Management of focal limbal stem cell deficiency associated with soft contact lens wear.

Purpose: To present the varying manifestations of and the treatment methods for corneal epitheliopathies because of focal limbal stem cell deficiency (LSCD) associated with soft contact lens (SCL) wear.

Methods: The medical records of patients seen at 3 institutions who developed focal LSCD, based on clinical examination, that was attributed to SCL wear were reviewed. Information regarding the patients' demographics, contact lens wearing schedules, medical and surgical treatment modalities, and clinical and visual outcomes were recorded.

Clinical experience with Acanthamoeba keratitis at the cole eye institute, 1999-2008.

Purpose: To review the clinical presentations, risk factors, medical and surgical management, and outcomes of patients with Acanthamoeba keratitis (AK).

Methods: Retrospective review of laboratory and medical records of all patients suspected of having AK from January 1999 through May 2008 at Cole Eye Institute.

Results: Twenty-nine eyes of 26 patients were identified as having either culture- or tissue-proven AK or presumed AK based on clinical examination and complete response to full course of treatment.

External refinement of the donor lenticule position during descemet's stripping and automated endothelial keratoplasty.

The authors describe a technique to facilitate the centration of the donor lenticule during Descemet's stripping and automated endothelial keratoplasty. The donor corneal lenticule is unfolded and grossly centered in the anterior chamber using a barbed 30-gauge needle on a 3-cc air syringe or a reverse Sinsky hook. Fine adjustments to center the lenticule can be achieved by applying external pressure to the cornea with a laser in-situ keratomileusis flap roller.

Epithelial debridement for the treatment of epithelial basement membrane abnormalities coincident with endothelial disorders.

Purpose: To determine if treatment directed at the epithelial basement membrane abnormalities in eyes with endothelial disorder can improve visual acuity and surface irregularity.

Methods: Retrospective interventional case series of 4 eyes of 3 patients with epithelial basement membrane abnormalities and endothelial disorder coincident with Fuchs endothelial corneal dystrophy or iridocorneal endothelial syndrome that had initial treatment directed only at the epithelial basement membrane disorder.

Results: In 2 of the 4 eyes undergoing epithelial basement membrane debridement, visual acuity improved by 3 Snellen lines.

Keratoconus diagnosis with optical coherence tomography pachymetry mapping.

Objective: To detect abnormal corneal thinning in keratoconus using pachymetry maps measured by high-speed anterior segment optical coherence tomography (OCT).

Design: Cross-sectional observational study.

Participants: Thirty-seven keratoconic eyes from 21 subjects and 36 eyes from 18 normal subjects.

Amantadine-associated corneal edema potentially irreversible even after cessation of the medication.

Purpose: To describe the clinical features of 3 patients with amantadine-associated corneal edema, including the histopathologic findings from 1 patient who underwent corneal transplantation for irreversible corneal edema.

Design: Interventional case series.

Participants: Three patients who sought treatment at the authors' institution with abrupt-onset, bilateral, diffuse corneal edema associated with systemic amantadine use.

Ocular TRUST: nationwide antimicrobial susceptibility patterns in ocular isolates.

Purpose: Ocular Tracking Resistance in U.S. Today (TRUST) annually evaluates in vitro antimicrobial susceptibility of Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae to ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, penicillin, azithromycin, tobramycin, trimethoprim, and polymyxin B in national samples of ocular isolates.

Multivariate model of refractive shift in Descemet-stripping automated endothelial keratoplasty.

Purpose: To relate in situ graft shape in Descemet-stripping automated endothelial keratoplasty (DSAEK) to surgically induced refractive error.

Setting: Academic eye institute.

Methods: High frequency arc-scanning ultrasound was performed in 7 patients enrolled in a prospective study of microkeratome-assisted endothelial keratoplasty approved by the Investigative Review Board.

Late repeat Descemet-stripping automated endothelial keratoplasty.

Purpose: To report the outcomes of 2 patients who underwent repeat Descemet-stripping automated endothelial keratoplasty (DSAEK) 13 and 23 months after their primary surgeries.

Methods: Two patients underwent repeat DSAEK for late graft failure at approximately 1 and 2 years, respectively. The operative procedure involved removing the failed graft and replacing it with new donor tissue.

Visual acuity, refractive error, and endothelial cell density six months after Descemet stripping and automated endothelial keratoplasty (DSAEK).

Purpose: To evaluate visual acuity, refractive outcomes, and endothelial cell density 6 months after Descemet stripping and automated endothelial keratoplasty (DSAEK).

Methods: We performed an institutional review board-approved prospective study of a surgical case series of 34 patients at 2 institutions undergoing DSAEK for Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, or aphakic bullous keratopathy with or without simultaneous phacoemulsification and intraocular lens implantation. Clinical outcomes, including best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, and refractive astigmatism and topographic or keratometric astigmatism, were assessed at the 6-month postoperative examination and compared with preoperative values with paired Student t tests.

Anterior segment and external ocular disorders associated with human immunodeficiency virus disease.

