Stromal thickness in the normal cornea: three-dimensional display with artemis very high-frequency digital ultrasound

PURPOSE

To characterize the stromal thickness profile in a population of normal eyes.

METHODS

Stromal thickness profile was measured in vivo by Artemis very high-frequency digital ultrasound scanning (ArcScan, Morrison, Colo) across the central 10-mm corneal diameter on 110 normal eyes. Maps of the average, standard deviation, minimum, maximum, and range of stromal thickness were plotted. The average location of the thinnest stroma was found. The cross-sectional hemi-meridional stromal thickness profile was calculated using annular averaging. The absolute stromal thickness progression relative to the thinnest point was calculated using annular averaging as well as for 8 hemi-meridians individually.

RESULTS

The mean stromal thickness at the corneal vertex and at the thinnest point were 465.4+/-36.9 mum and 461.8+/-37.3 mum, respectively. The thinnest stroma was displaced on average 0.17+/-0.31 mm inferiorly and 0.33+/-0.40 mm temporally from the corneal vertex. The average absolute stromal thickness progression from the thinnest point could be described by the quadratic equation: stromal thickness = 6.411 x radius(2) + 2.444 x radius (R(2) = 0.999). Absolute stromal thickness progression was independent of stromal thickness at the thinnest point. The increase in hemi-meridional absolute stromal thickness progression was greatest superiorly and lowest temporally.

CONCLUSIONS

Three-dimensional thickness mapping of the corneal stroma and stromal thickness progression in a population of normal eyes represent a normative data set, which may help in early diagnosis of corneal abnormalities such as keratoconus and pellucid marginal degeneration. Absolute stromal thickness progression was found to be independent of stromal thickness.

Epithelial thickness profile changes induced by myopic LASIK as measured by Artemis very high-frequency digital ultrasound

PURPOSE

To characterize changes in the corneal epithelial thickness profile induced by myopic LASIK.

METHODS

This was a prospective study of 37 eyes of 19 myopic LASIK patients. Eyes were divided into three groups according to sphere in the maximum myopic meridian: low (-1.00 to -4.00 diopters [D]), moderate (-4.25 to -6.00 D), and high myopia (-6.25 to -13.50 D). The epithelial thickness profile was measured by prototype Artemis very high-frequency (VHF) digital ultrasound scanner (ArcScan Inc) across the central 10-mm corneal diameter preoperatively and between 3 and 6 months postoperatively. The epithelial thickness profile was determined by averaging the epithelial thickness within annular bands centered on the corneal vertex. The change in epithelial thickness profile was calculated as the difference between the preoperative and postoperative epithelial thickness profiles.

RESULTS

The corneal epithelium thickened after myopic LASIK across the central 6 mm with maximum thickening centrally and progressively less thickening centrifugally in low myopia, and a more homogenous thickening in moderate and high myopia within the 5-mm diameter. The mean epithelial thickening at the corneal vertex was 7.41 +/- 1.09 microm, 9.29 +/- 1.22 microm, and 12.33 +/- 1.05 microm for low, moderate, and high myopia, respectively. The rate of epithelial thickening at the corneal vertex per diopter of myopia treated decreased with increasing myopia.

CONCLUSIONS

Although the magnitude of epithelial thickening increased with increasing ablation depth, in accordance with Barraquer's Law of Thicknesses, the myopic refractive shift due to epithelial thickness profile changes was paradoxically more significant in low myopia than in high myopia.

High-frequency chirp ultrasound imaging with an annular array for ophthalmologic and small-animal imaging

High-frequency ultrasound (HFU, >20 MHz) is an attractive means of obtaining fine-resolution images of biological tissues for ophthalmologic, dermatological and small-animal imaging applications. Even with current improvements in circuit designs and high-frequency equipment, HFU has two inherent limitations. First, HFU images have a limited depth-of-field (DOF) because of the short wavelength and the low fixed F-number of conventional HFU transducers. Second, HFU is usually limited to shallow imaging because of the significant attenuation in most tissues. In a previous study, a five-element annular array with a 17-MHz center frequency was excited using chirp-coded signals, and a synthetic-focusing algorithm was used to extend the DOF and increase penetration depth. In the present study, a similar approach with two different five-element annular arrays operating near a center frequency of 35 MHz is implemented and validated. Following validation studies, the chirp-imaging methods were applied to imaging vitreous-hemorrhage-mimicking phantoms and mouse embryos. Images of the vitreous phantom showed increased sensitivity using the chirp method compared with a standard monocycle imaging method, and blood droplets could be visualized 4mm deeper into the phantom. Three-dimensional datasets of 12.5-day-old mouse embryo heads were acquired in utero using chirp and conventional excitations. Images were formed and brain ventricles were segmented and reconstructed in three dimensions. The brain ventricle volumes for the monocycle excitation exhibited artifacts that were not apparent on the chirp-based dataset reconstruction.

Effect of corneal hydration on ultrasound velocity and backscatter

The cornea's acoustic properties (speed-of-sound, backscatter, attenuation) are related to its state of hydration. Our aim was to determine these properties as a function of corneal hydration using high-frequency ultrasound. Bovine corneas were suspended in a Dexsol-equivalent corneal preservation medium at 33 degrees C and then immersed successively in 75%, 50% and 25% medium and distilled water. Using a 38-MHz focused ultrasound transducer, we measured speed-of-sound and corneal thickness (n = 8) and stromal backscatter (n = 6) after 45-min immersion in each medium. Corneal speed-of-sound was modeled as a function of corneal thickness. We found the mean speed-of-sound to be 1605.4 +/- 2.9 m/s in normotensive medium. The maximum observed speed-of-sound was 1616 m/s. As we decreased medium tonicity, the cornea swelled and the speed-of-sound decreased, reaching 1563.0 +/- 2.2 m/s in water. Average corneal thickness increased from 969 +/- 93 microm in 100% medium to 1579 +/- 104 microm in water. Going from 100% medium to water, stromal backscatter (midband-fit) increased from -60.0 +/- 0.8 dBr to -52.5 +/- 3.5 dBr, spectral slope increased from -0.119 +/- 0.021 to -0.005 +/- 0.030 dB/MHz and attenuation coefficient decreased from 0.927 +/- 0.434 to 0.010 +/- 0.581 dB/cm-MHz. The observed correlation between acoustic backscatter and attenuation with the speed-of-sound offers a potential means for more accurate determination of speed-of-sound and, hence, thickness in edematous corneas.

Correlation of anterior chamber angle and ciliary sulcus diameters with white-to-white corneal diameter in high myopes using artemis VHF digital ultrasound

PURPOSE

To determine whether horizontal angle diameter and sulcus diameter can be accurately estimated by conventional external measurements in high myopic eyes.

METHODS

Ten horizontal anterior segment scans were obtained with the Artemis 1 very high-frequency (VHF) digital ultrasound arc-scanner in 40 eyes of 20 patients. Angle and sulcus diameters were measured and descriptive statistics and within-eye repeatability were calculated. Linear regression was performed between each permutation of white-to-white, angle diameter, and sulcus diameter. Multivariate regression also included anterior chamber depth (ACD), age, manifest refraction, keratometry, and central corneal thickness (CCT). The standard deviation and 95% confidence interval (CI) of the residuals were calculated.

RESULTS

The population mean +/-standard deviation (95% CI) was 12.88 +/- 0.42 mm [12.74, 13.02] for angle diameter and 12.85 +/- 0.69 mm [12.63, 13.07] for sulcus diameter. Within-eye repeatability was 0.13 mm for angle diameter and 0.23 mm for sulcus diameter. A weak correlation was noted between white-to-white and angle diameter (r2=0.59) with a 95% CI of +/-0.53 mm. Multivariate regression found white-to-white, CCT, and minimum keratometry predicted angle diameter (r2=0.69) with a 95% CI of +/-0.46 mm. For predicting sulcus diameter, there were weak correlations between white-to-white (r2=0.32) with a 95% CI of +/-1.11 mm and angle diameter (r2=0.46) with a 95% CI of +/-0.99 mm. Multivariate regression found angle diameter and ACD predicted sulcus diameter (r2=0.57) with 95% CI of +/-0.88 mm.

