhereditary manifestations,histologyorgeneticsofCDs.Thesearchwas cornealdiseases.Itincludesmanytypes,whichhave throughMay2015withnolanguagerestrictions.Each variedpathology,histologyandclinicalmanifestations. subtypeofCDswassearchedseparately.Forexample,the Recently,theexaminationtechniquesofophthalmology andgenesequencingadvancegreatly,whichdobenefit searchingkeyitemsofABMDinclude:ABMD,epithelial toourunderstandingofthesediseases.However,many basementmembranedystrophy(EBMD),Coganmicrocystic aspectsremainstillunknown.Andduetothepoor dystrophy,map-dot-fingerprint(MDF)dystrophy,clinic, knowledgeofthesediseases,theresultsofthetreatments
    [Show full text]
  • Financial Disclosures Introduction Fuchs' Endothelial
    3/23/2016 Financial Disclosures None Laurence T. D. Sperber, MD Clinical Professor Residency Program Director Director, Cornea Service Department of Ophthalmology New York University School of Medicine 61st Annual Rochester Ophthalmology Conference Flaum Eye Institute, Rochester, NY Introduction Fuchs’ Endothelial Dystrophy Discussion of the decision-making process related to Preoperative evaluation performing cataract surgery in patients with corneal • Careful history disease • Slit lamp examination • Fuchs’ Endothelial Dystrophy • Pachymetry • Herpes Simplex Keratitis • Specular Microscopy • Keratoconus • Discussion of correction of post surgical refractive error Fuchs’ Endothelial Dystrophy Fuchs’ Endothelial Dystrophy Surgical decision-making Surgical decision-making • History - vision worse in AM, better as day progresses, • Specular Microscopy suggestive of corneal edema . Examination of endothelial cell morphology and number • Slit lamp exam - clinical edema . Cell count < 1000 cells/mm2 concerning • Epithelial Use as a guide - no set numbers necessitate performing triple procedure (DSAEK or DMEK/CE/IOL) • Stromal +/- Descemet’s Folds 1 3/23/2016 Fuchs’ Endothelial Dystrophy Fuchs’ Endothelial Dystrophy Surgical decision-making Surgical decision-making – no set numbers • Pachymetry - measurement of corneal thickness • Pachymetry < 0.6mm with no corneal edema by exam or hx . Excellent gauge of endothelial cell function • Cataract Extraction alone . Most useful in choice of surgical procedure • Pachymetry > 0.6 mm • Consider
    [Show full text]