The eye is a common site for complications of human immunodeficiency virus (HIV) infection. Although cytomegalovirus retinitis remains the most prevalent of the blinding ocular disorders that can occur in individuals with the acquired immunodeficiency syndrome (AIDS), several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae. Some of these entities, such as Kaposi sarcoma, were well described, but uncommon, before the HIV epidemic.

Reopening of previously closed macular holes after cataract extraction.

Purpose: To evaluate the frequency of reopening of macular holes after cataract extraction.

Design: Retrospective, comparative, consecutive case series.

Methods: Two hundred and eleven eyes with idiopathic macular holes closed by vitrectomy were divided into four groups: Group 1: prior cataract extraction; Group 2: vitrectomy then cataract extraction; Group 3: vitrectomy only; and Group 4: vitrectomy and cataract extraction as a combined procedure.

Use of an air-fluid exchange system to promote graft adhesion during Descemet's stripping automated endothelial keratoplasty.

Dislocation of the graft is a well-recognized complication of Descemet's stripping automated endothelial keratoplasty (DSAEK). We describe a technique to promote adhesion of the graft during DSAEK using an anterior chamber air-fluid infusion and exchange for direct control of the pressure and medium used to tamponade the graft against the host stroma.

Simple technique to unfold the donor corneal lenticule during Descemet's stripping and automated endothelial keratoplasty.

We describe a technique to facilitate unfolding and prevent inversion of the donor corneal lenticule during Descemet's stripping and automated endothelial keratoplasty (DSAEK). The donor corneal lenticule is unfolded in the anterior chamber using a bent 30-gauge needle on a 3 cc air syringe. The needle tip is used to pinion the edge of the lenticule while an air bubble is simultaneously injected between the folded edges of the donor graft.

Narrow-strip conjunctival autograft for treatment of pterygium.

Purpose: To determine the efficacy of narrow-strip conjunctival autograft surgery in the treatment of pterygium.

Design: Retrospective noncomparative interventional case series.

Participants: Twenty-one consecutive interventions between 1994 and 2005 in 20 eyes of 18 patients for primary (n = 17 cases) or recurrent (n = 4 cases) pterygia.

Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.

Purpose: To develop current treatment recommendations for dry eye disease from consensus of expert advice.

Methods: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist.

A combined technique for surgical repair of Descemet's membrane detachments.

Background And Objective: Descemet's membrane detachments are an uncommon complication after cataract surgery that can result in severe visual loss. A combined technique of intracameral gas injection and transcorneal suturing for the repair of Descemet's membrane detachments is described.

Patients And Methods: In this interventional case series, four cases of Descemet's membrane detachments with associated corneal edema observed following cataract surgery were successfully repaired using a combined technique of intracameral gas injection and transcorneal suturing.

Immunohistochemical detection and Western blot analysis of nitrated protein in stored human corneal epithelium.

While the production of nitric oxide by human corneas in storage has recently been demonstrated, protein nitration as a result of this production has not been demonstrated. In this study, nitrated protein accumulation in the epithelium of stored human corneas was assessed. One half of five donor corneas maintained in storage media for 3 days were prepared for immunohistochemical studies.

A device to facilitate limbal stem cell procurement from eye bank donor tissue for keratolimbal allograft procedures.

Purpose: To develop a device that facilitates the procurement of corneal limbal stem cell grafts for keratolimbal allograft procedures used in the treatment of ocular surface disease associated with stem cell deficiency.

Design: Description of device design and technique for use.

Methods: The device is composed of a pedestal with a convex surface mounted to a flat platform.

Inhibition of nitric oxide synthesis in corneas in storage media.

The nitrate/nitrite content in storage media was determined after nitric oxide synthase inhibition by adding 400 microl of 100 mm N(G)-monomethyl-l-arginine (LMMA) to four chambers of Optisol GS corneal storage media, each containing one viable human cornea. The companion corneas in storage media without LMMA served as controls. Four hundred microlitre aliquots obtained at baseline (day 0) and at one-day intervals for 20 more days for both groups were analyzed for nitrate and nitrite (breakdown products of nitric oxide) concentration levels using a spectrophotometric method based on the Greiss reaction.

Confocal microscopy: a report by the American Academy of Ophthalmology.

Objective: To review the available evidence for the use of confocal microscopy in diagnosing infectious keratitis and for other applications for ophthalmic practice.

Methods: A MEDLINE search of the peer-reviewed literature for the years 1990 to 2001 yielded 94 citations. The search was limited to studies of human subjects published in English with abstracts.

Surgical management of conjunctival lymphangiectasis by conjunctival resection.

Purpose: To report the treatment of symptomatic conjunctival lymphangiectasis with conjunctival resection.

Design: Interventional case series.

Methods: Retrospective review of three cases of patients with symptomatic unilateral conjunctival lymphangiectasis who had conjunctival resection of the involved tissue down to bare sclera.

Lymphedema-distichiasis syndrome and FOXC2 gene mutation.

Purpose: To describe the clinical characteristics of a family with autosomal dominant lymphedema-distichiasis syndrome and to report the results of analysis of the FOXC2 gene

Design: Observational and experimental study.

Methods: The setting was a clinical practice. The study population was 17 members of a family with lymphedema-distichiasis.