CONCLUSIONS

Regression modeling found weak correlations among all combinations of white-to-white, angle diameter, and sulcus diameter. Given the relative accuracy of direct measurement of angle and sulcus diameter compared to the potential accuracy of these regression equations, it appears that direct measurement would increase the safety of anterior and posterior chamber phakic intraocular lens sizing.

High-resolution photoacoustic imaging with focused laser and ultrasonic beams

We report a photoacoustic imager that utilizes a focused laser beam in combination with a 20 MHz ultrasound focusing transducer to obtain micron-resolution tissue images over a long working distance. The imager is based on a ring transducer that combines ultrasonic and laser beams collinearly and confocally in a monolithic element. The combination of focused laser beam and short pulse irradiation led to significant improvement in lateral and axial resolutions compared to the pulse-echo ultrasonic imaging technique or photoacoustic imaging with an unfocused laser. Potential applications include clinical examination of the eye and characterization of thin and superficial tissues.

Central corneal thickness measured by the Orbscan II system, contact ultrasound pachymetry, and the Artemis 2 system

PURPOSE

To compare central corneal thickness (CCT) measurements by the Orbscan II device, contact ultrasound (US) pachymetry, and the noncontact Artemis 2 scanning US system.

SETTING

Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA.

METHODS

The CCT in 40 eyes (20 normal subjects) was measured by the Orbscan II followed by contact US pachymetry and then the Artemis 2. Results were compared using analysis of variance (ANOVA), paired t tests, and Bland-Altman plots.

RESULTS

There was a significant difference in CCT measurements between the 3 modes (F = 32.84, P = .0001, 1-way ANOVA). Artemis 2 and US pachymetry measurements were highly correlated (r2 = 0.963, P < .0001), although Artemis 2 values were a mean of 11.2 microm +/- 6.6 (SD) thinner than pachymetry values. Artemis 2 and Orbscan II measurements were less well correlated (r2 = 0.851, P < .001); Orbscan II values were a mean of 7.5 +/- 15.7 microm thinner than Artemis 2 values. Orbscan II values showed a trend toward increasing underestimation of CCT in thinner corneas.

CONCLUSIONS

Ultrasound pachymetry and Artemis 2 CCT measurements were highly correlated; the 11 microm mean difference in measurements may be attributed to decentration, oblique incidence of the probe to the cornea, or possibly the effect of topical anesthesia with contact pachymetry. Although the mean difference between Orbscan II and Artemis 2 values was 7.5 microm, Orbscan values were less correlated than Artemis 2 values with contact US pachymetry and were prone to underestimation of the CCT in thinner corneas.

High-resolution ultrasound imaging of the eye - a review

This report summarizes the physics, technology and clinical application of ultrasound biomicroscopy (UBM) of the eye, in which frequencies of 35 MHz and above provide over a threefold improvement in resolution compared with conventional ophthalmic ultrasound systems. UBM allows imaging of anatomy and pathology involving the anterior segment, including regions obscured by overlying optically opaque anatomic or pathologic structures. UBM provides diagnostically significant information in conditions such as glaucoma, cysts and neoplasms, trauma and foreign bodies. UBM also can provide crucial biometric information regarding anterior segment structures, including the cornea and its constituent layers and the anterior and posterior chambers. Although UBM has now been in use for over 15 years, new technologies, including transducer arrays, pulse encoding and combination of ultrasound with light, offer the potential for significant advances in high-resolution diagnostic imaging of the eye.

20 MHz/40 MHz dual element transducers for high frequency harmonic imaging

Concentric annular type dual element transducers for second harmonic imaging at 20 MHz / 40 MHz were designed and fabricated to improve spatial resolution and depth of penetration for ophthalmic imaging applications. The outer ring element was designed to transmit the 20 MHz signal and the inner circular element was designed to receive the 40 MHz second harmonic signal. Lithium niobate (LiNbO(3)), with its low dielectric constant, was used as the piezoelectric material to achieve good electrical impedance matching. Double matching layers and conductive backing were used and optimized by KLM modeling to achieve high sensitivity and wide bandwidth for harmonic imaging and superior time-domain characteristics. Prototype transducers were fabricated and evaluated quantitatively and clinically. The average measured center frequency for the transmit ring element was 21 MHz and the one-way --3 dB bandwidth was greater than 50%. The 40 MHz receive element functioned at 31 MHz center frequency with acceptable bandwidth to receive attenuated and frequency downshifted harmonic signal. The lateral beam profile for the 20 MHz ring elements at the focus matched the Field II simulated results well, and the effect of outer ring diameter was also examined. Images of a posterior segment of an excised pig eye and a choroidal nevus of human eye were obtained both for single element and dual element transducers and compared to demonstrate the advantages of dual element harmonic imaging.

Improved high-resolution ultrasonic imaging of the eye

Currently, virtually all clinical diagnostic ultrasound systems used in ophthalmology are based on fixed-focus, single-element transducers. High-frequency (> or = 20-MHz) transducers introduced to ophthalmology during the last decade have led to improved resolution and diagnostic capabilities for assessment of the anterior segment and the retina. However, single-element transducers are restricted to a small depth of field, limiting their capacity to image the eye as a whole. We fabricated a 20-MHz annular array probe prototype consisting of 5 concentric transducer elements and scanned an ex vivo human eye. Synthetically focused images of the bank eye showed improved depth of field and sensitivity, allowing simultaneous display of the anterior and posterior segments and the full lens contour. This capability may be useful in assessment of vitreoretinal pathologies and investigation of the accommodative mechanism.

Chirp-coded excitation imaging with a high-frequency ultrasound annular array

High-frequency ultrasound (HFU, > 15 MHz) is an effective means of obtaining fine-resolution images of biological tissues for applications such as opthalmologic, dermatologic, and small animal imaging. HFU has two inherent drawbacks. First, HFU images have a limited depth of field (DOF) because of the short wavelength and the low fixed F-number of conventional HFU transducers. Second, HFU can be used to image only a few millimeters deep into a tissue because attenuation increases with frequency. In this study, a five-element annular array was used in conjunction with a synthetic-focusing algorithm to extend the DOF. The annular array had an aperture of 10 mm, a focal length of 31 mm, and a center frequency of 17 MHz. To increase penetration depth, 8-micros, chirp-coded signals were designed, input into an arbitrary waveform generator, and used to excite each array element. After data acquisition, the received signals were linearly filtered to restore axial resolution and increase the SNR. To compare the chirpcoded imaging method with conventional impulse imaging in terms of resolution, a 25-microm diameter wire was scanned and the -6-dB axial and lateral resolutions were computed at depths ranging from 20.5 to 40.5 mm. The results demonstrated that chirp-coded excitation did not degrade axial or lateral resolution. A tissue-mimicking phantom containing 10-microm glass beads was scanned, and backscattered signals were analyzed to evaluate SNR and penetration depth. Finally, ex vivo ophthalmic images were formed and chirpcoded images showed features that were not visible in conventional impulse images.

40-MHz ultrasound imaging with chirps and annular arrays

High-frequency ultrasound (HFU) shows promise for fine-resolution imaging. However, the depth of field (DOF) and penetration depth of HFU waves limit clinical significance. In a previous study using a 17-MHz annular array, we established that chirp coded excitation and synthetic focusing can improve penetration depth and DOF simultaneously. In this study, we evaluated the same approach using two five-element annular arrays with focal lengths of 12 mm, total apertures of 6 mm. The annular arrays had center frequencies of approximately 35 MHz and were excited by a 4-micros chirp signal spanning the frequency range 15-65 MHz. Results demonstrated that DOF could be increased by a factor of about 3, SNR could be increased by more than 10 dB, and penetration depth into an attenuating phantom could be increased by 1.8 mm. The chirp imaging method was then evaluated on low-contrast phantoms and mouse embryos.

Ultrasonic tissue characterization via 2-D spectrum analysis: theory and in vitro measurements

A theoretical model is described for application in ultrasonic tissue characterization using a calibrated 2-D spectrum analysis method. This model relates 2-D spectra computed from ultrasonic backscatter signals to intrinsic physical properties of tissue microstructures, e.g., size, shape, and acoustic impedance. The model is applicable to most clinical diagnostic ultrasound systems. Two experiments employing two types of tissue architectures, spherical and cylindrical scatterers, are conducted using ultrasound with center frequencies of 10 and 40 MHz, respectively. Measurements of a tissue-mimicking phantom with an internal suspension of microscopic glass beads are used to validate the theoretical model. Results from in vitro muscle fibers are presented to further elucidate the utility of 2-D spectrum analysis in ultrasonic tissue characterization.

Accuracy, repeatability, and reproducibility of Artemis very high-frequency digital ultrasound arc-scan lateral dimension measurements

PURPOSE

To determine the accuracy, repeatability, and reproducibility of measurement of lateral dimensions using the Artemis (Ultralink LLC) very high-frequency (VHF) digital ultrasound (US) arc scanner.

SETTING

London Vision Clinic, London, United Kingdom.

METHODS

A test object was measured first with a micrometer and then with the Artemis arc scanner. Five sets of 10 consecutive B-scans of the test object were performed with the scanner. The test object was removed from the system between each scan set. One expert observer and one newly trained observer separately measured the lateral dimension of the test object. Two-factor analysis of variance was performed. The accuracy was calculated as the average bias of the scan set averages. The repeatability and reproducibility coefficients were calculated. The coefficient of variation (CV) was calculated for repeatability and reproducibility.

RESULTS

The test object was measured to be 10.80 mm wide. The mean lateral dimension bias was 0.00 mm. The repeatability coefficient was 0.114 mm. The reproducibility coefficient was 0.026 mm. The repeatability CV was 0.38%, and the reproducibility CV was 0.09%. There was no statistically significant variation between observers (P = .0965). There was a statistically significant variation between scan sets (P = .0036) attributed to minor vertical changes in the alignment of the test object between consecutive scan sets.

CONCLUSION

The Artemis VHF digital US arc scanner obtained accurate, repeatable, and reproducible measurements of lateral dimensions of the size commonly found in the anterior segment.

High-frequency ultrasonic imaging of the anterior segment using an annular array transducer

OBJECTIVE

Very high-frequency ultrasound (VHFU; >35 megahertz [MHz]) allows imaging of anterior segment structures of the eye with a resolution of less than 40 microm. The low focal ratio of VHFU transducers, however, results in a depth of field (DOF) of less than 1 mm. The aim was to develop a high-frequency annular array transducer for ocular imaging with improved DOF, sensitivity, and resolution compared with conventional transducers.

DESIGN

Experimental study.

PARTICIPANTS

Cadaver eyes, ex vivo cow eyes, in vivo rabbit eyes.

METHODS

A spherically curved annular array ultrasound transducer was fabricated. The array consisted of 5 concentric rings of equal area, had an overall aperture of 6 mm, and a geometric focus of 12 mm. The nominal center frequency of all array elements was 40 MHz. An experimental system was designed in which a single array element was pulsed and echo data were recorded from all elements. By sequentially pulsing each element, echo data were acquired for all 25 transmit-and-receive annuli combinations. The echo data then were focused synthetically and composite images were produced. Transducer operation was tested by scanning a test object consisting of a series of 25-microm diameter wires spaced at increasing range from the transducer. Imaging capabilities of the annular array were demonstrated in ex vivo bovine, in vivo rabbit, and human cadaver eyes.

MAIN OUTCOME MEASURES

Depth of field, resolution, and sensitivity.

RESULTS

The wire scans verified the operation of the array and demonstrated a 6.0-mm DOF, compared with the 1.0-mm DOF of a conventional single-element transducer of comparable frequency, aperture, and focal length. B-mode images of ex vivo bovine, in vivo rabbit, and cadaver eyes showed that although the single-element transducer had high sensitivity and resolution within 1 to 2 mm of its focus, the array with synthetic focusing maintained this quality over a 6-mm DOF.

CONCLUSIONS

An annular array for high-resolution ocular imaging has been demonstrated. This technology offers improved DOF, sensitivity, and lateral resolution compared with single-element fixed focus transducers currently used for VHFU imaging of the eye.

Role of 2-5A-dependent RNase-L in senescence and longevity

Senescence is a permanent growth arrest that restricts the lifespan of primary cells in culture, and represents an in vitro model for aging. Senescence functions as a tumor suppressor mechanism that can be induced independent of replicative crisis by diverse stress stimuli. RNase-L mediates antiproliferative activities and functions as a tumor suppressor in prostate cancer, therefore, we examined a role for RNase-L in cellular senescence and aging. Ectopic expression of RNase-L induced a senescent morphology, a decrease in DNA synthesis, an increase in senescence-associated beta-galactosidase activity, and accelerated replicative senescence. In contrast, senescence was retarded in RNase-L-null fibroblasts compared with wild-type fibroblasts. Activation of endogenous RNase-L by 2-5A transfection induced distinct senescent and apoptotic responses in parental and Simian virus 40-transformed WI38 fibroblasts, respectively, demonstrating cell type specific differences in the antiproliferative response to RNase-L activation. Replicative senescence is a model for in vivo aging; therefore, genetic disruption of senescence effectors may impact lifespan. RNase-L-/- mice survived 31.7% (P<0.0001) longer than strain-matched RNase-L+/+ mice providing evidence for a physiological role for RNase-L in aging. These findings identify a novel role for RNase-L in senescence that may contribute to its tumor suppressive function and to the enhanced longevity of RNase-L-/- mice.

Probability Model of the Inaccuracy of Residual Stromal Thickness Prediction to Reduce the Risk of Ectasia After LASIK Part I: Quantifying Individual Risk

PURPOSE

To measure the imprecision of microkeratome cuts, preoperative corneal pachymetry, and laser ablation depth and develop a statistical model to describe the probability of the residual stromal bed thickness (RST) after myopic LASIK being significantly thinner than predicted.

METHODS

Preoperative corneal thickness, flap thickness, ablation depth, and RST were measured in 36 eyes by a prototype three-dimensional very high-frequency (VHF) 50 MHz digital ultrasound scanning device (<1.2 microm precision), precursor to the commercially available Artemis 2. All eyes had undergone LASIK with the Moria LSK-One microkeratome and the NIDEK EC-5000 excimer laser. Based on the statistically combined uncertainty (standard deviation) and bias (accuracy to intended value) of corneal thickness measurement, flap thickness, and ablation depth, a continuous probability function was devised describing the chance of obtaining an actual RST less than a specified "cut-off". The model was applied using the data collected from the cohort of eyes. The model was also applied using published flap thickness statistics on a series of microkeratomes.

RESULTS

Precision (standard deviation) was 0.74 microm for VHF digital ultrasound measurement of pachymetry, 30.3 microm for Moria LSK-One flap thickness, and 11.2 microm for NIDEK EC-5000 ablation depth. Assuming negligible laser ablation depth bias, the model found the probability that the actual RST will be <200 pmicromgiven a target RST of 250 microm is 7.56% with the Moria LSK-One. The model applied to published flap statistics revealed a range of probabilities of leaving <200 microm given a target RST of 250 microm from <0.01% to 33.6%.

CONCLUSIONS

The choice of microkeratome, laser, and pachymeter has a significant impact on the variation of the depth of keratectomy and thus on the risk of ectasia. This model together with high-precision microkeratomes, preoperative pachymetry, and knowledge of laser ablation precision would enable surgeons to determine the specific imprecision of RST prediction for individual LASIK cases and minimize the risk of ectasia.

Improved visualization of high-intensity focused ultrasound lesions

Spectral parameter imaging in both the fundamental and harmonic of backscattered radio-frequency (RF) data were used for immediate visualization of high-intensity focused ultrasound (HIFU) lesion sites. A focused 5-MHz HIFU transducer with a coaxial 9-MHz focused single-element diagnostic transducer was used to create and scan lesions in chicken breast and freshly excised rabbit liver. B-mode images derived from the backscattered RF signal envelope were compared with midband fit (MBF) spectral parameter images in the fundamental (9-MHz) and harmonic (18-MHz) bands of the diagnostic probe. Images of HIFU-induced lesions derived from the MBF to the calibrated spectrum showed improved contrast (approximately 3 dB) of tumor margins versus surround compared with images produced from the conventional signal envelope. MBF parameter images produced from the harmonic band showed higher contrast in attenuated structures (core, shadow) compared with either the conventional envelope (3.3 dB core; 11.6 dB shadow) or MBF images of the fundamental band (4.4 dB core; 7.4 dB shadow). The gradient between the lesion and surround was 3.4 dB/mm, 6.9 dB/mm and 17.2 dB/mm for B-mode, MBF-fundamental mode and MBF-harmonic mode, respectively. Images of threshold and "popcorn" lesions produced in freshly excised rabbit liver were most easily visualized and boundaries best-defined using MBF-harmonic mode.

Probability Model of the Inaccuracy of Residual Stromal Thickness Prediction to Reduce the Risk of Ectasia After LASIK Part II: Quantifying Population Risk

PURPOSE

To derive a statistical model to estimate the rate of excessive keratectomy depth below a selected cut-off residual stromal thickness (RST) given a minimum target RST and specific Clinical Protocol; apply the model to estimate the RST below which ectasia appears likely to occur and back-calculate the safe minimum target RST that should be used given a specific Clinical Protocol.

METHODS

Myopia and corneal thickness distribution were modeled for a population of 5212 eyes that underwent LASIK. The probability distribution of predicted target RST error (Part I) was used to calculate the rate of excessive keratectomy depth for this series. All treatments were performed using the same Clinical Protocol; one surgeon, Moria LSK-One microkeratome, NIDEK EC-5000 excimer laser, Orbscan pachymetry, and a minimum target RST of 250 microm--the Vancouver Clinical Protocol. The model estimated the RST below which ectasia appears likely to occur and back-calculated the safe minimum target RST. These values were recalculated for a series of microkeratomes using published flap thickness statistics as well as for the Clinical Protocol of one of the authors-the London Clinical Protocol.

RESULTS

In the series of 5212 eyes, 6 (0.12%) cases of ectasia occurred. The model predicted an RST of 191 microm for ectasia to occur and that a minimum target RST of 329 microm would have reduced the -rate of ectasia to 1: 1,000,000 for the Vancouver Clinical Protocol. The model predicted that the choice of microkeratome varied the rate of ectasia between 0.01 and 11,623 eyes per million and the safe minimum target RST between 220 and 361 microm. The model predicted the rate of ectasia would have been 0.000003: 1,000,000 had the London Clinical Protocol been used for the Vancouver case series.

CONCLUSIONS

There appears to be no universally safe minimum target RST to assess suitability for LASIK largely due to the disparity in accuracy and reproducibility of microkeratome flap thickness. This model may be used as a tool to evaluate the risk of ectasia due to excessive keratectomy depth and help determine the minimum target RST given a particular Clinical Protocol.

75 MHz ultrasound biomicroscopy of anterior segment of eye

Very high frequency ultrasound (35-50 MHz) has had a significant impact upon clinical imaging of the anterior segment of the eye, offering an axial resolution as small as 30 microm. Higher frequencies, while potentially offering even finer resolution, are more affected by absorption in ocular tissues and even in the fluid coupling medium. Our aim was to develop and apply improved transducer technology utilizing frequencies beyond those routinely used for ultrasound biomicroscopy of the eye. A 75-MHz lithium niobate transducer with 2 mm aperture and 6 mm focal length was fabricated. We scanned the ciliary body and cornea of a human eye six years post-LASIK. Spectral parameter images were produced from the midband fit to local calibrated power spectra. Images were compared with those produced using a 35 MHz lithium niobate transducer of similar fractional bandwidth and focal ratio. The 75-MHz transducer was found to have a fractional bandwidth (-6 dB) of 61%. Images of the post-LASIK cornea showed higher stromal backscatter at 75 MHz than at 35 MHz. The improved lateral resolution resulted in better visualization of discontinuities in Bowman's layer, indicative of microfolds or breaks occurring at the time of surgery. The LASIK surface was evident as a discontinuity in stromal backscatter between the stromal component of the flap and the residual stroma. The iris and ciliary body were visualized despite attenuation by the overlying sclera. Very high frequency ultrasound imaging of the anterior segment of the eye has been restricted to the 35-50 MHz band for over a decade. We showed that higher frequencies can be used in vivo to image the cornea and anterior segment. This improvement in resolution and high sensitivity to backscatter from the corneal stroma will provide benefits in clinical diagnostic imaging of the anterior segment.

Evaluating Microkeratome Efficacy by 3D Corneal Lamellar Flap Thickness Accuracy and Reproducibility Using Artemis VHF Digital Ultrasound Arc-scanning

PURPOSE

To present a method that determines the efficacy of flap creation using a microkeratome.

METHODS

Thirty-six eyes of 18 patients were included in the study, operated by two experienced surgeons using the Moria LSK-One microkeratome. Very high-frequency (VHF) digital ultrasound arc-scanning using Artemis technology was used to measure the Reinstein Flap Thickness Profile created by addition of the preoperative epithelial thickness profile to the postoperative stromal component of the flap. Descriptive statistics revealed central flap thickness accuracy and reproducibility. Univariate and multivariate regression analysis was used to determine correlations between central flap thickness and preoperative clinical parameters. Three-dimensional flap thickness maps demonstrated the mean, median, standard deviation, and range of thickness.

RESULTS

Intended flap thickness was 160 microm. Mean central flap thickness was 161 microm in the right eye and 166 microm in the left eye. Central reproducibility (standard deviation of the mean) was 30.3 microm, with a range of 106 to 228 microm. Central flap thickness correlated to preoperative corneal thickness measured by VHF digital ultrasound but not by Orbscan. On qualitative analysis, no consistency among eyes was observed in the three-dimensional flap thickness map. Flaps were on average thinner in the center, but not in all cases.

CONCLUSIONS

A systematic qualitative and quantitative statistical evaluation of microkeratome accuracy and reproducibility can be performed by measuring corneal flap thickness with arc-scanning VHF digital ultrasound.

Is there a role for high-frequency ultrasonography in clinical staging of retinopathy of prematurity?

PURPOSE

To compare 20-MHz ultrasonography with ophthalmoscopy in the staging of retinopathy of prematurity (ROP).

METHODS

We used a handheld 20-MHz ultrasound system to examine 38 eyes of 19 neonates who had an indirect ophthalmoscopic examination (diagnosis masked) within 48 hours prior to ultrasonography. Determination of ROP by indirect ophthalmoscopy was compared with independent identification of ultrasonic features indicative of ROP stages.

RESULTS

In masked cases, ultrasonography correctly identified 13 of 18 (72.2% sensitivity) eyes with zone 2, stage 2 ROP or worse and 19 of 20 (95.0% specificity) normal eyes (zone 2, stage 1 ROP or better) (chi-square, 18.4; P < .001).

CONCLUSION

In the neonatal nursery, a 20-MHz handheld ultrasound system may be an effective screening tool to initially identify ROP for further ophthalmoscopic evaluation and management.

High-frequency harmonic imaging of the eye

PURPOSE: Harmonic imaging has become a well-established technique for ultrasonic imaging at fundamental frequencies of 10 MHz or less. Ophthalmology has benefited from the use of fundamentals of 20 MHz to 50 MHz. Our aim was to explore the ability to generate harmonics for this frequency range, and to generate harmonic images of the eye. METHODS: The presence of harmonics was determined in both water and bovine vitreous propagation media by pulse/echo and hydrophone at a series of increasing excitation pulse intensities and frequencies. Hydrophone measurements were made at the focal point and in the near- and far-fields of 20 MHz and 40 MHz transducers. Harmonic images of the anterior segment of the rabbit eye were obtained by a combination of analog filtering and digital post-processing. RESULTS: Harmonics were generated nearly identically in both water and vitreous. Hydrophone measurements showed the maximum second harmonic to be -5 dB relative to the 35 MHz fundamental at the focus, while in pulse/echo the maximum harmonic amplitude was -15dB relative to the fundamental. Harmonics were absent in the near-field, but present in the far-field. Harmonic images of the eye showed improved resolution. CONCLUSION: Harmonics can be readily generated at very high frequencies, and at power levels compliant with FDA guidelines for ophthalmology. This technique may yield further improvements to the already impressive resolutions obtainable in this frequency range. Improved imaging of the macular region, in particular, may provide significant improvements in diagnosis of retinal disease.

Ultrasonic tissue characterization using 2-D spectrum analysis and its application in ocular tumor diagnosis

We are investigating the utility of a new ultrasonic tissue characterization technique, specifically two-dimensional (2-D) spectrum analysis of radio-frequency backscatter signals, which promises to provide quantitative measures of the physical properties of tissue microstructures. Previously successful 1-D spectrum analysis is expanded to 2-D to more fully characterize diagnostically significant features of biological tissue. Two new spectral functions, radially integrated spectral power (RISP) and angularly integrated spectral power (AISP), are defined to quantitatively characterize tissue properties. This new approach is applied to the diagnosis of in vivo ocular melanomas. Our initial results indicate that 2-D spectrum analysis can provide significant new information on tissue anisotropy that are not apparent in 1-D spectra. Acoustic scattering models are applied to relate the 2-D spectral parameters to the physical properties (e.g., size and shape) of biological tissues.

Comparison of ultrasonic and ophthalmoscopic evaluation of retinopathy of prematurity

PURPOSE

Screening for detection of retinopathy of prematurity (ROP) currently is limited to indirect ophthalmoscopy, which requires considerable examiner skill and experience. We investigated whether conventional 10 MHz B-scan ultrasonography could document the clinical stages of ROP as accurately as indirect ophthalmoscopy.

METHODS

Thirty-four eyes of 18 neonates were examined by masked, independent observers with indirect ophthalmoscopy and digitally recorded 10-MHz B-scan ultrasonography. After pupil dilation and lid speculum placement, the retinologist recorded the stage of retinopathy with a retinal drawing. The ultrasonographer, without use of papillary mydriatics or lid speculum, determined the presence or absence of a ridge or tractional elements, if present on the ridge.

RESULTS

Ultrasound grade correlated with clinical grade (R = .79, P < .001). However, nine eyes were overdiagnosed by one stage, and one eye, in which a peripheral detachment was mistaken for an artifact, was underdiagnosed.

CONCLUSIONS

Ten-megahertz ultrasonography offers the potential of imaging and detecting the clinical stages of ROP; the use of higher ultrasound frequencies, now becoming commercially available, is likely to enhance diagnostic accuracy. Care must be taken to distinguish between artifact and true anatomical structures in noncontact ultrasound examinations. Neonates with suspected ROP could be screened with B-scan ultrasonography by neonatal personnel without pupillary dilatation or lid speculum, thus eliminating potential morbidity, and clinically significant cases of ROP then could be referred to the retinologist.

High-resolution ultrasonic imaging of the posterior segment

PURPOSE

Conventional ophthalmic ultrasonography is performed using 10-megahertz (MHz) transducers. Our aim was to explore the use of higher frequency ultrasound to provide improved resolution of the posterior pole.

DESIGN

Prospective case series.

PARTICIPANTS

One normal subject and 5 subjects with pathologies affecting the posterior coats, including nevii, small melanomas, and macular hole.

METHODS

We modeled the frequency-dependent attenuation of ultrasound across the eye to develop an understanding of the range of frequencies that might be practically applied for imaging of the posterior pole. We compared images of the posterior coats made at 10, 15, and 20 MHz, and 20-MHz ultrasound images of pathologies with 10-MHz ultrasound and optical coherence tomography (OCT).

MAIN OUTCOME MEASURES

Ability to resolve normal and pathologic structures affecting posterior coats of the eye.

RESULTS

Modeling showed that frequencies of 20 to 25 MHz might be used for posterior pole imaging. Twenty-megahertz images allowed differentiation of the retina, choroid, and sclera. In addition, at 20 MHz the retina showed banding patterns suggesting an internal structure comparable in many respects to that seen in OCT and histology. Images of ocular pathology provided much improved detail relative to 10-MHz images and deeper penetration than OCT.

CONCLUSIONS

Twenty-megahertz ultrasound can be practically employed for imaging of the posterior pole of the eye, providing a 2-fold improvement in resolution relative to conventional 10-MHz instruments. Although not providing the resolution of OCT, ultrasound can be used in the presence of optical opacities and allows evaluation of deeper tissue structures.

Noninvasive in vivo detection of prognostic indicators for high-risk uveal melanoma Ultrasound parameter imaging

PURPOSE

Primary malignant melanoma of the choroid and ciliary body has traditionally been treated without histologic staging, using purely clinical indicators. The presence of extravascular matrix patterns (EMP) in histologic sections of uveal melanoma has been shown to be an independent indicator of metastatic risk. These patterns are of a dimension and physical composition that are likely to be detected with ultrasound backscatter analysis. Our aim was to determine whether ultrasound parameter imaging could detect the presence of EMP at a diagnostically significant level for treatment staging and for planning investigational studies of therapeutic modalities.

DESIGN

Prospective, masked ultrasound-pathologic correlative study.

PARTICIPANTS

One hundred seventeen patients diagnosed with previously untreated choroidal melanoma were scanned within 2 weeks before enucleation.

METHODS

Tumors were evaluated histologically and divided into high-risk and low-risk groups on the basis of the presence of 2% or more histologic cross-sectional area composed of EMP patterns. Digital ultrasound data were processed to generate parameter images representing the size and concentration of ultrasound scatterers. Histologic and ultrasound images and data were correlated, and linear and nonlinear statistical methods were used to create multivariate models for noninvasive differentiation of high-risk and low-risk tumors.

MAIN OUTCOME MEASURES

Presence or absence of high-risk EMP and associated ultrasound parameter classification models.

RESULTS

Of the 117 tumors, 69 were classified as low risk, and 48 were classified as high-risk with histologic analysis. A classification that used ultrasound parameter image features with linear discriminant analysis could correctly identify 79.5% of cases retrospectively and 75.2% of cases by use of cross-validation, an estimate of prospective classification ability. By use of a more powerful classification technique (support vector machine), 93.1% of cases were correctly classified retrospectively. With a cross-validation procedure, 80.10% of cases were correctly classified.

CONCLUSIONS

Ultrasound can be used noninvasively to classify tumors into high-risk and low-risk groups by detecting the presence of EMP patterns. By the use of previous studies that compared the histologic presence of EMP patterns with patient survival, estimates of hazard rates associated with ultrasound risk groups can be made. The noninvasive ultrasound classification is potentially useful as a prognostic variable and as a tool for stratification of patient populations for tumor treatment evaluation.

Very High Frequency Ultrasound Biometry of the Anterior and Posterior Chamber Diameter

PURPOSE

To measure the largest diameter of the anterior chamber (AC) and posterior chamber (PC) dimension and its orientation and determine the relationship with the principal keratometric meridians.

METHODS

Twenty-eight eyes of 14 subjects were scanned with high frequency (50 MHz) ultrasound in sequential meridional scan planes at 30 degrees increments. Observer identified angle and ciliary sulcus recess boundaries in each patient scan set were fit with an elliptical model to obtain the ellipse semi-major axis corresponding to the largest diameter and its meridional orientation. Anterior and posterior chamber diameters from raw data and model fit were compared using linear statistics. Circular statistics were used to compare the orientation of the largest diameter for raw ultrasound measurements, model estimations of largest diameter, and autorefractor determined keratometric axes.

RESULTS

The mean model diameters were anterior chamber OD 12.07 mm (0.32 SD); anterior chamber OS 12.06 mm (0.36 SD); posterior chamber OD 12.35 mm (0.42 SD); posterior chamber OS 12.33 mm (0.43 SD). The general trend for orientation of the meridian of largest diameter was in the horizontal meridian. In over 35% of eyes the difference between AC or PC meridian and the flat keratometric axis was greater than 20 degrees.

CONCLUSIONS

Accurate and reproducible anterior segment biometry depends on visualization of structures and minimization of eye and head movement error. The range and standard deviation of the diameter and orientation measures suggests anatomic variation is sufficient to require biometry for proper sizing and placement of intraocular devices that use angle or sulcus fixation.

Design of efficient, broadband single-element (20-80 MHz) ultrasonic transducers for medical imaging applications

This paper discusses the design, fabrication, and testing of sensitive broadband lithium niobate (LiNbO3) single-element ultrasonic transducers in the 20-80 MHz frequency range. Transducers of varying dimensions were built for an f# range of 2.0-3.1. The desired focal depths were achieved by either casting an acoustic lens on the transducer face or press-focusing the piezoelectric into a spherical curvature. For designs that required electrical impedance matching, a low impedance transmission line coaxial cable was used. All transducers were tested in a pulse-echo arrangement, whereby the center frequency, bandwidth, insertion loss, and focal depth were measured. Several transducers were fabricated with center frequencies in the 20-80 MHz range with the measured -6 dB bandwidths and two-way insertion loss values ranging from 57 to 74% and 9.6 to 21.3 dB, respectively. Both transducer focusing techniques proved successful in producing highly sensitive, high-frequency, single-element, ultrasonic-imaging transducers. In vivo and in vitro ultrasonic backscatter microscope (UBM) images of human eyes were obtained with the 50 MHz transducers. The high sensitivity of these devices could possibly allow for an increase in depth of penetration, higher image signal-to-noise ratio (SNR), and improved image contrast at high frequencies when compared to previously reported results.

Spectral parameter imaging for detection of prognostically significant histologic features in uveal melanoma

Specific extracellular matrix patterns in uveal melanoma are associated with metastatic risk. The laminin-rich composition and dimensions (on the order of a wavelength or less) of these structures suggest that acoustic backscatter might be affected by their presence. In this study, 10-MHz radiofrequency (RF) ultrasound (US) data were acquired before surgical removal of 117 eyes with uveal malignant melanoma. Histologic sections were evaluated for the presence of matrix patterns and acoustic backscatter was characterized using calibrated spectrum analysis. Statistical correlations between acoustic and histologic patterns were determined and linear discriminant analysis (LDA) and radial basis networks (RBN) were used to develop classification models for histologically based risk groups. Statistically significant correlations were found between acoustic parameters and the presence of histologic matrix-rich patterns. Retrospective classification accuracies of 74.4% and 78.6% were obtained with LDA and RBN, respectively. Leave-one-out analyses indicated estimated predictive accuracies of 71.8% and 75.0% for LDA and RBN, respectively.

Apoptosis and interferons: role of interferon-stimulated genes as mediators of apoptosis

IFNs are a family of cytokines with pleiotropic biological effects mediated by scores of responsive genes. IFNs were the first human proteins to be effective in cancer therapy and were among the first recombinant DNA products to be used clinically. Both quality and quantity of life has been improved in response to IFNs in various malignancies. Despite its beneficial effects, unraveling the mechanisms of the anti-tumor effects of IFN has proven to be a complex task. IFNs may mediate anti-tumor effects either indirectly by modulating immunomodulatory and anti-angiogenic responses or by directly affecting proliferation or cellular differentiation of tumor cells. Both direct or indirect effects of IFNs result from induction of a subset of genes, called IFN stimulated genes (ISGs). In addition to the ISGs implicated in anti-viral, anti-angiogenic, immunomodulatory and cell cycle inhibitory effects, oligonucleotide microarray studies have identified ISGs with apoptotic functions. These include TNF-alpha related apoptosis inducing ligand (TRAIL/Apo2L), Fas/FasL, XIAP associated factor-1 (XAF-1), caspase-4, caspase-8, dsRNA activated protein kinase (PKR), 2'5'A oligoadenylate synthetase (OAS), death activating protein kinases (DAP kinase), phospholipid scramblase, galectin 9, IFN regulatory factors (IRFs), promyelocytic leukemia gene (PML) and regulators of IFN induced death (RIDs). In vitro IFN-alpha, IFN-beta and IFN-gamma induced apoptosis in multiple cell lines of varied histologies. This review will emphasize possible mechanisms and the role of ISGs involved in mediating apoptotic function of IFNs.

Ultrasound measurement of the effect of temperature on microperfusion in the eye

Recent developments in ultrasound (US) technology have allowed the study of microperfusion in the anterior segment of the eye. Our aim was to determine the effect of the thermal environment on blood flow in the anterior segment. We measured blood flow in the major arterial circle of five rabbits. A 38-MHz US transducer was coupled to the eye with a normal saline water-bath with temperature controlled from 1 degrees C to 38 degrees C. The major arterial circle was localized and imaged using the swept-scan technique and M-mode data were then acquired for measurement of pulsatile flow. Peak systolic and mean velocity averaged 4.51 and 1.32 mm/s, respectively. Positive correlations were found between peak systolic (1.69%/ degrees C) and mean (1.76%/ degrees C) velocities and temperature. Vessel diameter (mean = 178 microm) did not show any significant change with temperature. High-resolution US flowmetry demonstrated decreasing flow rates in the iris with decreasing temperature.

Monitoring activation of ribonuclease L by 2',5'-oligoadenylates using purified recombinant enzyme and intact malignant glioma cells

A wide range of methods have been developed to study RNase L activation in cell-free systems and in intact cells. Many of the original methods were developed in the laboratory of I. Kerr in the early 1980s (e.g., see Knight et al.). Additional methods described in this article were developed or adapted from research in other fields after the cloning of RNase L and the appreciation of its role in apoptosis. These methods provide the basic techniques needed to induce RNase L activation in vitro and to measure some of its biological effects in living mammalian cells.

Safety levels for exposure of cornea and lens to very high-frequency ultrasound

OBJECTIVE

Very high-frequency (50-MHz) ultrasound is widely used for imaging the anterior segment of the eye. Our aim was to determine whether exposures to ultrasound at and above those used in diagnostic imaging systems might cause bioeffects in ocular tissues.

METHODS

We characterized the output parameters of a polyvinylidene difluoride transducer using a needle hydrophone. We exposed sites on the cornea or lens of rabbits for up to 30 minutes at a 10-kHz pulse repetition frequency. Tissue obtained immediately or 24 hours after exposure was examined by light microscopy. A numeric model was implemented to calculate expected temperature elevations in the cornea and lens under experimental conditions.

RESULTS

No tissue changes were observed directly or by slit lamp. Light microscopy showed no abnormalities attributable to ultrasound exposure. Simulations showed that even long-term exposures should produce temperature elevations of less than 1 degree C in both the cornea and lens.

CONCLUSION

With the use of exposure parameters 4 to 5 orders of magnitude greater than encountered in a clinical situation, no tissue changes were observed. This is consistent with the small (0.2 degrees C) temperature rises computed in simulations. The lack of biological effects is attributable to the small dimensions of the focal zone, allowing rapid dissipation of heat, and the low total acoustic power produced by the transducer.

Functional classification of interferon-stimulated genes identified using microarrays

Interferons (IFNs) are a family of multifunctional cytokines that activate transcription of subsets of genes. The gene products induced by IFNs are responsible for IFN antiviral, antiproliferative, and immunomodulatory properties. To obtain a more comprehensive list and a better understanding of the genes regulated by IFNs, we compiled data from many experiments, using two different microarray formats. The combined data sets identified >300 IFN-stimulated genes (ISGs). To provide new insight into IFN-induced cellular phenotypes, we assigned these ISGs to functional categories. The data are accessible on the World Wide Web at http://www.lerner.ccf.org/labs/williams/, including functional categories and individual genes listed in a searchable database. The entries are linked to GenBank and Unigene sequence information and other resources. The goal is to eventually compile a comprehensive list of all ISGs. Recognition of the functions of the ISGs and their specific roles in the biological effects of IFNs is leading to a greater appreciation of the many facets of these intriguing and essential cytokines. This review focuses on the functions of the ISGs identified by analyzing the microarray data and focuses particularly on new insights into the protein kinase RNA-regulated (PRKR) protein, which have been made possible with the availability of PRKR-null mice.

Chemistry and biochemistry of 2',5'-oligoadenylate-based antisense strategy

This review describes the application of a natural defense mechanism to develop effective agents for the post-transcriptional control of gene expression. 2-5A is a unique 2',5'-phosphodiester bond linked oligoadenylate, (pp)p5'A2'(p5'A)(n), that is elaborated in virus-infected interferon-treated cells. The 2-5A system is an RNA degradation pathway that is an important mechanistic component of interferon's action against certain viruses. It may also play a role in the anticellular effects of interferon and in general RNA decay. A major player in the 2-5A-system is the latent and constitutive 2-5A-dependent ribonuclease (RNase L) which upon activation by 2-5A, degrades RNA. This RNase L enzyme can be recruited for antisense therapeutics by linking it to an appropriate oligonucleotide targeted to a chosen RNA. Syntheses of 2-5A, its analogues, 2-5A-antisense, and its modifications are detailed herein. Applications of 2-5A-antisense to particular targets such as HIV, PKR, chronic myelogenous leukemia, telomerase, and respiratory syncytical virus are described.

RNA-dependent protein kinase PKR is required for activation of NF-kappa B by IFN-gamma in a STAT1-independent pathway

The IFN-inducible dsRNA-activated protein kinase PKR regulates protein synthesis through phosphorylation of eukaryotic initiation factor-2alpha. It also acts as a signal transducer for transcription factors NF-kappaB, IFN regulatory factor-1, and activating transcription factor-2. IFN-gamma, a pleiotropic cytokine, elicits gene expression by activating the Janus kinase-STAT signaling pathway. IFN-gamma can synergize with TNF-alpha to activate NF-kappaB in a number of cell lines. Here we show that IFN-gamma alone can activate NF-kappaB, by a Janus kinase-1-mediated, but Stat1-independent, mechanism. NF-kappaB activation by IFN-gamma is associated with degradation of IkappaB beta. The IFN-gamma response can be blocked by 2',5'-oligoadenylate-linked antisense chimeras against PKR mRNA. There was no activation of NF-kappaB by IFN in PKR-null cells, indicating that PKR is required for IFN-gamma signaling to NF-kappaB.

High-resolution ultrasonic imaging and characterization of the ciliary body

PURPOSE

To develop a means for noninvasive in vivo visualization of the ciliary processes using very-high-frequency (50 MHz) ultrasound and to develop quantitative morphologic descriptors that may relate to physiologic function.

METHODS

The region of the ciliary body was scanned with very-high-frequency ultrasound, both in rabbits and in normal human subjects. Data were acquired in a series of planes so that the spacing between them was less than the beam width of the transducer in its focal plane. Three-dimensional perspective images were constructed, representing the anatomy of the angle region, including the ciliary processes. The automatically detected boundaries of the ciliary processes were analyzed to compute their periphery, area, shape factor, and fractal dimension. These measures were compared between the human and the rabbit eye and analyzed for periodicities related to the spacing of successive processes.

RESULTS

Three-dimensional images allowed visualization of the radial arrangement of the processes. All biometric descriptors were significantly different between the rabbit and human eye and showed periodicities consistent with spacing between processes.

CONCLUSIONS

The methods described in this report are sensitive descriptors of the state of the ciliary processes. These techniques may be of value in measurement of changes in the ciliary body associated with disease, medical therapy, and aging.

Basis for regulated RNA cleavage by functional analysis of RNase L and Ire1p

RNase L and Ire1p are members of a superfamily of regulated endoribonucleases that play essential roles in mediating diverse types of cellular stress responses. 2'-5' oligoadenylates, produced in response to interferon treatment and viral double-stranded RNA, are necessary to activate RNase L. In contrast, unfolded proteins in the endoplasmic reticulum activate Ire1p, a transmembrane serine/threonine kinase and endoribonuclease. To probe their similarities and differences, molecular properties of wild-type and mutant forms of human RNase L and yeast Ire1p were compared. Surprisingly, RNase L and Ire1p showed mutually exclusive RNA substrate specificity and partially overlapping but not identical requirements for phylogenetically conserved amino acid residues in their nuclease domains. A functional model for RNase L was generated based on the comparative analysis with Ire1p that assigns novel roles for ankyrin repeats and kinase-like domains.

Increased severity of HSV-1 keratitis and mortality in mice lacking the 2-5A-dependent RNase L gene

PURPOSE

The2',5'-oligoadenylate-dependent RNase L gene functions in the interferon-inducible RNA decay pathway known as the 2-5A system. The purpose of this study was to determine whether the absence of this gene affects the pathogenesis of herpes simplex virus type 1 (HSV-1) ocular infection in the mouse.

METHODS

HSV-1 (strain McKrae) was applied bilaterally to unscarified corneas of RNase L-null mice and congenic controls. To evaluate the severity of herpetic keratitis, slit lamp examinations (SLE) were performed every other day for 14 days. To study corneal histology and apoptosis, HSV-1-inoculated RNase-L-null and congenic control mice, as well as mock-inoculated mice (apoptosis negative control), were killed at 6 and 18 hours postinoculation (PI). Uninoculated mice that underwent corneal scarification (apoptosis positive control) were killed 2 hours after scarification. Eyes were dissected and the corneas processed for light and transmission electron microscopy and the TUNEL assay.

RESULTS

In comparison with the congenic control mice, RNase L-null mice showed significantly more severe herpetic keratitis (PI day 8, SLE score, mean +/- SEM: 3.27 +/- 0.10 vs. 2.34 +/- 0.06; P: < 0.001) and significantly higher mortality (PI day 14, 70% vs. 20%; P: < 0.001). Few apoptotic cells were seen in HSV-1-infected RNase L-null mice, although DNA fragmentation consistent with apoptosis was detected in the corneas of congenic control mice 6 and 18 hours after HSV-1 inoculation and in uninfected mice with scarified corneas. Signs of apoptosis were not present in the mock-infected corneas. Electron microscopic evidence of keratocytic apoptosis was detected only in the uninfected scarified corneas and the HSV-1-infected congenic control corneas.

CONCLUSIONS

The increased severity of ocular disease and increased mortality in the RNase L-null mice provides evidence, for the first time, that the 2-5A system contributes to protection during ocular herpetic infection. The reduced frequency of apoptosis in these mice suggests that one possible mechanism for this protective effect could be the induction of apoptosis in corneal cells as a means of reducing the spread of infectious virus.

Caspase-dependent apoptosis by 2',5'-oligoadenylate activation of RNase L is enhanced by IFN-beta

The 2',5'-oligoadenylate (2-5A) system is an interferon (IFN)-regulated RNA decay pathway that provides innate immunity against viral infections. The biologic action of the 2-5A system is mediated by RNase L, an endoribonuclease that becomes enzymatically active after binding to 2-5A. RNase L is also implicated in mediating apoptosis in response to both viral and nonviral inducers. To study the cellular effects of RNase L activation directly, 2-5A was transfected into the human ovarian cancer cell line, Hey1B. Activation of RNase L by 2-5A resulted in specific 18S rRNA cleavage and induction of apoptosis, as measured by TUNEL and annexin V binding assays. In contrast, the dimeric form of 2-5A, ppA2'p5'A, neither activated RNase L nor caused apoptosis. Treatment with IFN-beta prior to 2-5A transfection enhanced cellular RNase L levels (< or = 2.2-fold) and increased the proportion of cells undergoing apoptosis (by < or =40%). However, rRNA cleavages after 2-5A transfections were not enhanced by IFN-beta pretreatments, indicating that basal levels of RNase L were sufficient for this activity. Apoptosis in response to RNase L activation was accompanied by cytochrome c release from mitochondria. Induction of apoptosis by either 2-5A alone or by the combination of 2-5A and IFN-beta was effectively blocked with either the pancaspase inhibitor, Z-VAD-fmk, or with the caspase 3 inhibitor, DEVD-fmk. Therefore, activation of RNase L by 2-5A leads to cytochrome c release into the cytoplasm and then to caspase activation and apoptosis. These results suggest potential uses for 2-5A in augmenting the anticancer activities of IFN.

Analysis and origins of the human and mouse RNase L genes: mediators of interferon action

The 2',5'-oligoadenylate-activated enzyme, RNase L, is an endoribonuclease implicated in the antiviral and apoptotic activities of interferons. To probe the genetics of the 2-5A system, the human and mouse genes were cloned, characterized, and compared. The first coding exon of both genes encodes the regulatory regions of RNase L, 67-70% of the proteins including nine ankyrin repeats, the 2-5A binding domain, and several protein kinase homology motifs. In contrast, the coding sequence for the ribonuclease domain in the mouse and human gene is divided among three exons. The transcriptional start site of the human RNase L gene was located in noncoding exon I by primer extension analysis. A complete coding sequence of mouse RNase L was obtained revealing a 735-amino acid protein with 64% identity to human RNase L. A hypothesis is presented concerning the evolutionary relationship of RNase L to both an ankyrin repeat protein kinase and the kinase-endoribonuclease. IRE1, that mediates the unfolded protein response.

RNase L-independent specific 28S rRNA cleavage in murine coronavirus-infected cells

We characterized a novel 28S rRNA cleavage in cells infected with the murine coronavirus mouse hepatitis virus (MHV). The 28S rRNA cleavage occurred as early as 4 h postinfection (p.i.) in MHV-infected DBT cells, with the appearance of subsequent cleavage products and a decrease in the amount of intact 28S rRNA with increasing times of infection; almost all of the intact 28S rRNA disappeared by 24 h p.i. In contrast, no specific 18S rRNA cleavage was detected in infected cells. MHV-induced 28S rRNA cleavage was detected in all MHV-susceptible cell lines and all MHV strains tested. MHV replication was required for the 28S rRNA cleavage, and mature cytoplasmic 28S rRNA underwent cleavage. In certain combination of cells and viruses, pretreatment of virus-infected cells with interferon activates a cellular endoribonuclease, RNase L, that causes rRNA degradation. No interferon was detected in the inoculum used for MHV infection. Addition of anti-interferon antibody to MHV-infected cells did not inhibit 28S rRNA cleavage. Furthermore, 28S rRNA cleavage occurred in an MHV-infected mouse embryonic fibroblast cell line derived from RNase L knockout mice. Thus, MHV-induced 28S rRNA cleavage was independent of the activation of RNase L. MHV-induced 28S rRNA cleavage was also different from apoptosis-related rRNA degradation, which usually occurs concomitantly with DNA fragmentation. In MHV-infected 17Cl-1 cells, 28S rRNA cleavage preceded DNA fragmentation by at least 18 h. Blockage of apoptosis in MHV-infected 17Cl-1 cells by treatment with a caspase inhibitor did not block 28S rRNA cleavage. Furthermore, MHV-induced 28S rRNA cleavage occurred in MHV-infected DBT cells that do not show apoptotic signs, including activation of caspase-3 and DNA fragmentation. Thus, MHV-induced 28S rRNA cleavage appeared to differ from any rRNA degradation mechanism described previously.

Arc-scanning Very High-frequency Digital Ultrasound for 3D Pachymetric Mapping of the Corneal Epithelium and Stroma in Laser in situ Keratomileusis

PURPOSE

To test and demonstrate measurement precision, imaging resolution, 3D thickness mapping, and clinical utility of a new prototype 3D very high-frequency (VHF) (50 MHz) digital ultrasound scanning system for corneal epithelium, flap, and residual stromal thickness after laser in situ keratomileusis (LASIK).

METHODS

VHF ultrasonic 3D data was acquired by arc-motion, meridional scanning within a 10-mm zone. Digital signal processing techniques provided high-resolution B-scan imaging, and I-scan traces for high-precision pachymetry in 4 eyes. Thickness maps of individual corneal layers were constructed. Reproducibility of epithelial, flap, and full corneal pachymetry was assessed for single-point and 3D thickness mapping by repeated measures. Thickness mapping of the epithelium, stroma, flap, and full cornea were determined before and after LASIK. Preoperative to postoperative difference maps for epithelium, flap, and stroma were produced to demonstrate anatomical changes in the thickness profile of each layer.

RESULTS

Surface localization precision was 0.87 microm. Central reproducibility for single-point pachymetry of epithelium was 0.61 microm; flap, 1.14 microm; and full cornea, 0.74 microm. Reproducibility for central pachymetry on 3D thickness mapping was 0.5 microm for epithelium and 1.5-microm for full cornea. B-scans and 3D thickness maps after LASIK demonstrated resolution of epithelial, stromal component of the flap, and residual stromal layers. Large epithelial profile changes were demonstrated after LASIK. Topographic variability of flap thickness and residual stromal thickness were significant.

CONCLUSIONS

VHF digital ultrasound arc-B scanning provides high-resolution imaging and high-precision three-dimensional thickness mapping of corneal layers, enabling accurate anatomical evaluation of the changes induced in the cornea by LASIK.

Effect of deficiency of the double-stranded RNA-dependent protein kinase, PKR, on antiviral resistance in the presence or absence of ribonuclease L: HSV-1 replication is particularly sensitive to deficiency of the major IFN-mediated enzymes

Control of viral replication by interferon (IFN) is thought to be principally mediated by the 2',5'-oligoadenylate synthetase (OAS)/RNAse L, double-stranded dependent protein kinase (PKR), and myxovirus resistance protein (Mx) pathways. In this study, we monitored the constitutive and IFN-induced antiviral activity in mouse embryo fibroblasts lines derived from mice with targeted disruption of either PKR or PKR/RNAse L genes. At high multiplicity of infection (moi = 10), the absence of PKR had no effect on replication of vesicular stomatitis virus (VSV) but moderately enhanced encephalomyocarditis virus (EMCV) growth and greatly increased replication of herpes simplex virus-1 (HSV-1). Replication of EMCV, HSV-1, and VSV was modestly higher in PKR-/- RNAse L-/- fibroblasts when compared with control cells. Although the antiviral action of IFN-alpha was unaffected by the absence of PKR, IFN action was significantly impaired in the double knockout cells but was dependent on the stage of the virus cycle. At early stages, it appeared that anti-EMCV and anti-HSV-1 action of IFN-alpha was significantly compromised, although weak residual antiviral activity was seen. The action of IFN-alpha against VSV was specifically compromised at a late stage of virus replication. The results showed that PKR is an important mediator in constitutive resistance against HSV-1 and that RNAse L is also necessary for the full antiviral activity of IFN against a variety of viruses. These results supported the existence of novel pathways aimed toward specific stages of the virus life cycle.